Words matter: The language of addiction and life-saving treatments

Sarah Wakeman, MD, FASAM, Medical Director, Massachusetts General Hospital Substance Use Disorder Initiative

News articles, radio, and television frequently report on the current opioid crisis. As the death toll has mounted, the media has importantly covered many aspects of the crisis. Unfortunately, this coverage often focuses on the very visible individuals who continue to struggle with active addiction. What is missing is a narrative of hope for a chronic disease which is as treatable as diabetes or high blood pressure.

In addition to the pessimistic portrait painted about addiction, the language used by the media is often problematic. Articles frequently use the term “abuse” or “abuser” or refer to individuals as “addicts.” Even the term “clean” is laden when referencing sobriety, as it implies that someone who is actively using is somehow “dirty.”

Language matters–a lot

The use of “abuse” and “abuser” has been shown to increase stigma even among highly trained clinicians, who recommend more punitive treatment when an individual is described that way. We do not call patients with diabetes “sugar abusers,” nor do we say their blood is “dirty” with sugar. Describing patients as having a substance use disorder demonstrates that their illness does not define them, just as we should no longer call a person with schizophrenia a “schizophrenic.”

The language we use related to addiction treatment also impacts stigma. Methadone and buprenorphine are lifesaving, effective medications for opioid use disorder. Their use reduces relapse and death far more than any other available treatment. And yet they are frequently referred to as “replacements,” worsening the mistaken notion that these medications are simply a way to substitute a legal opioid for an illicit opioid. They are not. Addiction is a behavioral syndrome characterized by compulsive drug use despite negative consequences. Patients successfully treated with methadone no longer meet the criteria for active opioid use disorder. Taking a medication to manage an illness is the hallmark of chronic disease treatment. Individuals taking medication to successfully treat addiction are physically dependent, just as someone taking insulin for diabetes requires a daily shot to be able to function normally. Both will get sick if they stop their medication. But someone on methadone is no more “addicted” than any person who relies on a daily prescription to keep a chronic disease under good control.

Stigma can deter people from treatment

In Boston, the term “methadone mile” has come to refer to a stretch of Massachusetts Avenue where the devastation of active drug use is highly visible. This reference is particularly unfortunate because it lumps those on treatment for opioid use disorder with those actively using. This insinuation that individuals on methadone maintenance are no different than those actively using heroin is incredibly stigmatizing and is one reason why many won’t consider this treatment.

Methadone was first discovered in 1965 through the groundbreaking research of scientists at the Rockefeller Institute. Those early studies demonstrated methadone’s remarkable ability to alleviate withdrawal and craving while dramatically improving the ability to function emotionally and socially. In the subsequent decades, the evidence supporting methadone’s positive effects has grown. These include significant reductions in drug use, new HIV infection, crime, and death from overdose. The research is so strong that methadone, along with buprenorphine (Suboxone), has been added to the World Health Organization’s list of essential medications. And yet despite this, only a minority of programs offer methadone treatment and the undeserved shame associated with this lifesaving medication persists.

Many would be surprised to learn that most people with a substance use disorder will get better, and the lifesaving medications methadone and buprenorphine are the most effective pathway to recovery, not detoxification. Those doing well on medication are often invisible because they are scared to share their pathway to treatment in the face of such misunderstanding.

Words matter and continued use of stigmatizing language perpetuates false stereotypes, spreads misinformation, and keeps people out of care.

Related Information: Harvard Health Letter

Comments:

  1. Silver Damsen

    This article provides a useful, interesting point on using the term “suds” that many in the larger Pro Recovery movement use; but this article also refers to “a disease”; and says things about methadone that seem far more controversial than the author seems to realize, as in most people in the larger Pro Recovery movement do not think that comparing insulin to methadone is appropriate, unlike the author. In addition, most here would not be likely to agree with the following, “the lifesaving medications methadone and buprenorphine are the most effective pathway to recovery, not detoxification” particularly the use of the words “most effective pathway.” Yes, methadone is more effective than AA, but this articles provides misinformation since it doesn’t mention other medications and alternatives methods besides AA.

  2. Lisa

    15 years ago Me and my husband got hooked on painkillers the dr that prescribe them to us told us at the time they wasnt addicting.. Guess wat he lied and hes in prison for writing and selling alot of pain pills scripts.To get to the point we started the methadone treatment and it saved out lifes.. But the clinics are getting so expensives its getting so hard to pay 800.00 a month thats for me and my husband..We are almost 60 years old and we have health problems and We dont know how we r gonna pay for our meds.We have to go to the clinics because we cant find a dr to prescribe our methadone.We live in Memphis tn and we was wandering is it true that insurance companies gonna start helping people pay for some of the methadone clinics..I wish they would because money is getting hard to make at our age…The bad thing if u dont pay on time for ur methadone they will finance detox u quickly..And when they do that to people they could die ..

    • Kevin Miller, MD

      Suboxone may be a good alternative for you and your husband, for less expense. Insurance companies have to cover treatment for opioid use disorder including medications. Search for a Suboxone provider on Suboxone.com or search under the American Society of Addiction Medicine, or SAMSHA.

  3. ccsledge

    Actually, Methadone was developed in Germany in the late 1930’s and has been approved for use in the US since 1947. Methadone as a treatment for Opioid Use Disorders was developed at Rockefeller in the 1960’s.

  4. Carol Salami-Goswick

    I agree with the point about language and think that it may be helpful. Just as I’ve seen that some diabetics do not adhere to the medical regimen they need to stay health and suffer horribly, patients with substance abuse disorder don’t always adhere to their medical regimen either so the problem is far more complex than a strictly medication approach. Examples of these situations are a painful part of my life as a friend and a mother. My friend has been in a long term care hospital for diabetic related problems and my son, who had been in and out of the Methadone maintenance program for many years sadly, died of a Methadone overdose last year after allegedly purchasing it on the street near the methadone clinic.

