Stigma Can Kill: Words Matter in Addiction  

stigma addiction

We need to change how we talk about drugs and alcohol to help improve treatment outcomes for all 

By Jennifer Taylor 

February 16, 2021

In recent years, in part fueled by the devastation of the ongoing opioid epidemicthe addiction treatment community has increasingly identified the role of stigmatizing language in undermining outcomes. 

As early as 2004, addiction expert John F. Kelly, Ph.D., ABPPElizabeth R. Spallin professor of psychiatry at Harvard Medical School, identified how language used in discussing addiction could be harmful. In his seminal article “Toward an Addictionary: A Proposal for More Precise Terminology,” Kelly questions the terms “abuse” and “abuser.”  

Nearly 20 years later, the research is clearHow we talk about addiction matters and is directly correlated to treatment results. 

That’s why we at are pleased to support Shatterproof, the national nonprofit dedicated to reversing the addiction crisis, in their efforts to address stigma in journalism and other media.

Last July, Shatterproof announced a new nationwide strategy called Movement to End Addiction Stigma. The early-stage initiative is designed to address the discrimination and negative public attitudes and behaviors toward people with addiction that create a barrier to treatment.  

Shatterproof will release its “The Language Guide” on Feb. 26. Treatment Magazine will provide a link to the guide, so watch this space.  

What Is Stigmatizing Language? 

The impact of stigmatizing language prevents individuals from seeking treatment and ultimately costs lives. 

Certain stigmatizing terms—such as “abuse” instead of the recommended “misuse” and “clean” instead of “in recovery”can induce stigmatizing attitudes toward people with substance use disorder. Even if no harm is intended, according to Kelly.  

“Even when reporters, the media, don’t really mean any harm, certain terms do harm. We found that out,” Kelly says. “The media’s use of certain terminology can, for sure, negatively influence the public’s perception, or it can continue those misperceptions or exacerbate stigma.” 

A shift in language, however, requires an understanding of addiction as a health condition like hypertension, diabetes or cancer. Research has demonstrated how people become susceptible to substance use disorder via their genetics, and how the brain changes as a function of exposure to substances over time, according to Kelly.  

“The nature of the disorder means there is a medical, biological impact, which affects one’s ability to regulate the impulses to use drugs despite their consequences,” Kelly says. “And this is, of course, what we call addiction.” 

A New Approach to Language 

That’s why Kelly, who is also the founder of the nonprofit Massachusetts General Hospital Recovery Research Institute, created Addictionary®, a glossary of more than 200 terms defining the language of addiction.  

And in 2018, the National Institute on Drug Abuse published its first-ever guide for journalists on the latest scientific information on addiction. It recommends using “misuse” instead of “abuse” to avoid shaming. And it explains the differences between dependence, tolerance and addiction—terms that are often conflated in the media.  

Additionally, Kelly believes the media should balance reporting by presenting addiction as a condition with a high recovery rate. “Most people, even though it’s a devastating condition, do recover,” he says. 

The Role of the Media in Reducing Stigma 

The evolution of language around addiction took a major step in 2017 when editors of The Associated Press Stylebookthe leading language guide for U.S. journalists, updated its “addiction” entry.   

AP makes a distinction between the preferred term of “addiction” and some health professionals’ preference of “substance use disorder.”  

The guide also advises avoiding the terms “abuse” or “problem” in favor of “use” with an appropriate modifier such as “risky.” Also discouraged: the use of “alcoholic,” “addict,” “user” and “abuser.” Furthermore, terminology like “crackhead”  isn’t appropriate unless in quotations. 

The stylebook explains that “stigmatizing…language can be inaccurate by emphasizing the person, not the disease.” Instead, it guides journalists to choose phrasing like “he was addicted” or “people with heroin addiction.” 

Just as the Associated Press decided a language shift around addiction was necessary, all of us who work, write and talk about addiction and treatment need to do more than acknowledge the role of language in helping improve addiction outcomes. 

The words we use are a great place to start. They can make, literally, a life and death difference in our communities.