Will Changing the Language of Addiction Help?

Michael Botticelli, in his term as director of the White House Office of National Drug Control Policy (ONDCP), has been a powerful example of recovery in action, especially by moving the needle of public perception of substance use disorders (SUDs) to being understood as the brain disease it is versus a personal or moral failing. He has had a substantial impact on previously skeptical legislators, corporate leaders, law enforcement, and faith communities, and also on average Americans who could also comprehend and begin to support treatment over incarceration as a major solution, halting the irrational filling of America’s prisons with sick people, not bad people. 

One of the last public documents released on Botticelli’s watch addressed the terminology related to alcoholism, drug addiction, substance abuse, and recommending, with clear rationale, changing the language to “substance use,” “substance misuse,” and “substance use disorders.” Botticelli’s “Changing the Language of Addiction” was developed through consultation with research, policy, provider, and consumer stakeholders, as well as federal agencies to assist the culture to use more accurate and less stigmatizing language that has developed over the years. 

These evolving language changes have been steadily sliding into our policy discussions, our scientific journals, and our treatment and education programs. For the most part they are being accepted and perfected, and can be expected to continue to foster the downslide of stigma which has often held people struggling with the disorder and their loved ones from seeking help. Witness the recovery movement that has grown in numbers and clarity of message and in giving back to help others. The increase in awareness about the nature of SUDs, from misuse to addiction, and the recognition that early interventions through such programs as the evidence-based Screening and Brief Intervention and Referral to Treatment (SBIRT) in the general medicine world work to halt the development of the disorder early in its process. Similarly, the student assistance programs in our schools, including the educational support programs for elementary-age children of parents with SUDs, played an SBIRT-type role in hundreds of school districts for nearly thirty years, saving thousands of young lives. Without student assistance or an effective preventive intervention, the young people who are most at risk for developing their parents’ disease will too often become the depressed adolescents and young adults with a SUD.

The growing awareness that words can seriously affect hurting individuals and families is steadily leading to positive changes in how our government, our criminal justice system, our schools, and our society in general respond to SUDs, including the current opioid/heroin epidemic. It is helping to change the language, and changing the language is helping to create a greater understanding that propels the recovery movement forward, with its thousands of volunteers staffing recovery centers, helping one struggling person and one concerned family at a time to grab the recovery railing and keep pulling up. Most of this is fueled by America’s leading and strongest advocacy and recovery community support organization, Faces and Voices of Recovery, with centers across the country impacting policy and programs across multiple federal agencies as well as supporting the growing recovery movement on the ground.

The role that Recovery Month has played for over twenty-five years in creating a nurturing platform and supporting a remarkable public and private partnership between SAMHSA and over two hundred planning partner organizations is an ongoing and remarkable collaborative that supports thousands of recovery awareness projects throughout the year and especially during September, when Recovery Month is observed. The changing language, initially brought to the country through Recovery Month, has been a powerful motivator for the new understanding that is saving lives and families in increasing numbers each year because it is destroying shame, reducing stigma, and freeing concerned family members and colleagues to take action. 

When we discuss adolescents and young adults with SUDs, too often the stigma is most felt by their parents and adolescent siblings. Driven by the denial that stigma fosters, parents disbelieve, cover, make excuses, cajole, and try to rescue and give one more chance to their grown children, feeding their denial in their compulsive efforts to control and protect them. Nonpejorative language that concerned and desperate parents can use to look objectively at their adolescent or young adult son or daughter and see that a toxic brain is driving attitude, demands, accusations, irresponsibility, and emotional and verbal abuse, and learn that there is an official medical name for it, is helpful language. 

When parents are up against a toxic brain, it is a strange thought that they are not the solution, but that they can slip into being part of the problem with well-intentioned and ineffective efforts. They keep expecting rational thinking and awareness, but the brain is hijacked. When parents themselves grew up with a parent or parents suffering from addiction, the past merges into the present and too often they behave as though they are solving an unresolved problem from the past in response to their child. This is a family disease—generational shame and stigma traps every member of the family. Without recovery, these well-intentioned parents continue the cycle of multigenerational disease and trauma. With gentler and more definitive language, denial can soften into seeing reality and accepting it. It can also free them to ask for help for the entire family. 

For younger children, however, such language is confusing and confounds their feelings of abandonment and fear. For children the concept of addiction—a disease of the brain that can be treated and from which parents can be rescued—can be readily understood, as can the behavior that it engenders. Imagine eight-year-old children in an educational support group where the topic of the day is the disease that is hurting a parent, where they are learning that a parent has a disease that stops them from loving their children and from giving them the support they need. The lesson calls for writing a letter to the disease, telling the disease how they hate it and want the disease to get away from their family, but the letter is to begin, “Dear Substance Use Disorder.”

Child development experts use the term “age-appropriate” for a reason. Let’s help the adults, young adults, and their parents use the language that will be medically correct and, at the same time, help diminish the stigma that has dogged both alcohol and drug addiction, and has paralyzed parents in helping “just one more time” rather than recognizing and arranging an appropriate and effective intervention to save their child’s life from a SUD. But let’s help their young children or siblings to understand and heal in language that works for them. For them, let’s keep it simple!

As government and the general community adjust to the new language, and as it becomes common knowledge over the ensuing years, we must remember to be sensitive to how individuals in recovery self-identify as we work for uniformity and simplicity to remove stigma as an obstacle to recovery for the whole family.