In an October 15, 1890, letter to his friend George Bainton, Mark Twain famously wrote: “The difference between the almost right word and the right word is really a large matter—it’s the difference between the lightning bug and the lightning.”

Twain knew that choosing the right word matters. Words shape the way we talk about certain subjects, and, more importantly, words shape the way we feel about certain subjects. Words can make us feel compassionate or scornful. They can make us angry. Drive us to action. Cause us to shut down. So when it comes to addiction, and shaping the conversations around addiction, using the right language is imperative.

In 2009, John F. Kelly, Ph.D., the Elizabeth R. Spallin Associate Professor of Psychiatry in Addiction Medicine at Harvard Medical School, set out to answer a question related to language: Do certain substance-related terms convey meanings that have stigmatizing consequences and present a barrier to treatment? Or, to put it less clinically, does the language we use when we talk about addiction matter?

In search of an answer, Kelly and his fellow researchers, Sarah J. Dow and Cara Westerhoff, crafted a questionnaire that consisted of a brief initial descriptive narrative labeling two individuals as either a substance abuser or as having a substance use disorder.

“Two individuals are actively using drugs and alcohol,” it read. “One is a substance abuser and one has a substance use disorder. The following questions ask you to compare these two individuals.”

The 35 questions that followed dealt with treatment (“Which of these two individuals is more likely to benefit from inpatient care?”), punishment, social threat (“Which of these two individuals would be more likely to benefit from probationary monitoring?”), blame, exoneration, and self-regulation. The idea was to examine just how harshly each person would be judged based solely on the language used to describe them.

Participants in this study knew nothing about these individuals other than what was conveyed in the words used to describe them.

In the end, more than 300 people completed the questionnaire and the results were just as Kelly, Down, and Westerhoff hypothesized: “People were more likely to view the substance use disorder individual as more in need of treatment compared to the substance abuse individual, who was viewed as more deserving of punitive measures, such as a jail sentence and fines.”

Participants were also much more likely to view the substance abuser’s problems as being “associated with ‘willful misconduct’ caused by personal recklessness and his own choices.”

Removing Barriers

What this study proved was that simply framing a person with a substance issue as a substance abuser rather than someone who has a disorder could affect whether or not that person receives help. But both individuals need, and deserve, treatment.

After Harvard Medical School published the results of Kelly’s experiment, which included a recommendation to remove “abuser” language, the news spread quickly. It was an impactful enough research finding that Kelly traveled to Washington, D.C., to meet with the director of the White House Office of National Drug Control Policy. He then presented his research at the first Drug Policy Reform Conference in 2013. Not long after, the White House adopted Kelly’s new, recommended terminology.

“If we want addiction destigmatized,” Kelly told the Harvard Gazette, “we need a language that’s unified and really accurately portrays the true nature of what we’ve learned about these conditions over the last twenty-five years.”

He added, “This goes beyond political correctness. It’s not just a matter of being nice. What we now know is that actual exposure to these specific terms induces this implicit cognitive bias. If you really want to solve the problem, you want to remove any barriers and obstacles.”

Or, said another way, the difference between the right word and the almost right word can be the difference between treatment or a lifetime of struggle.


— Sober since January 2005, Tim earned a Master of Arts in Writing and Publishing from DePaul University in Chicago. Find his work here.

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