Users or Abusers? How Language Shapes the National Attitude Toward America’s Opioid Crisis

Much of the language used to describe drug users is profoundly negative. People with Substance Use Disorder (SUD) are commonly referred to as drug abusers, addicts, junkies, etc. Colloquial use of the word “addict” implies a habitual user with inadequate willpower to stop using, when in reality, opioid addiction is a much more nuanced issue and ends up having very little to do with willpower. Similarly, the US AIDS Epidemic of the 1980s involved a cocktail of victimizing, inaccurate, and demeaning language to describe people living with HIV. Patients were commonly discriminated against, victimized, or shamed, impacting their willingness to seek out care. The similarities between the social responses to the two crises are striking. Language is a powerful tool for both empowerment and humiliation; it can sometimes mean the difference between life and death. But what can we learn from the AIDS Epidemic, and how are similar themes coming into play in the modern-day Opioid Crisis? Since the lexicon of a community is so intricately tied to identity, using vocabulary that supports the identities of the people about whom we communicate is critical; that includes the scientific, journalistic, support group, and the affected communities. In doing so, those affected by SUD will feel more empowered to seek out help. Voluntary participation in rehab programs provides the best chance of preventing relapse, so non-derogatory language is the first step in ensuring that people do so. The objective of each of the aforementioned communities must focus on saving lives in a productive and sustainable way: not through intimidation, but through support. Changing the language surrounding opioid addiction has the potential to increase the number of patients voluntarily seeking treatment and encourage public support for rehabilitative as opposed to punitive responses.

Turning back the clock, the AIDS Epidemic was not really an epidemic of AIDS. The transmissible virus itself is called HIV, and AIDS can sometimes be a consequence of that virus. The virus can remain dormant in patients for years before any symptoms manifest and the patient develops AIDS. At the time, in the early and mid-1980’s, different communities had different ideas of what terminology should be used in the context of the disease. This led to the spread of misinformation by scientists and journalists alike.

The only link between cases for the first few years of study was that the patients were men who had sex with men. This led to the initial term for the mysterious ailment, Gay-Related Immune Deficiency (GRID). But, as Randy Shilts so astutely noted in his journalistic novel And the Band Played On, “Nature rarely respects such artificial divisions among people.” The initial misunderstanding in the science community, that the link was not sexuality but rather sexual practices, led to a good deal of misinformation disseminated by reputable sources. Clarifying the distinction could’ve led to an earlier realization that HIV was a sexually transmitted (and not gay-exclusive) disease. Concurrently, many leaders in the gay community advocated for a new dictionary called AIDSpeak where, for example, “semen” would instead be referred to as “bodily fluids.” Even though this language was more palatable for broader audiences, the connotations of bodily fluids led people to believe that HIV was much more transmissible than it actually was, sparking mass panic once the media eventually started to pay attention. A recent study investigates treatment and people-descriptors in all scientific abstracts presented at the International AIDS Conference over a 25-year period. Over time, a decrease in terms referring to people as “victims” or “carriers” is observed, substituted for more accurate terms such as “people with HIV” and “HIV patient.” Not only are these terms more precise, but they’re also less derogatory. America has yet to note the parallel subtleties in drug addiction. For instance, it’s becoming increasingly important to refer to addiction as substance use disorder because the connotations of words make a difference. Issues can be discussed with less bias when the language used to talk about them has less inherent bias in the first place. For example, you might feel less sympathy for an “addict” than for someone affected by a disorder.

In 2015, for an assignment, I investigated the scientific study of madness across the centuries. In my search, I found associations between gayness and madness: gayness and vice. Fortunately, the evolution of scientific understanding has moved past this, but these papers remind me that I was not always accepted, even by science. My queerness was not only an abnormality but a disease, and I imagine the clashes between these two communities made it difficult to find oneself as a queer scientist. The prime example is Alan Turing, a scientist at odds with his own identity. Turing, sentenced to chemical castration after being convicted of gross indecency (having a sexual relationship with a man), eventually died from what was believed to be a suicide. He believed there was something wrong with him, likely in part due to this vicious description of his identity, and died deep in a depression.

The prevalence of demeaning vocabulary in sources like scientific reports leak into journalism and propagate through mainstream culture, which can induce self-stigma and shame. More often than not it can lead to depression, increasing the prevalence of mental illness and dissuading those affected from seeking help even further. In the words of P. W. Corrigan, “A major difference between mental illness and SUD stigma is that the latter is legally and socially sanctioned.” Opposition to clean needle exchanges and other harm reduction strategies are remnants from the War on Drugs that peaked in the 1980s under President Reagan. DARE programs, while educating children about and dissuading them from drug use, also associated drug use with criminality. This follows since recreational drug use is criminalized in almost all instances. Unfortunately, the criminalization of drug use leaves many users with no options. Seeking help for addiction, clinically defined as a brain disease, can result in going to jail where drug use abounds, thus continuing the cycle. A National Academy of Science (NAS) study on SUD stigma concludes that “American children learn at a young age that addicts are violent.” Everything from school programs to popular media seems to equate drug use with criminals with moral corruption. The truth is, regardless of how individuals become addicted, the only way to prevent the abominable pain of withdrawal is to continue using. Addicts’ brains are nearly incapable of functioning without the drug. Once the brain has become addicted, the issue no longer lies in poor judgment or morals. It is a disease, and it should be treated as such.

