Words Matter! INPUD and ANPUD Language Statement and Reference Guide

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WORDS MATTER! The guide is designed to be brief, clear, and easy to navigate. It does not
cover every possible term or circumstance, as the meaning and effects of
language — good and bad — are context-dependent and culturally deter-
INPUD & ANPUD Language Statement & Reference Guide
mined. It does, however, serve the purpose of highlighting the language
that is preferred within the INPUD global network, and provides reasons
for why certain widely-used terms might be problematic or even harmful.
WHY IS LANGUAGE IMPORTANT?
Language is fundamental to all human societies. Language is how
Who is INPUD?
we make and shape meaning. It is how we create and make sense of
The International Network of People Who Use Drugs (INPUD) is a global, the world and the people around us. Language is one of the main ways
peer-based network that seeks to promote the health and protect the we communicate our attitudes, beliefs, and values. The language you
rights and dignity of people who use/have used drugs. (For more infor- choose to use can say a lot about you as a person.
mation about INPUD see: www.inpud.net)
Language is always evolving. One of the reasons we change our
language is because we understand its power not only to uplift but also
Who is ANPUD?
to dehumanise. In recent decades, we have seen progressive changes
The Asian Network of People who use Drugs (ANPUD) is a regional to language in relation to race, ethnicity, gender, sexuality, disability, and
community-led organisation for community empowerment, human mental health. In these areas, we have moved away from language that
rights, and people-centered evidence- & rights-based drug laws and is pejorative, pathologising, stigmatising, and dehumanising towards
policies. (For more information about ANPUD see: www.anpud.org) language that values people first, promotes equality and inclusion,
acknowledges diversity, and is strengths-based.
WHAT’S THE AIM OF THIS STATEMENT & GUIDE?
WHAT ABOUT LANGUAGE & PEOPLE WHO USE DRUGS?
Language does not stand still. It is dynamic, and the language and
words we use are always changing. This makes it difficult to be absolute The need to change our language in relation to people who use drugs has
in the way we use language. Nevertheless, there are times when certain become an increasing topic of discussion, but there is still a long way to
language and words used in relation to people who use drugs can be go. People who use drugs are highly diverse and their relationship with
disempowering, divisive, confusing, or give offence. drug use takes many different forms. Current prohibitionist approaches
to drug use and ‘war on drugs’ rhetoric does little to encourage language
This guide aims to explain INPUD’s current position on the use of language
that acknowledges this diversity. Instead, it promotes and maintains
and to provide clear advice on what is acceptable to us as communi-
negative stereotypes that construct people who use drugs as morally
ties of people who use drugs. We want to encourage all people to be
flawed, inferior, unreliable, and dangerous.1
thoughtful about the language and words they use, and have therefore
provided a reference guide that identifies stigmatising language and
1. Ahern. J., Stuber, J. & Galea S. (2007). Stigma, discrimination and the health of illicit drug users.
gives non-judgemental, strengths-based, and respectful alternatives. Drug Alcohol Dependence 2007;88(2–3):188–96. doi: 10.1016/j.drugalcdep.2006.10.014.
2 INPUD & ANPUD Language Statement & Reference Guide INPUD & ANPUD Language Statement & Reference Guide 3
Pejorative People-first In the health system — sadly another key setting for stigmatising and
Equality discriminatory attitudes — language and actions associated with drug-related
Pathologising
Stigmatising Inclusion stigma can make people feel unsafe and unwelcome. Research studies have
Diversity shown this can lead to a reluctance in disclosing drug use, create barriers
Dehumanising to accessing drug treatment and other health services, including people
Strengths-based
delaying access until they are very unwell.6 Stigma can also lead to poor
and discriminatory treatment in many other contexts including the criminal
justice system, housing, employment, and other aspects of daily life.7
from:to
Language is powerful and our choice of language and words matter!
For example, research studies into the effects of stigmatising language
Due to criminalisation, people who use drugs experience high degrees in relation to people who use drugs found that simply varying the phrase
of stigma and discrimination from family, friends, and broader society. or word used changed the doctors’ response from a negative or punitive
Stigma breaks down trust, prevents communication, and leads to shame reaction to a more beneficial or therapeutic response.8 This study demon-
and marginalisation. While research shows that the type and extent of strates that changing language is not a small or trivial matter, but it is
stigma varies according to the drug(s) being used,2 other research has important and can have a positive impact not just on attitudes and
confirmed stigma is so pervasive in relation to drug use that it is an judgments, but on the way that people act towards each other.
almost universal experience for people who use drugs.3
WHO DECIDES WHAT LANGUAGE IS APPROPRIATE?
