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A lesson in language

April 3, 2017
by Gary A. Enos, Editor
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Michael Botticelli

In preparing the Changing the Language document, ONDCP consulted with research, policy, provider and consumer stakeholders. Botticelli cites several criteria used to arrive at the suggested language in the document:

  • The presence of any direct research supporting use of certain language;

  • An effort to align the field with currently accepted medical terminology, such as that in the DSM-5; and

  • An attempt to move the field toward regular use of person-centered terminology.

An introduction to the document states, “By using accurate, non-stigmatizing language, we can help break the stigma surrounding this disease so people can more easily access treatment, reach recovery, and live healthier lives.”

Botticelli says he also understands the limits of this endeavor, in areas such as potentially changing the names of federal agencies to reflect a changing mindset. He consistently explains that the act of removing the word “abuse” from the name of an agency such as the National Institute on Drug Abuse would have to occur as part of agency reauthorization language in Congress.

Also accompanying the document's table of 15 commonly used terms and their alternatives is suggested language for describing persons' attempts to work within “a system that often tries to control them,” as the document states. For example, someone labeled as “manipulative” would have the situation reframed as needing “to work on more effective ways of getting his needs met.” Someone labeled as “non-compliant” should instead be seen as “looking for other options,” and so on.

Botticelli believes progress has been made in improving the field's language, but some stark examples of an older way of thinking linger.

“I can't think of another disease where we would identify the results of tests as 'dirty' or 'clean,' he says.

A director's impact

Botticelli, who is now heading Boston Medical Center's new Grayken Center for Addiction Medicine, was the first ONDCP director with a public story of personal recovery. He looks back proudly on numerous initiatives during his tenure, from highlighting the need for strong enforcement of the federal parity law to playing a role in congressional approval of $1 billion in funding for states to combat the drug crisis. At the same time, he does not hesitate to say that if the vocabulary of substance use disorders changes, that could have as important an effect as any of the other accomplishments.

“One of the things I feel proud of is that we really tried to ensure that substance use disorders were seen as health issues and public health issues,” he says. In that endeavor, he emphasizes, words truly do matter.


Language of Recovery



Treatment is the goal

Treatment is the only way into recovery

Treatment is an opportunity for initiation into recovery (one of multiple pathways into recovery)

Untreated addict/alcoholic

Individual not yet in recovery

Substance abuse

Substance use disorder/addiction/substance misuse

Drug of choice/abuse

Drug of use



Relapse prevention

Recovery management

Pathology-based assessment

Strength/asset-based assessment

Focus is on total abstinence from all illicit and non-prescribed substances the clinician identifies

Focus is on the drug the client feels is creating the problems

A drug is a drug is a drug

Each illicit substance has unique interactions with the brain; medication, if available, is appropriate


Recurrence/return to use