When it comes to addiction, using people-first language doesn’t always cross everyone’s mind. In fact, it hadn’t actually crossed mine until recently. Several years ago, many close friends experienced addiction and substance use disorders. Others in our extended friend group overdosed and died.
Before working at Healthline, I worked as a personal care assistant for a woman with disabilities throughout college. She taught me so much and brought me out of my able-bodied ignorance — teaching me how much words, no matter how seemingly small, can affect someone.
But somehow, even when my friends were going through addiction, empathy didn’t come so easily. Looking back, I’d been demanding, self-centered, and at times mean. This is what a typical conversation looked like:
“Are you shooting up? How much do you do? Why won’t you return my calls? I want to help you!”
“I can’t believe they’re using again. That’s it. I’m done.”
“Why do they gotta be such a junkie?”
At the time, I was having a hard time separating my emotions from the situation. I was scared and lashing out. Thankfully, a lot has changed since then. My friends stopped misusing substances and got the support they needed. No words can convey how proud I am of them.
But I hadn’t really thought about my language — and others’ — surrounding addiction until now. (And maybe getting out of your early 20s helps, too. Old age brings wisdom, right?) I cringe at my actions, realizing that I’d been mistaking my discomfort for wanting to help.
Many people frame well-intended conversations wrong, too. For example, when we say, “Why are you doing this?” we really mean, “Why are you doing this to me?”
This accusatory tone stigmatizes their use — demonizing it due to stereotypes, belittling the actual brain changes that make it difficult for them to stop. The overwhelming pressure we then place on them to get better for us actually debilitates the recovery process.
Maybe you have a loved one who had or is currently experiencing a substance or alcohol use disorder. Believe me, I know how hard it is: the sleepless nights, the confusion, the fear. It’s OK to feel those things — but it’s not OK to act on them without taking a step back and thinking about your words. These linguistic shifts may seem awkward at first, but their effect is enormous.
Dependence vs. addiction
It’s important not to confuse these two terms so we can fully understand and talk clearly to people with addictions.
|Dependence||The body becomes used to a drug and usually experiences withdrawal when the drug is stopped.||Withdrawal symptoms can be emotional, physical, or both, like irritability and nausea. For people withdrawing from heavy alcohol use, withdrawal symptoms can also be life-threatening.|
|Addiction||The compulsive use of a drug despite negative consequences. Many people with addiction are also dependent on the drug.||Negative consequences can include losing relationships and jobs, getting arrested, and doing harmful actions to get the drug.|
Many people may be dependent on a drug and not realize it. And it’s not just street drugs that can cause dependence and addiction. People prescribed pain medications can become dependent on the meds, even when they’re taking them precisely as told by their doctor. And it’s completely possible for this to eventually lead to addiction.
First, let’s establish that addiction is a medical problem
Addiction is a medical problem, says Dr. S. Alex Stalcup, medical director of New Leaf Treatment Center in Lafayette, California.
“All of our patients get an overdose kit on their first day. People thought it was creepy at first, but we give Epi-Pens to people with allergies and devices for people who are hypoglycemic. This medical device is for a medical disease,” he says. “It’s also another way of explicitly stating this is a disease.”
Since New Leaf started providing overdose kits, deaths have also been averted, says Dr. Stalcup. He explains that folks who carry these kits are really just dealing with major risk factors until they get better.
Abuser vs. user
Certain labels are charged with negative connotations. They reduce the person to a shell of their former self. Junkie, tweaker, drug addict, crackhead — using these words erase the human with a history and hopes, leaving behind a caricature of the drug and all the prejudices that come with it.
These words do nothing to support people who need help getting away from the addiction. In many cases, it only prevents them from getting it. Why would they want to make their situation known, when society judges them so harshly? Science backs up these prejudices in a 2010 study that described an imaginary patient as a “substance abuser” or “someone with a substance use disorder” to medical professionals.
Researchers found that even medical professionals were more likely to hold the individual to blame for their condition. They even recommended “punitive measures” when they were labeled as an “abuser.” But the imaginary patient with a “substance use disorder”? They didn’t receive as harsh of a judgment and would probably feel less “punished” for their actions.
Maintaining respect and dignity
But what about when people refer to themselves as a junkie? Or as an alcoholic, like when introducing yourself in AA meetings?
Just like when talking to people with disabilities or health conditions, it’s not our call to make.
“I’ve been called a junkie a thousand times. I can refer to myself as a junkie, but no one else is allowed to. I’m allowed to,” says Tori, a writer and former heroin user.
“People throw it around... it makes you sound like s***,” Tori continues. “It’s about your own self-worth,” she says. “There are words out there that hurt people — fat, ugly, junkie.”
Amy, an operations manager and former heroin user, had to balance burdensome cultural differences between her first-generation self and her parents. It was difficult, and still is to this day, for her parents to understand.
“In Chinese, there are no words for ‘drugs.’ It’s just the word poison. So, it literally means you’re poisoning yourself. When you have that harsh language, it does make something seem more severe,” she says.
