By Rick Docksai
We UUs generally agree that we should choose our words wisely when talking about sensitive social issues such as gender, racism, or immigration. We know that even a well-meaning person can cause hurt feelings—or in some cases, perpetuate harmful stereotypes—by saying incorrect or ignorance-based things in a conversation about one of these topics. The same is true for conversations about addiction. The medical community’s understanding is constantly evolving, and it’s finding that many of the ways we commonly talk about addiction and those who have addictions are not accurate and may even be harmful. We need to change them if we really want to help. I’ll go over some examples in this article.
Problematic: “He/she/they is an alcoholic.”
Instead, say this: “He/she/they has alcohol use disorder.”
Why: “Alcoholic” was never a medical term. And medical professionals have in recent years shifted toward a new term, “alcohol use disorder” (AUD). And someone who is fully addicted to alcohol isn’t an “alcoholic”; they’re a person with “severe AUD.” The DSM-V, published 2013, states that AUD covers the full spectrum of problem drinking, from “alcohol abuse” on one end to full-blown “alcohol dependence” on the other.
This trend toward using AUD is partly because problematic drinking is indeed a spectrum. The line between drinking too much and being dependent on alcohol is blurry, and people can move from the low end to the severe end over time. Likewise, some do the opposite: They engage in problem drinking for a short time but return to safe moderate drinking, without ever needing to quit drinking forever.
But that’s not the only reason that health professionals don’t like the word “alcoholic.” It’s also because the word that still carries stigma and shame. No one wants to be called an alcoholic. And telling someone that they are one may only make them defensive and even less inclined to seek help.
Problematic: “Addiction is a disease.”
Instead, say this: “Addiction is a problem. Let’s help you solve it.”
Why: The “disease” theory of addiction became popular in the mid-twentieth century, driven partly by Alcoholics Anonymous. But ask yourself: If it is a disease, then where does the infection first occur? What “germ” is responsible? Why can’t medications cure it?
Alcohol isn’t a germ. If it was, every drinker would become addicted. And the “infection” doesn’t happen at just one drink. It takes time to develop. Addiction—to alcohol or any other substance—isn’t comparable to any disease we know.
That’s because it isn’t a disease. It’s a behavior. In the words of addiction expert Anne Fletcher, it’s “a habit that grows and perpetuates itself relatively quickly when we repeatedly pursue the same highly attractive goal,” which over time results in “new pathways being built in the brain” that reinforce more and more drinking or using.
What difference does it make what we call it?, you might ask. A profound one. First, if AUD is a disease, then the person suffering from it has no control. The symptoms—uncontrollable drinking—just happen, and the sufferer has no choice in the matter. Only the lifelong intervention of a 12-step program can offer them any relief.
But if it’s a habit, then it is not uncontrollable. And it is not forever. Bad habits can be broken.
Any habit starts in the brain. So does AUD. Most—if not all—AUD sufferers have some underlying psychological or psychiatric issues that drive them to drink or use. Just ask Chris and Pax Prentiss, cofounders of the hugely successful Passages rehab center in Malibu, who identify four underlying causes of addiction:
- A chemical imbalance in the brain
- Events of the past that the person has not reconciled
- Current life conditions that the person cannot cope with
- Beliefs the person holds that are not true
Any person with an addiction has at least one of the four, according to the Prentisses. They say that sobriety is possible after—and only after—the underlying cause is successfully treated.
Like any habit, the longer and harder the person has been repeating the AUD habit, the harder it will be to break. But it’s possible to “unlearn” even a very serious AUD habit with counseling and support groups that teach healthier ways of thinking and better ways of coping with stresses. And after enough counseling, the person can move forward into a healthy, sober life. No longer addicted, and no longer “sick.” The pattern of AUD is broken. The “disease” is no more, as long as they don’t pick up another drink.
If we’re going to confront a problem, let’s first be precise about what the problem is.
Problematic: “This person has been in recovery for many years. Good for them!”
Instead, say this: “This person had a problem with alcohol but got help and solved it. Good for them!”
Why: Don’t be surprised if someone who’s got years or even decades of continued sobriety tells you, “I’m in recovery.” They’re saying this because the disease notion has been so thoroughly ingrained into them. They’ve been taught that they have a lifelong illness and thus are still “diseased” even after all these years of treatment.
To be fair, the first few months of treatment can feel like getting over a terrible illness. But with time, the person’s head clears, the withdrawal symptoms ease, they discover new healthy hobbies and pursuits, and the urge to drink or use fades away. By any measure, that person is now in good health. There is no more “recovering” to do; just the daily effort of living sober.
And yes, living sober is a commitment. But it may be easier if you think of yourself as healthy and able, rather than fixing toxic labels to yourself like “sick” and “needing recovery”. It’s good to feel good about yourself. You have the right to affirm that you are now healthy and that your life is good. You are allowed to get better.
Problematic: “You need AA.”
Instead, say this: “You need help, but let’s figure out what kind of help you need.”
Why: To many Americans, getting help for alcohol addiction means going to AA. But it is absolutely possible to get and stay sober without AA meetings. AA is not the solution for every AUD sufferer.
A number of alternative programs have sprung up over the years, including SMART Recovery, LifeRing, Secular Organizations for Sobriety (SOS), and Women for Sobriety, among others. Those who work these other programs with the intention of permanent abstinence have rates of success comparable to AA members, according to a 2018 study published in the Journal of Substance Abuse Treatment.
And some people don’t need meetings at all. Psychotherapy and taking up healthy pursuits like meditation, yoga, and exercise may be all they need. A sobriety blogger who calls herself Operation Clean Recovery recalls leaving AA after just one meeting. She’s now been sober for six years, all on her own. She realized that moderate drinking was just not possible for her, became absolutely determined to live a sober life, and made it happen. If the will is there, it can be done.
“That said, one of my strongest sobriety mottos is that you have to be willing to throw everything you have at quitting if you really want to quit,” she wrote.
There are many paths to recovery. If you or someone you know has a problem with addiction, consider all the issues at hand and decide what course of action will be best. It might involve 12 steps, but it doesn’t have to.
The Bottom Line
Many of us know someone who habitually drinks or uses drugs destructively, or someone who eats, gambles, or engages in some other behavior compulsively. Maybe we ourselves have one of these habits. We want to change the behavior—and that’s a good thing to want. But we need to know how to talk about it. Talk with understanding, caring, and awareness that there is always more to learn, and there’s a better chance you’ll get the right results.