Language is important to avoid perpetuating stigma, but the language preferences among people suffering from substance use disorders themselves are unclear. This study characterized the terms people in treatment prefer to describe themselves and their substance use.
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Recently, the substance use research field has called for a move away from potentially stigmatizing language, such as “addict,” “substance abuser,” and “junkie,” to more person-first language, such as “person with a substance use disorder.” This is a well-intentioned effort by substance use researchers and clinicians to avoid perpetuating stigma and stereotypes. Indeed, patient-centered approaches in treatment programs can improve treatment outcomes.
However, this call to use person-first language has not been driven by people with lived experience themselves. Not engaging the people who are affected by the condition in language preferences could be risky, since people with other conditions, such as autism, prefer identity-first language instead of person-first language (e.g., “I am autistic”). This is especially relevant given research in 12-step programs, where taking on the identity of the condition as an “addict” or “alcoholic” is commonly used and is a culturally normative way to maintain motivation for recovery.
There have been few studies that have engaged people with substance use disorders to determine their actual preferences. Of the studies that have been conducted, results showed that people in treatment most commonly reported “addict” as how they prefer to self-identify, but preferred person-first language when presented with a list of terms. Another study found that whether people in recovery identified as an “addict” or “person with a substance use disorder” depended on whether the setting was family-based or 12-step program-based. More research that engages people with substance use disorders would help to clarify their language preferences. The researchers in this study explored terminology preferences among patients in methadone treatment for opioid use disorder.
The research team conducted a survey with patients enrolled in methadone treatment to examine their preferences for words describing substance use disorders and the people who have them. They also examined whether these preferences differ by age, sex, and race/ethnicity.
Surveys were conducted between January 1, 2019 and February 28, 2020 during participants’ first treatment plan review, which was approximately 30 days after they initiated treatment. The survey included 3 questions that assessed how participants: (1) prefer counselors describe the problems they are seeking treatment for; (2) prefer counselors to refer to them broadly; and (3) prefer counselors describe them personally. Each question was followed by a list of words that the research team compiled from diagnostic systems, literature, and the authors’ own experiences with patients, to which participants could respond using a 7-point Likert scale ranging from Strongly Disagree (1) to Strongly Agree (7). The survey also included a fourth question that assessed whether participants believed 12-step programs (e.g., AA, NA) were the “best treatment” for them, to which they could respond using the same 7-point Likert scale. Demographic information (i.e., age, sex, race, and ethnicity) was collected during participants’ enrollment in the methadone treatment program.
The research team analyzed descriptive statistics to determine the top 3 and bottom 3 preferred terms. Differences among demographics were examined only among the top 3 terms. The race variable was collapsed into 2 categories: White/Caucasian and Other (i.e., a binary variable).
Separately, the study examined whether belief that 12-step groups were the “best treatment” for the person, was uniquely associated with a preference for the term “addict” specifically, given the term’s role in these programs, also including age, sex, and race/ethnicity in the model.
Participants were recruited from the APT Foundation, a non-profit, outpatient methadone maintenance treatment program in southern New England. The APT Foundation is one of the largest methadone maintenance treatment providers in the area and is a community-based organization that uses an open-access model, which is intended to reduce common barriers to treatment. Patients were eligible for the study if they were receiving treatment at the APT Foundation and if they were literate in English.
A total of 450 participants completed the survey. Of these, the majority identified as men (59.6%), as White (77.6%), and as not Hispanic or Latino (87.3%). Participants’ average age was 38.5 years old.
Participants preferred medically accurate, person-first language
For the question asking how participants prefer counselors to describe the problems they are seeking treatment for, participants on average had the highest ratings for the terms “addiction,” “substance use,” and “substance abuse.” Their lowest preference ratings were for the terms “drug misuse,” “substance misuse,” and “substance-related disorder.”
For the question asking how participants prefer counselors to refer to them broadly, participants on average had the highest ratings for the terms “client,” “patient,” and “guest.” Their lowest preference ratings were for the terms “customer,” “service user,” and “consumer.”
For the question asking how participants prefer counselors to refer to them personally, participants on average had the highest ratings for the terms “person with an addiction,” “person with substance use disorder,” and “substance-dependent person.” Their lowest preference ratings were “junkie,” “druggie,” and “drug user.”
Preferences differed by demographics and belief in a 12-step program as the best treatment
For the question asking how participants prefer counselors to describe the problems they are seeking treatment for, there were differences by race, with White people preferring the terms “addiction,” “substance use,” and “substance abuse” slightly more than those who identified as other races. There was also an age difference, with people who were older preferring the term “substance use” less than younger people. There were no differences by sex for the top 3 highest rated terms.
For the question asking how participants prefer counselors to refer to them broadly, there were no differences by sex, age, and race among the top 3 highest rated terms.
For the question asking how participants prefer counselors to refer to them personally, there was a race difference, with people identifying as a race other than White preferring the term “person with a substance use disorder” slightly less than people identifying as White.
When examining individual characteristics associated specifically with preference for the term “addict”, each 1-point increase in belief in 12-step programs as the best treatment option was uniquely associated with a 22% increase in a 1-point stronger preference for the term “addict.” Identifying as White was also positively associated with preference for the term “addict”; compared to races other than White, these participants were 82% more likely to have a 1-point preference for the term “addict”.
The research team investigated language preferences among people enrolled in a methadone treatment program. In general, participants rated terms that were medically accurate and person-first the highest, while they rated terms that were condition-first and stigmatizing the lowest. This pattern of findings is largely similar to a study of individuals with opioid use disorder in medically-supervised detoxification. However, this varied slightly by demographics and by belief in 12-step programs as the best treatment option. People identifying as White seemed to prefer certain terms that were medically accurate and person-first slightly more than people identifying as other races, and people who identified as White and believed 12-step programs were the best treatment showed an increase in their preference for the term “addict.”
The preference for the term “addict” in the subgroup of methadone patients who believe 12-step programs are the best treatment reflects the power of the term in such programs and, for some, is not experienced as stigmatizing. However, the term was not among the highest 3 rated terms, which may suggest that people in treatment/recovery prefer counselors to refer to them with medically accurate, person-first language, while they prefer to self-identify as “addict.” The individuals with opioid use disorder in medically-supervised detoxification also preferred the term “heroin addict”, though to a lesser degree than “person with heroin addiction”. Further, the finding that identifying as White was also associated with preference for the term “addict” in the same statistical model may be consistent with other work showing White people may be more likely to attend 12-step groups than people of other races, even when adjusting for clinical severity and treatment attendance.
Of note, when this sample of individuals with opioid use disorder in a methadone program reacted to language regarding the problems for which they sought treatment, the difference between the highest rated term (“addiction”) and lowest rated term (“drug misuse”) was less than 1. On the other hand, differences between the highest and lowest rated terms were larger for language regarding how they wished to be referred to by counselors broadly (a 2.63 difference) and personally (a 2.85 difference). This suggests that people in treatment may not feel as strongly about what their condition is referred to as much as they feel about how they are referred to, which may reflect views on stigma. For instance, the term “junkie” carries much more stigma than “person with an addiction,” which is more medically accurate and person-first.
Overall, these findings are mostly consistent with recent calls to use person-first, medically accurate language. However, there were certain instances where this was not the case, such as preference for the term “addict” among people who believe 12-step programs are the best treatment option and “substance-dependent person” being among the top 3 highest rated terms. Accordingly, asking how people with substance use disorders would like to be referred may be best practice.
People in methadone treatment for opioid use disorder generally prefer medically accurate, person-first language over stigmatizing, business-oriented language. Belief in 12-step programs as the best treatment and identifying as White are associated with increases in preference for the term “addict.”
