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These words definitely matter

September 1, 2007
by Gary A. Enos, Editor
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At age 89 and ever aware of the forces that aim to shape the addiction field for good or ill, Mel Schulstad never fails to command the attention of those of us who are still learning. So you have to give proper consideration when the co-founder of NAADAC suggests that the most important legislation on Capitol Hill this year doesn't address insurance equity or reauthorization of a government bureaucracy. Instead, it's about changing the vocabulary we adopt when we talk about alcohol and drugs.

Schulstad is most optimistic about legislation that would remove the word “abuse” from the names of the two National Institutes of Health research institutes for alcohol and illegal drugs. Senate Bill 1011, sponsored by Sen. Joseph R. Biden Jr. (D.-Del.), would rename the National Institute on Drug Abuse (NIDA) the National Institute on Diseases of Addiction and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) the National Institute on Alcohol Disorders and Health. “I don't know of another piece of legislation that deals with this issue of nomenclature this squarely and fairly,” Schulstad says.

Schulstad also doesn't know of many colleagues in the addiction field who have railed against use of the term “abuse” for as long as he has. “It makes abusers out of all of us,” he says. “It puts us in a class with child abusers, wife abusers, animal abusers.”

Backed by several field organizations, including NAADAC and Faces and Voices of Recovery, S. 1011 was approved in late June by the Senate Health, Education, Labor and Pensions Committee. A companion bill in the House, H.R. 1348, is sponsored by Rep. Patrick J. Kennedy (D.-R.I.), co-sponsor of comprehensive insurance parity legislation for behavioral health.

The findings section of the proposed Senate bill states, “The pejorative term ‘abuse’ used in connection with diseases of addiction has the adverse effect of increasing social stigma and personal shame, both of which are so often barriers to an individual's decision to seek treatment.”

Schulstad remains puzzled that the NIDA and NIAAA names survived so many changes in the leadership of the two institutes over the years. According to Faces and Voices of Recovery, momentum for name changes began to build after the recovery organization's 2005 summit, at which an advocate asked NIDA Director Nora D. Volkow, MD, about the issue. Schulstad says that although the general use of the term “abuse” dates to the medical profession's first attempts to define the illness syndromes associated with alcohol and illegal drugs, he does not know why anyone would choose to perpetuate stigma today.

It has often been alleged that members of the addiction field need to do a better job at picking battles. Some might tend to think that a long debate over the name of an organization could pose a distraction from more mission-critical topics. But words do matter—they can be inclusive or they can do serious harm. Since “abuse” is a word that has become so prevalent in how drug and alcohol topics are discussed, perhaps a high-profile action at the highest levels of government is what is needed to begin to eradicate it.

To those who would dismiss the legislation's importance, Schulstad brings other medical conditions to the argument. “Diabetics aren't called ‘sugar abusers,’” he says. And on the topic of eating problems, “Ask people why there isn't a National Institute of Gluttony.”

Gary A. Enos, Editor