Stigmatizing Language Is a Roadblock to SUD Treatment That Can Be Overcome

The language that health professionals use to describe individuals with substance use disorder (SUD) has the power to promote or dispel stigma and thus affect the quality of care. That was the message experts drove home at APA’s Annual Meeting today in a session titled “Words Will Never Hurt Me: Examining the Stigma of Addiction.”

“Language is part of the fabric of our society. It’s what connects us to one another and allows us to communicate, so the way we [use language] as it concerns patients with addiction is critically important,” said session chair Alëna Balasanova, M.D., the director of addiction psychiatry education in the Department of Psychiatry at the University of Nebraska Medical Center. “There’s research to show that we all have unconscious bias and that … we go into a negative headspace when we hear certain terms.”

Balasanova highlighted a study that showed how stigmatizing language affects health professionals’ perception of, and attitude toward, people with SUD. Health professionals were given one of two vignettes about a patient with SUD. In one vignette, the patient was described as a “substance abuser.” In the other, the patient was described as having an SUD. The health professionals who read the vignette with stigmatizing language were more likely to assign blame to the individual, agree with the need for punishment, and see the person as less deserving of treatment compared with those who received the vignette without stigmatizing language.

“I liken this to another chronic condition, diabetes. If somebody has diabetes and has poorly controlled blood sugars … and they’re eating a piece of cake, are you going to think that they’re committing a crime and deserve to be punished?” Balasanova said.

Anne Ruble, M.D., M.P.H., a co-medical director at the Johns Hopkins Broadway Center for Addictions and an associate program director of the Johns Hopkins adult psychiatry residency, described an incident during her training in which a nurse said a patient in the ICU who had overdosed on opioids was “in here all the time, and it would be easier if she just died.”

“I never heard anything like that in any other rotation, and I felt like we needed to do something to help these patients,” Ruble said. “One of the ways we can help is by providing good, solid education to our residents about how to engage with people [with SUD] when they [come to us] for clinical services.”

Ayana Jordan, M.D., Ph.D., a past trustee of APA, stressed that appropriate training is particularly important for addiction psychiatrists who treat patients in racial/ethnic minoritized communities.

“We can see this in our own profession, even with psychiatrists in the way [some of them] talk about people with substance use disorder, … and then even more so when we’re thinking about people who have different minoritized identities,” said Jordan, the Barbara Wilson Associate Professor of Psychiatry at New York University Grossman School of Medicine. She added that patients who come from racial/ethnic minoritized backgrounds and do not have stable access to health care are treated even worse.

Jordan described one response to this dilemma, the Recognizing and Eliminating disparities in Addiction through Culturally informed Healthcare (REACH) program, where she is the medical director. The program, funded by the Substance Abuse and Mental Health Administration, has two main goals:

• Increase the overall number of racial/ethnic minoritized addiction specialists in addiction psychiatry and addiction medicine.


• Increase the number of addiction specialists adequately trained to work with racial/ethnic minoritized patients with SUD.

“If you go into any addiction [psychiatry/medicine] meeting and you see folks of color, more than likely they were trained in the REACH Program,” Jordan said.

Patrice Harris, M.D., M.S., a past trustee of APA and a past president of the American Medical Association, spoke of the need for seasoned health professionals to be mindful of the language they use.

“We have to unlearn things that we’ve learned and I think we need to do that in the midst of stigmatizing language,” Harris said. “We have to meet our colleagues where they are, model the language, and coach them … into using non-stigmatizing language.”

According to Harris, there is room for optimism.

“I have seen that our Congressmen and -women are using the correct terminology now. That has been a good shift and that is due to the advocacy of many of us in this room,” Harris said. ■

(Image: Getty Images/iStock/tolgart)