If We Stop Saying “Addict,” Will People Quit Using?

In 1939, William Griffith Wilson, Founder of Alcoholics Anonymous  received an important letter. The first physician to endorse his new program, Alcoholics Anonymous, was William D. Silkworth. Wilson included it in the forward to the first edition of the “Big Book.” He was elated at endorsement from a medical professional. It helped his campaign to change the public perception of alcoholism, from that of a moral failing to a medically treatable disease.

The term alcoholic was in use since the days of Dr. Benjamin Rush coined it in colonial Pennsylvania. With it came the notion that a person who developed a dependency on alcohol was morally lazy or weak. It’s easy to see the logic.

Every morning the alcoholic, wracked with fear and withdrawal symptoms, vainly attempts to to stick with his plan to not drink. Inevitably, craving saps his resolve. Then he drinks, and the alcohol molecules themselves further corrode his willpower. From the outside, it seems as if he could just muster enough conviction, everything would be okay.

Moving the willpower issue (weak moral character), into the medical realm, looked like a sound approach back then. But like as drinking itself, this spawned a tangle of unintended consequences. Medicalization of the drinking habit has helped many, but for others, the cost in social stigma has been high.

The difference between calling people addicts, and saying that they have weak character, is functionally indistinguishable and factually absurd. A more correct terminology would be to admit some habitual behaviors lead to undesirable results. A nonjudgmental way of using words, neither medical nor ecclesiastical, frees people from the tyranny of misapplied language.

Politically correct, or patently unhelpful?

In an October 2018 article published in the Portland Business Journal, “The stigma around addiction must end,” panelists say. The Director of the Kaiser Hospitals in the Emerald City called for measures to end the stigma surrounding addiction.

The focus here is on the terms; specifically, the words ‘addict,’ and ‘alcoholic.’ I get it. Labeling a person with mental illness affects their treatment and self-conception. These terms are widespread and we defend them as part of recovery culture.

Recently in the Los Angeles Times, I saw an article referring to vagabonds as ‘persons experiencing homelessness.’ This pretzel-wise locution tries to make us feel more compassionate, but instead simply muddles reality. Not only does it not properly frame the problem, it also pretends that people have no responsibility for how they live.

If you’re merely ‘experiencing homelessness,’ you’re a temporary passive victim. For many though, there’s nothing temporary about it. Escaping a life on the streets can be hard to do, requiring persistence in despite the challenges. The same is true of overcoming addiction. It is hard, but the individual controls his own trajectory.

More and more of the same

Researchers at the University of Pennsylvania think the words are the real problem. They aver for a change in language to reduce addiction. They draw an analogy with the HIV epidemic of the 90s, as an example of stigma reducing access to care.

The real issue goes much deeper. If you ask a random person, “would you rather be known for your moral failing or for your mental illness,” most would say neither.

In a similar article, published in The Hill, the terminology debate is extended to the national epidemic du jour: the opioid crisis. Unfortunately, it’s more of the same. Instead of saying someone is addicted to heroin, they encourage us to say a person is experiencing a substance use disorder. We are in an echo chamber.

The people suffering with this problem see right through this spin, and I believe this simple re-labeling does them a disservice. People habituated to intravenous drugs refer to themselves junkies; they refer to each other as dopers and druggies. Let’s stop pretending. I don’t think it would have been easier to detox if I’d been referred to as a fentanyl enthusiast.

Digging up the roots, and planting better seeds

The word addiction comes from Latin meaning assigned or sold into slavery. Roman soldiers who performed well were awarded slaves after a successful battle. The slaves were bound to the soldier, his -addicts.  You could wind up an addict if you received pleasure or value in advance and couldn’t pay for it, you (debtor). Since the temperance movement of the 19th century, we unfortunately limited addiction to alcohol and drugs. Anything we slavishly adhere to could be called addiction.

On the other hand, a habit is ‘a settled or regular tendency or practice, especially one that is hard to give up.’

I like saying habit because regular tendency or practice accurately conveys the internal unrest you experience when you’re blocked from following a habit (smokers on an airplane). The second part of the definition, hard to give up, encapsulates the challenges we face when quitting.

In my own experience, I was weak facing the compulsion to get loaded. I was enslaved to the effect of the substance (fentanyl). That’s not mental illness, but I sometimes felt like I wasn’t in control. Much of my behavior when I was addicted could be just called nuts. Once I replaced drug use with a different set of habits, I got hooked on the feeling of freedom that comes with sobriety, To quote a Roman, Cicero, “No man is truly free until he submits himself to a set of laws.”

People working at the hard task of solving addiction have their hearts in the right place. Lowering psychological, linguistic and social barriers to change are noble and worthwhile fights. We would do better to call a habit a habit and worry less about stigma. To what pleasurable experience are you bound?

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