Changing the terms of addiction medicine: What you say counts

How we talk about addiction matters. With millions of Americans experiencing substance misuse, the conversation is a common one for students of all ages.

Understanding changes to terminology in addiction medicine can help us make the words we choose count.

Reducing stigma

Social stigma has long surrounded alcoholism, addiction, and all other forms of Substance Use Disorders (SUD). The National Institute on Drug Abuse (NIDA) describes stigma as “a discrimination against an identifiable group of people, a place, or a nation. Stigma about people with SUD might include inaccurate or unfounded thoughts like they are dangerous, incapable of managing treatment, or at fault for their condition.”

Despite what conventional wisdom might suggest, addiction does not reflect poor moral behavior or self-control. As the Substance Abuse and Mental Health Services Administration (SAMHSA) shares, addiction results from changes to brain circuits. These changes impair an individual’s decision-making and ability to control their substance use. While an SUD can be mild, moderate, or severe, at any stage addiction remains a treatable, chronic disease.

When stigmatized views founded in false beliefs persist, NIDA explains that problems can follow:

• People with SUDs may be less willing to seek treatment.
• Those who experience addiction are more likely to encounter social isolation.
• Treatment for SUDs can suffer when negative social views extend to health care providers, limiting the quality of their care.

Reducing stigma around addiction and other forms of SUD starts with fostering accurate awareness. Bringing more informed language to the discussion surrounding substance misuse can help.

The power of “Person-first” language

While SUDs may shape what an individual experiences, they do not define who they are. The language we choose when discussing substance misuse must take this distinction into account. How can we do this? By trading terms like “junkie” or “addict” for “a person with an SUD.” Or avoiding use of “clean” to describe a person’s drug test status, and instead acknowledging them as “sober."

Terms that focus attention on a person with an SUD, rather than their experience of addiction as a problem, embody what Stop the Addiction Fatality Epidemic (SAFE) Project calls person-first language. The organization defines this language as speech that “conveys respect and acceptance by emphasizing the fact that people with behavioral, psychological, or substance use issues are first and foremost just that: people.”

When we use language that emphasizes people before their conditions, we can lessen stigma as a barrier to seeking help. Those with an SUD can find freedom from the judgment of colleagues in the workplace. They can also escape different treatment among friends.

According to SAFE Project, person-first language can best reduce stigma when combined with:

• Seeing people as more than the challenges of the illness or disorder they experience
• Offering compassion and empathy to those with a stigmatized health condition
• Seeking reliable and factual information about SUDs, among other actions

Find more ways you can help reduce stigma

Some terms to know

Below is a breakdown of some of the key terminology currently used in addiction medicine. Diagnostic criteria from DSM–5 shape many of these terms.

Addiction - The SAMHSA describes addiction as the “most severe form of substance use disorder, associated with compulsive or uncontrolled use of one or more substances. Addiction is a chronic brain disease that has the potential for both recurrence (relapse) and recovery.” Addiction can develop with severe use of any substance. This includes alcohol, illicit drugs and over-the-counter drugs.

Alcohol Use Disorder (AUD) - The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines an AUD as “a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It encompasses the conditions that some people refer to as alcohol abuse, alcohol dependence, alcohol addiction, and the colloquial term, alcoholism.”

Binge drinking increases a person’s risk of developing the disorder. Experiencing two or more criteria symptoms indicates AUD, with cases ranging in severity.

Cannabis Use Disorder (CUD) - According to the National Center for Biotechnology Information (NBCI), CUD is “a behavioral disorder that can occur with chronic cannabis use.” The disorder covers cannabis abuse and dependence driven by nine pathological patterns.

SAFE Project shares that cannabis products stem from species of the Cannabis plant. Only some of these species serve as marijuana. Cannabis use can occur for therapeutic or recreational purposes under a legal status that varies by state.

Opioid Use Disorder (OUD) - The American Psychiatric Association (APA) states that OUD is “a problematic pattern of opioid use leading to problems or distress.” Systemic over-prescription of opioids and the resulting tolerance, dependence, and addiction have fueled an opioid epidemic in the United States. Experiencing two or more of the criteria symptoms or behaviors within a year of using opioids qualifies as an OUD. Opioids are available as prescription medications or in illegal forms.

Substance misuse - According to the SAMHSA, substance misuse is “the use of any substance in a manner, situation, amount, or frequency that can cause harm to users or to those around them.” All use of certain substances qualifies as misuse, such as illicit drugs.

Any substance use among teens—including underage drinking and drug use—also represents misuse.

Substance use - The SAMHSA identifies substance use as the “use—even one time—of any substance.”

SUD - The SAMHSA defines an SUD as a “medical illness caused by repeated misuse of a substance or substances." Those experiencing two or more criteria symptoms are considered to have an SUD. The disorder can develop over time with any substance, regardless of if it generates withdrawal or tolerance.