How to talk about substance use

A screenshot from the BC government's overdose prevention website.
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According to BC Coroners Service, 1,449 people died from illicit-substance overdoses in British Columbia in 2017. Compare that to the average of 206 people per year from 2000 to 2010.

Despite the province announcing a public health emergency in response, stigma regarding substance use remains at an all-time high. Here are two Facebook comments on a recent CBC Vancouver story about rising overdose deaths:

“I wish the addicts would all just die so we can get on with spending money where it needs to be prioritized.”

“Survival of the fittest, thinning the herd.”

Sadly, comments that promote the death of people with substance use disorders are commonplace online. Even more common, online and offline, is the idea that substance use disorders stem from character flaws: “He’s just not a good person.” Or from lack of willpower and effort: “She could get better if she really wanted to.”

Like cancer, substance use disorders are recognised medical conditions, yet it’s hard to imagine the same language used towards someone living with cancer or other chronic health conditions.

Stigma allows us to maintain distance from whatever or whomever we deem unacceptable. It allows us to look at a group of people who make us uncomfortable and say, “They are not like us.” We reinforce this sense of otherness through languagecalling people “junkies” or “crack heads.”

The use of these names helps us to feel different, safe. We think, “That could never happen to me.” However, the reality is much different. According to a 2012 Statistics Canada report, 21.6 percent of Canadians meet the criteria for a substance use disorder in their lifetime.

When it comes to the current overdose crisis, stigma blocks our ability to have constructive conversations and address the issue. If we refuse to accept substance use disorders as valid medical conditions, how likely is it that we’ll implement effective measures to help save those dying from overdoses.

Avoid “abuse”

In 2013, Diagnostic and Statistical Manual of Mental Disorders removed the term “substance abuse.” It now refers to 10 separate “substance use disorders,” according to the classification of the substance used such as “alcohol use disorder” and “stimulant use disorder.”

Even after the change, some organizations continue to use “substance abuse” and “drug abuse.” The problem with “abuse” is that it implies the person using substances is an “abuser,” which can have real consequences on the medical care people with substance use disorders receive. In a 2010 study in International Journal of Drug Policy, mental health clinicians were much more likely to think “a substance abuser” deserved punishment compared to “a person with a substance use disorder.”

Avoid “clean” and “dirty”

Using “clean” and “dirty” to describe needles and toxicology reports dehumanises substance use. The actions and behaviours of people with substance disorders are neither clean nor dirty, but rather an aspect of a medical condition. This type of purity and cleanliness language also promotes the otherness that stigma thrives on; people who use substances are “dirty,” people who don’t are “clean.”

For toxicology reports, use “positive” and “negative.”

For needles, use “new” and “used.”

Use people-first language

Instead of saying “opioid addict,” say “a person with an opioid use disorder.” Doing so recognises the medical nature of substance use disorders while emphasising the person is more than just their condition.

A 2016 article in Alcoholism Treatment Quarterly points out that we already use people-first language for other mental health conditions. For example, we say “a person with an eating disorder” instead of a “food addict” or “food abuser.”  

It’s important to note that millions of Canadians use substances, legal and illegal, without experiencing substance use disorders. Only describe a person as having a substance use disorder when it’s appropriate.

As our understanding of substance use disorders evolves, so does the language to describe them. Even the most compassionate people, from medical professionals to those with substance use disorders, sometimes use outdated and stigmatising language. Being open and willing to adapt to new, respectful language will help reduce the stigma that people with substance use disorders experience.