The Power of PFL: How Person-First Language Changes Clinical Outcomes and Reduces Stigma

The vocabulary we use to discuss problematic substance use often carries a heavy, unintended legacy. For many, terms like “addict,” “junkie,” or using words like “clean/dirty” to describe drug tests are simply habits—language that comes from a time when problematic substance use was misunderstood and seen as a moral failing, not a chronic health condition.

This casual use of outdated terminology, while often unintentional, creates massive hurdles for people seeking help, making them feel ashamed or afraid to ask for treatment. It also influences how doctors, policymakers, and the public view the issue, often pushing for punishment (like jail) instead of medical care. To truly embrace a compassionate, evidence-based approach to recovery, we must change our words.

This vocabulary isn't just about being politically correct; it's a profound barrier to public health.

The shift from using morally charged labels to using medically accurate, person-first terminology is a necessary step toward reducing stigma and, critically, improving treatment outcomes.

The Stigmatizing Effect: Why Words Harm

The use of certain terms is problematic because it immediately defines an individual by their diagnosis, reducing a complex person to a single, negative characteristic. Research has shown that this language directly influences professional attitudes and willingness to treat:

• Reinforcing Moral Failure: Terms like “addict,” “junkie,” and “abuser” imply a willful, moral failing rather than recognizing problematic substance use as a chronic, treatable medical disease, as defined by medical bodies (ASAM, 2021). This framing promotes punitive responses, such as incarceration, over clinical interventions.

• Influencing Clinical Judgment: A study from Harvard researchers found that clinicians were more likely to favor punishment (a jail sentence) over treatment for a hypothetical patient when that individual was described as a “substance abuser” compared to when they were described as having a “substance use disorder” (Palliative Care Network of Wisconsin, 2021). The difference in just two words shifted the perceived need from medical care to criminal penalty.

• Creating Treatment Barriers: Stigma is cited as a major reason why individuals with substance use problems will avoid seeking help. Fear of being labeled, judged, or denied services due to shame can keep a person trapped in their condition. When healthcare providers or institutions use stigmatizing language, it reinforces the patient’s internalized shame and reduces their trust in the system.

  
  

The Solution

The solution lies in adopting person-first language (PFL) and medically accurate terminology. PFL emphasizes the individual’s humanity by separating them from their condition, highlighting that a person has a problem, but they themselves are not the problem.

The core idea of Person-First Language is to separate the individual from their diagnosis.

When you encounter a term, ask yourself: Does this word assign blame, suggest moral failure, or define a person by their drug use? If the answer is yes, pivot to language that is objective, clinical, or focuses on the state of recovery.

• Instead of: Abuse/Abuser

• Say: Person experiencing problematic substance use, or Person who uses substances

• Rationale: The term "abuse" is judgmental and criminalizing. Focusing on the person and the problematic use is more accurate and compassionate.

• Instead of: Drug Offender or Drug Criminal

• Say: Person whose substance use has led to legal consequences

• Rationale: This avoids defining the person solely by their illegal action and recognizes the underlying health issue.

• Instead of: Dope Sick

• Say: Experiencing acute withdrawal symptoms

• Rationale: "Dope sick" is slang that sensationalizes and trivializes a severe medical condition that requires clinical management.

• Instead of: Addict, Junkie, Crackhead (etc.)

• Say: Person who is currently engaging in problematic substance use

• Rationale: These are derogatory slurs that have no place in professional or public dialogue; they strip the individual of their dignity.

• Instead of: Relapsed

• Say: Experienced a recurrence of use

• Rationale: "Relapse" carries heavy connotations of failure. The medical term "recurrence" acknowledges that recovery is non-linear and acknowledges a return to use as simply a setback in a chronic illness, not an endpoint.

When medical professionals, the media, and every-day people consciously use person-first language, they are advocating for the treatment of a disease rather than the punishment of a crime.

This shift in vocabulary is a powerful tool—an act of compassion that paves the way for a more effective and humane public health response.

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References:

• American Society of Addiction Medicine. (2021). Words matter: Terms to use and avoid when talking about addiction. ASAM.

• The Blanchard Institute. (2025, April 11). The impact of language on stigma in addiction and mental health.

• Palliative Care Network of Wisconsin. (2021, September 17). De-stigmatizing the language of addiction.