Free Your Mind: Will the Associated Press change how we talk about drugs?

Earlier this summer, I sent a note around to my team that the way we talk about drugs and drug use needs to change.

It was prompted by two things. A conversation with a friend about declining -- but persistent -- use of the “r word” when talking about people with genetic disorders such as Down syndrome. And a decision by the Associated Press to update its guidelines for reporters and other writers in how we describe addiction.

My thought was simple. If most of us can agree that the “r word” is offensive and never to be used when writing about health care and health policy, can’t we agree on a new way of writing and talking about addictive drugs?

The AP Stylebook changes are big step toward that goal:

Avoid words like alcoholic, addict, user, and abuser unless they are in quotations or names of organizations, such as Alcoholics Anonymous. ... Instead, choose phrasing like ‘he was addicted, people with heroin addiction, or he used drugs.’

The AP Stylebook continues:

Addiction to alcohol and other drugs is considered a disease that affects a person's brain and behavior. ‘Addiction’ is the preferred term for the disease, although ‘substance-use disorder’ is preferred by some clinicians.

So how do you refer to someone who habitually and compulsively drinks alcohol or takes drugs? The AP recommends "person with addiction."

To follow the AP Stylebook to the letter would be a big change for most health writers. Just look at some recent stories. The bold face is mine:

The New York times ran a special project this July headlined:

The Lawyer, the Addict: A high-powered Silicon Valley attorney dies. His wife investigates, and finds a web of drug abuse in his profession.

That same day, the Washington Post published a piece that used multiple no-no phrases:

State and local officials say it might be time for “tough love”: pushing soaring medical costs onto drug abusers or even limiting how many times first responders can save an individual’s life. … But in the suburban and rural communities that largely escaped that epidemic, the debate this time is far more intimate, as residents’ traditional views about law and order — and how to spend limited resources — are being tested by a growing number of addicts. … Even if saved, an opioid user often is back on drugs within days, if not hours, officials say. … With the help of an algorithm, Leana Wen, Baltimore’s health commissioner, makes decisions about where to supply naloxone kits, prioritizing needle exchanges because addicts who inject drugs are at a high risk of overdosing. … ‘It’s not just the opioid users themselves that we are protecting,’ said Keith Cain, the sheriff in Daviess County, Ky. …Instead of rebelling against Narcan, drug policy advocates say local officials should focus on getting more users into treatment. 

That story encapsulates the reason language choices are so important. The way that people refer to the problem influences decisions about what should be done. Are we rationing treatments for patients with debilitating illnesses? Or are we showing “tough love” for people with moral failings or personal weaknesses who just need to toughen up in response?

Having worked for the AP early in my career, I know that these changes did not come without much discussion and debate. The AP is deliberate in most things and knows that its guidelines can have a massive impact.

But do these changes matter? Are they fig leaves to absolve individuals of their own roles in what is now seen as a nationwide epidemic of drug addiction? Or do they reflect a more science-based understanding of how addiction develops and what actually works in helping people cope? Your response to those questions likely will reflect your larger political views, and that’s part of the problem with how we talk about drugs.

Here are three thoughts on the AP changes that I will address in future posts.

1. These language changes do matter because the way we talk about things has a direct impact on how we act.

2. The changes are late and incomplete but welcome.

3. The changes already are having an impact on the way we tell the story of drug use.

A special shout out to Pia Christensen at the Association of Health Care Journalists (AHCJ) for her piece in Covering Health about the AP Stylebook update, which alerted me to the changes. On August 24, AHCJ will host a webinar on “Responsible, Accurate reporting on addiction.” Click here for more information.