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July 19, 2014 2:48 PM   Subscribe

The Editorial Team of Substance Abuse make[s] an appeal for the use of language that (1) Respects the worth and dignity of all persons (“people-first language”), (2) Focuses on the medical nature of substance use disorders and treatment, (3) Promotes the recovery process, and (4) Avoids perpetuating negative stereotype biases through the use of slang and idioms. We ask authors, reviewers, and readers to carefully and intentionally consider the language used to describe alcohol and other drug use and disorders, the individuals affected by these conditions, and their related behaviors, comorbidities, treatment, and recovery in our publication.

Why does it matter what we call it?

“The language we use to describe these problems may perpetuate stigma, and that can potentially harm patients and continue the suffering among families.

New evidence indicates that the commonly used “abuse” and “drug abuser” terms, for example, are conceptually linked to the notion that individuals are at fault for their addiction and therefore should be blamed and punished. These terms fitted well with the “war on drugs” policy approach. In contrast, use of the more medical and scientifically accurate “substance use disorder” terminology is linked more to a public health approach that conveys the notion of a medical malfunction.

We tested the effect of using these terms experimentally. We randomly assigned a paragraph vignette describing an individual in legal trouble due to alcohol and drugs; in half the vignettes the individual was described as “a substance abuser” in the other half he was described as “having a substance use disorder”; otherwise, the scenarios were identical.” Full study (PDF)

The National Drug Control Strategy (PDF) is also adopting the use of non-stigmatizing language (see page 2).

MeFi's own Maias on Why ‘Substance Abuse’ Is a Label We Should All Reject.
posted by rtha (43 comments total) 28 users marked this as a favorite

 
Reading between the lines here, does the quote from the study criticizing the War On (some) Drugs approach, plus the NDCS thing from the White House imply that maybe the stupid War On (some) Drugs is ever so slightly getting walked back?
posted by feckless fecal fear mongering at 3:11 PM on July 19


That study is from 2010 and has quite a few methods issues. Yet another call to change language because it "may" harm someone.

Stick a feather in it and call it macaroni...
posted by CrowGoat at 3:12 PM on July 19 [2 favorites]


Stigmatizing/stereotyping language demonstrably harms people. Please explain, if you disagree, how it doesn't.
posted by feckless fecal fear mongering at 3:15 PM on July 19 [11 favorites]


I don't think that shame should be a driving force by any means. But I wonder if some moral weight behind a behavior, with an implied negative stigma, can be helpful at times. Finding the balancing act here is the trick, I think, and I don't have a clear answer for how this would work. But I worry that watering down experiences to strictly neutral terms can mute the perceived harm of the initial participation in an act. Shame when people are in the throws of an addiction is arguably not helpful. But casting a behavior in moral terms beforehand, with the idea that a good citizen does not participate in heroin while pregnant (for example), might actually prevent some harm.
posted by SpacemanStix at 3:33 PM on July 19


What language is stigmatizing and what language isn't can be controversial, though. I don't think that people-first language or changes of really very stigmatizing terms like "abuse," in reference to substance use disorders, are likely to be all that controversial (even if there's also likely to be a learning curve -- I know there is/will be for me). But more generally, I've read elsewhere that some people find that people-first language can deny how important an aspect of their life is to their identity, or other reasons why they might prefer to be called "[such-and-such] person" as opposed to "a person with [such-and-such]."

I also have some issues with the Substance Abuse* editorial team's emphasis on the medical model. Not that I think the medical model of substance use/disorders is totally invalid or anything, it just seems off-putting to me for them put *so* much emphasis on it at the expense of other aspects of the person or their lives or even of their substance [mis]use. They even mention arguments against it, like how it puts people in the relatively disempowered and passive role of patient, but they don't really say that much about how they're going to address those arguments? It's great to use phrases that connote agency, but how much agency can you really rhetorically grant someone when you're talking about them only in a medicalized context in which they're playing the role of someone who doesn't have much agency by definition? I feel like the rhetoric of agency can only go so far in that case, since the content of what you're saying when speaking of substance [mis]use only within the medical model is inevitably going to be disempowering.