The role of mainstream media in promoting and perpetuating negative
stereotypes, vilifying language, and sensationalist ideas in relation to Language should not be censored, forbidden, or regulated, but there are
people who use drugs is well acknowledged.4 In recent years, INPUD important reasons why we find some language and words disempow-
and its regional members have conducted advocacy campaigns to draw ering and offensive and why others are preferred by our communities.
attention to specific cases. While this and other advocacy work has When using language that relates to people who use drugs, INPUD
resulted in some positive developments such as published retractions, believes the views and preferences of our communities should be
updating of style guides and codes of practice, the media continues to accepted as the basis for preferred language. To ignore the prefer-
drive negative public perceptions of people who use drugs in large part ences of communities exacerbates marginalisation and further minimises
due to the use of stigmatising language.5 our expertise and experience.
2. Brown, S. A. (2015). Stigma towards marijuana users and heroin Users. Journal of Psychoactive
Drugs, 47(3), 213-220.
3. Room, R. (2005). Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review, 6. Crapanzano, K.A, Hammarlund, R., Ahmad, B., Hunsinge, N. & Kullar R. (2018). The association
24(2), 143-155. between perceived stigma and substance use disorder treatment outcomes: A review. Substance
4. Global Commission on Drug Policy. 2017. The World Drug Perception Problem: Countering Abuse Rehabilitation 2018;10:1–12. doi: 10.2147/SAR.S183252.
Prejudices About People Who Use Drugs – Report. Media & Public Perception pp.26-30. https:// 7. Lancaster, K., Seear, K. & Ritter. A. (2018) Monograph No. 26: Reducing stigma and discrimination
www.globalcommissionondrugs.org/wp-content/uploads/2018/01/GCDP-Report-2017_Perceptions- for people experiencing problematic alcohol and other drug use. DPMP Monograph Series. Sydney:
ENGLISH.pdf National Drug and Alcohol Research Centre. http://doi.org/10.26190/5b8746fe72507.
5. Blog post: “Media Needs More Than a New Style Guide to Get Them to Stop Stigmatizing People 8 Kelly, J.F., Westerhoff, C.M. (2010). Does it matter how we refer to individuals with substance-
Who Use Drugs”. 18 July 2017. Drug Policy Alliance: https://www.drugpolicy.org/blog/media-needs- related conditions? A randomized study of two commonly used terms. International Journal of Drug
more-new-style-guide-get-them-stop-stigmatizing-people-who-use-drugs Policy, 2010;21(3):202–07. doi: 10.1016/j.drugpo.2009.10.010.
4 INPUD & ANPUD Language Statement & Reference Guide INPUD & ANPUD Language Statement & Reference Guide 5
Slang and idioms associated with the social and cultural aspects of 10 TIPS FOR WORDS THAT MATTER!
illicit drug use play an important role in everyday lives of people who
1. Emphasise the ‘person’ first - don’t define people by their drug use or
use drugs. Everyone should assess the use of such language for them-
selves in the context of their circumstances and relationships. If you diagnosis (e.g. person who uses drugs/person living with hep C – not drug
are unsure, consult with people who use drugs around you and value user, she/he’s hep C, etc.).
their opinion and their expertise. People who use drugs have the moral
2. Don’t impose your language or values on others – check with the person about
authority to redeploy the symbols of their oppression and to use terms
how they would prefer to be addressed/spoken to and respect their views.
like “junkie” as a form of empowerment, when referring to themselves
and their communities. One of the problems with stigma is that over
3. Choose terms that are ‘strength-based’ and ‘empowering’ – avoid
time, people can accept and internalise the negative views they hear so
‘non-compliant’ instead ‘chooses not to’/’decided against’ – emphasise
often – which is referred to as ‘self-stigma’. By always making positive
agency and choice.
language choices, you will automatically support people who use drugs
to view themselves and their communities in the best possible light.
