Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Word Choice Related to Substance Use Disorders


Words matter; calling patients with a substance use disorder an “addict” defines them by their addiction. We need to ensure that our patients feel comfortable and supported so that they will engage in treatment.  

The language we use to talk about substance use disorder can be stigmatizing. Patients often hear people refer to them as “addicts.” Often, patients hear their toxicology results described as “clean,” which has no clinical meaning but implies that someone with substances in their system is “dirty.” Language matters, and there’s no place for using these terms, or other terrible slang like “junkie,” when talking to or about patients with a substance use disorder.  


It may seem like changing the language of addiction is a pointless effort at political correctness, but rigorous research using randomized experiments show that it matters: healthcare professionals exposed to a description of a patient who is a “substance abuser” were more likely to say that that patient deserved blame and punishment than clinicians exposed to an otherwise identical description of a patient who “has a substance use disorder.”  


The language we use to talk about effective medications for opioid use disorder also matters.  Sometimes the gold-standard treatments methadone and buprenorphine are referred to as “medication-assisted” treatment, which implies that medication alone is not effective at treating opioid use disorder (it is), or “substitution” or “replacement” strategies, terms that perpetuate the myth that methadone and buprenorphine substitute one addiction for another (they do not).  


Here’s what we can do:  


1. When communicating with and about patients with substance use disorder, use non-stigmatizing terms.  


2. Instead of “addict” or “abuser,” say “person with a substance use disorder.”  


3. Instead of “substance abuse,” say “substance use.”  


4. Instead of “addicted babies” or “born addicted,” say “neonates exposed to opioids.”  


5. Instead of “substitution” or “replacement” therapy, say “medication for opioid use disorder.”  


It’s not easy to change our vocabularies, but it is imperative. Substance use disorders are treatable, but most people do not get treatment. To change that, we need to make people feel welcome and supported. Changing our language is one important step.   







This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.