Lethbridge Harm Reduction
The Importance of Person first language
What is Stigma?
“Stigma is any attitude, belief, or behavior that discriminates against people”
- CCSUA [1}
It is “not simply a discrediting individual characteristic, but rather [ ] a social process involving labeling, stereotyping, status loss and discrimination that unfolds when unequal power dynamics exist.”[2]
How Does Stigma Impact People?
This stigma, including stigmatizing language, can have a large impact on people who use drugs in many different ways:
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It can impact how people who live with substance use disorder view themselves [1]
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Affects how people are treated by other people in the community [1]
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Causes people to internalize stigma and can make them feel worthless or experience shame [1]
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Can discourage individuals from getting help (When individuals internalize stigma or are treated poorly by other citizens or professionals in the system they may be less likely to seek out help from the systems that exist [1][3]
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Using stigmatizing language can impact policy- Speaking to officials who make policies regarding access and funding for treatment and resources for people with SUD with stigmatizing language can encourage biased ineffective programs and policies [1]
What Does Stigma Look Like?
In our community we often see stigma show up in many ways. In Lethbridge and other cities, there is a tendency for people to fall into the thought pattern of “Not in My Back Yard”- ism, also called NIMBY-ism. This NIMBY-ism is represented in the sentiment that people do not want harm reduction or substance use disorder services in their backyard (their neighborhood), meaning they do not want to deal with the unintended consequences that they associate with harm reduction services, like a supervised consumption service in their community [4]. However, these concerns are potentially unwarranted, given the findings of the opening of Vancouver’s first injection site. Following the opening of the site, there were no changes in some crime and a reduction in vehicle break-ins and theft [5]. Similarly, ARCHES (2019) reported that the safe consumption site had not increased crime rates. The average growth rate for crime was expected to increase at a rate of 14.9 % percent based on previous years; however, the growth rate was less, at 13. 05% in 2018 after the site had opened [6]. Stigma can also look like the spread of misinformation by citizens, including the words of political and public figures.
Stigma Can Include:
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Equating the identity of a person who uses substances with the substance use [1]
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Criticizing a person’s values because they use substances [1]
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Criminalizing language has been used to refer to people that use drugs often because of the ‘War on drugs’ [3]
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Pushing abstinence-based approaches as the only option for treatment of SUD [3]
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Amongst healthcare professionals, sometimes there is an assumption that any individual who is seeking pain medication has drug-seeking behaviour (a substance use disorder) [7]
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Myths that "once an addict always an addict" [7]
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Myths about recovery that it is only for those who want it [7]
Person-First Language
One way to combat stigma includes using person-first language! Person-first language is one way we can shift the way we view substance use disorder and the people who live with it. Person-first language involved being able to see the person for who they are apart from their substance use; it is acknowledging the person "before describing their personal attributes or health conditions" [1]. One important step includes referring to the condition as substance use diroder rather than addiction. Substance use disorder is a complex neurobiological disorder that changes the structure of the brain, resulting in compulsive drug-seeing and drug-taking behaviour, despite severe negative consequences [8]. "Genetics, brain development, environment, and indirivudal experieinces" can all be reasons that someone may develop a substance use disorder [1]. Referring to "addiction" as substance use disorder uses language that indicates that this is an important health condition which must be addressed, and helps individuals to gain better access to life-saving interventions [3]. Using this language shifts the stigma away from the idea that dependence on drugs or alcohol is a choice that a person makes, but in fact, is a health condition that they are living with. There is plenty of research that tells us that chronic stress, childhood trauma, and adulthood trauma are associated with substance use disorder, and as such it is important that we extend our compassion for individuals who use drugs and alcohol and continue to move away from this idea of "choice" [9][10]. Changing the way we speak about people who use drugs to language that is more compassionate and understanding can be very important in being able to respond to this overdose crisis [3]. Collins et al. (2018) suggest that in doing so, we can focus our attention on the systemic societal structures that are worsening the overdose crisis and gain further support form the people who can help alleviate this crisis; policy-makers for example. These societal structures include the lack of affordable housing, lack of funding and access to proper support for people living with substance use disorder, along with social isolation, and contaminated drug supplies [3].
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A derogatory language that further marginalizes people as they start to feel that they are not being cared for which can impact their ability to seek help [1]
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Attitudes that we have not taken time to acknowledge within ourselves [1]
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This can include the belief that individuals living with substance abuse disorder choose to have it
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Use of labels that can function to dehumanize people [1]
Overdose Prevention Sites Versus Supervised Consumption Sites
One suggestion in changing the language used is our choice of words when speaking about supervised consumption services. Following the provincial Medical Officer announcment that the opioid crisis was deemed a public health emergency, B.C. quickly implemented supervised injection facilities, called "overdose prevention sites [3]. These sites are meant to provide an area where oxygen or naloxone could be used if an overdose occurs while also allowing for safer consumption of drugs through safer conditions; so, overdose response sites might be a better term for them [3]. Shifting to the use of "overdose prevention sites" from "supervised injection sites" may shift the language away from the perception of the individual’s control in using Drugs [11]. While a change in our use of language by itself will not be able to solve the opioid crisis, changing our language can be considered vital to collectively addressing this public health crisis [3]. Using the terms "overdose prevention site" helps us all realize how important it is for us to intervene at different levels to save the lives of those who are living with substance use disorder [3].
