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Let’s Talk About Substance Use Disorder

By LeAnn Rees, APRN June 14, 2024 Posted in: Mental Health

For far too long, substance use disorder (SUD) has been shrouded in negative biases and misunderstandings that end up stigmatizing people. 

Fortunately, the tide is turning. Thanks to groundbreaking research, we now have a much deeper understanding of SUD. Well-supported scientific evidence shows that:

  • Addiction to alcohol and/or substances is a chronic brain disease that has potential for recurrence and recovery.
  • Disruption to three areas of the brain are particularly important – the basal ganglia, extended amygdala and the prefrontal cortex. These disruptions can reduce functioning of the brain’s executive control systems which enable decisions to regulate one’s actions, emotions or impulses. 

Myth: Substance Use is a Sign of Weakness

One of the most common stigmas related to SUD is people who use substances are “weak” and relapse is a sign of that weakness. Researchers are finding that much more is going on. For example, studies have shown that: 

  • Neuroadaptations occur in the brain’s structure and function as individuals continue to misuse alcohol or other substances. These progressive changes may be related to the transition from controlled, occasional substance use to chronic misuse. 
  • These brain changes can endure long after a person stops using substances and may produce continued cravings for the substance(s). More than 60% of people treated for a SUD experience relapse within the first year after discharge and may remain at risk for many years. 

Knowledge like this is paving the way for a more empathetic approach to how we talk about and treat individuals with SUD.

Why Words Matter When Discussing Substance Use

Research suggests just one in four people consider SUD to be a chronic illness. This misunderstanding reinforces stigma related to substance use. Stigma can get in the way of individuals seeking and thus receiving the treatment they need (and deserve because they are people). 

  • Out of 54.6 million individuals who needed substance use treatment, just 13.1 million actually received treatment, according to data from 2022. 

Common Stigmas and Misconceptions of Substance Use

Examples of common stigmas and misconceptions, according to the Centers for Disease Control, include: 

  • Assuming a person chooses not to change their behavior.
  • Considering SUD to be a moral instead of medical issue.
  • Withholding rather than offering support or treatment, based on a belief that offering support (social or financial) enables a person to continue using drugs. 

Factors Impacting Risk of Developing a SUD

Often people don’t realize there can be a greater risk of developing a SUD due to a person’s: 

  • Genetic background and their personal environment 
  • Adverse childhood experiences (ACE)
  • Mental health conditions

Stigmas like these can prevent people from admitting to loved ones or health care professionals that they are struggling, and ultimately get in the way of them receiving the care they need (and deserve). 

Reframing the Conversation Around Substance Use

When you know better, you do better – and that applies to how we talk about substance use disorder. Language that reflects an accurate, science-based understanding of SUD includes these suggestions: 

  • Replace judgmental terms like “addict,” “substance abuser” and “junkie” with person-first language, such as “person with a substance use disorder.” This emphasizes that individuals are not defined by their illness.
  • Instead of saying “habit,” say “substance use”. The term “habit” implies that a person chooses to use substances or can choose to stop while undermining the seriousness of the disease. 
  • Avoid saying “abuse” and instead say “use” for illicit drugs or “misuse” for prescription medications. The term “abuse” has a high association with negative judgments and punishment. “Misuse” for prescription medication use acknowledges that legitimate use is limited to prescribed parameters. 

These subtle shifts in language reinforce that these are people with a chronic and treatable illness. They are more than their disorder. They are someone’s mother, father, son or daughter. Treating them compassionately and as a person first ultimately improves the chances they will seek treatment so they can recover to lead healthier lives. 



LeAnn Rees, APRN
LeAnn Rees, APRN

LeAnn Rees, APRN is a psychiatry provider with CHI Health.

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