Those in recovery and the medical community are sometimes at odds over the language they use to describe what they see: addiction? or substance use disorder?
By Alex Wittenberg
The terminology used to address addiction — or substance use disorder — can sway how members of the public view people who struggle with that chronic condition.
On the one hand, groups such as Alcoholics Anonymous or its related offshoots have used the term “addict” to describe those who find themselves powerless to control the abuse of drugs. On the other hand, health care providers argue the term is imprecise and sometimes stigmatizing, which can discourage someone from seeking help.
“Stigma is a very, very strong thing, both within the person and society in general,” said Audrey Klein, executive director of the Butler Center for Research, a subsidiary of the addiction treatment and advocacy organization Hazelden Betty Ford.
The language debate often centers on the word “addict,” and it can take the form of whether to use “addict” or “person in recovery” when referring to someone in treatment. In the medical realm, the debate is whether to refer to the disease itself as “addiction” or “substance use disorder.”
“Addiction can be a very factual term,” Klein said. “But depending on the person that’s either using the term or hearing the term, it’s really hard to tell how that word’s going to affect that person’s perceptions.”
Sam Gunnarson, who refers to himself as an addict, says he prefers a straight-up, frank approach. Gunnarson is a member of Augsburg University’s StepUP program, a campus recovery community that supports students in long-term recovery. Within the program, Gunnarson said the word “addiction” is used frequently and “very loosely, actually.” He said it’s commonplace for students in StepUP to use the term, and it’s also common among counselors.
Gunnarson said the openness with which the term is used has actually helped relieve stigma.
“It’s almost to the point where it numbs the word out,” Gunnarson said. “I think it’s assumed, almost, that you don’t go to StepUP unless you have that personal realization that you’re an addict or you have a drug problem.”
Thenedra Roots, a chemical dependency counselor for StepUP, also said a frank approach is beneficial to recovery. “Using that language helps with the acceptance piece,” Roots said. “Part of using that language is reminding them that, yes, this is something you’re working towards.”
Roots also said the open use of the term “addict” can help take the power out of the word. “I think that by using that terminology it takes the shock value out of it,” Roots said.
Klein acknowledged that even at Hazelden Betty Ford, therapists use the term “addiction.” But increasingly, as addiction’s status as a chronic brain disease has become a more prominent part of its treatment, replacing in many ways the spiritual disciplines of AA, terminology has shifted.
As a result, Klein said researchers and some health care professionals have embraced the term “substance use disorder,” mostly because it has been adopted by the DSM-5, a manual put out by the American Psychiatric Association that sets the standard for medical diagnoses in the psychiatric realm.
The debates about terminology often come down to tradition and orientation, Klein said. “There’s a very sharp discrepancy between what happens in 12-step fellowships and how these disorders are referenced by the scientific community and the therapeutic community.”
Another reason for the shift is because the term “substance use disorder” can embrace the full range of troubles with substances, covering both abuse and dependence criteria.
But others see more of a problem with using “addiction.”
Philip Rutherford, director of operations for the Washington, D.C., advocacy group Faces and Voices of Recovery, refers to himself as a person in long-term recovery and said the term “addiction” can be stigmatizing.
“A lot of the stigma that sort of binds people up is wrapped around language,” Rutherford said.
Rutherford said language can have an effect on how people struggling with that chronic condition are perceived. “What do you want to be, a drug addict or a person in recovery? Which one of those sounds more like someone you want babysitting your kids?” he said.
Furthermore, he says, the use of “addiction” can shift focus away from what he says is the more important subject — recovery.
“I’m not suggesting that we hide from it,” Rutherford said of the use of “addiction.” But to the extent that we labor in the discussion of the problem, I think we do a disservice to the solution.”
Rutherford said a central issue with the use of “addiction” is the focus it places on the problem.
“I understand the instinct to talk about it in open, frank terms. But we’ve beaten the subject of addiction to death,” Rutherford said. “I believe we need to move the dialogue to the solution.”
But for Gunnarson, part of getting to that solution is taking the power out of the words “addict” and “addiction.” He said using “addict” helps unite the community through common experience — and sometimes humor. “There’s also inside jokes on campus about quirky addict tendencies,” he said. “You can take the funny parts of it, the real parts of it — it just kind of numbs out the negative stigma.”