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Unread 01-25-2006, 01:18 PM   #1
TIM
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Default The Words we choose matter

Changing the stigma associated with opioid addiction treatment will benefit everyone. It will allow patients to more easily regain their self esteem, allow politicians to appropriate funding, allow doctors to treat without disapproval of their peers, let the public understand this is a medical condition as real as any other.

One way to combat the stigma is with the words used to describe the condition and treatments associated with it.

"...In discussing substance use disorders, words can be powerful when used to inform, clarify, encourage, support, enlighten, and unify. On the other hand, stigmatizing words often discourage, isolate, misinform, shame, and embarrass. Recognizing the power of words, this guide is designed to raise awareness around language and offer alternatives to stigmatizing terminology associated with substance use disorders. It is offered primarily as a resource to those who work within the field of prevention, treatment, and recovery support...."

Excerpt from "Substance Use Disorders:
A Guide to the Use of Language" published by SAMHSA

Drug War terms have been very effective at creating the stigma and demonizing drugs and the people who use them. It is unrealistic to expect that these words can now create an opposite image in the minds of the public. To change the perception of the disease of addiction we must eliminate the slang terms and replace them with medical terms or other appropriate respectful language. Fortunately this is something we can all do, and have an impact on the stigma and discrimination endured by the people suffering from this condition. Below are some words and suggested alternatives.

Will the entire recovery community be willing to adjust language that has been the tradition for years? Probably not, but will people just entering this phase of their lives, with effects of stigma and discrimination still fresh in their minds, consider their use of language, hopefully. Even if only some people replace stigmatizing terms with medical or otherwise respectable language, it will help reduce stigma and make addiction treatment more accessible in the future.

Even if you don't agree with some of the alternative words, please find at least one you can change or one not on the list. Anyway you can help decrease stigma will help.


The 01-24-2006 USA Today article shows how correct phrasing and descriptors can medicalize and add creditability to the condition.
Link: http://www.usatoday.com/news/health/...reatment_x.htm

In contrast this article written 01-23-2006 [link no longer active] sets a different tone by using the word "addict" 8 times in a short article (no one quoted used that word, only the reporter)

For more reading on "The language of Addiction Medicine" see:
http://naabt.org/documents/LANGUAGEBillWhite.pdf
and
http://naabt.org/documents/ES-lettervoc.pdf
and the entire SAMHSA guide:
http://naabt.org/documents/Languageo...onmedicine.pdf
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Important disclaimer: Any information in this post is not and does not constitute medical advice under any circumstances. Addiction Survivors, Inc. does not warranty or guarantee the accurateness, completeness, adequacy or currency of the information contained in or linked to the Site. Your use of information on the Site or materials linked to the Site is entirely at your own risk. Voluntary Disclosure: Timothy L. is the President of The National Alliance of Advocates for Buprenorphine treatment. (NAABT.org) The views and opinions of Timothy L., or any poster, are not necessarily the views of AddictionSurvivors.org. NEVER take any online advice over that of a qualified healthcare provider Any information you read here should only serve to inspire you to investigate further with credible, verifiable referenced sources or your doctor.
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Unread 01-25-2006, 01:18 PM   #2
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Words That Work:

Addiction
Why it works: This widely understood term describes uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences. 1 There is a distinction between addiction and physical dependence, although many use the words interchangeably. Addiction conveys both social and health problems, whereas physical dependence only encompasses the latter.

Caveats:Clinically speaking, both the DSMIV and the ICD10
use the term "Substance dependence", not addiction. (See dependence and substance dependence.) Also, addiction cannot be used as an umbrella term for substance use disorders, because not all substance use disorders reach the level of addiction. Finally, without a modifier
(e.g. addiction to alcohol and drugs), addiction as a standalone
term could potentially encompass any addictive disorders (e.g. alcohol and drugs, gambling, shopping, eating, or sexual disorders).

Addictive Disorder, Addictive Disease
Why it works: By incorporating disorders or disease, these terms reinforce the medical nature of the condition. See addiction.
Caveats: See caveats under addiction.
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Unread 01-25-2006, 01:24 PM   #3
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Words to avoid:

Abuse
Problem with the term: Although this is a clinical diagnosis in the DSMIV and ICD10, this is a stigmatizing word because (1) it negates the fact that substance use disorders are a medical condition; (2) it blames the illness solely on the individual with the illness, ignoring environmental and genetic factors, as well as the drugs abilities to change brain chemistry; (3) it absolves those selling and promoting addictive
substances of any wrong doing; and (4) it feeds into the stigma experienced not only by individuals with substance use disorders, by also by family members and the treatment/recovery field. See also substance abuse.