But misinformation, miseducation, and stigma tend to prevail when it comes to broader society. The NAS report referred to in Corrigan’s piece highlights the relative lack of research on SUD stigma as compared to mental illness stigma. The lack of research itself is indicative of a greater bias against SUD within the science community. As with the AIDS Epidemic, scientists were reluctant to study these vital areas due to prejudice. The study also found that “Endorsement of the opioid stigma corresponds with greater support for punitive policies towards those who use the drug,” and "adolescents addicted to opioids who endorse the stigma are less likely to seek out care." In all likelihood, the individuals’ self-stigma convinced them that they are undeserving of treatment since addiction is associated with criminality and weakness. That very thought ends up costing tens of thousands of lives every year. The sad truth is that "only about 25% of people with SUDs ever participate in any care," and many are still doomed to relapse.

The broader scientific community, try as they might to communicate objectively, remain biased simply by their lexis. Scientific papers, as texts of this particular group, are "representative of the values, needs, and practices of the community that produces them.” When there exists a certain consensus on terminology, such as referring to the disease as GRID or referring to people with SUD as addicts, scientists are forced to choose their allegiance. Why should it be this way? Why can’t the scientifically correct term also be an empowering term? Results from the International AIDS Conference (IAC) survey show this exact shift over the course of 25 years. The push toward adopting “medically accurate, ‘person-first’ language” was as prevalent during the AIDS epidemic as it is in the Opioid Crisis, at least among experts. Dr. Sarah Wakeman is a leading proponent of this idea in the context of the opioid crisis. She explains why language is so important, citing the fact that “the use of ‘abuse’ and ‘abuser’ has been shown to increase stigma even among highly trained clinicians, who recommend more punitive treatment when an individual is described that way.”

Language is fundamental to influencing self-perception and behavior. Many programs have already been established to tackle the US Opioid Crisis. In particular, statewide efforts have resulted in grants for progressive treatment programs. The Opioid Task Force, whose headquarters lies in Franklin County, MA, is one such organization. Their mission is to “implement and promote an array of prevention, intervention, treatment, and recovery strategies.” But, as witnessed by a field trip to the site, the forefront obstacle almost always involves the lack of participants. “But think about Alcoholics Anonymous. It all started with a few guys in a room,” said one of the executive board members. Despite Massachusetts having over 2.5 times the national death rate for opioid-related deaths, the comprehensive program has serviced under 100 people in total. Lack of voluntary participation in treatment is a layered issue involving criminalization, fear-mongering, and stigma. Changing the cultural attitude towards drug use involves a shift in language from demeaning to empowering. Then and only then can individuals affected by SUD really stand a chance against this disease.

An almost greater issue lies in the stigma surrounding medically assisted treatment. Some people, including people with SUD, consider the treatment an addictive substitute for the former, or a legal opiate in exchange for an illegal one. In the words of the great Dr. Wakeman, “Methadone and buprenorphine are lifesaving, effective medications for opioid use disorder...Taking a medication to manage an illness is the hallmark of chronic disease treatment. Individuals taking medication to successfully treat addiction are physically dependent, just as someone taking insulin for diabetes requires a daily shot to be able to function normally.” We as a society need to work towards viewing addiction as a brain disease, and not as a character flaw. Politically, we need to treat it primarily as a public health crisis. This can only be accomplished through first communicating about substance use disorder in a factually accurate and emotionally articulate manner. By establishing a standard, person-first, non-derogatory lexis surrounding the Opioid Crisis in all these communities, we’re one huge step closer to getting people with SUD the support they deserve.

This essay was a finalist for RIT's Stan McKenzie Prize

Suits Me

College is a magical realm over the rainbow and a world away from Deerfield Academy. Here at RIT, the pride flag is framed in the entrance to the Student Alumni Union, and small colorful ribbons line the student bulletin boards. As a member of the LGBTQ+ community myself, I not only feel welcome, but also a distinct lack of other-ness that tends to follow those who fall outside the norm.

At my graduation from Deerfield last year, I wore a suit and tie in place of the typical white dress and flower. This is because I believe women should feel free to wear what they choose, no matter what others may assume. I believe that gender expression should not be inhibited by out-of-date standards like the current dress code. Gender-queer or gender questioning people, upon stepping onto Deerfield campus, are forced to make a very public, very bold statement about their identity, something extraordinarily daunting when around 78% of trans youth report significant abuse at school. In college, people wear whatever they feel like wearing and, surprisingly, it never seems to get in the way of anyone’s education.

