The Warring Words of Addictions and Choices

Is There Really a Difference Between Drug Addiction and Drug Dependence? Put simply, YES there is, but as ever; debate about terminology is having an impact on what many people are trying to achieve…

Negative factors not only impact those individuals seeking help with their problems but also, our ‘factual’ understanding about addictions and terminology (incorrect or stigma inducing) create problems for our society, along with impacting upon the overall efficacy of addictions treatment and recovery support structures.

Does It Really Matter How We Talk About Addiction? – Words can hurt when they reinforce misconceptions: The old adage, “Sticks and stones may break my bones, but words can never hurt me,” implies words cannot convey harm. Today, however, more and more research on stigma is showing that words truly can hurt people… This seems to be especially true when those words serve to reinforce misconceptions and misrepresentations of already heavily stigmatized medical conditions. (psychologytoday.com)

There is often intense and ongoing debate about which words we should or shouldn’t use, whilst supporting people with addictive behaviours. A recent blog at scientificamerican.com also highlighted that it’s really “no secret that misinformation about addiction is rampant in popular media” (read more).

Choice of language can impede access to medicines… Referring to a person as a “substance abuser” rather than “a person with substance use disorder” evokes stigma and there is evidence that it reduces patients’ access to appropriate treatment. (British Medical Journal)

One of the largest sources of ‘misinformation’ is born in the language we use, promoted by the media and consequently common within our society, when we are describing problematic addictive behaviours.

Scientific America, Nov 2019: …the distinction between these two concepts—addiction and dependence—is not trivial. Medical professionals are ethically required to get the diagnosis right so that they can get the treatment right.” (Jonathan N. Stea)

The ‘Addiction’ Spectrum

Personally, I’ve always held a mindset that dictates; ‘addiction’ (or addictive behaviours) is a actually a collection of issues along an extremely wide spectrum of impacts. One person’s hedonism is another person’s life-changing problematic issue. Irrespective of those impacts being, financial. health, relationship factors, or any combination of these and more.

At a slight tangent but connected to this topic, language and consequently our understanding of addiction issues, also drives political and social response to the problems. It’s one of the reasons why I also question why any government would criminalise a person, for their individual choices, especially if/when there is (arguably) little or no impact upon others, or our wider society.

Horses For Courses

Politically motivated ‘morality’ or pompous virtue-signalling within our society, serves to embolden dogmatic beliefs about ‘correct’ support and/or ‘appropriate’ recovery pathways. It should be remembered; that total abstinence isn’t always a choice that some people want to make, at least not initially. Resulting from the past prominence of historic doctrine around addictions, our society has come to believe; life-long ‘abstinence’ and ‘sobriety’ equate to ‘recovery’ and anything less is failure… not so.

These perspectives tend to come from people who present as ‘experts’ on recovery. But often, the value of sharing your lived-experience in a mutual-aid setting with others doesn’t actually equate to ‘expert’ status. Yes, this process undoubtedly helps many to see that recovery is possible, when you have (effectively) dealt with your issues behind your addictions however; those issues that you faced (all be they similar) are not the same issues faced by anybody else. To suggest they are is (often) unhelpful and counterproductive for many people’s own recovery.

For people with alcohol issues, abstinence isn’t the only answer. Forcing everyone down the same path means losing sight of many on the way. (Addaction)

Dependant upon pathway choice, some people find the whole ‘mutual-aid’ process belittling, dis-empowering or even an enforced removal of their individuality. Many are happy with the process but still too often, people in need of support aren’t provided with sufficient opportunities (or facts) that allow them to make informed decisions. The prominent belief across our society, thanks again (in part) to the media), suggests that; addiction recovery can only be realised with a lifelong commitment to AA meetings (or similar). That alone creates additional barriers to recovery, for many people.

For decades this type of thinking has also been the bedrock of prohibitive legislation in the U.K. and elsewhere. Our thought processes about drug use (including alcohol) have fuelled many social assumptions about ‘addicts’, ‘alcoholics’ and subsequent ‘criminality’ around their addictive behaviours. All of which creates social stigma.

War of Words

Research shows that words (and our choice of terminology) can also present “explicit and implicit bias” within our response to addictions but most worryingly, create barriers for any subsequent treatment associated with addictions and recovery support (see here).

It’s Time to Change How We Talk About Disorders of Addiction: What if word choice was the most cost-effective and clinically useful strategy to reduce the incidence, increase access to services, and prevent deaths associated with disorders of addiction? (Read more)

Often, how we talk about the addictions subject, and the people who are impacted by this spectrum of issues, is simply wrong. But, our choice of words (and our subsequent thinking) have served to form the foundations of a constant War On Drugs, something that continues and helps to form so many more unforeseen consequences and perverse outcomes, both for individuals and our wider society.

The Transform Drug Policy Foundation, an independent charitable think-tank have shown (for more than 50yrs) that the war on drugs harms communities, increases risks for individuals and has “gifted a multi-billion dollar trade to criminal gangs and networks” however;

We can’t halt drug trade with arrests, says crime agency chief (The Guardian)

Irrespective of all the known exploitation and vulnerability, for an increasing number of young people (within County Lines operations), because of the illicit drugs trade; our continued use of drug laws to combat addiction issues just isn’t working. Arguably, ‘prohibition’ (alone) is not fit for purpose (see here).

