Language matters: “Achieving” Sobriety, Defining your Recovery, and Reducing Harm

 

Sobriety is defined as the state of being sober and the definition of sober, is outdated, referring to being unaffected by alcohol. (Interesting, how it only mentions alcohol, right?) Today most people reference being sober in regards to being free from mind altering substances. And truthfully, when you factor caffeine, nicotine, and psychotropic medications in there, most people are not sober. So can we talk about the glorified pedestal we put sobriety on? And maybe take it down a notch?

When people use the phrase “achieving sobriety” they inadvertently imply that not being sober is an act of failure -if that’s the case, the majority of the world is failing at life. Fortunately, that’s not the case. (Sidebar: Psychotropic medications for example have been an effective and beneficial option to those who need them.) Sobriety isn’t something you achieve or fail to accomplish. Yes, if you can do it, be proud, because it’s definitely difficult to do and maintain, especially for those who have had an addiction. However, let’s be sure the language we use doesn’t put others down in the process.

^^This reminds me of the mom politics surrounding childbirth. Women who endure the pain of a non-medicated vaginal delivery are often proud of their pain medication-free delivery method. And to them, I say, “Way to go!” However, it does not make you a better mom than the woman in the room next door with an epidural.

Not having substance use disorder doesn’t make you a better person than someone who does.

All this said, please consider the word “achieve” when you are talking about sobriety.

Further, in a recent conversation with Dan Bigg who is often referred to as the, “Patron Saint of Harm reduction” and the director of the Chicago Recovery Alliance, I found myself reevaluating the word, “recovery” a term he defines as, “any positive change”. This coincides well with the definitions of recovery according to various dictionaries which define it as, “the act, process, duration, or an instance of recovering” and “a return to a normal or healthy condition”. With recovery often being seen as a process, or current state of being, and seeing as most people don’t use it in the past tense claiming to “be recovered” from substance use disorder, perhaps recovery is what we should encourage people towards, instead of sobriety.

You see, sobriety, being looked at with its high and holy zero-tolerance policy, it’s pretty difficult to acquire. As mentioned, most people don’t have it going on. Further, the word has recently evoked controversy among those in recovery over whether those who use medically assisted treatment are able to consider themselves sober. By current definition, which only references alcohol, the answer is yes. And if you are going to use today’s interpretation of the word – free from mind altering substances- well than no one who uses caffeine, nicotine, psychotropic medications, or has an occasional alcoholic beverage is ever always sober.

See the word sober, as it’s defined, carries no real time frame. So I’m not sure when or why we allowed sobriety to be the golden standard of recovery, but I think it’s time we all see recovery as individualized as the people and treatment plans for those with substance use disorder.

Perhaps those with substance use disorder and those impacted by substance use disorder should simply work toward recovery through reducing harm and any positive change.

#DefineYourOwnRecovery

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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.

Do we really need to keep arguing about choice?

In response to the following post…

 

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Typically when we think of a habit, we think of a regularly practiced tendency that is difficult to give up. But there are other definitions of a “habit” such as it is a person’s “bodily condition”. So you are right, addiction is a habit. But the definition this post is implying isn’t the one that was intended when society adopted the term, “habit” in relation to addiction. A person who has an addiction to drugs or alcohol depends on such substances, and therefore habitually uses. It’s a bodily condition because the way drugs work in our bodies, they have the ability to chemically alter the rest of our body, including the way we are wired to think and act. And regardless of which definition you, or anyone applies to it, it does not negate the fact that addiction is a health issue.

For so long society has taught us to view addiction as a moral failing and “a poor choice” but society has done a really terrible job at backing that claim up with science, or any evidence for that matter. Addiction, or substance use disorder as referenced in the DSM5 –think of it as a dictionary for doctors and used for making diagnoses—backed by science- classifies addiction quite different from society’s collective, generalized viewpoint. I personally, prefer the science over generalizations, society’s definition of social norms or socially acceptable behavior, and completely irrelevant unsubstantiated claims- but that’s just me.

So now that we’ve established addiction is a health issue. Let’s address some other points in this post. Twice, the phrase, “addiction is a choice” appears. I think this should be repeated ….silently….in one’s head…until the phrases implications really sinks in. “Addiction is a choice” implies people wake up and decide, “today I’m going to become addicted to drugs”. I find that hard to believe and think anyone with a smidgen of intelligence would agree that of the millions addicted to drugs, most if not all, didn’t wake up and make a choice to be addicted. So now that we’ve let that sink in, let’s just stop with the “addiction is a choice”. It was false the first time it was said. It is still false now. And it’s going to be false ten minutes from now.

Let’s focus on something in this post that is true. Before the drugs or pills you did not have an addiction. This makes me giggle because that’s just logic. But what does this statement do to negate addiction as a health issue? Before 8 years ago I didn’t have anxiety. Before 5 years ago I didn’t have PTSD. Before 6 months ago, I didn’t have polycystic ovarian syndrome. Before yesterday I didn’t have a migraine. But things change, including health, and now I do. And it’s weird because I totally didn’t decide to get ANY of them. Weird.

Interestingly, I’ve been given prescriptions for some of my health inflictions and some of them have highly addictive qualities. (I happen to be fortunate to know quite a bit more than the average person about a solid percentage of medications. And further, to have a doctor who will spend a full hour with me addressing questions and consulting with my pharmacist. But I wonder how many people get that type or treatment. Because I know one too many people who became addicted from prescription drugs following necessary treatment).

Regardless, of treatment procedures or “weak minds” or lack or self-control, as referenced in this post. What makes it ok to devalue a human life? And what kind of human does that devaluing? Debate that. Because “choosing to debate the science of addiction without the expertise”…..<—-well that, just read that til it sinks in.