I guess my problem with that is, it seems contradictory to me to on the one hand try to diminish the stigma of substance disorders by saying people are suffering from a medical disorder and using the medical model largely/solely in your rhetoric, but on the other hand simultaneously try to diminish the stigma of substance disorders by using language that emphasizes the agency and choices of people who have substance disorders. Those two different tactics of attempting to diminish the stigma seem to work against rather than with each other, at least to me?

*Wait, so the editorial team came out with these guidelines that specifically seek to get away from stigmatizing slang and that implies moral judgment, such as using the word "abuse," but the publication is still going to be called Substance Abuse? I'm not being snarky, am actually confused about that.
posted by rue72 at 3:35 PM on July 19 [6 favorites]


Except that appeals to morality in this sort of context are basically always bullshit.

You don't really get that sort of morality without some type of shaming, and hasn't it pretty much been universally proven that in no context does shaming really help anything?
posted by emptythought at 3:37 PM on July 19 [1 favorite]


SpacemanStix: That is a terrible approach. People with addictions are at the mercy of their addictions; it's not about morality at all. I mean, the pull quote right there talks about substance use disorder as a medical issue, not a moral judgement one one.

They even mention arguments against it, like how it puts people in the relatively disempowered and passive role of patient

That's probably another attitude that we need to change; the idea that being a patient is to be passive is completely wrong. We should be teaching everyone to be advocates for their own health, and to be involved in the process--and providing advocates for those who need them.

Your asterisked point confused the hell out of me too. Maybe the Editorial Board doesn't have the ability to change the name themselves?
posted by feckless fecal fear mongering at 3:39 PM on July 19 [3 favorites]


I am all about harm reduction and dealing with drug problems through treatment and support rather than punishment, and usually I like Maias articles, but I am strongly of the opinion that this mincing words, bullshit, and forced acceleration of the euphemism treadmill accomplishes nothing.

I mean, look at this stuff:
For example, adjectives such as “noncompliant,” “unmotivated,” or “resistant” can subtly reinforce paternalistic models of health care. Alternatively, the use of phrases such as “not in agreement with the treatment plan,” “opted not to,” “has not begun,” and “experiencing ambivalence about change,”
The thing is, everyone knows what the bullshit phrases mean. Just a smokescreen.

I would definitely believe the "poor guy, just can't help him/herself" implication here could be harmful. The paper itself notes this tension:
Nonetheless, we are behooved to acknowledge that for some communities or individuals, the medicalization of substance use may be perceived as problematic instead of helpful. Framing substance use as a medical problem with a medical solution inherently converts individuals into disempowered “patients” roles vis-à-vis healthcare providers or “the system,” and can promote medication and medically-oriented treatment as the most important aspect of recovery, failing to recognize the proverbial notion that “pills don't teach skills.” This implicit conversion and narrow perspective on treatment may be perceived as antithetical to the autonomy, empowerment, and partnership inherent to the comprehensive recovery process. A medication focus also raises legitimate questions about the extent of pharmaceutical company influence on the field and our conceptions of treatment and recovery.
posted by save alive nothing that breatheth at 3:44 PM on July 19 [1 favorite]


That is a terrible approach. People with addictions are at the mercy of their addictions; it's not about morality at all. I mean, the pull quote right there talks about substance use disorder as a medical issue, not a moral judgement one one.

I'm talking about before the addiction, however ("before they indulge.") For my daugher, for example, I think there is value in her knowing there is a negative social stigma attached to participating in hard drug culture, and I'm not apologetic about that. There is value in people being aware at certain times that there are moral implications for behavior. Some of this is conveyed in the way that we refer to things. You mute the implications by neutering the terminology, and it can have the other effect: namely, we are freely allowed to dabble in things that will eventually have medical solutions.