4. Avoid trivialising, victimising or sensationalising people or drug use - sayings
like ‘has a drug habit’ or ‘suffering from addiction’ can be very disempowering.
5. Use language that is accessible – don’t speak ‘above’ or assume a person’s
Acknowledgments: understanding (incl. avoiding slang and medical jargon - can be misinterpreted
This statement & guide has been developed by the International Network of
and cause confusion especially for people for whom English is not their first
People Who Use Drugs (INPUD) and the Asian Network of People who use
language).
Drugs (ANPUD) in consultation with other regional networks, It also builds on
earlier INPUD advocacy statements and position papers addressing issues
6. Don’t make assumptions about a person’s identity – be inclusive (e.g. use
related to human rights, stigma, language, and terminology.9,10,11,12 We also wish
(gender) neutral terms ‘they’, ‘their’ or person’s name).
to acknowledge several other language guides and articles that have been used
as reference materials in the development of this resource.13,14,15
7. Be aware of the context of the language - some language is OK when used
within a community to claim identity but stigmatising when used by others
9 INPUD and Youth Rise, 2013, The Harms of Drug Use: Criminalisation, Misinformation, and Stigma
(London: INPUD and Youth Rise), available at http://www.inpud.net/The_Harms_of_Drug_Use_ e.g. “junkie”.
JayLevy2014_INPUD_YouthRISE.pdf
10 INPUD, 2015, Drug User Peace Initiative: Stigmatising People who Use Drugs (London: INPUD), 8. Avoid diminishing people – your language should empower the person
available at http://www.druguserpeaceinitiative.org/dupidocuments/DUPI-Stigmatising_People_
who_Use_Drugs.pdf (don’t speak to people like children, victims, pathologising or incapable/
11 INPUD 2015, Consensus Statement on Drug Use Under Prohibition: Human Rights, Health, and
the Law (London: INPUD), available at https://www.inpud.net/consensus_statement_2015.pdf without agency).
12 INPUD (International Network of People who Use Drugs), 2011, INPUD Position Statement on
Language, Identity, Inclusivity and Discrimination, available at http://www.inpud.net/INPUD_ 9. Value the perspective of people who use drugs – people who use drugs are
Statement_Position_Paper_on_Language_Identity_Inclusivity_Discrimination_Nov2011.pdf
13 NUAA & NADA Guide – Language Matters: https://www.nuaa.org.au/language-matters experts in their own lives. Ask their opinion and trust their advice!
14 Language: Abandoning Addiction Blog file: https://pointsadhs.com/2018/08/28/language-
abandoning-addiction/ 10. Communication is not just verbal – use non-verbal, tone of voice, body
15 How Stigmatising Language Effects people in Australia Who Use Tobacco, Alcohol & Other Drugs:
https://www1.racgp.org.au/ajgp/2020/march/how-stigmatising-language-affects-people-in-austra language to demonstrate respect for the dignity and worth of all people.
6 INPUD & ANPUD Language Statement & Reference Guide INPUD & ANPUD Language Statement & Reference Guide 7
LANGUAGE REFERENCE GUIDE
WHAT TO SAY WHAT NOT TO SAY AND WHY TO SAY IT
People/person Drug user; drug abuser; Person-first language recognises our collective humanity. Removes moral
who use/s drugs druggo; druggies; judgment e.g. ‘abuser’ or constructing people using drugs as a ‘problem’.
drug fiend;
Take care to state the complete phrase or term. Acronyms can
acronyms (PWUD, etc.)
dehumanise and objectify, reducing people to a set of capital letters
and should be avoided in verbal communication.
People/person Injector; junkie; smack- ‘Injector’ defines a person solely on the basis of a practice they
who inject drugs head; injecting drug user; engage in.
meth-head; acronyms Slang and shortcuts can, implicitly or explicitly, be judgemental and
(PWID, IDU, etc.) pejorative, and acronyms should be avoided.
People/person Pothead; chuffer; Communities can reclaim identity by taking back or ‘reclaiming’ terms,
who smoke drugs meth-head but this does not mean others should adopt these terms without
constraint.
People/person who Recreational drug user People use drugs for many reasons and can experience drug
use/s drugs occasionally use as ‘recreational’ even if their drug use is regular, frequent,
or opportunistically or ‘dependent’.
