felt it was important for the exhibition to have a public art components of the work could reach the widest possible audience. more than just a promotion, the posters connect the work of these powerful artists with new audiences, including the vital chicano and latino community. images can be found in bart stations located in san for cisco and oakland. >> it is enormously exciting for me personally and for the institution. the poster with up right after new year's, and i remember very vividly -- i am a regular rider, and i went into the station and saw the first poster i had seen, it was incredibly exciting. it is satisfying to know that through the campaign, we are reaching a broader audience. >> for more information about [music]

hello, i'm ivette torres. welcome to another edition of the road to recovery. today we'll be talking about the language that we use on issues related to addiction and recovery. joining us in our panel today are: daphne baille, director of communications, treatment alternatives for safe communities, tasc incorporated, chicago, illinois. dr. john kelly, associate professor in psychiatry, massachusetts general hospital, harvard medical school, boston, massachusetts.

lureen mcneil, director, bureau of recovery services, new york state office of alcoholism and substance abuse services, new york, new york. carlos hardy, director of public affairs, baltimore substance abuse systems, incorporated, baltimore, maryland. john, what role does language play in forming public opinion on addiction and mental health issues? i think language plays a critical role in the way that, after all, it's the, it conveys the meaning of, of what we're trying to express. and so i think it plays a very important role and we should think carefully about the terms that we use because of that. so, why does some language impede the understanding, lureen, of, of our field and the way we refer to people?

well i think particularly now that we have this new recovery framework, people are holding on to the old language. and the new language really holds the fullness of the framework, it really shows the validity of the framework, it shows the reality of recovery. and so the fact people are holding on to that old language, is really impeding us from moving forward into this new framework. and daphne what type, what are we talking about in terms of the old language, the new language and, and the transition that we're trying to create? old language is using phrases like addict, junkie, user, substance abuser, calling people by, rather than calling people, people, then we're using terms that define them by an action and that is inappropriate. new language refers to a person, a john, a lureen, a carlos, daphne.

we are people, first and foremost and we may be people with histories of substance use disorders or whatever term that we choose to use, how we choose to call ourselves. but the old way, the old language talks about a person in association with the illness. the new language is the person. the illness or a value-laden opinion about that person and not even referring to that person. thank you, yes, the old language is more judgmental, it makes moral statements and moral judgments and the new language talks about this as a health issue. this is a health issue that we're dealing with and the old language doesn't acknowledge that. and carlos, did that affect you in your path to recovery? it did early on. september is really important because it happens to be my anniversary month... it's also recovery month. it is also recovery month, thank you for pointing that out. but september 23rd will represent my 17th year

as a person in long-term recovery. and so i go back to my first opportunity to be in the treatment and some the labels and what was really interesting is that folks in the program themselves were labeling themselves. so the, you could be in a 12-step meeting and it's recommended, a particular fellowship that i attend, that you identify yourself simply as an addict. and folks thought it was real cute to identify themselves as low bottom or a rock star or some of the things. so for as much as society and the public labels us or attaches labels, early in the recovery process, folks had a tendency back in the day to label their own selves as well. and john, therein lies the conundrum i think. the notion of the mutual support process, does promote and sustain a certain type of language

that would tend to perpetuate i believe, the very labels that we're trying to overcome is that correct? i think so because these, these terms are so embedded in, in our culture, in our psyche that i it takes a long time for them to, to change. even in spite of, as daphne was saying, you know the new scientific knowledge we have of the nature of these disorders. talk a little bit about that. well in terms of, we've, we've learned a lot in the last 25 years in terms of i think particularly neuroscience findings, that have really elucidated the mechanisms, the kind of brain damage that occurs as a function of chronic exposure to alcohol and other drugs. and this has really helped us really understand what's really going on and why people who historically have been viewed as having weak character and weak will, is really a function of

brain damage which impairs their ability to regulate those impulses. and that's i think very, very important. and i think given that understanding, i think it's very important that we establish and convey the new terms as people have talked about. for example, calling it a disorder, if it's a disorder, a substance abuse disorder, and of course when you use the term substance, according to someone, as having a substance abuse disorder as, as opposed to a substance abuser. the distinction there i think can be, when you stop and think about it, can be quite clear. one's more of a medical connotation, the other one's more of a judgmental in identifying the individual themselves as the, as the disorder, instead of as daphne was saying, a person with the disorder. but it is very difficult, i think, it takes a long time to, to change these terms in the cultural psyche and so this is why this is such a good idea. well hopefully today we can enlighten folks.