I do agree, though, that those who are at the mercy of their addictions, there is no value in shame. Shame can be a downword spiral, rather than a way out. No one is guilted out of an addiction. At those times, the way that we refer to things matters.
posted by SpacemanStix at 3:50 PM on July 19 [1 favorite]


Portraying this as only about euphemisms and shame and self-esteem and such is either well-intended but ignorant (at best) or disingenuously misleading (at worst).

That's because the terms used imply different things and are based upon various assumptions, some of which are very wrong. A prime example of this is the common equivocation of addiction as dependency, which are distinct, but people think that the latter is a technical or euphemistic synonym for the former and that, therefore, dependency implies addictive behavior. So all sorts of practical things in the actual world, from policy to individual interactions, are affected by this misunderstanding which is revealed in language.

Obviously, changing the language usage won't automatically correct the misunderstanding. This is the point that people make who argue against proposed changes in language usage, that it's purely cosmetic. But this is mistaken for the very reason I just explained: different terms have different connotations attached to them and while changing usages won't erase the underlying worldviews and behaviors, what it will do is lessen the reinforcing interaction between those misunderstandings and worldviews and the language that's used.

You can easily see this with apolitical, not-emotionally-charged examples of technical language that's entered into popular usage. In science, sometimes at the beginning of the study of something, or the beginning of a science, a term will be appropriated from common language into science as a technical term. But it will carry with it those common language connotations which, at the outset, were part of the point because the scientific first-look seemed to validate the idea that this X-technical phenomenon is well-described by that X-common-language term. But as the science develops, there's increasing divergence between the common language term's connotations and what is rigorously known about this scientific topic. This can be a problem in the science because it can impede further understanding of the topic when scientists are subtly constrained in their understanding by the connotations of the everyday language word. More frequently, it can be a huge impediment in education about the topic and in public awareness about the topic.

Changing the word doesn't, by itself, cure any misunderstandings. But what it does is severe the connection with the connotations that are involved in perpetuating those misunderstandings. There will be other things, too, that perpetuate such misunderstandings, and they will have to be dealt with separately. But altering language usage is actually a fairly effective step in changing how people think about something. It's not just cosmetic.
posted by Ivan Fyodorovich at 4:00 PM on July 19 [6 favorites]


For the last five years I have witnessed my dear friend whose son suffers from spastic cerebral palsy try to educate people on how "spaz" is a hurtful term, and the frankly hateful, defensive backlash is startling and disturbing to me every time. I think the authors of this study make a very good point and it's nice that they want to change the dialogue, but I guess my feeling is: good luck.

In my experience, shaming in the context of drug addiction does nothing but perpetuate and exacerbate the problem. Addicts already feel badly enough about the way their life has turned out; being made constantly aware of how they're looked down upon for their self-destruction only gives them more reason to continue doing what they're doing.

And the thing is, SpacemanStix (and this is a point made in the first link), nearly everyone tries alcohol. A lot of kids try pot. For those prone to addiction, that's often enough to send them down the path toward trouble. Kids are bombarded with messages about how cocaine and heroin and meth (et al) are dangerous, and it's never stopped people with a predisposition to addiction from using those drugs. Because for some people, the first time they get high, on whatever chemical substance may happen to be before them, it's like a switch flips and they suddenly feel okay. Like this is the solution to the unease inside themselves, a feeling that has made them feel different from other people their whole lives. I have heard this from so, so many addicts. It's like a temporary respite from a discomfort they have never been able to describe. For those of us who don't have that predisposition - it's just fun. And it's hard to understand that it isn't the case for everyone. So, maybe instead of trying to demonize the drugs themselves, we should talk to kids about why people do them in the first place - which I can tell you that despite the "drug education" that went on in my public schools was never once addressed - and what their other, better options are for dealing with the turmoil inside themselves.
posted by something something at 4:01 PM on July 19 [11 favorites]


That's probably another attitude that we need to change; the idea that being a patient is to be passive is completely wrong. We should be teaching everyone to be advocates for their own health, and to be involved in the process--and providing advocates for those who need them.

