Ian Hamilton: Language alone cannot reduce the stigma that people who use drugs experience

The derogatory language we use to describe people who use drugs is merely a symptom of a deeper problem, says Ian Hamilton

It is seductively simple to think that adopting a new vocabulary to describe people who have problems with drugs will reduce the stigma they experience. The advice offered by the Global Commission on Drug Policy is to avoid terms like “junkie” or “crackhead,” and instead use terms such as “person with drug dependence” or “person with substance use disorder.” But will this really improve the perception and care of these patients? If people learn what is acceptable to say without altering what they believe then all that is achieved is a veneer of change while core beliefs remain unchanged.

The commission’s report calls on doctors and healthcare staff to take the lead in challenging misconceptions of this patient group, stating that they have “a major role to play in changing the perceptions on drugs.” But the report fails to point out that it is not just members of the public who can hold negative views about such patients, but health professionals too.

Health workers who avoid patients who use drugs or who have minimal contact with them are more likely to hold negative and stigmatising views. This is no coincidence as exposure to such patients yields the personal stories that underpin the relationship the individual has developed with drugs. But why would you choose to come into contact with a group of people you perceive to be manipulative, potentially violent, unmotivated, and hard to treat—all attitudes cited by some health professionals in a review of their perceptions of patients with substance use disorders. Such views may not be entirely unfounded as some people who have problems with drugs can be challenging, unmotivated, and may relapse (even several times) while in recovery. But they all have the capacity to change, as do the clinicians who hold negative views about them.

However, conforming to using carefully circumscribed, approved language, while at the same time having a different view is a fallacy. It’s also a disparity that patients will spot, as this group can be tuned into non-verbal signs of discomfort. Without a change in attitude, workers may continue to discriminate against patients with drug dependence problems by limiting the amount of time they make available and the degree of engagement offered.

With many medical schools failing to include addiction in their curriculum this sends a clear message early on in doctors’ medical careers that patients with drug dependence problems don’t matter. Recognising the importance of drug use at this stage has the potential to equip these doctors of the future with the skills and understanding they will need to support a group of patients they will inevitably encounter. An obvious resource that could help provide training is addiction psychiatry, but in England at least this specialty has been decimated in recent years. By removing this pool of expertise it is not just medical students who are disadvantaged, but all health professionals who are unable to call on their experience and ability to provide a role model for the optimal approach to treatment.

It is also worth remembering that healthcare workers are not immune from developing problems with drugs themselves. Although this should improve acceptance of patients who have similar problems, we still have some way to go.

The derogatory language we use to describe people who use drugs is merely a symptom of a deeper problem. The danger of adopting a new vocabulary while retaining the same values and attitudes is that we sound more accepting but really nothing has changed from the patient’s point of view. I hope I am wrong.

Ian Hamilton is an academic at the University of York with an interest in addiction and mental health. He previously worked as a mental health nurse with people who had combined mental health and substance use problems.

Competing interests: I am affiliated with Alcohol Research UK.