How We Speak Matters: Undoing Stigmatizing Language: Andrew Schreier

Andrew J. Schreier is a licensed professional counselor with over twenty years of experience in substance use, mental health, gambling, and clinical supervision with extensive experience in clinical supervision, counseling, and education. He serves as the Director of Clinical Services for Community Medical Services in Wisconsin and Minnesota, overseeing treatment programs for opioid use disorder. A national speaker and host of the Talking Addiction & Recovery podcast, Andrew explores topics such as substance use, mental health, and gambling to foster meaningful change for individuals seeking care and growth and development for professionals.

The passion for this topic stems from witnessing the profound impact that stigma can have on individuals seeking help. I’ve seen how a single word—uttered carelessly or in written communication—can either empower someone or push them further into isolation. This has driven me to advocate for compassionate, person-first language in every aspect of treatment and recovery for several issues impacting millions of people.

Language is the foundation of human connection. Words can shape people and culture. It’s how we communicate thoughts, share feelings, and build relationships. But when it comes to substance use, mental health, gambling, criminal justice, and recovery, the words we use can do more than just describe; they can harm, stigmatize, or exclude.

What Is Stigma?

Stigma is a negative association with circumstance or trait that can result in discrimination against a person for a certain characteristic(s).  Stigma can also be described as internal feelings of shame or judgment from others.  Language includes words or phrases with negative labels that assign judgment.  

Stigma around addiction may come from old and inaccurate ideas or fear of things that are different or misunderstood. Today, we know that addiction is a chronic, treatable medical condition. We also know that people can recover and continue to lead healthy lives.

The Power of Language

Words matter. Language is not just a tool for communication; it shapes perceptions, influences policies, and defines how individuals are treated. Yet, in relation to substance use, mental health, gambling, and criminal justice spaces, stigmatizing language remains a persistent issue.  Examples of stigmatizing language include: 

• Terms like “addict,” “junkie,” or “relapse” reduce people to their conditions and perpetuate shame.   
• Many generations have grown up in a society where language such as “crazy,” “psycho,” “loony,” “nutty,” and “mentally ill” were acceptable words to describe an individual with mental health.  
• “Pathological,” “compulsive,” “irresponsible gambler,” and “gambling addict” generally attract substantial negative stereotypes, social distancing, emotional reactions, status loss, and discrimination.
• Designed to desensitize, terms such as “felon,” “convict,” “offender,” and “criminal” replace names and other descriptions, such as “woman,” “daughter,” “father,” “child,” or “person.” These labels compound punishment and ultimately harm by reducing people to their worst moments, fueling stigma and haunting people for years after sentences are served.

The consequences of this language are far-reaching. Stigmatizing terms discourage individuals from seeking help, fearing judgment or discrimination. Feeling stigmatized can reduce the willingness of individuals with substance use disorders to seek treatment.  Stigmatizing views of people with substance use disorders are common; this stereotyping can lead others to feel pity, fear, anger, and a desire for social distance from people with a substance use disorder.  In clinical settings, they can perpetuate bias in documentation and decision-making.  Stigmatizing language can negatively influence healthcare provider perceptions of people with substance use disorders, which can impact the care they provide.  At the community level, such language reinforces negative stereotypes, reducing public support for funding and policy changes that could expand access to treatment.

By addressing this issue, we can create a more inclusive and supportive environment for those struggling with addiction and other behavioral health challenges. Shifting to person-first language—such as “person with a substance use disorder” or “person with a gambling disorder” instead of  “substance abuser” or “gambling addict”—respects the individual’s humanity and acknowledges their capacity for recovery.

Introducing Person-Centered Language 

Person-centered language is a language that puts people first. People are so much more than their substance use disorder, mental illness, or disability. Using person-centered language is about respecting the dignity, worth, unique qualities, and strengths of every individual. 

The solution to this issue begins with awareness and education. Through my work, I’ve identified several actionable strategies that can help professionals, organizations, and communities move toward more supportive language:

1. Adopt Person-First Language: Referring to individuals as “persons with a substance use disorder” or “persons experiencing gambling-related harm” emphasizes their humanity and potential for recovery. This small change can make a big difference in how people feel about seeking help.
2. Eliminate Stigmatizing Terms: Words like “relapse” can be replaced with “return to use,” and “addict” with “individual in recovery.” Such shifts reduce shame and promote a more constructive dialogue.
3. Train Professionals: Regular training for clinicians, social workers, and other providers can help them understand the impact of their words and adopt best practices for communication.
4. Revise Documentation Practices: Clinical records should reflect person-centered care by avoiding labels and focusing on specific behaviors, needs, and strengths.
5. Raise Public Awareness: Community education campaigns can dispel myths, challenge stereotypes, and encourage supportive attitudes toward those in recovery.