Worryingly, these aren’t new or unknown issues and sadly they are still ignored by many today. Going back to 2009, Prof. David Nutt, the then Govt Chief Adviser on drugs, “incurred the wrath of the government” (see here) and got sacked for his efforts when he told them; “alcohol and tobacco were more harmful than many illegal drugs” but prominent prohibition policies continue.

This puerile and pedantic prohibition, within a landscape and atmosphere of increasing demand, in the extremely lucrative marketplace, defies logic. It simply fuels organised crime and will continue to fail (see here).

The sharp rise in adults using crack cocaine in England is being fuelled by a lack of police on the streets and aggressive marketing by dealers who offer customers “deals of the day”, according to a government report. (The Guardian)

Light at the end of the tunnel

There are some people, outside of that clearly insular Westminster Bubble, who see that our continued prohibitive processes have failed.

However, despite all the belated but thankfully growing noise, there are still way too many who believe we can arrest our way out of addiction, and the problems connected to problematic drug use. They are (arguably) sadly deluded.

New Response to Old Issues

Perhaps a little late with a valid response to many of the issues but, several police forces across the UK are now diverting people [who use drugs] into education, treatment and recovery support programmes. This application of effective harm-reduction, rather than pure adherence to past punitive approaches to drugs and addiction issues is laudable (see here)… long may it continue to grow.

OK, some of this has come from the impacts of savage cuts to policing (and other public support structures) in recent years however; many of those responsible for enforcing drug laws understand the futility of that process (see ukleap.org).

If some individuals and organisations can now see that our previous methodology – criminalising already traumatised, marginalised and vulnerable people – is the incorrect response, within a so-called civilised society, why can’t the rest of us?

The increase in drug-related deaths hasn’t suddenly happened, deaths have been rising significantly for years. There has been ample opportunity to think about how to reverse this horrendous trend. And unusually, we know how to do it. The evidence has been collected and made available to ministers. (Ian Hamilton, The Independent)

Change Our Thinking

As Prof Ian Hamilton recently pointed out; we need to be honest, “how many of us actually care about the record number of drug-related deaths?” But, we can’t simply blame the politicians. Despite often sound reasoning behind that temptation; they [politicians] “instinctively follow public opinion, rather than shape it.” Hamilton is correct; “The uncomfortable truth might be that we [the electorate] are ultimately responsible” (read more).

It’s time we all tried to adopt some person-first language, to promote some respect for the human worth and dignity of individuals. Society (driven by the media) needs to drop past negative assumptions around addictions. Not all individuals impacted by an addictive behaviour face the same issues. A person’s addiction falls within a spectrum of issues that may (or may not) include psychological or physiological dependencies but that doesn’t make them a ‘bad’ person. And it certainly doesn’t warrant any of the “dirty addict” comments and assumptions, so often proffered by many. People who are impacted by addictive behaviours sit within all societal demographics.

Support & Choice

Talking with a volunteer SMART Facilitator recently, who has successfully ‘recovered’ from their past addictive behaviours, I was disappointed to hear the person say;

Society already looked down on me; the people I looked to for help were judgemental, my key-worker didn’t respect me as another human being, they didn’t want to support my individual recovery goals… what hope for any long-term success on my journey to recovery?

OK, this person’s journey started four years ago and (hopefully), those comments are no longer indicative of the ‘norm’, in most treatment and support resources, across the UK addictions landscape. However and worryingly, I still find pockets of similar circumstances. We still need to drive forwards with the person centred  approach, one that is free of dogma and stigma.

The media, politicians and our society as a whole would do well to try to understand addiction in a little more depth. Rather than continually spouting the tired political rhetoric, or pompous self-righteousness… very little of which finds root in fact.

Those who support people through addictions recovery should always be guarded against using terms that perpetuate this continued stigma of addiction. Thankfully this is now (mostly) the case. However, when people [supporting others] have ‘lived-experience’ of their own to draw upon, is it actually helpful to channel the people they work with down specific recovery support pathways, based upon their past experiences?

In my opinion, suggesting – “once an addict always an addict” – perpetuates a perception that personal desires and efforts are irrelevant to recovery. Not so. It also serves to dampen an individual’s resolve to change their problematic behaviours… ergo recovery is mostly futile. Again, incorrect.

When a person sees that long-term sustainable recovery is possible, and that many people arrive at that place, with little or no support from external agencies, groups or individuals (professional or otherwise); how can this (often directed) process be seen by anyone as appropriate?

Individuals looking to make life changes around their substance use, or seeking long-term sustained recovery from their past addictive behaviours, must be supported to make informed personal choices around support pathways. Sadly that’s not always the case and it should be. Personal choice is critical for many during their recovery journey, any removal of that choice, real or perceived, is both counterproductive and woefully incorrect.

Note: The author is a National Coordinator for UK SMART Recovery, a secular science based programme and registered charity. Promoting Choice in Recovery through a national network of mutual-aid meetings and self-management training. This blog post is a collection of personal observations and opinion and is not attributable to the author’s employer.