“Do We Need the Abuse?”

William White’s 2006 work The Rhetoric of Recovery Advocacy: An Essay on the Power of Language is a powerful paper that suggests an essential focus for our recovery community work. He analyses the impact of the language that we apply to ourselves and that has been assigned to us by others.

Language helps to define us to ourselves, and shapes how others define us. Social policies and laws that are influenced by public perception are a result.

Those existing policies and perceptions reinforce the barriers to recovery of which we are all aware. One of the primary underlying causes of those barriers is the stigma associated with substance use disorders. That stigma has been shaped, in large part, by words.

White’s paper states that we must abandon some words while at the same time establish a ‘pro-recovery language.’

I’d like to focus on the negative aspects of the terms ‘abuse’ and ‘abuser,’ and suggest some actions that we at Rhode Island Communities for Addiction Recovery Efforts (RICARES) have taken and are preparing to take to rid ourselves of a term that White calls ‘one of the most ‘ill-chosen.’

White notes that this was recognized as long ago as 1973 when the National Commission on Marihuana and Drug Abuse criticized the term and stated that “continued use of this term with its emotional overtones, will serve only to perpetuate confused public attitudes about drug using behavior.’

The statement was prophetic.

This term is ill-chosen because:

There are heinous crimes committed by horrible people such as domestic abuse, elder abuse, sexual abuse, animal abuse, and child abuse. At some level of consciousness, people associate substance abuse with that group. We don’t belong there.
If we believe that addiction and the range of substance use disorders are medical conditions, why do we use the term when it is not used for any other condition? People with diabetes are not treated for ‘sugar abuse.’
Our use of the term ‘substance abuse’ has contributed to the reluctance of many people to accept addiction as a biomedical condition, and continue to believe that the most appropriate and effective way to deal with the societal issue of addiction is as a criminal issue rather than as a public health issue.
The Diagnostic and Statistical Manual, 5th edition (DSM-V) has discontinued the designations of ‘abuse’ and ‘dependency.’ The new term is ‘substance use disorder,’ (e.g., alcohol use disorder, cocaine use disorder, etc.). So, the term ‘abuse’ is even diagnostically outdated
Unfortunately, ‘abuse’ has become institutionally embedded. Most states have Departments, Divisions or Offices of Substance Abuse. SAMHSA (the Substance ‘Abuse’ and Mental Health Services Administration) oversees our services and much of our funding.

It is our responsibility, and to our benefit, to continue the effort to abandon ‘abuse’ for ‘substance use disorder’ or ‘substance use condition’ – no one else will.

Some suggested actions:

RICARES has communicated with our SAMHSA Regional representative and asked her to raise the issue at her level. She replied that she would be happy to raise the issue across the constituency groups with whom she interacts and to move it forward to the appropriate policy people.
A RICARES member is enrolled in the Chemical Dependency/Addiction Studies Program at Rhode Island College. She advocated for the revision of ‘abuse’ to ‘substance use disorder’ in all the program-generated literature. This has occurred.
We pointedly make the distinction whenever we speak to relevant groups about recovery. For example, in the last week we have spoken to a clinical group of nursing students and to case managers and clinicians at a community mental health center and hammered the distinction
Whenever we interact with treatment organizational leadership and clinicians, we hammer the distinction.
We shall communicate with leadership and with our allies at the state legislature and ask them to use ‘substance use disorder’ rather than ‘substance abuse’ in all relevant new legislation
We shall communicate with the new leadership at our Department of Behavioral Healthcare and ask them to make the revision in their speech and department-generated literature. We are optimistic about this step as the Department recently changed all their old references for ‘Retardation’ to ‘Developmental Disabilities.’
We shall communicate with the new leadership at the state’s Executive Office of Health and Human Services and ask them to make the revision in their speech and literature.
We know that you can think of many other actions.
Our regional SAMHSA representative noted, “it would help if the noteworthy leaders in treatment and recovery stepped out in favor of revising the terminology.” This is a simple but powerful step that we can take to start the action to, as White states: change the way that we see ourselves and are seen by others, change the language that affects social policies, and “to personally and culturally close one chapter in history and open another.”

This blog post was provided by Ian Knowles, Project Director, Rhode Island Communities for Addiction Recovery Efforts (RICARES), a Charter Member of the Association of Recovery Community Organizations (ARCO).