Alcohol use disorder (AUD) is the clinical term used to describe a chronic health disease marked by not being able to stop drinking despite negative outcomes to your health, work, and relationships1 Studies show that on average, only about 10% of people who need treatment for substance use disorders (including alcohol) get any form of treatment.2 One common reason people give for not seeking help is that they don’t want people to think poorly of them. These negative judgments are called stigma, and they can present a very real barrier to recovery. One way to help reduce stigma is to change the way we talk about alcohol addiction. Neutral, supportive language can help people with AUD feel safe and increase the chances they’ll get the evidence-based help they need. Keep reading to learn more about stigma and how it impacts people’s efforts at recovery. What Is Stigma? In simple terms, stigma is negative beliefs that can lead to discrimination. For example, thinking that alcohol use disorder (AUD) is a moral failing or that people who use drugs or alcohol are dangerous.3 Stigma can be explicit, which means you’re aware of your own bias, or implicit, where you aren’t consciously aware that you hold these negative beliefs.4 Stigma can also be externalized or internalized. Externalized stigma is stigma that you experience, whereas internalized stigma is when you apply society’s negative beliefs to yourself. This is also called self-stigma, and studies show it prevents people from seeking treatment and contributes to relapse as well as dropping out of treatment early.4,5 To make matters more complex, addiction stigma can be further worsened by stigmas surrounding race, gender, class, and sexuality.4,6 These types of intersectional stigmas often overlap, creating multiple layers of discrimination and judgment. An example of this in action is how racism influenced 1990s U.S. prison sentences for crack versus cocaine use. Despite the fact that white people were 3 times more likely than Black people to use crack, public perception was that mostly Black people used crack and therefore, people who used crack received harsher penalties than people who used cocaine.4,7 How Does Stigma Impact People with AUD? Addiction science tells us that environment, genetics, and other external factors play a role in how addiction and other mental health disorders develop.4 Yet society as a whole still often has false beliefs that people cause their own addictions and can therefore control them.8 Many people believe that people with alcohol and other substance use disorders deserve to be punished instead of helped. These public beliefs about people with addiction can influence harmful public policy.4 In turn, these laws and policies (often referred to as “structural stigma”) may seem to endorse the public’s opinion, further perpetuating a cycle of stigma.5 Public and Structural Stigma Some examples of public and structural addiction stigma include:7,9,10 The “war on drugs”: The “war” President Nixon began rested largely on the idea that people could control their drug use and would stop (or not start to begin with) if the known punishments were severe enough, and that this would in turn decrease crime. Yet this instead led to a sharp increase in prison sentences (disproportionately high among marginalized groups) without any decrease in crime or drug use.7 Employment: Many businesses use drug tests in hiring and firing decisions. And while the Americans with Disabilities Act (ADA) does protect people in recovery, there is a gap for people in the early stages of recovery who may still be using and are thus vulnerable to being fired. Healthcare: Doctors without addiction training may be less willing to screen patients for substance use disorders (SUDs), including alcohol use disorder. Housing: It is common for housing agencies to deny people who have a history of using drugs and alcohol, which can lead to people in recovery being unhoused (which in turn can worsen addiction). General resources: Communities may overall be less willing to fund evidence-based addiction treatments, harm reduction services, and the like. Self-Stigma As discussed earlier, people can also turn public and structural stigma inward.11 Self-stigma in people with SUDs can lead to a “why-try” attitude—the thought that if society doesn’t value them anyway, why bother trying to recover?5 Research shows that these thoughts and feelings can make people less likely to:11 Admit to themselves that they have a problem. Tell others. Seek help, especially early. Stigma can create a feedback loop of negative thoughts and behaviors. For example, real and perceived stigma often leads to feelings of shame. To cope with these feelings and the way society treats them, people with addiction may isolate themselves and continue