Can terminology reduce stigma in opioid addiction? Different terminology for different stigma goals; Facing up to saving and losing face. FaceTime needed. 

In SAVVY, a new study researched what terminology would reduce stigma in the prevention and treatment of opioid addiction.

In SKILLS, the choice of terminology may depend on the purpose of communication. Use medical terminology to decrease blame for addiction.  Use non-medical terminology to increase confidence that the person can recover and is not dangerous.

In SOUL, it is not about “losing face” or “saving face” over the Presidential election results.  It’s about “facing up” to “face our problems” and use some “FaceTime” to listen to each other.

savvy

Earlier this month (January 20, 2021) there was a news release: 

“Opioid addiction is persistently stigmatized, delaying and preventing treatment for many – an urgent problem with overdose deaths continuing to rise. To help alleviate this, various medical ways of describing opioid-related impairment, such as “a chronically relapsing brain disease,” “illness,” or “disorder,” have been promoted in diagnostic systems and among national health agencies.”

Researchers argue that one potential tool to reduce stigma could be studying the terminology we use.  John F. Kelly, PhD, the lead investigator of a study published in the journal Addiction, is Director of the

Recovery Research Institute at Massachusetts General Hospital (MGH), Boston, Massachusetts.  He explained:

“While intensely debated, there were no rigorous scientific studies out there to inform practice and policy about which terms may be most helpful in reducing stigma….We wanted to test to what extent, if any, exposure to a variety of commonly used medical and nonmedical terms describing opioid-related impairment actually makes a difference in people’s attitudes toward those with opioid addiction.”

Tip 1

Medical terms for opioid addiction don’t always reduce stigma

Some have argued that over-medicalization of opioid-related impairment may:

• Decrease the public’s perception that people can recover
• Reduce the sufferer’s own confidence in their ability to change
• Inadvertently increase the public’s perception that people suffering from opioid-related impairment are dangerous and should be socially excluded.

Kelly’s team conducted a nationally representative study with more than 3,500 participants. 

• Six common terms describing someone treated for opioid-related impairment were tested – “chronically relapsing brain disease,” “brain disease,” “disease,” “illness,” “disorder,” and “problem.”
• Study participants were assigned one of these terms at random, which was embedded within a short paragraph vignette describing someone treated for opioid-related impairment.
• All vignettes were identical except for the specific term used to describe opioid-related impairment. 

Participants then rated the extent to which they agreed or disagreed with a number of stigma-related statements. These statements assessed several stigma dimensions:

• Whether they thought the individual in the vignette was personally to blame for their opioid use
• Whether they thought they could recover from it
• How dangerous they thought the person was
• Whether they thought the person should be socially excluded – for example, whether they would hire the person as a babysitter or have them as a roommate.

Tip 2

No one single term can reduce all potential stigma biases.

Dr. Kelly: “We found that while some terms were very good at reducing certain types of stigma, these same terms increased other types of stigma, and vice versa.” 

• When the person in the vignette was described as having a ‘chronically relapsing brain disease’, participants in the study significantly reduced ratings that there was personal blame for having opioid addiction
• In other words, participants felt people were not at fault for having a ‘chronically relapsing brain disease’ 
• But simultaneously such a term decreased people’s belief that the same person could recover – participants felt that people with a ‘brain disease’ couldn’t recover
• Use of this more medical ‘chronically relapsing brain disease’ terminology also increased perceptions that the person was dangerous and 
• Should be socially excluded.

In contrast, when using nonmedical terminology – describing the individual as having an ‘opioid problem’:

• Participants in the study rated increased perceptions that there was personal blame for the opioid problem 
• In other words, they felt that if you have an ‘opioid problem’, you are more at fault and blame
• But simultaneously, participants felt that a person with an ‘opioid problem’ could actually recover and that
• The person was not dangerous and 
• Did not need to be socially excluded.

Reference:

John F. Kelly  M. Claire Greene  Alexandra Abry (2020): “A US national randomized study to guide how best to reduce stigma when describing drug‐related impairment in practice and policy” Addiction

First published: 16 November 2020 https://doi.org/10.1111/add.15333.

skills

As a result of these findings, to reduce stigma, Kelly and colleagues made recommendations about the language and terminology we use.

Tip 1

Tailor terminology and language used to the specific purposes of the communication.

Dr. Kelly:

• “If you want to decrease stigmatizing blame, use of more medical terminology may be optimal; 
• If you want to increase confidence that the person can recover and is not dangerous, use of non-medical terminology may be best.”

Tip 2

There is not one single recommended term that can reduce stigma in all desired clinical and public health settings.

Terminology in the addiction and recovery field is constantly evolving. 

Dr. Kelly:

“We need to be more thoughtful about our choice of language in order to help those suffering from opioid-related impairment feel less stigmatized and be seen as capable of recovery, as not dangerous, and to be welcomed into society as much as anyone else.” 

Bottom Line

The implications of this study for clinical practice and public health policy are that the choice of terminology depends on the purpose of communication.

soul

I use an Apple iPhone and love the Face ID feature that allows me to login to my phone and Apps just by using my face as the password.  

Initially I was concerned that someone might hold a gun to my head, force me to look at my phone screen, and unlock all my data.  But then I figured that the ‘bad guys’ already have remote and virtual ways to get my data that are a lot easier and safer for them than meeting me and using a gun.

So I keep using Face ID, unless I ‘lose face’ and need some FaceTime to ‘save face’.  

(For non iPhone users, FaceTime is the video-chat feature available to all iPhone users.) 

As the USA has just inaugurated President Biden and Vice President Kamala Harris, there are millions of Americans who do not want to embrace the new President and Vice President concerned that they will ‘lose face’.  Many firmly hold to explanations for losing the election and ‘save face’  

There are also millions of Americans who want to ‘rub it in their face’ that they made a mistake about massive fraudulent voting. They might even use aggressive ‘in-your-face’ methods to make their point.

But my New Year’s resolution for 2021 is that we all ‘face up’ to the fact that most of us are people of good will, wanting and willing to ‘face our problems’ head on and find solutions together.

What if we forget about ‘losing face’ or ‘saving face’ and have some FaceTime to get to know each other humbly, empathically, and respectfully. (I thought about ending with a ‘smiley face’ 🙂 but resisted).