Research Snapshot: Using non-stigmatizing terminology improves outcomes for people with opioid use disorder

What you need to know

Stigmatizing language negatively affects enrolment and treatment outcomes for people with opioid use disorder (OUD). Researchers found that non-stigmatizing language improved outcomes for people with OUD. Non-stigmatizing language involves using judgment-free and medically accurate terminology.

What is this research about?

The researchers noticed that only 20% of people with OUD access care. The researchers aimed to understand how stigmatizing language affects OUD treatment outcomes and how changing language can then improve those outcomes.

Stigma is a dehumanizing process based on the idea that someone is morally inferior or defective. Stigmatizing language includes phrases that are associated with negative attributes or stereotypes. Since 1964, experts have been trying to find language that focuses on substance use disorder (SUD) as a medical condition rather than as a poor personal choice.

What did the researchers do?

The researchers conducted a narrative review of the literature between 2010 and 2019. Using “opioid use disorder,” “substance use disorder,” “stigma,” and “language” as key search terms, the researchers screened 52 articles for inclusion, and 17 articles were included in this review.

What did the researchers find?

The researchers found that stigmatizing language creates a gap between people who have OUD and people who do not. When we use phrases that have a negative meaning in our culture it defines people with OUD by their condition rather than their personhood. This way of viewing people with OUD has an impact on how they view themselves and how care is provided to them.

The research team found four main themes:

  1. Stigma in language: The researchers found that stakeholders had negative implications with terms such as “addict” or “abuser.” The researchers found that person-first phrases, such as “person with a SUD” are more likely to reduce stigma. Some of the articles reviewed reported that person-first language improved outcomes and lowered stigma. Even though Table 1 outlines terms that are neutral and stigma-free, some people in recovery may identify with labels like “addict” and their choice should be respected by service providers.
  2. Stigma in language used by health care providers: The review found that using phrases like “substance abuser” to describe a client increased the odds that a service provider would see the client as at fault for their circumstances. Further, the review found that health care providers' use of stigmatizing language could cause clients to feel unworthy, jeopardizing treatment. Lastly, using stigmatizing language can perpetuate the use by the general public.
  3. Stigma and language used by the general public: The review found that news media is increasingly using stigmatizing language to describe OUD. Use of stigmatizing language damages the public’s opinion of people with OUD and harm reduction programs. The general public, including health care providers, have negative associations with words like “addict.” Additionally, they found that phrases like “resumption of use” had a positive implication compared to phrases like “relapse.”
  4. Stigma and language used by people with OUDs: The review found that people with OUD can absorb stigma from the public and health care providers. According to the researchers, when people absorb stigma, it negatively impacts their functioning, worsening their dependence on substances and increasing their suffering. The review found that people with OUD who described themselves as a “person with an OUD” had better treatment outcomes than people who used the term “addict.”

Table 1: Examples of stigmatizing language and preferred terms

Stigmatizing termNeutral termReason

opioid abuse

opioid use disorder

as per DSM-V

overdose

poisoning

implies wrongdoing or personal blame

relapse

recurrence of use

judgmental

sober/straight/clean

not currently using/consistent with recovery

judgmental

manipulative/drug-seeking

attempting to have needs met/seeking medication

terms should be descriptive, not demeaning

Note: This chart is populated by information provided in Table 2 of Addressing bias and stigma in the language we use with persons with opioid use disorder: A narrative review

What are the limits of this research?

The team used three search engines to keep results manageable and may have found more articles if they had used more search engines. The same research group wrote six of the articles discussed, which could lead to bias. One of the articles used the same data set as another article, which could also skew results in a particular direction. Lastly, a narrative review can be more prone to bias than a literature review but is useful when examining broad themes.

How can you use this research?

Start with person-first language, but respect the right of someone to identify using the label they feel most comfortable using. Health care providers can advocate in their workplace to use non-stigmatizing language (see Table 1 for examples) and to their college to support the use of non-stigmatizing language in their profession. Health care professionals can advocate for media to use neutral and precise language.

Educators can work to improve the SUD content in their curriculum. An important first step is reviewing the curricula for formal, informal, and hidden curricula. Another opportunity for improvement is creating opportunities to work directly with people with SUD in order to develop empathy, which the research suggested was an effective counterbalance to negative bias that students are exposed to in clinical practice. 

About the authors

Karen Werder, PhD, MSN, PMHNP-BC1

Alexa Curtis, PhD, MPH, PMHNP-BC, FNP-BC2

Stephanie Reynolds, MPH3

Jason Satterfield, PhD3

  1. Sonoma State University, Rohnert Park, CA, USA
  2. University of San Francisco, San Francisco, CA, USA
  3. University of California, San Francisco, CA, USA

References

Werder, K., Curtis, A., Reynolds, S., & Satterfield, J. (2021). Addressing bias and stigma in the language we use with persons with opioid use disorder: A narrative review. Journal of the American Psychiatric Nurses Association, 28(1), 9–22. Available: https://journals.sagepub.com/doi/pdf/10.1177/10783903211050121. Accessed May 16, 2023

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