I agree that the power dynamics in medicine are a serious problem in terms of people seeking/accessing/receiving/benefiting from treatment (in a very broad sense, not just in terms of substance disorders/misuse -- this is a HUGE issue in terms of gender and women's pain or symptoms not being taken seriously or not even being studied, for example). However, I think that changing the culture/power dynamics of the medical field is way beyond the scope of language changes like this. It's not that those discussions couldn't or shouldn't happen, but that's not what these language changes are meant to correct, I think.

It sounds to me like these language changes are meant to correct or at least mitigate the stigma surrounding substance misuse. And I think that changing the language around an issue is a perfectly valid way to try to mitigate or correct a stigma -- I have zero problem with that in principle.

But I don't know that putting such a heavy emphasis on the medical model, *especially* while not meanwhlie seeking to change the power dynamics within the medical field, in which patients *are* disempowered in favor of empowering providers (and in the US, insurance companies and billing departments!), is actually a good idea in terms of diminishing that stigma. And there's a tension within the guidelines themselves in terms of that -- the tactic of explicitly *not blaming* the people misusing substances by emphasizing the medical model (and their disempowerment, as patients, within that model) is in pretty direct opposition to the tactic of empowering people misusing substances by using language that emphasizing agency and that's person-first. I mean, I can see pros and cons to each of those tactics, and I don't have an intractable philosophical problem with any of them, it just seems bizarre and self-undermining to me to try them both/all at once.

For my daugher, for example, I think there is value in her knowing there is a negative social stigma attached to participating in hard drug culture, and I'm not apologetic about that.

I don't really know why shame needs to be involved, because it's not like "developing a substance disorder" is all that appealing on its own merits. There are huge practical and physical problems/risks that come with it, there doesn't have to be a stigma *as well.*

Personally, the most effective anti-drug campaign I've ever been exposed to in my life was the movie "Requiem for a Dream."
posted by rue72 at 4:01 PM on July 19 [9 favorites]


I guess for my part I'm more interested in alleviating suffering that is already happening than perpetuating the kind of shame that may or may not serve as a deterrent to future suffering.
posted by dogheart at 4:02 PM on July 19 [9 favorites]


Abuse in particular is very nebulous. A little alcohol is okay; too much is abuse. But in practice this is fairly arbitrarily defined--more than fourteen standard drinks per week for men, seven for women, acc. to one medical definition. What's the actual amount required to produce harm? Man, that's variable.

Then there's marijuana. The average human literally cannot overdose on cannabis, although they can from alcohol. Marijuana withdrawal, finally confirmed as A Thing, is uncomfortable but not nearly as unpleasant (or potentially fatal) as alcohol withdrawal. But marijuana abuse is essentially any use at all. Because it's illegal.
posted by adoarns at 4:02 PM on July 19 [1 favorite]


I don't really know why shame needs to be involved, because it's not like "developing a substance disorder" is all that appealing on its own merits. There are huge practical and physical problems/risks that come with it, there doesn't have to be a stigma *as well.*

I would agree with this. My main concern would be muting language such that is obfuscates risk. As long as we can maintain an appropriate notion of risk, I think this is the important detail, and a primary concern. But maybe that's my paternal instinct, and I do suspect that a notion of being able to do this without using shaming language is correct.

An ideal world for me would be one in which risk is still emphasized while shame is mitigated for those who are suffering.
posted by SpacemanStix at 4:10 PM on July 19


Kids are bombarded with messages about how cocaine and heroin and meth (et al) are dangerous, and it's never stopped people with a predisposition to addiction from using those drugs.

