How to Write About Addiction

By Dorri Olds 11/09/16

When the National Press Foundation suggested journalists use 'person with alcohol or drug use disorder' instead of 'addict,' my first thought was ‘Oh, puh-lease.’

A keychain with the word ADDICT written on it.
It's not just about political correctness.

Should language about addiction be chosen carefully? The National Press Foundation thinks so. NPF even provides guidelines on how to write about addiction without stigmatizing and further marginalizing this community. Their goal: “Making Good Journalists Better.”

NPF wants writers to avoid using certain words—including addict, alcoholic and abuse—and replace them with less stigmatizing options like person with alcohol or drug use disorder. And instead of saying dependence, journalists can write heavy use.

My first thought was "Oh, puh-lease." Isn’t that just picayune semantics and annoying political correctness? But then I clicked on the page’s video tab. Speaking on the topic, Dr. Richard Saitz, a Boston University professor and senior editor of the Journal of Addiction Medicine, comes across as compassionate while explaining how and why words really do matter. His points were intriguing, so I reached out to interview him for The Fix.

“What about AA’s practice of admitting you are powerless over alcohol or drugs?” I asked. In AA, the words addict and alcoholic are used to acknowledge defeat, accept help, and commit to living sober.

Saitz said, “If anybody feels that it helps to say, ‘Hi, my name is Rich and I’m an alcoholic,’ more power to them. If it helps them be part of a fellowship that gives them a social network and they get benefit out of it, I have no problem at all with that. But maybe 20 or 30 years from now, people who suffer from alcohol use disorder or drug use disorder will do what cancer survivors do—use the words for their condition. You don’t say, ‘Hi, I’m cancer.’”

He suggested that in a few decades, AA language may change to: “Hi, I’m Jim and I suffer from alcoholism.”

“I would guess,” he speculated, “that people in AA may feel less good about themselves and more ‘other’ by calling themselves an alcoholic or an addict. They may feel they’re different from other people by internalizing the idea that their being is infused by being an addict or an alcoholic. And I’m not sure that’s so great.”

According to Saitz, doctors are now thinking more about their word choices. “Doctors used to say, ‘Can you bring this medicine to the asthmatic in bed 7?’” he said. “But it’s not 'the asthmatic,' it’s somebody’s grandmother or child or friend.”

As for the word abuse, Saitz, who’s on the board of ISAJE (International Society of Addiction Journal Editors), said, “A year ago we asked scientists and journal editors to avoid that word. That seemed easiest to change and we had the most agreement about avoiding it. However, many state agencies have abuse in their name.” He pointed out that would require legislative acts to change.

I sought out more experts on addiction including The Recovery Book authors Al J. Mooney, MD, and Catherine Dold. “I’m not in recovery myself,” said Dold. “I am a health writer. When I read The Big Book [of Alcoholics Anonymous], I thought, ‘This language is really old.’ I’ve written about cancer. You don’t refer to somebody as a cancer victim. You call them someone who has a cancer diagnosis. Many advocacy groups have media guides, and say, ‘This is how we prefer to be referred to.’ A lot of groups think it’s definitely time to change the addiction language.”

About word choices, Dold said, “Shaming doesn’t help. In The Recovery Book, we do use the word addict. And substance abuser maybe twice. But we don’t refer to people as junkies. The whole dirty testing, and being clean versus dirty. That’s just stigmatizing.”

However, Dold said, “Writing ‘a person with substance use disorder’ is very clunky. You can use that once or twice, but not every time because you’ll just lose your readers.”

Dr. Mooney talked about his background. “Growing up, alcohol and drugs were in charge of our family.” His father, John Mooney, was a physician who “drank at night and used pills during the day,” he said. “My mother did her best, but she took codeine for hangovers, tranquilizers for depression, and barbiturates to sleep.”

Mooney’s father was in and out of psychiatric hospitals, but things finally changed “for the better,” he said, “when my father was sent to prison for six months for writing his own phony prescriptions.”

While incarcerated, an AA member visited him, and that, Mooney said, led his dad to a life of sobriety and helping other alcoholics.

Mooney said, “Before the AMA declared addiction a disease in, I think, 1957, it was looked at as a moral issue. Medicine came up with the terminology alcohol abuse. Even as a kid starting out with my career I said, ‘Why would we say that? This is an illness.’

