Chemical Dependence

Addictive Disorder or Chemical Dependence: Labels That Won’t Ease Heartache

People-First Language for Drug-First People

Are we part of the problem if we call our addicted child an addict or alcoholic? Because, they say, such labels perpetuate the moralistic stigma that cascades into less accessible drug addiction treatment, prison overcrowding fueled by the opioid epidemic, public resistance to needle exchange programs, and maybe even drought in California?

Sorry for the sarcasm, but I’m a little sick of hearing about all the ways I’m contributing to a problem I’d do just about anything to fix. But, like anyone who loves an addict (oops), I’m going to dig deep and yet again find maturity and open-mindedness and compassion enough to try to understand why the world might be a better place if I humble myself enough to consider a new language. Here goes.

According to the federal Substance Abuse and Mental Health Services Administration, the labels “drug addict” and “alcoholic” are demeaning because they define a person by his/her illness:

“By making no distinction between the person and the disease, (the labels) deny the dignity and humanity of the individual. The labels imply a permanency to the condition, leaving no room for a change in status.”

I could make a pretty good argument that it’s the opiates that rob the individual of dignity and humanity, and that the use of the “addict” label confronts – rather than denies – the depersonalizing reality of addiction. I could make a pretty good argument that the condition of addiction IS permanent unless chronic drug use stops, and that I’d be foolish to think words or a change of words provide any defense against the crippling, soul-thieving power of heroin.

Really, I could make the argument. Or I could sit back and let heroin make it for me.

What Is “People-First” Language?

The Americans With Disabilities Act (ADA) of 1990 launched an era of awareness, advocacy, and accessibility that led to the concept and practice of people-first language – language that highlights and respects the worth and dignity of all persons, rather than prioritizing our focus on a disability at the expense of our awareness of the person.

In the context of addiction as disease, according to the professional journal Substance Abuse:

People-first language literally puts the words referring to the individual before words describing his/her behaviors or conditions. This practice helps highlight the fact that an individual’s condition, illness, or behavior is ‘only one aspect of who the person is, not the defining characteristic.’

But, for me, if I’m living in reality, I have to see that addicts literally put drugs before people, and that the practice of putting drugs before people highlights the fact that addiction IS the defining characteristic of the active addict.

The Substance Abuse editorial goes on to explain that:

In the realm of addiction, terms such as “alcoholics,” “addicts,” “users”…. linguistically erase individual differences in experience.

Here’s where I struggle: is it even possible to linguistically erase individual differences in experience when heroin has already robbed addicts of all individuality? Opioids send the addict into a la-la land of generic oblivion and then into a generic cycle of withdrawal and drug seeking where drugs are first and the people who love addicts don’t even make the cut. Isn’t active addiction pretty much characterized by a complete lack of any unique or individual experience, goal, talent, or relationship?

To be fair, the Substance Abuse editorial, titled “Confronting Inadvertent Stigma and Pejorative Language in Addiction Scholarship: A Recognition and Response,” is directed at researchers, health care professionals, and scientists in the field of addiction medicine rather than at the families and individuals who struggle every day to love an addict, to get a good night’s sleep, to breathe, and to hold onto hope while simultaneously holding on to wallets.

And the journal isn’t alone in calling for people first language. From a wide variety of agencies and experts, a sampling of the “preferred” terminology:

Person in active addiction
Person with a substance misuse disorder
Person experiencing an alcohol/drug problem
Individual with addictive disorder
Person with AOD (alcohol and other drug) problems
Person who uses drugs (PWUD)
Person with alcohol dependence syndrome
Person with substance induced disorder

What Are Compassion-first Eyes?

I’m sure the encouraged shift in language is intended to sway professional and public opinion away from language that reinforces moralistic judgment rooted in ignorance and prejudice and move it toward avenues of discussion and advocacy, all for the benefit of recovery from addiction and alcoholism. I’m sure the mindfulness toward language isn’t meant to level another hammer of criticism or fault toward families already suffering the heartache of addiction. But, really, sensitivity and empathy and compassion don’t originate along the linguistic pathway from head to tongue; authentic recognition of humanity is born in the heart and revealed in the eyes.

The readership of professional journals such as Substance Abuse are likely concerned with the primary costs and policies associated with the huge public health crisis brought on by inappropriate opioid use. But secondary consequences manifested in the families of persons with substance induced disorders – the financial strain, the insomnia, the stress, the lost wages and employee absenteeism, the hypertension, the depression, the anxiety, the fatigue – create an exponentially greater public health crisis concern.

When the mother of an addict reaches out to any social or healthcare professional – when she lets her shoulders droop, lets the tears well, confesses to the chronic headaches and inflamed joints and terrifying impotence of her love – she doesn’t need people-first language. She needs you not to look away.

Get it right in the eyes and it won’t matter so much what words follow.