that's right. and, and encourage them. carlos, i think you were going to say something. i, i think we've done a great job of, of identifying and quantifying the scientific and the clinical aspects of it. i think and so we have slogans that we back it up with like treatment works, recovery happens, or treatment is effective. but my concern or my issue is, how does that message resonate within non- traditional groups, if you will? the community person that has a treatment program as a neighbor, what, what kind of message do we convey to them beyond what they see? and so i think it's real important that, and, and i think bill white talks about this, that the greatest stigma reducer is when you begin to promote these relationships, their interactions between communities and people in recovery or the interaction between treatment programs and the neighborhoods where they're located. and i think it's really, really important. and lureen i want to go into the, the treatment system itself.

are there opportunities for the treatment system, the individuals that are providing the treatment in your, you're in a state entity and certainly this program is sponsored by a federal entity, are there opportunities for, for those entities to look at the change that needs to happen in language and, and what can be done about that? i think it's very important, i do think it's an opportunity. one of the things that we're doing in new york is that, we've taken the language that samhsa has promoted and we have sort of tweaked it. we have a one-pager, two-sided, that we are going to be taking to every meeting, every meeting with a provider, every convention, everywhere. because we do think that language is important and there is an opportunity. we are working with the treatment system on this whole move towards the recovery framework and language is very, very important. the whole idea that, that recovery is self-directed,

we need to be able for people to self-talk. one of the things when john was talking about the disease, one of the things that i remember very clearly is, how the addict feels about themselves and how the language really impacts you, being called a junkie, being called an addict. you begin to believe that. you begin to, to enact that behavior. so it's, very, very important that while people are in treatment and not only treatment, the other pathways, the faith institutions. we want to get this information to them. the, the mental health system, the child welfare system, all different systems, we want to get this language to them so that people will begin to adapt this language and begin to get it to the people that they serve and, and it's very, very important. just briefly, give us you own example, i know you're in recovery, give us your own example of experiences that you may have had where you were able to correct someone or, or educate someone.

i remember when i was a, a program manager early in my recovery. and i actually went out to a program and i was reviewing the program and i was asking about certain things that i saw in certain records. and the director of the program said to me, after i had questioned her for awhile, and this was someone who, who was a leader in the field. she said, well you know, they're just junkies. and that really hit me because those people that she's talking about, who were just junkies, she didn't realize that i was one of those people, you know. and i have not forgotten where i came from. and so to say that, it really shows me your whole thought, the whole, and how can you help people to recover if you believe, if you have this belief about them. and when we come back, we're going to continue to chat about both inside our field and externally, how to deal with the language issue. we'll be right back. [music]

language plays a critical role, like the media, when we are talking about media or we're talking about images, or we're talking about an individual's sense of shame or guilt or expectation. the language used by those around them or even language in, that they use themselves, about themselves, can affect their willingness to pursue a recovery and to pursue rehabilitation. we on one hand want to offer hope, on the other hand we want to stress that being in the throes of your addiction is not a, a good experience, without casting aspersions on the character of the person who has the problem. where's mom? did she forget me? i wonder what happened to her.

what if i get left here? drugs and alcohol may make you forget your problems, for a moment, but that's not all you forget. my mother worked hard to be in recovery and i love her for that. for drug and alcohol treatment for you or someone you love, call 1-800-662-help, brought to you by the us department of health and human services. i had no idea it was going to be so hard. i didn't know what to expect. you hear the stories, but i never took any of it seriously until i found myself here. and then i realized i was going to have to work hard for my recovery. if you or someone you know has a drug or alcohol problem, you are not alone. call 1-800-662-help. recovery was the hardest job i ever had and the most important. brought to you by the us department of health and human services. [music]

well my passion is really advocacy around treatment and recovery issues. i've had the, the wonderful career over the past 16, 17 years, of being a direct service provider, being a treatment and recovery advocate, to heading up a large advocacy organization to actually working inside right now. and my primary purpose is to make sure that to make sure that the next person, that person that's still out there using now, when they do have this aha moment, that the system is ready to welcome them and to embrace them and support them as they begin their journey on recovery. what recovery has brought to me is an ability to take it to the next level. and, and be vocal about it, not be ashamed, you know, not hide behind a wall because you're afraid that oh well, god they're going to know but i'm a recovering addict.

