The stigma of addiction impacts people worldwide. In the early 1900s, individuals with an alcohol use disorder were considered “moral inferiors,” their children “born criminals”. Even now, addictive disorders are often perceived as self-inflicted, arising from a personal shortcoming or moral failing.
Today, science suggests that the language used to describe such conditions contributes to social stigma. Particularly, terms such as “addict” and “alcoholic” generalise people by their illness, erasing the physical, genetic, social, and environmental factors that contribute to a person’s substance use disorder. In contrast, person-first language, such as “a person with alcohol use disorder,” emphasises the individual by placing them before their illness or disease. Importantly, the use of person-first language can help deter social stigma.
Over the past decade, there has been a push in the form of guidelines from the research community to use person-first language and to avoid stigmatising words. We wanted to see if this was reflected in a reduction in the use of these terms in scientific research articles.
What our study examined
In 2022, we conducted a study on the use of stigmatising terms such as “alcoholic,” “abuser,” and “addict” in one of the leading alcohol journals – Alcoholism: Clinical and Experimental Research. We examined a total of 1,903 scientific articles from the previous 10 years. We found an overall decrease in the use of stigmatising words, but the term “alcoholic” was still being used in almost half of articles published each year. These findings are important because these articles are available to the research community and the public, and therefore can influence the opinions of the larger population.
How stigma impacts women
For women, the stigma around alcohol use is often worse because it is compounded by social expectations and gender-specific barriers to treatment. Since the 20th century, physicians regarded women who used alcohol as “significantly more deviant” than men. They believed such women had defied their “natural” social roles and responsibilities by engaging in immoral behavior that was associated with “sexual promiscuity and ruined motherhood”. These beliefs still impact medicine and research today. Compared to men, women with alcohol use disorder are less likely to receive treatment and are more likely to seek treatment in non-specialty settings.
Moreover, the stigma associated with problem alcohol use may also deter women from entering clinical studies. Despite government guidelines (in America) that require the inclusion of women in clinical studies, women are less likely to enter alcohol and substance use research studies compared to men.
For example, a recent study reviewed two decades of work in the area of alcohol and substance use and brain imaging and found that women were included as research participants at significantly lower rates than men. This disparity is important because we know there are many sex and gender differences that impact alcohol use disorder. As such, failing to include women at similar rates as men and test for sex differences prevents the development of treatment strategies for alcohol and substance use disorders which are responsive to sex differences. Reducing the social stigma of an alcohol use disorder may result in increased participation in research studies by women and lead to more optimised treatments for all.
Shift towards person-first language
The use of stigmatising language to describe people with an alcohol or substance use disorder has real consequences, including preventing people from seeking treatment. As a community, we have the responsibility to shift away from negative labels and promote the use of person-first language. In doing so, we hope to reduce stigma, increase treatment seeking, and promote recovery for all people managing a substance or alcohol use disorder.
Written by Hannah Shi, Professor Kelly Cosgrove, and Professor Sherry McKee, Yale University.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.