Preferred terminology: Misuse, harmful use, inappropriate use, hazardous use, problem use, risky use, substance use disorder

Abuser, Addict, Alcoholic
Problem with the terms: These terms are demeaning because they label a person by his/her illness. By making no distinction between the person and the disease, they deny the dignity and humanity of the individual. In addition, these labels imply a permanency to the condition, leaving no room for a change in status.

Preferred terminology: Person with alcohol/drug disease, person with a substance use disorder, person experiencing an alcohol/drug problem, Patient or Person receiving services (if referring to an individual receiving treatment )
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Unread 01-26-2006, 05:37 PM   #4
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Words to avoid

Clean, Dirty (when referring to drug test results)
Problem with the terms: These words commonly are used to describe drug test results, but they stigmatize by associating illness symptoms (i.e. positive drug tests) with filth.

Preferred terminology: Negative, positive

Drug Problem
Problem with the term: By saying someone has a drug problem, the full weight is on the person with the illness. Also, by employing the singular form of both drug and problem, the term portrays the condition as an isolated issue unrelated to the other
aspects of a person’s health, relationships, etc.

Preferred terminology: problems caused by alcohol/drugs, alcohol and drug related
problems


Habit or Drug Habit
Problem with the term: Calling substance use disorders a habit denies the medical nature of the condition and implies that resolution of the problem is simply a matter of willpower.

Preferred terminology: addiction, addictive disorder, substance use disorder, alcohol and drug disorder, alcohol and drug disease
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Unread 01-26-2006, 05:43 PM   #5
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Words that work

Misuse
Why it works: It offers the same intended meaning as what has traditionally been termed as abuse, but without the stigma and judgmental overtones that abuse carries.

Caveat: Some argue that technically speaking; one does not misuse a substance when it is used as intended. For instance, marijuana is produced and purchased for the intention of being smoked, so technically it is not misused when people smoke it. For this reason, some prefer the terms risky use or problem use.


Treatment (instead of Detox, or rehab)
Why it works: According to ASAM, Treatment is the use of any planned, intentional intervention in the health, behavior, personal and/or family life of an individual suffering from alcoholism or from another drug dependency designed to enable the affected individual to achieve and maintain sobriety, physical and mental health, and a maximum functional ability.

Caveats: Treatment does not constitute the entire recovery process, nor is professional treatment the only path to recovery.
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Unread 01-26-2006, 07:57 PM   #6
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Tim,
I just posted something under a different topic and used this: was addicted to pain pills, should I be starting to say: people like myself who have misused pain pills?
Thanks!
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Unread 01-26-2006, 08:25 PM   #7
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Doris,
I think "addicted" is ok. "Misuse" is a good substitute for "abuse" which is not only stigmatizing, but inaccurate (most people with an addiction disorder took very good care of their substance, hardly abuse).

There are arguments against using the words addiction and addicted as well, but I feel they are well understood and not stigmatizing. I like to say addictive disorder, or substance addiction, to medicalize it further.

We will never get everyone to agree on all the words, and I want to make sure we all avoid correcting each other. The main point is to use medical language when speaking of the medical condition of addiction, and use respectful language when speaking of non-medical aspects.

12 step programs have a long tradition of using stigmatizing terms as part of their therapy model. My name is___I am a___ For people who find these programs useful, they don'’t need to change their internal language, but it would be helpful to everyone if they would adjust their language when speaking outside their group, like with reporters. Almost every industry has an internal language, shop talk that they modify when communicating with people outside of the industry. Eliminating this stigmatizing terminology will be a step in the right direction.

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Unread 01-28-2006, 07:48 PM   #8
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Words to avoid

I wanted to add this excerpt about the word "abuse"
Although, I wish the author used a different word other than "addict" while making his point.

Abuse

"...Of all the words that have entered the addiction/treatment vocabulary, abuse is one of the most ill-chosen and, as Mark Keller once characterized it, pernicious. First of all, to suggest that the addict mistreats the object of his or her deepest affection is a ridiculous notion. Alcoholics do not abuse alcohol (mixing Jack Daniels with fruit punch does come to mind here) nor do addicts abuse drugs. Addicts, more than anyone, treat these potions with the greatest devotion and respect.

