The Psychology Query Issue 7 - Addict vs. Person With Addiction: Does the Term Matter?
Today’s question speaks to an area that I find to be one of the most important things I write and speak about. This is has to do with labeling and how we view and refer to others, especially others suffering from a condition, in particular, some type of habit related condition. Since I’ve mentioned this before in a lot of my writing, I will just put out a few reminders.
Being identified, through an imposed label, as having a mental health problem, medical condition, behavioral problem or habit related difficulty, has been shown to impact a person’s self concept and subsequent behavior. While it is a reasonable assumption, there is also ample research to suggest that such labeling might have serious implications in both the short and long term. Labels tend to stick around when they are formalized by including them in a charts, reports or informal communication and the effects can be devastating.
I know of several people who kicked drug habits. It took each of them years, repeated attempts at rehab, rehospitalization, numerous medication and therapy trials, and in two cases life threatening overdoses, but, in the end, all of them finally fought free. I saw much of what they went through as they often called me when they were having a particularly rough time so I could talk them down. I was called by one friend or by his family during crises, and ended up facilitating a hospitalization from the side of the road in a downpour to ensure my friend wouldn’t hurt himself or someone else. *SEE IMPORTANT NOTE BELOW*
Being aware of all they had gone through in the process of their recovery, gave me the utmost respect for their strength, perseverance, tenacity and drive to do whatever it took to establish the lives they wanted to have. Their recovery and post recovery was made all the more difficult however, since in each case certain legal problems were visible on background checks for jobs. And despite not being ethical or strictly legal, the permission form allowed their complete history to be included in the background check including anything filed with their insurance companies.
None of them thought they’d ever work again because employers would just see a label in their records and they would not be given the chance to explain. When they decided to take the high road and put the information out there before the background check, the rest of the interview process was ultimately canceled albeit the reason was always something along the lines of having identified a stronger candidate or just that they weren’t the best match.
I’ve talked about how labels can result in people acting according to the way they are treated, the effects of learned helplessness, and the effects on self-esteem, self- confidence and the degree to which someone has control over their world and life. Yet this discussion points out other serious potential effects of labeling someone regardless of whether they retained the conditions or if it had remitted years before. Labels truly have a life of their own both on a personal level and at a more macro level such as with legal systems, employment situations and even housing. Combine the inability to get a job or apartment to the other self views the person has adopted and the problem worsens. Additionally when such problems occur repeatedly, the effects of those early labels can sometimes last a long time.
I am a psychology intern and am completing my current rotation on a drug rehab unit. My supervisor is constantly correcting me when I use the term “addict,” substituting “person with an addiction.” Is this such a big deal? What’s the difference in whether I say someone is an addict, which seems like a descriptive label, or if I say the person has an addiction? It seems like splitting hairs to me.
I’m glad you asked this question. Is there a difference between calling someone "an addict" vs. "a person with an addiction"? You bet there is. I ask that you bear with me through this answer, as it is one of the areas I feel very strongly about (see my personal comments, below).
For years, people with addictions have wanted to know when the media would recognize their condition as a medical problem, instead of a moral one — when they would recognize those with addictions as people first and not characterize them as people whose every characteristic is related to their addiction. It has become common practice to use the more respectful and accurate "person first" language for people with other diseases and disorders. For example, the label "epileptic" has been replaced by “person with epilepsy,” and the label "diabetic" has been replaced by "person with diabetes."
Some progress has been made in mental health areas, as well. The formerly used term "schizophrenic’’ has been replaced by "person with schizophrenia," while the term "depressive" has been replaced by "person with depression." This language represents the effort to recognize that the person is not defined by their disorder, that there is far more to them that whatever condition they have. It focuses on the person as a unique individual with lots of strengths and skills. This type of language will also remind other people involved in the life of a person who has they have some type of disorder
Recently, the Associated Press implemented a change in the language used when referring to people with addiction. The new edition of the widely used AP Style book states that the term "addict" should no longer be used. "Instead," it says, "choose phrasing like he was addicted, people with heroin addiction or he used drugs." This change is not just a matter of semantics or being politically correct.
Essentially, the AP is underscoring that a person is a collection of numerous unique characteristics, strengths and weaknesses, experiences, hopes, dreams, emotions, opinions, viewpoints all of which is superimposed on a biological backdrop of genetics and predispositions. In other words, the wording selected by the AP aims to separate, the person from the disease. The disease does not make up the person. It may influence and affect many areas of the person’s life but every person is much bigger that the substance they are using. This applies even to those who have been using drugs for years or decades, who have gone through multiple rehab and treatment programs or even have been arrested for their behavior while using drugs.
When we say someone is an "addict," we may give up hope that they will ever be normal again. When we say a person has an addiction, we recognize that there are a whole host of other parts of the person which means that we can draw those out and still maintain a relationship with the person without it being necessary to have a relationship with the addiction. This is important since if we focus exclusively on the addiction and try talking to it, it is stubborn and does not want to be gotten rid of.
While this may sound silly, it just means if you focus on what is coming from the addicted characteristics of a person, focusing on what the drugs are doing to them, why they should stop, the consequences of their drug related behavior etc. the individual is likely to shut down. This is often because they think others have no idea what they are going through and become annoyed by the judgements and advice. And unless we have a similar history, they are right, we don’t know the reality of what they are going through.
