Research paper
Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms

https://doi.org/10.1016/j.drugpo.2009.10.010Get rights and content

Abstract

Objective

Stigma is a frequently cited barrier to help-seeking for many with substance-related conditions. Common ways of describing individuals with such problems may perpetuate or diminish stigmatizing attitudes yet little research exists to inform this debate. We sought to determine whether referring to an individual as “a substance abuser” vs. “having a substance use disorder” evokes different judgments about behavioral self-regulation, social threat, and treatment vs. punishment.

Method

A randomized, between-subjects, cross-sectional design was utilized. Participants were asked to read a vignette containing one of the two terms and to rate their agreement with a number of related statements. Clinicians (N = 516) attending two mental health conferences (63% female, 81% white, M age 51; 65% doctoral-level) completed the study (71% response rate). A Likert-scaled questionnaire with three subscales [“perpetrator-punishment” (α = .80); “social threat” (α = .86); “victim-treatment” (α = .64)] assessed the perceived causes of the problem, whether the character was a social threat, able to regulate substance use, and should receive therapeutic vs. punitive action.

Results

No differences were detected between groups on the social threat or victim-treatment subscales. However, a difference was detected on the perpetrator-punishment scale. Compared to those in the “substance use disorder” condition, those in the “substance abuser” condition agreed more with the notion that the character was personally culpable and that punitive measures should be taken.

Conclusions

Even among highly trained mental health professionals, exposure to these two commonly used terms evokes systematically different judgments. The commonly used “substance abuser” term may perpetuate stigmatizing attitudes.

Section snippets

Study population and protocol

The study population consisted of 728 mental health care providers attending two mental health/addiction-focused conferences in October, 2008. Conference attendees present at the start of two addiction-focused talks (there was only a single stream of conference presentations) were handed the study survey and asked if they would be willing to complete it. There were two survey forms representing the two levels of the independent variable (IV; i.e., “substance abuser” and “substance use

Results

The 516 individuals who completed the survey (71% response rate) had a mean age of 51, almost two-thirds were female (63.4%), four-fifths identified as “White” (81.0%); and almost two-thirds had a doctoral-level degree (64.5%). The majority indicated a professional focus in mood (66.9%) and anxiety disorders (59.9%), followed by psychosis (37%), and alcohol/drug problems (34.8%).

The principal axis factoring extraction and oblique Promax rotation yielded a solution with three interpretable

Discussion

This study examined the effects of two randomly assigned substance-related terms on individuals’ perceptions about whether someone with alcohol/drug problems is personally culpable, a social threat, able to self-regulate substance use behavior, and should be subjected to more punitive vs. therapeutic measures. Exposure to the two terms was not found to evoke differential judgments regarding the individual being a social threat or whether he should be directed to various forms of treatment.

Conclusions

Results from this study suggest it may matter how we refer to individuals with substance-related conditions and that use of, and exposure to, the “abuser” label may inadvertently elicit and perpetuate stigmatizing attitudes. Because such a low proportion of individuals with these costly and harmful conditions access treatment and cite stigma as a major barrier (Substance Abuse and Mental Health Services Administration, 2008), a worthwhile public health policy goal would be to eradicate or

Acknowledgments

The authors would like to thank John W. Finney, Ph.D., William L. White, MA, Jerrold F. Rosenbaum, MD, Julie D. Yeterian, BA, and Sarah Dow, BA for their helpful comments on an earlier draft of this manuscript.

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    This study was funded by Massachusetts General Hospital Institutional Grant #020753.

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