How To Help Someone With Addiction To Drugs – Does it matter how we talk about people with substance use disorders? Research has found strong experimental evidence that inadvertent exposure to certain terms actually leads to systematic cognitive biases that can affect clinical judgment and quality of care.
Illicit drug use disorders are the most stigmatized health conditions in the world, and alcohol use disorders are tied for fourth in the world, among the 18 most stigmatized conditions internationally. Importantly, the level of stigma is related to the perceived cause of the condition (perceived as no one to blame, lower stigma) and perceived control over the condition (perceived as uncontrollable, lower stigma).
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In a previous special issue of the Rehabilitation Research Institute newsletter, we highlighted several studies related to substance use disorder stigma, including one that shows that portraying opioid use disorder as treatable can help reduce the stigma associated with the condition.
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In this study, Kelly and his colleagues were interested in whether the language we use to describe individuals with substance-related problems may lead to different types of stigmatizing attitudes. The terms used to describe individuals with substance-related conditions may reflect different attributions of causality and controllability that they perceive.
More specifically, the study authors tested whether describing someone as “substance abusing” increased the likelihood of eliciting more punitive attitudes than describing the same person as having a “substance use disorder.” The term “abuse” can give the impression that the person is in control of the situation (one of the two factors associated with stigma) and is therefore committing intentional wrongdoing. On the other hand, the term “disorder” can give the impression that there is some medical harm, which increases the possibility of a more therapeutic treatment.
In one survey, 314 people answered 35 questions related to their perceptions or feelings about two people who “actively use drugs and alcohol.” One is called “substance abusing” and the other is called “with a substance use disorder.” No further information was provided about this hypothetical person.
Half of the participants worked in health care, while 20% were students, 29% worked outside of health care or were unemployed or retired, and 5% did not report employment. They had a median age of 31 years (range, 17 to 68 years), 81% were white, 76% were female, and half had a bachelor’s degree or higher.
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All of these differences were large, with the exception of higher levels of social threat, which was a moderately large difference.
In the study figure below, the values represent the average response to the items that make up the scale. Thus, if the scale value is closer to 100%, participants are more likely to select that person (“comparison user” or “substance use disorder”) when responding to scale items. Although the questionnaire asked participants to specifically choose one or the other individual, they could choose both or could choose neither person, so values for each stigma domain do not necessarily add up to 100%.
For example, for “treatment,” the bar for substance use disorder (green) is 69%, and the bar for “substance abuse” (yellow) is 41%, showing that participants are more likely to select individuals with “substance use disorder “. by doing, answer the item about who would benefit more from the treatment. It is important to reiterate that in some cases more than one construct (set of items) indicates less stigma (e.g., treatment), while in other cases more constructs indicate more stigma (e.g., social threat).
In contextualizing the importance of this work, it is important to mention another related study also conducted by Kelly and colleagues. In the study, mental health clinicians (two-thirds of whom had doctoral degrees) were randomly assigned to receive only one of two vignettes about individuals with substance-related problems. The vignettes were identical except that – as in the studies reviewed here – one vignette referred to the individual as a “substance user” and the other as “with a substance use disorder”. The questions that followed exposure to the vignettes were similar to this study, though not exactly the same, and instead of choosing one or the other hypothetical individual, they simply answered their level of agreement with the statements they were given about the people in the study. vignettes. For these clinicians, compared to those in the “substance use disorder” group, those in the “substance abuse” group believed that the individual was more to blame for their problem and more in need of punishment to change their substance use (eg, “He can avoid alcohol and drugs” and “He should do some jail time to serve as a wake-up call”).
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There were no differences between groups in terms of perceiving the individual as a social threat or whether the individual was unable to control their difficulties and would benefit from treatment. In general, trained mental health clinicians are less prone to language-influenced perceptions of individuals with substance-related problems than non-mental health individuals. However, they are not entirely immune to the role that language plays in how we view individuals with health conditions—in this case, substance-related health conditions.
It is possible that exposure to the term “user” elicits a more punitive, implicitly cognitive bias, while the term “substance use disorder” elicits a more therapeutic attitude. Using the term “substance use disorder” might be better because it might be less annoying. Given the widespread use of the term “abuser” by clinicians, scientists, policymakers, and the general public, this term may be part of the reason individuals seek or remain in addiction treatment.
For example, in a large and representative sample of individuals with alcohol use disorders, those who perceived alcohol-related problems as a highly stigmatized condition by people they knew in their daily lives were less likely to seek treatment, whereas those who perceived alcohol-related problems were less likely to seek treatment. were less likely to seek treatment in case of problems. People stigmatized by these people are more likely to seek treatment. Therefore, a reasonable hypothesis is that if we as a society can begin to address the stigma of substance use disorders, we can help increase the number of people seeking treatment. One way to do this may be to change the language, moving away from the term “abuser” and using terms that are consistent with medical and public health approaches.
Overall, this study is part of a body of literature that is helping to drive change in language use in this area. Recently, the editors of the Journal of the International Society on Addiction, based largely on this research, issued guidance that strongly cautioned against using the term “abuse” and instead endorsed any of the substance use disorders (if substance use meets diagnostic thresholds). or some change in the use of substances that may cause harm, such as the use of dangerous substances or the use of dangerous substances.
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There are several possible next steps related to research on stigma and substance use disorders, including, but not limited to, the following three areas:
Kelly, J.F., Dow, S.J., & Westerhoff, C. (2010). Does choice of substance-related terms affect perceptions of need for treatment? Empirical research with two commonly used terms.
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Watching someone you love struggle with a substance use disorder can be very upsetting and affect your mental and emotional well-being. Whether the drug user is a close friend, spouse, parent, child, or other family member, their addiction can easily take over your life. It can pile up stress after stress, test your patience, strain your bank balance, and create guilt, shame, anger, fear, frustration, and sadness.
You may worry about where your loved ones are at any moment, the risk of an overdose, or the damage they are doing to their health, their future, and their home life. You may owe them for their living expenses, the cost of legal problems related to drug use, or failed rehab and rehab attempts. You may also be tired of protecting your loved ones at home or at work, taking on neglected responsibilities, or unable to devote more time to family, friends, and other interests in life.
Even if you give up, you are not alone in your struggle. A 2017 Pew Research Center survey found that nearly half of Americans have a family member or close friend who is addicted to drugs. Across the Western world, the abuse of prescription painkillers and tranquilizers has increased in recent years, creating a public health crisis. (Along with marijuana, they are now one of the most abused drugs.)
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