CADILLAC — For many people, the word "addiction" elicits strong opinions, emotions, assumptions and in some cases, painful memories.
Other words also have a profound effect on people.
Dr. James Whelan, acting chief of medicine at Munson Healthcare Cadillac Hospital, said an illustration of the influencing power of words is a recent study where researchers asked health care workers their thoughts on a patient who uses drugs.
One group was asked questions framed around the term, "substance abuser" while the other was asked questioned framed around the term, "substance use disorder."
Based on their responses to questions, those from the "substance abuser" group were found to be significantly more likely than those from the "substance use disorder" group to believe the individual was less likely to benefit from treatment, more likely to benefit from punishment, more likely to be socially threatening, more likely to be blamed for their substance related difficulties, less likely that their problem was the result of an innate dysfunction over which they had no control, and that they were more able to control their substance use without help.
Since words have such a powerful effect in the world, a concerted effort is being made among those in the treatment community to lessen the stigma that is associated with addiction, oftentimes as a result of the language used to describe it.
An example of this in practice is to refrain from using certain common phrases that have been associated with addiction for a long time, such as "staying clean." Whelan said this term implies that those who are actively using drugs are somehow dirty.
Such perceptions about addiction pervade not just those in the treatment community and society at large, they also subconsciously make their way into the minds of those struggling with substance use disorder and further contribute to a negative self-image, Whelan said.
Why does any of this matter? Because the way people think about addiction can have direct consequences on a person's ability to get well, the support they receive from the community and family members, and also things such as funding for services related to addiction and law enforcement, Whelan said.
Another example of how this plays out in real life is the way people view services such as medicated assisted treatment, which involves the prescribing of medications like suboxone to help people recover.
Whelan said while medication assisted treatment is 10 times more effective than abstinence-based treatment (which is an incredibly high success rate for virtually any kind of medical treatment), many people see it as merely trading one drug for another.
Much of the stigma tied to addiction stems from the fairly commonsense intuition that people are responsible for their own behaviors and choose to do drugs, drink alcohol and engage in other harmful behaviors, Whelan said.
"People used to think it was a personality flaw," Whelan said. "... a personal failure."
As science has continued to shed light on the root causes of addictive behavior (and how addiction changes the way a person's brain functions), however, Whelan said the picture has grown more complex.
For instance, there is ample evidence showing that some people are more predisposed to addictive behavior due to a combination of genetic and environmental factors, such as growing up in a household where substance abuse is an acceptable way of dealing with stress and anxiety.
"Certain people are more vulnerable in part because of childhood experiences (and trauma) they have no control over," Whelan said.
Pam Lynch, director of Harm Reduction Michigan, which has an office in Cadillac, said when a person uses drugs long enough, their brain begins to prioritize that activity alongside survival urges like finding food and water.
When this happens, Lynch said it generally takes around 180 days of rehabilitation before the person's brain is able to heal and they are able to make decisions logically once again.
"Nobody sets out to become an addict," Lynch said. "It's more complicated than saying it's just a choice."
Given the variety of people that deal with addiction on a regular basis, there naturally are differences in opinion about the role that stigma plays and the amount of personal responsibility a person has for their actions.
"Is there a stigma? Yes," said Wexford County Prosecutor Jason Elmore. "Stigmas are natural. They exist for a reason. Stigmas are often a response to those rippling impacts beyond the user. The word stigma may have a stigma itself, but it is a natural reaction to a real trigger ... The problem is when stigmas cause us to lose sympathy. But sympathy is its own trap because no one is responsible for the user’s choices other than the user."
Elmore said law enforcement essentially only see the "tip of the iceberg" when they come into contact with someone who has substance use disorder.
"We need to address the problem before a person lands in jail," Elmore said. "Criminal law is about more than punishment. It is about deterrence, rehab, and protection of society … Right now, I do not see enough effective treatment programs locally. Therefore, confinement, which means a person staying alive and protecting society, is my only alternative ... My brother-in-law died on Christmas morning in our home 10 years ago. I prefer your loved one be alive and safe in prison than dead from an overdose or kill someone on a road. Until there is are more resources, law enforcement has no other way to protect the person and society."
Whelan agreed that funding for treatment programs is sorely lacking in Northern Michigan due in part to people's reservations about spending money on addiction-related services, which ties directly into the stigma they're trying to reduce.
While Whelan acknowledged that choosing to use certain words over others may seem like a form of unnecessary political correctness, the point is to encourage people to think more carefully about the language they use and the biases they may not even realize they have.
"Our words have impact on many levels," Whelan said. "These are the conversations that keep us moving forward."