Research has demonstrated that when clinicians and others use terms like “drug abuser” or “addict” when discussing patients, health care worsens (Van Boekel LC, et al. Drug Alcohol Depend. 2013;131:23-35, https://doi.org/10.1016/j.drugalcdep.2013.02.018).
So why does the practice persist?
For much of history, using drugs or other substances has been viewed as a moral failing, and the language commonly used to discuss substance use reflects this judgmental stance (Botticelli MP, Koh HK. JAMA. 2016;316:1361-1362, https://jamanetwork.com/journals/jama/fullarticle/2565298).
This stigma has resulted in a health care system that not only disenfranchises those with substance use disorders but also can be outright hostile. People with substance use disorders may feel excluded, unwelcome and judged, and such stigma often goes hand in hand with racism.
How can pediatricians move away from stigma against individuals who use substances and create a more welcoming pediatric health care setting?
A crucial first step is changing the language. A new AAP policy statement provides recommendations for using medically accurate, person-first and nonstigmatizing terminology on substance use disorders.
The policy Recommended Terminology for Substance Use Disorders in the Care of Children, Adolescents, Young Adults and Families, from the Committee on Substance Use and Prevention, is available at https://doi.org/10.1542/peds.2022-057529 and will be published in the June issue of Pediatrics.
In the pediatric context, an adolescent might be grappling with a substance use disorder. Or a new mother who used drugs prenatally may be struggling to do the best for her child and manage early recovery.
When patients and families are met with derogatory language that paints their substance use as defining features or are dismissed as simply making poor choices, it drives a wedge between “us” and “them.” It makes it difficult for families to engage in care. It results in internalized stigma for the entire family and can compound preexisting trauma.
Stigma against individuals who use substances while pregnant is prevalent and harmful. For individuals with opioid use disorder, medication is the standard of care and is highly effective, safe and life-saving; unfortunately, stigma against what sometimes is called “replacement therapy” often discourages individuals from seeking or continuing this treatment due to fear of discrimination or judgment (Patrick SW, Schiff DM. Pediatrics. 2017;139:e20164070, https://doi.org/10.1542/peds.2016-4070).
“The language we use is a critical part of the care we provide,” said Wanda D. Barfield, M.D., M.P.H., FAAP, director of the Centers for Disease Control and Prevention’s Division of Reproductive Health. “Our words can help heal or they can add to fear, distrust and other challenges our patients face in getting the care they need. We must be mindful about using accurate and respectful terminology when we provide care.”
As the first pediatric society to offer guidance on preferred language regarding substance use, the AAP aims to promote child health by reducing stigma against individuals and families affected by substance use.
The policy includes a table that provides examples of preferred language, such as “a person with a substance use disorder” and “a baby with neonatal opioid withdrawal syndrome.” This language should replace stigmatizing terminology such as “drug abuser” and “addicted baby.”
The policy recommends the following:
- Pediatricians, policymakers and the media should use medically accurate terminology instead of stigmatizing jargon in describing interactions with patients, families and the public, as well as in written materials, including medical record documentation, correspondence, manuscripts, op-eds and news stories.
- They should use person-first language that respects the dignity of an individual first and foremost as a person in interactions with patients, families and the public, as well as in written materials.
- Professional entities should encourage authors submitting manuscripts or materials for publication to use medically accurate and respectful person-first language.
Pediatricians have a crucial role in advocating for children’s health in the context of families affected by substance use. Using language that respects the dignity and personhood of individuals with substance use disorders is a necessary first step in providing better care through a more inclusive and recovery-friendly pediatric health care setting.
Dr. Alinsky is the lead author of the policy statement and a member of the AAP Section on Adolescent Health.