Language Matters: The dirty truth about the word, “Clean”.

The word “clean” has been a part of language surrounding drug use and addiction for years. But we use it for other topics too, such as clean eating and clean living. It sounds positive and health focused and we need those components when talking about substance use disorder.

However, clean’s antonym is “dirty” and “being clean” when referencing sober time, implies that someone using drugs isn’t clean, they are instead dirty. That is a really unfair and false implication. Phrases like, “She’s been clean” or “he had a dirty drop” reinforce the ignorant and old school image of a “junkie”. Which is synonymous with unworthy, unloved, and the various other words we discussed in our previous post on language and the word “addict”. It instills the image of a homeless person, living under a viaduct, “shooting up” with old, used, dirty needles.

And here’s the thing about that image, today’s typical person with substance use disorder, isn’t homeless or dirty. As it relates to the opioid epidemic, the typical person with heroin use disorder is from the suburbs, and quite honestly, that doesn’t matter. Regardless of if the individual is from the city, suburbs, or a rural area, regardless of if they are homeless or not. Heck, regardless of if they are clean or not. They are people, and they deserve the same respect, treatment, and dignity as anyone else. We have to stop dehumanizing people and undermining their worth.

These words; “clean” and “dirty” have roots in the past and we can look just to the early 1980’s with the development of needle exchange programs following the CDC’s suggestion to avoid injecting drugs and sharing needles to prevent transmission of HIV during the AIDs epidemic to see it. (It’s not that needle exchange programs are bad; by no means do I mean to suggest they are. Needle exchange programs have demonstrated endless positive impacts in reducing harm; there is scientific evidence to back them, and I fully support them.) It is however, at that time when people with AIDS were viewed as “dirty”. Their condition was considered a result of their “lifestyle choices” and they were often shunned, making it difficult, if not impossible to access care. Is this sounding familiar?

It sounds a lot like we are repeating history instead of learning from our mistakes.

The words, “clean” and dirty” don’t belong in conversations regarding Substance Use Disorder, just like they don’t belong in conversation about AIDS. So what should we be saying instead?

Well instead of suggesting someone’s drug test was “clean” or “dirty”, we should just say the result were negative or positive. And instead of saying, “I’m clean” to reference the fact that a person is not currently using drugs, why not just say, “I’m not using”, “I’m in recovery”, “I’m in remission”, or “I’m sober” any of which not only highlight sobriety, but also don’t put down those who haven’t gotten there.



Language Matters: The word “Addict” and not letting your struggle become your identity.

Language matters. This isn’t breaking news; we’ve been saying it for years. And when it comes to language surrounding health, the phrase, “sticks and stones may break my bones but words can never hurt me” is far from true. Particularly when it comes to language surrounding addiction, words can prevent people from accessing treatment.

Now I know someone is going to want to argue that, because words preventing people from getting treatment seems ridiculous. And I agree, it is ridiculous! But that doesn’t mean it isn’t true. And in defense of that statement, I want to point out hundreds of international experts spent more than ten years defining and classifying mental health disorders, including terms regarding addiction, or rather “substance use disorder”, specifically with the goal of improving diagnosis, treatment, and research. If language didn’t impact health, why would so many experts spend so much time doing that?

That said, I’m going to spend some time in a series of blog posts, explaining the language we need to stop using, staring with the word, “addict”. The word “addict” has become highly stigmatized. It’s synonymous with other words such as “junkie”, and “druggie”. It is often pre-faced with “loser”, “bum-a$$”, or “low-life”. It includes the connotations of “dirty”, “thief”, “scumbag” and “worthless”. It is all so overwhelmingly negative.

Imagine being called that each day. Imagine being treated like that, like you mean nothing. Imagine people who don’t even know you acting as if you were better off dead. And imagine, your friends or family feeling that way about you. I think, I’d start to believe it. I think it would be hard for anyone not to. And I think living like that would further my struggle, not help it.

The weight of those words, make people feel unworthy of love, life, health, and happiness. So how are they supposed to get any better? I’m going to go as far as to say this, calling someone an “addict”, is bullying, its emotional abuse. It needs to end.

