Zgierska, colleagues work to reduce stigma in addiction terminology

Patty McCarthy has too many stories to share.

They’re about people in recovery from substance use disorders who are unable to pursue dream careers or get life insurance policies because of their history of addiction.

McCarthy is the chief executive officer of Faces and Voices of Recovery, a national advocacy organization that works to reduce the stigma around addiction and its recovery. She hopes that people who need treatment will seek it, that clinicians who treat those with substance use disorders will provide unbiased, nonjudgmental care and that people in recovery will not be haunted by the scars of their past and current struggles.

“That starts by changing the way we talk about addiction,” McCarthy said. “As a woman in long-term recovery myself, I have personally experienced the negative judgment associated with substance use disorder and its treatment.”

Dr. Aleksandra Zgierska

McCarthy partnered with Dr. Aleksandra Zgierska, vice chair for research, and Dr. David Rabago, vice chair of faculty development, both in the Department of Family and Community Medicine at Penn State College of Medicine, and other authors to offer commentary on an editorial published in the Journal of Addiction Medicine. The editorial lists stigmatizing diagnostic terms and suggests replacements for them.

“The stigma around addiction may prevent some patients from getting the treatment they need,” Zgierska said. “Everyone from policymakers and health care professionals to families, patients and the public should adjust the way they talk about substance use disorders and the people who live with them.”

Penney Cowan, a coauthor of the commentary and founder and chief executive officer of the American Chronic Pain Association, said that people living with chronic pain, particularly those treated with opioids as a part of their care, are often labeled with judgmental terms similar to those associated with addiction.

“People with chronic pain are often written off as drug seekers, even by people in the medical community,” said Cowan. “They report feeling ashamed or embarrassed for needing medications to manage their pain.”

Dr. David Rabago

Cowan lives with chronic pain and believes that one way to end stigma is to validate a patient’s experiences and work with them to find better ways to manage their chronic pain.

Zgierska said she has a unique perspective on how word choice can have unintended negative outcomes. Having grown up in Poland, she appreciates the nuance of the English language and how subtle changes can make a big difference.

The authors offer some tips for people who want to start making positive changes to how they talk about addiction:

Use person-first language.

“When we use terms like ‘addict,’ we imply that the person is defined by their struggle with substance use,” Zgierska says. “Referring to someone as ‘a person with substance use disorder’ recognizes that their personhood extends beyond their disease.”

Avoid the word “abuse.”

“People associate the word ‘abuse’ with violence and criminality, which isn’t helpful for people in recovery,” McCarthy said. “It’s better to use non-stigmatizing terms such as substance misuse or substance use disorder, rather than ‘substance abuse.’”

It is better to refer to someone as having a substance use or behavior disorder instead of saying they abuse drugs.”

Avoid words like “clean” and “dirty.”

“When you’re talking about a drug screen, use accurate medical terms like positive or negative results, rather than clean or dirty,” said McCarthy.

When Zgierska educates other medical professionals who work with patients with substance use disorders, she often invites someone to present with her who can discuss their personal experiences with addiction-related stigma and its impact. She said firsthand accounts help clinicians better understand why language matters and why it sometimes is a barrier to patients seeking out help.

“Addiction is not a moral failing or a character flaw deserving of punishment,” Zgierska said. “Using non-judgmental, medical-based terminology can improve communication and increase patient motivation to access to care.”

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