I know that it's stopped me, and I certainly have a predisposition towards drug abuse. The reason is that community norms and expectations are certainly formative in the character of people, which take into account our inclinations towards addictive types of behavior. Biological inclinations are not inevitable. I'm not sure how one would argue, actually, that moral language is not helpful in general without knowing whether there are those who would have taken these drugs without the warnings.

All that being said, though, I fully agree that shaming is not helpful. High standards of social behavior can be, for some people (with a graceful response thrown in for those who are having trouble).
posted by SpacemanStix at 4:14 PM on July 19


I don't think anyone's saying anything about obfuscating risk.
posted by feckless fecal fear mongering at 4:14 PM on July 19


I don't think anyone's saying anything about obfuscating risk.

I asked whether it might naturally happen as a result of changing language.
posted by SpacemanStix at 4:16 PM on July 19


That seems unlikely. The Just Say No approach hasn't worked and never will. Frankly, I think JSN is probably responsible for more people falling into addiction. When you're a teenager and everyone's saying ALL DRUGS ARE BAD AND WILL KILL YOU and you smoke a joint with your friends and don't die, you're probably going to assume you're being lied to about everything else too and be more likely, not less, to try 'hard' drugs that lead to substance use disorder.

Removing stigma != obfuscating risk. The key, and this is where JSN utterly failed, is actual frank honesty about drugs, how they work, what they do, and what the risks are. Without any moral judgements anywhere.
posted by feckless fecal fear mongering at 4:23 PM on July 19 [8 favorites]


The Just Say No approach hasn't worked and never will. Frankly, I think JSN is probably responsible for more people falling into addiction. When you're a teenager and everyone's saying ALL DRUGS ARE BAD AND WILL KILL YOU and you smoke a joint with your friends and don't die, you're probably going to assume you're being lied to about everything else too and be more likely, not less, to try 'hard' drugs that lead to substance use disorder. ... The key, and this is where JSN utterly failed, is actual frank honesty about drugs, how they work, what they do, and what the risks are.

Yep, I agree!
posted by SpacemanStix at 4:25 PM on July 19


Then you'll forgive me for being confused, since you started out by saying "But I wonder if some moral weight behind a behavior, with an implied negative stigma, can be helpful at times."

I'm also confused as to why you elided four words out of what I said.
posted by feckless fecal fear mongering at 4:28 PM on July 19


It was a personal breakthrough for me to realize that I didn't have to be concerned with what to label myself, and that I could think of myself as simply someone who really needed to stop drinking. After that, there's plenty of time to think about who is or isn't an alcoholic, what that means, and so on. Maybe this is banal, but it was a revelation to me that I did not have to have everything figured out and understood before I got better. It's at least worth a try, if you are suffering, to just disengage from worrying if you should label yourself an alcoholic or an addict or a substance abuser or whatever and think about if your life would be better sober.
posted by thelonius at 4:31 PM on July 19 [11 favorites]


Then you'll forgive me for being confused, since you started out by saying "But I wonder if some moral weight behind a behavior, with an implied negative stigma, can be helpful at times."

I'm also confused as to why you elided four words out of what I said.


Partly because you've persuaded me of what you were saying, but also because I think the very thing that you mention in terms of discussing risk, etc., can be tied into a discussion about human flourishing, which I think carries a certain type of moral weight inherently (but I didn't want to take issue with your last four words, because I think we probably agree more than we disagree.)
posted by SpacemanStix at 4:34 PM on July 19


My own observation from childhood is that a not-insignificant portion of experimentation and subsequent abuse of alcohol and drugs is natural adolescent rebellion and, as such, a direct and proportional response to the degree to which parents are judgmental and alarmist about it.

That's not to say that this messaging doesn't deter other adolescents, because it surely does. And it may be that it ends up a net benefit all things told, though I doubt this.

My point is only that the shaming and alarmism and other vigorously negative messaging are not uniformly dissuasive; for some, it's persuasive or otherwise positively confounding and, for others, it's independent but otherwise harmful. Because shaming always causes harm; and thus it should be understood that shaming as a useful tool is precisely equivalent to amputation or chemotherapy or such in that the benefit outweighs the cost and there is a significant cost.

