Pubdate: Thu, 04 Feb 2016
Source: Boston Globe (MA)
Copyright: 2016 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52
Author: Felice J. Freyer

LANGUAGE OF ADDICTION ITSELF CAN HURT, ADVOCATES SAY

Windia Rodriguez remembers the sting of the words hurled at her 
during a hospital stay a few years ago. "Crackhead." "Addict." 
Especially, she recalls the scorn in the voices that pronounced her 
"just an addict."

"They treated me like I was beyond hope," Rodriguez said.

But she found hope, and these days, free of drugs for four years, 
Rodriguez makes a point of adding two words to the standard 
salutation in her 12-step group. "I'm an addict," she says, "in recovery."

In so doing, Rodriguez, a Boston resident and regional coordinator 
for the Massachusetts Organization for Addiction Recovery, quietly 
adds her voice to those of researchers and advocates who want to 
rewrite the lexicon of addiction.

These advocates seek to excise language that blames or disparages the 
patient and replace it with medical terms free of judgment. They 
assert that commonly used words - "junkie," "abuser," even "substance 
abuse" and "addict" - can discourage people from seeking help, induce 
health professionals to treat patients harshly, and exacerbate the 
stigma that bedevils people suffering from drug addiction.

"The biggest thing we trade in is hope," said Dr. Barbara Herbert, 
Massachusetts chapter president of the American Society of Addiction 
Medicine, a confederation of doctors and other medical workers. "Our 
biggest enemy is hopelessness. That's why I think language matters a lot."

Those rebelling against common expressions follow in the footsteps of 
earlier activists who banished such terms as "cripple," "mental 
retardation," and "insane asylum." But they face special challenges 
with addiction. Attitudes are fierce and entrenched, and agreement is 
lacking on which words are most harmful and which substitutes most apt.

It doesn't help that the reviled terms "substance abuse" and "drug 
abuse" are embedded in the well-recognized titles of government 
agencies, nonprofits, and scientific journals. Or that a phrase such 
as "person with a substance use disorder" - often suggested as an 
alternative to "addict" or "drug abuser" - is both cumbersome and vague.

Michael Botticelli, director of the Office of National Drug Control 
Policy, has been working to standardize federal communication about 
addiction and eliminate pejorative terms. "For a long time, we've 
known that language plays a huge role in how we think about people 
and how people think about themselves," said Botticelli, adding that 
he raises the language issue in just about every talk he gives. 
"Words have to change so attitudes change."

The words targeted by Botticelli and others run the gamut from 
obvious insults, such as "junkie," to common expressions that many 
might not consider derogatory or that are often used by people in recovery.

To call addiction a "habit" is inaccurate, likening a life-destroying 
compulsion to nail biting. To say people are "clean" when not taking 
drugs implies they're dirty when using. A "dirty urine" - a sample 
with evidence of drug use - carries the same implication. "I can't 
think of a more telling example of judgmental terminology," said 
Botticelli, former chief of Massachusetts' Bureau of Substance Abuse 
Services. "We don't say for a diabetic whose blood sugar spikes that 
they have a 'dirty blood sugar.' "

But the words provoking the most contention are "addict," because the 
word labels a person as a health condition, and "abuse" and 
"abusers," because, some specialists say, these words affix blame on 
the sick and evoke some of the worst crimes, such as child abuse.

Dr. Kevin P. Hill, an addiction psychiatrist at McLean Hospital in 
Belmont, is especially disturbed by "addict" because it defines 
people by their illness.

"This person is much more than one illness," he said.

'Words have to change so attitudes change.'

Others can live with "addict" but reject "abuse."

John F. Kelly, director of the Recovery Research Institute at 
Massachusetts General Hospital, has been beating the drum against the 
words "abuse" and "abuser" for more than a decade.

In a 2009 study, Kelly asked 516 health care workers at a conference 
to read a paragraph about a man who was having difficulty complying 
with a court-ordered addiction-treatment program. Half received a 
paragraph describing the patient as a "substance abuser"; the other 
half read a paragraph describing the man as "having a substance use disorder."

When asked questions about the treatment he should receive, those who 
thought of him as a "substance abuser" were much more likely to blame 
him for his difficulties and recommend punishment.

"This is one of the reasons people don't seek treatment," Kelly said. 
"Rather than seeing themselves as sick, they think they're bad 
people. They feel ashamed and embarrassed."

Last year, Kelly and Dr. Richard Saitz of Boston University School of 
Medicine traveled to Budapest for a meeting of the International 
Society of Addiction Journal Editors and persuaded the group to stop 
using the words "abuse" and "abusers" (except in the titles of the 
journals themselves).

Two less specialized and more prominent medical journals, the New 
England Journal of Medicine and the Journal of the American Medical 
Association, said they don't have explicit policies on the words used 
in articles about addiction. But both said they avoid the word 
"addict" because it labels people.

Among major media outlets, The New York Times, the Associated Press, 
The Boston Globe, and National Public Radio said they had not been 
asked to change addiction terminology, had not discussed doing so, 
and have no policies addressing the issue.

What about federal agencies? The Substance Abuse and Mental Health 
Services Administration. The National Institute on Drug Abuse. The 
National Institute on Alcohol Abuse and Alcoholism. Any name changes 
would require an act of Congress.

Dr. Nora D. Volkow, director of the drug abuse agency, tried that 
more than a decade ago, proposing "the National Institute on Diseases 
of Addiction." When that effort failed, Volkow moved on and today has 
more urgent priorities, she said.

Also, she doesn't object to the word "abuse," finding it useful in 
distinguishing a severe disorder from milder conditions. Volkow said 
she agrees with efforts to avoid derogatory terms but urges precision 
and clarity in choosing replacements.

Otherwise, she said, "you end up in a world of grayness, where it's 
very, very difficult to communicate."

The Substance Abuse and Mental Health Services Administration is 
working on a project that might help, said chief of staff Tom 
Coderre. The agency has teamed with the National Academies of Science 
to study which words promote stigma and which alternatives hold 
meaning for the public.

"If we want more people to seek treatment and we want public policy 
makers to make treatment available," Coderre said, "changing the 
lexicon is going to be really important."
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MAP posted-by: Jay Bergstrom