Words Matter When Discussing Alcohol Issues: A New Stigma-Free Vocabulary for Better AUD Outcomes

Word choice may seem out of place among the myriad factors that can influence outcomes for a complex condition like alcohol use disorder (AUD). In fact, the stigma created by the language that is used to describe alcohol problems can decrease many people’s willingness to seek help for alcohol problems. It also can affect how people with AUD are treated in all aspects of life.

“Stigmas are the negative attitudes toward people that are based on certain distinguishing characteristics,” says National Institute on Alcohol Abuse and Alcoholism (NIAAA) Director George F. Koob, Ph.D. “More than a decade of research has shown that stigma contributes significantly to negative health outcomes and can pose a barrier to seeking treatment for mental illness or substance use disorders.”

In the United States, nearly 90 percent of people with substance use disorders and 35 percent of people with serious mental illness do not receive treatment. In a recent article published in Neuropsychopharmacology, National Institute on Drug Abuse Director Nora D. Volkow, M.D.; National Institute of Mental Health Director Joshua Gordon, M.D., Ph.D.; and Dr. Koob discuss how people with a mental illness or substance use disorder who experience stigma may begin to internalize it, leading to lower self-esteem, decreased interest in seeking help, and worsening of their symptoms. The researchers also point to evidence that stigma-related bias among clinicians can contribute to a treatment-averse mindset and to flawed clinical care, including failure to implement proven methods of treatment. Studies have shown that using scientifically accurate language and terms that centralize the experience of patients with mental illness and substance use disorders is one key component to reducing stigma. Such efforts can improve how people with these conditions are treated in healthcare settings as well as throughout society.

“Although more evidence-based treatment options for AUD are available today than ever before, stigma is a factor that prevents some people from reaching out for help and from being treated with dignity,” says Dr. Koob. “Understanding that AUD is a medical condition and choosing our words carefully when discussing alcohol-related problems are important steps toward changing the conversation and reducing stigma around AUD.”

Dr. Koob explains that we can help alleviate the stigma associated with alcohol-related conditions by consistently using non-pejorative, non-stigmatizing, person-first language to describe these conditions and the people who are affected by them. Some words that are commonly used in society, such as “alcoholic” and “alcohol abuse,” can be stigmatizing.

Some Recommended Language for Reducing Alcohol-Related Stigma

When discussing alcohol-related issues, use these terms to help reduce stigma:

• Alcohol use disorder instead of alcohol abuse, alcohol dependence, and alcoholism. In their recent article in Neuropsychopharmacology, Dr. Koob and his co-authors noted that the term “abuse” remains in the names of National Institutes of Health (NIH) Institutes that study addiction. They added that there is increased interest—both in the scientific community as well as among the affected patient populations—in seeing those names changed to reflect current understandings of addiction as a treatable disorder.
• Alcohol misuse instead of alcohol abuse when referring broadly to drinking in a manner, situation, amount, or frequency that could cause harm to the person who is engaging in drinking or to those around that person. For some individuals, any alcohol use constitutes alcohol misuse.
• Person-first language to describe people with alcohol-related problems such as:
  • Person with alcohol use disorder instead of alcoholic or addict
  • Person in recovery or person in recovery from alcohol use disorder instead of recovering alcoholic
  • Person who misuses alcohol or person who engages in alcohol misuse instead of alcohol abuser and drunk
• Alcohol-associated liver disease instead of alcoholic liver disease. The use of “alcoholic” as an adjective may perpetuate stigma for people with alcohol-associated liver disease and other alcohol-related health conditions.
• Alcohol-associated hepatitis, alcohol-associated cirrhosis, and alcohol-associated pancreatitis instead of alcoholic hepatitis, alcoholic cirrhosis, and alcoholic pancreatitis.

To learn more about how the language we choose can help reduce alcohol-related stigma, please visit NIAAA’s Words Matter web page. And while all NIAAA materials reflect the “Words Matter” concepts, the NIAAA Alcohol Treatment Navigator provides a one-stop resource for learning about AUD and its treatment. The Navigator also shows people how to recognize high-quality treatment providers and how to search several national directories of treatment programs and specialists.

References:
Kelly, J.F.; Saitz, R.D.; and Wakeman, S. Language, substance use disorders, and policy: The need to reach consensus on an “addiction-ary.” Alcoholism Treatment Quarterly 34(1): 116–123, 2016. https://doi.org/10.1080/07347324.2016.1113103

Kelly, J.F.; and Westerhoff, C.M. Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy 21(3):202–207, 2010. PMID: 20005692

Volkow, N.D.; Gordon, J.A.; and Koob, G.F. Choosing appropriate language to reduce the stigma around mental illness and substance use disorders. Neuropsychopharmacology 46(13):2230–2232, 2021. PMID: 34276051

Han, B. Key Substance Use and Mental Health Indicators in the United States: Results From the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2020. https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR090120.htm. Accessed January 13, 2022.

Thornicroft, G.; Rose, D.; and Mehta, N. (2010). Discrimination against people with mental illness: What can psychiatrists do? Advances in Psychiatric Treatment 16:53–59, 2010. https://doi.org/10.1192/apt.bp.107.004481

This article first appeared in NIAAA Spectrum.

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