Stigmatising language about drug use is everywhere and it can stop people getting the best treatments. Discussing language often means having difficult conversations; some of which are with yourself. 

Talking to myself

I was on Twitter, donating more hours to the scroll, and saw a tweet that said something like: “We need urgently to reflect on how to address stigmatising language”. The reactionary in me woke up, slammed its hand on the desk and began to construct a reply along the lines of “No, what we urgently need is better treatment services” as if these were either/or options.

I had a quick chat with myself and went to make a cup of tea, putting distance between me and my Twitter account.

As I filled the kettle, I remembered that those false equivalences and zero-sum games are almost never real. I reminded my inner reactionary that it’s possible to fund treatment services and to address stigmatising language at the same time. So why the irritation – why did that part of me wake up?

Difficult conversations

Many of the words and insults that were used so casually back then would be appalling in any setting now. I wince at the memory and wonder how that awful language shaped the lives of those children who are now adults.

Part of me had, I think, recalled all those difficult conversations about language, revisiting the many times I had got this wrong. I was taken back to my secondary school’s playground in the 1990s. Many of the words and insults that were used so casually back then would be appalling in any setting now. I wince at the memory and wonder how that awful language shaped the lives of those children who are now adults. It’s uncomfortable to think of. I am loaded with regret. I hastily retreat back to the present day and flick the kettle on.

Throughout my life, I have been challenged, informed, taught, and educated about the impact of my words. Most of those conversations were difficult. Some involved friends pointing out that my words were racist, homophobic, that they were unacceptable. Some involved me challenging my friends – heart beating like a drum – putting a strain on the night out and a risk on our friendship. Every conversation was necessary and important for growing up, for becoming a better person and for hurting fewer people. Yet every conversation is also a loaded memory that makes my stomach lurch.

Perhaps my Twitter irritation was because I don’t want to have any more of those conversations. I want us to have decided on the final and best set of words. It’s 2022, we must have got this sorted by now, surely? I know, however, that when I’m 60 I will look back at the words I use now with the same levels of embarrassment that I have now for the language I used in my 20s. Part of me wants to send a message forward to my 60-year-old self, saying that I did my best, that I tried. I drop a teabag in my empty cup as the kettle begins to whisper.

Talking to, not about, people who use drugs

My, and other people’s reasons for reflecting on language are complicated. For some, it seems to be a simple question of words that are right and wrong. For others, it can be about trying to stay on top of what is considered right and wrong. I have, at times, been careful about language, not to reduce stigma, but to avoid having difficult conversations. I then worry that issues of stigma become about my avoiding arguments with people who care about words, rather than about my avoiding harm to people who use drugs. Am I then discussing preferred words without involving the people who are affected? This kind of exclusion can only increase, rather than decrease stigma and disempowerment.

I remember the pride with which some people identified as an ‘addict’ alongside the visible discomfort that the same word caused others in the same group.

I remind myself to revisit the publication from the International Network of People Who Use Drugs and the Asian Network of People Who Use Drugs. A document that was written by people who use drugs. Many of whom care about language and stigma because of the impact it has had on their lives.

Names change

The sound of boiling water reminds me of my early days working in addiction treatment services, where the urn would constantly simmer in the kitchen and where tea was a routine intervention. In those first few months I learned hundreds of new words. Some therapeutic, others drug related, and some particular to that service. I remember that over the years many of those words changed: ‘patients’ turned into ‘clients’ and into ‘service users’, ‘Project workers’ became ‘recovery workers’, the NTA became PHE and then UKHSA/OHID. Some things changed with the words, some things stayed the same.

I remember the pride with which some people identified as an ‘addict’ alongside the visible discomfort that the same word caused others. Most would, if prompted, talk at length about why they valued or disliked the term so much.

There was one slow drop-in session when I spent the afternoon talking about this to the only person to turn up. They explained to me that, on a societal level, casting people who use drugs as ‘addicts’ worked to dehumanise them. That it was far easier to be bombastic about sending people to prison if they are not seen as real people. Thinking about the real people behind drug-related headlines raises difficult questions that most people want to avoid over their coco-pops. Those questions are easier to ignore when you’re just talking about ‘addicts’. I learned so much from talking to people in drop-in sessions that it sometimes felt a bit odd calling it work.

Person-first language

I remember, much later, coming across person-first language and the phrase ‘people who use drugs’. Person-first language immediately made sense to me. The first thing anyone is, is a person and remaining attributes are secondary. I am a person who occasionally writes blogs, I am not a blogger. I pour the water into my cup and wait for it to brew, I am a person who drinks tea.

There was a time when I thought that adopting non-stigmatising language was a diversion that didn’t make any difference in the ‘real world’, although this didn’t last long. I knew that society should support people who use drugs, and I also knew that repeated use of demeaning language could make people who use drugs feel worthless, guilty and embarrassed to ask for help. The words that I used when working in treatment services and that I use now as a website editor can deter people from accessing the help they deserve – it is a big responsibility and one that I need to take seriously.

Language inevitably and inexorably shapes how society views and supports people who use drugs.

Just a few months ago the government published its latest UK Drug Strategy. This was mostly good news for the field, yet its launch focused on punishment and ‘cracking down’ on drug use. I remember a research paper on how people who are exposed to stigmatising language about drugs are more likely to endorse punishment than those exposed to non-stigmatising language. Was the Drug Strategy advertised to a public whose views have been shaped by continuous exposure to stigmatising language, articles and headlines? It’s probably more complicated than that.

Stigma and policy

My search for a teaspoon makes me remember that there is a long history of language being used to stir up both unpleasant and positive views. Language inevitably and inexorably shapes how society views and supports people who use drugs. Reflecting on language is not something that comes at the expense of treatment funding, naloxone provision, prescribing, support or outreach; reflecting on language is essential for making long-term improvements to treatment services.

In the absence of any suitable cutlery, I scald my fingers trying to bob the teabag out of its cup whilst daydreaming of a drug strategy launched by a minister boasting about finally giving society the state-of-the-art treatment services that people who use drugs deserve. Imagine that? One step towards this kind of radical change, would be to reduce everyone’s exposure to stigmatising messages that push the criminal, unworthy, guilty, ‘you-do-it-to-yourself (you do)’ messages.

I get back at my computer with my tea and (okay then) a biscuit. The cursor is where I left it, hovering over Twitter’s ‘reply’ button. I move it over to the ‘like’ option but can’t quite bring myself to click there either. In the end I do nothing, a hesitation that causes me to dunk my biscuit for too long. As the hobnob disintegrates into my tea, I realise that I have reflected on stigmatising language quite a lot in the last 5 minutes, which I guess was the point of the original tweet. It is annoying when Twitter is right.

by Rob Calder

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