Also, the moralizing and shaming end up rubbing-off on others merely by association. One among several reasons that I stopped using the narcotic pain medication for my severe genetic illness -- an illness and degree of pain that every doctor I've ever seen, including those quite reluctant to prescribe opioids, believes is unquestionably justifiably severe enough to treat with opioids -- is all the side-eyeing and such I experienced as being someone who took narcotic pain medication.

It's not clear to me why I should have so much trouble, practical and social, in taking a medication that doctors in my experience unanimously believe is appropriate for me to take because, culturally, we've decided that one of the essential tools we have available for combating addiction is moralizing about it and the consequent shame surrounding it.
posted by Ivan Fyodorovich at 4:37 PM on July 19 [5 favorites]


Sorry then, it was actually eight words you elided, SpacemanStix.

Try thinking of it this way: would you throw moral judgements in with teaching your children facts about sex? Of course not* (I hope). So why the moral judgements around substance use? As Ivan just pointed out on preview, shame and moral judgements are more likely to push kids into trying things they might not otherwise try, had they received a purely facts-based education.

* I mean beyond issues around consent & sexual assault, with which the only analogue in substance use is crime to further your disorder
posted by feckless fecal fear mongering at 4:41 PM on July 19


Sorry then, it was actually eight words you elided, SpacemanStix.

My apologies. I wasn't actually trying to change the context of what you were saying, I was hoping to identify some common ground.

I would use moral judgments in almost all contexts of human life, actually, but not in ways that are shaming (which I appreciate this conversation for). I would have discussions in terms of what it means for people to flourish as human persons, and whether or not there are things that are risks to that end.
posted by SpacemanStix at 4:47 PM on July 19


I would use moral judgments in almost all contexts of human life, actually, but not in ways that are shaming

That's the thing though; any (negative) moral judgement carries with it the production of shame. Sometimes this is a net positive, as when dealing with racism/sexism/____ism. Most of the time it's not; sex and substances belong in the latter category. (Again, obviously moral judgement about sexual assault e.g. is a different animal.)

I mean, you can't say to someone that you are judging them on moral grounds and they are failing without making them feel shame or diminishment. Just can't be done. Unless they DGAF about what you're saying anyway, in which case you're wasting your time.
posted by feckless fecal fear mongering at 4:55 PM on July 19


That's the thing though; any (negative) moral judgement carries with it the production of shame.

That's why it might be helpful to do it in positive terms, in terms of human flourishing. I thought that might be what you were getting at in terms of discussing risk, etc. The implications are that the better kind of life is one in which negative risks are not taken, and you try to encourage people towards that kind of life. There are moral implications built in that are positive and don't have anything to do with shame.
posted by SpacemanStix at 4:59 PM on July 19


Personally, the most effective anti-drug campaign I've ever been exposed to in my life was the movie "Requiem for a Dream."

Enjoyable enough as a movie but just a ridiculous portrayal.
posted by save alive nothing that breatheth at 5:05 PM on July 19


Hubert Selby Jr. isn't about subtlety.
posted by mr. digits at 5:09 PM on July 19


I'm Breaking Up With the Word 'Addict' and I Hope You'll Do the Same

"Even in a chaotic stage of drug use, we are not "other." We are women, we are someone's daughter, we continue to laugh, we continue to like jazz and cheeseburgers and comfy pajamas. We cry, we get so lonely, we hate sitting in traffic. Addiction can be wretched, no question, but we do not ever stop being human beings, even during the times in our lives when we are dependent on drugs.

