Are The Terms “Alcoholism” and “Addiction” Outdated?

If you’ve been following mental health literature or even news articles over the past 10 or so years, you may have seen a subtle yet significant shift in the kind of vocabulary used to describe situations where individuals may have a problem with substance use. We’re starting to see terms like “alcoholism” and “alcohol abuse” occur far less often. Even “dependence”, the term that we often use to soften the blow of the word “addiction” has occurred less and less often in serious discussions.

In the place of most of these terms, many clinicians and health topic writers now use alcohol use disorder (AUD) or substance use disorder (SUD). Substance abuse is now more broadly referred to as misuse or “unhealthy” or “unprescribed” consumption of substances, just to name a few. This trend is also true in many drug rehab programs in Dallas.

Rationales for changing terminology

While the knee-jerk reaction of many people will be to decry the recent trend as political correctness gone haywire, there are some very good reasons for the change. Below are just two of the reasons why clinicians, policymakers, and journalists alike have shifted towards new terminology.

1.) The changes are in line with the DSM-5

Diagnostic and Statistical Manual of Mental Disorders or DSM is considered to be the main reference for mental health disorders and diagnostics in North America as well as in many other parts of the world.

The Diagnostic and Statistical Manual of Mental Disorder 5th Edition: DSM-5, published in May 2013, introduced some very big changes over the previous editions, one of the more controversial of which was the reclassification of addiction and abuse into one condition – substance use disorder or SUD. This reflects a more current understanding of the workings behind the disease.

Within SUD, we also have disorders related to specific substances or categories, such as alcohol use disorder (AUD), drug use disorder (DUD), benzodiazepine use disorder (BUD), and so on. The conditions could then be classified as mild, moderate, or severe to help with triage and to allow for better treatment.

This means that, within the United States, addiction, abuse, and dependence are no longer current terminologies in mainstream mental health or in academic contexts. Any serious paper written post-2013 is likely to adopt the new terminologies as well.

However, even psychiatrists and other clinicians may still use the older terms when communicating with patients and other laypeople to help better bring their point across, as the new terms have not seen universal adoption outside mental health practitioners and the academe.

2.) We want to destigmatize the disease

AUD and other SUDs are unique among mental health disorders in that there is considerable social and cultural baggage attached to them. While society, in general, has gotten better at understanding how individuals with mental illness should and shouldn’t be treated, there remains a stigma against people with drug and alcohol problems.

While this stigma is great for riling up people and getting politicians elected, it makes it less likely for people with SUD to seek treatment. Words do have power, and the terms “addict” and “abuse” have over a century of negative connotations behind them that can cause unnecessary distress, not just for the individual that needs help, but for their family as well.

Family members of people with SUD may feel unnecessary shame and fail to act because they don’t want people to know their loved one is a “drunk” or an “alcoholic” or an “addict”. By using terms that make it more clear that the condition is a disease like any other, the hope is that we may encourage more people to seek treatment for themselves or a loved one.

Can you still use alcoholism, addiction, abuse, etc.?

Many organizations involved in discussing or treating AUD have their own guidelines on the terms that could be used. Alcoholics Anonymous, for example, will rarely, if ever, use the updated DSM-5 terminologies. Other groups like SMART Recovery, will be more likely to use AUD.

In any case, other English-speaking countries like the UK will still use terms like “addiction” and “abuse” as these are still current within the World Health Organization’s International Classification of Diseases, currently in its tenth edition, the ICD 10–CM. There is also little reason to use the updated DSM-5 terms when addressing people who may not yet understand them. However, care must be taken to avoid a negative or condemning tone when using these terms.

Summary

Addiction, abuse, alcoholism, and dependence are only outdated within the narrow context of the DSM-5, which is primarily used in North America. In more general writing and everyday communications, you are free to use whatever language you wish. However, we must always be cognizant that our words hold power, and there are situations where you may want to be more discerning about how you choose to describe issues with drug and alcohol use. Good luck, stay kind, and stay sober!