Words Matter
Words Matter
Language shapes our understanding of the world and our attitudes toward those with a substance use disorder
by Gabriella Granata
Language is the lens through which we perceive reality—it frames our understanding of the world. Attitudes are not merely reflected but constructed through language. Our attitudes and beliefs are often unconsciously formed by the words we use. Words, therefore, shape how health professionals view people and how they treat them. This interplay between language and belief underscores the importance of critically examining the words we use. To ensure patients with SUD can access healthcare and evidence-based treatments, we must address the conscious and unconscious biases that providers often hold. Stigma is propagated through words.
To underscore the impact words have on the care of patients, one landmark study compared the responses from clinicians who were presented with a case vignette and asked a series of questions.1 All of the participants received the same case except in one vignette the individual was described as “a substance abuser” and in the other “having a substance use disorder.” When the patient was described as a “substance abuser,” the respondent was more likely to indicate that the individual in the vignette was personally responsible for the disorder and should be punished. Furthermore, the participants were significantly less likely to offer to help the “substance abuser” seek treatment.
The words clinicians use often get transmitted through medical records and influence how other providers perceive the patient. In another study, research conducted a qualitative analysis to determine if physicians use stigmatizing language in their clinical care notes.2 The researchers found that providers frequently express their biases towards patients in the medical record. These positive and negative attitudes can profoundly change the care a patient receives. Some of the most common forms of negative language included statements questioning the patient’s credibility, expressing disapproval of a patient’s reasoning, portraying the patient as difficult, and emphasizing the provider’s authority over the patient.
While any patient with a SUD is likely to encounter stigmatizing language and beliefs, stigma is often compounded by other patient-specific factors, including stereotypes based on race, social class, or history of incarceration. (See related essay Double Jeopardy by Stuart Haines)
Words have impacted me at my most vulnerable times. Some words felt like attacks, attempting to replace my true identity. Instead of intelligent, funny, or hard-working, I became homeless, indigent, and incapacitated. The words become grenades— strategically spoken at times in order to do the most damage.
These labels erased my humanity. Total strangers felt allowed to criticize or judge me, saying that I was ‘such a waste of life,’ ‘useless,’ or ‘just a drunk or addict.’
After a while, I began to believe these words.
Spoken words cannot be un-said, and they have the power to build up a person, or to destroy a person.
-Marissa Angerer, Mother, Friend, Lawyer, Person in Recovery, and Shatterproof Ambassador
Quote excerpted from the Shatterproof Addiction Language Guide
While addressing stigma is not easy, there is hope for both patients and providers. There is a growing body of evidence to suggest that we can change people’s attitudes and beliefs through training and self-reflection.3,4,5 Changing one’s language can have reverberating affects not just for patients with SUD, but also among health professional colleagues and for our communities at large. Shatterproof ADDICTION LANGUAGE GUIDE is a free resource that provides a list of recommended language to use when speaking about and to people with a substance use disorder. Plus, it includes helpful suggestions for implementation.
It cannot go without saying that the job of healthcare workers comes with many challenges, both professionally and emotionally. The burden of this work should not fall solely on the shoulders of those working on the front lines with patients. We also must seek to address systemic stigma, holding institutions accountable for instituting policies and practices that prioritize the health of all patients in their care.
References
Kelly JF and Westerhoff CM. Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. Int J Drug Policy 2010; 21(3): 202-207.
Park J, Saha S, and Chee B. Physician use of stigmatizing language in patient medical records. JAMA Netw Open 2021; 4 (7): e2117052
Avery J, Knoepflmacher D, Mauer E, et al. Improvement in residents’ attitudes toward individuals with substance use disorders following an online training module on stigma. HSS J 2019; 15 (1): 31-36.
Greer D, Barta L, Liu MT, Andrews LB. Subjective and objective benefits of a novel opioid-related disorders simulation learning experience for pharmacy students. J Am Coll Clin Pharm 2024; 7: 133-1349.
Bielenberg J, Swisher G, Lembke A, Haug NAC. A systematic review of stigma interventions for providers who treat patients with substance use disorders. J Substance Abuse Treat 2021; 131: 108486.