well i like to say that i'm in long-term recovery as opposed to an addict or an alcoholic because there's more positive sounding because people still run with, well addict, oh bad, alcoholic, oh troublemaker. but long-term recovery has a nice twist to it and if i can't get it back, i'll lose it. carlos, on coming back to our own field, i think lureen mentioned some issues related to how her coworker referred. but should we be looking internally first and, and seeing how we ourselves feel about those that we serve? i think it's important, as a matter of fact i believe it's critical. what's really unique in my human service career for about 16 or 17 years, i started out as a direct service provider and managing supportive housing programs for a lot of our residents who were

coming from treatment programs. and then i worked five years as a drug treatment organizer, looking at the whole nimby issue and... and nimby is? not in my back yard and there's a whole host of acronyms that you can use. and then i actually was executive director for the national council on alcoholism and drug dependence for a couple of years. and all of that to say is that i focused a lot on the advocacy part of it and, and pushing the system if you will. and, and what i began to see, once i came on the inside with my current organization, is there is stigma and discrimination and biases within the field, probably just, if not to a larger degree than what you see outside. i think the whole issue of medication assisted treatment is one that, that we just don't want to talk about. i think some of it is, is that the workforce is basically trained in a certain modality or methodology or clinical approach and don't want to

veer far from that approach. but in this new day and this new age, we're focusing more on the strength based approach, a person centered approach, more so than identifying the person by an action. and john, should we be looking internally first and, and if so, how do we approach the education of our field first, you know, because as we're sitting here, you know we're talking about how everyone else perceives, you know, their, their moral value-laden approach towards this field. and, and how do we deal internally? it's a good question. i think we have to treat it the same way as we, as we treat out, you know individuals trying to convey the message outside of the field. it's very ironic to me that in the studies that have been done, they've been done a lot of with mental health clinicians actually who are

professionally focused in the area of addiction and mental health. actually hold, have been shown to hold very biased prejudiced, stigmatizing attitudes towards people, clever studies that have been done have shown this. so what you're talking about seems to be supported by empirical evidence which always is kind of baffling when you, you know, think about people actually educated in the areas that they're actually, and still hold these maybe implicit, unconscious biases that can be elucidated through these studies. so i think and as i mentioned before it's, it's so embedded in our psyche and culture, it's very hard to shift that. but you have to take very conscious, i think, proactive efforts to do that. you know we were talking earlier about the fact that it's embedded even in the, the institutes themselves who are trying to de-stigmatize the

conditions that they're focused on. by their names. by their names and also in, in published literature. it's not uncommon to see the term abuser, you know, the individual is referred to as a, as an alcohol abuser or a drug abuser, substance abuser. when by the same token, we're publishing materials which are advocating against using those kinds of terms. so there's obviously a, a disconnect...daphne. there are many people in the field who came into this field in the '70s and in the '80s, when we were using the old language. so for each of us personally, this is a process of learning and enlightenment, and we each have to recognize our own language and first become conscious of what we're saying. and this about raising consciousness about what are the words that we're using, what do they mean, how do they further stigmatize or label or keep people in a place that is negative, as opposed to language that elevates. and we each have to come to this, individually,

and then we do it as field, because language does indeed shape our thinking and our thinking shapes our behaviors and our decisions which of course shape our lives. and so our language can actually either affect positive change or keep us in a negative place. so we as a field, and it's fantastic that samhsa is hosting this conversation because it's part of just raising awareness and talking with each other about what are we saying and what, what word does work? but we certainly i think can look at some of the words and say, this is not effective anymore and we can move beyond that. i think there's some other issues going on here though. i think that there is a resistance to the move from the acute crisis model to the chronic care model, for a lot of different reasons. and i think that language becomes one entity of that. so why are you saying that i can't use substance abuser, i've used it all the time? what's wrong with that? and i think that we have to recognize that and then we do have to do a lot of presentations, a lot of

discussions like this and, and i really appreciate the fact that samhsa is supporting this new language. even within and i have to admit, even within our own agency, mean our, our team in the consumer affairs office, checks you know many, many materials that are going to be put out and sometimes it's even internally, it's very difficult to keep everyone on a straight and narrow path of using. daphne was involved with us at one point in, in creating a document that is still out in draft, related to language and that people are using now. do you remember that daphne? i do remember and it was based a lot on the work of william white, who has written so much on language and the rhetoric of recovery, and what words keep us stuck and what words move us for, forward. for exam, example, the issue of relapse. we talk about relapse and in other illnesses, we might talk about a recurrence or we might

talk about re-initiation. but relapse somehow focuses on this was the expected, negative outcome and so...and failure. and so again, it goes back to the consciousness and what are we conveying and what, what kind of expectations are we conveying with our language? and there are a number of those examples that can be found actually on william white's website and, and in other publications that have been done by samhsa and by faces and voices of recovery. there are some wonderful resources to help us become more conscious of the language we use. and that connects to the fact that what we can do within the treatment system. if you're working with a person and they understand the framework, they understand the stages of change. they understand that it's, it maybe a recurrence, that's not a negative thing, but that may be a part of their stages of change of their recovery, rather than relapse and the stigma that is connected relapse. relapse is this, this horrible place that once you fall down, that sometimes you don't get up from. so that's a way that we can work with the treatment system.

