Chapter 2
Conversations about terminology can be difficult. Language inevitably changes over time in a way that tracks the concepts relevant to the people who speak it. English as most people can fluently read today is only a couple centuries old. English actually changes pretty fast compared to other languages as a result of cultural conquests that dramatically changed the conventions of grammar and vocabulary. So, it’s pointless to complain about the fact that language changes. The meaningful discussion to be had is around how language should change and whether we have the tools to drive changes. As any cursory glance at the history of science will show, we constantly reinvent terminology for both technical and social reasons, ultimately to improve our communication.
I appreciate that the authors don’t just make a moral argument, but an efficacy argument driven by empirical evidence. This makes it quite easy to move past the wishy-washy subjective arguments about changing language to accommodate feelings. We can just point out that changing language leads to tangible changes in treatment outcomes, and we should prioritize language that leads to better outcomes. No need to delve into the mechanics of humanizing a human to achieve a standard of decency while hoping the virtues of doing so become apparent. Just follow the research.
“Stigmatizing terms can negatively affect clinician judgment and quality of care. For example, research demonstrates that when patients are described as having substance abuse instead of a use disorder, clinicians are more likely to recommend punitive approaches to treatment. Although there may not be consensus on exactly which terms are stigmatizing versus which are not, using terminology in a way that ignores the many human aspects of patients beyond their substance use and defines them by their behavior or condition is potentially stigmatizing. Examples include the use of the terms alcoholic, abuser, drunk, user, addict, or junkie. Although some may view the use of terms such as alcoholic and addict as acceptable in 12-step or other nonmedical settings, these terms should be replaced with more medically defined and less stigmatizing terms that incorporate person-first language (eg, “patient with alcohol use disorder” and not “alcoholic,” “patient with OUD” and not “OUD patient”). Our patients are individuals first, who secondarily have a disease or disorder.”
Ironically, we spend a lot of language making people uncomfortable with change more comfortable.
“Some patients (eg, those succeeding in part with participation in social networks such as Alcoholics Anonymous) clearly find benefit to calling themselves an alcoholic or addict, even if it might reflect some internalized stigma. However, as patients frequently carry negative self-appraisals and shame about their substance use disorder, other patients have strong negative associations with being labeled a drug addict or drunk, which impedes their treatment engagement. Furthermore, patient acceptance of such labels has not been shown to be necessary to achieve favorable clinical outcomes. The purpose of this chapter is not to police language used or to call out those who use a term with good intentions.”