Learn / “Substance Use” vs. “Abuse:” The Impact of Language
“Substance Use” vs. “Abuse:” The Impact of Language
Key Points
- Language matters when talking about addiction.
- Stigmatizing language discourages people from seeking help.
- Neutral terms and person-first language reduce stigma and supports recovery.
The term “substance abuse” has historically been used to describe problematic substance use. But for some, this term carries a heavy stigma that implies weakness or moral failing. Recognizing this negative connotation, the recovery community is shifting towards more neutral language, favoring terms like “substance use disorder” (or SUD) which acknowledges the serious, diagnosable, and complex nature of addiction.
What Is Stigmatizing Language?
Stigmatizing language refers to words or phrases that promote stereotypes about certain groups of people. In the context of addiction, terms like “addict” or “substance abuser” might be received as shaming and judgmental. This kind of language can discourage people from seeking help or participating in treatment because of their fear of being labeled or judged. It can also lead to discrimination in areas like employment and housing, hindering someone’s chances of a successful recovery.
As addiction researchers point out in a study on the impact of language on stigma around substance use disorders:1 “Language plays a major role in shaping people’s thoughts and beliefs, and scientific communication can sometimes be an inadvertent vector of harmful stereotypes and assumptions.” We can fight these damaging stereotypes by carefully choosing the language we use to talk about addiction and the people affected by it.
How Does Stigmatizing Language Affect People With Substance Use Disorders?
The language we use shapes how we perceive people with substance use disorders (SUDs). Stigmatizing terms like “addict,” for example, can paint them as weak-willed or morally questionable.
Social Impact
In larger society, this shapes our views of addiction, the people struggling with it, and what kind of care they deserve. One study on stigmatizing language in media coverage of the opioid epidemic,2 for example, found that “The language included in U.S. news media coverage of the opioid epidemic may contribute to and reinforce widespread public stigma toward people with opioid use disorders,” and that “This stigma may be a barrier to implementation of evidence-based interventions to prevent opioid overdose deaths.”
Quality of Care
This also has implications for the quality of care people with substance use disorders receive. Research from the American Psychological Association (APA) uncovered increased bias toward patients when they were referred to as “drug abusers.”3 This has real implications for their treatment outcomes. According to the National Institute on Drug Abuse,
- “Feeling stigmatized can reduce the willingness of individuals with SUD to seek treatment.
- Stigmatizing views of people with SUD4 are common; this stereotyping can lead others to feel pity, fear, anger, and a desire for social distance from people with an SUD.
- Stigmatizing language can negatively influence healthcare provider perceptions of people with SUD, which can impact the care they provide.”
Widening the Treatment Gap
Shaming language around substance use can also affect whether someone receives addiction treatment at all. Addiction has a wider treatment gap5 (the difference between the number of people who have an addiction and those who seek treatment for it) than any other mental health condition—and stigma only works to increase that. For example, only 18% of people with opioid addiction receive medication for opioid use disorder, despite the widespread availability of medication and the devastating impact of the opioid epidemic.
Addiction is a mental health condition. And like any other health concern, it requires attention and care. “We don’t speak this way about other health conditions,” says John Kelly, PhD, founder and director of the Recovery Research Institute, “so we shouldn’t speak this way about addiction.”6
How Can We Address Stigmatizing Language and Labels?
We see how stigmatizing words for addiction can create barriers to recovery by promoting shame, and isolation, and discouraging people from seeking help. Luckily, we get to choose the words we use. And as such, we have the power to dismantle the negative impact of stigmatizing language and labels.
One of the most powerful ways to do this is by using person-first language.7
Promote Person-First Language
Person-first language8 “shows that a person ‘has’ a problem, rather than ‘is’ the problem.” Terms like “addict” and “alcoholic” define people by their condition rather than acknowledging their full humanity. Person-first language can help reduce the “punitive attitudes and individual blame” caused by using terms like “addict.”
In their guide on how to talk about addiction,9 the APA recommends naming the person first, and the condition second:
Person-first language prioritizes the individual and avoids defining them solely by their addiction. Terms like ‘person with a substance use disorder’ or ‘someone in recovery’ acknowledge the person’s identity beyond their struggle. This approach fosters respect and dignity, promoting a more inclusive environment where individuals feel comfortable seeking help.
Educate Yourself and Others
The first step toward positive change is exactly what you’re doing now: educating yourself about the harmful effects of stigma.10 These labels fail to capture the complexity of SUDs and instead reduce people’s identity to their addiction. Learn the difference between substance use vs. abuse, addiction, and dependence. Share this knowledge with those around you and be a part of open and honest conversations about addiction.
Lead by Example and Challenge Stigma When You Hear It
Be mindful of your own word choices when discussing substance use, and don’t shy away from challenging stigma when you encounter it. You can do so respectfully and offer a more compassionate alternative. For example, if someone says, “He’s such a drunk,” you could gently suggest, “He’s struggling with alcohol use disorder right now.” Actions as simple as gently correcting terminology can work to raise awareness and promote a more understanding dialogue around addiction.
