A speaker at an opioid conference this month at the University of Massachusetts mentioned a startling finding: In national surveys, when asked if they support safe consumption sites, 29 percent of survey takers approved; when asked about overdose prevention sites, the approval rate went up to 45 percent.
Both names refer to the same thing.
Tapestry Health Executive Director Cheryl Zoll, who attended the Sept. 6 conference, “Addressing the Opioid Crisis in Small and Rural Communities in Western Massachusetts,” was surprised not only by the findings but the terminology.
“That was the first time I heard about calling safe injection facilities overdose prevention sites and I thought it was brilliant because that’s what it is,” she said.
Safe injection facilities are places where people can inject drugs in a supervised setting, which means in the event of an overdose, medical professionals are at the ready. Though not currently legal in the United States, there are around 100 in Canada, Australia and in Europe, where studies show they save lives by reversing overdose and improve health by providing treatment for a host of related ailments related to IV drug use.
For the record, this column is not about safe injection sites. It’s about language.
Word choice matters.
And there’s research backing that up, not only when it comes to safe injection sites versus overdose prevention sites, but also a host of other, often negative, language commonly used for people living with substance use disorders.
Researcher and psychologist John F. Kelly, founder of the Recovery Research Institute of Mass General Hospital, has conducted numerous studies looking at the role of language in the treatment of people with substance use disorders. He maintains that the findings are clear: when negative, stigmatizing words such as “addict” and “abuser” are used, people face discrimination.
In one study reported in the Journal of Drug Issues, Kelly and two co-authors tested responses to people described either as being a “substance abuser” or a “person with substance use disorder.” Study participants tended to view the person with substance use disorder as more in need of treatment, while seeing the substance abuser as engaged in “willful misconduct” caused by recklessness.
Kelly and his team also suggest that the routine use of terms like abuser take a toll on the people suffering from the disease of addiction because they internalize terms like abuser, “increasing their sense of shame and anxiety and creating a barrier to honest self-disclosure and treatment seeking.”
Another study presented doctoral-level mental health and addiction clinicians with two case studies about people in legal trouble due to alcohol or other drugs, one using the description substance abuser and the other “having a substance use disorder.” Kelly and his team found that clinicians were “significantly more likely” to judge the person as deserving of blame and punishment when the term abuser was used in the vignette.
“Even among well-trained mental health and addiction specialists, exposure to terms like ‘abuser’ creates an implicit cognitive bias that results in punitive judgments that may perpetuate stigmatizing attitudes towards individuals suffering from addiction,” Kelly and his team write.
In their study about safe injection versus overdose prevention sites, Johns Hopkins Bloomberg School of Public Health researchers found that public support of such facilities increased substantially when the term overdose prevention was used.
“The magnitude of the difference was large — 16 percentage points — suggesting that a fairly minor wording change could matter in shifting public support for this harm reduction intervention,” the team wrote in a 2018 article published in the American Journal of Public Health.
“These findings raise the larger question of why so few Americans support this evidence-based policy to combat drug overdose deaths. One likely explanation is pervasive, persistent stigma toward people who use drugs,” they wrote. “Stigma shapes beliefs about appropriate responses to the opioid epidemic.”
What does all of this mean?
In short, language is a powerful tool that shapes attitudes. What it means for the opioid overdose death epidemic is that while evidence-based prevention, treatment and recovery options are crucial, so, too, is a focus on the language used when discussing opioid use disorder and the people who suffer from it.
This science backs up what people in the harm reduction field have been saying for many years.
“When you call someone an addict or drug abuser, it completely removes the human element of it,” said Zoll, whose agency Tapestry offers a range of harm reduction strategies aimed at building respectful relationships with people dealing with substance use disorders.
“So much of the stigma is taking the person out of it and when you take the person out of it, you lose the compassion, the empathy, the understanding,” she said. “Our objective is to keep people alive as they struggle with this disorder.”
Laurie Loisel is director of community outreach and education at the Northwestern District Attorney’s office, which is part of the Hampshire HOPE opioid prevention coalition run out of the city of Northampton’s Health Department. Hampshire HOPE members contribute to this monthly column about local efforts addressing the opioid epidemic.