The National Institute on Drug Abuse (NIDA), which, just for the record, is now considered stigmatizing language due to the use of the word “abuse,” says that “stigma may stem from antiquated and inaccurate beliefs that addiction is a moral failing.” (NIDA nidamed)
In 2020, the National Institute of Health reported in “The stigma of mental illness: Α historical overview and conceptual approaches” that “the term stigma originates from ancient Greek language…[meaning] ‘to carve, to mark as a sign of shame, punishment or disgrace.’” (PubMed) This means that stigmatizing language is a mark of shame or disgrace. If I refer to someone as an “addict,” it’s because I’m stigmatizing that person. If I say he has a “dirty test,” I’m shaming him. If I say that she is an alcoholic, I’m punishing her. If I say that someone abuses drugs, I’m treating that person disgracefully.
But wait: our government entities, the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Substance Abuse and Mental Health Services Administration (SAMHSA) all have a stigmatizing word in their titles, and we’re asked to stay away from this word – “abuse,” among others – because it “may inadvertently elicit and perpetuate stigmatizing attitudes.” (Science)
Changes in language, what’s referred to as “semantic change,” occur relatively slowly, but I will say that the language of addiction has been changing fast and furiously. I started working in the addiction field in 1989, and in 2017 I attended a national conference on the topic. I asked a brilliant trainer, David H. Jernigan, PhD, from Boston University’s School of Public Health, what happened to “other drugs.” I explained that when I started in the field, everyone referred to our work as that of “alcohol and other drugs,” and then when I re-entered the field in 2009, no one called it that. It was “alcohol and drugs” or “drugs and alcohol,” and “substance use” was just starting to be used, so what happened to “alcohol and other drugs”? Dr. Jernigan said with utter confidence that in about 1989 our government promised the alcohol industry that they wouldn’t call it “alcohol and other drugs anymore.” I’m not saying this was a financial decision. I AM saying that historically there are two elected officials in Congress to every single alcohol lobbyist, so you figure it out. To be clear, alcohol IS indeed a drug, and not referring to it as such causes a lot of misinformation and a false sense of security about an exceedingly deadly drug – even more deadly than opioids. Still.
So maybe our changing language isn’t really changing for all the right reasons. I’m not suggesting that stigmatizing language should continue to exist; I am, however, suggesting that we consider what is truly stigmatizing.
I recently had an opportunity to point out to George Koob, PhD, the Director of NIAAA, that we are using language in this field in such a way that it has become nonsensical. He was a facilitator of a conversation about the use of “pre-addiction,” which had been introduced by NIAAA and NIDA in hopes that identification “could motivate greater attention to the risks associated with early-stage substance use disorder and help marshal the policies and healthcare resources that will support preventive and early intervention measures.” (NIDA about)
My understanding is that this idea was dismissed out of hand by those people who get to make these decisions. I, however, think “pre-addiction” is a brilliant term…if, in fact, we bring back “addiction.” As I said to Dr. Koob: “If someone has pre-diabetes and it goes untreated, that person gets diabetes. If someone has pre-cancer and it goes untreated, that person gets cancer. If someone has pre-addiction and it goes untreated, that person DOESN’T get a ‘substance use disorder.’ He gets ADDICTION…but we have whitewashed our language in such a way that it no longer makes sense.”
He told me that he’s not that invested in labels. And I get it; I really do. I don’t think labeling PEOPLE is useful…but it’s pretty hard to help someone overcome a chronic, progressive, lethal disease if we aren’t able to name it. We don’t pretend that someone with breast cancer has a “flesh disorder.” We don’t pretend that those with diabetes have a “hormone disorder.” It’s NOT stigmatizing to use clear language. It’s simply style over substance, and we may find that letting people DIE because we’re afraid to discuss their DISEASE of ADDICTION may be more deadly than stigma has ever been.
References
https://nida.nih.gov/about-nida/noras-blog/2022/07/time-to-start-talking-about-pre-addiction
https://www.sciencedirect.com/science/article/abs/pii/S0955395909001546?via%3Dihub
Guided by Guida 
Leave a comment