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How the Words We Use Can Create, or Avoid, Stigma for the Person with Substance Use Disorder

“Language matters,” says Shawn Ryan, MD, chief medical officer at BrightView Health in Cincinnati, Ohio. “We know that patients can suffer under the stigma of inappropriate language” when referring to their use of opioids and other drugs. By changing that language, Dr. Ryan says, healthcare practitioners can deliver more compassionate care and better help patients cope with their condition.

Stigma is the social disapproval of a person or a person’s behavior intended to induce feelings of shame, dishonor, or isolation. “Drug addict” is one of the most powerfully stigmatizing terms in medicine, with its connotations of weak willpower or poor choice. “A patient—not an addict—is someone who has substance use disorder as their disease state,” says Dr. Ryan, who is board-certified in both addiction medicine and emergency medicine.

Changing language goes along with changing perspective. People with substance use disorder “have a disease of the brain,” Ryan emphasizes. Physical proof, including neuroimaging, have established addiction as an organic brain disease. “That’s what makes these the right terms to use in the medical community.”

“Addiction” is still used in the field—Dr. Ryan notes. But the term “addict” should not be. “This really has no place in a professional setting. I promise you, our patients feel bad enough about what’s going on with their disease and in their life without anyone helping them feel worse.”

Similarly, he says, the term “drug abuse” has been replaced by substance use disorder, a term that is now found in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. “The problem with ‘drug abuse’ is the negative connotation. ‘Misuse’ is different—it is defined as using a medication or drug in a way it was not prescribed or intended.”

Underlying much of the stigma toward those with substance use disorder is the idea that patients have chosen to become addicted to the drugs they use. Nothing could be further from the truth, Dr. Ryan believes.

Addiction is driven by 3 factors: genetics, environment, and exposure. Twin studies have shown that from 40% to 50% of addiction risk is genetic, over which the patient has no control. Similarly, environment—especially the home during childhood and adolescence—is largely or completely out of the control of the person who may go on to develop substance use disorder. “Many patients have terrible trauma in early life,” Dr. Ryan says, including severe neglect or abuse.

Finally, he says, while patients may have made some decisions to increase their exposure, “the vast majority of patients who are now addicted to opioids or other substances were exposed through a route that was not their choice.” And rapidly after that exposure occurs, the patient develops “a compulsive brain disorder that is as powerful as any other compulsion there is in human function, including for food, shelter, or sex.”

Changing the language to use about patients with substance use disorder can help healthcare providers keep all this in mind as they work with their patients to manage their disease. “Patients are not choosing this miserable life,” Dr. Ryan says, and it is the goal of treatment to help them achieve a better one.

You can watch Dr. Ryan’s full discussion of stigma and substance use disorder at https://megvault.egnyte.com/dl/BI0JNaUJrS/.