Surviving Opioids - Beyond an Epidemic

Words Matter : Reviewing the NIDA's new recommendations on language for SUD's.

• Jeff Simone • Season 1 • Episode 19

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Words matter.

There’s no question about that – they’re a big driving force of stigma, and it’s always a  heated debate when it comes to semantics with these touchy areas.

One of the many challenges is that while the healthcare guidelines move away from words like 'addict,' many popular 12-step fellowships have fully embedded that word into their culture, and a lot people choose to use it as a point of personal pride.

But despite of this, in recent years the culture has been shifting heavily against the use of that word. For example, most dictionaries have replaced all instances of addict used as a noun with “a person addicted to” or a “habitual user of.”

But why would a dictionary change a word that’s been around for centuries? The way we use language evolves—and so do dictionaries. And when it comes to words around addiction, there’s been a lot of evolution in recent years.

Episode 19 discusses the National Institute of Drug Abuse (NIDA)'s recent updated guidelines on the language they recommend using and avoiding when talking about substance use disorders.

In this show I'll provide a review of the recommendations, personal perspectives on the topic of language, and of course some relatively unrelated tangents and personal stories that you've come to expect from these episodes :-)

If you enjoy the episode, leave a review, and share it with someone!

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Addict, alcoholic, drunk, junkie, abuser… these are all common words used to describe someone with a drug addiction, but words do matter so what affect are they having on the addiction community.Today’s episode is all about terms to use and terms to avoid when we’re talking about people with addictions.

 

Welcome to the Surviving Opioids – Beyond an Epidemic – Podcast – your one stop show for everything opioids, addiction, and recovery. I’m your host Jeff Simone. The purpose of this show is to hear from all different voices on the opioid crisis, and to give a perspective on certain topics that might be a little different than you’re used to hearing. 

It’s a show to remind you that although we’ve lost a lot of good people the past couple decades, we also do recover. Through establishing community, slowly changing our daily behaviors, addressing underlying conditions, and holding each other accountable, we can get better. 

Recovery, not merely temporary abstinence, is possible.

If you enjoy the episode, give it a rating, share it with someone, and keep the conversation going. Alright guys, enjoy the episode……

 

Alright so words matter, there’s no question about that – they’re a big driving force of stigma, and it’s always a pretty heated debate when it comes to semantics with these touchy areas. 

Also one of the issues is that as a culture we seem to have gotten very sensitive over a relatively short period of time so now one of the things we need to contend with is that since it seems like everyone is offended by everything all the time, a lot of us have become desensitized to sensitivity, if you will.

Okay, desensitizied to sensitivity/

So although as with a lot of things, I feel that the cultural pendulum may’ve swung too far in the other direction in certain respects, as it relates to behavioral health, and substance use disorders in particular, it has not.

And there are certain unique challenges within this niche of using non-stigmatizing language and those are some of the things I’m going to talk about here…

The biggest challenge, by far, without any close second, is not pop culture or differeces in the different generations or the educational system, nothing like that, it’s the fact that all of these words that current day medicine and healthcare are trying to move away from have been embraced and embedded within the most mainstream of recovery communities.

Whether you’ve attended a 12-step meeting or not, you know how their members qualify. Before speaking someone says “my name is so and so and im an addict” “or im an alcoholic.” Or “drug addict and alcoholic.”

And they don’t mean that theyre currently addicted, people with 20/30/40 years contiuous abstinence will still speak about it in the present tense because they have owned that label, and it means something to them.

And I’m not critiquing that either, most people within the groups who stay long enough to start getting better do eventually come to terms with it…. The problem is that we in those groups also have a habit of casting that word about in every day life and tossing it on other people loosely because we think that since we identify as that that it bestows upon us some inherent right to say it to other people.

It’s like the classic Seinfeld episode where Brian Cranston is Jerry’s dentist and he wants to make jokes about Jewish people, but he realizes that the only people who seem to be allowed to are other jewish people so he converts religions just to be able to make the jokes with impunity.

But no, just because you yourself have had a certain condition or experience, although it allows you to speak maybe more credibly from that lived experience, it doesn’t mean that you’re now immune to the rules that the rest of the people are expected to follow. 

