Alcohol and other drug (AOD)-related conditions are among the top public health concerns in the US1. Language shapes the way we view the world and is reflective of our attitudes towards certain objects, concepts, or people. Both addiction and recovery scientists highlight language as not a mere debate about semantics but as vital to reducing stigma and promoting self-help seeking behaviors1.
Most people do not use phrases such as “food abuser” and have moved away from socially defined health conditions (people with Hansen’s disease were called “lepers” and HIV was initially called “Gay-Related Immune Deficiency)1. This type of language does two things:
(1) make the person the problem, not the disease they experience, and
(2) fails to capture the full nature of a disease.
This week’s blog builds on science by Kelly et al. (2016) by providing you an “addiction-ary,” complete with appropriate uses of non-stigmatizing person-first language:
Health. The World Health Organization (WHO)2 conceptualizes health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (1948, p. 1). This implies that someone can have problematic substance use but not meet the clinical threshold for being diagnosed with a substance use disorder.
Substance misuse. Substance misuse is the use of substances (e.g., nicotine, alcohol, cannabinoids, opioids, depressants, stimulants, or hallucinogens) “at high doses or in inappropriate situations which lead to a health or social problem either immediately or over time”3. One example relevant to college students is the stereotypical party-college narrative of binge drinking during tailgates during football games4. Researchers3 have described substance misuse as infrequent instances involving substance use that result in low severity or transient embarrassment.
In general, person first language is always preferable (i.e., “persons with/suffering from a substance use) and the words “abuse” and “abuser” should never be used1 :
"misuse" can be used when referencing prescription drugs
"use" for a purpose such as for “nonmedical reasons”
"used to achieve euphoria"
For heavy alcohol use: “harmful alcohol use,” “hazardous alcohol use” or “unhealthy alcohol use” could be said instead of "alcoholic".
Substance use disorder. A substance use disorder (SUD) is a “separate, independent, diagnosable illness that significantly impairs health and function . . . occurs when [substance misuse] become[s] prolonged, repeated . . . at high doses and/or high frequencies (quantity/frequency thresholds vary across substances)”4. It requires a formal diagnosis from a clinician or is characterized by time spent in treatment facilities.
SUD is diagnosed using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association5. This manual allows for an individual SUD diagnosis across a continuum of mild, moderate, or severe per substance. The DSM-5 further defines remission from addiction as merely the absence of problems, not the absence of substance(s). It makes logical sense, then, that someone can be in remission, or recovery, for one substance but not others, or from disordered eating but not substances.
Substance use habit. Related to substance misuse and SUD is that of a substance use habit6. This describes problematic substance use that is not goal-directed. Substance use is engrained into American culture and society4,7, so people may shift along the continuum of healthy integration, misuse, and problematic use but never reach a clinical threshold of substance use disorder. It’s also important to consider how many people may not (by choice or otherwise) access services to obtain a formal diagnosis. These individuals can still enter a state of “in-recovery” and chose to adopt a recovery identity as they begin to grow in their awareness about their relationship to-, and with-, the object of their addiction.
Recovery. The Recovery Science Research Collaborative is an independent panel of experts who support the direct expansion of the science of recovery and recovery support systems8. They synthesized definitions of recovery from the Substance Abuse Mental Health Service Administration (SAMHSA), the American Science of Addiction Medicine (ASAM), the Betty Ford Institute, the UK Drug Policy Commission, and the Scottish government.
This led to defining recovery as “an individualized, intentional, dynamic, and relational process involving sustained efforts to improve wellness.”
Distinguishing abstinence from sobriety. “Abstinence exclusively refers to the symptomatic dimension of the disease, sobriety goes deeper, also referring to its emotional and mental dimensions9”.
In other words, abstinence only refers to refraining from substance use, or the objective of the addiction (i.e., gambling or porn). Sobriety refers to a deeper integration of life practices or worldviews, and often refers to the relationship someone has with the object of their addiction.
Someone can be abstinent, but not sober; or someone can be sober, but not abstinent.
In both instances, they can still be “in recovery” because they are working on individualized, intentional, relational, and dynamic processes to improve their wellness.
Distinction between treatment and recovery support services10. Treatment is individualized medical care given to a patient for an illness or injury. The goal of most treatments is to change thoughts and behaviors, and, if needed, manage physical dependence on drugs or alcohol.
Recovery support services help people enter into, and navigate, systems of care, remove barriers to recovery, stay engaged in the recovery process, and live full lives in communities of their choice.
Lived experience. Anyone who self-identifies as having experienced mental health and/or substance use conditions, either first-hand or through their family members is considered to qualify as a person with “lived experience” in substance use disorder or mental health conditions11.
It’s important to keep pathways to the recovery open, inclusive, and accessible. Gatekeeping who gets to be “in-recovery” or how they have to practice their recovery could dangerously exclude people from seeking supportive services or communities could help them live more fulfilling, mindful, intentional lives. Everyone’s journey is different and privileging principles over methods could even root us deeper in our recovery while saving someone else’s life.
1. Kelly, J. F., Saitz, R., & Wakeman, S. (2016). Language, substance use disorders, and policy: the need to reach consensus on an “addiction-ary”. Alcoholism treatment quarterly, 34(1), 116-123.
2. World Health Organization (WHO). (n.d.). Lexicon of Alcohol and Drug Terms. Published by the World Health Organization. Retrieved December 16, 2021, from https://www.who.int/about/governance/constitution
3. McLellan, A. T. (2017). Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare? Transactions of the American Clinical and Climatological Association, 128, 112–130.
4. Palmer, C. (2015). [Re]Thinking Drinking and Sport: New Approaches to Sport and Alcohol. Routledge.
5. American Psychiatric Association, D., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5, No. 5). Washington, DC: American psychiatric association.
6. Vandaele, Y., & Janak, P. H. (2018). Defining the place of habit in substance use disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 87, 22–32. https://doi.org/10.1016/j.pnpbp.2017.06.029
7. Aikins, R. D. (2015). From recreational to functional drug use: The evolution of drugs in American higher education, 1960–2014. History of Education, 44(1), 25–43. https://doi.org/10.1080/0046760X.2014.979251
8. Ashford, R. D., Brown, A., Brown, T., Callis, J., Cleveland, H. H., Eisenhart, E., Groover, H., Hayes, N., Johnston, T., Kimball, T., Manteuffel, B., McDaniel, J., Montgomery, L., Phillips, S., Polacek, M., Statman, M., & Whitney, J. (2019). Defining and operationalizing the phenomena of recovery: A working definition from the recovery science research collaborative. Addiction Research & Theory, 27(3), 179–188.
9. Helm, P. (2019). Sobriety versus abstinence. How 12-stepper negotiate long-term recovery across groups. Addiction research & theory, 27(1), 29-36.
10. SAMHSA. (2023, April 4). Types of Treatment. Retrieved from https://www.samhsa.gov/find-support/learn-about-treatment/types-of-treatment.
11. SAMHSA. (2023, May 1). Substance Abuse and Mental Health Services Administration Policy on the Inclusion of People with Lived Experience. Retrieved from https://www.samhsa.gov/sites/default/files/inclusion-policy-tc.pdf
About the author
Chelsea is a person in long term natural recovery from substance misuse. She holds a PhD in Higher Educational Leadership and Policy Studies from Florida State University where she vitalized early efforts to implement a Collegiate Recovery Program. She is a recovery scientist, identity theorist, and committed to expanding the conversation of recovery as inclusive as possible. She currently serves on the Board of Directors for the Association of Recovery in Higher Education and Christine Ortoll Charity. Learn more about her, here.