Want to Reduce Stigma? Choose Your Words Wisely

July 30, 2021

In a recent perspective in Neuropsychopharmacology that I coauthored with my colleagues, Dr. Nora D. Volkow, Director, National Institute on Drug Abuse, and Dr. Joshua A. Gordon, Director, National Institute of Mental Health, we discuss how the words that we—the public, research community, and healthcare professionals alike—choose to talk about mental illness and substance use disorders can help reduce stigma. In fact, stigma is a significant barrier in many people’s willingness to seek help for alcohol problems and can affect how they are treated in all aspects of life, including availability and quality of care. Reducing stigma is a step toward addressing these problems.

We can help alleviate the stigma associated with alcohol-related conditions by consistently using non-pejorative, non-stigmatizing, person-first language to describe these concerns and the people who are affected by them. Keep in mind that some words that are commonly used in society, such as “alcoholic” and “alcohol abuse,” can be stigmatizing.

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Below are recommended terms to use when discussing alcohol-related issues:

• Alcohol use disorder instead of alcohol abuse, alcohol dependence, and alcoholism. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), alcohol use disorder (AUD) replaces the older categories of alcohol abuse and alcohol dependence with the single disorder, AUD, which ranges from mild to severe. AUD is treatable and individuals with AUD do recover. Lasting changes in the brain associated with AUD can make individuals vulnerable to relapse.

• 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 them. For some individuals, any alcohol use constitutes alcohol misuse. These include individuals younger than the minimum legal drinking age of 21 and women who are pregnant. Alcohol misuse can be acute (e.g., binge drinking on a weekend night) or chronic (e.g., drinking associated with AUD). Do not use “abuse of alcohol.” Research has demonstrated that “abuse” and “abuser” are strongly associated with negative judgments and punishments. [Citations: Kelly, J.F., Saitz, R.D., Wakeman, S. (2016). Language, substance use disorders, and policy: The need to reach consensus on an “addiction-ary”. Alcoholism Treatment Quarterly. (34)(1): 116-123; Kelly, J.F., Westerhoff, C.M. (2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy. 21(3):202-7.]

• Person-first language to describe people with alcohol-related problems such as:
  • person with alcohol use disorder instead of alcoholic,
  • person in recovery or person in recovery from alcohol use disorder instead of recovering alcoholic,
  • person with alcohol use disorder instead of addict, and
  • person who misuses alcohol or person who engages in alcohol misuse instead of alcohol abuser or drunk.

• Alcohol-associated liver disease (ALD) instead of alcoholic liver disease. Use of ‘alcoholic’ as an adjective may perpetuate stigma for people with ALD and other alcohol-related health conditions. Alcohol-associated liver disease has been adopted officially in the field of alcohol research.

• Alcohol-associated hepatitis, alcohol-associated cirrhosis, and alcohol-associated pancreatitis instead of alcoholic hepatitis, alcoholic cirrhosis, and alcoholic pancreatitis. While the substitution of ‘alcoholic’ with ‘alcohol-associated’ has not been adopted widely for these health conditions, changing the language may help to reduce stigma for people diagnosed with these health conditions.

Although more evidence-based treatment options for AUD are available today than ever before, stigma is a factor that prevents some people from reaching out for help and from being treated with dignity. Understanding that AUD is a medical condition and choosing our words carefully when discussing alcohol-related problems is an important step toward changing the conversation and reducing stigma around AUD.

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