There is no doubt in my mind that if there had been no 12-step groups, and they were just started today for the first time ever, all other things being considered the same, the tradition of beginning each share from now until the end of time with “I’m Jeff and I’m an addict” would not be in there.

I think its only there because of tradition, and even though we’ve convinced ourselves otherwise… and no the most important thing is that I never forget who I am and what I am, and I need to remind every day lest I forget and end up back where I was… that does sound nice and it’s a good way of justifying a behavior that we’re going to be doing anyway, but I do not believe that that is true.

It’s remained unchanged because in large part the groups have remained unchanged, not because there’s some special benefit to calling myself an addict for the rest of my life.

And this goes for family groups too. I actually stopped referring to myself as an addict before my wife did. She’s been exposed to al anon and they often refer to the person as “the addict” and “addict behavior” and so long after I stopped making those jokes about myself out loud, she’d still do it….whatever it was, say I wasn’t doing something with the kids that she thought I should be doing, she might say “typical selfish / self-centered addict.” 

And I’d been abstinent for a couple years at this point, fighting for my life to do it by the way, so although it might not have been said necessarily to hurt me, although it probably wasn’t being used as joke, I still had to finally say, “I know some people use that language forever and it’s kind of cute or funny or something, but that doesn’t make me feel good when you say that.”

…..And I think that ended it… maybe she snuck one or two more in just for good measure, I don’t remember, but the point is that since those words can be very common place and used so casually in certain groups, if you don’t like it, sometimes it might be on you to actually say it.

Now, is there a clinical benefit to being able to address a problem and admit to needing help? Absolutely… It’s nearly impossible to end an addiction without first accepting the fact that you have one to begin with.

So being able to say “I AM ADDICTED.” Is HUGE and a major sign in the beginning that someone might be getting close to the desire and willingness to change, but that’s not the question.

The question is is thinking of myself as an addict, sometimes long after the behavior has been corrected.. is that helpful?.... And I’m not sure the answer to that.

I will say that personally, the words get stuck in my throat a lot more now than they did years ago when I was first introduced to the 12-step groups. Which is a little strange because usually the opposite happens – where people resist the word at first and then eventually say it and then have no problem continuing to say it.

In my case though the issue was a little different – the treatment center that I was court ordered to go to used to shuttle a van full of us to AA meetings at night…. And the rehab only had one van so when the non alcohol-addicted people (which was the majority) said things like “but Im not an alcoholic”, they would say “well its all one big spiritual disease. Just go and identify yourself as an alcoholic, and if you have trouble doing that, ask God for the courage to change until He lets you start saying it.”

That was basically the answer to all of my questions by the way. Any time that I tried to question anything, it was – Ask God for the willingness to change the way you’re thinking.

And I was sick and withdrawaling and in terrible shape, of course I didn’t have the strength or the resources to really fight back – plus I had a huge looming administrative court case over my head so I was just along for whatever these guys said…..

And I’ll be honest that word alcoholic has always sort of stuck in my throat. Not because of the stigma associated with it, but because it didn’t really apply to me. I haven’t been drunk since I was 22 years old, alcohol intoxication just wasn’t a feeling that I was after, I liked opiates and amphetamines and muscle relaxers, occasionally benzos to help sleep, for me alcohol kind of interfered with those feelings that I was after… 

So I’ll just be honest that it’s never felt quite right to envision spending the rest of my life identifying as an alcoholic when alcohol was never a thing… regardless of whether the word itself is stigmatizing or empowering, that’s neither here nor there with regard to what im talking about now.

And its an issue with opioids addictions. It is. A whole lot of people are first brought there by whoever, and forced to identify as an alcoholic, and its true that if youre in bad enough shape and desperate enough youll do whatever and say whatever, but I know plenty of people who never felt quite right about it.

Jen Elizabeth was on episode 2 and she got to a similar crossroads with the word and now identifies at meetings as “Hi my name is Jen and im a person in recovery.”

Now, you might say well good, that makes sense, it doesn’t matter what words we use, you can identify as whatever you want…

But youd only say that if you’ve never been part of a 12-step fellowship… there is a lot of pressure within the groups to completely fall in line with all of the groups rules and customs, and any variance is not looked upon as you being an individual and asserting what feels good to you or something, no, it is all your ego taking over and you’re still just doing things your way, and you’re still trying to be unique and special, and refusing to own that word just means you have reservations, and all kinds of stuff, and you cant argue because how does one argue against 30 people that are laughing at you and dismissing any challenge that you try to make.

