Words matter more than most people realize. The language we use to talk about substance use and mental health does not just describe reality — it shapes it. Every time we call someone an "addict" or describe their drug test as "dirty," we add another brick to the wall of silence that keeps people from getting help.
This isn’t about being politically correct. This is about being accurate. And it is about understanding that the words you choose can either push someone toward help or push them deeper into hiding.
The Words We Grew Up With
Most of us learned to talk about substance use from movies, news stories, and casual conversation. The vocabulary we inherited is loaded with judgment:
"Addict." "Junkie." "Druggie." "Crackhead." "Pillhead."
These words reduce a human being to a single behavior. They erase everything else about a person — their relationships, their talents, their history, their humanity. When we call someone an "addict," we are saying that their substance use is the most important thing about them. It is their identity. It is who they are.
That isn’t just unkind. It is wrong.
A person with substance use disorder is a person first. They are a parent, a sibling, a friend, a colleague, a neighbor. They are someone who is dealing with a medical condition that affects the brain. They deserve the same language of dignity that we extend to people with any other health condition.
Nobody calls a person with diabetes "a diabetic failure." Nobody calls a person with cancer "a tumor."
The "Clean" and "Dirty" Problem
One of the most common and most damaging language patterns is the use of "clean" and "dirty" to describe drug test results or recovery status.
When we say someone is "clean," the implication is clear: they were dirty before. Their substance use made them contaminated, impure, soiled. And when they relapse — as many people do, because substance use disorder is a chronic condition — they become dirty again.
This language framework turns recovery into a moral binary. You are either clean or dirty, good or bad, worthy or unworthy. It leaves no room for the messy, nonlinear, deeply human process that recovery actually is.
Better alternatives:
- Instead of "clean," say "in recovery" or "not currently using"
- Instead of "dirty test," say "positive test result"
- Instead of "relapse," consider "recurrence" (the same term we use for other chronic conditions)
Person-First Language: A Practical Guide
Person-first language puts the human being before the condition. It is simple to learn and powerful in practice.
Instead of "addict" or "substance abuser," say "person with substance use disorder."
Instead of "alcoholic," say "person with alcohol use disorder."
Instead of "drug habit," say "substance use disorder" — it is a medical condition, not a habit.
Instead of "abuse" (as in "drug abuse"), say "use" or "misuse." The word "abuse" implies a moral failing. The word "use" describes a behavior.
Instead of "medication-assisted treatment," say "medications for addiction treatment" or simply "medication for substance use disorder." The word "assisted" implies the medication is secondary, when for many people it is the foundation of their recovery.
Instead of "former addict," say "person in recovery" or "person in long-term recovery." Recovery is ongoing. It is not something you were. It is something you are.
What the Research Says
This isn’t theoretical. Research consistently shows that the language used to describe people with substance use disorders directly affects how they are treated.
A landmark study by Kelly and Westerhoff (2010) found that when clinicians read a case study describing a "substance abuser," they were significantly more likely to recommend punitive measures than when the same case study described a "person with a substance use disorder." Same person. Same behavior. Different words. Different treatment.
A 2018 study in Drug and Alcohol Dependence found that shame-loaded language was one of the top barriers preventing people from seeking treatment. People who felt judged by the language used around them were less likely to ask for help, less likely to enter treatment, and less likely to stay in treatment.
The National Institute on Drug Abuse (NIDA) has officially recommended person-first, non-judgmental language in all communications about substance use. So has the Associated Press, which updated its style guide to discourage terms like "addict" and "alcoholic" as nouns.
The evidence is clear: language that reduces, shames, and dehumanizes keeps people sick. Language that dignifies, includes, and humanizes helps people heal.
What to Say (and What Not to Say) to Someone Who Is Struggling
If someone in your life is dealing with substance use or mental health challenges, here are some practical guidelines:
Say: "I am here for you. You don’t have to go through this alone." Not: "You just need to get clean" or "Why can’t you just stop?"
Say: "I care about you and I am worried." Not: "You are ruining your life" or "Think about what you are doing to your family."
Say: "What kind of support would help you right now?" Not: "Have you tried just not doing it?" or "You need to go to rehab."
Say: "Recovery looks different for everyone. I respect your path." Not: "My cousin’s friend got sober by going cold turkey — you should try that."
Say: "I don’t fully understand what you are going through, but I want to." Not: "I know exactly how you feel" — even if you think you do.
The goal isn’t to have perfect language. The goal is to lead with compassion, listen more than you speak, and remember that the person in front of you is a whole human being, not a diagnosis.
Changing the Culture, One Conversation at a Time
Sam’s OATH is built on the belief that cultural change happens at the level of individual conversations. Every time you choose "person with substance use disorder" over "addict," you are changing the culture. Every time you describe a positive drug test without calling someone "dirty," you are changing the culture. Every time you talk about your own family’s experience honestly instead of hiding it, you are changing the culture.
This is what Authenticity looks like in practice. It is the "A" in OATH. It means choosing words that reflect reality instead of reinforcing shame.
You don’t have to be perfect at this. You will slip up. We all do. What matters is the direction you are moving.
Take the Next Step
Share this post with someone who might benefit from it. Save it as a reference when you aren’t sure what to say. And if you haven’t already, take Sam’s OATH and become part of a community that is rewriting the language of substance use, one honest word at a time.
If you or someone you love needs support right now:
- 988 Suicide and Crisis Lifeline: call or text 988
- SAMHSA National Helpline: 1-800-662-4357 (free, confidential, 24/7)
- Crisis Text Line: text HELLO to 741741