The Words We Choose to Use in Behavioral Health

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September is National Recovery Month, and while I have not been directly impacted by what is referred to as a substance use disorder, many people that I know personally have or still are struggling. Mental health conditions and substance use disorders may not be exactly the same thing, but often times they are co-occurring, meaning they can be existing at the same time and one often leads to the other.

Here are the four main categories of substances that commonly cause dependency and some examples:

• Analgesics (narcotics/painkillers)
  • Natural (Opiate) examples:
    • Codeine
    • Heroin
    • Morphine
    • Opium
  • Synthesized/Synthetic (Opioid) examples:
    • Carfentanyl
    • Dextromethorphan
    • Dextropropoxyphene
    • Fentanyl
    • Hydrocodone
    • Hydromorphone
    • Loperamide
    • Meperidine
    • Methadone
    • Oxycodone
    • Oxymorphone
• Depressants
  • Barbiturates
  • Benzodiazepines
  • Nicotine
• Stimulants
  • Amphetamines
  • Caffeine
  • Cocaine
  • Ecstasy
  • Sugar
• Hallucinogens
  • Cannabis (THC)
  • Ketamine
  • LSD
  • Psilocybin

When we talk about substance use, we often think of illicit natural (opiate) painkillers like heroin or stimulants like cocaine, but other controlled substances cause dependency when not used as directed, these commonly include prescription opioids like fentanyl, oxycodone, or morphine, as well as prescription stimulants like amphetamines.

What we don’t often think about are depressants like alcohol and nicotine, or stimulants like sugar and caffeine. Even though these substances are legal to use, and products like alcohol, sugar, and caffeine are generally viewed as safe, they also have a profound effect on our bodies and minds with long-term consumption, and for many people are addictive and cause dependency.

The sensation you get when you haven’t had your morning cup of coffee, or you haven’t had your mid-afternoon sweets, or your hourly dose of nicotine, is a form of withdraw. While sugar and caffeine may produce a lower grade of withdraw than nicotine or alcohol, all of them train your brain to become dependent upon the chemical reaction caused by the substance.

While it’s generally easy to reduce the consumption of sugar and caffeine, most people will struggle to ever eliminate the use of these substances completely. Similarly, nicotine can be very challenging to eliminate when someone has become dependent. For more addictive substances like heroine, cocaine, and crystal meth, eliminating their use can be an overwhelming battle.

Alcohol, caffeine, marijuana, nicotine, and sugar have been a part of human culture for a very long time and have become a staple of the human experience for a sizable portion of the population. However, these reasons should not dismiss the negatives of their consumption or use.

When we have conversations about substance use, especially with people who are struggling, we need to be mindful of the language we use. Terms like “abuser”, “addict”, “druggie”, “drunkard”, and “junkie” are no longer acceptable. Terminology like this is derogatory, causes conflict, and labels the person as the disorder and not as a human being, none of which is helpful for someone experiencing addiction.

People are more than the conditions they battle with. We often forget this when we encounter them under the influence. Someone who may be violent when consuming alcohol, or someone who commits theft when seeking funds to purchase their substance of dependency, can be extremely difficult to see as a victim of their disorder. So it can be hard to stop labeling people with burdens as the burden itself, but if we ever hope to assist the person into recovery then words of support must replace words of judgment.

I used to speak about this during one of my classes, it’s so fundamentally important that we pay attention to the words we choose to use when referring to people. Not just those with substance use disorders but those with mental health conditions as well.

While I wouldn’t encourage them to do so, it’s okay for someone with a substance use disorder to refer to themselves as an “addict” or “drug abuser,” if that’s the terminology they choose to use. But it is not okay for someone else without a substance use disorder to refer to them in this way.

The same goes for people with mental health conditions. I often call myself “crazy,” due to my bipolar disorder, but this is not an invitation for others who have no lived-experience with a mental health condition to refer to me as “crazy” or as a “crazy person.”

You may be wondering why we use these words to describe ourselves if outsiders are deterred from doing so. I can’t speak for everyone as I think each person has their own justification, but for me it’s like taking back the power taken from me. Claiming a word for myself that is often used as a weapon against people like me feels as though it saturates its potency and makes it mine, rather than theirs.

Aside from avoiding derogatory terms like “addict” and “crazy” we should also not refer to people as their condition or disorder because they are not one in the same. I used to mention this in my class as well, we want to make sure that we are not confusing a human being with a mental health condition or substance use disorder, they are two very different things.

It’s not okay to use phrases like “heroine junkie” or “meth-head,” when referring to someone with these specific substance use disorders. The same goes for mental health conditions like schizophrenia and bipolar disorder. It’s not okay to refer to people with these conditions as “schizos” or to use phrases like “she’s bipolar.” Perhaps the worst of all is to refer to someone with a disorder or condition as a “burden.”

We have to remember that these are human beings struggling with substance use or mental illness. We are more than our substance use and mental illness, we struggle with those things but we are not those things. We have a burden, but we are not the burden. We are more than the burdens we carry on our shoulders, we are more than our struggles.

Think about it, do you really go around and refer to people with infertility issues as “infertiles” or “sterile people” as if they are somehow not other human beings deserving of equal compassion? No, of course not. Their condition does not rob them of their humanity, so why would we rob anyone else struggling with a condition or disorder of theirs?

Proper terminology is to say “He has schizophrenia” or “She has bipolar disorder.” Stating that someone has a disorder or condition separates their identity from the things they struggle with and allows them to maintain a degree of dignity and humanity, allowing us to treat everyone as the fellow human beings they really are.

It’s true that substance use and mental illness can morph people into individuals we no longer recognize, dramatically altering their behavior and in some cases physically changing their appearance, but no matter how bad it gets, they do not cease to be human, they do not cease to be your family member, friend, colleague, or neighbor, and it’s at those lowest points when they need you the most and your willingness to treat them humanely.

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If you or someone you know is experiencing a mental health or substance use crisis, please access my immediate assistance resource page.  A comprehensive listing of online and phone resources and services is also available.