In addition to being technically incorrect, references to alcohol/drug/substance abuse drip with centuries of religious and moral censure. In 1673 Increase Mather in his sermon, Woe to Drunkards proclaimed that alcohol was the good creature of God but that the abuse of drink was from Satan.9 Terms such as alcohol abuse, drug abuse, substance abuse all spring from religious and moral conceptions of the roots of severe alcohol and other drug problems. They define the locus of the problem in the willful choices of the individual, denying how that power can be compromised, denying the power of the drug, and denying the culpability of those whose financial interests are served by promoting and increasing the frequency and quantity of drug consumption.

Abuse has long implied the willful commission of an abhorrent (wrong and sinful) act involving forbidden pleasure, e.g., the historical condemnation of masturbation as self-abuse.10 The term has also come to characterize those of violent and contemptible character those who abuse their partners, their children or animals. It was the very weight of this history that led the National Commission on Marihuana and Drug Abuse to criticize the term drug abuse in 1973. The Commission suggested that continued use of this term with its emotional overtones, will serve only to perpetuate confused public attitudes about drug using behavior.

To refer to people who are addicted as alcohol, drug or substance abusers misstates the nature of their condition and calls for their social rejection, sequestration and punishment. There is no other medical condition to which the term abuse is applied. If we truly believe that addiction is a serious health problem, then why do we continue to have departments and centers of substance abuse? The terms abuse and abuser should be now and forever be abandoned in discussions of people with severe and persistent alcohol and other drug-related problems..."


Excerpt from "The Rhetoric of Recovery Advocacy:
An Essay On the Power of Language" by William White
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Unread 01-28-2006, 08:33 PM   #9
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Self-help

"It is common to refer to Alcoholics Anonymous, Narcotics Anonymous, Women for Sobriety and other such organizations as self-help groups or refer to a broader self-help movement. Ernest Kurtz and William Miller have quite insightfully noted that such designation conveys a pulling-oneself-up-by-the-bootstraps image of addiction recovery. They noted, in contrast to this image, that people who seek help from such groups usually do so as an acknowledgment that all attempts at self-help have failed. Recovery in many support groups is not self-help but the utilization of resources and relationships beyond the self. As such, the New Recovery Movement organizations could more correctly depict these groups as recover support or mutual aid groups."

Excerpt from "The Rhetoric of Recovery Advocacy:
An Essay On the Power of Language" by William White
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Unread 01-29-2006, 03:02 PM   #10
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Words that work

Remission

Why it works:This term is aligned with medical terminology that describes a period of time in which the signs and symptoms of the illness have disappeared.

Caveat: Until now this term seldom has been used in relation to alcohol and drug disease.

alternative: formerly addicted
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Unread 01-30-2006, 02:21 PM   #11
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I JUST FOUND THE WORDS THREAD AND CLEAN AND DIRTY are bad.
i have a problem with CLIENT. i think people who see doctors are Patients. Lawyers have clients and even escorts have clients but a suboxone person is a patient of a doctor or medical center. You may think i am being stupid but once you we lost the patient word in methadone soon we lost most of the medicine too. I mean soon people who we saw were all administrators and that is were we started having problems.
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Unread 02-01-2006, 02:18 PM   #12
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Word to avoid

User:

Problem with the term: The term is stigmatizing because it labels a person by his/her behavior. It is also misleading because the term user has come to refer to one who is engaged in risky use of substances, but use alone (e.g. of alcohol or prescription drugs) is not necessarily problematic.

Preferred terminology: If referring to use: person who uses alcohol/drugs. If referring to misuse: person engaged in risky use of substances, or misuse of a substance.
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Unread 02-06-2006, 11:19 AM   #13
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RECOMMENDATIONS

The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine recognize the following definitions and recommend their use.

I. Addiction
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

II. Physical Dependence
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

III. Tolerance
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.

(excerpt from American Academy of Pain Medicine, American Pain Society and American Society of Addiction Medicine)


Further reading on these terms:
http://www.addictionsurvivors.org/vbulletin/showthread.php?t=14759
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Unread 04-29-2006, 03:42 AM   #14
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Please see our glossary for other words:
http://naabt.org/glossary.cfm
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Unread 03-18-2007, 04:32 PM   #15
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WORDS TO AVOID:

Replacement therapy or Substitution therapy


Problem with the term: This implies equality to street drugs like heroin and treatment medications like buprenorphine. The term suggests a lateral move from illegal addiction to legal addiction and this does not accurately characterize the true nature of the treatment.