Deerfield Academy operates on the idea that standards for men and women should be decidedly separate. The Hess Center displays two statues exemplifying the “Deerfield Boy” and the “Deerfield Girl,” dorms are strictly gendered, and visitations are fundamentally heteronormative.

If a straight person wants to spend time with a member of the opposite gender, they need only follow the ordinary rules; non-hetero people are faced with a moral dilemma. They must first ask themselves whether they trust their hall resident enough to disclose their identity, something many kids aren’t even safe to tell their families. (Note: LGBTQ+ youth face more than twice the average rate of homelessness in the US.) On top of that, in making their visitations request, they disclose the orientation of the other person as well. If others on the hall notice the trashcan or shoe in the door, both of them are “outed” to the hall, and we all know how rumors spread. Finally, there’s the technicality that no other same-gender person on hall or off can enter their room without visitations permission. Personally, I find this absurd. A truly welcoming community would not support alienation of this kind.

But again, this brings into question the purpose of visitations. The idea behind having a process is to protect students from unsafe sexual interaction. But the underlying assumption in this setup is that any member of the opposite gender would only care to enter your room if they intend to have sex. Similarly, it also assumes that any member of the same gender would never intend to have sex. Visitations create both uncomfortable stigmas about opposite gender friendships and unfair expectations for same-gender relationships.

People who fall outside the standard should not need to feel like a burden to the rest of the community. Gay people shouldn’t need to follow a meticulous and otherwise anxiety-inducing process that only further isolates them from their hall and the broader student body.

I’ve found that many students are afraid of straying from campus norms, concerned that they’ll become estranged from the community. Being original on Deerfield campus means accepting that eyes will be on you, a lot. Furthermore, the Academy’s constant, looming expectation not to be proud of being oneself, but to be worthy of something passed highlights DA’s resistance to change. I’m a strong advocate of creating a more equitable system for all: gender-neutral bathrooms, gender-neutral dorms, and, at long last, a gender-neutral dress code. These inequitable standards have held up for too long, and it’s high time DA implements policies that help solve the issues rather than perpetuate them.

PS To any DA student reading this: remember that your self-worth is not defined by the length of your skirt or the expectations for excellence imposed by the Academy. Continue to listen to others’ ideas and challenge your own--but don’t be afraid to challenge other ideas too. Deerfield can be a daunting place, but you reserve the right to be unapologetically you. Let nobody tell you otherwise. If you have an opinion, express it, discuss it, and always fight for what you believe in. You make your own path through Deerfield; I know I did.

Published in Deerfield Academy's Newspaper The Scroll

Make Mistakes, Get Messy: How Autocorrect Might Ultimately Cause Our Downfall

We live in a digital age. Word processing has provided people remarkable assistance in writing cleaner and more sophisticated paragraphs. Trubek eloquently summarizes research on whether student writing quality has declined. She specifically highlights the unvarying quantity of writing-related errors across generations, putting the particular disdain toward modern tweeting teenagers to rest. However, even though modern-day students do not appear particularly dumbed by social media in this regard, the study could have been improved.

While mistakes are, indeed, a fact of life, our technological prowess has increased our grammatical accuracy while limiting our understanding. Trubek mentions that spellcheck has significantly reduced spelling errors, though lending itself to a slew of new errors specific to this digital age. She writes, "The new number-one error in student writing is now 'wrong word'" (Trubek 1). Even though autocorrecting to the wrong form of a word is common, autocorrect, of itself, changes the accuracy of this study.

Students no longer have to remember how exactly to spell a word, but rather, how to approximate it before letting autocorrect finish the job. Auto-capitalization and grammar check indicate errors where the writer might not have thought to look for one in the first place. These aids provide a significant advantage to today's students, regardless of new, tech-specific slip ups. To more evenly compare the writing then to the writing now, the samples should comprise only written writing. In that way, the effect of autocorrect becomes more apparent. While students always have and do make mistakes, the total errors might increase over time if the autocorrect handicap were removed, it directly influencing students' capability to perfect their own writing. As in, the cumulative sum of would-be errors that were autocorrected and the errors made in spite of autocorrect might turn out to be greater than those of 50 years ago.

While the lack of independent writing ability might not impact students in the long run, seeing as every industry is slowly transferring their information from paper to digital files (and most jobs will actually encourage use of autocorrecting programs), the understanding required to complete a piece of writing declines. While not necessarily terrible, it impacts students' comprehension and thus their ability to recognize their own mistakes. Writing without a computer necessitates a certain level of independence and problem-solving. Although students are not using "'text-speak' or emojis in their papers" (Trubek 1), they do harness the readily available and extraordinary power of the digital age to perfect their professional writing. The decreasing need to know English fluently to write it might have a detrimental impact on students' future communication skills and could lead to more embarrassing mistakes later on. However, more research is necessary to support this.

This article was written in response to Student Writing in the Digital Age by Anne Trubek