So then of course one of three things happens – 1)  you leave, 2) you stay and never feel quite right about it or 3) you just own that word and start saying it yourself.

So I never used to talk about my feelings around that word, but when I did I started getting all kinds of people saying that they secretly felt the same way, so that’s why I can speak a little more comfortably now…. But it did take a while, because talking this way makes me vulnerable to the snickers and the gossip of the group, which doesn’t feel good of course, but I have come to a place where restraining how I feel about something feels worse than the temporary snickers… but again, took a while to get there.

But okay I want to talk a little bit about a new guidance that was put out by the NIH – National Institute of Health last month around addiction language.

When it comes to preferred language for talking about addictions, there are tips and suggestions for family and providers and just the general public to keep in mind around person-first language.

Which is the direction for a lot of conditions, not just addictions. It goes a long way to reduce stigmas… For example, “She’s a person on the autism spectrum , vs “that girl’s autistic.”

And look, this takes practice. You’ve probably been using the word addict as casually as you use any other word so working it out of your vocabulary is a process over time.

I’ve personally been tuned into this for a while so I actually don’t use the word addict very often anymore. Hardly ever. Junkie? I cant remember the last time I used that word.

And some of this stuff is a little hard to change just out of convenience sake… Especially when writing – like I write a lot for social media posts and blogs, and I’ll choose a few words for a headline on a social media video – and anyone who makes videos like that, you know that the whole name of the game is to deliver your message to quickly capture attention as concisely as possible – in other words in as few words as possible….

So the word addict” gets a message across quickly, whereas saying “a person suffering with substance use disorder” is a bit more of a mouthful.

So that’s a real thing too – and I don’t hear a lot of people talking about that.

Now its not a reason to keep using a word – convenience, im just saying it’s something that will come up most likely…..

But mostly we’re talking about reducing stigmas. That’s  the purpose for paying attention to our language.

A stigma is a form of discrimination against a specific group – in this case people with substance use disorders. And it has an effect – feeling stigmatized can reduce willingness to seek treatment, it can make other people feel pity for these folks, or maybe fear or anger towards them… a lot of times it makes people want to stay away all together, and maybe just gossip behind their back.

Stigmatizing language can absolutely negatively influence health care providers perceptions of people with SUDs and the care they provide.

I worked on the pharmacy bench for 10 years, talked with nurses, and doctors, and receptionists all day long, if you don’t think the stigma towards addicted people is alive and well within the healthcare world, you would be sorely mistaken…

So when were talking about changing stigmatized behavior, we need to consider using language that reflects an accurate, science-based understanding of the condition that’s consistent with our role – particularly if im talking here to other professionals. 

Now myself, for example, if you hear me talk, you’ll notice that the type of language that I use, even just the way I talk seems to change in different contexts, and that is because I have developed a clinical intuition over the years by working with thousands of people in all different situations, and I understand that everyone to one degree or another speaks a slightly different language, and for me to be as impactful as I’d like to be, I always consider my audience.. and its mostly automatic at this point.

Now this doesn’t mean I’m being a different person, no Im the same person, but my approach naturally shifts a bit in different circumstances.

So even that being said, certain types of language should universally be considered.

It’s true that often times a treatment center worker or therapist of some stripe might be the first point of contact for a person with SUD, but it’s also true that anyone in the social media space who begins to develop a bit of a following sees how often some of their material gets viewed and shared.

And a lot of times, a family member might see something, resonate with it, think that it would be good for their son or daughter, or cousing, or co-worker or someone to see and then share your account with them.

And I’m aware of this. So with that in mind, to the best of my ability, even just online I try to take the steps necessary to reduce the potential for stigma and negative bias.

Am I perfect with it? Of course not. Anyone who does a lot of unscripted talking – so stuff like this, going live on social media, guesting on a podcast, you don’t have the benefit of all the editing and carefully pre-planned words and a lot of times the words just come out.