In a study completed in the US in November and July in 2017, involving the use of online surveys, researchers presented information regarding supervised consumption sites to participants and at the end asked if they supported the legalization of these initiatives within their community [12]. Two surveys were administered that were exactly the same except that in some surveys they referred to these services as "overdose prevention sites" and in the other surveys called them "safe consumption sites" [12]. The results suggested that 45% of respondents supported the overdose prevention sites, while only 29% supported safe consumption sites [12]. Perhaps using the language of overdose prevention sites puts emphasis on how many people are dying during this opioid epidemic, and using this term may increase how many people choose to agree with the policies of implementing the sites [12]. Comparatively, the language of safe consumption sites highlights how they are “making an illegal activity safer for a highly stigmatized population” [12].
Even with the language of "overdose prevention sites" we may be using stigmatizing language [13]. In a news article from CBC, doctors in B.C. questioned how we view drug overdoses compared to alcohol overdoses. they suggested that we use the term "alcohol poisoning" when people consume an abundance of alcohol, whereas, when people consume a large amount of a drug we call it an "overdose" [13]. In this article, doctors discuss how within the document that the Canadian Medical System uses, overdoses are only used to describe "the action that led to the recommended diagnostic term, which is poisoning" [13]. They suggest that an accurate word to describe what has happened to a person who has consumed too much of a drug is "poisoning" [13]. By using the word poisoning instead of overdose, we are using more accurate language, bu also removing this sense of personal onus that is implied when someone says the word overdose, suggesting someone has knowingly given themselves too much [13].
Some Language to Consider:
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Avoid using words like “dirty” and “clean” when referring to a person’s sobriety as this increases discrimination [1]
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Instead of using words like “dirty” or “clean” talk about “use of substances” [1]
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Use “substance use disorder” instead of “addiction” [1]
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Do not use words like “druggie,” “junkie,” or “addict” [1]
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Saying “person who uses drugs” instead of “drug addict” or “drug abuser”
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Realize that recovery is not a linear path, and that dealing with trauma and emotional pain can be very difficult for people, and that having a setback is a very normal process that is part of the journey [1]
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Support people who have used drugs again after a period of sobriety by recognizing and validating their experiences
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Use “poisoning” instead of “overdose” [13]
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Always refer to the person first - for example instead of saying “I saw an overdose,” say “How can I help this person who has suffered an overdose” [1]
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When you hear people talk about punishing people who use drugs, encourage them to consider this person’s health condition [1]
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Recognizing your own privileges and biases when you speak about people who use drugs
language is powerful
It is about showing compassion and seeing people as humans first.
[1] Canadian Centre on Substance Use and Addiction. (2019). Overcoming stigma through language: A primer [Pamphlet]. Government of Canada. https://www.ccsa.ca/sites/default/files/2019-09/CCSA-Language-and-Stigma-in-Substance-Use-Addiction-Guide-2019-en.pdf. (p.5, p.8, p.4, p.9)
[2] Chang, J., Dubbin, L., & Shim, J. (2016). Negotiating substance use stigma: The role of cultural health capital in provider–patient interactions. Sociology of Health & Illness, 38(1), 90–108. https://doi.org/10.1111/1467-9566.12351
[3] Collins, A. B., Bluthenthal, R. N., Boyd, J., & McNeil, R. (2018). Harnessing the language of overdose prevention to advance evidence-based responses to the opioid crisis. International Journal of Drug Policy, 55, 77-79. https://doi.org/10.1016/j.drugpo.2018.02.013
[4] Gerster, J. (2019, August 4). ‘Not in my backyard’: How NIMBYism impacts access to vital support services. Global News. https://globalnews.ca/news/5698658/addictions-nimby/
[5] Wood, E., Tyndall, M. W., Lai, C., Montaner, J. S., & Kerr, T. (2006). Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Substance abuse treatment, prevention, and policy, 1(1), 13. doi:10.1186/1747-597X-1-
[6] ARCHES. (2019). Report to mayor and city council. http://lethbridgearches.com/wp-content/uploads/2019/08/Report-to-Mayor-and-City-Council-Final.pdf. (p.6)
[7] G. Garner, Personal Communication, February 3rd, 2020.
[8] Camí, J., & Farré, M. (2003). Drug addiction. The New England Journal of Medicine, 349(10), 975-86.
[9] Sinha, R. (2001) How does stress increase risk of drug abuse and relapse? Psychopharmacology, 158(4), 343-359. Doi: 10.1007/s002130100917
[10] Afful, S. E., Stickland, J. R., Cottler, L., Bierut, L. J. (2010). Exposure to trauma: A comparison of cocaine-dependent cases and a community-matched sample. Drug and Alcohol Dependence, 112(1), 46-53. https://doi.org/10.1016/j.drugalcdep.2010.05.012
[11] Fraser, S. (2017). The future of ‘addiction’: Critique and composition. International Journal of Drug Policy, 44, 130–134.
[12] Barry, C., Sherman, S., & Mcginty, E. (2018). Language matters in combatting the opioid epidemic: Safe consumption sites versus overdose prevention sites. American Journal of Public Health, 108(9), 1157-1159. (p.1159).
[13] Allingham, J. (2017, September 2). Is the fentanyl situation an overdose crisis or a poisoning crisis? CBC News. http://www.cbc.ca/news/canada/british-columbia/overdose-fentanyl-1.4269917