How to Talk About Addiction, Substance Use in Ways That Empower People

A substance use disorder occurs when people have problems with drugs or alcohol, and it is a type of mental health disorder. A 2019 survey found that about 20.4 million Americans ages 12 and over had a substance use disorder within the past year. Many of these people face stigma or judgment that could impact their ability to recover. 

One way to help combat stigma and increase treatment access is to change the way we talk about substance use disorders. Using more supportive language can go a long way in promoting change. Read on to learn more. 

Is there a difference between a substance use disorder and substance abuse?

The term substance use disorder was first introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was published in 2013. People with a substance use disorder may have a hard time quitting or cutting back. They may also put substances before other important responsibilities or be physically dependent. A substance use disorder can range from mild to severe, depending on the number of symptoms a person has. 

Substance abuse is an outdated term found in the previous edition of the DSM. It was once used to diagnose people experiencing mild problems with drug or alcohol use. Professionals no longer use this term for diagnostic purposes. But some people may still use it to describe those who use drugs or alcohol but do not have a substance use disorder.

When talking about people who have problems with drugs or alcohol, substance use disorder is the correct term.

What are the symptoms of a substance use disorder, and how can you talk about them effectively?

Symptoms of a substance use disorder include:

• Unsuccessful efforts to cut down on substance use 

• Taking more of a substance over time or for longer than planned

• Cravings to use drugs or alcohol

• Using substances in dangerous situations, such as driving while under the influence of a substance

• Spending long amounts of time getting, using, or recovering from substances

• Continuing to use substances even though they cause problems with friends, family, or in other relationships

• Continuing to use substances even though they cause or worsen physical or mental health problems

• Failing to fulfill responsibilities at home, work, or school because of substance use

• Giving up important activities because of substance use

• Tolerance, which happens when a person needs more of a substance to feel its effects or feels less of an effect with the same amount

• Withdrawal, which are painful, uncomfortable, or dangerous symptoms that can develop after stopping or reducing use of a substance, such as anxiety, insomnia, vomiting and diarrhea.

When someone you care about has a substance use disorder, their symptoms may directly affect you. Keep in mind that the person is not intentionally trying to cause you stress. Rather, they are dealing with a condition that affects many areas of their life. Just like other medical conditions, these symptoms are treatable. 

What are the major sources of stigma surrounding substance use and mental health?

Stigma involves negative attitudes toward a person or a specific group of people. These attitudes are often based on characteristics like mental illness or disability. They can lead to judgement and discrimination. Unfortunately, there is still a lot of stigma surrounding mental health and substance use. Two major factors that contribute to this stigma are cause and controllability.

Cause

There is a popular belief that people cause their substance use and mental health issues. But that is incorrect. Genetics and other external factors can affect a person’s risk of developing substance use and mental health problems. Also, about half of those who have a substance use disorder also have another mental health disorder and vice versa. Blaming a person’s character for these problems is harmful. 

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Controllability

Many people also falsely assume that substance use is completely within a person’s control. Over time, substance use can change the brain’s structure. And these changes can make it more difficult to control use.

The way we talk about substance use, addiction, and mental health can contribute to stigma. Certain terms may suggest that they result from moral failure, rather than that they are chronic conditions and that people can recover. 

What terms should you NOT use when talking about substance use?

When talking about substance use, certain words can have negative associations. These words suggest that a person, not their substance use disorder, is the problem. The following types of terms can be harmful when referring to people with substance use disorders:

• Addict

• Alcoholic

• Junkie

• Drunk

• User

• Abuser

Other terms may also be associated with negative judgments. They can undermine the seriousness of substance use disorders and contribute to misconceptions. Avoid the following terms:

• Habit

• Abuse

• Clean/dirty

• Addicted baby

Why are terms such as ‘addict’ and ‘abuser’ not helpful?

