The Language We Use Matters More Than We Think

# The Language We Use Matters More Than We Think Words build rooms. Some rooms feel safe enough to speak in. Others don't. That might sound abstract, but if you've ever been in a conversation where someone referred to your loved one as "a junkie" or "a drunk" or described them as "crazy," you know exactly what I mean. You felt the door close. You felt the temperature change. And you probably stopped talking about what was really going on. This post isn't about policing anyone's vocabulary. It's about understanding why the words we choose either open doors or slam them shut - and what that means for families navigating substance use and mental health challenges. ## The Problem with Labels Here's a sentence: "He's an addict." Here's a different sentence: "He has a substance use disorder." Same person. Same reality. Completely different framing. The first sentence defines a human being by a condition. It collapses everything they are - father, friend, coworker, person who loves bad movies and makes great pancakes - into a single label. And that label carries centuries of moral judgment with it. "Addict" doesn't sound like someone who's sick. It sounds like someone who chose this. The second sentence describes a person who has a medical condition. It leaves room for everything else they are. It also leaves room for something essential: the possibility that things can change. This isn't a semantic game. The National Institute on Drug Abuse (NIDA) and the American Medical Association (AMA) both specifically recommend person-first language because research shows it measurably changes how people - including healthcare providers - respond to someone seeking help. A landmark 2010 study by John Kelly and Cassandra Westerhoff at Harvard Medical School found that when clinicians read a vignette describing someone as "a substance abuser," they were significantly more likely to recommend punitive action than when the same vignette described a person "with a substance use disorder." Same facts. Different words. Different treatment. ## "Clean" and "Dirty" This one runs deep. We've been saying it for decades. Someone is "clean" when they're not using. They're "dirty" when they relapse. Think about what those words actually mean. Clean implies purity. Dirty implies contamination. We're telling people that their moral worth is determined by whether a chemical is present in their body. A person who uses insulin isn't "dirty" when their blood sugar spikes. A person managing depression isn't "dirty" during a depressive episode. But somehow, we've accepted that a person with a substance use disorder is contaminated when their illness flares. Better alternatives: "in recovery," "not currently using," "in remission." These are medical terms that describe a medical reality without attaching shame to it. ## Why This Matters for Families If you're reading this as a family member, you might be thinking: "Okay, but I'm not a clinician. I'm just trying to get through the day. Why does this matter to me?" It matters because language shapes the conversations you're able to have. When your neighbor asks "how's your son doing?" and you know they think of addiction as a character flaw, you say "he's fine." Conversation over. Isolation continues. When your coworker talks about "those people" and you know your sister is one of "those people," you stay silent. The wall goes up another brick. When your own internal monologue uses words like "junkie" or "crazy" - even about someone you love - it erodes your compassion. It makes it harder to show up with patience. It makes the guilt worse. Families absorb the language around them. If the culture says this is shameful, families feel shame. If the culture says these are moral failures, families feel like they failed. Changing the language doesn't fix everything. But it changes the weather. It makes it a little easier to breathe. A little safer to be honest. ## What to Say Instead Here's a practical reference. Not rules - just alternatives that leave more room for humanity. | Instead of... | Try... | |---|---| | Addict, junkie, druggie | Person with a substance use disorder | | Alcoholic (as a label) | Person with alcohol use disorder | | Clean | In recovery, abstinent | | Dirty | Actively using, not in recovery | | Drug abuse | Substance use, substance misuse | | Habit | Substance use disorder | | Drug problem | Health condition, medical issue | | Crazy, insane, psycho | Person with a mental health condition | | Committed suicide | Died by suicide | | Failed a drug test | Tested positive | You don't have to memorize a chart. The core principle is simple: describe the person first, the condition second. And choose words that leave room for recovery rather than words that slam the door. ## The Openness Connection The first letter of Sam's OATH stands for Openness. And openness requires safety. Nobody opens up in a room where they expect to be judged. Language is one of the primary ways we signal safety or danger. When a parent hears person-first language at a school meeting, they might mention that their family is going through something. When an employee hears their manager talk about mental health as a health issue, they might actually use the EAP. Every time you choose words that separate the person from the condition, you're building a room where someone might feel safe enough to speak. ## This Isn't About Being Perfect I want to be clear: nobody gets this right all the time. Language is habitual. Words come out before we think about them. I catch myself using outdated terms and have to course-correct. The goal isn't perfection. The goal is awareness. Once you start noticing the impact of language - on yourself, on the people around you, on the conversations you're able to have - you can't un-notice it. And that awareness, over time, changes things. We've created a [language guide](/resources/language-guide) that goes deeper into person-first language for substance use and mental health. It's designed to be practical and shareable - something you can pass along to a teacher, a coach, a coworker, or a family member. Because the words we use either make it easier or harder for someone to ask for help. And right now, too many people aren't asking.