What’s In A Name?
~ Brian Sherman, PhD, Center for Motivation and Change
“By continuing to use the term “addict” and “alcoholic,” treatment providers are doing a disservice to their patients and potentially negating progress towards destigmatization and successful long-term treatment.”
What’s in a name? Sure, by any other name a rose may smell so sweet, but by any other name would an “addict” feel so stigmatized? Were Shakespeare alive today I would ask that he reconsider his stance. With the gradual pace of change in addiction treatment highlighted by the continued advancement and implementation of evidence-based treatments, why is the field so far behind in not using more clinically appropriate and de-stigmatizing — albeit a bit cumbersome – language such as: “person with a substance use disorder” or “person suffering from addiction”? It has been years now that the field of clinical psychology did away with stigmatizing terms such as “schizophrenic”, “manic-depressive”, or “autistic.” Why then does the field of addiction remain so far behind?
As an addiction psychologist I do not discourage my patients for whom the term “addict” works. If it motivates them to change, fantastic. For many people, the term “addict” is a helpful way of identifying symptoms and issues, and finding a way to connect and bond with others in a healthy way that promotes change. However, when that term creates a prolonged sense of failure or guilt which ultimately may lead to relapse (negative emotions are one of the strongest predictors of relapse) or prevent someone from seeking help in the first place (because they don’t want to accept the label, and the stigma that is associated with it), I question its utility.
People are people first, before they develop an addiction. Just as they are people before they develop heart disease, diabetes, or depression. The “addict” label suggests the whole person is the problem, rather than the problem being the problem. A person with a substance abuse problem has a far better chance at recovery than a person who is the problem him or herself at their core. It is no one’s fault that the term “addict” and “alcoholic” continue to permeate daily news stories dispersed to mass audiences, even though they are not diagnostic terms. It is the fault of the treatment community who fail to promote a new language, one of compassion and accuracy. Treating the whole person means respecting other aspects of the individual, including the positive traits and skills that promote change and personal growth.
Why, then, does a label like “addict” or “alcoholic” continue to be so prevalent in our society today? Somehow, the term “addict” (and all its associations) satisfies our need to justify a person’s unfathomable use of drugs in the face of great success or great consequence (see Philip Seymour Hoffman, and countless less famous people who succumb to substance dependence). The evidence does suggest that compulsive behaviors can alter the pleasure, reward, and executive functioning systems of the brain, making it nearly impossible to resist the morning use that staves off sickness, however, the reasons for continued use, or relapse, are far more complex still. By simplifying those choices down to “addict behavior” we are not allowing other factors (i.e. genetics, family environment, trauma, etc.) their due, and we are not seeing the individual as a whole person.
We must move beyond these stigmatizing labels to a more accurate and sensitive language. By continuing to use the term “addict” and “alcoholic” treatment providers are doing a disservice to their patients and potentially negating progress towards destigmatization and successful long-term treatment. To my colleagues in the addiction field, please take this step of eliminating the words “addict” and “alcoholic” from the field and let us continue progressing towards a more accurate, kind, and effective treatment environment. Because, what’s in a name does matter.
Dr. Sherman is a clinical psychologist with specialized training in relational psychodynamic psychotherapy, Dialectical Behavior Therapy (DBT), and Cognitive Behavioral Therapy (CBT) with a focus on treating anxiety, depression, personality disorders, and substance abuse.
Source: Center for Motivation & Change (used with permission)
Sponsor: 2014 SMART Recovery Annual Conference
I ALSO FEEL THAT WHILE 12 STEP PROGRAMS WORK FOR SOME…ITS TIME TO LOOK AT THOSE STEPS & “RENEW” THEM…NOW THAT WE HAVE A BETTER UNDERSTANDING OF IT ALL….BILL W WAS ON TO SOMETHING WHEN HE STARTED AA…BUT AS WITH EVERYTHING…REVISIONS NEED TO BE MADE..THERE IS A MENTAL HEALTH FACTOR THAT NEEDS TO BE INCORPORATED …
Having been involved in AA, before stumbling onto SMART Recovery, I saw firsthand that for many people the program of AA was working for them. For me, however, I could never swallow the required label we administered upon ourselves, during every introduction. AA told me that the first step in recovery was to acknowledge that I had a problem and I was an alcoholic with a incurable disease.
This is simply not true and making the decision to buy into that MYTH, might have haunted me for the rest of my life.
Thank you very very much for this article. Many many sober ‘tough love’ or AA types would disagree with this whole article, but it’s been something I’ve felt at a base level for…pretty much ever. I’ve always felt that
I (as in, MYSELF, ME) have habits, I am not ONLY one harmful or regular habit, I’m Corinne. It may happen to currently be an unfortunate top layer or priority at this moment, but it’s STILL ME…thank you again for a professional opinion that helped me feel better about my alcohol dependence habit/issue (which I am trying slowly to change.)
Right on, Brian! We don’t call a person with cancer a cancer, and we don’t call a person with depression a depressive! We call them a person with cancer and a person who suffers with depression. So, why call a person with an addiction an addict? As you said, we are people first and foremost.
Thank you very much for this article. Addiction is a serious problem that many people deal with each day. Even people who are fully on the road to recovery still need to consider how addiction affects them.
I heartily agree with you Brian. Words are important! That’s why we avoid such labels entirely in our web apps, http://www.drinkerscheckup.com and http://www.overcomingaddictions.net (we developed for SMART Recovery).
I wholly concur. Stigmatizing words like “getting clean” suggest that the person is less than.
I attended AA for 11 months and disagreed with much of the program, which is why I have since joined SMART. I do not agree that alcoholism is a disease, but an addiction caused by abuse of the substance. Automatically this put me at odds with the program. Regardless of rather one agrees or disagrees with the disease concept, I nevertheless feel it is harmful to have to introduce yourself as an alcoholic every time you speak. I’m diabetic, but I would certainly never introduce myself in that manner. I found this process uncomfortable and happy it’s part of my past today. I’m also thankful that I don’t consider alcoholism a disease. I fear too many who buy into this theory take on the role of victim. I believe I’m the one responsible for my actions and for me this makes change much easier.
The disease model of addiction is not an AA thing. It’s a mental health thing. Nowhere in the AA literature does it refer to Alcoholism or addiction as “a disease.” In fact, it’s contrarian to AA’s spiritual-malady/allergy theory to think of alcoholism or addiction as a medical/mental health diagnosis, suggesting that modern medicine can fix it, rather than the “spiritual solution” that AA relies on. If calling it a disease makes you feel uncomfortable then don’t say it. It doesn’t mean it’s not a clearly defined diagnosis in the DSM-V. I for one feel that giving addiction/substance use disorder some clearly defined symptoms and having received that diagnosis gives me a place from which to start healing.
SMART Recovery tools can help you regardless of whether or not you believe addiction is a disease.
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