The words “addict” and “abuser” have often been used to refer to people who have substance use disorders. These words can be harmful for the following reasons:

• They imply that a person is to blame for their substance use disorder.

• They are associated with negative attitudes and judgements.

• They suggest that a person should be punished for their behavior.

Using words like “addict” or “abuser” can perpetuate stigma, even among professionals. One study asked mental health and addiction clinicians to read descriptions of people with substance use problems. Half of the descriptions used the term “substance abuser,” and the other half used the term “person with a substance use disorder.” The clinicians who read the descriptions with the term “substance abuser” were more likely to have punitive attitudes than the other group.

What phrases SHOULD you use when talking about substance use?

Instead of those terms above, consider using these phrases when talking about substance use:

• Person with a substance use disorder

• Person with an alcohol use disorder

• Person who is in recovery

• Positive or negative toxicology result

• Baby born to a mother who used substances during pregnancy

How do stigmas surrounding substance use and mental health prevent people from seeking care?

The way we talk about substance use disorders contributes to stigmas. And stigmas can affect whether or not people with substance use disorders get the help they need. Research shows that stigmas can have the following effects:

• Individuals who feel judged are less likely to get help, even when help is available.

• Policymakers are less willing to fund programs and policies for people with substance use disorders. 

• Providers are less likely to screen patients for substance use problems.

Stigmas can hinder a person’s ability to get the help they need and deserve. So eliminating stigma is paramount. Using neutral or non-judgmental language when talking about substance use disorders is one way to support this effort. 

What are positive resources to refer to people who need help with a substance use disorder?

If someone you know has a substance use disorder, remember to use supportive language and avoid terms that are negative or critical. It takes courage to acknowledge the need for help.

The following organizations provide information on drugs and alcohol, including how they affect the body. They also offer information on evidence-based treatments for substance use disorders:

• National Institute on Drug Abuse

• National Institute on Alcohol Abuse and Alcoholism

It can also be helpful to refer a person dealing with a substance use disorder to a recovery self-help group. These groups are free, peer-led, and provide an opportunity to connect with others in recovery. There are many self-help groups available, but the most popular ones include:

• Alcoholics Anonymous

• Narcotics Anonymous

• SMART Recovery

Self-help groups work best when a person wants to join and is not forced to attend. You can encourage their attendance by offering to help them find a group or going with them to their first meeting. If the group is not a good fit, suggest that they try another meeting and keep searching for the right one. 

If your loved one is willing to get help, you can also encourage them to contact the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA’s website features an online treatment locator, where a person can search for treatment options in their area. They can also contact SAMHSA’s National Helpline at 1-800-662-HELP (4357) to speak to a representative about treatment options.

Things to keep in mind when talking to someone with a substance use disorder

Remember that it is important to use empowering language when talking to someone with a substance use disorder. Your language can influence the way someone with a substance use disorder feels. It may affect their willingness to get help. Keep these points in mind:

• Use the term “substance use disorder” rather than “habit” or “abuse.”

• Avoid judgmental words like “addict” and “alcoholic.” Instead, say “person with a substance or alcohol use disorder.”

• Instead of using words like “dirty” or “clean” when talking about drug toxicology results, stick to “positive or negative results.”

• Remember that people with substance use disorders have an illness. They are not their illness.

• Be aware of any other language you use. Make an effort to phrase things in a neutral, non-judgmental way.

• If you make a mistake, correct yourself. You don’t have to be perfect. Acknowledging that you used the wrong word can go a long way.

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Written by:

Emily Guarnotta, PsyD

Emily Guarnotta, PsyD, is a licensed clinical psychologist and certified perinatal mental health professional with over 10 years of clinical experience.

Reviewed by:

Mona Bapat, PhD, HSPP

Mona Bapat, PhD, HSPP, has 15 years of clinical experience providing therapy. She is a licensed clinical psychologist in Indiana and Illinois with treatment experience in individual, couples, family, and group therapy modalities.

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