Stigma Hall of Shame

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Leaders within the alcohol and other drug (AOD) problems arena have interrogated the terms alcohol/drug/substance “abuse” and “abuser” and concluded that such language represents the stigmatizing misapplication of moral language to a medical condition, and that such language has no scientific validity. There is growing consensus to purge the “abuse” and “abuser” language at public, policy and professional levels and replace it with language that is more science-grounded and solution-focused. Progress on this front includes:

*Historical analyses of the religious/moral roots of the “abuse” language in the portrayal of AOD problems in the United States (White, 2004; White & Kelly,2011). 

*Early commentaries suggesting the stigmatizing effects of the “abuse” language (National Commission, 1973; Keller, 1982; Schulstad, 1989, Renaud, 1989).

*Studies confirming that “abuse/abuser” language elicits stigma and more punitive responses to people experiencing AOD-related problems (Kelly, et al, 2010a,b; Ashford et al 2019);

*Elimination in 2013 of the “Substance Abuse” diagnosis in the American Psychiatric Association’s fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM);

*Discouragement of the derogatory language “alcohol/drug/substance ABUSE/ABUSER” by prominent field organizations, e.g., the National Institute on Drug Abuse (yes, quite ironic!), the American Society of Addiction Medicine, the American Psychiatric Association, the Recovery Research Institute, Join Together, Faces and Voices of Recovery, and numerous local recovery community organizations.

*Discouragement of ABUSE language by the International Society of Addiction Journal Editors.

In spite of such advances, several organizations deserve membership in the Stigma Hall of Shame for perpetuating the abuse language:

*The two nation public health institutes responsible for addiction-related research: the National Institute on Alcohol ABUSE and Alcoholism and the National Institute of Drug ABUSE;

*The three national organizations responsible for supporting the national network of public prevention and addiction treatment organizations: the Substance ABUSE and Mental Health Services Administration, the Center for Substance ABUSE Prevention, and the Center for Substance ABUSE Treatment;

*The fifteen state agencies responsible for planning, funding, and evaluation of prevention and addiction treatment services that still have names that include the ABUSE language: AL, AK, DE, FL, HI, ME. MN, MS, NY, NC, OK, SC, TN, UT, and VT; and

*The ten peer-reviewed addiction-related journals that continue the ABUSE language in their names, including Substance Abuse and Rehabilitation, American Journal of Drug and Alcohol Abuse, Substance Abuse Prevention Treatment and Policy. Journal of Ethnicity and Substance Abuse, Advances in Alcohol and Substance Abuse, Journal of Substance Abuse Treatment, Journal of Child and Adolescent Substance Abuse, Journal of Drug Abuse, Journal of Substance Abuse and Alcoholism, and Substance Abuse.

How can organizations who purport to be science-based address addiction-related stigma when all of their pronouncements spring from an organizational moniker rooted within and dripping with social stigma? How can they hold themselves up as science-grounded institutions when their very name reflects not the language of science but the language of moral condemnation? What should the recovery advocacy message be to all of these organizations: Stop being part of the problem; change your damn name! And adopt an alternative name that is truly science-grounded and solution focused.

Further Reading

Ashford, R.D. (2018). “Abusing addiction”: Our language still isn’t good enough. Alcoholism Treatment Quarterly, 36 (2), 274-285. DOI: 10.1080/07347324.2018.1513777

Ashford, R., Brown, A. M., & Curtis, B. (2019). Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias. Drug and Alcohol Dependence, 189, 131-138. doi: 10.1016/j.drugalcdep.2018.05.005. Epub 2018 Jun 13.

Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. The American journal of psychiatry170(8), 834–851. https://doi.org/10.1176/appi.ajp.2013.12060782

International Society of Addiction Journal Editors. (2015). ISAJE terminology statement. Retrieved July 26, 2021at http://www.parint.org/isajewebsite/terminology.htm

Keller, M. (1982).  On defining alcoholism:  With comment on some other relevant words.  In L. Gomberg, H. White, & J. Carpenter (Eds.), Alcohol, science and society revisited (pp. 119-133).  Ann Arbor:  The University of Michigan Press.

Kelly, J. F., Dow, S., & Westerhoff, C. (2010a). Does our choice of substance-related terminology influence perceptions of treatment need? An empirical investigation with two commonly used terms. Journal of Drug Issues, 40(4), 805-818.

Kelly, J. F., & Westerhoff, C. (2010b). Does it matter how we refer to individuals with substance-related problems? A Randomized study with two commonly used terms. International Journal of Drug Policy, 21(3), 202-207.

National Commission on Marihuana and Drug Abuse. (1973). Marihuana: A signal of misunderstanding.  Washington, D.C.: U.S. Government Printing Office. 

Renaud, J. (1989). Substance abuse is language abuse. The Counselor, 7(4), 26-27.

Saitz, R., Miller, S.C., Fiellin,D. A., & Rosenthal, R. N. (2020). Recommended use of terminology in addiction medicine. Journal of Addiction Medicine, 15(1), 3-7. doi: 10.1097/ADM.0000000000000673.

Schulstad, M. (1989). Let’s eliminate the term “substance abuse.” The Counselor, March/April, 5, 46.

White, W. (2002). An addiction recovery glossary: The languages of American communities of recovery. Posted at www.williamwhitepapers.com

White, W. (2004) The lessons of language: Historical perspectives on the rhetoric of addiction.  In Tracy, S and Acker, S. Eds.  Altering American Consciousness: Essays on the History of Alcohol and Drug Use in the United States, 1800-2000 (pp. 33-60).  Amherst: University of Massachusetts Press.

White, W. & Kelly, J. (2011). Commentary.  Alcohol/drug/substance “abuse”:   The history and (hopeful) demise of a pernicious label.  Alcoholism Treatment Quarterly, 29(3), 317-321.