As Rhode Island struggles with the unprecedented impact of the COVID-19 epidemic, an older and equally devastating epidemic has gotten worse. In 2019, over 300 hundred people in our state died of a drug overdose—the numbers are now increasing for the first time in three years. COVID-19 has thrown gasoline on the flames by disrupting access to treatment, social support, recovery meetings (like AA and SMART recovery), harm reduction supplies like the life saving medication Naloxone, and basic medical care. But the fire was already burning out of control.

Among people who want help for their addiction, perceived stigma from family, friends, and the community is the single greatest obstacle to reaching out for help. We are afraid of losing our jobs when employers find out about our substance use. We fear judgment and abandonment by our families and friends. We worry that doctors will censure, reject, or label us “medication seeking”—blacklisting us from care. We live with shame and self-doubt from a lifetime of hearing that addiction—a serious, but entirely treatable, health condition—is a choice or moral failing.

Looking at research, we see that stigma undermines every aspect of our society’s efforts to address the overdose epidemic. Stigma among treatment providers is linked to mistreatment, lower program completion rates, and worse outcomes. Internalized stigma feeds depression and anxiety that can, in turn, drive more severe and dangerous use. Public stigma leads to support for criminalization rather than care. Stigma, and ultimately the ensuing discrimination, bars people from housing, meaningful employment, and education—the very things that promote successful long-term recovery.

As Rhode Island’s recovery community organization, RICARES is calling on newspapers, televisions stations, radio, and online media to join with the recovery community in tackling stigma in our state. As daunting as this may sound, multiple studies show that there is a free and easy way to build momentum: we need to change the way we talk about addiction and recovery. 

Words like “addict” and “alcoholic” reduce us to a stereotype or diagnosis. Words like “clean” imply that we were tainted and soiled (rather than living with an illness). “Substance Abuse” implicitly compares us with child and spouse abusers. Although it is tradition (and can be personally transformative) for people in recovery to claim these labels, evidence shows that they lead both professionals and the general public to believe we are more deserving of punishment and less likely to benefit from treatment. For these reasons, the Associated Press published new guidelines in 2017 on how to write and speak about addiction in the press.

To jump start this discussion, RICARES has joined with the City of Providence to organize “Words Matter: A Conversation About Stigma, Substance Use, and COVID-19.” A two-hour online workshop, this event will include people in recovery speaking about their experiences of stigma and discrimination, nationally recognized journalists, and world-renowned researchers

Our goal is that three television channels, three newspapers, three radio stations, and three online platforms publicly pledge to uphold the AP guidelines by the end of National Recovery Month, September 2020. We see this as a first step toward all RI news platforms embracing person-centered and medically accurate language. No other state has made this kind of effort. Achieving this goal would make the RI press leaders in the national conversation.

Join RICARES and the City of Providence for a workshop led by veteran journalists, leading researchers, and people in recovery about:

Questions? Contact Jon Soske at jsoske@ricares.org

Simultaneous Spanish translation will be provided.

addiction

Addiction to alcohol and other drugs is considered a disease that affects a person’s brain and behavior. It can cause changes in brain circuits and chemistry that lead to  inability to control use, despite resulting harmful behavior including damage to health and relationships. Genetics, mental illness and other risk factors make certain people susceptible to addiction
Addiction is the preferred term for the disease. The term substance use disorder is preferred by some clinicians and is acceptable in some uses, such as in quotations or scientific contexts. Alcoholism is acceptable for an addiction to alcohol.

Avoid words like abuse or problem in favor of the word use with an appropriate modifier such as risky, unhealthy, excessive, or heavy. Misuse is also acceptable. Don’t assume all people who engage in risky use of drugs or alcohol have an addiction.

Avoid words like alcoholic, addict, user, and abuser unless they are in quotations or names of organizations, such as Alcoholics Anonymous. Many researchers and organizations, including the Office of National Drug Control Policy and the International Society of Addiction Journal Editors, agree that stigmatizing or punitive-sounding language can be inaccurate by emphasizing the person, not the disease; can be a barrier to seeking treatment; and can prejudice even clinicians. Instead, choose phrasing like he was addicted, people with heroin addiction, or he used drugs. 

Examples: Keene had trouble keeping his job because of alcoholism, not Keene had trouble keeping his job because he was an alcoholic. Yang joined other people with heroin addictions at the conference, not Yang joined other heroin addicts at the conference. 

As of early 2017, leading clinicians said disorders with tobacco and gambling can also meet the criteria for addiction. Other compulsivebehaviors such as eating internet gambling, sex and shopping did not meet the clinical criteria for addiction.

When practical, try to confirm that individuals described as having addictions have received such a diagnosis by letting them talk about it themselves, or get confirmation from a doctor or relative in the position to know.

Do not use the terms addiction  and dependence interchangeably. Addiction  usually refers to a disease or disorder; dependence may not invovle one, such as some babies born to mothers who use drugs or cancer patients who take prescribed painkillers.

Note the subtle difference between prescribed and prescription drug.Prescribe usually is used to describe specific drugs a doctor has authorized for a patient; prescription refers to classes of drugs meant for that purpose. The cancer patient took prescribed painkillers. Health officials observed wide misuse of prescription painkillers.