As a senior editor at a scientific journal specializing in addiction and drug policy, I often find myself mediating heated debates among reviewers, authors, editors, and readers. Surprisingly, these arguments revolve not around research methods or empirical data, but around the terminology used to describe vulnerable groups. The field of addiction and drug policy has a long history of feuds over language, with disagreements over whether terms like “vagrants” or “bums” should be replaced with more respectful alternatives like “homeless people,” “people who are homeless,” “unsheltered persons,” or “persons with lived experience of being unhoused.” These linguistic battles extend beyond academia, permeating politics, journalism, education, workplaces, and even family conversations. When even well-intentioned individuals fail to reach a consensus on which words perpetuate social injustice and harm, these debates can become emotionally bruising.
Fortunately, some arguments eventually resolve themselves as pejorative terms like “crackhead” and “junkie” naturally fade away from public discourse. Scholars and practitioners in addiction research and treatment understand the detrimental impact of negative language on public attitudes towards individuals with substance use disorders. However, it is crucial to approach claims about the harmfulness of specific terms as hypotheses until they are proven as factual. When confronted with assertions that a particular term causes harm or that only one specific term is respectful, a fair-minded individual’s response should be, “What evidence supports this claim?”
Of course, when someone clearly expresses their preferred description, their wishes should be respected without the need for empirical validation. In certain cases, honoring individuals’ self-conception may involve tolerating language that well-meaning outsiders perceive as direct, impolite, or even destructive. For example, some experts in my field argue that individuals in recovery should avoid labeling themselves as “addicts” or “alcoholics” to prevent potential stigmatization. However, these terms are widely embraced by participants in 12-step programs. Scientists and clinicians must demonstrate respect for people’s humanity, including their right to speak for themselves and define their own identities.
While it may seem resistant to change, requesting evidence for the harmfulness of a term is a reasonable approach. Considerable evidence regarding the effects of terminology exists to guide us, justifying linguistic shifts in specific cases. For instance, one study in my field revealed that describing an individual as a “substance abuser” rather than someone “having a substance-use disorder” increases the likelihood of perceiving them as a safety threat deserving punishment. Certain terms are unquestionably harmful, as demonstrated by empirical research.
However, many claims regarding the harmfulness or virtue of individual terms lack clear evidence, demanding humility when making generalizations. The strongest argument for the tolerance of varied terminology lies in the diversity of preferences among different groups. One day, a white American colleague reprimanded me for using the apparently demeaning term “elder” when discussing drug overdoses among Medicare recipients. Shortly after, during a Zoom call, Indigenous Canadian colleagues repeatedly utilized the same term as a sign of respect for the oldest members of their community. Similarly, during my clinical training as a psychologist, I was advised (without evidence) to avoid using the term “patient” and exclusively use “client” in mental health care. However, surveys indicate a lack of consensus among people seeking care, with preferences varying depending on the healthcare professional. Acceptance of alternative terms, such as “service users,” “people who use services,” and “consumers,” varies significantly. In essence, there is no universally perfect term, as individuals with the same condition routinely differ in their preferred labels.
Ironically, the attempt to promote equity through new terminology sometimes overlooks individual and cultural diversity. Many academics in the United States quickly adopted the term “Latinx” as an inclusive, gender-neutral alternative to “Hispanic” or “Latino.” However, this neologism bemuses or annoys some individuals of Latin American descent, and survey data suggests that few identify with it. The impact of other language aimed at reducing social stigma remains uncertain. While “homeless” has fallen out of favor in some circles, it has yet to be established whether individuals without reliable shelter benefit from or prefer terms like “unhoused” or “houseless.” Good intentions can often lead to cumbersome terms that eventually become abbreviated into acronyms. For instance, “person with alcohol-use disorder” may possess some humanizing potential, but shortening it to “PWAUD,” as seen in academic papers, remains a matter of conjecture regarding its desired effect.
Denouncing others’ terminology as harmful and demanding the adoption of one’s own can be an intoxicating endeavor, making empirical testing of these disputes seem somewhat mundane. However, making judgments in a rigorous, evidence-based manner prevents experts, policymakers, and the general public from becoming entangled in facile word arguments. Our focus should be on tackling substantial social problems rather than simply debating semantics. Embracing a shared commitment to evidence provides a path to resolve contentious disagreements, while also offering opportunities for growth and improvement when harm has been inadvertently caused.
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