Johann, we have a problem.
In your article on The Influence last week—“Should We Stop Using the Word ‘Addict?'”—you conclude, despite reservations, that no, we should not stop using it. You write:
“We have abandoned the terms ‘negro’ and ‘homosexual,’ because they do have older, uglier associations that nobody wants to revisit. I can understand why people think—over time—the word ‘addict’ may go that way. That’s why I’m open-minded—despite having some reservations—to the idea that a better term may come along. But my biggest worry is that the alternatives that have been proposed so far are actually, alas, worse.”
I appreciate your work to travel the world and tell the stories you artfully weave throughout your book, Chasing the Scream. You even quoted me in it. Thank you for that.
But we have a problem. A big one. Not you and me, but me and millions like me, and you and millions like you. It’s about who gets to decide if the word “addict” is okay to use to describe other people who are addicted to or struggling with drugs. And it’s about precisely how urgent this issue really is.
“When I argue for greater compassion towards addicts, I often get somebody replying who says something like: ‘Then you shouldn’t call them “addicts.” Stop using that word.’ It’s a serious argument, and one that is worth thinking through in public. I feel divided about it.”
You’re right that this is an issue worth thinking through in public. But I am not divided about it. While I do appreciate that you express some empathy for the millions of us trapped under that label we never asked for, you stop short of supporting our right to be free of it, immediately, citing your “reservations” and “worry.”
What is your right to have reservations and worries about how stigmatized people choose to fight their stigmatization? I am on the record as a person who struggled for many years with a serious alcohol and drug problem. You are not. So this is not your humanity at stake; it’s mine—and that of many others. And I’m fighting for it.
I am a woman with the lived experience of so many people, of internalizing the stigma of my drug use—of feeling not regarded as a whole, individual human being with thoughts, feelings and dreams. As I write this, if you type the phrase “drug addicts are” into Google, do you know what pops up? I’ll save you the effort: Apparently we are “selfish,” “losers,” “pathetic,” “criminals,” and “not victims.” And guess what kinds of things you see if you Google “drug addict meme”? This is the stigma we face, right now, today.
I was labeled and regarded as “an addict,” lumped into that big, mushy linguistic pit for the convenience of others. People found it easier to talk about me and my problems when they could reduce me to that one word. And when I first reached out for help, I was told that I was an “addict” (and an “alcoholic”) and that I would always be one, forever, because “once an addict, always an addict.” Even treatment centers call their clients “addicts.”
That was a bitter pill. It seemed to me the only people who felt okay about being called “addicts” were people who no longer used drugs. For everyone else, “addict” remained a shaming, hurtful slur. I didn’t know a single active drug user who enjoyed any kudos in identifying herself as an “addict.” The opposite was true. I didn’t want to own an identity riddled with stigma for the rest of my life because I sought help for a problem. I just wanted help for my problem. It was confusing and painful.
I kept all of this to myself for many years because like so many others, I internalized the shame of it. I’m still reluctant to tell my full story because I am aware that doing so risks exposing me to the scorn of colleagues, potential employers or average citizens. Research confirms I’m right to be worried about it. It absolutely happens. There’s even a technical name for how I manage my internalized stigma: secrecy coping. It’s how many people with drug problems deal with and hide the worthlessness, fear and shame that we experience from our stigmatization.
And for people like me who do not claim to be “working a recovery program,” disclosure is particularly risky. Even though I have not used drugs problematically in 20 years, in many people’s eyes, I may always be “at risk” of relapse and still an “addict”—a word, as I have written before, so singularly loaded with stigma and contempt that it’s appalling we continue to let it be used so indiscriminately.
Still don’t believe me? Then try to think of an example of a one-word identifying noun relating to a person’s mental or physical health issues that remains acceptable in public life. “A Down’s Syndrome,” as you noted in your article, is out, as is “a spastic.” What about “an epileptic”? “An autistic”? Still no luck?
It’s easy to think of examples, however, that were once used, but are no longer okay. Here’s one: “cripple.” Can we say “a cripple” any more, despite its pithiness as a way of denoting people with physical disabilities? Of course we can’t. We know it’s disparaging. So instead, we take the very slight trouble of saying “people with disabilities.”
So why might “addict” be seen as an exception to this rule? I’ll suggest two factors.
