Learning objective
Identify and replace stigmatizing language used in relation to patients with OUD.
The language we use to describe drug use and opioid use disorder (OUD) can increase bias and stigma towards people with OUD and those living in recovery. When patients are described with stigmatizing language such as “substance abuser”, healthcare professionals have more negative views of the patient.1In these scenarios, healthcare professionals assign more blame to the patients for their disorder and believe the patients to be more deserving of punishment than patients who are described with more neutral terminology such as
“having a substance use disorder”.2 This has been shown in other settings with people outside of the healthcare profession as well, including in the general public.3,4 As discussed earlier in this module, bias and stigma towards patients with substance use disorders including OUD can directly impact the treatment patients receive or seek out.
In general, we should talk about addiction using person-first language that is “neutral”, “precise”, and “respectful”.5 Person-first language recognizes that someone with a disorder is a person who has a disorder, rather than a person who is their disorder. For example, someone who uses heroin is not an “addict.” They are a person who also has an opioid use disorder. Using non-biased language is also critical— words like “abuser” and “abuse” denote
morally bad people such as “child abuser” or “physical abuse.” Words like “clean” to refer to a urine drug screen or a person in recovery implies that a person with an active substance use disorder is in some way “dirty.” Furthermore, these are not precise medical terminology.
Here are some examples of stigmatizing language and preferred terminology to use instead:
.
.
Person with substance/opioid use disorder
Negative vs. positive (as a test result)
In recovery Not using drugs
Pharmacotherapy
Medications for opioid use disorder
Medications for addiction treatment
Opioid agonist therapy
Treatment
“Medication-assisted treatment” suggests that medication on its own is not full treatment for addiction, whereas data show improved outcomes for people on these medications as their main treatment modality. “Substitution therapy” implies that being on medication is “substituting one addiction for another”, whereas medications for OUD are actually treating addictions rather than creating new addictions.
When we hear someone around us, such as a coworker, using language that might lead to stigma towards people with OUD, we can use a two-step process, in which we ask ourselves, “Should I respond?” and, if so, “How should I respond?”6
Deciding to respond to the use of stigmatizing language is a personal decision. It is suggested to bring awareness to the language as often as possible, but there may be some situations in which an individual might not feel comfortable responding or in which the situation may not be safe. That is okay. Consider starting in situations that feel easier to you, and with practice, you will start to feel confident in addressing stigmatizing language in a greater number of situations.
When deciding whether to respond, think about certain factors, such as how defensive the person who used the stigmatizing language might become and how your relationship with that person might be affected. Weigh those factors with your answers to the following two questions: (1) “If I don’t respond, will I regret not saying something?” and (2) “If I don’t respond, does that convey that I accept the language or statement?”
When you decide to speak up and bring attention to the language use, do so both assertively and respectfully. Be steadfast in your conviction that more appropriate language can be used, and make it clear that you understand that the person did not purposefully intend to stigmatize addiction if that is the case. Using “I” statements can be helpful, so that the person does not feel attacked or blamed. You can also offer an alternative phrase or word to use instead. Here are some examples of how you can bring up the use of language:
“I heard you use the phrase “drug abuser” when talking about our patient. I know that’s a common phrase that people use, but there’s actually recent evidence that “abuser” can reinforce the stigma that exists towards people with OUD. I definitely understand that you didn’t mean anything negative by it, but the phrase “person with an opioid use disorder” is a more neutral phrase that can be used.”
“When you mentioned the patient’s urine drug screen, I heard you use the phrase “dirty” to describe the results. This can sometimes lead to unconscious or conscious bias towards people with substance use disorders, by associating drug use with being a “dirty” person. A more accurate phrase that would be good to use is just saying that the urine drug screen is “positive” for opioids.”
“I noticed in the patient’s medical record that you described their current symptoms as consistent with “substance abuse requiring medication-assisted treatment.” I know this is the language we have frequently used in our records, but recent research suggests this can transmit bias and stigma to other professionals who may care for this patient in the future. Did you know that “opioid use disorder” or “opioid misuse” implies the same symptoms but doesn’t carry the same negative bias? And “medication-assisted treatment” suggests that medication on its own is not full treatment for addiction, even though it has high success when used as the main treatment option. I’d be happy to share some of this research with you if you are interested in learning more.”
People in recovery, particularly in 12-step mutual aid support groups, often refer to themselves as “addicts”. However, even people in recovery prefer that other people use the term “person who uses drugs” or “person in recovery” to refer to them, no matter how they self-identify.7 Every person, including those in recovery, has the right to self-label however they prefer; however, that does not extend a right to professionals to adopt the same language. Healthcare providers should continue to use precise, neutral, and respectful language when talking with and about patients, however they identify.
Stigmatizing language is common in society. It is ingrained in our culture. For example, half of news stories in the media use stigmatizing terminology.8 And even national organizations that have explicitly discouraged the use of terminology of “drug abuse”, such as NIDA (National Institute on Drug Abuse) and SAMHSA (Substance Abuse and Mental Health Services Administration), have the term “abuse” in their names. However, it should be noted changing the names of these federal agencies would require legislation by the U.S. Congress. But as a healthcare professional, you can take the first step by changing your own language and bringing awareness about stigmatizing language to the people with whom you work.
