I've written quite a bit about mental-health issues over the years, and I've never thought twice when typing the words "substance abuse." But then I read this excellent piece on CommonHealth - a Q&A with Harvard psychiatrist John Kelly, PhD, - and it got me thinking. In it, Kelly, a former Stanford/VA Palo Alto Health Care System scientist, addresses the stigma surrounding addiction and discusses why we shouldn't refer to those with drug problems as "abusers." From the piece:
It seems clear that addiction is not a good thing. It can cause people many problems, even kill them. But you’re saying that the trouble with addiction stigma is that it goes beyond seeing addiction as bad, to actually blaming the addict?
Yes. The degree of stigma is influenced by two main factors: cause — ‘Did they cause it?’ — and controllability — ‘Can they control it?’ We now know that about half the risk of addiction is conferred by genetics – what you’re born with. On controllability, neuroscience has also taught us that alcohol and other drugs cause profound changes in the structure and function of the brain that radically impair individuals’ ability to stop, despite often severe consequences.
The language we use to describe these problems may perpetuate stigma, and that can potentially harm patients and continue the suffering among families.
You pointed out at the drug reform summit that other mental health fields don’t use the term ‘abuse.’
Right. Individuals with ‘eating-related problems’, are uniformly described as ‘having an eating disorder,’ not as ‘food abusers.’ We need to do the same in the addiction field.
Because the term ‘abuse’ gives rise to the ‘abuser’ term, it is better to use the term ‘misuse.’ Furthermore, given the lack of scientific specificity associated with the ‘abuse’ and ‘abuser’ terms, its nonuse would not result in any loss of scientific accuracy.
Kelly spoke last week at a White House summit on drug policy reform. The rest of his thoughts are worth a read.
Previously: “Brains are unmentionable:” A father reflects on reactions to daughter’s mental illness and Addiction: All in the mind?