Not ‘word policing’: why language matters in reducing alcohol harm - Guest blog, by Dr James Morris
Issues of stigma and language choice have been gaining increased attention, prompting debate and sometimes even opposition to calls to be mindful of language. Concerns about language choice and its role in stigma are of course valid, one reason being that the context in which they are used matters. For instance, whilst terms such as ‘alcoholic’ or ‘addict’ reflect harmful stereotypes, they are also often used by people in recovery to self-label, and even as a way to challenge stigma.
However, studies show that in broader public contexts, using person-first language (sometimes abbreviated to PFL) results in less stigma than terms such as ‘alcoholic’. Calls for PFL shouldn’t be viewed as telling people how to describe themselves, but instead simply as recognising the harm that some words or labels can drive. Whilst stigmatised groups experience unfair treatment and lower social status, stigma also undermines a person’s self-worth, self-belief and confidence in their ability to change, and is one of the most common barriers to people seeking help.
Other alcohol-related terms or concepts may also be context dependent – that is, generally best avoided, but accepted within some contexts. For example, terms such as ‘denial’ or ‘relapse’ are often associated with harmful or stereotyped beliefs about addiction, but also common in recovery contexts. Such language should therefore be avoided by professionals who recognise their imprecise meanings and potential to harm recovery outcomes, but whilst respecting people’s right to describe their own experiences in their own words.
Other terms may be best left behind altogether. The term ‘alcohol abuse’, for instance, has connotations with violent or exploitative behaviour, but also orientates the problem as one of the individual who is ‘abusing’ alcohol. ‘Alcohol abuse’ therefore overlooks the many and complex reasons why people may develop problems with alcohol, which are highest amongst people who have themselves experienced trauma, mental health problems and other issues including stigma and poverty. Whilst arguably not as problematic, terms like ‘excessive’ or ‘binge’ drinking’ or ‘alcohol misuse’ are also probably best avoided altogether given the availability of more neutral and precise terms.
Framing the issue
Efforts to shape language choice are sometimes challenged as ‘word policing’, but it is clear that language is influential in many important ways, as a range of ‘addiction’ language guides seek to highlight.
However, language is not just about stigma, but also has clear implications for treatment, policy or prevention. For example, how alcohol problems are defined or understood shapes how society and policy makers feel about them, and as a consequence, how people might respond to people they meet (i.e., stigma), or via attitudes towards different policies. For instance, sections of the alcohol industry have pushed a narrative of ‘personal responsibility’, which places emphasis on individuals, irrespective of their circumstances or environment. Whilst the idea of ‘personal responsibility’ is one which few people disagree with at face value, framing the issue in this way isolates it from important environmental influences such as price, availability and marketing.
Other debates include how alcohol problems are defined and described. For instance, whilst ‘alcohol use disorder’ (AUD) is a professional classification approach broadly aligned with harmful drinking/dependence, it is rarely used amongst the public. Whilst a more appropriate term than ‘alcoholism’ in professional contexts, AUD is still applied in different ways and still has a number of limitations when used clinically to identify alcohol problems. Such terms and concepts therefore have a range of implications for how we seek to reduce harm across the very broad spectrum of alcohol harm. A recent project led by University of Stirling and funded by Alcohol Change UK looked at how framing alcohol-related issues differently can affect attitudes relevant to reducing alcohol harm. This includes a toolkit for professional bodies to consider when communicating about alcohol, although this work is still relatively untested.
Staying in lane
These are important issues which our recent paper, Key terms and concepts for alcohol use and problems: a critical evaluation, sought to explore. Of course using or avoiding certain language is not going to address alcohol problems alone, but it does influence important attitudes and decisions. Essentially, language not only reflects reality, but also shapes it.
Crucially, there is a balancing act, and the evaluation of different terms and concepts should be guided by evidence. For instance, in some cases it has been suggested that the term ‘drinkers’ should be avoided in professional lexicon since it is not person-first language. This might be a step too far since – as far as we are aware – use of the term ‘drinkers’ itself is not found to be associated with stigma in the way other terms are.
Collectively referring to people who drink as ‘drinkers’ may therefore be a harmless shorthand, assuming a more precise description is not required. Whilst it may be more complex when referring to an individual, and more research would be useful, it is unlikely that much of the public could be persuaded that calling someone a ‘drinker’ is problematic and should be replaced with ‘person who drinks’ or ‘consumer of alcohol’.
Similarly, whilst cases of ‘dependence’ (or AUD) are generally best referred to as such, in many contexts it might suffice to just refer to them as ‘alcohol problems’, particularly where a clinical diagnosis has not been made. For instance, saying ‘as a society we need to do more to help people with alcohol problems’ isn’t problematic. In fact, it may be preferable given the broad spectrum of alcohol problems beyond just dependence and the over-use of ‘alcoholism’ framings amongst the public.
Giving consideration to the language we use is therefore important, but we also must avoid over-stepping into territory that might more legitimately be deemed ‘word-policing’.
Dr James Morris is a research consultant, behaviour change specialist, lecturer, trainer and a Visiting Scholar in the Psychology department at London South Bank University. His specialist areas include alcohol and addiction behaviour change, stigma, social and cognitive psychology, public health and treatment interventions. James was recently Alcohol Programme Manager at the Department of Health and Social Care, recruited to support development and authorship of new UK clinical guidelines for alcohol treatment.
James has over 20 years of experience in public health and policy related roles including alcohol treatment commissioning, training, strategy, research, teaching, policy and skills development. In 2009 he co-founded a social enterprise seeking to advance alcohol knowledge and skills development, acting as Director from 2009-2020. He is a board member for Alcohol Focus Scotland and chair of the New Directions in the Study of Alcohol Group. He hosts The Alcohol ‘Problem’ Podcast, which aims to explore the nature of problem drinking through a range of academic and lived experience perspectives.