Focus on Recovery Efforts
When discussing addiction, highlight the positive aspects of recovery. Uplift stories of people who are overcoming their struggles and are living fulfilling lives. This focus on hope in recovery can inspire others to seek help and debunk the myth of addiction as a dead-end situation.
Advocate for Change
Support organizations and initiatives working to reduce stigma surrounding addiction. This could involve volunteering, raising awareness on social media, or even contacting your local representatives to advocate for policies that support recovery efforts.
By taking these steps, we can break down the walls built by stigmatizing language and create a more inclusive environment where people with SUDs feel empowered to seek help and improve their lives.
Non-Stigmatizing Language to Use Instead
Here are some terms to guide you toward more inclusive terminology (based on the APA’s inclusive language guide):11
| Instead of | Try |
| Substance abuse | Substance use, person with a substance use disorder |
| Addict, drug user, drug abuser | Person who uses drugs |
| Alcoholic, alcohol abuser | Person with alcohol use disorder, person in recovery from alcohol use disorder |
| “Clean” or “dirty” drug screens | Positive or negative |
| Fell off the wagon | Relapsed |
| Hit rock bottom | Reached a crisis point |
Simple tips to keep in mind:
- Focus on the person, not the addiction.
- Be respectful and avoid judgmental language.
- Use neutral terms to describe substance use and recovery efforts.
- Focus on hope and success.
Words matter. Stigmatizing language can feed into misconceptions around addiction and can significantly impact those seeking help. Thankfully, we also have the power to change that. By being mindful of the terms we use and continuing to learn as language evolves, we can create a supportive environment where people feel empowered to get the addiction help they need.
Frequently Asked Questions About “Substance Use” vs. “Abuse”
What is the difference between substance use & substance abuse?
Substance use is simply using a substance, such as alcohol or drugs. Substance abuse is when a person uses a substance in a way that causes problems in their life, such as issues with their health, relationships, or work. However, behavioral health professionals now recommend using terms like “substance use” or “person with a substance use disorder” instead of “substance abuse.”
What’s the best way to talk about substance use?
Use person-first language, such as “person with a substance use disorder” instead of “addict.” Focus on the person, not the addiction, and avoid blaming or judgmental language.
How can I help reduce the stigma surrounding addiction?
Educate yourself and others about the dangers of using stigmatizing terms. Promote person-first language and challenge stigma when you hear it. Share stories of empowerment through addiction recovery to inspire hope.
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Volkow, N.D., Gordon, J.A. & Koob, G.F. Choosing appropriate language to reduce the stigma around mental illness and substance use disorders. Neuropsychopharmacol. 46, 2230–2232 (2021). https://doi.org/10.1038/s41386-021-01069-4
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Emma E. McGinty, Elizabeth M. Stone, Alene Kennedy-Hendricks, Colleen L. Barry, Stigmatizing language in news media coverage of the opioid epidemic: Implications for public health, Preventive Medicine, Volume 124, 2019, Pages 110-114, ISSN 0091-7435, https://doi.org/10.1016/j.ypmed.2019.03.018.
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American Psychological Association. (2019, June 1). How to talk about addiction. Monitor on Psychology, 50(6). https://www.apa.org/monitor/2019/06/cover-opioids-talk-sidebar
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Abuse, National Institute on Drug. Words Matter - Terms to Use and Avoid When Talking About Addiction | National Institute on Drug Abuse (NIDA). 29 Nov. 2021, https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction.
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Volkow, Nora D., et al. “Choosing Appropriate Language to Reduce the Stigma around Mental Illness and Substance Use Disorders.” Neuropsychopharmacology, vol. 46, no. 13, Dec. 2021, pp. 2230–32. www.nature.com, https://doi.org/10.1038/s41386-021-01069-4.
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American Psychological Association. (2019, June 1). How to talk about addiction. Monitor on Psychology, 50(6). https://www.apa.org/monitor/2019/06/cover-opioids-talk-sidebar
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Nelson, ALice. “Use Person-First Language to Reduce Stigma.” Mental Health First Aid, 12 Apr. 2022, https://www.mentalhealthfirstaid.org/2022/04/use-person-first-language-to-reduce-stigma/.
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Abuse, National Institute on Drug. Words Matter - Terms to Use and Avoid When Talking About Addiction | National Institute on Drug Abuse (NIDA). 29 Nov. 2021, https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction.
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American Psychological Association. (2019, June 1). How to talk about addiction. Monitor on Psychology, 50(6). https://www.apa.org/monitor/2019/06/cover-opioids-talk-sidebar
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“Mental Health: Overcoming the Stigma of Mental Illness.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477. Accessed 19 July 2024.
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“Inclusive Language Guide.” Https://Www.Apa.Org, https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines. Accessed 19 July 2024.
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