you know and i also think that, that this, we're presenting really a moving target if you will. it's probably what you would call the flavor of the month syndrome and that also language is open to interpretation, like prevention is somebody in the field would probably mean something that's, evidence-based practice. but if you talk to a community person, prevention would be keeping the recreation center open for hours. we talk of things like paradigm shift or transformation. and all of these terms we use, so we have co-occurring, we have substance use disorder, we have substance abuser, we have chronic illness, we have disorder. and i, i think it's confusing, it's confusing to the field itself and, and sometimes we, we fall into this trap where we think language is interchangeable, and i think it causes more harm than good. you know, you've hit on something that i have observed over the last 13 years that i've been at samhsa and, and that is that just when you get

comfortable using one terminology, along comes someone else and then they find, particularly not only in the substance use disorder field, but also in the mental illness field. right, john, i mean it's, it's just you know as difficult as we find the, the subject matter in, in the substance use disorder field, you know the mental illness side also presents with, i think, some similar circumstances. for sure. when you think about other disorders, for example, the thought, the one, the disorder comes to mind quickly when, as a first cousin of substance abuse disorder are eating disorders. now when you talk about eating disorders, we always, invariably, people use the term inside, outside of the field, they refer to it as an eating disorder, not as food abuse or, and don't refer to them as food abusers. and that has grown up just in, in a very consistent fashion. it's always been eating disorders, as far as i can remember it, it's never been anything else. and i've never heard the term food abuser, even,

and so it has, there are models for this kind of terminology which seem to be palatable, acceptable to most people, when you're talking about food. but when it comes to substances, of course, we have this abuser term, somehow has gotten into the language and culture and becomes very difficult to shift. and if i could just mention how this may be actually unconscious and the effects of it may be unconscious is that we did a study where we randomly assigned the term abuser, substance abuser and substance use disorders. we had those two terms and these were mental health practitioners, many of them were doctoral level, 500 and, over 500 clinicians doing this study. and they had a vignette which described someone with a substance related problem and the, the vignettes were identical except for the term used. so half the subjects got the vignette describing

the individual as a substance abuser and half of them, half of them got the individual described as having a substance use disorder. and then they were asked a number of questions about whether they perceive this person, needed treatment versus should be punished, whether they had sympathy for the person, whether they were able to control their problem, so this kind of issue of self-regulation, whether they thought they were personally to blame for the situation for the problem that they had. and those who were assigned the substance abuser condition were more likely to have more punitive attitudes than those who had the substance abuse disorder condition. and these were, these were doctoral level, most doctoral level mental health clinicians. so it may be that even unconsciously it triggers a bias that people aren't even aware of. i think this is very important because even though we may use the term ourselves, thinking well, i don't mean it like that, i mean it like this.

i mean in a more general sense and i certainly don't mean it in a stigmatizing way. but what can be conveyed and picked up, unconsciously perhaps, is that it does evoke, elicit, these more punitive attitudes towards these individuals. and when we come back, we're going to continue to chat about that and i think we need to get into a dialogue about how we can change this. we'll be right back. [music] it's important to be familiar with the proper terminologies surrounding addiction and recovery. one of the terms you'll want to be familiar with is, discrimination. discrimination is treating someone less favorably

than someone else because he or she has, once had, or is regarded as having a disability. for more information on this and other recovery jargon, visit the recovery month website. people who suffer from drug or alcohol addiction, sometimes say hurtful things. they drive the people who love them most, away. if you know someone who suffers from drug or alcohol addiction, listen, try to hear what they are really saying. know that there is hope and help them find their voice again. for drug or alcohol treatment referral for you or someone you know, call 1-800-662-help. brought to you by the us department of health and human services. they tell me i was there but i don't remember. i don't know where i really was. i do not know what i had for breakfast. i do not know who won the game.

i don't recognize this man. if you or someone you know is struggling with a drug or alcohol problem, there is a solution: recovery. call 1-800-662-help for information and for hope. through treatment my life's a whole lot brighter now. brought to you by the us department of health and human services. [music] language is such an important part of communicating with people what addiction, mental health disorders and recovery is all about.