Words matter, and even more so in medicine. There has been a movement in the last several years to adopt a person-first language of disease that emphasizes the humanity of each individual and divests them from any diseases they might have. Thus, someone is not a diabetic or a schizophrenic, they are a person with diabetes or schizophrenia. This is a kinder and more humane, not to mention more precise, way of speaking about patients, and discourages the cynicism and distance that is poisonous to the doctor-patient relationship. This is especially important in medicine because there is a high correlation between disease states as adjectives and social stigmatization, and the line between the two can easily become blurred. For example, you would be hard-pressed to find someone with leukemia described as “a cancer” but encountering a manic depressive or a psychotic is relatively common. This of course is not always true, as is the case with “hemophiliac,” but still, by referring to a person with hemophilia only as their disease state you reduce them from a person with an ailment to a gene mutation with a face.
Person-first language has been gradually adopted throughout medicine but the language used to describe addiction has notably lagged behind. I frequently hear junkie, crackhead, meth head and stoner, among many other adjectives, dropped casually in conversation among health professionals, often with no awareness of how dehumanizing it is to patients. This perpetuates stigma which, at best, is counterproductive to care goals as it tends to discourage people from being truthful and seeking treatment, and at worst, signals to a patient with a substance use disorder that their provider does not care about them. This is reflected in the robust findings that negative attitudes toward people with substance use disorders among healthcare professionals lead to poorer outcomes for their patients. Numerous studies have also demonstrated that describing patients as a “substance abuser” vs a “person with a substance use disorder” in written vignettes leads to more punitive behavior, and lead providers to be less likely to report that those individuals deserved treatment. The way healthcare providers describe individuals with substance use disorders directly contributes to worse care, and therefore it is incumbent on all of us to do our part to alleviate this stigma and provide better care to our patients.
With the importance of this endeavor in mind, the DSM-5 did away with the categories of substance abuse and substance dependence and replaced them with a single category of substance use disorder with a mild, moderate, or severe designation. Furthermore, numerous specialty groups like the American Medical Association have called upon practitioners to eliminate stigmatizing language surrounding addictions. Abuse of a substance has exited the official medical lexicon because it is pejorative and fairly unhelpful clinically. Other examples of this trend are to refer to urine drug screens as “positive” or “negative”, rather than “clean” or “dirty,” respectively, and to apply person-first language to other substance use-related conditions such as alcohol-related cardiomyopathy (as opposed to alcoholic cardiomyopathy). The terms “addict” and “alcoholic” are in a grey area because they are being somewhat reclaimed by substance users much in the same way that “queer” was reclaimed by gay people, but as a general rule, providers should not use these terms unless the patient prefers them.
In all, by making a commitment to use person-first language, providers can help to improve care for this especially vulnerable and stigmatized population. I believe this is a worthy goal that is worth a few brief words to correct your colleagues.
