When we stigmatize addiction, no one wins.
When I was newly sober, I told a friend (who lived across the country and admittedly hadn’t seen the worst of my drinking) that I was no longer drinking alcohol.
“Yeah, but you can still have a glass of wine every now and then, right?” she replied. “It’s not like you’re an addict.”
After a little more discussion, it became clear that her conception of an “addict” was not someone like me: a person in her early 20s who had graduated college, gotten a good job, and appeared to be holding her life together.
Although that perception was very far from my reality, there are plenty of people who struggle with substance use disorders and addiction who don’t fit the stereotype of the “town drunk,” who wanders the streets with a plastic gallon jug of cheap vodka before passing out somewhere obvious and inappropriate.
One of the reasons that’s become the stereotypical picture of addiction is because of how, societally, we’ve talked about addiction for so long.
How we talk about addiction and substance use matters.
It affects our understanding of these conditions and how we view people who have them.
Language like “junkies” and “drunks” not only connotes a certain type of extreme that’s not true for everyone who has a substance use disorder, but it’s also stigmatizing.
This is why, in 2017, the Associated Press recommended eliminating certain words on this subject and replacing them with more accurate, less stigmatizing ones.
Among the less discussed but equally important changes concerns the use of the word “clean.”
This is one you’ll often hear people in recovery use about themselves (“Before I got clean,” someone might say in a recovery meeting), or about someone else (“My friend has been clean for 5 years”).
It may seem like a harmless word choice; if a positive drug test is “dirty” and a negative drug test is “clean,” why can’t the same be true of someone using drugs? (Side note: It’s also not great to refer to drug tests as dirty or clean. Let’s stick to positive or negative, shall we?)
While many people who use the word “clean” in this context wouldn’t necessarily refer to a drug user as dirty, that’s inherently the implication.
And using the word “dirty” has hugely stigmatizing effects, especially in a medical context.
This has been especially damaging when it comes to women and sexually transmitted infections (STIs). Calling a woman who has an STI “dirty” is akin to slut-shaming, labeling someone as “less than” because of their sex life.
But my main beef with the word “clean,” especially in recovery circles, is that it implies a kind of purity test for sobriety.
In other words, for someone to be sober, their blood must be free of any drug that one could misuse.
But that’s an unrealistic standard many in recovery (myself included) are doomed to fail.
What might be a medically necessary anti-anxiety pill for one person in recovery could be a drug that’s routinely misused by another. Medication that’s critical for people with ADHD to function could be the same thing that lands a different person back in rehab.
Many of us in recovery rely on medication to keep us sober. If you have debilitating anxiety but can’t take an anti-anxiety pill, alcohol (or another drug) is even more appealing.
Too often, however, people in recovery feel that they have to meet the “clean” purity test. All that does, however, is exclude people from recovery spaces and make people feel ashamed for taking what can be life-saving medications.
Substance use disorders don’t manifest in everyone identically, so many of the terms we use are necessarily subjective.
But words like “clean” (and most definitely “dirty”) don’t leave room for nuance.
Not to mention, they’re stigmatizing to boot.
I firmly believe that, when speaking about someone else, people should stick to the Associated Press’ guidelines 100 percent of the time. I get a little more conflicted when folks want to refer to themselves by these terms.
In general, I’m a pretty strong advocate of people being able to call themselves whatever they feel is most appropriate.
For example, I call myself an alcoholic all the time because a) I know I am one and b) it’s a personal reminder to myself that there’s no wiggle room for me when it comes to alcohol.
It wasn’t something I misused for a time. It’s a substance to which I was completely and totally addicted.
So, if you’re in recovery and calling yourself clean is an important part of your recovery, go for it.
But if it’s not — and it’s just a useful shortcut — consider an alternative.
Sober, drug-free, substance-free, and abstinent all come to mind as words that might be appropriate replacements, none of which carry stigmatizing connotations.
And please, please don’t use it in reference to someone else. Instead, stick to neutral alternatives unless they tell you otherwise.
Words really do matter. And in a community that already battles shame, judgment, and even hostility, it’s all the more important that we do what we can to break down stigma once and for all.
If you’re interested in nonstigmatizing substance use language and/or the revised Associated Press guidelines, check out the links below:
- The Words We Use Matter: Reducing Stigma Through Language from the National Alliance of Advocates for Buprenorphine Treatment
- Paying Attention to Word Choice When Writing About Addiction from Nieman Reports
- The AP Learns to Talk About Addiction. Will Other Media Follow? from Undark
Katie MacBride is a freelance writer and the associate editor for Anxy Magazine. You can find her work in Rolling Stone and the Daily Beast, among other outlets. She spent most of last year working on a documentary about the pediatric use medical cannabis. She currently spends far too much time on Twitter, where you can follow her at @msmacb.