25 Jul “Changing the Narrative”: How to Increase Engagement with People Who Have a Substance Use Disorder

The Centers for Disease Control (CDC) announced that one in 14 Americans report having a substance use disorder. Compounding this incidence rate is the reluctance to seek treatment based on the stigma associated with having substance use issues. Healthcare workers have a call to action to reduce the barriers associated with accessing life-saving treatment. One pivotal step is to be intentional with the words we use when interacting with our patients and clients. In the article “Why Words Matter in the Substance Use Conversation”, The Pew Charitable Trusts cited Northeastern University’s School of Law Health in Justice Action Lab and the “Changing the Narrative” educational campaign to highlight that improper language and stigma still contribute to the reasons why people with substance use disorders are hesitant to seek treatment. 

Changing the Narrative

There are three principles from the campaign: 

1. 1. Use person-first language; for example, a person with an opioid use disorder
   2. Refrain from using words with negative implications; for example,  people who misuse drugs are “dirty” or when they stop using they are “clean”
   3. Treat a substance use disorder like any other medication condition 

 
Healthcare workers are getting better at incorporating the first two principles but need more understanding regarding the third.

Let’s level-set and start with the American Society of Addiction Medicine’s (ASAM) definition of addiction. “Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.” 

This definition is easy to understand if we consider how we approach the treatment of things like diabetes, hypertension, or thyroid disease. We don’t place medication stipulations on these patients or tell them how to define their recovery or fault them for “relapsing.” Moreover, we wouldn’t ask a patient who takes insulin, a hypertensive medication, or thyroid hormone to stop when they are feeling better; they understand these medications are essential to long-term self-management. Accepting that a substance use disorder is a medical condition will help us be intentional about how to approach patients and clients from a compassionate, destigmatizing lens; thus increasing engagement.

Strategies for Implementing Change

Here are some organizational strategies for implementing the three principles from “Changing the Narrative”.

First, from a leadership perspective, consider adopting the “Words Matter Pledge” using the example from Boston Medical Center’s Grayken Center for Addiction. Then, add staff training.

• Show Shatterproof’s, “Words Matter” 2-minute video to start the conversation.
• Use their “Addiction Language Guide” Resource Inventory to start a weekly or monthly lunch and learn series.
• Review the ASAM website to review the National Institute on Drug Abuse (NIDA) document, “Words Matter” guide to ensure staff are incorporating the recommended tips to reduce stigma.
• Use examples from the “Changing the Narrative Style Guide” to reinforce that staff and clients/patients are using the universal terminology.
• Use person-first language when charting and documenting in your behavioral health EHR.

 
There is a powerful quote from the Addiction Policy Forum to underscore the need to be intentional with our words, “Substance use disorders get worse over time. The earlier treatment starts the better the chances for long-term recovery. Many families are wrongly told to ‘wait for rock bottom’. The idea that we should wait for the disease to get worse before seeking treatment is dangerous.” 

About the Author

Jennifer McCarthy has been a Licensed Clinical Professional Counselor for over 20 years in a variety of settings including community mental health, primary care, and owned her own practice. She is also a health professions educator and seeks out any opportunity to enhance and empower the healthcare workforce.