Changing the Way We Talk About Substance Use

Jessica Lareau, a graduate social work intern in the Division of Alcohol, Drugs, and Addiction, is working to change the language used to discuss substance use at McLean Hospital.

Lareau is building on studies that show the negative impact of stigmatizing language. She seeks to replace stigmatizing language with person-first language in the hospital’s written and verbal communication about addiction.

“The goal is to encourage everyone to view substance use disorders as the same as any other medical diagnosis,” Lareau said. “We do not judge people who refuse to properly treat diabetes with insulin or fight cancer with chemotherapy. Yet as a society, we look down on people who experience symptoms of active addiction and who may not seek help due to fear of negative judgment or stigma.”

Lareau explained that words and phrases like “addict,” “alcoholic,” “substance abuse,” and “drug user” can be understood as “labels that overshadow a person’s entire identity. Instead language can inspire hope by thinking of the individual as a mother, father, brother, and most importantly, a person living with a disease from which they can recover.”

Person-first language can include “person with a substance use disorder,” “person with an addiction,” and “person in recovery.” Phrases such as these clearly “highlight the strengths of an individual and recognize that recovery is a process which includes more than just sobriety,” she said.

For her work, Lareau draws on research by Harvard Medical School’s John Kelly, PhD. She described one of Kelly’s studies in which over 500 mental health clinicians were exposed to identical stories describing the same patient as either a “substance abuser” or a “person having a substance use disorder.”

“The study showed that when the exact same patient was described as a ‘substance abuser,’ clinicians reacted more negatively. They advocated for punishment rather than treatment and believed the patient was more personally responsible for their addiction,” she stated.

Inspired by Kelly’s research, Lareau pushed for change at Boston University, where she is a graduate student in the School of Social Work. She created the Support Recovery Initiative, which aims to improve how people at the university speak about addiction.

Students and staff are encouraged to pass out the Words Matter pledge in every class. Developed by the Grayken Center for Addiction at Boston Medical Center, the pledge asks individuals to use “clinically appropriate and medically accurate terminology that recognizes substance use disorder is a chronic illness from which people can and do recover, not a moral failing.”

Students and staff are also asked to facilitate a discussion about stigma. They agree to use non-stigmatizing language within school curricula, classroom discussions, written papers, and in everyday life.

Building on the BU program, Lareau is working with McLean to increase use of non-stigmatizing language within the hospital. She has presented to hospital leaders, large groups of clinicians within various staff meetings, patient therapy groups, and family support groups. She discusses the research behind stigmatizing language and work toward new approaches.

Lareau is also assisting the Integrated Recovery-Oriented Practice (IROP) committee in the development and presentation of training modules for McLean staff. She said the Division of Alcohol, Drugs, and Addiction has been supportive by providing opportunities for her to discuss non-stigmatizing language. She has also collaborated with fellow clinicians on how to further integrate this language into clinical forms, resources for families, patient education materials, group therapy descriptions, and hospital marketing.

“I take great joy in sharing this research with fellow clinicians and teaching patients that there are different options in how they can choose to refer to themselves,” she said. “Patients feel empowered after realizing the large role they can play in the fight against stigma, through their own use of non-stigmatizing language and willingness to begin discussions with loved ones.”