Reducing the Stigma of Substance Use Disorder Prevention and Treatment

March 22, 2018|2:27 p.m.| ASTHO Staff

In a 1923 speech to the Royal College of Surgeons, Rudyard Kipling remarked, “Words are, of course, the most powerful drug used by mankind. Not only do words infect, ergotise, nacotise, and paralyse, but they enter into and colour the minutest cells of the brain.” As public health practitioners and policymakers continue to grapple with the effects of yet another powerful drug—opioids—Kipling’s insight into the influence of words is a reminder of how the terms and phrases we use can stigmatize the diagnoses and treatment of substance use disorders (SUD).

Language can play a role in both perpetuating and reducing stigma. Stigmatizing terms can evoke more punitive attitudes from clinicians and members of the public towards people with SUD. This type of language fails to account for how health research and practice show SUD to be a “chronic, relapsing brain disease.” In response, healthcare providersacademics, and journalists have updated the words they use to describe SUD to reflect evidence-based medical terminology. The Office of National Drug Control Policy also developed a guidance document “addressing terminology related to substance use and substance use disorders” and encouraged its use by federal agencies when crafting “internal and public facing communications.” The Recovery Research Institute even developed the Addictionary to help researchers, clinicians, policymakers, and the public understand how to use the words and language surrounding SUD to minimize stigma.

In addition, state legislatures are considering revisions to statutory language to address stigma and encourage a public health approach to SUD. In Maine, the state’s opioid task force recommended legislation to address stigma-reducing language in its final report. In response, lawmakers introduced LD 1871 to replace terms such as “drug user” and “substance abuse” throughout the state’s laws with language “intended to be respectful and minimize stigma.” The bill also directs the Maine Department of Health and Human Services to rename the office of substance abuse and mental health services and change references to “substance abuse” in its forms, regulations, and other guidance documents.

Lawmakers in Rhode Island are considering similar measures, with legislation (H 7475) to ensure that laws and regulations use appropriate terminology for both disabilities and SUD. The bill authorizes the director of the Law Revision Office to amend statutes to replace stigmatizing terms as they appear in statute. The bill also authorizes the personnel administrator to revise job descriptions for state government positions to incorporate appropriate disability language. Similarly, a bill (HB 1340) in Washington replaces the term “chemical dependency” with “substance use disorder.”

Stigma can also impact the treatments available for SUD, and lawmakers can address these consequences as well. Research shows that medication-assisted treatment (MAT)—the combination of counseling and behavioral therapies with one of three medications approved by FDA (methadone, buprenorphine, and naltrexone)—is an effective treatment for opioid use disorder. Existing laws may lead to the stigmatization of MAT as the mere substitution of one drug for another rather than an effective treatment. For example, in Washington, current law declares the main goal of MAT to be the “total abstinence from substance use,” while a legislative proposal (HB 2489) would declare the goal to be “the cessation of unprescribed opioid use, reduced morbidity, and restoration of the ability to lead a productive and fulfilling life.”

Ensuring that individuals with SUD are properly diagnosed and have access to effective treatment is a critical piece of addressing the opioid epidemic. Unfortunately, the words used in laws and policies can limit SUD prevention and treatment efforts by stigmatizing them. Removing stigma from the diagnoses and treatment of SUD is recognized by ASTHO’s 2017 President’s Challenge as a way to prevent substance misuse, addictions, and the related consequences. With this in mind, ASTHO will continue to inform its members of emerging trends in state legislation that destigmatizes SUD and other efforts to reduce opioid misuse.