Prior research has documented that the language we use to describe addiction and recovery is important; words used to describe people with substance use disorders can either contribute to or detract from the stigma surrounding these diseases. A new study assessed the explicit and implicit bias elicited from commonly used negative and positive terms related to substance use, misuse, and disorders among members of the general public. Positive terms included “person with a substance use disorder,” “person with an alcohol use disorder,” “person with an opioid use disorder,” “recurrence of use,” “pharmacotherapy,” and “long-term recovery,” while negative terms included “substance abuser,” “addict,” “alcoholic,” “opioid addict,” “relapse,” “medication assisted-treatment,” and “medication-assisted recovery.” Participants (N = 1,288) were recruited from ResearchMatch, a national health volunteer registry. This sample was 75.8% female, 88.8% White, highly educated, and relatively wealthy. The final sample consisted of 1,162 individuals who completed all portions of the study. Participants were divided into seven groups representing each pair of positive and negative terms (e.g., “substance abuser” and “person with a substance use disorder”). In a randomized order, each group completed a Go/No Go Association Task (GNAT), completed a vignette-based social distance measure, and provided basic demographics. The GNAT was designed to measure implicit associations with both stigmatizing and non-stigmatizing terms; GNAT responses were scored using the d-prime (d’) method. Each participant was randomly assigned to one of three vignettes within their group: A control vignette that did not describe a substance use-related scenario, a positive-term vignette, and a negative-term vignette. After reading the vignette, participants completed the Bogardus Social Distance Scale (BSDS) in relation to the person described in the assigned vignette. This scale was designed to assess the degree to which participants felt comfortable in response to characters in the vignettes. BSDS scores were analyzed using one-way analysis of variance (ANOVA) tests with social distance as the dependent variable and the vignette type as the independent variable. GNAT d’ scores were analyzed using a within-subjects repeated measures ANOVA with four levels of the dependent variable (term + evaluative category [good/bad]) measured at the one-time interval. Results indicated social distance scores were not significant for the “substance abuser”/ “person with a substance use disorder”, “alcoholic”/ “person with an alcohol use disorder” or “medication-assisted recovery”/ “long-term recovery” groups, yet scores for the “addict”/ “person with a substance use disorder” group were significant (F(2, 102) = 7.384, p = 0.001), as were scores for “relapse”/ “recurrence of use” (F(2, 166) = 13.686, p < .001), “opioid addict”/ “person with an opioid use disorder” (F(2, 178) = 5.559, p = .005), and “medication-assisted treatment”/ “pharmacotherapy” (F(2, 173) = 4.917, p = 0.008). Post-hoc tests of these three pairs found lower mean social distance scores for each of the stigmatized terms, meaning participants reported less willingness to have less social distance between the person described in the vignette and themselves. Analysis of the GNAT d’ scores indicated “alcoholic” + bad (d’ = 2.436) was the strongest association in its group and it was significantly different from the other three terms and associations. Results for “opioid addict” + bad were similar (d’ = 2.413). The association between “medication-assisted recovery” + good was the strongest in its group and it was significantly different from the other pairings.
Take away: Results of this study indicated the terms “substance abuser” and “opioid addict” were most strongly associated with the negative and were significantly different from the less stigmatizing terms “person with a substance use disorder” and “person with an opioid use disorder.”
Ashford, R.D., Brown, A.M. & Curtis, B. (2018). Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias. Drug and Alcohol Dependence [published online ahead of print June 13, 2018] doi: 10.1016/j.drugalcdep.2018.05.005