Advertisement

The Reply

      We thank Braillon for his laudatory comments about our editorial
      • Kelly J.F.
      • Wakeman S.
      • Saitz R.
      Stop talking ‘dirty’: clinicians, language, and quality of care for the leading cause of preventable death in the United States.
      and commend him for engaging further in discussion about the important topic of language and clinical terminology pertaining to substance use disorders and individuals suffering from them.
      Braillon makes the point that some of the words and phrases that we implied were not helpful in our editorial (eg, “You use, you lose”; and use of the word “war” in the popular aphorism, “War on drugs”), which are associated with US policies targeting alcohol and other drug use, may not be necessarily bad, and may even be helpful.
      Braillon's more positive take on the use of this kind of rhetoric is based on the fact that tobacco and alcohol kill hundreds of thousands of individuals each year in the United States alone, and he implies that in many countries a “war” is in fact being fought continuously between the interests of public health and those of the alcohol and tobacco industry, who stand to profit from harmful, and even lower-risk, patterns of use. For him, this tougher stance and related language seems appropriate and may be what is really needed to fight effectively against well-funded corporate interests.
      Although, ultimately, the question of whether the use of this type of combative and threatening language is actually more helpful than harmful is an empirical one, we would argue that the broad, hardline, military-style policies that have been in keeping with “the war on drugs” rhetoric have resulted in substantially greater criminalization and incarceration of a large segment of our population—a disproportionate number of whom have been minorities—without producing significant reductions in the economic, medical, and social burdens associated with substance use.
      We share Braillon's frustration and passion for finding more effective ways of addressing our endemic public health problems related to alcohol, tobacco, and other drugs, but we believe that resorting to the aggressive language of threat in the hopes of deterring substance use consequences is likely to continue to be ineffective and to increase personal blame on those who are more vulnerable to addiction. We also believe that it is at odds with medical and broader public health approaches.

      Reference

        • Kelly J.F.
        • Wakeman S.
        • Saitz R.
        Stop talking ‘dirty’: clinicians, language, and quality of care for the leading cause of preventable death in the United States.
        Am J Med. 2015; 128: 8-9

      Linked Article

      • Neither Abusiveness with Patients nor Naivety with Drugs
        The American Journal of MedicineVol. 128Issue 7
        • Preview
          Kelly et al1 must be commended for condemning abusive language for individuals with addiction (eg, substance “abusers” or “addicts”) and recommending the use of “people with a substance use disorder.” Indeed, reducing stigma is vital for building the therapeutic alliance with these patients with low self-esteem. Sadly, this is not yet usual: Elkind,2 when discussing the risk of recurrent ischemic stroke, called smoking a “volitional behavior.” However, the condemnation of public health messages such as “war on drugs” or “You use, you lose” deserves comments.
        • Full-Text
        • PDF