Ending the Stigma Against Alcohol Use Disorder Starts With Language

Apr 22, 2023


April is Alcohol Awareness Month in the US. Since 1987, the National Council on Alcoholism and Drug Dependence has used the month of April to raise awareness of the issues caused by alcohol abuse. While it originally targeted college-age students who might not yet know how to drink responsibly, it’s expanded to encompass all ages and communities – because alcohol misuse and its effects impact all populations.

While we’ve all heard the statistics and horror stories about alcohol addiction, one thing we often don’t hear about is the shame and secrecy that people suffering from it experience. Unfortunately, studies show that only one in ten people who struggle with substance use will reach out for professional help, and the stigma around admitting one has a problem is a major contributing factor. One way that we can encourage people to seek help is by changing the way we speak about addiction.

There are a number of terms used to describe an unhealthy or excessive use of alcohol, including alcoholism, alcohol addiction, alcohol abuse, alcohol dependence and more. You’ll hear these in the media, 12-step groups and some rehab programs.  However, in a clinical setting, we use the term “Alcohol Use Disorder.”

There are two reasons why the medical community uses this term. The first is that Alcohol Use Disorder (AUD) is easily defined – it has a set of specific diagnostic criteria set out by the American Psychological Association, and these are used by medical and mental health providers in the US. With this diagnosis, doctors can communicate clearly with one another and insurance. Cases of AUD can be easily classified as mild, moderate, and severe based on the number of symptoms someone experiences. This allows people to easily be referred for appropriate treatment. “Alcoholism,” on the other hand, has no strict definition and can be interpreted differently by different people.

The other reason we don’t use the terms “alcoholism” or “alcoholic” is that these labels are stigmatizing. While AUD is a condition that someone can heal and recover from, calling someone an alcoholic is dehumanizing and reduces a whole person to their struggles with addiction. Not only does this cause people who are struggling to be isolated from their community, the shame associated with the term can actually prevent people from seeking help. While some people find it helpful to self-identify as alcoholics as part of their path to recovery (for example, members of Alcoholics Anonymous), using the term should be a choice. Unfortunately, it’s easy to use this word as an insult or slur against people who are struggling, and that makes it inappropriate for a clinical setting.

In cases where someone doesn’t fit the diagnostic criteria for Alcohol Use Disorder, but still feels that their pattern of drinking causes them problems in life, the terms “unhealthy alcohol use” or “excessive alcohol use” is better than alcoholism or addiction. Medical organizations define unhealthy use as more than 4 standard drinks per occasion or 14 drinks per week for men and 3 drinks per occasion or 7 drinks per week for women. This could apply to someone who drinks infrequently and is not physically dependent on alcohol.

The term “alcoholic” isn’t the only word that can be stigmatizing when discussing AUD and Substance Use Disorder (SUD). There are many other terms like “drunk,” “junkie” and “addict” that can also shame people into hiding that they have a problem. The National Institute on Drug Abuse has provided guidance on language that helps reduce stigma toward people with SUD, which you can read here.