A misconception about people who are addicted to substances is that they don’t realize that drugs are bad for them, cause them problems and are negatively affecting their relationships, work or school success, ability to plan for the future, opportunities, and general quality of life and life satisfaction. They will be the first to say that the substances have some pretty awful consequences they wish they could fix. Yet the addiction and fear of what life would be like without being able to use the substance is so frightening that it overcomes their ability to follow through on their knowledge of how bad the substances are for them.
When we focus on drawing out other aspects of who the individual is, what they are good at, why they are a good person, the positive things they do for us and others every day, we remind the individual, and ourselves, that there is more to them than just the addiction. And yes, even those individuals with serious addictions have these aspects within them if you are willing to look for them hard enough. If all they are is the addiction, when you talk about taking that away from them they begin to wonder, “What will be left of me?” When you get in touch with the other aspects of who they are, letting them access those aspects as well and letting them know you recognize the are far more complex than the results of the substances they use, it gives them strength to begin considering fighting the habit. It lets them know that there is a complete person there even without everything the addiction has changed about their life, their personality and their behavior. These change are not permanent and even when still suffering from an addiction, the original aspects of the person are still there and usually have been part of the person far longer than the addiction.
When the AP makes a point of using terms focusing on the person and not the addiction, because of their influence the new terms are adopted and better understood by institutions like The New York Times and CBS News among many others associated with the AP. This influence could help improve drug treatment and policy in a practical manner by decreasing stigma against lifesaving forms of treatment at a time when drug use and overdose have become crises which seem to be poised to only grow. If we add our voices to all those affected by AP’s policy, recognizing the person as someone struggling with a problem and not as the problem itself, we provide a bit more strength to those fighting these battles . We also gain a better understanding of the nature of addiction, reducing the negative stigma of having a substance use disorder and seeking treatment for it. This will also increase compassion for those fighting this incredibly difficult battle.
It’s important to acknowledge that these comments do not mean accepting, normalizing or excusing the drug use. This also doesn’t mean that those who are being hurt physically, emotionally or financially by someone with an addiction should accept it as the “addiction talking." Staying safe and setting up rules and boundaries to as protection in such circumstances to prevent being harmed in some way is critical.
What all of this does mean is that the things you feel you need to say or discuss will be coming from a place of acceptance of the individual if not the addiction, compassion for their experiences while admitting you know nothing about what they are really going through, and the compassion, caring and love you feel for the person though obviously not the addiction. This atmosphere will allow you to discuss the problem in a calm, non judgemental, non critical manner, without the anger, frustration or hopelessness that many people who have individuals with addictions in their lives feel.
The bottom line is when we treat a person solely as an addiction, that is the behavior that is most likely to continue as it reinforces the idea that the person is nothing apart from the addiction. Treat the individual as a person with a very difficult problem they aren’t sure how to solve and they will at least perceive themselves as more than the addiction. They will see that what really makes them the person they are is separate from the addiction.
If it’s possible a simple change of wording can do all that I have mentioned here, isn’t it worth it to give it a try? Making the individual feel more like a person and not a weak willed monster can battle a lot of the internal dialogue the individual constantly has going through their head changing it to something more hopeful. It will also provide a shot of resiliency to help them take the first or next step in their battle to free themselves from the substances they use.
*IMPORTANT NOTE: IT IS BEST NOT TO TRY THIS NO MATTER WHAT TITLE YOU HOLD.*
Let the professionals who work with the person hospitalize them so you can remain the person’s friend, support, and one of their lifelines and you won’t harm the friendship. In the case I am speaking of, I had a long history with the person, knew them well, and they had just walked in and trashed a relative's business, getting cut badly in the process.
The police were called, they took him to a hospital and at that point I received a call from his parents from out of town explaining what had happened. They were fearful because no psych consult had been ordered despite the parents requesting it since my friend was an adult, the place was packed, and all the staff were overworked. I made a call to the Chief of Psychiatry despite it being pretty unethical to do
With my credentials I was taken seriously and a psychiatrist was assigned to my friend. I Was able to speak with the assigned psychiatrist prior to him meeting with my friend - doubly unethical. Yet I knew worst case scenarios could result in serious damage to property, serious self harm to my friend, and suicide attempts. There was also the possibility of harm to others as he had backed his mother into a corner and twisted her am while yelling at her. Other times he threw objects at people which, on one occasion, resulted in a person being taken to the hospital for stitches and a workup for a concussion.
If nothing had been done, I feared for his safety and the safety of others, or minimally that he might commit an act that would land him in jail. This would have ended his hopes for law school. At the same time if he had ever been told of my involvement he would have been hurt to the point we would have been unlikely to remain friends.
Everything turned out alright but this episode is one which I continue to wonder whether I did the right thing. Had there been any other viable option, I would have used it but the way the situation developed there were no other choices that I could discern. Yet I would never get involved professionally in this way with friends or family as it unquestionably compromised his rights as an adult and when thinking about someone doing the same to me, I would have felt furious and betrayed.
When he was back to himself he was extremely upset about the hospitalization saying his life was ruined since everyone who completed a background check on him would find out about the involuntary hospitalization. I reassured him that medical records were confidential (this was before HIPAA) and he had nothing to worry about.
Unfortunately, he was right and I was wrong. Luckily his family had contacts at the school he wanted to attend so they overlooked the hospitalization which had left him labeled as an “addict.” Now more than 15 years later he continues to worry about when that record might show up on someone’s radar and cause him problems. Labels can become disclosed in a variety of ways and create problems and distress despite HIPAA and even if they don't apply any longer.
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