[lg policy] Words matter: The language of addiction and life-saving treatments

Harold Schiffman haroldfs at gmail.com
Fri Aug 19 10:50:20 EDT 2016

 Words matter: The language of addiction and life-saving treatments
[image: Sarah Wakeman, MD, FASAM, Medical Director, Massachusetts General
Hospital Substance Use Disorder Initiative]
Posted August 15, 2016, 9:30 am
Sarah Wakeman, MD, FASAM, Medical Director, Massachusetts General Hospital
Substance Use Disorder Initiative
<http://www.health.harvard.edu/blog/author/swakeman>, Contributor
[image: white flower growing on crack street, soft focus, blank text]

News articles, radio, and television frequently report on the current
opioid crisis. As the death toll has mounted, the media has importantly
covered many aspects of the crisis. Unfortunately, this coverage often
focuses on the very visible individuals who continue to struggle with
active addiction. What is missing is a narrative of hope for a chronic
disease which is as treatable as diabetes or high blood pressure.

In addition to the pessimistic portrait painted about addiction, the
language used by the media is often problematic. Articles frequently use
the term “abuse” or “abuser” or refer to individuals as “addicts.” Even the
term “clean” is laden when referencing sobriety, as it implies that someone
who is actively using is somehow “dirty.”
Language matters–a lot

The use of “abuse” and “abuser” has been shown to increase stigma even
among highly trained clinicians, who recommend more punitive treatment when
an individual is described that way. We do not call patients with diabetes
“sugar abusers,” nor do we say their blood is “dirty” with sugar.
Describing patients as having a *substance use disorder* demonstrates that
their illness does not define them, just as we should no longer call a
person with schizophrenia a “schizophrenic.”

The language we use related to addiction *treatment* also impacts stigma.
Methadone and buprenorphine are lifesaving, effective medications for
opioid use disorder. Their use reduces relapse and death far more than any
other available treatment. And yet they are frequently referred to as
“replacements,” worsening the mistaken notion that these medications are
simply a way to substitute a legal opioid for an illicit opioid. They are
not. Addiction is a behavioral syndrome characterized by compulsive drug
use despite negative consequences. Patients successfully treated with
methadone no longer meet the criteria for active opioid use disorder.
Taking a medication to manage an illness is the hallmark of chronic disease
treatment. Individuals taking medication to successfully treat addiction
are physically dependent, just as someone taking insulin for diabetes
requires a daily shot to be able to function normally. Both will get sick
if they stop their medication. But someone on methadone is no more
“addicted” than any person who relies on a daily prescription to keep a
chronic disease under good control.
Stigma can deter people from treatment

In Boston, the term “methadone mile” has come to refer to a stretch of
Massachusetts Avenue where the devastation of active drug use is highly
visible. This reference is particularly unfortunate because it lumps those
on treatment for opioid use disorder with those actively using. This
insinuation that individuals on methadone maintenance are no different than
those actively using heroin is incredibly stigmatizing and is one reason
why many won’t consider this treatment.

Methadone was first discovered in 1965 through the groundbreaking research
of scientists at the Rockefeller Institute. Those early studies
demonstrated methadone’s remarkable ability to alleviate withdrawal and
craving while dramatically improving the ability to function emotionally
and socially. In the subsequent decades, the evidence supporting
methadone’s positive effects has grown. These include significant
reductions in drug use, new HIV infection, crime, and death from overdose.
The research is so strong that methadone, along with buprenorphine
(Suboxone), has been added to the World Health Organization’s list of
essential medications. And yet despite this, only a minority of programs
offer methadone treatment and the undeserved shame associated with this
lifesaving medication persists.

Many would be surprised to learn that most people with a substance use
disorder will get better, and the lifesaving medications methadone and
buprenorphine are the most effective pathway to recovery, not
detoxification. Those doing well on medication are often invisible because
they are scared to share their pathway to treatment in the face of such

Words matter and continued use of stigmatizing language perpetuates false
stereotypes, spreads misinformation, and keeps people out of care.



 Harold F. Schiffman

Professor Emeritus of
 Dravidian Linguistics and Culture
Dept. of South Asia Studies
University of Pennsylvania
Philadelphia, PA 19104-6305

Phone:  (215) 898-7475
Fax:  (215) 573-2138

Email:  haroldfs at gmail.com

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