Now before anyone goes jumping on their high horse to tell me the first step in the road to recovery involves admitting there is a problem and acknowledging they are an “addict”, hold off. (Because not everyone uses a step-like program to sobriety and those that do may not share the same interpretation of each step. And honestly this isn’t in favor or against the step program. So let’s not make it that way. I am all for whatever step and interpretation gets a person to sobriety. If calling themselves an “addict” does the job, they can! Infact, when people take ownership of a word they have the ability to change the stigma associated with it and for that matter, I think they should. Further, I think they should be able to say it with pride, not shame. But everyone else needs to stop).

Let’s focus on what we really need to get to. In my professional life I’ve had the opportunity spending years working with people who have special needs and mental health disorders. I spent much of my earlier career working with children who have autism. Language development appeared regularly on our quarterly mandatory organization agendas. “People-first language” was adopted as the standard of care and it is high-past time we apply that logic to substance use disorder.

It is typically with mental health diagnosis’s (and a handful of physical ones such as diabetic) that we label a person by their health. (ie. Autistic, Schizophrenic, Bipolar, psychotic, alcoholic). These are all examples of language in which the fact that the individual is a living, breathing, human being with worth and feelings, is secondary to their health. It is not people-first language, and it is not supportive, and it can feel dehumanizing.

What I learned from working with people who get labeled by their diagnosis, is that for starters, they don’t appreciate it. They don’t see it as their identity. It is a part of them, but it is not who they are, and neither are the connotations that accompany them.
In so many online support groups for friends and family of those with substance use disorder I see the initials “AD” and “AS” appear. It stands for “addicted daughter” and “addicted son”. And while I believe those who use the term mean well, they have simultaneously just put their loved ones addiction, ahead of the fact that they are their child. Introductions that include a diagnosis are unnecessary. It is not your “addicted child”, it is not “your child who has an addiction”, it is simply “your child”.

So I ask you this, consider what side of the mental health you are on. Consider the statistics associated with mental health and substance use disorder, do you want to see those change?  Do you want to see an improvement in the way mental health, substance use disorder, and the opioid crisis are treated? Do you want to see more accessibility to treatment?  Do you want your loved one to get better?


If so, start by considering your language.

A letter to David Vincent

A letter to Mr. David Vincent (and those sharing his post),

I’ve seen your Facebook post, as so many have. I think it’s worth a discussion.

I’ll start by admitting, I’m not sure I understand the placement of the quotation marks in your incredible inaccurate status. Unless it is there to imply sarcasm in regards to the word “free” given narcan is not free.

What makes you think it is free?

Narcan, or naloxone, is $5000 for the auto-inject, $150 for the nasal spray, and $45 for the vile and syringe at Walgreens, last I checked.  It isn’t always covered by insurance, unlike “chemo”. (Again, what’s up with the quotations?) It is made available for “free” by nonprofit organizations like the one I operate, which PAYS for it, and then gives it away because who am I or you or anyone else to judge the value of another person’s life?

Fun fact for you: The auto-inject naloxone was initially on the market for $400, but the price was raised to $5,000 as the demand for it increased. This may sound familiar if you are aware of Mylan’s appalling skyrocketing price of the epi-pen for anaphylaxis. One might argue pharmaceutical manufacturers see people’s lives as a matter of making profit. That said, if you want to have some kind of feelings or opinion about who gets treatment and who doesn’t…take it up with big pharma, start a nonprofit, or dish out the cash for someone else’s treatment. But deciding who gets to live and who gets to die based on YOUR interpretation of a disease – opposed to the definition in the DSM5 – is ignorant. And further, this uneducated “analogy” doesn’t actually help anyone. It does however, say a lot about the quality of individual who wrote it and arguably about those who share it. If the goal of posting it was to benefit cancer patients, it does absolutely nothing of the sort. What it does do, is hinder those who see it, who suffer with an addiction, from getting help. Perhaps helping people with addiction isn’t important to you or those who share it, but is it necessary to put those people down? That’s the only thing your status has accomplished. That and putting down the work of people who fought to change the laws to make narcan accessible.

You want to do something for cancer patients? Then actually do something! You can even call me up and I will gladly help you navigate setting up a 501c3, raise funds, donate my time and money, and hit up Washington as I’ve done for addiction. I’ll do it all without downplaying another health crisis and judging the value of another’s life.