by Enrique Oviedo, M.D.
Assistant Medical Director, Family Services

It has been well documented that when pejorative words are used to refer to someone struggling with a substance use disorder, they are more likely to receive substandard care. Conversely, when words are used that respect the worth and dignity of an individual, the treatment team is more likely to promote the recovery process. Individuals with a SUD often experience shame regarding their disorder. By creating a welcoming and nonjudgmental environment, we are more likely to be able to help these individuals.

Confronting the negative

With the transition from [psychiatric diagnostic and treatment guides] DSM IV to DSM 5, the diagnoses substance abuse and substance dependence were replaced with substance use disorder. The term “abuse” has been found to have a high association with negative judgments. Person-first language has been recommended to replace negative terms used to label people with health conditions. In the field of addiction medicine, “a person with a substance use disorder” is recommended instead of “addict” or “substance abuser.” The term “drug habit” is discouraged because it implies that someone is [deliberately] choosing to continue using a substance.

No person is “dirty”

Urine toxicology screening is an essential part of addiction treatment. Until recently, the terms “clean” and “dirty” urine were used to describe toxicology results. Non-stigmatizing language is preferred. A “negative toxicology screen” should be used instead of a “clean urine,” and a “positive toxicology screen” should be used instead of a “dirty urine.” In no other field of medicine do we refer to a test result as being clean or dirty. When a person is already dealing with so much shame and guilt, it is hurtful to them to be described as “dirty.”

What counts as “recovery”?

In the past, there used to be disagreement whether someone was in recovery if they were using medication-assisted treatment such as methadone or buprenorphine. This is no longer the case. A person can be considered in recovery while taking medications to help treat their substance use disorder. With regard to methadone and buprenorphine (which are used to treat opioid use disorders), the terms “replacement drug” has been used, which implies that someone is just substituting one drug for another. This is inaccurate. When used properly, these medicines treat withdrawal symptoms, reduce cravings, and help the brain circuits heal while a person progresses through their recovery.

Although I prefer to use the term “abstinent” for someone who has stopped using drugs, some patients are unfamiliar with this word, in which case I describe it as being synonymous with “sober.” The terms “sober” and “achieving sobriety” are still commonly used by patients. Using these terms is certainly preferable to asking a patient, “Have you stayed clean?” or “How much clean time do you have?” I will often ask the individual what language they are most comfortable with as it relates to their recovery so that we can talk the same language.

Although the term “medication-assisted treatment (MAT)” has been widely adopted in reference to the use of medications for opioid use disorder, it has recently been suggested that MAT should stand for “medications for addiction treatment.” This more accurately reflects that the standard of care in the treatment of substance use disorders is medication plus psychosocial interventions, and that the medication part is not optional.

What matters most

The terminology will continue to change as we make further advances in the field. However, what is most important is to be mindful about the impact of words, and attempt to use person-first, nonjudgmental language.