Stigmatizing terms used to describe individuals who have a substance addiction, including “addict,” alcoholic,” and “substance abuser,” may be associated with negative explicit and implicit biases and should be replaced with positive terms that still describe the conditions accurately, according to a study published in Drug and Alcohol Dependence.

The national health volunteer registry, ResearchMatch, was used to enroll a total of 1288 participants (mean age, 43.18±16.16 years). Participants were categorized into 7 groups that represented different word pair options, such as “substance abuser” and “person with substance use disorder” and “addict” and “person with substance use disorder.”

A Go/No Go Association task and a measure of social distance using vignettes were completed by each participant. For the Go/No Go Association task, participants were asked to classify both the objective and evaluative word categories. In addition, 3 vignettes were used, with the first vignette serving as the control and the other vignettes used for substance use, treatment, recovery, and stigmatizing addiction-related terminology. The Bogardus Social Distance Scale was used to measure participants’ comfort levels associated with the stigmatizing and nonstigmatizing labels for addiction.

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Social distance scores were found to be significant for the “addict” and “person with substance use disorder” group (F[2, 102] = 7.384; P =.001). In a post-hoc analysis, a significant difference was observed between the control and “addict” groups (P =.001), with a mean 1.27 lower total social distance score in the “addict” group compared with the control group. In addition, social distance scores for “opioid addict” and “person with an opioid use disorder” were significant (F[2, 178] = 5.559, P =.005).

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In the “substance abuser” and “person with substance use disorder” group, the strongest association found was for “substance abuser” plus “bad” (d’ = 2.169), an association which was significantly different from “substance abuser” + “good” (d’ = 1.222; P <.001), “person with a substance use disorder” plus “good” (d’ = 1.337, P <.001) and “person with a substance use disorder” plus “bad” (d’ = 1.862, P =.007). In the “addict” and “person with a substance use disorder” group, “addict” plus “bad” had the strongest association (d’ = 2.395) and was significantly different from “addict” plus “good” (d’ = 1.584; P <.001), “person with a substance use disorder” plus “good” (d’ = 1.584; P <.001), and “person with a substance use disorder” plus “bad” (d’ = 2.069, P =.001). Similar associations were found in the “relapse” and “recurrence of use” group and in the “opioid addict” and “person with an opioid use disorder” group.

A limitation of the analysis includes its lack of generalizability because of the predominantly female and white population.

”Terms such as ‘substance abuser,’ ‘addict,’ ‘opioid addict,’ ‘alcoholic,’ and ‘relapse’ should be used sparingly, if at all. More positive terms can be used in their place, such as ‘person with a substance use disorder,’ ‘person with an opioid use disorder,’ ‘person with an alcohol use disorder,’ and ‘recurrence of use,’ and are likely to elicit stronger positive implicit bias and minimize any negative explicit or implicit bias,” concluded the investigators.


Ashford RD, Brown AM, Curtis B. Substance use, recovery, and linguistics: the impact of word choice on explicit and implicit bias. Drug Alcohol Depend. 2018;189:131-138.

This article originally appeared on Clinical Pain Advisor