What’s Wrong With “Addicts”?

[The following is a guest post by Maggie Taylor, a PhD student in the Philosophy Department at the University of Colorado Boulder]

What’s Wrong With “Addicts”?

I spent yesterday serving as a judge at the Colorado High School Ethics Bowl tournament, one of nearly 40 regional events across the country that are part of the National High School Ethics Bowl (NHSEB). This was my third time participating in an NSEHB tournament, where students respond to cases based on real-world ethical dilemmas. This year’s cases, for instance, had students considering the rights of teachers to go on strike, effective altruism, and whether it’s okay to punch Nazis. Teams of high schoolers are invited to struggle with these and other difficult moral problems in a non-adversarial way. As public debate becomes more partisan and reactionary in the United States, NHSEB tournaments are a bright spot of civility and intellectual rigor. In my experience, NHSEB tournaments have exemplified the organization’s goals to promote “respectful, supportive, and rigorous discussion of ethics” among high school students, and I see tremendous value in such an endeavor.

This year, two NHSEB scenarios (cases 14 and 15) concerned people who use drugs. During yesterday’s tournament, I cringed as I read these cases and listened to a group of talented, compassionate, and sensitive high school students discuss scenarios in the language used by the NHSEB, who referred to the subjects receiving our moral consideration as “addicts.”

For many people reading this, the word “addict” is an innocuous one. