Alcoholic? Addict? Problem Drinker? Words Matter

While many treatment professionals have moved away from these labels years ago now (along with alcohol “abuse” or drug “abuse”), they are still in common use. It’s time to re-think this.

Let us be clear though – we are not referring to how people label themselves. If it’s helpful for a person to conclude that he or she is an “alcoholic” and to refer to themselves that way, we have no argument with that. It should also be noted that whether one accepts a label of alcoholic or not may not impact their outcomes in treatment. (Morgenstern et al., 2002)  What’s important in this context is an acknowledgment by the person that their alcohol or other drug use is causing too many problems or putting them at a higher risk for substance-related problems, and they need to make a change.

Now back to how we think of others. How we describe a person and his or her alcohol or drug use affects our attitudes towards them. JK’s research team has been studying how labels affect a person’s perception and stigma related to the individual. They conducted two independent studies that compared referring to a person as an individual with a “substance use disorder” or to a person as a “substance abuser”. In looking at the data, the substance abuser “was perceived as engaging in willful misconduct, a greater social threat, and more deserving of punishment” compared to the person described as having a substance use disorder. (Kelly et al., 2010). And even after successfully resolving problems with alcohol or drugs, another study has found that it is common for such folks to experience discrimination Vilsaint et al., 2020).

Words and labels can be disparaging, harmful and, ironically, increase or decrease the chances that heavy drinkers or drug users will seek help. Using person-first terms like “a person with a substance use disorder” (as opposed to an “alcohol abuser” or “drug abuser) reduces stigma that is a barrier to people entering treatment. Anything we can do to reduce barriers to help people resolve their alcohol and drug problems is a worthwhile endeavor. Something to consider the next time you talk with a person who’s drinking heavily or misusing drugs.

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Dr. Reid K. Hester is the Chief Science Officer at CheckUpandChoices.com.

Dr.John Kelly is the Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine at Harvard Medical School.