People/person with drug Addict; drug addict; ‘Addict’ language is based on morality and negative connections.
dependence drug abuser; It describes people as compromised and as if they are a collection
problem[atic] drug user; of symptoms.
misuser; substance
Pathologising, disempowering, and creates barriers for people.
abuser*; person who
is addicted *People/person with a substance use disorder – see explanation
on “substance use disorder” below.
Drug dependence Addiction; Addiction-as-disease model is highly contested, based on an arbitrary
drug addiction; set of symptoms that label people as sick, dangerous, disempowered,
substance abuse; and unable to exercise agency, choice, and self-determination.
substance use Drug dependency relates to the physical/psychological connection to
disorder† a chemical/compound within framework of tolerance, adaption and
withdrawal.
Does not carry the historical and political connotations of ‘addiction’.
†“Substance Use Disorder”: sometimes the use of definitions can be
complex e.g. DSM V replaced “addiction” in the previous version (DSM
IV) with “substance use disorder” – this was viewed as a step forward.
8 INPUD & ANPUD Language Statement & Reference Guide INPUD & ANPUD Language Statement & Reference Guide 9
WHAT TO SAY WHAT NOT TO SAY AND WHY TO SAY IT
Client/s; service user/s Patient Service user highlights that the person is accessing or receiving a service.
Term client[s] generally preferred for people using drugs who are
receiving services.
Patient can evoke a sense of ‘power over’ or imbalance within medical
framework and/or the ‘disease model’.
Currently using drugs Relapse; non-abstinent; Removes nagative connotations associated with taking up using after
fallen off the wagon; a period of not using.
using again; had a
Use appropriate modifiers including occasional or opportunistic drug use
setback; lost cause
(see above).
People/person who has Clean; sober; drug-free; Previous expertise in using drugs.
used drugs ex user; in recovery; Phrase that acknowledges the time component can be fluid - states facts
maintaining recovery; without additional emotion, value judgment, or negative connections.
ex-alcoholic
Positive/negative Clean/dirty urine/blood Keeps to neutral and medically accurate terminology; removes any
drug screen; connotation or meaning with emotive/judgmental words.
Presence/absence of
drug metabolite in
screening process
Communities (of Drug using population[s]; Positive recognition of sense of connection, empathy, and trust among
people who use drugs); affected communities; people who use drugs.
Networks (of people vulnerable populations
Reduces the surveillance or ‘victim’ aspect, and is defined in purely
who use drugs);
epidemiological/public health or social welfare terms
Peer-led networks
Opioid Treatment Opioid Substitution Effective treatment for opioid dependence that is not simply
Program; Opioid Treatment; Opioid ‘replacing’ or ‘substituting’ one drug for another.
Agonist Treatment Replacement Therapy
10 INPUD & ANPUD Language Statement & Reference Guide INPUD & ANPUD Language Statement & Reference Guide 11
This work is licensed under a Creative INPUD is part of Bridging the Gaps –
Commons Attribution-Non-Commer- health and rights for key populations.
cial-NoDerivs 3.0 Unported Licence This unique programme addresses
the common challenges faced by sex
Published in 2020 by workers, people who use drugs and
INPUD Secretariat lesbian, gay, bisexual and transgender
Unit 2C09, South Bank Technopark people in terms of human rights viola-
90 London Road, London, SE1 6LN tions and accessing much needed HIV
www.inpud.net and health services. Go to www.hivgaps.
org for more information.
The International Network of People
who Use Drugs (INPUD) is a global INPUD is very grateful for financial
peer-based organisation that seeks support from Bridging the Gaps, the
to promote the health and defend Robert Carr Fund and the Global Fund to
the rights of people who use drugs. Fight AIDS, Tuberculosis and Malaria.
INPUD will expose and challenge
stigma, discrimination, and the crim- Written by: Annie Madden and Charles
inalisation of people who use drugs, Henderson.
and its impact on the drug-using
community’s health and rights. INPUD With contributions from: Jake Agliata,
will achieve this through processes of Happy Assan, Judy Chang, Mary Harrod,
empowerment and advocacy at the Bikas Gurung, Francis Joseph, Jay Levy,
international level, while supporting David Subeliani
empowerment and advocacy at Proofread by: Zana Fauzi
community, national and regional Designed by: Mike Stonelake
levels. www.inpud.net