WHAT’S IN A NAME? STIGMA, SUBSTANCE USE, AND LANGUAGE - PowerPoint Presentation

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WHAT’S IN A NAME?

STIGMA, SUBSTANCE USE, AND LANGUAGE

Sarah Rider, PMHNPDepartment of Psychiatry University of Colorado Anschutz Medical Campus

      Center for Dependency, Addiction and RehabilitationA Division of University of Colorado Hospital

Substance use and the implications of stigma

Terminology

Documentation

QuestionsOVERVIEW

This stigma associated with drug use--the belief that bad kids use, good kids don't, and those with full-blown addiction are weak, dissolute, and pathetic--has contributed to the escalation of use and has hampered treatment more than any single other factor.

~David Sheff

LABELING

ASSOCIATING NEGATIVE ATTRIBUTES

SEPARATING “US” FROM “THEM”

DISCRIMINATION STIGMA LINK-PHELAN MODEL

STIGMA AND SUBSTANCE USE

Factors that Increase Blame and Judgement

Cause (it’s their fault)

Control (they could stop if they wanted)Treatability (poor prognosis)

STIGMA Domains

Communities: stereotyping, fear, rejection

Systems: health, legal, economicPersonal: shame, worth, isolationMedications: misconceptions, restrictions, disparities

TERMINOLOGY

Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.

Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.

(American Society of Addiction Medicine, 2019)

GENERALGUIDELINES

Chronic Health Condition: medical terminology for medical settings

Treatable: instills confidence Person-first: individual before the condition/disease/behavior

Strengths-based: builds on resilience, empowersUse language that is consistent with how the person identifies: ask!

Chronic Health Condition:

-Patient describes drinking 1-2 pints of vodka daily for 3-4 years. She reports last drink as yesterday, 1/1/1, at approximately 2300. Patient states she feels “shaky” and anxious this evening. She throws up when she eats and thinks there was some bright red blood in vomit.

Treatable: -”I don't understand everything you are going through, but maybe together we can find something that could work for you. “Person-first: -Patient is diagnosed with opioid use disorder, severe, in sustained remission x 15 years.

Strengths-based: -”It's clear you're really trying to change your cannabis use.” -”I can see that you are a very resourceful person.”

Instead of…

Use…

Because…Abuse

DependanceHabitRecreationalSubstance UseSubstance Use DisorderUnhealthy/Hazardous UseMisuse/Not using as prescribed (for prescription medications)Reflects current diagnostic terminologyIncreases consistency in medical documentationDrug of choicePatient reports using Patient states they useRecent substance use includesHistory of *** use

Considers the biomedical and psychosocial understanding of substance use

Addict

Alcoholic

Injection user/Injection drug use (IDU)

Substance abuser

Alcoholic

Former addict

Reformed addict

Has a substance disorder

Person who uses substances

Person who is using

Person who injects drugs (PWID)

Person in recovery

Substance use in remission

Sustained abstinence

Terms like alcohol abuse, drug abuse, substance abuse all spring from religious and moral conceptions of SUDs that assign blame to the individual.

The person has a problem rather than is the problem.

Medication Assisted Treatment (MAT)

Replacement therapy

Substitution therapy

Medications for substance use treatment

Pharmacotherapy

Opioid Agonist Treatment (OAT)

Medication for Opioid Use Disorder (MOUD)

Medications for Addiction Treatment (MAT)

Acknowledgment that pharmacotherapy is a first-line treatment that is central to a patient’s treatment plan.

Taking a medications for opioid use disorder is not equivalent to using opioids in the context of a use disorder.

Consistent with general medical terminology

Clean

Dirty

Negative/Positive result

Expected/Unexpected result

Clinically accurate, non-stigmatizing, non-punitive

Model with your own language when treating patients who might use stigmatizing slang

Relapse

Recurrence of use

Returned to use

Began using

Experienced a recurrence of symptoms

Consistent with general medical terminology (i.e. recurrence of symptoms)

In no other chronic medical condition is a return to being symptomatic described a “relapsing”

Needle Exchange

Clean/Dirty (e.g. syringes and other supplies for using substances)

Syringe service program (SSP)

Harm Reduction Services

Sterile/Used equipment/supplies/syringes

Captures a full-range of services that many programs provide

AA

12-step

Self-help

Mutual aid groups

Peer support groups

Peer recovery services

Inclusive 

Acknowledges that there are a variety of pathways to recovery

Sarah Rider

Psychiatric Nurse Practitioner

sarah.rider@cuanschutz.edu720.848.3037 (CeDAR outpatient)

720.848.3000 (CeDAR main)

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