?Abuse? is an ugly word. ?Child abuse,? ?sexual abuse,? ?physical abuse,? ?emotional abuse,? ?domestic abuse.? And then, of course, there?s ?substance abuse.?
But one of those things is not like the others: In all of the other types of abuse, there is a perpetrator who is harming a victim. In substance abuse, however, it makes no sense to argue that the victim is the poor innocent line of methamphetamine or glass of Chardonnay. The damage done?both by the problem and by the term?is focused primarily on substance users themselves. The label is far from innocuous, and I vote that we retire it.
Debates over language often seem absurd or trivial. However, they make a difference in how issues are framed and therefore what solutions are proposed. Frame addiction as ?substance abuse? and it is easy to see why it should be a crime, but call it ?substance use disorder? and it sounds like something to be treated medically. If we want to make progress in ending stigma, we should think hard about the words we use.
In the case of ?substance abuse,? there is empirical evidence of the harm that this framing can do. In a 2010 study, researchers surveyed over 500 mental health practitioners at a conference?two thirds of whom had PhDs. Participants were asked to determine treatment for two hypothetical patients who were identical except that one was labeled as having a ?substance use disorder? and the other was said to be a ?substance abuser.?
Despite their training, the practicing clinicians favored a more punitive approach when the patient?who was described as having relapsed during court-ordered treatment?was labeled as being an abuser as opposed to having a disorder. More clinicians supported jail or community service rather than further treatment for the ?substance abuser.?
This is one reason why the recent revision of the DSM?psychiatry?s diagnostic manual?no longer includes ?substance abuse? as a diagnosis. The term brings up stigmatizing associations between abusive behavior and drug taking?even though the vast majority of people with drug problems do not engage in child abuse, sexual abuse or domestic violence. While the DSM revision made many mistakes?for example, it conflates the milder substance-problem diagnosis with the more severe one (mild problems do not require abstinence and the last thing we need is more reason to apply ?one size fits all? treatment in this area), the editors were right to get rid of the abuse label.
But there is another reason why labeling someone a ?substance abuser? or as having a ?substance use disorder? matters. That is, the ?substance abuser? label encompasses the whole person, defining him or her by dysfunction. In contrast, the ?substance use disorder? tag simply describes one problem, rather than an entire identity.
[...]