“Connotations matter,” Amy continues. “You’re making them feel a certain way.”
“Language defines a subject,” says Dr. Stalcup. “There’s a huge stigma attached to it. It’s not like when you think of other conditions, like cancer or diabetes,” he says. “Close your eyes and call yourself a drug addict. You’ll get a barrage of negative visual images you can’t ignore,” he says.
“I feel strongly about this... A person is a person is a person,” Dr. Stalcup says.
Don’t say this: “She’s a junkie.”
Say this instead: “She has a substance use disorder.”
Clean vs. dirty
Arthur*, a former heroin user, also shared his thoughts on the language surrounding addiction. “I have more respect for dope fiends,” he says, explaining that it’s a hard road to travel and understand if you haven’t gone through it yourself.
He also alludes to racism in addiction language, too — that people of color are painted as addicted to “dirty” street drugs, versus white people dependent on “clean” prescription medications. “People say, ‘I’m not addicted, I’m dependent cause a doctor prescribed it,’” Arthur adds.
Perhaps it’s no coincidence that there’s growing awareness and empathy now, as more and more white populations are developing dependency and addictions.
Empathy needs to be given to everyone — no matter race, sexuality, income, or creed.
We should also aim to remove the terms “clean” and “dirty” altogether. These terms hold belittling moralistic notions that people with addictions were once not good enough — but now that they’re in recovery and “clean,” they’re “acceptable.” People with addictions aren’t “dirty” if they’re still using or if a drug test comes back positive for use. People shouldn’t have to describe themselves as “clean” to be considered human.
Don’t say this: “Are you clean?”
Say this instead: “How are you doing?”
Just like with the use of the term “junkie,” some people with use disorders may use the term “clean” to describe their sobriety and recovery. Again, it’s not up to us to label them and their experience.
One day at a time
“The reality is and will remain that people want to sweep this under the rug,” says Joe, a landscaper and former heroin user. “It’s not like it’s going to change overnight, in a week, or in a month,” he says.
But Joe also explains how quickly people can change, like his family did once he began treatment.
It may seem that after a person has overcome their substance use disorder, everything will be fine going forward. After all, they’re healthy now. What more could anyone want for a loved one? But the work doesn’t stop for the former user.
As they say in some circles, recovery takes a lifetime. Loved ones need to realize this is the case for many people. Loved ones need to know they themselves need to continue to work to maintain a more empathetic understanding, too.
“The aftermath of being a drug addict is sometimes the hardest part,” explains Tori. “To be honest, my parents still don’t understand... [Their language] was just really technical, medical language, or that I had a ‘disease,’ but to me, it was exhausting,” she says.
Dr. Stalcup agrees that the language families use is absolutely critical. While it’s wonderful to show an interest in your loved one’s recovery, he stresses that how you do it matters. Asking about their progress isn’t the same as if your loved one has diabetes, for example.
With addiction, it’s important to respect the person and their privacy. One way Dr. Stalcup checks in with his patients is asking them, “How’s your boredom? How’s your interest level?” He explains that boredom is a big factor in recovery. Checking in with specific questions catered to your friend’s interests will show you understand while making the person feel more comfortable and cared for.
Don’t say this: “Have any cravings lately?”
Say this instead: “What have you been up to, anything new? Wanna go on a hike this weekend?”
When I started working at Healthline, another friend began her recovery journey. She’s still in treatment, and I can’t wait to see her in the new year. After talking to her and attending a group meeting at her treatment center, I now know I’ve been dealing with addictions in a totally wrong way for years.
Now I know what I, and other people, can do better for their loved ones.
Uphold respect, compassion, and patience. Among the people I talked to about their addictions, the single biggest takeaway was the power of this sensitivity. I’d make the argument that this compassionate language is just as important as the medical treatment itself.
“Treat them how you’d want to be treated. Changing the language opens doors to different ways of behaving,” Dr. Stalcup says. “If we can change the language, it’s one of the fundamental things to lead toward acceptance.”
No matter who you’re talking to — whether to people with health conditions, people with disabilities, transgender people or nonbinary folks — people with addictions deserve the same decency and respect.
Language is what allows this compassion to thrive. Let’s work on breaking these oppressive chains and see what a compassionate world has in store — for all of us. Doing this will not only help us cope, but help our loved ones actually get the help they need.
The behaviors of a person with an active substance use disorder may make you not want to be compassionate. But without compassion and empathy, all we’re left with will be a world of hurt.
*Name has been changed at the request of the interviewee to preserve anonymity.
A very special thank you to my friends for giving me guidance and their time to answer some hard questions. Love you all. And very big thank you to Dr. Stalcup for his earnestness and dedication. — Sara Giusti, copy editor at Healthline.
Welcome to “How to Be Human,” a series on empathy and how to put people first. Differences shouldn’t be crutches, no matter what box society has drawn for us. Come learn about the power of words and celebrate people’s experiences, no matter their age, ethnicity, gender, or state of being. Let’s elevate our fellow humans through respect.