  5. Maria I Townsley

    My son has been on methadone for seven years. Methadone has caused bad side effects for him: he smokes a lot more, he craves for sweets, his testosterone level has gone down and a psychologist told him that methadone causes profound changes in the brain.

    His pain doctors want him to get off it and although he is doing it very gradually, the side effects are very hard: anxiety, hot and cold sweats, mood swings and depression.

  6. Rev. James L. Mengel III

    Is alcohol our greatest, long-lasting problem–even as a legal addiction? And can we now dismiss the stigmatizing word “mental” and more honestly and accurately use the words “brain disorder”? Thank you!

  7. Kevin Kirby

    Well done, with one pretty significant exception. A narrative of hope is not consistent with the term, “substance use disorder.” As you know, addiction is a complex bio, psycho, social and spiritual disease. Some of its symptoms relate to the use of a substance but many more of its symptoms relate to how we feel about ourselves and how we relate to others. Painting addiction with this descriptor gives a false impression to those who suffer, those who wonder if they suffer, families and others that cessation of use is the answer. While cessation might, in fact, be necessary, it alone is rarely sufficient to live a life of wellness. Recovery doesn’t equal dry or sober or clean. It means much more than that.

  8. Bill Godshall

    Sarah Wakeman is correct.

    With the sharp increase in opioid overdoses among whites, it appears that intentional stigmatization of opioid users has declined slightly.

    Unfortunately, Obama’s DHHS, the WHO, Big Pharma and their many funded health and medical organizations have aggressively stepped up their War on all tobacco users (including millions of vapers who quit smoking by switching to vaping) by deceitfully conflating the use of very low risk smokeless tobacco and smokefree vapor products with highly addictive and deadly cigarettes.

    While cigarette smoking cause >99% of all tobacco attributable morbidity, disability, mortality and healthcare costs, tobacco controllers have been deceitfully insinuating that all tobacco and nicotine products are just as harmful as cigarettes by falsely claiming “tobacco use is the leading cause of disease and death” and by deceitfully claiming very low risk tobacco/nicotine alternatives are “not a safe alternative to cigarettes”.

    And while smokeless tobacco and vapor products have helped millions of cigarette smokers quit smoking (just as methadone has helped hundreds of thousands become and remain heroin-free), DHHS, WHO, ACS, AHA, AMA, AAP, etc. still falsely claim there is no evidence these products can help smokers quit smoking.

    To achieve their abstinence-only puritanical goals, these tobacco controllers have also:
    – falsely claimed nicotine is a highly addictive and toxic substance that causes brain damage,
    – lobbied FDA to ban the manufacturing and sale of low risk smokefree alternatives (but not cigarettes),
    – lobbied to tax smokefree alternatives at the same rate as cigarettes,
    – lobbied to ban the use of smokefree alternative (even though they pose no risks to nonusers), and
    – labelled/stigmatized all nicotine users (including former cigarette smokers who quit smoking by switching to lifesaving vapor and smokeless tobacco products) as disgusting “addicts” .

    And yet, nicotine is very similar to, and no more harmful than, caffeine.

    Seems like nicotine users have replaced opioid users as the leading targets for inhumane and unethical prohibition laws, hatred and stigmatization.

    • Paulette

      I am in recovery from tobacco, clean for 15 years. I still have the traits that my clients experience on cocaine, marijuana, alcohol, and so forth. There are no blanket statements for what works for all. If you find yourself angry over percecution of your drug of choice, you are an addict. If you choose to keep using, you can do that. Please do not try to convence others, as cannibus addicts have been doing, that your drug of choice is ok.

  9. arlenewla

    Agree completely on the importance of words used. Not just in the matter of addiction but across the board, words have the power to create; either for the positive or negative. One’s self image can be shaped just by the verbiage utilized.

    However, words can be co-opted into something they are not. Methadone clinics use the word “clean” to describe someone who is abstinent from all other drugs other than Methadone. It is they who have co-opted the language of recovery. It’s the great lie sold by the MM communities to make the Methadone user feel as they are something they are not. One is not “clean” while taking Methadone.

    I was on MMT for 15 years and experientially can tell you that there is a vast difference when one is taking Methadone as opposed to -0- drugs most inclusive of Methadone. Methadone is one of the most highly toxic opioids there is. And unlike Bupe, has no ceiling. One is likely to develop a tolerance to their Methadone dose and are forced to ask for an increase. And let no man or woman say that they don’t get a buzz or a high from Methadone! People of the Lie.

    I fought to get all opioids out of my system. I fought to kick those 15 years of Methadone, a process that almost killed me. So please do not carry a dishonest message. Clean is clean and using Methadone, while a step up from slamming, snorting or taking pills by the dozen, can not be put in the same category. Words are powerful for the story they tell but let the story be truthful.

  10. Abby Coulter

    This is absolutely one of the BEST articles written regarding the IMPORTANCE of the Language used when discussing, reporting about, educating etc, Opioid Use Disorder. As an MMT Patient, Peer Support Specialist & Advocate getting people in general to understand the impact that language often feels like an uphill battle. But among my peers in recovery via MMT & recovery of all paths honestly, getting them to break free from the ‘language’ barrier is even MORE trying.
    This article is one I will definitely be sharing through our Organization, MMTSA as well as in our FB Support Group & sister Groups HAS (Heroin Addiction Support & Women’s MMT Support & Love). Thank you so much!

    Truly Sincere –

    Abby Coulter