I may be in the fight of my life with drugs, but I am not the drugs that I take. I am a fighter, a survivor -- I am never merely "an addict." Please do not destroy the totality of who I am by reducing me to that one word. We retain our full humanity despite our challenges, particularly when our challenges are much deeper than our attention-grabbing drug use might suggest."
posted by gingerbeer at 5:14 PM on July 19 [3 favorites]


I don't think the terminology changes being discussed here obfuscate the nature of drug/ alcohol use disorders, and I don't think the new terms mince words. "Drug use disorder" describes exactly what is going on, a disorder involving a person's use of drugs. And as Maias' article notes, "drug abuse" is not a very clear term in that it fails to follow the pattern of other 'abuse' terms. Using an accurate clinical term for a condition should not be a major controversy. It doesn't mean we cannot be honest about the risks of drug use and the nature of addiction.

When I was a kid I we had the D.A.R.E. program, which has since been found by multiple studies to be at best ineffective and at worst actively harmful. The education we got, at least at my school, conveyed a lot of the risks associated with drug and alcohol abuse, but mixed that liberally with hyperbole about the effects of drugs and shaming, stigmatizing attitudes toward people who use drugs or have addiction disorders. I came from a family where pretty much everyone had a drug or alcohol use disorder, and I can still remember how terrible I felt sitting in my 6th grade classroom listening to that. Alternating between shame and fear of my family secrets being found out, and white hot anger at the people who were "educating" us. I wasn't left with any sort of moral compass concerning drug use; what I got was a lot of fear and hatred toward anti-drug people. And kids from families like mine are exactly the kids that most need effective interventions, given our much higher likelihood of developing substance use disorders ourselves.

Teach people about the physical, emotional, and legal ramifications of drug use, and teach them about warning signs of drug use disorders and where to turn for help. But there's no reason to teach them shame, and there's certainly no reason for clinicians to persist in using shaming language.
posted by bookish at 5:21 PM on July 19 [9 favorites]


The implications are that the better kind of life is one in which negative risks are not taken, and you try to encourage people towards that kind of life. There are moral implications built in that are positive and don't have anything to do with shame.

There are also shame-based implications buried in that; if you see living without negative risks being taken as a moral good, therefore taking negative risks is morally bad, therfore shameful.

I thought that might be what you were getting at in terms of discussing risk, etc.

Not at all. Not by a long shot. I was talking about facts: this drug acts in these ways on your brain, it produces these effects, and these side effects, and these long-term consequences. I'd include nicotine and alcohol on the list. Fact-based education (whether formal or informal), without moral implications either way. Because you cannot uphold Lifestyle X as being morally good without simultaneously implying that deviation from that lifestyle is morally bad, therefore engendering shame if someone deviates.

But I don't really see much point in going in further circles on this topic, do you?

I am never merely "an addict."

Exactly. "I am a person with a substance use disorder" is a totally different thing to say. Neal Stephenson touched on this in Cryptonomicon when he was talking about Shaftoe being what Germans would call (in a literal translation) "morphine-seeking" rather than "an addict to morphine." Person first, disorder second. (This is one of the reasons I think the Twelve Step model is damaging and has probably caused a great deal of harm; it forces people to define themselves, forever, as an addict--even when they've beaten the disorder.)
posted by feckless fecal fear mongering at 5:21 PM on July 19 [2 favorites]


But I don't really see much point in going in further circles on this topic, do you?

I think I see what you are getting at, though, and although we might fundamentally disagree about the role of moral discussion (and how it's framed), I do appreciate your thoughts about shame and how we should carefully considered how and whether it's conveyed. Thanks for the discussion.
posted by SpacemanStix at 5:30 PM on July 19 [1 favorite]


This is one of the reasons I think the Twelve Step model is damaging and has probably caused a great deal of harm; it forces people to define themselves, forever, as an addict--even when they've beaten the disorder.

I'm not going to defend the 12 Step Model, given its very questionable efficacy, but there is a logic behind the self-labeling concept. Your average person with a history of addiction (that is, compulsive life-destabilizing substance use) will never again be able to use their substance of choice in a casual way, no matter how long they've been sober. Not that their aren't exceptions, but the statistical trend leans overwhelmingly in the direction of relapse.

