What the Latest Research Says about Recovery, Stigma, and the Language We Use

A recently published study out of the University of Pennsylvania Perelman School of Medicine provides further support for reducing the impact of stigma and stigmatizing language on individuals in recovery (Ashford, Brown, & Curtis, 2018). As a basis for their research, the authors cite previous studies that showed that stigmatizing language impacts those in recovery or those who would be in recovery. First, there is a negatively biased perception of people in recovery by the general public and peers that prevents many people from accessing care for substance use disorder (SUD) (Center for Behavioral Health Statistics and Quality, 2016).

The second impact comes from stigma affecting the quality of healthcare and recommendations for treatment, as provided by medical personnel to people in recovery, as well as the actual treatment people received once they were actually involved in treatment (van Boekel et al., 2013; Kelly and Westerhoff, 2010). Citing earlier work by ways Goffman, (1963) and Link and Phelan (2001), authors based their study on a multidimensional construct of stigma involving a label and a stereotype. The label “The label (e.g., addict) links the person to a set of undesirable characteristics that work to form the stereotype (i.e., beliefs held about a group of people with a substance use disorder). When people link a certain label to a person, and they believe the stereotype, they react negatively to the person which in turn leads them to place a more social distance from the person, engage in discriminatory ways, or support potentially harmful activities to the stereotyped individual (Ashford, et.al, 2018.)”

The study involved administering two measures, the Go/No Association Task (GNAT) and a vignette-based social distance scale called the Bogardus Social Distance Scale (BSDS) to 1,288 subjects. The purpose was to identify labels with positive or negative associations and equated “good terms” with non- stigmatizing associations and “bad terms” with stigmatizing associations. The BSDS identified terms that led to negative beliefs and a tendency to create social distance, discrimination, or even harmful behaviors toward persons in recovery.

Results of the study have led the authors to encourage ending the use of the terms “addict”, “alcoholic”, “opioid addict”, and “substance abuser”. The study authors also support the use of “recurrence of use,” “pharmacotherapy,” “medication-assisted recovery,” and “long-term recovery” as appropriate as they are positive terms that do not promote stigma. These research results bring to the forefront the important fact that what we say and the words we use make a huge difference in reducing stigma and helping to remove some of the barriers to recovery faced by persons with substance use disorders. During Recovery Month and beyond, helpful infographics illustrating the “recovery dialects” (also available in Spanish) are useful tools we can use to share the latest evidence that guides behavioral health professionals.

References

2015 National survey on drug use and health: Detailed tables. Substance Abuse and Mental Health Services Administration Retrieved 9.14.2018 from: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf .

Ashford, R. D., Brown, A. M., & Curtis, B. (2018). Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias. Drug and Alcohol Dependence, 189, 131-138. doi: 10.1016/j.drugalcdep.2018.05.005 Retrieved 9.14.2018 from: https://www.ncbi.nlm.nih.gov/pubmed/29913324 .

Ashford, R. D., Brown, A. M., & Curtis, B. (2018). Systemic barriers in substance use disorder treatment: A prospective qualitative study of professionals in the field. Drug and Alcohol Dependence, 189, 62-69. doi: 10.1016/j.drugalcdep.2018.04.033 Retrieved 9.14.2018 from: https://www.ncbi.nlm.nih.gov/pubmed/29883870 .

Botticelli, M. P., & Koh, H. K. (2016). Changing the language of addiction. Jama, 316(13), 1361-1362. doi:10.1001/jama.2016.11874 Retrieved 9.14.2018 from: https://jamanetwork.com/journals/jama/fullarticle/2565298 .

Center for Behavioral Health Statistics and Quality, 2017. 2016 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD Retrieved 9.14.2018 from: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf .

Goffman, Erving. (1963) Stigma: notes on the management of spoiled identity Englewood Cliffs, N.J., Prentice-Hall.

Kelly, J. F., & Westerhoff, C. M. (2009;2010;). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy, 21(3), 202-207. doi: 10.1016/j.drugpo.2009.10.010 Retrieved 9.14.2018 from: https://www.ncbi.nlm.nih.gov/pubmed/20005692 .

Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27(1), 363-385. doi: 10.1146/annurev.soc.27.1.363 Retrieved 9.14.2018 from: https://www.annualreviews.org/doi/abs/10.1146/annurev.soc.27.1.363 .

van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug and Alcohol Dependence, 131(1), 23-35. doi: 10.1016/j.drugalcdep.2013.02.018 Retrieved 9.14.2018 from: https://www.ncbi.nlm.nih.gov/pubmed/23490450 .