Angelo Pricolo examines how language can matter when helping people with stigmatised conditions
We are all susceptible to the negative affects of inappropriate language but also how positive our words can be other times. As health professionals we need to be particularly aware of not just what we say but also how we address the people we are talking to.
About a year ago I was fortunate to be present for the launch of a quick guide discussing the correct terminology to use in the drug and alcohol sector. It encouraged me to explore the words used in situations that sometimes warrant careful selection.
Often if a relationship already exists we can be more relaxed with our language and maybe less careful. But it is also true to say this can be a trap because liberties may be taken that land us in hot water.
When people already feel vulnerable or marginalised, like we often see in the drug and alcohol sector, then most would agree it is important to consider our language before delivery. Of course how the words are used, the tone and context will also influence whether it is acceptable and appropriate.
Stigma involves negative attitudes or discrimination against someone based on a distinguishing characteristic such as a mental illness, health condition, or disability. Social stigmas can also be related to other characteristics including gender, sexuality, race, religion, and culture.
While stigma is about more than just language, this is a good starting point. Focusing on stigmatising language can start the conversation and help individuals reconsider how they think about people.
By now most of us have adjusted our language when we refer to people living with medical conditions like epilepsy or addiction. Defining people by their disease starts with calling them epileptics or addicts.
Finding expressions that make everybody more comfortable is really just an exercise in being considerate and understanding. Suddenly it becomes just as easy to talk about the woman who has epilepsy or the people who inject drugs (PWID).
These are examples of using person-first or person-centred language. It is also important to be aware that language is dynamic and acceptable terminology often changes.
To be honest I have often struggled with customers, patients and clients. Sometimes the answer is not simple but this should not stop us from trying to be accommodating, especially when we understand how much of an impact a simple word can have on another human being.
Some terms may be okay if used by some, but not by all. The way a group of African-American friends refer to each other in their group could lead you in a sticky situation if you adopted the same greeting.
When we look at the drug and alcohol sector as an example, there is a range of language that we will commonly hear. We can use traffic light signals to rank.
RED or stigmatising terms include junkie, druggie, drug user or drug abuser.
YELLOW or terms that may be stigmatising in certain contexts but accepted in others include addict, alcoholic/alkie, IDU/injecting drug user, intravenous drug user.
GREEN or preferred neutral terminology, person who uses or has used alcohol or other drugs.
Person-centred, clear and non-judgemental language is preferred as it is less stigmatising and works to empower.
Looking at people who use alcohol/drugs, RED includes drug habit. YELLOW includes alcoholic, addict or person with a substance use disorder. GREEN is person with a dependence on drugs or person with a dependence on alcohol.
Do not assume that someone who is using alcohol or other drugs has a Substance Use Disorder (SUD). SUD is a clinically accurate term to describe the ‘constellation of impairments caused by repeated use of a substance’.
By not making assumptions about how and when someone uses drugs, you can maintain trust and work positively to support the person, their family or the wider community.
RED Suffering from addiction
GREEN Person experiencing addiction
RED Abuse, misuse, problem use, non-compliant use
YELLOW Alcohol abuse, pharmaceutical misuse
GREEN Substance use, non-prescribed use, non-medical use
RED Using again, fallen off the wagon, failing treatment
YELLOW Had a setback, relapse
GREEN Currently using drugs/alcohol (after a period of not using)
RED Dirty/clean urine/blood, tainted blood
GREEN Positive/negative urine/blood drug screen, specific description of clinical condition, blood-containing hepatitis C
RED Complex/challenging people
GREEN People with complex, challenging, or co-occurring needs
RED Doctor shopper
GREEN Person with multiple prescribers
RED Clean, ex-addict, former addict, stayed clean, hit rock bottom
YELLOW Person who is recovering from drug use/dependence, sober
GREEN Person who is no longer using, person who has stopped using drugs, person with lived experience of drug use/dependence
RED Replacing one drug/addiction for another, liquid handcuffs
GREEN Pharmacotherapy treatment, Medication-Assisted Treatment of Dependence (MATOD), Opioid Substitution/Replacement Therapy/Treatment (OST/ORT), Opioid Pharmacotherapy Program (OPP)
RED Non-compliant, lacks insight, in denial, resistant, unmotivated
YELLOW Not engaged, hard to reach, hard to engage
GREEN Treatment has not been effective, chooses not/disagrees to treatment
RED Catch it, became infected/reinfected with
GREEN Contract, acquire, has been exposed to/diagnosed with hepatitis C or HIV
RED Spread, give/gave
For more information and advice on alcohol and other drugs you can Email: firstname.lastname@example.org
If you would like more about the work that was completed to develop these guidelines, how to apply them download at: adf.org.au/powerofwords
Angelo Pricolo is an addiction medicine pharmacist and former National Councillor of the Pharmacy Guild of Australia.