Gazzola, M. G., Maclean, E., Beitel, M., Carmichael, I. D., Cammack, K. M., Eggert, K. F., … & Barry, D. T. (2023). What’s in a name? Terminology preferences among patients receiving methadone treatment. Journal of General Internal Medicine, 38(3), 653-660. doi: 10.1007/s11606-022-07813-w
l
Recently, the substance use research field has called for a move away from potentially stigmatizing language, such as “addict,” “substance abuser,” and “junkie,” to more person-first language, such as “person with a substance use disorder.” This is a well-intentioned effort by substance use researchers and clinicians to avoid perpetuating stigma and stereotypes. Indeed, patient-centered approaches in treatment programs can improve treatment outcomes.
However, this call to use person-first language has not been driven by people with lived experience themselves. Not engaging the people who are affected by the condition in language preferences could be risky, since people with other conditions, such as autism, prefer identity-first language instead of person-first language (e.g., “I am autistic”). This is especially relevant given research in 12-step programs, where taking on the identity of the condition as an “addict” or “alcoholic” is commonly used and is a culturally normative way to maintain motivation for recovery.
There have been few studies that have engaged people with substance use disorders to determine their actual preferences. Of the studies that have been conducted, results showed that people in treatment most commonly reported “addict” as how they prefer to self-identify, but preferred person-first language when presented with a list of terms. Another study found that whether people in recovery identified as an “addict” or “person with a substance use disorder” depended on whether the setting was family-based or 12-step program-based. More research that engages people with substance use disorders would help to clarify their language preferences. The researchers in this study explored terminology preferences among patients in methadone treatment for opioid use disorder.
The research team conducted a survey with patients enrolled in methadone treatment to examine their preferences for words describing substance use disorders and the people who have them. They also examined whether these preferences differ by age, sex, and race/ethnicity.
Surveys were conducted between January 1, 2019 and February 28, 2020 during participants’ first treatment plan review, which was approximately 30 days after they initiated treatment. The survey included 3 questions that assessed how participants: (1) prefer counselors describe the problems they are seeking treatment for; (2) prefer counselors to refer to them broadly; and (3) prefer counselors describe them personally. Each question was followed by a list of words that the research team compiled from diagnostic systems, literature, and the authors’ own experiences with patients, to which participants could respond using a 7-point Likert scale ranging from Strongly Disagree (1) to Strongly Agree (7). The survey also included a fourth question that assessed whether participants believed 12-step programs (e.g., AA, NA) were the “best treatment” for them, to which they could respond using the same 7-point Likert scale. Demographic information (i.e., age, sex, race, and ethnicity) was collected during participants’ enrollment in the methadone treatment program.
The research team analyzed descriptive statistics to determine the top 3 and bottom 3 preferred terms. Differences among demographics were examined only among the top 3 terms. The race variable was collapsed into 2 categories: White/Caucasian and Other (i.e., a binary variable).
Separately, the study examined whether belief that 12-step groups were the “best treatment” for the person, was uniquely associated with a preference for the term “addict” specifically, given the term’s role in these programs, also including age, sex, and race/ethnicity in the model.
Participants were recruited from the APT Foundation, a non-profit, outpatient methadone maintenance treatment program in southern New England. The APT Foundation is one of the largest methadone maintenance treatment providers in the area and is a community-based organization that uses an open-access model, which is intended to reduce common barriers to treatment. Patients were eligible for the study if they were receiving treatment at the APT Foundation and if they were literate in English.
A total of 450 participants completed the survey. Of these, the majority identified as men (59.6%), as White (77.6%), and as not Hispanic or Latino (87.3%). Participants’ average age was 38.5 years old.
Participants preferred medically accurate, person-first language
For the question asking how participants prefer counselors to describe the problems they are seeking treatment for, participants on average had the highest ratings for the terms “addiction,” “substance use,” and “substance abuse.” Their lowest preference ratings were for the terms “drug misuse,” “substance misuse,” and “substance-related disorder.”
For the question asking how participants prefer counselors to refer to them broadly, participants on average had the highest ratings for the terms “client,” “patient,” and “guest.” Their lowest preference ratings were for the terms “customer,” “service user,” and “consumer.”
