Free Your Mind: Put people before problems as you write about drugs

The push to change the way we talk about drug addiction started decades ago.

It started because clinical professionals and, later, government agencies tasked with improving the health and well-being of people started to look at addiction to drugs not as a personal weakness or a criminal behavior but as a mental disorder.

One of the early changes was in 1965 when the American Medical Association started describing alcoholism as a medical disorder.

In 1980, the American Psychiatric Association (APA) listed in its Diagnostic and Statistical Manual of Mental Disorders (DSM-3) two categories: substance abuse and substance dependence. Then, in 2013, in the fifth edition of the DSM (DSM-5) the APA eliminated “abuse” and “dependence.” Instead, both were captured as “substance use disorders.”

For the first time, the APA explicitly stepped away from the concept of “addiction,” writing that addiction “is omitted from the official DSM-5 substance use disorder diagnostic terminology because of its uncertain definition and its potentially negative connotation.”

So what should writers use when writing about drug use disorders? Is everything a disorder or can we write about “addiction” or “addictive behaviors”? There are multiple opinions out there, and, for now, those writing guides for journalists have been sticking with “addiction” but eschewing “addict.”

In September 2015, the National Center on Disability and Journalism (NCDJ) published a style guide that, referring to the APA, recommended that people avoid using the term “addict.”

The American Psychiatric Association recommends avoiding the term addict (and alcoholic), suggesting instead the phrase “someone experiencing a drug/alcohol problem.” The association also discourages using the term junkie, which specifically refers to someone who misuses heroin.

The NCDJ landed in the same place where the Associated Press ultimately landed, recommending that writers use terms such as “someone with a drug addiction” and “someone recovering from a methamphetamine addiction.” This is sometimes referred to as “person first” language, meaning that it puts the emphasis on the person and not on the disorder.

In general, this is a great way to think and write about health issues. It can be easy to continually use terms like “diabetic” or “paraplegic,” as if the particular health challenge a person might be facing is their sole defining feature. When you force yourself to use person first language, you actually will find yourself viewing the sources of your stories in a different light. Even if you are only quoting a person in the story and, because of space constraints and deadline pressure, summing them up with a two-sentence anecdote, the simple act of thinking about how you describe their health – be it a drug use disorder or something else – will have an impact on how your story connects with your audience, nearly all of whom will have their own health challenges, because most of us do.

One of the last acts of the Obama White House was to issue a guide for how to talk about drug use disorders. The Director of the Office of National Drug Control Policy, Dr. Michael Botticelli, issued a memo that said, among other things:

Substance use disorder (the most severe form of which is referred to as “addiction”) is a chronic brain disorder from which people can and do recover. Nonetheless, sometimes the terminology used in the discussion of substance use can suggest that problematic use of substances and substance use disorders are the result of a personal failing; that people choose the disorder, or they lack the willpower or character to control their substance use. However, research shows addictive substances can lead to dramatic changes in brain function and reduce a person’s ability to control his or her substance use, and that repeated use of these substances powerfully alters brain chemistry and the function of brain circuitry to create a neurobiological disorder.

The changes already are having an impact. When the AP Style Guide this year changed the way it described substance use disorders, Felice J. Freyer, an influential health writer at the Boston Globe, wrote about the changes and implemented them at the same time. In a caption for a story about the changes, the Globe wrote, “The Associated Press Stylebook, one of the most widely used guides to language for news organizations, is recommending that journalists be mindful of the language they use to describe people like Jessica, who is a homeless Philadelphia woman with a heroin addiction.”

One of the most important things about the way the Globe handled the story is that they shared a photograph of Jessica. She is a person, the Globe is saying, not an “addict,” not an “abuser.” She deserves the same respect as anyone else.

One final note: The NCDJ guide is very useful for a range of health issues. Reading through it, you may second guess yourself on how you have written about any number of things in the past. (You’ll think twice about using a term like “spastic,” for example.) On substance use disorders in particular, the center raises important questions about a number of words and phrases. Based on that guide, on the AP Style Guide and on the National Drug Control Policy memo, I offer the following lists:

Terms to avoid:

Addict

Drug abuser

Junkie

Drug abuse

Substance abuse

Drug habit

Clean drug test

Dirty drug test

Getting clean

Substance abuse

Substitution

Terms to use instead:

Substance use disorder

Someone experiencing a drug or alcohol problem

Testing positive or negative for a particular drug

Someone with a drug addiction

Someone recovering from a drug addiction

Person with a Substance Use Disorder

Negative toxicology screen

Not currently using substances

Person who is currently using substances

Person in recovery

Medication-assisted treatment

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