Right Words Matter: The Language of Substance Use Disorder

Next Generation Series

January 20, 2025

Tom O'Connor, Author & Publisher

Owen Flanagan, Subject Matter Expert

Topic

Substance use disorder is the most stigmatized health condition in the world. It is one of the most significant barriers to recovery and treatment.

A person shouldn't be defined or labeled by their disease or illness. We have a choice when we communicate. We can use words that perpetuate the negative stigma around substance use. We can label people with words in a hostile, shameful, and judgmental way. Or we can use words that are compassionate, supportive, and respectful. The right words help others understand substance use disorder as the healthcare issue that it is.

By choosing to rethink and reshape our language, we can allow people with a substance use disorder to regain their self-esteem, make them feel more comfortable seeking treatment, allow medical physicians to deliver better treatment, allow lawmakers to appropriate more funding, enable insurers to increase coverage of evidence-based treatment and help the public understand this is a medical condition that should be treated as such.

This article follows up on our January 6 issue, "Change the Narrative on Substance Use Disorder," which I co-authored with Sandra Rivers, Founder of Authentic Trainings LLC.

Our Subject Matter Expert (SME) is Owen Flanagan, an emeritus professor of philosophy and neurobiology at Duke University. Owen's essay is adapted from his new book, What Is It Like to Be an Addict? His publisher, Oxford University Press, is the world's largest university press, publishing in over 190 countries and 70 languages. https://blackwells.co.uk/bookshop/product/What-Is-It-Like-to-Be-an-Addict-by-Owen-Flanagan/9780199388929

Additional Information For You

Substituting Negative Words With Positive Language

For a long time, we have known that language plays a significant role in shaping our perceptions of others, influencing how we interact with them, and affecting how they perceive themselves. Words matter!

Right Words Matter

Negative Words	Examples	Positive Framework
Abuse Abuser	He's a drug abuser. She's an alcohol abuser.	They are using non-prescribed substances.
Addict Addiction	He's an alcoholic or a drunk. She's a person with an addiction or a junkie.	They have a substance use disorder.
Clean Sober	He has been sober for six months. She smoked pot for many years, but now she is clean.	They are on a path toward recovery. They are not currently using non-prescribed substances.
Habit	He has a nasty drug habit.	They have a non-medical, unhealthy, and risky use of substances with substance use disorder.

Owen Flanagan, Book Author: What is it Like to Be an Addict?

On January 9, Owen Flanagan wrote an essay on the op-ed page of the Wall Street Journal titled: People Say Addiction Is a Disease. Mine Wasn't. Owen states that after decades of struggling with alcohol and drugs, he was convinced that addiction is a disorder that involves a person's entire being, not a brain disease as labeled by scientists. In 1997, the National Institute of Drug Abuse published a manifesto called Addiction Is a Brain Disease, and It Matters. Owen adds that more than a quarter-century later, however, there is no agreement on what that brain disease is, although almost everyone says it is one. He added that scientists and psychologists studying addiction have pointed to essential circuits in at least 18 different brain areas. Still, they have not identified a single neural syndrome or profile that might be the disease of addiction.

According to Owen, even when individuals subscribe to the modern view that addiction is the victim of a disease, they still hold people with an addiction responsible for what they do. Owen believes it's more accurate to describe addiction as a disorder that he finally overcame because of a combination of love and support from both families, the community of peers suffering from substance use disorders, and mental health professionals. He ended his essay by declaring, "The solution was social."

Conducting Additional Substance Use Disorder Research 

Substance use disorder is a complex condition in which there is the uncontrolled use of a substance, either alcohol or non-medical, non-prescribed drugs, despite harmful consequences. This complex condition can impair these individuals' ability to function in daily life.

Repeated substance use can cause changes in how the brain functions. People with a substance use disorder may have distorted thinking and behaviors. Changes in the brain's structure and function are what cause individuals to have intense cravings, changes in personality, abnormal movements, and other behaviors. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision-making, learning, memory, and behavioral control. Addiction to substances is a mental health disorder, not a brain disease.

Many people experience substance use disorder along with other mental health disorders, referred to as co-occurring disorders. One mental health disorder can, but does not necessarily, precede another mental health disorder. It is also possible that the use of a substance may trigger or worsen a mental health disorder.

Mental Health Disorders

There are more than 200 classified forms of mental health disorders, including:

• Anxiety Disorder

• Attention-Deficit/Hyperactivity Disorder (ADHD)

• Bipolar Disorder

• Depression

• Obsessive-Compulsive Disorder (OCD)

• Post-Traumatic-Stress Disorder (PTSD)

• Substance Use Disorders (SUD)

• Schizophrenia

Your Call to Action

For Healthcare Practitioners

Rethink and reshape your language, allowing your clients/patients with a substance use disorder to:

• Help them regain their self-esteem.

• Make them feel more comfortable seeking substance use disorder treatment.

• Promote best practices such as screening, intervention, and treatment of substance use disorders by healthcare practitioners to deliver more effective treatment.

• Allow lawmakers to appropriate more funding for substance use disorders.

• Enable insurers to increase coverage of evidence-based treatment and help the public understand this is a medical condition that should be treated as a substance use disorder.

For Individuals Suffering from Substance Use Disorder and Family Members

Treatment for a substance use disorder can change your life or your loved one's life. It can help you regain control, improve relationships, and achieve your goals. Take the following steps toward recovery:

• Recognize you and your family members are afflicted with a substance use disorder that inflicts damage to the entire family unit.

• Stand up to the stigma attached to having a substance use disorder.

• Engage a medical professional in conducting a formal assessment of symptoms to identify if substance use disorder is present.

• Realize that all individuals who have a substance use disorder can benefit from treatment, regardless of whether the disorder is mild, moderate, or severe.

• Learn all you can about substance use disorders. The entire family unit should independently conduct substance use disorder research and discuss findings in a family gathering.  

• Each family member should express love and concern for the loved one with a substance use disorder. Talk to the loved one about your concerns, and offer your help and support, including your willingness to go with them and get help.

• If your loved one opposes help, engage a substance use disorder therapist or professional substance use disorder interventionist to gain professional guidance.

• If you or a loved one goes through recovery and treatment and then has a reoccurrence of active substance use disorder, don't despair or feel defeated. It is not how many times we fall that defines us. Instead, it's how many times we get up after we fall. Recently, I met several individuals who, over 5 times, had returned to substance use disorders until they were able to sustain their recovery. Never give up!

It's far past time to stop playing word games with this complex medical condition, substance use disorder.

Right Words Matter

Right Words	Wrong Words
They are using non-prescribed substances.	They abuse alcohol or drugs. They are abusers of alcohol or drugs
They have a substance use disorder.	They have an addiction.
They are on a path toward recovery. They are not currently using non-prescribed substances.	They are clean. They are sober.
They have a non-medical, unhealthy, and risky use of substances with substance use disorder.	They have a habit.