It’s time to retire the word ‘addict’

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Over 200 overdose prevention activists staged a protest. (Photo by Erik McGregor/ LightRocket via Getty Images)

“The mother and father are both on drugs. The mother is a heroin addict. The father uses heroin and crystal meth.” This description was cut and copied repeatedly on official documents pertaining to my child services case, beginning with the April 2018 shelter petition, the mechanism by which my two young daughters were first taken from me. That handful of paragraphs, written out by an inexperienced Broward County Sheriff child services investigator, followed me for the next two years.

My husband, on the other hand, was never referred to as an addict, even though he was actually being accused of using one more illicit substance than me — methamphetamine in addition to heroin. It may be hard to understand why something like this matters. After all, don’t people use the word “addict” all the time?

There is an ongoing debate among the addiction treatment and harm reduction communities about which terms should be used when referring to drug use and addiction, and in what settings. In 2017, the Associated Press Stylebook updated their recommendations for reporting on addiction and drug use to exclude potentially stigmatizing terms such as “addict,” “alcoholic,” and “drug abuser,” except in the form of direct quotes. Instead, they recommend using person-first language, such as “person with a substance use disorder” or “people who are addicted to opioids.” These changes aligned with updates to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, as well as recommendations by the Office of National Drug Control Policy.

Others followed suit: a 2018 update to the National Institute on Drug Abuse’s blog specified that they no longer use terms such as “addict” or “substance abuser” (though the institute’s name remains unchanged), and in 2020 dictionary.com updated their website to replace all uses of the word “addict” as a noun with terminology such as “person with an addiction” or “habitual user.” They also updated their definition of the word “addict” to note that some might consider it offensive, and added a lengthy sensitivity note explaining: “addiction is the complicated result of genetic predisposition intersecting with dysfunctional behavior, neurochemical modification, environmental factors, and social influences,” and that many members of the treatment and recovery communities advocate against its use.

Controversy around terms such as “addict,” “alcoholic,” and “substance abuse” has been boiling for years. Many members of the medical, recovery, and harm reduction communities are happy to see changes like this implemented. For example, Olivia Pennelle, founder of Liv’s Recovery Kitchen and a journalist in long-term addiction recovery who covered the language debate for The Fix in 2018, said the dictionary.com changes are “important,” adding: “Only 10 percent of people [with a substance use disorder] get access to treatment…[and] a major factor is stigma. If we can do anything to change that, we should.”

On the other hand, Amy Dresner, also a journalist in long-term addiction recovery who authored an autobiography titled My Fair Junkie: A Memoir of Getting Dirty and Staying Clean, said she considers the use of language such as “junkie” and “addict” to be empowering when reclaimed as self-identifiers. And she says terms such as “person with a substance use disorder” fail to “convey the horror” of what she experienced during her active addiction.

“All that PC language feels like putting lipstick on a pig and hiding it more…[the changed terminology] sounds better, it sounds like you have empathy but does it really change somebody’s opinion?” she asked.

Recent research backs the moves by dictionary.com and the Associated Press. A series of studies published in the Journal of Drug and Alcohol Dependence in 2018 found that several terms, including the word “addict,” were associated with negative social perceptions. It also found that these terms produced negative biases significant enough to impact people’s access to healthcare; for example, both treatment professionals and members of the general public were more inclined to recommend incarceration or other punitive measures to those labeled an “addict” or “substance abuser” while a “person with a substance use disorder” was more likely to be deemed in need of medical care.

Robert Ashford, the lead researcher in the language studies, explained a potential cause in a story I wrote for Filter Mag. “[Language is] the primary way we communicate…The cliché ‘words have power’ is the truth.” Regarding language employed in court settings specifically, he added: “It’s not that those [terms such as ‘person with substance use disorder’] are inherently positive; it’s that they are less negative than the pejorative terms that have been created over time. These things have a really strong emotional reaction to most people. We don’t need to do [courtroom actors] any favors by…using language that has come to mean something biased.”

“How you speak about the person you’re representing is how other people will see them and so using the correct language is extremely important,” added Dinah Ortiz, a harm reduction-oriented parent advocate located in New York City. “Language is like a stepping stone, then comes the harder stuff, but it starts with language…if we don’t care about calling a person a ‘junkie,’ a ‘dope fiend,’ a ‘crackhead,’ then we don’t care about that person.”

In my Florida State child services case, my husband and I both received the same charges — neglect and imminent risk of harm — and we both had our parental rights terminated in early 2020. On paper, we shared the same nightmare outcome at the end of a case riddled with misrepresentations of fact, blatant bias, and government overreach at its darkest. But there was a palpable difference in the courtroom between his treatment and mine. While my every word was interrogated with suspicion — I was never even counted as having income despite clearly being able to pay my bills and child support — my husband was rarely questioned. I was criticized for circumstances he and I shared, such as not having a car and relying on his parents for rides to our supervised visits, while he usually escaped mention.

At the disposition for our initial trial, when the judge determined that our daughters were unsafe in our care and should remain with their paternal grandparents while we completed a slew of tasks to try to regain custody, the judge cited as her reasons for issuing these charges against me: “The mother is an extraordinarily educated and gifted individual. You have a gift for language, both oral and written. Unfortunately, the Court finds that you could probably sell ice to an Eskimo.”

Although she issued the same charges against my husband, the judge stated that she “found the father’s testimony essentially credible before this Court,” and mentioned that he acknowledged having a “substance abuse history,” something I likewise acknowledged about myself (though I clarified it as a substance use disorder, as per the DSM IV and V).

While it is impossible to pinpoint my classification as an “addict” versus my husband’s as a “person who uses heroin and meth” as the reason for our differences in courtroom treatment, it can’t be ignored that this experience aligns near perfectly with the outcomes of Ashford’s experiments.

And, as explained by Sheila Vakharia, a former social worker and the current deputy director of the Department of Research and Academic Engagement for the Drug Policy Alliance: “When you refer to someone as an ‘addict,’ and you make salient one person’s single relationship with a drug or several drugs, what happens is you then start to see that person through that lens of that one characteristic or trait, and it can make it hard to see the complexity of a person’s identity.”

Still, it’s hard to know how much, if at all, my case would have changed if I’d not been labeled an “addict” at the outset. Would my daughters be home today? Or would I merely have had a slightly more comfortable courtroom hanging?

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