NOTE: The information here is presented in the context of opioid dependence, but applies to the treatment of any substance use disorder.

Until fairly recently, opioid dependence was seen as a character flaw—the result of a selfish, undisciplined nature. Now, with the understanding that dependence is a medical condition, new language is being encouraged to change the negativity and stigma associated with this disease.

The Center for Substance Abuse and Treatment (CSAT) has created a guide to raise awareness among medical professionals of the damaging impact some words can have on patients. For example, doctors would not call a diabetic patient "clean" when his or her blood sugar level was normal, or refer to someone with high cholesterol as a "user" because she or he continued to eat foods high in fat. But in our culture it is common to call dependent people "abusers" and to refer to their urine as "clean" or "dirty." Using demeaning words to describe people affected with opioid dependence undermines their self-esteem and can discourage them from seeking the medical attention they need to manage their condition.

The CSAT guide provides alternative words to use, with medical meanings that accurately portray substance abuse as a medical condition that needs to be discussed in medical terms. Changing the language used to discuss opioid dependence helps decrease the stigma of the disease, increase its acceptance as a medical condition, and provide a framework within which society can begin to change its negative beliefs about dependence.

This type of change has been taking place over the past 3 decades with regard to depression, which for years was viewed as a sign of weakness. As knowledge about the biological roots of depression grew, the medical community became more accepting of it, new treatments were developed, and people experiencing depression became more comfortable about seeking help. The same shift may occur as people learn about and accept the biologic roots of opioid dependence. As a friend or family member of or a person with dependence, you can be a part of changing the language of dependence by changing the way you think and talk about it.

The following is adapted from the 2004 CSAT language guide. Click here to view the document in its entirety.

Words That Work 
Words to Avoid

Words That Work¹

Addictive disorder/addictive disease—Reinforces the medical nature of the condition.

Alcohol and drug disease—Clearly defines the condition as a health issue.

Dependence—Communicates a distinct clinical diagnosis. The words "addiction" and "addict" are often seen as stigmatizing and demeaning to the person.

Disease management—Pertains to the medical concepts of suppressing symptoms and providing the appropriate level of intervention.

Medication-assisted recovery—A practical, accurate, and nonstigmatizing way to describe the path of recovery facilitated by medically monitored pharmacological agents.

Patient—Accurately refers to a person under care for a substance use disorder, reinforcing the fact that such disorders signify a health issue.

Recovery—Reflects a paradigm shift from the focus of pathology to one of resiliency.

Recovery management—Reinforces that substance use disorders are illnesses that can be treated and managed, and from which people recover similar to other chronic diseases—placing the focus on the individual rather than on the efficiency of costs and services.

Recovery process—Conveys that recovery happens over time as patients increase their awareness of and ability to manage their behavior.

Misuse—Offers the same intended meaning as abuse but without the stigma and judgmental overtone. NOTE: The 2004 CSAT language guide departs from the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in that the guide suggests using the term misuse instead of abuse as a clinical diagnosis because it is less stigmatizing.

Substance dependence—Suggests that the person continues to use a substance despite a cluster of cognitive, behavioral, and psychologic symptoms.

Substance use disorder—Encompasses a range of severity levels, from problem use to dependence and addiction.

Treatment—Communicates the use of a planned, intentional intervention in the health, behavior, and personal, or family life of the patient.

Words to Avoid¹

Abuse—Negates that substance use disorders are a medical condition, places blame on the patient, absolves those contributing to the problem (eg, dealers), and perpetuates stigma.

Abuser, addict, alcoholic—Demeaning terms that make no distinction between the person and the disease and imply that the condition is permanent.

Clean, dirty (when referring to drug test results)—Demeaning to patients because terms associate illness symptoms with filth, not a medical condition.

Drug problem—Places blame fully on the patient, isolates the condition from other aspects of the patient's health and life.

Habit or drug habit—Denies the medical nature of the condition.

User—Labels the person by his or her behavior.