The essence of addiction is uncontrollable compulsive behavior, that results in physical harm, ruined relationships, and many more problems we associate with this disease. The first goal of addiction treatment is to stop this dangerous addictive behavior. With successful buprenorphine therapy, as part of a comprehensive treatment plan, the dangerous addictive behavior is stopped not replaced with an equally dangerous uncontrollable compulsion to take the treatment medication. Instead, patients tend to return to a more normal state of being. That is not replacement it is treatment.

Preferred terminology: Treatment, medication assisted treatment, medication


Also see: Am I just switching one addiction for another?
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Unread 09-22-2007, 06:48 PM   #16
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Words to avoid: (depending on your audience)

"In recovery"
This may be appropriate when speaking to people within the recovery community, but less so when speaking outside those circles.

In 2004 801 adults were asked, When you hear the word recovery, as in This person is in recovery from an addiction, what does recovery mean?

Only 22% answered that it meant that the person is no longer using addictive substances. The rest receive the wrong message every time that phrase is used. According to this research as we promote people being in recovery3 out of 4 people are thinking we are promoting something entirely different. This is a clear case of for ever 1 step forward we take 3 steps back The recovery community has used the phrase in recovery for 50+ years and even after all that time only 1 out of 4 understand the meaning. It may be time to reexamine the language. After all, the point of language is to convey meaning, what good is it to insist on using terms most people don't understand?

"In recovery" is well understood within the circles of the recovery community and used there it is effective, but just as companies have their own shop talk and adjust their internal language to make it understandable to the public so should the recovery community, if it wants to effectively convey its message.

Alternatives to "recovering addict" and "in recovery" are "addiction survivor" and "addiction is in remission". Who is more likely to be accepted by the public or in a neighborhood, or gain support of lawmakers, or covered by insurance plans a "recovering addict” or an "addiction survivor”?

Will the entire recovery community be willing to adjust language that has been the tradition for years? Probably not, but will people just entering this phase of their lives, with effects of stigma and discrimination still fresh in their minds, consider their use of language, hopefully. Even if only some people replace stigmatizing terms with medical or otherwise respectable language, it will help reduce stigma and make addiction treatment more accessible in the future.
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Unread 11-06-2007, 07:21 PM   #17
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Detox

Problem with the term:
Short for detoxification, the term is often mistakenly used interchangeably with treatment or recovery. Detoxification is only the short initial portion of a much more comprehensive treatment. Detoxification treatments alone only remove opioids from the body, they do nothing to treat the brain disease of addiction. Using the term detox might lead to a misunderstanding by implying that detox characterizes addiction treatment or that it plays a more significant role in the overall treatment plan than it does. It also implies that the medication being tapered from is a toxin, and as with buprenorphine, that is not the case.

Preferred terms: opioid medical withdrawal, Taper, Treatment
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Unread 11-06-2007, 07:30 PM   #18
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Kick as in Kick the habit, Cop/ Fix, Hard Core, Wasted, Junkie, Dope Fiend, Strung out, Hooked, Clean

Problem with terms: All of these slang terms are more obviously derogatory, than some of the others. All of them contribute to the stigma and reinforce the notion that addiction is an ongoing choice rooted in deficient morality. Not using them will help change the way people perceive a person with an addictive disorder and that will translate into more people getting the help they need from more available resources. Plus it makes you sound smarter when you use medical terms, and otherwise respectful language
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Unread 12-13-2007, 07:38 PM   #19
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Here's the pdf of the new NAABT literature piece: "The Words We Use Matter. Reducing Stigma through Language"

http://www.naabt.org/documents/NAABT_Language.pdf

Thanks!
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Unread 01-30-2008, 01:49 AM   #20
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Definitions Related to the Use of Opioids for the Treatment of Pain http://opi.areastematicas.com/genera...aceos.AAPM.pdf
A consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine
February, 2001
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Important disclaimer: Any information in this post is not and does not constitute medical advice under any circumstances. Addiction Survivors, Inc. does not warranty or guarantee the accurateness, completeness, adequacy or currency of the information contained in or linked to the Site. Your use of information on the Site or materials linked to the Site is entirely at your own risk. Voluntary Disclosure: Timothy L. is the President of The National Alliance of Advocates for Buprenorphine treatment. (NAABT.org) The views and opinions of Timothy L., or any poster, are not necessarily the views of AddictionSurvivors.org. NEVER take any online advice over that of a qualified healthcare provider Any information you read here should only serve to inspire you to investigate further with credible, verifiable referenced sources or your doctor.
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