Language Matters

Editor’s Note:  I have been fortunate to see first-hand Dr. Yngvild Olsen contribute to both enhancing patient care and improving the treatment system. Dr. Olsen brings to the addiction field an extraordinary degree of dedication and energy. Her commitment to making the language of substance use disorders less judgmental is particularly admirable. I appreciate her efforts to engage her patients and colleagues in conversations that are more “positive” or as she writes, “just plain effective.”   -Dr. George Kolodner

By Yngvild Olsen

“I just want her to be clean,” her mother said as I looked across the table at her daughter, the person who I had treated for opioid use disorder for the last year. That person, head hung low, was clutching her bag until her knuckles blanched.

It sounded funny, coming from an educated, relatively affluent woman – clean. It made it sound as if her daughter hadn’t showered recently or was wearing dirty clothes. That didn’t seem to be the case to me. I wondered what the mother really thought of her daughter and vice versa and what kind of relationship they really had. I wondered how I would feel if my mother said the same about me. “If I’m not clean, mom, then I must be dirty, and who wants to love or help a dirty person?”

I began thinking about the language of substance use disorders several years ago when patients told me about the names they had often been called by other healthcare providers. I realized that many of the terms I and my colleagues were using perpetuated stigma, negatively stereotyped people, and did not align with the science of addiction as a chronic illness. Worse, I saw how many of my patients had so internalized terms such as “clean,” “dirty,” and “addict” that they had lost hope that their lives could be any different.

Since adopting new language of “in recovery,” “positive test,” “negative,” “person with a substance use disorder,” I have been amazed at how people have responded. It has allowed me to engage people more actively in conversations about the neuroscience of addiction, behavior change, individual progress in treatment, and regaining recovery after relapse.

It catches people’s attention, has them sitting up straighter in their chairs, improves eye contact, and makes them smile. Best of all, patients have now started letting me know during visits that their next urine test result will likely be “positive” because they used cocaine after fighting with their spouse or it will be “negative” because they realized that walking down an alternate street to get home from the bus stop prevented triggers and cravings. In the words of SAMHSA’s Recovery-Oriented Systems of Care (ROSC), this is a person-centered and strengths-based approach – or as I would call it, just plain effective.

Dr. Yngvild Olsen currently serves as medical director for the Institutes for Behavior Resources, Inc. /REACH Health Services in Baltimore. Throughout her career as an internist, addiction medicine specialist, and public health professional, Dr. Olsen has written and lectured extensively on opioid use disorder and its treatments.