Content style guide

Destigmatizing language in substance use

When writing about substance use and substance use disorder, the words we use matter. This is true both in content for Veterans as well as in our treatment plans, policies, and other documents.

Research shows that stigmatizing language can make it harder for people with substance use disorder to seek treatment. It can also negatively shape the perspectives of the people providing treatment in a way that negatively impacts the care they provide.

At VA, we use language that reflects how we provide treatment and support to Veterans with substance use disorders:

We recognize people as human beings first and not as defined by their problems or conditions.
We know that people have problems but are not themselves the problem.
We show support and understanding for people who have substance use problems, rather than negativity, punishing attitudes, or blame.
We recognize substance use disorder as a serious condition and not a choice or “habit.”

Substance use: Language to use and avoid

Use: Alcohol, drug, or substance use disorder; alcohol, drug, or substance use addiction
Avoid: Alcohol, drug, or substance abuse; alcohol, drug, or substance dependence

Use: Person with a substance use disorder; person with a substance addiction; person who uses drugs, substances, or medications other than as prescribed
Avoid: Addict; addicted; alcohol, drug, or substance user; alcohol, drug, or substance abuser

Use: Person with alcohol use disorder; person who engages in unhealthy drinking
Avoid: Alcoholic; drunk

Use: Not currently using drugs, substances, or medications other than as prescribed
Avoid: Clean

Use: Currently using drugs, substances, or medications other than as prescribed
Avoid: Dirty

Use: Person in recovery or remission from alcohol, drug, or substance use disorder
Avoid: Ex-, former, recovering, or reformed addict or alcoholic

Use: Person with a severe substance use disorder
Avoid: Hardcore

Use: Person who is currently injecting drugs or substances
Avoid: Injection, injecting, or IV drug user

Use: Person with stimulant use disorder; person who engages in unhealthy use of stimulants
Avoid: Meth head

Supply of substances: Language to use and avoid

Use: Person who traffics or sells drugs, substances, or medications other than as prescribed
Avoid: Dealer

Use: Extensive involvement in the unlawful sale of drugs, substances, or medications other than as prescribed
Avoid: Hardcore

Drugs and substances: Language to use and avoid

Use: Potential for a substance to lead to addiction or unhealthy use
Avoid: Abuse potential; potential for abuse

Use: Substances that can lead to addiction or unhealthy use
Avoid: Drugs of abuse

Use: Non-medical use of prescription medication; using medication other than as prescribed
Avoid: Prescription drug abuse

Use: Cannabis
Avoid: Marijuana

Use: Syringes; injection equipment
Avoid: Works; rigs

Use: Sterile, unused, or not previously used (when referring to syringes or injection equipment)
Avoid: Clean

Use: Unsterile, used, or previously used (when referring to syringes or injection equipment)
Avoid: Dirty

Toxicology: Language to use and avoid

Use: Provide a sample for drug or toxicology testing
Avoid: Drop

Use: Tested positive for substances
Avoid: Dirty; fail; pop

Use: Tested negative for substances
Avoid: Clean; pass

Treatment: Language to use and avoid

Use: Alcohol use disorder
Avoid: Alcoholism

Use: Person doesn’t agree with others’ perspectives of their substance use; person perceives their substance use differently than how others perceive it
Avoid: Denial

Use: Unsuccessful course of treatment; didn’t benefit from treatment
Avoid: Fail

Use: Substance use disorder; substance addiction
Avoid: Habit

Use: A recurrence of alcohol, drug, or substance use
Avoid: Lapse; slip

Use: Medication for opioid use disorder MOUD); medication for alcohol use disorder (MAUD); medication or pharmacotherapy for substance use disorder
Avoid: Medication-assisted treatment (MAT); maintenance; maintenance treatment; methadone maintenance; replacement treatment; opioid substitution

Use: Person has chosen not to complete the recommended treatment (or other course of action); person has decided not to complete the recommended treatment (or other course of action)
Avoid: Non-compliance

Use: Recurrence of symptoms of substance use following remission
Avoid: Relapse

Use: Experiencing discord or friction in the therapeutic relationship; unsure about treatment
Avoid: Resistant

Criminal justice system (or criminal legal system): Language to use and avoid

Note: We acknowledge the movement toward replacing references to the “justice system” with references to the “legal system.” We’re including both terms at this time and may update this information in the future as consensus arises.

Use: Person with justice system involvement; person with legal system involvement
Avoid: Convict; criminal; delinquent; offender

Use: Person who was formerly involved in the justice (or legal) system
Avoid: Ex-con; ex-convict; ex-offender

Use: Person who pled guilty to, or was judged guilty of, a felony offense; person officially declared guilty of a felony offense in a court of law
Avoid: Felon

Use: Undocumented immigrant; person who doesn’t have documentation of U.S. residency
Avoid: Illegal; illegal immigrant

Use: Person who is incarcerated
Avoid: Inmate

Use: Person in detention, jail, or prison
Avoid: Prisoner

Use: Person experiencing severe poverty, homelessness, housing insecurity or instability; person who is unhoused
Avoid: Derelict; transient

Use: Under-resourced neighborhood; neighborhood with a high rate of poverty; marginalized community
Avoid: High-poverty (in reference to a place or community)

Use: Lower-income or marginalized metropolitan neighborhood or community
Avoid: Inner-city

Use: Difficulty in seeing a means to recovery; in a challenging situation
Avoid: Hopeless

Use: A harmful challenge affecting many people
Avoid: Scourge

Resources

We encourage you to use these resources for more guidance:

The Recovery Research Institute’s “Addictionary®” (RRI website)

The National Institutes on Drug Abuse’s “Words matter – Terms to use and avoid when talking about addiction” guide (NIDA website)

Additional references we consulted to create this guidance:

The 2017 Executive Order on changing federal terminology regarding substance use and substance use disorders (Obama Whitehouse Archives website, PDF)

The Drug Enforcement Administration’s community outreach and prevention support style guide (link not yet available).

Broyles, L. M., Binswanger, I. A., Jenkins, J. A., Finnell, D. S., Faseru, B., Cavaiola, A., Pugatch, M., & Gordon, A. J. (2014). Confronting inadvertent stigma and pejorative language in addiction scholarship: a recognition and response. Substance abuse, 35(3), 217–221. https://doi.org/10.1080/08897077.2014.930372

Tran, N. T., Baggio, S., Dawson, A., O’Moore, É., Williams, B., Bedell, P., Simon, O., Scholten, W., Getaz, L., & Wolff, H. (2018). Words matter: a call for humanizing and respectful language to describe people who experience incarceration. BMC international health and human rights, 18(1), 41. https://doi.org/10.1186/s12914-018-0180-4