• Scott Luetgenau MSW, LCAS

Words Go a Long Way: How the Language We Use Can Improve Long-Term Recovery Outcomes

When we talk about substance use disorders, it is essential to consider the delicate and influential role that language plays. Stigma, personal bias and preconceived perceptions often perpetuate myths surrounding addiction and as such, hinder an individual’s chances for long-term recovery. Low self-esteem and anxiety often accompany substance use disorders, but we can draw on these conditions for guidance on how to best support our clients. When it comes to a disorder that is as isolating as addiction, the words we use and the conversations we engage in can mean the difference between an individual who asks for help and one who walks out the door.

We can define stigma as an attribute, behavior or condition that is socially discrediting (Goffman, 1963). The World Health Organization recently surveyed in 14 different countries to determine which of the 18 most stigmatized conditions ranked highest – substance use disorders won in a landslide.

Now that we know language choice matters, how do we avoid making a mistake? The easiest and most natural way to approach this is to use words that show respect to the individual, whether they are present or not. If inappropriate language has a negative effect on individuals, it goes to show that appropriate language can have a positive one. If we can remove language that perpetuates negative stereotypes (such as slang and idioms), we can encourage recovery. Using “person-first language”, which was established by mental health and disability advocates, is a great tactic. For example, rather than referring to an individual as an addict (which defines their identity for them), we can refer to them as “a person with a substance use disorder.” This lets both the individual and others know that this is one aspect of their identity and opens their mind to a future that doesn’t include substance use.

In a randomized study, health care workers attending two addiction/mental health conferences were asked to complete a survey, which included a short paragraph describing an individual as either a “substance abuser” or as “having a substance use disorder.” The vignette described “Mr. Williams,” who was having difficulty complying with a court-ordered substance-related treatment protocol. Half the study participants received the paragraph describing him as a “substance abuser,” while the other half received the paragraph describing him as having a “substance use disorder,” with the rest of the wording identical. Those receiving the “abuser” paragraph were significantly more likely to agree that Mr. Williams should be punished and was more to blame for his condition and failure to comply with the treatment protocol. Even among highly trained mental health clinicians, exposure to the abuser label produced a reliably different and more punitive/blaming attitude toward the same individuals.

“The right words awaken processes of personal healing, family renewal, and community and cultural revitalization. The wrong words stigmatize and disempower individuals, families and communities.”

William L. White – Author, Researcher & Recovery Advocate