Letting Go of Stigmatizing Terms

Throughout my career, I have witnessed firsthand how stigmatizing language impacts individuals in treatment. Early in my work, I noticed how terms like “noncompliant” or “frequent flyer” in clinical documentation shaped the attitudes of treatment teams. Patients were often unfairly labeled before they even walked through the door. Recognizing this, I began advocating for changes within my teams, encouraging the use of language that focused on behaviors and needs rather than labels.

Initially, the thought of simply removing stigmatizing words and replacing them with person-centered language appeared easy.  However, after beginning to take on that task it became more apparent at how prevalent stigmatizing language is through policies, procedures, textbooks, sources, narratives, educational materials, and awareness campaigns to name a few.  In asking people to eliminate stigmatizing language meant asking them to let go of words they have come to use on a regular basis.  

Some people used those words to describe themselves in their own recovery with lived experience. Professionals have used stigmatizing terms in how they talked not only to but about people they served. Helping professionals let go of stigmatizing language involves acknowledging past habits, understanding their impact, and actively working through a process that includes reflection, education, and practice. Here are some tips to facilitate this journey, including the idea that it might resemble a grief process:

1. Acknowledge Past Usage Without Judgment
   1. Normalize Mistakes: Remind professionals that everyone has used stigmatizing language at some point due to societal norms, training, or common phrases.
   2. Create Safe Spaces: Foster environments where professionals can openly discuss their language habits without fear of judgment. Encourage the perspective that improvement begins with self-awareness.

2. Understand the Emotional Attachment to Language
   1. Recognize Resistance: Letting go of familiar terms can feel uncomfortable. Professionals may associate certain languages with their identity, training, or professional experience.
   2. Embrace the Grief Process: Encourage professionals to view this shift as a form of grief. They might feel denial, anger, or sadness before accepting and embracing change. Support them by discussing these emotions openly.

3. Educate on the Impact of Language
   1. Highlight Harmful Effects: Show how stigmatizing language perpetuates stereotypes and discourages individuals from seeking help. For example, terms like “addict” increase perceptions of personal blame, leading to worse treatment outcomes.
   2. Use Data and Stories: Share research and real-life examples demonstrating how person-first language fosters dignity and better outcomes for individuals.

4. Provide Practical Strategies for Change
   1. Use Person-First Language: Train professionals to replace terms like “addict” with “person with a substance use disorder.” This approach focuses on the individual rather than the condition.
   2. Pause and Reflect: Encourage them to pause and consider the potential impact of their words before speaking.
   3. Use Tools and Resources: Offer quick-reference guides or charts that suggest alternatives to stigmatizing terms.

5. Normalize Continuous Learning
   1. Reframe Learning as Growth: Remind professionals that language evolves. A commitment to lifelong learning aligns with professional ethics and improves patient care.
   2. Practice Role-Playing: Use training sessions to practice reframing conversations and identifying stigmatizing phrases.

6. Promote Organizational Support
   1. Leadership Modeling: Encourage leaders to adopt and model inclusive language to set an example for their teams.
   2. Policy Updates: Advocate for policies and documentation practices that reflect non-stigmatizing language.

7. Celebrate Small Wins
   1. Acknowledge progress, even if it’s incremental. Shifting language habits takes time and effort, but every step forward is meaningful and recognizing any positive change provides dignity, compassion, and respect for the people we serve.  

By normalizing the discomfort that comes with change and framing it as part of a growth process, professionals can move toward language that uplifts and empowers those they serve.  

Language as a Tool to Change

Undoing stigmatizing language is about more than changing words; it’s about transforming the culture of substance use, mental health, gambling, criminal justice, and other spaces related to people we serve. By speaking with care and intention, we can create environments where individuals feel valued, supported, and empowered to seek help.

In talking to and about individuals, the best practice and way to eliminate harm is by letting people choose how they want to be described. If you are not sure what words to use, just ask.  Avoid using language that defines someone by their condition. Use updated, accurate terminology instead of outdated terms. Avoid language that makes judgment. Describe without downplaying or becoming overly graphic. Use person-centered language that avoids seeing them as their diagnosis and instead focuses on the whole person.  

Looking ahead, I envision a future where person-first language becomes the standard in all areas of behavioral health. This includes expanding training programs, integrating these principles into policy and advocacy work, and using a multitude of platforms.  

Language has the power to heal or harm. Let’s choose to use it as a tool for connection, compassion, and change.