A Better Way to Talk About Problems with Alcohol Misuse

April 5, 2022

This piece was originally published as a guest post on the NIH Director’s Blog on April 5, 2022.

Image

Did you know that language commonly used to describe alcohol misuse and alcohol use disorder (AUD) can influence treatment outcomes in people suffering from alcohol problems? Yes, that can often be the case. In fact, the stigma perpetuated by such language can decrease a person’s motivation to seek help for an alcohol problem.

The stigma also can affect one’s self-esteem, as well as how they are perceived by others. And, sadly, AUD is still often viewed as a moral failing or character flaw, rather than a chronic medical disorder from which people can—and do—recover. Less than 10 percent of people with AUD obtain treatment or help for alcohol problems. Reframing the way we talk and think about alcohol problems can encourage people to seek and receive the help they need to recover.

In a recent article published in the journal Neuropsychopharmacology, my NIH colleagues, National Institute on Drug Abuse Director Nora D. Volkow, and National Institute of Mental Health Director Joshua Gordon, and I discuss the impact of stigma on people who have a mental illness or an alcohol or other substance use disorder [1]. We discuss how word choice can perpetuate stigma, leading to lower self-esteem, decreased interest in seeking help, and consequent worsening of symptoms.

We also point to evidence that stigma-related bias among clinicians can contribute to a treatment-averse mindset and to suboptimal clinical care, including failure to implement evidence-based treatment [2]. Studies have shown that the use of clinically accurate language and terms that centralize the experience of patients reduces stigma, resulting in higher quality health care.

Although more evidence-based treatment options for AUD are available today than ever before, stigma is a barrier that prevents some people from accessing treatment. Understanding that AUD is a medical condition and choosing our words carefully when discussing alcohol-related problems are important steps toward changing the conversation. It will empower people to seek treatment for AUD and help clinicians to deliver optimal care.

We can help alleviate the stigma associated with alcohol-related conditions in all settings by consistently using non-pejorative, non-stigmatizing, person-first language to describe such conditions and the people who are affected by them.

Here is some recommended language for reducing alcohol-related stigma that might be helpful:

• Use alcohol use disorder, or AUD, instead of alcohol abuse, alcohol dependence, and alcoholism. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), AUD replaces the older categories of alcohol abuse and alcohol dependence with the single disorder, AUD, which ranges from mild to severe.
• Use alcohol misuse instead of alcohol abuse when referring broadly to drinking in a manner, situation, amount, or frequency that could cause harm to the person who is engaging in drinking or to those around that person. For some individuals, any alcohol use constitutes alcohol misuse.
• Use person-first language to describe people with alcohol-related problems such as:
  • Person with alcohol use disorder instead of alcoholic or addict
  • Person in recovery or person in recovery from alcohol use disorder instead of recovering alcoholic
  • Person who misuses alcohol or person who engages in alcohol misuse instead of alcohol abuser and drunk
• Use alcohol-associated liver disease instead of alcoholic liver disease. Also use alcohol-associated hepatitis, alcohol-associated cirrhosis, and alcohol-associated pancreatitis instead of alcoholic hepatitis, alcoholic cirrhosis, and alcoholic pancreatitis. The use of “alcoholic” as an adjective may perpetuate stigma for people with alcohol-associated liver disease and other alcohol-related health conditions.

April is Alcohol Awareness Month, which is a good time to think about how alcohol is affecting your life. If you or a loved one need help for alcohol-related problems, the NIAAA Alcohol Treatment Navigator is a one-stop resource for learning about AUD and evidence-based AUD treatment. The Navigator teaches what you need to know and what you need to do to find evidence-based treatment options in your area.

References

[1] Choosing appropriate language to reduce the stigma around mental illness and substance use disorders. Volkow ND, Gordon JA, Koob GF. Neuropsychopharmacology 2021 Dec; 46(13):2230–2232.

[2] Discrimination against people with mental illness: What can psychiatrists do?  Thornicroft G, Rose D, Mehta N. Advances in Psychiatric Treatment 2010 Jan; 16:53–59.

Links:

Alcohol Facts and Statistics (National Institute on Alcohol Abuse and Alcoholism, NIH)

When It Comes to Reducing Alcohol-Related Stigma, Words Matter (NIAAA)

NIAAA Alcohol Treatment Navigator (NIAAA)

Rethinking Drinking (NIAAA)

Best wishes,
George F. Koob, Ph.D.
NIAAA Director