The Language of Recovery - Choosing Better Words

Exploring the stigma around addiction and substance use through the lens of a Recovery Coach. [updated March 2023]

As a Recovery Coach, I know firsthand the negative impact that stigmatizing language can have on those seeking to recover from addiction and substance use issues.

I've spent the last decade bearing witness to these impacts as my clients open up to me, sharing intimate details of the things they’ve kept hidden for years, and sometimes decades.

I see the deep shame on their faces, and hear the pain in their voices as they share their stories of addiction and substance use.

And I also see the relief they finally feel when they’re able to be honest, without judgment and blame.

I’m continually in awe of the healing that takes place when people are given a safe place to unpack and explore their issues – a refuge from the stigma around addiction.

From this perspective, I’ve come to be mindful about the language I choose to use. Not only do my words impact my clients directly, they also play a part in addressing (or perpetuating) the shame and stigma around addiction and substance use.

I have many ideas about why there is still so much shaming and labeling around addiction and substance use, but I always come back to a strongly held belief that most people genuinely want to help.

And for this reason, I think it’s helpful to continue promoting new perspectives and discussion in this area.

So let’s dive in and explore:

• Why words matter
• What stigma around addiction really means
• Ways to ensure your language is supportive

Words Impact Access to Care.

Being mindful about our words is about more than just being kind or “politically correct”.

Simply put, words matter because they can and do make it harder for people to get help.

It’s basic psychology.

When someone feels guilty or shameful for experiencing a problem they are less likely to bring it up with their GP or seek out support from friends and family.

And while there are a growing number of supportive communities, both online and in-person, there’s still a high prevalence of stigmatizing language being used.

According to the Canadian Centre on Substance Use and Addiction (CCSA):

• 1/10 Canadians experience substance use problems today.
• 8/10 Canadians with a substance use disorder say they experienced barriers to recovery, including stigma.
• Almost 50% of Canadians in recovery from a substance use disorder experience stigma when in active addiction.

So we have a growing number of people with substance use problems, with almost half reporting that they’ve experienced the stigma around addiction.

These numbers speak for themselves.

They speak to the reason I have clients show up scared to ask for help after keeping their struggles to themselves for years on end.

As humans we develop patterns and behaviors as survival mechanisms. And for many people suffering from addiction and substance use issues, they learn to keep their struggle hidden because they’ve come to subconsciously believe that their substance use makes them unloveable.

This shame runs so deep that even when they’re in a safe place, with someone like myself who’s been in their shoes before, it takes time to let the protective armor dissolve - to relearn how to be vulnerable.

This is the kind of cumulative power our words can have.

But, What Exactly is Stigma?

Stigma is when someone views you in a negative way because of a certain attribute like your skin color, religion, sexual identity, or in this case alcohol addiction or substance use.

It often emerges in the form of condescending language that shames and belittles a person.

When I look at topics such as body image and sexual identity, it’s clear we’ve made strides in the right direction, adopting more inclusive and supportive language. And sometimes I wonder if the field of addiction and substance use is falling behind on this front.

Perhaps the slower change within this field has to do with the fact that people still view substance disorders as a moral failure, which is a topic for another day, but let it suffice to say that there is ample evidence to paint a very different picture.

So, how does the stigma around addiction show up in our day-to-day lives?

The Obvious and the Not So Obvious.

One of the more obvious forms of stigma is the use of derogatory terms like “junkie”.

Maybe you can think of an example where you’ve heard something along these lines:

• “He’s just a harmless neighborhood drunk”
• “My dad used to be a total junkie, but he’s turned his life around”
• “I’m worried about my daughter hanging around those druggies”
• “Yeah, I drink most weekends but it’s not like I’m an alchie or something.”

Then you have the less obvious forms of stigma that you might not immediately recognize as hurtful, like unhelpful labels and words with negative connotations, like “dirty”.