Like it’s way safer to write than it is to speak. Writing is great and can be really cathartic and helpful in a lot of ways but speaking on camera, or on a recorded mic…  that’s scary. It’s scary because you’re vulnerable. And we’re in a dangerous cancel culture type of atmosphere where people get resentful sometimes or jealous and maybe scanning over your words with a fine toothed comb, or if you develop an enemy and you’re a big enough name, now there are teams of people pouring over your every word looking for a “gotcha” moment.

I’m pretty sure this is why most people don’t do stuff like this… Because you’re too unprotected.

But it needs to be talked about, and I’m in the fortunate position where I’m no longer under the lock and key of a major corporation so I don’t have to worry about my words reflecting back on them…. My words are just my words, if you like it, you keep listening, if you don’t, you tune out… But most people are not so situated. 

Also, I have come to an incredible place after many, many years to realize that people are going to dislike me whether I keep quiet or not… so…. I  may as well speak… Which is such a nice place to be by the way, and I sleep so well these days…

But the point is that you want to use person-first language and then let the individuals themselves choose how they’re described. It maintains the integrity of the person as a whole human being – by removing language that might permanently associate someone with a certain condition.

Now, if someone likes the word addict and refers to themselves that way, should you encourage them not to say that anymore? No, of course not. Like I mentioned earlier, a lot of that comes from the 12-step fellowships where people are taught to own that label like a badge of honor so I’m not here to suggest to anyone otherwise.

We just don’t need to be forcing the label on to someone else either.

As far as the term “substance use disorder” that is a catch all for all drug addictions, including alcohol. When you want to specifcy you can say alcohol use disorder, opioid use disorder, but substance use disorder describes all of them… and then from there we can use severity specifiers based on criteria – mild/  moderate / severe… 

That makes it helpful too as far as knowing how to refer out. 

And it’s significant for someone like me too, a coaching service can provide unique value to a given situation, and compliment a particular treatment approach, but the severity and stage of the condition would matter – 

someone with a moderate/severe SUD who just completed an inpatient stay, is enrolled in an outpatient setting and then reaches out for private coaching is in a stable place… a person with a mild AUD who is not ready or willing to accept inpatient care who’s maybe seeing a family therapist and then also reaches out for private coaching is in a relatively stable place… 

Now a person with an actively severe alcohol use disorder who reaches out for coaching is not by definition stable, and this person needs to be encouraged to seek more intensive treatment as soon as possible. 

So the severity markers are not stigma-inducing, they’re clinically relevant and helpful….

Okay, so that being said, some of the words we don’t really use anymore: addict, abuser, junkie, alcoholic, drunk, felon even…. We say person with sud, person with oud / aud, patient, client, person in recovery, person in longterm recovery, that sort of thing.

The idea is that the change in wording shows that the person has a problem rather than the person is a problem.

When the National Institute of Drug Abuse put out there updated guidelines, they also suggested not using the word “habit” to describe a physical dependency. They say the word undermines the seriousness of the disease – that it inaccurately implies that a peson is choosing to use substances therefore they should be able to choose to stop.

Abuse is another word we’re moving away from… If we’re talking in the context of illicit drugs, it should be “use” or “user” – so she’s a user of heroin… 

Or for prescription medication it should be misuse… “He’s misusing his percoccet prescription.”

And that was because they ran a study that showed “abuse” to have a high association with negative judgements and punishments.

The words ‘clean’ and ‘dirty’ really shouldn’t be used to describe a person. Again, it’s tough when theres a huge fellowship of people who talk about “clean time” and being “clean and sober” its just not the direction we’re moving in.

But we don’t talk about other conditions that way, if someone has heart disease and we tell them to limit salt and saturated fats, then their blood work shows high levels of triglycerides, we don’t say that they “tested dirty” 

so again… (slow) its all about reframing the way we talk which eventually reframes the way we think and the way we treat one another……

Alright I think that’s enough, I went a little longer than I wanted to with a few tangents but for the most part I stayed on topic.

To summarize, words matter, they’ve always mattered, we’re becoming more aware of it now, the NIH has sponsored studies that prove that words matter and impact how someone feels about themselves which in turn determines the likelihood that they’ll eventually go on to seek treatment and hopefuly eventually fully recover from their condition.

So its important.

Alright guys, if you found this helpful, leave a review, send it to someone. Reach out on social media, @reactionrecovery, keep the conversation going.

Bye for now.