New Statement against the Use of Stigmatizing Language in the Addiction Field
Substance use disorders (SUDs) are among the most highly stigmatized health conditions in the world which can have implications for help-seeking and treatment (see here for an infographic on stigma). The International Society of Addiction Journal Editors (ISAJE) released an addiction terminology statement recommending against the use of terminology that “can stigmatize people who use alcohol, drugs, other addictive substances or who have an addictive behavior.” The following statement was approved by ISAJE at its annual meeting in Budapest, Hungary on August 31 to September 2, 2015.
ADDICTION TERMINOLOGY STATEMENT
The International Society of Addiction Journal Editors recommends against the use of terminology that can stigmatize people who use alcohol, drugs, other addictive substances or who have an addictive behavior.
Rationale: Terms that stigmatize can affect the perception and behavior of patients/clients, their loved ones, the general public, scientists, and clinicians (Broyles et al., 2014; Kelly, Dow & Westerhoff, 2010; Kelly, Wakeman & Saitz, 2015. For example, Kelly and Westerhoff (2010) found that the terms used to refer to individuals with substance-related conditions affected clinician perceptions. Clinicians who read a clinical vignette about “abuse” and an “abuser” agreed more with notions of personal culpability and an approach that involved punishment than did those who read an identical vignette that replaced “abuse” and “abuser” with “substance use disorder” and “person with a substance use disorder.”
ISAJE is aware that terminology in the addiction field varies across cultures and countries and over time. It is thus not possible to give globally relevant recommendations about the use or non-use of specific terms. “Abuse” and “abuser” or equivalent words in other languages should, however, in general be avoided, unless there is particular scientific justification (an example of scientific justification of the use of “abuse” is when referring to a person who meets criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol abuse; that person would be said to have “alcohol abuse”). Another example of stigmatizing language is describing people as “dirty” (or “clean”) because of a urinalysis that finds the presence (or absence) of a drug (Kelly, Wakeman & Saitz, 2015). Instead, the test results and clinical condition should be described.
References
Broyles, L. M., Binswanger, I. A., Jenkins, J. A., Finnell, D. S., Faseru, B., Cavaiola, A., Pugatch, M., & Gordon, A. J. (2014). Confronting inadvertent stigma and pejorative language in addiction scholarship: A recognition and response. Substance Abuse, 35, 217–221.
Kelly, J. F., Dow, S. J., &Westerhoff, C. (2010). Does our choice of substance-related terms influence perceptions of treatment need? An empirical investigation with two commonly used terms. Journal of Drug Issues, 40, 805–818.
Kelly, J. F., Wakeman, S. E., & Saitz, R. (2015). Stop talking ‘dirty’: Clinicians, language, and quality of care for the leading cause of preventable death in the United States. American Journal of Medicine, 128, 8–9.
Kelly, J. F., & Westerhoff, C. M. (2010). Does it matter how we refer to individuals with substance-related problems? A randomized study with two commonly used terms. International Journal of Drug Policy, 21, 202–207.
Click here to view the full ISAJE statement.