For the question asking how participants prefer counselors to refer to them personally, participants on average had the highest ratings for the terms “person with an addiction,” “person with substance use disorder,” and “substance-dependent person.” Their lowest preference ratings were “junkie,” “druggie,” and “drug user.”
Preferences differed by demographics and belief in a 12-step program as the best treatment
For the question asking how participants prefer counselors to describe the problems they are seeking treatment for, there were differences by race, with White people preferring the terms “addiction,” “substance use,” and “substance abuse” slightly more than those who identified as other races. There was also an age difference, with people who were older preferring the term “substance use” less than younger people. There were no differences by sex for the top 3 highest rated terms.
For the question asking how participants prefer counselors to refer to them broadly, there were no differences by sex, age, and race among the top 3 highest rated terms.
For the question asking how participants prefer counselors to refer to them personally, there was a race difference, with people identifying as a race other than White preferring the term “person with a substance use disorder” slightly less than people identifying as White.
When examining individual characteristics associated specifically with preference for the term “addict”, each 1-point increase in belief in 12-step programs as the best treatment option was uniquely associated with a 22% increase in a 1-point stronger preference for the term “addict.” Identifying as White was also positively associated with preference for the term “addict”; compared to races other than White, these participants were 82% more likely to have a 1-point preference for the term “addict”.
The research team investigated language preferences among people enrolled in a methadone treatment program. In general, participants rated terms that were medically accurate and person-first the highest, while they rated terms that were condition-first and stigmatizing the lowest. This pattern of findings is largely similar to a study of individuals with opioid use disorder in medically-supervised detoxification. However, this varied slightly by demographics and by belief in 12-step programs as the best treatment option. People identifying as White seemed to prefer certain terms that were medically accurate and person-first slightly more than people identifying as other races, and people who identified as White and believed 12-step programs were the best treatment showed an increase in their preference for the term “addict.”
The preference for the term “addict” in the subgroup of methadone patients who believe 12-step programs are the best treatment reflects the power of the term in such programs and, for some, is not experienced as stigmatizing. However, the term was not among the highest 3 rated terms, which may suggest that people in treatment/recovery prefer counselors to refer to them with medically accurate, person-first language, while they prefer to self-identify as “addict.” The individuals with opioid use disorder in medically-supervised detoxification also preferred the term “heroin addict”, though to a lesser degree than “person with heroin addiction”. Further, the finding that identifying as White was also associated with preference for the term “addict” in the same statistical model may be consistent with other work showing White people may be more likely to attend 12-step groups than people of other races, even when adjusting for clinical severity and treatment attendance.
Of note, when this sample of individuals with opioid use disorder in a methadone program reacted to language regarding the problems for which they sought treatment, the difference between the highest rated term (“addiction”) and lowest rated term (“drug misuse”) was less than 1. On the other hand, differences between the highest and lowest rated terms were larger for language regarding how they wished to be referred to by counselors broadly (a 2.63 difference) and personally (a 2.85 difference). This suggests that people in treatment may not feel as strongly about what their condition is referred to as much as they feel about how they are referred to, which may reflect views on stigma. For instance, the term “junkie” carries much more stigma than “person with an addiction,” which is more medically accurate and person-first.
Overall, these findings are mostly consistent with recent calls to use person-first, medically accurate language. However, there were certain instances where this was not the case, such as preference for the term “addict” among people who believe 12-step programs are the best treatment option and “substance-dependent person” being among the top 3 highest rated terms. Accordingly, asking how people with substance use disorders would like to be referred may be best practice.
People in methadone treatment for opioid use disorder generally prefer medically accurate, person-first language over stigmatizing, business-oriented language. Belief in 12-step programs as the best treatment and identifying as White are associated with increases in preference for the term “addict.”