In the medical field, you're considered to have heart disease if you've had a major cardiac event. No matter how low you get your cholesterol levels, no matter how much you exercise, you will forevermore have heart disease. And the reason for this is that, statistically speaking, one major cardiac event is highly likely to be followed by another. The label has a clinical purpose.

That doesn't mean, of course, that someone needs to let a diagnosis define them as a person.
posted by dephlogisticated at 6:05 PM on July 19 [1 favorite]


I too come from a family where almost everyone has a substance use disorder. I once worked at a design firm that was doing some pro bono work on an anti-drug campaign aimed at teens and I was furious with the whole thing because I knew it would be useless, and it was actually a positive message ("Be Free" or some such). I was at too low a level for anyone to listen to me, but no one seemed to have any awareness of what goes through the mind of the type of teen that is most at risk.

The substance use disorder gene passed me by, but many family members have benefited immensely from twelve step programs. Maybe they work best for certain types of disorders? Maybe they work best for Irish Catholics?
posted by maggiemaggie at 6:22 PM on July 19 [1 favorite]


Substance abuse is rarely, if ever, the pathology. Rather, it is an underlying pathology that leads/drives the person to engage in substance abuse as a way of mitigating it.

Pathologizing the effect of an underlying cause serves only to further separate the person in need of help from potential solutions.

Furthermore, not to put too fine a point on it, my mother was never a drunk because of "stigmatizing language", but because of lifelong depression, and low self-esteem.
posted by gsh at 5:49 AM on July 20 [1 favorite]


Which, gsh, is just more reason to erase the stigmatizing language and deal with her as a person with problems, of which substance use disorder is one.
posted by feckless fecal fear mongering at 6:39 AM on July 20


"Bullshit phrases"

Yeah like how when someone refers to the mentally ill I just think "looney, nut job, psycho, etc." Oh wait I'm not my grandmother. This is progress. It's not bullshit, just as saying that someone who flippantly labels it as such is a person acting from a point of negativity and judgment rather than just an irredeemable ass.
posted by aydeejones at 10:00 AM on July 20 [1 favorite]


Self esteem is a huge component in many cases of major depression. So it's just absurd and obtuse to claim no co morbidity. Ffs.
posted by aydeejones at 10:02 AM on July 20 [1 favorite]


And definitely substance abuse, especially the common addict mentality of crossing an irredeemable point of no return. It's disingenuous as hell to interpret this as "stigma creates drug addicts." No, stigma helps justify their own lack of will to improve in the face of a throwaway culture that writes people off like adjustments on a ledger.
posted by aydeejones at 10:05 AM on July 20 [2 favorites]


Furthermore, not to put too fine a point on it, my mother was never a drunk because of "stigmatizing language", but because of lifelong depression, and low self-esteem.

Nothing in any of the links claims a causal link between stigmatizing language and developing a substance use disorder. Did you read that claim elsewhere, and if so, could you link?
posted by rtha at 10:08 AM on July 20 [1 favorite]


Substance abuse is simply a dumb term (thanks for linking my article, btw!) because it's inaccurate. Children can be abused. Dogs can be abused. Wives can be abused and so can husbands. but who is getting abused when someone "abuses" drugs? It's not the drug— and it's not typically everyone other than the user because the vast majority of people who take drugs don't hurt anyone, even themselves.

People who are taking drugs in a harmful way tend to hurt themselves most of all — but that would be "self abuse" not "drug abuse" but we use that term for something entirely different!

We should stigmatize behaviors that hurt people— drunk driving, for example, is rightly seen as shameful and rightly stigmatized. This *does* deter both people with drinking problems and those without drinking problems from drunk driving. The deterrent works best when provided with alternative behaviors— things like free ride services and designated drivers, for example.

But we shouldn't stigmatize *people* because increasing shame actually increases addictive behavior, and so is counter productive.
posted by Maias at 8:25 PM on July 25 [4 favorites]


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