Human language is an amazing thing. We humans have become the top of the food chain mainly because we can communicate effectively enough to work together efficiently. We accomplish much of this work through our use of language. In an effort to be efficient however, we have created many language-based “short-cuts” and words end up meaning different things to different people and they often change over time.
Many people would like to minimize the impact of words and frequently wish people who are reacting to their word choice would just “be less sensitive”. The reality is that our word choice can have unintended consequences on the person listening to you. When it comes to changing substance use patterns, your word choice can have a dramatic impact on motivation and willingness to change. For example, the word “addict?” is so often connected with stigma and negative connotations that the writers of the new version of the Diagnostic and Statistical Manual (DSM-V, the diagnosis guide for all things mental health related) overwhelmingly agreed to use the word dependence over addiction. They decided that the word was actually a pejorative term.
Researchers have also shown the potential impact of using the word addict or alcohol when referring to someone who is in treatment for a substance use problem. Terrie Moyers, a psychologist at CASAA in New Mexico who is one of the leaders in motivational treatment approaches, conducted research with substance abuse counselors and examined attributes they attached to the label “alcoholic.” She found that associated with this label were the beliefs that “alcoholics are liars,” “cannot make good decisions for themselves,” “have personality deficits that predate drinking,” have special “spiritual deficits,” and “need strong confrontation.” These are professionals who work directly with people who struggle with their substance use!
We also hear treatment providers saying their client “just needs to accept he is an alcoholic” as if doing that will somehow help the problem resolve. This reasoning is incomplete and prevents us from being able to look at each person as an individual, with genetics, life experiences, and current environments that all contribute to their relationship with substances and need to be addressed in order to help them change.
“My wife tells me I’m an alcoholic” is something we also hear in our work. While this person’s spouse may have good intentions in telling him this, including hoping he gets some help, it is all too common that the person receiving the label just wants to push it away and find all the reasons they are not an alcoholic. To insist that someone identify with and accept that they are an addict or alcoholic can be a motivation killer.
This does not mean that, across the board, everyone in the world feels that these words are not helpful. Quite the opposite, many people feel that identifying as being an addict or alcoholic helps them put into context very difficult and confusing feelings and thoughts. Additionally, it can be empowering, and even supportive as they can then identify as part of a group, like people do in the fellowship of AA meetings! The difference here is the idea of choice; choosing to identify with the word is one thing, having it assigned to you is another.
In the process of change, whether you are trying to change your own behaviors or helping someone else change theirs, the words you choose can open the doors to change and expand perspectives or they can set up barriers and roadblocks to understanding. We cannot escape the reality that stigma is conveyed by word choice: once spoken, the genie cannot go back in the bottle. IF you are trying to help someone consider changing their relationship with drugs or alcohol, choose your words wisely.