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Our Words Can Be Weapons: Stigmatizing Language in Substance Use Disorder Treatment

2022; Lippincott Williams & Wilkins; Volume: 98; Issue: 6 Linguagem: Inglês

10.1097/acm.0000000000005069

1938-808X

M. Kalkat,

Mental Health Treatment and Access

To the Editor: The resident tossed the word into the ether so carelessly that I almost wondered how it did not burn his tongue on the way out. “Junkie.” I stopped. Waited. Cleared my throat. But when I opened my mouth to speak, I felt as if the word had coated the back of my throat like black tar. I thought of someone I loved hundreds of miles away. Someone who could defeat anyone in Mario Kart and never met an animal she did not hug. “Junkie.” To reduce an entire person’s existence to a word distills the constellation of who they are and what they are going through. In a study of emergency department physicians, who are often the first to consult patients with substance use disorders, over half agreed that patients with substance use “irritated” them, and 72% felt that patients with substance use and pain were particularly difficult to work with. 1 It may be argued that what is said behind closed doors or between health care professionals does not break into the hallowed ground of the patient relationship. But a systematic review found that negative attitudes of health care professionals were associated with diminished treatment outcomes and reported feelings of disempowerment among patients with substance use disorders. 2 Even when these words are borne through our charts instead of our voices, using stigmatizing language in medical records is significantly associated with more negative attitudes toward patients and less aggressive management of their pain. 3 As health care professionals, we have too much power to wield our words like weapons instead of spades, cultivating the entire story of our patients’ lives beyond their most challenging moments. Disillusionment is our greatest detriment as we fight not to become jaded. Research has demonstrated that encouraging health care professionals to actively engage with people in recovery from substance use disorders can help produce long-term changes in bias. The most effective interventions are those in which this contact is face to face. 4 In these interactions, health care professionals can separate the patient from the person, exploring who they are outside of the hospital. In my brief conversation with one patient with a substance use disorder, I had learned that his favorite season was spring and that he liked feeling the grass between his bare toes. When he was discharged from the hospital a few days later, I watched as he walked to the patch of grass outside, buried his feet in the ground, and exhaled out.