using alcohol or drugs, which can in turn worsen addiction and societal treatment.4,12 In fact, stigma is the third leading cause of why people who want treatment don’t get it. (The first two reasons are not having insurance/not being able to afford treatment and not being able to find the treatment they want.)2 Why Does It Matter How We Talk about Addiction? Remember that language shapes the way society views people with AUD and how people with AUD think about themselves.3 Research shows that stigma can worsen AUD and prevent people from seeking help, leads to worse outcomes in people who do seek help, and can distance people from the social support that helps them live healthy lives in recovery.13 We can help reduce stigma in ourselves and in society by changing the way we view and talk about addiction. Alcohol use disorder is a chronic disease that people can and do recover from. Neutral, supportive language is more accurate and supportive, increasing the chances that people with AUD will seek help. Words to Avoid When talking about addiction, some words imply that the person is to blame for their problems, not the disease. The following words have negative associations and can be harmful.14 Alcoholic Drunk Abuser User Addict Junkie Words to Use Instead Using language that is person-first and medically accurate helps reduce stigma. Phrases to consider include:14 Person with alcohol use disorder Person in recovery Person who misuses alcohol Person who engages in risky alcohol use Person in active alcohol use Treatment Resources If you or someone you know is struggling with alcohol addiction, know that it takes courage to ask for help. You’re never alone, and it’s never too late to start recovery. Some ways to reach out include: Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP (4357) Al-Anon and Ala-teen hotline: 1-800-356-9996 American Addiction Centers: [phone] [sources] National Institute on Alcohol Abuse and Alcoholism. (2021, April). Understanding alcohol use disorder. Substance Abuse and Mental Health Services Administration. (2021, October). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Broyles, L. M., Binswanger, I. A., Jenkins, J. A., Finnell, D. S., Faseru, B., Cavaiola, A., Pugatch, M., & Gordon, A. J. (2014). Confronting inadvertent stigma and pejorative language in addiction scholarship: a recognition and response. Substance Abuse, 35(3), 217–221. Earnshaw V. A. (2020). Stigma and substance use disorders: A clinical, research, and advocacy agenda. The American Psychologist, 75(9), 1300–1311. Committee on the Science of Changing Behavioral Health Social Norms; Board on Behavioral, Cognitive, and Sensory Sciences; Division of Behavioral and Social Sciences and Education; National Academies of Sciences, Engineering, and Medicine. Ending discrimination against people with mental and substance use disorders: The evidence for stigma change. Washington (DC): National Academies Press (US); 2016 Aug 3. 2, Understanding stigma of mental and substance use disorders. Meyers, S. A., Earnshaw, V. A., D'Ambrosio, B., Courchesne, N., Werb, D., & Smith, L. R. (2021). The intersection of gender and drug use-related stigma: A mixed methods systematic review and synthesis of the literature. Drug and Alcohol Dependence, 223, 108706. Moore, L. D., & Elkavich, A. (2008). Who's using and who's doing time: incarceration, the war on drugs, and public health. American Journal of Public Health, 98(5), 782–786. Kelly, J. F., Wakeman, S. E., & Saitz, R. (2014). Stop talking “dirty”: Clinicians, language, and the quality of care for the leading cause of preventable death in the United States. American Journal of Medicine, 128(1), 8­–9. Yang, L. H., Wong, L. Y., Grivel, M. M., & Hasin, D. S. (2017). Stigma and substance use disorders: an international phenomenon. Current Opinion in Psychiatry, 30(5), 378–388. Kulesza, M., Matsuda, M., Ramirez, J. J., Werntz, A. J., Teachman, B. A., & Lindgren, K. P. (2016). Towards greater understanding of addiction stigma: Intersectionality with race/ethnicity and gender. Drug and Alcohol Dependence, 169, 85–91. Keyes, K. M., Hatzenbuehler, M. L., McLaughlin, K. A., Link, B., Olfson, M., Grant, B. F., & Hasin, D. (2010). Stigma and treatment for alcohol disorders in the United States. American Journal of Epidemiology, 172(12), 1364–1372. Matthews, S., Dwyer, R., & Snoek, A. (2017). Stigma and self-stigma in addiction. Journal of Bioethical Inquiry, 14(2), 275–286. Crapanzano, K. A., Hammarlund, R., Ahmad, B., Hunsinger, N., & Kullar, R. (2018). The association between perceived stigma and substance use disorder treatment outcomes: a review. Substance Abuse and Rehabilitation, 10, 1–12. National Institute on Drug Abuse. (2019, November 29). Words matter: Terms to use and avoid when talking about addiction. [/sources] ...