As Sarah Wakeman, Medical Director of the Substance Use Disorders Initiative at Harvard-affiliated Massachusetts General Hospital (MGH), explains,

“A doctor would never tell a patient suffering from diabetes that their blood was dirty with glucose. We should ask, ‘Is this a term we would use for another medical condition?’ If the answer is ‘no,’ we shouldn’t use it.”

I love Wakeman’s suggestion because she gives us a simple litmus test. If you wouldn’t talk about a condition like diabetes or cancer or autoimmune disease in the same way, don’t do it with alcohol addiction and substance use issues.

Wakeman has written frequently on the topic, urging people to adopt “person-first” language.

Person-First Language.

Using person-first language starts with acknowledging that a person is much bigger than whatever condition, disorder, or experience they may be having at the time.

Person-first language doesn’t define a person based on their medical disorder. It’s nonjudgmental, neutral, and treats the diagnosis as purely clinical.

In a memo sent to the U.S. Executive Office of the President, which includes a wealth of scientific references supporting the use of person-first language, governmental agencies are encouraged to adopt the following terminology when discussing alcohol addiction and substance use.

Avoid	Use Instead
Addict	Person with substance use disorder
Alcoholic	Person with alcohol use disorder
Drug abuse	Drug misuse
Clean	Abstinent, not actively using
Dirty	Testing negative for substance use

Modern Recovery Doesn’t Require Labels.

Terms like “addict” and “alcoholic” may seem harmless, but labels usually aren’t helpful when it comes to supporting someone’s journey towards better health.

The truth is that addiction is so stigmatized in our society that we think there are only two types of people when it comes to drinking: Alcoholics and “Normal People”. And if you’re not in the first category, you should carry on drinking because you don’t have a “real problem”.

In this way labels keep people stuck. They rob people of their true potential and happiness, teaching them that things are “good enough” as long as they don’t qualify for a certain clinical diagnosis or societal category.

My advice with respect to labels falls in line with several other progressive programs of modern recovery such as Tempest, led by Holly Whitaker, and The Luckiest Club (TLC), led by Laura McKowen.

Labels are optional.

I remind clients that labels are something to be self-selected, not imposed on them by someone else. If it feels helpful for a client to identify as an alcoholic, that’s great. If they absolutely hate that word and never want to say it again, that’s also great!

Focus on What You Can Control.

Ultimately, we can’t control or change what others do or say. And the road to collective change can be long and winding, just like the path to recovery.

But we can control the words we choose to use when talking about alcohol addiction and substance use with friends and family, or online. And we can also choose to speak up when we bear witness to others using disempowering language.

Surprisingly, I am starting to become aware of how pervasive the stigma around addiction really is, even among professionals who are trying to help people recover. It’s not always easy to figure out how to best contribute, but I’m committed to staying engaged on this topic within my field.

Supportive Communities Temper the Stigma Around Addiction.

I’m always looking for ways to build community with like-minded people who are working to break down the barriers to recovery because I believe in the power of numbers and in the healing benefits of supportive communities.

If you’re a fellow professional in the addiction & recovery space, I invite you to reach out with your thoughts on this topic, or connect with me on social media.

For prospective clients and families, I offer a complimentary consultation call where I help you make sense of what’s going on, answer questions, and walk through your available support options.

If you’re ready to explore the potential of working together, I’d love to chat. Michael is based in Victoria British Columbia Canada. The other Recovery Coaches on the team are based in Nanaimo, Vancouver British Columbia Calgary, Edmonton Alberta, Toronto Ontario, Montreal Quebec, and Halifax, Nova Scotia. Because we all work virtually — we can work with anyone no matter what city, province or country around the world. We have clients all across Canada and the USA, Seattle, Los Angeles, Dallas, Miami, New York City, Denver, Nashville, Berlin, Tel Aviv, London, Singapore and Australia.

e: coach@michaelwalsh.com
ph: 250.896.8494

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References

1. Pearson, C., Janz, T., & Ali, J. (2013). Mental and substance use disorders in Canada. Health at a Glance. Statistics Canada Catalogue no. 82-624-X. Retrieved from: statcan.gc.ca