“Does it Matter How We Talk About People with Substance Use Disorder?”

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Most of you have never met me.

I am about to write something that may change what you think about me. I am going against the advice of people I respect – my wife and my Psychiatrist. (In fact, even saying that I have a Psychiatrist may change what you think…).

In diagnostic terms, I have a mental illness: I live with depression and anxiety. And most days I do very well.

Would it matter if I wasn’t a writer? An Addiction Therapist? Owned a home? Had a good job? Had two children and was married for over 20 years? What if I was homeless? Or what if I drank a lot?

Stigma lives within all of us

Addiction is one of the most stigmatized health conditions that a person can experience. Whether it is over use of alcohol or drugs, or mental illness, stigma will impact a person’s well being, quality of life and can lengthen their recovery time.

In a study of 314 individuals, Kelly and colleagues were interested in how we describe individuals with substance-related problems may evoke different types of stigmatizing attitudes. They looked into how describing someone as a “substance abuser” would evoke more punitive attitudes versus describing the same person as having a “substance use disorder”.

Study demographics: Half of participants worked in the healthcare field, while 20% were students, 29% worked outside healthcare or were unemployed or retired, and 5% did not report an occupation. They were 31 years old, on average (ranging from 17 to 68 years old), 81% were White, 76% were female, and half had a bachelor’s degree or higher level of education.

The study found that participants viewed a person labelled as a “substance abuser” was:

• a) less likely to benefit from treatment
• b) more likely to benefit from punishment
• c) more likely to be socially threatening
• d) more likely to be blamed for their substance related difficulties and less likely that their problem was the result of an innate dysfunction over which they had no control
• e) that they were more able to control their substance use without help

The diagram below illustrates the differences in perception based on how we refer to a person with a substance use problem:

Stigma has significant effects on how we view those who live with substance use

• We may subtly change how we treat them, avoiding them or offering less help or care than others in a similar situation (ie: with diabetes). Stigma effects how we feel and how we treat a person in recovery and those not choosing to change their situation. We may conclude that there is something wrong with them.
• Health care needs may be ignored or delayed because we think a person who uses substances needs to hit “rock bottom” before they can truly be helped. This can lead to unnecessary suffering, cruel treatment and even premature death.
• We tend to stigmatize any disorder or condition that we are uncomfortable with or do not understand: Heroine use, Injection drug use, Self injury, Anorexia, Schizophrenia, Meth use are just a few examples. We may conclude that the person is dangerous, unwilling to help themselves, unable to change, and a drain on our healthcare system. 
• Stigma can disappear when we allow our boundaries to lower a little and meet someone who lives with what we fear or dislike. People who live with a substance use disorder or a mental illness are more like us than we know. And that may be just what we may fear.
• Stigma can prevent a person from securing a good job and safe housing.

The result of stigma is that often people who experience mental illness or addiction may hide what they are experiencing. They feel ashamed and unable to seek the help that they need to thrive. At times, a person may experience ridicule and rejection because of their experience.

Take a moment consider the power of  your words: How you describe someone who lives with a mental illness

Think about the words that you use to describe yourself or others who may experience substance use disorders. When we use words like “abuse,” “abuser” our attitudes will tend to blame and assume that a person is choosing not to help themselves. Some other examples can be describing someone as “clean” (which sends the message that if they happen to use, they are “dirty), an “addict” (which may convey that they always will be), or “junkie.”

If you (or your son or daughter or parent) were living with a mental illness or substance use experience, how would you like to be treated? The exact words may not matter, but think about how the following phrases are different than those I just listed: “substance use disorder” or “person with a substance use disorder (or alcohol abuse pattern)” or “living with a mental illness” or “mental health experience.”

I don’t think that you hate me, or anyone who lives with addiction or mental illness. But I do recognize that stigma can change how we treat each other.

Where we reject those who suffer, we also reject a part of ourselves and our humanity recedes one more step. Where we honor those in need, we use the power that we have to help ourselves and humanity to move towards a better way. 

If you enjoyed this post, I would love to hear from you in the comments. I invite you to see some of my other work:

Is the World Broken? Perhaps. But You and I Have the Power to Change it.

Judgment Against Addiction is Alive and Real Today

4 Ways that Depression has Changed My Life

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Keep it Real!

Sources:

(N.D.) The Real Stigma of Substance Use Disorders. Research Recovery Institute.

(N.D.) Addiction Terminology Statement. International Society of Addiction Journal Editors.

Shrivastava, A., Johnston, M., & Bureau, Y. (2012 Jan-Dec.) Stigma of Mental Illness-1: Clinical reflections. Mens Sana Monogr. ; 10(1): 70–84. doi:  10.4103/0973-1229.90181

Photos by Jonathan Kos-Read