What’s in a Name?
There is much discussion in the field of substance use disorder about the stigma associated with the words “addiction” and “alcoholism.” Being old enough to remember when there was no other name for addicts and alcoholics, and the behavioral territory that went with it, it’s easy enough to understand why there is a stigma.
In the 1970’s there was a push toward the term “chemically dependent.” That phrase didn’t last very long as we recognized that diabetics, heart patients and a whole list of patients with other conditions could be described as chemically dependent—while in recovery! The best one I heard was from a fellow patient during this period of time who exclaimed, “C’mon, my pool is chemically dependent.”
Then came “dual dependent” as a description of someone abusing both alcohol and other drugs. That term was even shorter-lived as the recognition came that they were the same disorder.
Problems with “substance use disorder”
The term being used today, included in the DSM, is “substance use disorder.” I don’t like it! It worsens the blurring, mystery and misunderstanding that exists in our society between two issues:
- The individual who was prescribed long-term opioid pain medication, is now physically dependent and experiences withdrawal when taken off
- The individual buying drugs on the street
In fact, the lousy job of differentiating between physical dependence and addiction has pushed us towards defining “addiction” (as opposed to “dependence”) by the behavioral issues that come with it: pre-occupation, failed attempts to control, hiding, sneaking, dishonesty and crime. This is a clear move back in the direction we have tried so hard to move away from (even while all of those things are true)!
Role of personal responsibility
Addiction is not the only condition that comes with some stigma and judgment from society at large. Think about the obese and sedentary heart patient. Think about the diabetic who still indulges in a diet loaded with sugar. Addiction is not the only condition where a change in lifestyle is recommended and needed to obtain recovery. I’m afraid the term “substance use disorder” and our push to de-stigmatize the “addict” is eroding the concept of personal responsibility from the recovery package.
No one decides they want heart disease, diabetes or addiction. But all three conditions have an element of personal responsibility and choice in maintaining ongoing recovery. The argument for using the term “brain disorder” says that the “addict” loses the power of choice when in active “addiction.” This begs the questions: Do we get that power back in abstinence/recovery? When? At the point that physical withdrawal ends? At 45 days? At a year? If the answer is “yes” to any of these, then relapse becomes a matter of personal responsibility. Of choice.
No matter what you call it, there is hope
There is much to still be figured out and argued about in regard to what makes someone an “addict” … or whatever you want to call them. It is obvious that some people are different in this regard than the rest of society. SAMSHA says 12 percent of people. Is it genetics? A brain disorder that exists before we take that first drug or drink? Fact is, no one really knows.
What is known is that it can be treated and that there are solutions that work. Maybe we ought to concentrate on de-stigmatizing treatment and recovery before we can do the same for the condition! After all, when the diabetic relapses on sugar and gets sick again, no one says, “Treatment didn’t work.”