NOTE: The information here, while presented in the context of opioid dependence, applies to the treatment of any substance use disorder.

For several hundred years, opioid dependence was regarded as a character flaw that could be reversed if only users were willing to exercise better self control.

Recognition of opioid dependence as a medical condition in the latter part of the 20th century began a fundamental revolution in how this disease was approached and treated; today, treatment is more available than ever before.

But while the medical community is increasingly receptive to viewing opioid dependence as a medical condition, the idea is still relatively new. Consequently, the language used to describe opioid dependence is often inconsistent, and much of it still reflects the outdated belief that opioid dependence is the result of moral weakness.

To address these issues and encourage a common language for substance use disorders, the Center for Substance Abuse Treatment (CSAT) has published Substance Use Disorders: A Guide to the Use of Language (referred to here as the "CSAT language guide").

The CSAT language guide is designed to raise awareness of the impact of language—particularly that used by professionals involved in substance abuse prevention, treatment, and recovery. In addition, the guide offers alternatives to negative and stigmatizing terminology in an effort to promote "the use of words that will advance the understanding of substance use disorders as a health issue."¹

Excerpts from the 2004 CSAT language guide are included below. Click here to view the document in its entirety.

Words That Work 
Words to Avoid

Words That Work¹

Addictive Disorder/Addictive Disease—Reinforces the medical nature of the condition.

Alcohol and Drug Disease—Clearly defines the condition as a health issue.

Dependence—Communicates a distinct clinical diagnosis that encompasses both the social and health problems associated with compulsive use (both the DSM-IV and ICD-10 use the term "dependence," not "addiction"). See also "Substance Dependence." Preferred as an umbrella term for substance use disorders, because not all substance use disorders reach the level of addiction. Also, without a modifier (eg, addicted to X), "addiction" may potentially include any addictive disorder (eg, alcohol, drugs, gambling, shopping, eating, or sexual disorders).

Disease Management—Pertains to the medical concepts of suppressing symptoms and providing the appropriate level of intervention—focusing on service and cost efficiency.

Medication-assisted Recovery—A practical, accurate, and nonstigmatizing way to describe the path of recovery facilitated by medically monitored pharmacologic agents.

Misuse—Offers the same intended meaning as abuse, but without the stigma and judgmental overtone. NOTE: The 2004 CSAT language guide departs from the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in that the guide suggests using the term misuse instead of abuse as a clinical diagnosis because it is less stigmatizing for vernacular usage.

Patient—Accurately refers to a person under care for a substance use disorder, reinforcing the fact that such disorders signify a health issue.

Recovery—Reflects a paradigm shift from the focus of pathology to one of resiliency.

Recovery Management—Reinforces that substance use disorders are illnesses that can be treated and managed and from which people recover, similar to other chronic diseases—placing the focus on the individual rather than on the efficiency of costs and services.

Recovery Process—Conveys the fact that recovery happens over time as patients increase their awareness of and ability to manage their behavior.

Substance Dependence—Suggests the patient continues to use a substance despite a cluster of cognitive, behavioral, and psychological symptoms.

Substance Use Disorder—Encompasses a range of severity levels from problem use to [physical] dependence and addiction.

Treatment—Communicates the use of a planned, intentional intervention in the health, behavior, and personal and/or family life of the patient.

Words to Avoid¹

Abuse—Negates the fact that a substance use disorder is a medical condition, places blame on the patient, absolves those contributing to the problem (eg, dealers), and perpetuates stigma. NOTE: The 2004 CSAT language guide departs from the ICD-10 and DSM-IV in that it suggests using the term misuse instead of abuse as a clinical diagnosis because it is less stigmatizing for vernacular usage.

Abuser, Addict, Alcoholic—Demeaning terms that make no distinction between the person and the disease.

Clean, Dirty (when referring to drug test results)—Demeaning to patients because terms associate illness symptoms with filth, not a medical condition.

Drug Problem—Places blame fully on the patient, isolates the condition from other aspects of the patient's health and life.

Habit or Drug Habit—Denies the medical nature of the condition.

User—Labels the person by his or her behavior.