Words have power! People first!

August 15, 2016

The New England ATTC Network Regional Center Staff
Dan Squires, PhD, MPH, Director
Leslie Cohen, BS, Co-Director
Sara Becker, PhD, Evaluation Director
Denise Bayles, BM, Project Coordinator
Raymond Sanchez, Application Coordinator
Stacey Howley, BS, Workforce Development Coordinator

The language used to refer to people can exert a powerful impact on both perceptions and expectations.

For example, if someone is referred to as a “survivor”, assumptions—likely favorable—are made immediately, and without specific details.  Likewise, however, if someone is referred to as a “victim”, assumptions—likely more variable and less favorable—are made, even though both references could easily refer to the same individual in the same context.

Surgeon General Vivek Murthy: “For far too many people living with addiction, they feel that they are living with stigma. Many people see addiction, still, as a character flaw or a bad choice. They don’t recognize that addiction is in fact a chronic disease of the brain. If we shift that cultural perception of addiction, it will make it easier for people to get help." Surgeon General: We Have To ‘Change How Our Country Sees Addiction’
Chronic condition vs. moral failing

One area (among many) where the use of language is particularly impactful is in addiction treatment and recovery. For many decades, those who have struggled with addiction have been subjected to a range of pejorative labels and even encouraged to self-identify by often well-meaning treatment and recovery entities in ways that are inherently negative (e.g. addict, alcoholic, etc.).  With the recent epidemic of overdose deaths, the use of these terms has become even more prevalent—especially in the media.  

In contrast to the impressions created by such references, scientific and medical advances have helped to clarify that addiction is not simply the product of moral deficits or personal failings. Rather, addiction is better understood the way many other complex health challenges like cancer, cardiovascular disease, autoimmune disorders, etc. are—as a multi-dimensional, multi-factorial health condition that no person in the history of humanity was ever born hoping to experience. Why then do we insist on continuing to embrace and encourage the use of derogatory, degrading language to describe not only those who struggle, but even those who are “survivors” of addiction? Are there not better ways to refer to those of us both within and beyond the struggle of addiction that better inspire the hope, determination, and grit that all survivors come to possess?  Unequivocally, the answer is YES!

People first language 

For more than 20 years, the Addiction Technology Transfer Center Network has advocated for those struggling with addiction through a focus on developing and supporting the addiction treatment and recovery workforce.  Recently the entire ATTC Network implemented an initiative to promote the use of “people first” language.  People first language encourages reference to people in a way that recognizes their humanity and individuality first (e.g. a person struggling with addiction), as opposed to language that defines people by their struggle or problem—especially in an implicitly derogatory manner (e.g. “addict”).  It also eliminates related language that is inherently judgmental like “clean” or “dirty.”

It is the Network’s hope that others across the spectrum of addiction treatment and recovery will make similar efforts. To assist with encouraging changes, the Network will soon be posting a list of suggested people-first references, many of which have been encouraged by the Substance Abuse and Mental Health Services Administration and the Center for Substance Abuse Treatment.

It is time to stop the misguided blame and unnecessary stigma associated with both addiction and recovery. The use of affirming language inspires hope and advances recovery. 

Language matters.  Words have power.  People first!


  1. Addict and Alcoholic are not always used in the way that you think.. 12 Step programs have been successful all over the world for numerous decades. For a person to admit (s)he is an addict or alcoholic has nothing to do with shame or blame or stigma. It is the first step (literally) to admitting/acknowledging the issues and doing something about it. Sugar coating/minimizing it doesn't have the history of success that 12 step programs do, and i find this article to be insulting to those of us with decades in recovery in ways that work for us.

    1. If you really believe what the Surgeon General says "addiction is in fact a chronic disease of the brain", you should focus more on the word "Behavioral" in Behavioral Health.

    2. Thank you for your perspective on how words are used and for sharing regarding the recovery success you have experienced through 12 step programs.

    3. This is good info for those who misconcept the real meaning of addiction..
      Such words as dirty and clean do need to be changed because they definitely degrade more than help the ongoing disease of addiction..thank you for knowledge .you definitely have a very good point here.

    4. This is good info for those who misconcept the real meaning of addiction..
      Such words as dirty and clean do need to be changed because they definitely degrade more than help the ongoing disease of addiction..thank you for knowledge .you definitely have a very good point here.

  2. 12-Step programs wouldn't be the first subculture to insulate itself from stigma by re-appropriating derogatory language used to describe its members. Nor would the debates over the propriety of using those terms amongst each other. Referring to themselves as 'addicts' can be self-stigmatizing, serving to bind members to each other in the belief that the world outside the sanctuary disdains them; and it might be an empowerment of re-definition.

    I'm not a Friend of Bill myself, but I'm reminded that stigma, derision, and discrimination, spread via speech, were what put the anonymity in AA in the first place. Anonymity is out of fashion and technically obsolete these days; and self-declaration, confession, and identity politics are the order of the day. It's one thing to work for destigmatization, and another to limit the dimensions of identity.

  3. Negative labels should be avoided, but so should sweeping generalizations. PC language often sounds silly in the real world of addiction and substance use disorders. I have been a recovering alcoholic for over 30 years and feel no shame or hesitation about identifying myself as such. Better we spend our time learning about the different manifestations of addictive disorders and leave off putting a happy face on it.

    1. It amazes me that people who are not in recovery decide what is "proper" or not for us.

  4. Personally, on this subject I have no trouble with how people wish to describe themselves. However, I also know that words matter and stigma is a crucial issue in how policy is formed/adopted which drives funding and legislation. Unfortunately, words like "alcoholic" and "addict" are negatively loaded for most people. I wish they were more neutral but they are not. Individuals who struggle with addictions are more than the disease/disorder. Using person first can hopefully be part of the movement in that direction. Professionals in the field should lead the way. (The other group that I have a bone to pick on this issue is the media, but that is another post. In any event, we can not expect them to move in this direction if we in the field do not.)
    By the way, I also do not use terms like diabetic and schizophrenic either.