Gazzola, M. G., Maclean, E., Beitel, M., Carmichael, I. D., Cammack, K. M., Eggert, K. F., … & Barry, D. T. (2023). What’s in a name? Terminology preferences among patients receiving methadone treatment. Journal of General Internal Medicine, 38(3), 653-660. doi: 10.1007/s11606-022-07813-w
l
Recently, the substance use research field has called for a move away from potentially stigmatizing language, such as “addict,” “substance abuser,” and “junkie,” to more person-first language, such as “person with a substance use disorder.” This is a well-intentioned effort by substance use researchers and clinicians to avoid perpetuating stigma and stereotypes. Indeed, patient-centered approaches in treatment programs can improve treatment outcomes.
However, this call to use person-first language has not been driven by people with lived experience themselves. Not engaging the people who are affected by the condition in language preferences could be risky, since people with other conditions, such as autism, prefer identity-first language instead of person-first language (e.g., “I am autistic”). This is especially relevant given research in 12-step programs, where taking on the identity of the condition as an “addict” or “alcoholic” is commonly used and is a culturally normative way to maintain motivation for recovery.
There have been few studies that have engaged people with substance use disorders to determine their actual preferences. Of the studies that have been conducted, results showed that people in treatment most commonly reported “addict” as how they prefer to self-identify, but preferred person-first language when presented with a list of terms. Another study found that whether people in recovery identified as an “addict” or “person with a substance use disorder” depended on whether the setting was family-based or 12-step program-based. More research that engages people with substance use disorders would help to clarify their language preferences. The researchers in this study explored terminology preferences among patients in methadone treatment for opioid use disorder.
The research team conducted a survey with patients enrolled in methadone treatment to examine their preferences for words describing substance use disorders and the people who have them. They also examined whether these preferences differ by age, sex, and race/ethnicity.
Surveys were conducted between January 1, 2019 and February 28, 2020 during participants’ first treatment plan review, which was approximately 30 days after they initiated treatment. The survey included 3 questions that assessed how participants: (1) prefer counselors describe the problems they are seeking treatment for; (2) prefer counselors to refer to them broadly; and (3) prefer counselors describe them personally. Each question was followed by a list of words that the research team compiled from diagnostic systems, literature, and the authors’ own experiences with patients, to which participants could respond using a 7-point Likert scale ranging from Strongly Disagree (1) to Strongly Agree (7). The survey also included a fourth question that assessed whether participants believed 12-step programs (e.g., AA, NA) were the “best treatment” for them, to which they could respond using the same 7-point Likert scale. Demographic information (i.e., age, sex, race, and ethnicity) was collected during participants’ enrollment in the methadone treatment program.
The research team analyzed descriptive statistics to determine the top 3 and bottom 3 preferred terms. Differences among demographics were examined only among the top 3 terms. The race variable was collapsed into 2 categories: White/Caucasian and Other (i.e., a binary variable).
Separately, the study examined whether belief that 12-step groups were the “best treatment” for the person, was uniquely associated with a preference for the term “addict” specifically, given the term’s role in these programs, also including age, sex, and race/ethnicity in the model.
Participants were recruited from the APT Foundation, a non-profit, outpatient methadone maintenance treatment program in southern New England. The APT Foundation is one of the largest methadone maintenance treatment providers in the area and is a community-based organization that uses an open-access model, which is intended to reduce common barriers to treatment. Patients were eligible for the study if they were receiving treatment at the APT Foundation and if they were literate in English.
A total of 450 participants completed the survey. Of these, the majority identified as men (59.6%), as White (77.6%), and as not Hispanic or Latino (87.3%). Participants’ average age was 38.5 years old.
Participants preferred medically accurate, person-first language
For the question asking how participants prefer counselors to describe the problems they are seeking treatment for, participants on average had the highest ratings for the terms “addiction,” “substance use,” and “substance abuse.” Their lowest preference ratings were for the terms “drug misuse,” “substance misuse,” and “substance-related disorder.”
For the question asking how participants prefer counselors to refer to them broadly, participants on average had the highest ratings for the terms “client,” “patient,” and “guest.” Their lowest preference ratings were for the terms “customer,” “service user,” and “consumer.”
