Among the many fields I've encountered as a journalist, from economic development to criminal justice to general health, addiction treatment clearly has the biggest challenge with language. Few other professions struggle so much with the basic terms used to describe the people they serve and why they serve them, with the word choices assumed to influence how policy-makers and the public view alcohol and drug problems and their possible solutions.
As famed author and field historian William L. White wrote this year in an article he co authored with John F. Kelly, PhD for Alcoholism Treatment Quarterly, “Put simply, we can't seem to make up our collective minds about these substances and the people who use them to excess.”
Several professionals have expressed concern to me lately over how the field refers to the individual in its care. Some say the word “client” minimizes the medical aspect of the disease of addiction, which they say needs to gain prominence as healthcare becomes more integrated. Others dislike using the word “patient” because they say it suggests a paternalistic relationship, or avoid “consumer” in part because that has become a term of art in mental healthcare.
Can the field achieve consensus in this area? I recently asked David Mee-Lee, MD, senior vice president of The Change Companies and author of the American Society of Addiction Medicine's (ASAM) Patient Placement Criteria, about the implications of language, and his response suggested that widespread agreement likely will remain elusive.
Physicians tend to think of themselves as lawyers or architects, not medical professionals, when they hear the term “client” used to describe the person receiving addiction treatment, Mee-Lee says. Conversely, addiction counselors think using “patient” conveys an attitude of the provider knowing what's best for the individual, and demanding that a certain course of action be taken.
Realizing that the audiences for each of the trainings he conducts are likely to include at least one person who dislikes each of the terms commonly used, Mee-Lee says he tends to employs all of them rather than only one in his presentations: client, patient, consumer, customer, person.
But how important is the word choice when you come right down to it? Mee-Lee told me, “Whatever term you use, we have to treat people with compassion and respect. So even if we use ‘consumer’ or ‘client’ but tell the person what to do and expect compliance, then it's just a word. If you use ‘patient’ but treat the person as an empowered person, then the word ‘patient’ is not standing in the way.”
The patient/client word choice is not the only conundrum facing field professionals, of course. Despite longstanding calls from many prominent leaders for its ouster from the addiction lexicon, the term “abuse” remains a staple in the field-so much so that it remains part of the name of the major federal agencies/institutes for substance use services and research.
The use of “abuse” and “abuser” was the subject of the aforementioned column from White and Kelly, who wrote, “If we truly believe that substance use disorders constitute serious health problems, legitimate medical disorders, and at their core, brain diseases, then why do we continue to have departments and centers of substance abuse?”
I'd like to know your thoughts on the vocabulary of the field. Are there terms you actively avoid in everyday parlance, or in your program materials? Do your colleagues routinely discuss the language used with the people you treat, with their families, with the entities funding your programs? Do we pay too little attention to the terms that define the field? Too much?
Send your comments to me via e-mail at email@example.com, and we'll share some with readers in an upcoming issue of the magazine.
Gary A. Enos, Editor Addiction Professional 2011 November-December;9(6):6