The what, why and how of health and development

The Do’s and Dont’s of substance use language, according to journal editors

Back when I was City journalism student learning about health reporting – and later a copywriter for health charities – the sensitivity of language around medical subjects was drilled into me by various experts in fields such as mental health, HIV, and TB. The choice of terminology determines the tone of an article and sometimes even the journalist can be unaware of the implications of the language they’re using – something I often see as a freelance sub-editor of tabloid news.

The biggest mistakes do tend to appear in tabloid press, although all health journalists have a responsibility to find a middle ground between rigid medical terminology and the more illustrative language of journalism. But according to a guidance paper published by a a group of journal editors last week, scientists don’t always get it right either.

Editors of the journal Substance Abuse were apparently so concerned at some of the terms found in submitted papers they published an article appealing for researchers to use language that ‘respects the worth and dignity of all people…focuses on the medical nature of substance use…and avoids perpetuating negative stereotypes and biases through the use of slang and idioms’.

Some of the ‘what not to do’ examples sound like they could have come out of a column of a judgemental newspaper editorial:

“Although it is perhaps surprising, our journal has received submissions that contain explicitly morally laden language, e.g., referring to the “depraved and degenerate lives” of individuals who use substances,” wrote the Substance Abuse editors. They also revealed that some submissions included slang words such as ‘addicts’, ‘speedball’, and ‘clean’/’dirty’ urine.

Less obvious, but equally important, was the advice on using ‘people-first’ language, and highlighting that a person’s condition is only one aspect of them and not their defining characteristic. ‘Addicts’, ‘users’, or ‘alcoholics’ are terms, according to the authors, that erase individual differences and presumes an homogeneity in experiences. They advise instead on using: ‘person with a ‘cocaine use disorder’ or ‘adolescent with an addiction’.

By the same token, they suggest that referring to a convict by their crime – murderer, drug dealer, thief – may be dehumanising. Instead they advice using the terms ‘people in prison’ or ‘people on parole’, a phrase perhaps suitable for scientific papers but not one I can ever see getting past a newspaper editor (although I did recently read an article that used the phrase ‘people with vaginas’).

They also turn the mirror on to themselves however, acknowledging that the very title of the journal they’re editing – Substance Abuse – could be deemed pejorative, referencing addiction expert William L. White’s article The Rhetoric of Recovery Advocacy: An Essay On the Power of Language.

In his essay, White writes that “of all the words that have entered the addiction/treatment vocabulary, ‘abuse’ is one of the most ill-chosen” and “to suggest that the addict mistreats the object of his or her deepest affection is a ridiculous notion”. He argues this word comes from an historic religious and moral concept of addiction and can be compared to the now – thankfully – defunct term ‘self-abuse’ that was once used to describe masturbation.

Both White and the Substance Abuse authors agree however that people recovering from these conditions are really the ones who should shape their own language and definitions.

“Most importantly, we need to know much more about the thoughts and preferences of the individuals and families who are affected by drug and alcohol use: how do they feel about
their own and others’ use of the terminology discussed above? What language would they like us to use, and what are the implications for the services and policies they need?” the journal editors ask.

To summarise, I’ll borrow a fitting quote from the introduction to White’s paper (that he borrowed himself nonetheless):

“The difference between the right word and the almost right word is the difference between lightning and the lightning bug.” – Mark Twain

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