For the question asking how participants prefer counselors to refer to them personally, participants on average had the highest ratings for the terms “person with an addiction,” “person with substance use disorder,” and “substance-dependent person.” Their lowest preference ratings were “junkie,” “druggie,” and “drug user.”
Preferences differed by demographics and belief in a 12-step program as the best treatment
For the question asking how participants prefer counselors to describe the problems they are seeking treatment for, there were differences by race, with White people preferring the terms “addiction,” “substance use,” and “substance abuse” slightly more than those who identified as other races. There was also an age difference, with people who were older preferring the term “substance use” less than younger people. There were no differences by sex for the top 3 highest rated terms.
For the question asking how participants prefer counselors to refer to them broadly, there were no differences by sex, age, and race among the top 3 highest rated terms.
For the question asking how participants prefer counselors to refer to them personally, there was a race difference, with people identifying as a race other than White preferring the term “person with a substance use disorder” slightly less than people identifying as White.
When examining individual characteristics associated specifically with preference for the term “addict”, each 1-point increase in belief in 12-step programs as the best treatment option was uniquely associated with a 22% increase in a 1-point stronger preference for the term “addict.” Identifying as White was also positively associated with preference for the term “addict”; compared to races other than White, these participants were 82% more likely to have a 1-point preference for the term “addict”.
The research team investigated language preferences among people enrolled in a methadone treatment program. In general, participants rated terms that were medically accurate and person-first the highest, while they rated terms that were condition-first and stigmatizing the lowest. This pattern of findings is largely similar to a study of individuals with opioid use disorder in medically-supervised detoxification. However, this varied slightly by demographics and by belief in 12-step programs as the best treatment option. People identifying as White seemed to prefer certain terms that were medically accurate and person-first slightly more than people identifying as other races, and people who identified as White and believed 12-step programs were the best treatment showed an increase in their preference for the term “addict.”
The preference for the term “addict” in the subgroup of methadone patients who believe 12-step programs are the best treatment reflects the power of the term in such programs and, for some, is not experienced as stigmatizing. However, the term was not among the highest 3 rated terms, which may suggest that people in treatment/recovery prefer counselors to refer to them with medically accurate, person-first language, while they prefer to self-identify as “addict.” The individuals with opioid use disorder in medically-supervised detoxification also preferred the term “heroin addict”, though to a lesser degree than “person with heroin addiction”. Further, the finding that identifying as White was also associated with preference for the term “addict” in the same statistical model may be consistent with other work showing White people may be more likely to attend 12-step groups than people of other races, even when adjusting for clinical severity and treatment attendance.
Of note, when this sample of individuals with opioid use disorder in a methadone program reacted to language regarding the problems for which they sought treatment, the difference between the highest rated term (“addiction”) and lowest rated term (“drug misuse”) was less than 1. On the other hand, differences between the highest and lowest rated terms were larger for language regarding how they wished to be referred to by counselors broadly (a 2.63 difference) and personally (a 2.85 difference). This suggests that people in treatment may not feel as strongly about what their condition is referred to as much as they feel about how they are referred to, which may reflect views on stigma. For instance, the term “junkie” carries much more stigma than “person with an addiction,” which is more medically accurate and person-first.
Overall, these findings are mostly consistent with recent calls to use person-first, medically accurate language. However, there were certain instances where this was not the case, such as preference for the term “addict” among people who believe 12-step programs are the best treatment option and “substance-dependent person” being among the top 3 highest rated terms. Accordingly, asking how people with substance use disorders would like to be referred may be best practice.
People in methadone treatment for opioid use disorder generally prefer medically accurate, person-first language over stigmatizing, business-oriented language. Belief in 12-step programs as the best treatment and identifying as White are associated with increases in preference for the term “addict.”
Gazzola, M. G., Maclean, E., Beitel, M., Carmichael, I. D., Cammack, K. M., Eggert, K. F., … & Barry, D. T. (2023). What’s in a name? Terminology preferences among patients receiving methadone treatment. Journal of General Internal Medicine, 38(3), 653-660. doi: 10.1007/s11606-022-07813-w
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