What's In A Name : Terminological Preferences Among Patients Receiving MOUD

Background: The language used to describe substance use disorders (SUDs) and the people who have them has been an area of active discussion in the medical literature and lay press[1]. While research has demonstrated a connection between language choice and stigma by medical practitioners and the general public[2, 3], few studies have examined terminological preferences among people with SUDs[4], including person-first or DSM-5 diagnostic terminology. This study examines language preference among individuals with opioid use disorder (OUD) enrolled in treatment with medication for opioid use disorder (MOUD) at a low-barrier-to-treatment-entry program.

Methods: Participants were recruited at 30-day initial treatment review sessions to complete a survey entitled “Your Word Preferences.” Demographic information about participants was obtained from medical record review. Participants were asked 3 questions followed by a list of terms written by experienced addiction specialists derived from current and prior DSM categories, medical literature, and personal experiences with people who have SUDs: (1) “How do you prefer counselors to describe the problems you are seeking treatment for?” (2) “How do you prefer counselors to refer to you?” (3) “How do you prefer counselors to describe you?” Participants selected responses from a 7 point Likert-type scale from 1 (“Strongly Disagree”) to 7 (“Strongly Agree”). Summary statistics were calculated for each terminology choice. Tests of between-subject effects were calculated for the top 5 preferred word choices for each question based on participant age, race, and gender. Statistical analysis was performed in SPSS version 26.

Results: Four hundred and fifty participants completed the study. Mean age was 38.5 years old (SD 11.3, range 18-69), 40.4% of participants self-identified as female and 22.4% as non-White. Participants’ most preferred terms to describe their “problem” were “addiction” (Mean 5.54, SD 1.60), “substance use,” (Mean 5.50, SD 1.53), and “substance abuse” (Mean 5.38, SD 1.65). Participants’ preferred term of referral was “client,” (Mean 5.90, SD 1.32) followed by “patient,” (5.08, SD 1.93) and “guest,” (Mean 4.24, SD 1.96). Participants’ most preferred terms for counselors to describe them were “person with an addiction,” (Mean 5.08, SD 1.86), “person with substance use disorder,” (Mean 4.66, SD 1.93), and “substance-dependent person,” (Mean 4.59, SD 1.93). Participants least preferred the terms “drug abuser,” “drug user,” “druggie,” and “junkie.” For some but not all word choices, there were significant differences in participant preference mean responses based on race, gender, or age.

Conclusions: Individuals with OUD enrolled in MOUD preferred terminology that is considered de-stigmatizing, including person-first language constructions, to describe themselves and their substance use. Pejorative language was least preferred, although participants preferred the term “addict” to “drug user” or “drug abuser.” Terminological preferences also differed based on age, race, and gender. Although participants favorably rated the DSM-5 term “person with substance use disorder,” it was preferred similarly to other person-first constructs.

References: 1. Saitz, R., International Statement Recommending Against the Use of Terminology That Can Stigmatize People. J Addict Med, 2016. 10(1): p. 1-2.
2. Kelly, J.F., S.J. Dow, and C. Westerhoff, Does Our Choice of Substance-Related Terms Influence Perceptions of Treatment Need? An Empirical Investigation with Two Commonly Used Terms. Journal of Drug Issues, 2010. 40(4): p. 805-818.
3. Ashford, R.D., A.M. Brown, and B. Curtis, Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias. Drug and Alcohol Dependence, 2018. 189: p. 131-138.
4. Pivovarova, E. and M.D. Stein, In their own words: language preferences of individuals who use heroin. Addiction, 2019. 114(10): p. 1785-1790.