“So, the AMA called it an illness and in AA, the alcoholic illness was what people identified with. Through DSM [The Diagnostic and Statistical Manual, the so-called 'bible' of mental disorders], 'the abuse dependent' has been part of medical language for 50 years. The DSM-5 [published in 2013] talked about ‘substance abuse disorders,’ which is more in-line with the disease concept than it’s ever been. But when my dad got out of prison, and my mom and dad began working with alcoholics and addicts in the 50s, it’s never been anything but an illness where people need lifelong help for their disability. Some people with clout are beginning to say things that should have been said a long time ago, like, it’s a chronic disease. I’m glad that’s finally being said.”

Regarding the AA language, Mooney said, “When we are a victim of something, it leaves us in a powerless role. The first step of AA talks about, ‘We’re powerless over alcohol and our lives have become unmanageable.’ It’s a starting point of an identity of surrender and defeat. The real wonderful thing about AA is that people move into a life of empowerment based on that knowledge and acceptance of where the problem is. The first step is: basically, there’s a problem and it’s me. Second step: there’s a solution and it’s not me. Third step: I can put the problem and solution together and have a life.”

What are all of the words he’d like to see change? “I don’t have the money or the power to fight battles of terminology,” said Mooney. “According to the World Health Organization, somebody dies from alcohol every 10 seconds; 180 people are dead now from when you and I started talking. There’s urgency in getting the message of recovery out there. To get involved in debates of politically correct language is something that I’m not interested in doing.”

Dr. Suzette Glasner, a psychotherapist, behavioral scientist, and the author of The Addiction Recovery Skills Workbook told me, “In the context of AA, where people suffering from addictions go to explore, make sense of, and recover from their problems with alcohol, it may make sense for them to focus on the aspect of their identity that has to do with excessive alcohol use.

“In a room full of other people whose lives have been adversely affected by alcohol use, to refer to oneself as an alcoholic or addict may provide some comfort, because it is a term that describes a problem that unites each person with everyone around them, and it provides a term to describe what it is that they are all suffering from, and a reminder that they are not alone. If a person is comfortable calling themselves an alcoholic or addict, and doesn’t feel disempowered by using that term, that says something about the appropriateness of the term for the individual.”

However, she pointed out that not everyone who suffers from addiction subscribes to AA. “There are those that don’t identify with feeling comforted by the term addict or alcoholic to describe what they’re suffering from. For society at large to label them as abusers or addicts could be quite stigmatizing, suggesting to some people that they are defined by their alcohol or other substance-related behaviors. Surely they have other qualities—an addict can be a parent or an engineer, an artist, a loving husband or wife, who happens to struggle with addiction. An addict can be caught in a downward spiral, struggling to find the motivation to do something to pull themselves out of a vicious cycle, or an addict can be working hard every day to achieve or sustain recovery. The use of that word alone doesn’t tell you much, so for some, it can feel very stigmatizing or demoralizing to be labeled that way.”

Lastly, I spoke with Dr. Russell Surasky, whose website says he is the only physician in New York who is double board certified in neurology and addiction medicine. He said, “The term addict has overwhelmingly negative connotations to most people and the negativity of that word labels someone as being less than. I think that far outweighs any benefits for writers that might think, ‘It’s easier to describe somebody as an addict, junkie or abuser.’ For someone who’s suffering from an addiction, it dehumanizes them.”

He continued, “Worse than the stigma is that the term addict takes away the rest of the person’s identity. You wouldn’t say, ‘My best friend, the epileptic,’ or ‘My best friend, the leukemia.’ You’re taking someone’s difficult challenge and making it their entire identity. That’s why language is important. They are persons first and this challenge is just one factor of their life.”

Surasky quoted Meghan Ralston’s article, “The End of the Addict.” She wrote, “I may be in the fight of my life with drugs but I am not the drugs that I take. I am a fighter, a survivor, I am never merely an addict. Please do not destroy the totality of who I am by reducing me to that one word.”

Regarding AA, Surasky said, “It’s a bit different within AA because the success in AA depends on one addicted person helping another. So the terms within AA’s walls, like addict or alcoholic, take on a different framework than in the general public, in popular media, or in popular culture. The language is different because it’s taught in a framework of the 12 steps where there are so many positives that I don’t think it’s as damaging.”

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Dorri Olds is an award-winning writer whose work has appeared in many publications including The New York Times, Marie Claire, Woman’s Day and several book anthologies. Find Dorri on Twitter, Facebook, and LinkedIn.