First-Person Language: Words to use and words to avoid – Libraries Advancing Community Learning to Reduce Substance Use

When you begin working with people who use, abuse, or are addicted to substances, you might be unsure or worried about how to address them to create a welcoming atmosphere in the library. As we know, words matter. It is good to ask people how they want to be described. People in 12-step programs might prefer to use the term ‘addict’ or ‘alcoholic.’

The following information about person-first language is from the National Institute on Drug Abuse and is in the public domain. It was written for healthcare providers but adapted for library workers.

This page offers background information and tips for providers to keep in mind while using person-first language, as well as terms to avoid to reduce stigma and negative bias when discussing addiction. For similar information for patients, visit NIDA’s Words Matter: Preferred Language for Talking About Addiction.

Stigma and Addiction

What is stigma?

Stigma is a discrimination against an identifiable group of people, a place, or a nation. Stigma about people with SUD might include inaccurate or unfounded thoughts like they are dangerous, incapable of managing treatment, or at fault for their condition.

Where does stigma come from?

For people with an SUD, stigma may stem from antiquated and inaccurate beliefs that addiction is a moral failing, instead of what we know it to be—a chronic, treatable disease from which patients can recover and continue to lead healthy lives.

How does stigma affect people with SUD?

Feeling stigmatized can reduce the willingness of individuals with SUD to seek treatment.^1,2
Stigmatizing views of people with SUD are common; this stereotyping can lead others to feel pity, fear, anger, and a desire for social distance from people with an SUD.²

How can we change stigmatizing behavior?

When talking to people with SUD, their loved ones, and your colleagues, use non-stigmatizing language that reflects an accurate, science-based understanding of SUD and is consistent with your professional role.
Use person-first language and let individuals choose how they are described.⁴ Person-first language maintains the integrity of individuals as whole human beings—by removing language that equates people to their condition or has negative connotations.⁵ For example, “person with a substance use disorder” has a neutral tone and distinguishes the person from his or her diagnosis.⁶

Terms to avoid, terms to use, and why

Consider using these recommended terms to reduce stigma and negative bias when talking about addiction.

Instead of…	Use…	Because…
Addict	Person with substance use disorder¹	Person-first language. The change shows that a person “has” a problem, rather than “is” the problem.⁷The terms avoid eliciting negative associations, punitive attitudes, and individual blame.⁷
User	Person with OUD or person with opioid addiction (when substance in use is opioids)
Junkie	Person in active use; use the person’s name, and then say “is in active use.”
Alcoholic	Person with alcohol use disorder
Drunk	Person who misuses alcohol/engages in unhealthy/hazardous alcohol use
Former addict	Person in recovery or long-term recovery
Reformed addict	Person who previously used drugs

Instead of…	Use…	Because…
Habit	Substance use disorderDrug addiction	Inaccurately implies that a person is choosing to use substances or can choose to stop.⁶“Habit” may undermine the seriousness of the disease.
Abuse	For illicit drugs:UseFor prescription medications:MisuseUsed other than prescribed	The term “abuse” was found to have a high association with negative judgments and punishment.⁹Legitimate use of prescription medications is limited to their use as prescribed by the person to whom they are prescribed. Consumption outside these parameters is misuse.
Opioid substitution replacement therapyMedication-assisted treatment (MAT)	Opioid agonist therapyPharmacotherapyAddiction medicationMedication for a substance use disorderMedication for opioid use disorder (MOUD)	It is a misconception that medications merely “substitute” one drug or “one addiction” for another.⁶The term MAT implies that medication should have a supplemental or temporary role in treatment. Using “MOUD” aligns with the way other psychiatric medications are understood (e.g., antidepressants, antipsychotics), as critical tools that are central to a patient’s treatment plan.
Clean	For toxicology screen results:Testing negativeFor non-toxicology purposes:Being in remission or recoveryAbstinent from drugsNot drinking or taking drugsNot currently or actively using drugs	Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions.¹⁰Set an example with your own language when treating patients who might use stigmatizing slang.Use of such terms may evoke negative and punitive implicit cognitions.⁷
Dirty	For toxicology screen results:Testing positiveFor non-toxicology purposes:Person who uses drugs	Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions.⁹May decrease patients’ sense of hope and self-efficacy for change.⁷
Addicted baby	Baby born to mother who used drugs while pregnantBaby with signs of withdrawal from prenatal drug exposureBaby with neonatal opioid withdrawal/neonatal abstinence syndromeNewborn exposed to substances	Babies cannot be born with addiction because addiction is a behavioral disorder—they are simply born manifesting a withdrawal syndrome.Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions.¹⁰Using person-first language can reduce stigma.

References

November 29, 2021