Stigma reduction
Language matters
The words used in consultations, referrals and notes shape whether people disclose substance use, whether they return, and whether they get the care they need.
Change the language, change the care
Why wording changes what happens next
Language influences how people are perceived and how they are treated. Experimental work found that describing the same person as a \u201Csubstance abuser\u201D rather than as \u201Ca person with a substance use disorder\u201D produced more blaming and more punitive judgements \u2014 including among clinically trained respondents (Kelly & Westerhoff, 2010).
Person-first language keeps identity separate
A person has a health condition; they are not the condition. That distinction is standard for every other diagnosis, and substance use should be no different.
This is not about blaming professionals
Outdated terminology is mostly inherited — from training, textbooks, coding systems and team culture. Using it does not mean someone intends to discriminate. Changing it is part of a broader professional and cultural shift, and it works best as a team change rather than a personal correction.
Say this, not that
Stigmatising terms and better alternatives
Person-first language is recommended across UK and international guidance on substance use, mental health and long-term conditions.
- Avoid
Addict, junkie, alcoholic, druggie
Use insteadPerson with a substance use dependency; person who uses drugs; person with alcohol dependence
Why: Labels define a person by one part of their life and carry blame. Person-first language names the condition without replacing the person.
- Avoid
Substance abuse / abuser
Use insteadSubstance use; problematic substance use; substance use dependency
Why: 'Abuse' implies wilful wrongdoing and is associated with more punitive judgements, even among clinicians.
- Avoid
Clean / dirty (urine, or a person)
Use insteadNegative or positive test result; not currently using; using
Why: Framing bodily fluids or people as 'dirty' attaches moral contamination to a health condition.
- Avoid
Drug-seeking
Use insteadRequesting pain relief; describing unmanaged pain; seeking treatment for withdrawal
Why: The term is used as shorthand for distrust and is a documented route to undertreated pain.
- Avoid
Non-compliant, failed treatment
Use insteadTreatment did not work for them; disengaged from this service; returned to use
Why: Places responsibility on the person rather than on whether the treatment or service fitted their needs.
- Avoid
Relapsed, fell off the wagon
Use insteadReturned to use; had a recurrence
Why: Neutral wording keeps a return to use as clinical information rather than a moral event.
- Avoid
Habit
Use insteadSubstance use disorder; dependence
Why: Understates a health condition and implies it can be dropped through preference alone.
- Avoid
Addicted baby, born addicted
Use insteadBaby with neonatal abstinence syndrome / neonatal withdrawal
Why: Newborns experience withdrawal; they do not have a dependency, and the label follows the family through services.
Interactive
Test your language
Read each phrase as it might appear in notes or a handover, then reveal a less stigmatising alternative.
"The patient is a known IV drug abuser."
"Urine was dirty again this week."
"She's just drug-seeking."
"He failed detox twice."
Remember
See the person, not the label.
One respectful conversation can be the difference between someone disclosing their substance use and someone deciding never to come back.
References & further reading
Language and stigma research
Link, B.G. & Phelan, J.C. (2001). Conceptualizing Stigma. Annual Review of Sociology, 27, 363–385.
The labelling, stereotyping, separation, status loss and discrimination model of stigma used on this page.
van Boekel, L.C. et al. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and Alcohol Dependence, 131(1–2), 23–35.
Systematic review of health professional attitudes and their effect on care.
Kelly, J.F. & Westerhoff, C.M. (2010). Does it matter how we refer to individuals with substance-related conditions? International Journal of Drug Policy, 21(3), 202–207.
Experimental evidence that the term used ("substance abuser" vs "person with a substance use disorder") changes judgements, including among clinicians.
Corrigan, P.W. et al. Work on self-stigma, public stigma and structural stigma in mental health and substance use.
Widely used framework distinguishing self, public and structural stigma and their different remedies.
Room, R. (2005). Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review, 24(2), 143–155.
Discussion of why substance use attracts stigma differently from other health conditions.
UK guidance and policy
Drug misuse and dependence: UK guidelines on clinical management (the "Orange Book")
Department of Health and Social Care and devolved administrations, 2017. Treatment and prescribing practice for drug dependence in the UK.
Open source ↗NICE guidance on alcohol-use disorders and drug misuse
Includes CG115 (alcohol dependence and harmful drinking), CG100 (alcohol-related physical complications) and CG51 (psychosocial interventions for drug misuse).
Open source ↗Office for Health Improvement and Disparities — alcohol, drugs and tobacco collections
UK Government guidance, commissioning support and data on treatment and recovery in England.
Open source ↗Independent review of drugs (Dame Carol Black)
GOV.UK, 2020–2021. Examines treatment capacity, funding and system barriers in England.
Open source ↗Rights, respect and recovery: alcohol and drug treatment strategy
Scottish Government, 2018. Sets out a rights-based, stigma-aware approach to alcohol and drug support.
Open source ↗Medication Assisted Treatment (MAT) standards
Scottish Government / Public Health Scotland. Standards on same-day access, choice, harm reduction and retention in treatment.
Open source ↗Public Health Scotland — substance use and stigma resources
Population health information and work on reducing stigma in services.
Open source ↗NHS inform and NHS.uk
Public-facing health information and service finders for drug and alcohol support.
Open source ↗World Health Organization — alcohol, drugs and addictive behaviours
International guidance, including WHO/UNODC International Standards for the Treatment of Drug Use Disorders (2020).
Open source ↗
This website provides educational information and is not a substitute for individual medical assessment, diagnosis or treatment. Information should be interpreted alongside current clinical guidance and evidence.