The first is that a significant number of people choose to self-identify as “addicts”—a choice I would argue is self-defeating, but one anyone has the right to make, nonetheless. If you want to call yourself an “addict,” peace be with you. It’s not my choice, but I get why you do it. Much of the internalization of the “addict” label originates in 12-step culture and many people have embraced it. Millions of us, however, did not and do not choose the 12 Steps as our path to wellness and have not internalized the “addict” identity. A person can call themselves whatever they want, and allow others to call them that, too. Many cultures and subcultures use in-group language to strengthen group identity. But you do not get to call me or anyone else an “addict” unless they identify themselves as such. It’s just that simple.
The second factor is that drug use and addiction are so unusually and profoundly stigmatized that people don’t find it necessary to extend the same respect to those affected as they would to people with other health conditions.
Like “cripple,” the term “addict” instantly others people, drawing a line between us and them. While it’s important, as you note, to fight to deconstruct the stigmas and prejudices about addiction and drug use that drive the power of the word, we should still cut it from our vocabulary while fighting that good fight. We fight for the rights of people with physical disabilities without calling them “cripples.” Even if a person “caused” their own “crippling” by engaging in risky or foolish behavior (which is how many think of people using drugs), we would still respect their right to be regarded as people first.
Stigma has real-life consequences for people struggling with drugs. They are more socially isolated and less likely to seek treatment. These are facts. Words do indeed have the power to harm and “addict” is not the only phrase in this field that we should avoid.
All marginalized groups—women, people of color, gay people, people in poverty and others—must struggle for their rights and their dignity. It’s a shame we have to work this hard to be seen as people deserving of basic respect, but that’s where we are.
I’m relatively lucky. I’m a white, employed, middle-class woman. People will listen to what I say, even if they utterly disagree. But many people around the world who use drugs in ways that cause problems for themselves are denied the right to assert their own humanity in ways that you and I, Johann, would take for granted.
A black mother in poverty who compulsively uses meth has more to lose by going public, speaking up and demanding that we respect her as a person first, above any other labels we may wish to burden her with. So someone has to speak up for her, and all others like her. I’m honored to have that opportunity.
It’s been two years since I wrote “I’m Breaking Up with the Word Addict.” The response I received to that article was quite revealing, with some people trying to shame and silence me, telling me my lived experience is wrong—that I’m wrong—reinforcing my ever-present secrecy coping.
But with the culture of rights and dignity evolving so rapidly since then—the rise of Black Lives Matter, the Trans Rights movement—it now seems quaint at best and antiquated at worst to still be wondering if we should respect the request of people who use drugs problematically to not be labeled by us as “addicts.”
When even our drug czar, Michael Botticelli—a member of a 12-step program, and hardly the torch-holder for radical, cutting-edge social justice—calls on us to stop describing people as “addicts” because it makes them less likely to seek treatment, isn’t it time to let that word fade into obscurity?
And finally, Johann, isn’t it patently ridiculous to continue stigmatizing people as “addicts” simply on the basis that the word itself is quick and easy to use, and easy to understand?
I want to believe that typing “people with addiction” versus “addicts” is not so onerous that you’re willing give up the fight of silenced people yearning to be treated fairly, for the sake of cranking out a pithier tweet. I know for sure that the phrase is no harder for anyone to understand.
And even if it is onerous to do this—may I be quite candid here?—I’m not troubled.
I’m not troubled if you are inconvenienced for a few seconds when wondering how to describe a woman struggling with chaotic meth use. I care about that actual woman struggling with chaotic meth use, whose humanity you are about to casually undermine.
For her sake, for mine—and really, for yours—please, let’s try to do better.
Woman in recovery; daughter struggling with heroin; son addicted to meth; friend battling a cocaine problem. There are many things we can say. Call it addiction, substance use disorder, addictive disorder, chemical dependence, a struggle, a battle, a journey. Call some “people who use drugs.” Call others “people addicted” to them.
But what’s vital, among everything else we must do, is to acknowledge our own—and other people’s—internalized negative feelings and beliefs about one specific word. Find a better way to talk about drugs and related human struggles. Just stop using the word “addict.”
Editor’s note: Johann Hari’s response to this piece can be found here.
Meghan Ralston is a drug policy consultant in Palm Springs, CA. She is the former harm reduction manager for the Drug Policy Alliance. Her previous articles for The Influence include “Rehabs’ Failure to Give Lifesaving Naloxone to Vulnerable Clients Is Unacceptable.” You can follow her on Twitter: @OverdoseGirl.