The irony is never lost on me when I am engaged in a conversation with a person in recovery who, between deep puffs of a cigarette or long sips of their sugar-filled cup of coffee, believes that the use of medications such as Methadone, Suboxone or Vivitrol excludes a person from being able to identify as being in recovery. If you’re smoking a pack of cigarettes a day or consuming caffeine like it’s your day job but claiming that a person using prescribed medication as part of their treatment for substance use disorder “isn’t clean”, your stance is problematic at best, hypocritical at worst.
Caffeine and nicotine are both stimulants. They are both addictive, mind and mood-altering substances. In fact, smoking is the number one cause of preventable death in this country. So to be using these drugs while stigmatizing, ostracizing and alienating individuals who are utilizing prescribed, evidence-based medication as part of their recovery journey is both foolish and harmful.
There are many pathways to recovery and many definitions of what that means for a given individual. While for some, certain medications may have been misused in the past or the use of them is not a strategy we would choose for ourselves, that does not mean we should impose our beliefs on others. And while for some, choosing to use the most harmful drug in the United States is not something we believe excludes us from identifying as “clean” or in recovery, we all ought to allow each and every individual to identify for themselves what recovery means for them. With drug overdoses being the number one accidental cause of death in this country, the time is now to be more inclusive and welcoming than ever.
“If we truly believe that addiction is a serious health problem, then why do we continue to have departments and centers of substance abuse?” – William L. White
Language is extraordinarily powerful. As our understanding of substance use disorder has continued to grow with research and a greater recognition of the need for better policies to address substance use disorder has continued to emerge, there is no time like the present to revisit the critical and long overdue act of adjusting our language. Not only does our language need to be adjusted within the discourse of our individual conversations; it needs to be modified in the names of the very institutions charged with leading the way.
As renowned addiction recovery author William L. White has written, “Of all the words that have entered the addiction/treatment vocabulary, “abuse” is one of the most ill-chosen.” The term abuse “has long implied the willful commission of an abhorrent (wrong and sinful) act involving forbidden pleasure” and “has also come to characterize those of violent and contemptible character–those who abuse their partners, their children or animals.” To include such a stigmatizing and shaming word in our conversations about substance use disorder is to continue to frame addiction as a moral failing on the part of an individual rather than a preventable and treatable health condition with multiple biological, sociological, psychological, cultural and environmental factors. To include such a stigmatizing word in the very names of our nation’s leading organizations charged with addressing substance use disorder is perhaps even more harmful as it continues to perpetuate this misconception at the highest levels.
When I look at some organizations funded by my tax dollars such as the federal Substance Abuse and Mental Health Services Administration (SAMHSA), Pennsylvania’s Office of Mental Health and Substance Abuse Services (OMHSAS) and the National Institute on Drug Abuse (NIDA) – the last of which actually uses the web domain of “drugabuse.gov” – I can’t help but feel compelled to demand better. If our nation’s leading organizations that are tasked with addressing the health condition of substance use disorder continue to use the word “abuse” in their agency names and website addresses, how can we truly expect the general public to move its language and perception of substance use disorder away from the idea of abuse?
Change is possible.
In my city of Philadelphia, our publicly funded behavioral health system used to be called the Philadelphia Department of Behavioral Health and Mental Retardation Services (DBHMRS) prior to advocates at the national level demanding the removal of the stigmatizing word “retardation.” These advocates in the intellectual disability arena successfully asserted “that the term “mental retardation” has negative connotations, has become offensive to many people, and often results in misunderstandings about the nature of the disorder and those who have it.” Shortly following the implementation of a 2013 federal rule requiring that the word “retardation” be replaced with “intellectual disabilities”, Philadelphia, under the leadership of Commissioner Dr. Arthur C. Evans, changed the name of its publicly funded behavioral health system to the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). Not only was there a swift change to abolish the word “retardation” but a special emphasis was placed on celebrating the strengths of individuals living with an intellectual disability by making the “d” a lowercase “d” and capitalizing the “A” for the word “disAbility.” Witnessing this extraordinary act of leading by example take place in my city served as proof that with a little advocacy and some public will alongside strong leadership, a small but powerful name change is possible for any organization or bureaucracy.
The time is now to see this symbolic act of leadership take place at the national level when it comes to language surrounding substance use disorder. The time is now that we, those of us who pay for these agencies, demand to see this change. The time is now for our nation’s leading organizations on substance use disorder to alleviate the very word that continues to perpetuate the idea that substance use disorder is anything less than the health condition they are charged with addressing. The time is now to get rid of the word “abuse” for good.