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Language of addiction itself can hurt, advocates say

Windia Rodriguez remembers the sting of the words hurled at her during a hospital stay a few years ago. “Crackhead.’’ “Addict.’’ Especially, she recalls the scorn in the voices that pronounced her “just an addict.”

“They treated me like I was beyond hope,” Rodriguez said.

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But she found hope, and these days, free of drugs for four years, Rodriguez makes a point of adding two words to the standard salutation in her 12-step group. “I’m an addict,” she says, “in recovery.”

In so doing, Rodriguez, a Boston resident and regional coordinator for the Massachusetts Organization for Addiction Recovery, quietly adds her voice to those of researchers and advocates who want to rewrite the lexicon of addiction.

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These advocates seek to excise language that blames or disparages the patient and replace it with medical terms free of judgment. They assert that commonly used words — “junkie,” “abuser,” even “substance abuse” and “addict” — can discourage people from seeking help, induce health professionals to treat patients harshly, and exacerbate the stigma that bedevils people suffering from drug addiction.

“The biggest thing we trade in is hope,” said Dr. Barbara Herbert, Massachusetts chapter president of the American Society of Addiction Medicine, a confederation of doctors and other medical workers. “Our biggest enemy is hopelessness. That’s why I think language matters a lot.”

Those rebelling against common expressions follow in the footsteps of earlier activists who banished such terms as “cripple,” “mental retardation,” and “insane asylum.” But they face special challenges with addiction. Attitudes are fierce and entrenched, and agreement is lacking on which words are most harmful and which substitutes most apt.

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It doesn’t help that the reviled terms “substance abuse” and “drug abuse” are embedded in the well-recognized titles of government agencies, nonprofits, and scientific journals. Or that a phrase such as “person with a substance use disorder” — often suggested as an alternative to “addict” or “drug abuser” — is both cumbersome and vague.

Michael Botticelli, director of the Office of National Drug Control Policy, has been working to standardize federal communication about addiction and eliminate pejorative terms. “For a long time, we’ve known that language plays a huge role in how we think about people and how people think about themselves,” said Botticelli, adding that he raises the language issue in just about every talk he gives. “Words have to change so attitudes change.”

The words targeted by Botticelli and others run the gamut from obvious insults, such as “junkie,” to common expressions that many might not consider derogatory or that are often used by people in recovery.

To call addiction a “habit” is inaccurate, likening a life-destroying compulsion to nail biting. To say people are “clean” when not taking drugs implies they’re dirty when using. A “dirty urine” — a sample with evidence of drug use — carries the same implication. “I can’t think of a more telling example of judgmental terminology,” said Botticelli, former chief of Massachusetts’ Bureau of Substance Abuse Services. “We don’t say for a diabetic whose blood sugar spikes that they have a ‘dirty blood su- gar.’ ”

But the words provoking the most contention are “addict,” because the word labels a person as a health condition, and “abuse” and “abusers,” because, some specialists say, these words affix blame on the sick and evoke some of the worst crimes, such as child abuse.

Dr. Kevin P. Hill, an addiction psychiatrist at McLean Hospital in Belmont, is especially disturbed by “addict” because it defines people by their illness.

“This person is much more than one illness,” he said.

‘Words have to change so attitudes change.’

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Others can live with “addict” but reject “abuse.”

John F. Kelly, director of the Recovery Research Institute at Massachusetts General Hospital, has been beating the drum against the words “abuse” and “abuser” for more than a decade.

In a 2009 study, Kelly asked 516 health care workers at a conference to read a paragraph about a man who was having difficulty complying with a court-ordered addiction-treatment program. Half received a paragraph describing the patient as a “substance abuser”; the other half read a paragraph describing the man as “having a substance use disorder.”

When asked questions about the treatment he should receive, those who thought of him as a “substance abuser” were much more likely to blame him for his difficulties and recommend punishment.

“This is one of the reasons people don’t seek treatment,” Kelly said. “Rather than seeing themselves as sick, they think they’re bad people. They feel ashamed and embarrassed.”

Last year, Kelly and Dr. Richard Saitz of Boston University School of Medicine traveled to Budapest for a meeting of the International Society of Addiction Journal Editors and persuaded the group to stop using the words “abuse” and “abusers” (except in the titles of the journals themselves).

Two less specialized and more prominent medical journals, the New England Journal of Medicine and the Journal of the American Medical Association, said they don’t have explicit policies on the words used in articles about addiction. But both said they avoid the word “addict” because it labels people.

Among major media outlets, The New York Times, the Associated Press, The Boston Globe, and National Public Radio said they had not been asked to change addiction terminology, had not discussed doing so, and have no policies addressing the issue.

What about federal agencies? The Substance Abuse and Mental Health Services Administration. The National Institute on Drug Abuse. The National Institute on Alcohol Abuse and Alcoholism. Any name changes would require an act of Congress.

Dr. Nora D. Volkow, director of the drug abuse agency, tried that more than a decade ago, proposing “the National Institute on Diseases of Addiction.” When that effort failed, Volkow moved on and today has more urgent priorities, she said.

Also, she doesn’t object to the word “abuse,” finding it useful in distinguishing a severe disorder from milder conditions. Volkow said she agrees with efforts to avoid derogatory terms but urges precision and clarity in choosing replacements.

Otherwise, she said, “you end up in a world of grayness, where it’s very, very difficult to communicate.”

The Substance Abuse and Mental Health Services Administration is working on a project that might help, said chief of staff Tom Coderre. The agency has teamed with the National Academies of Science to study which words promote stigma and which alternatives hold meaning for the public.

“If we want more people to seek treatment and we want public policy makers to make treatment available,” Coderre said, “changing the lexicon is going to be really important.”

Felice J. Freyer can be reached at felice.freyer@globe.com.
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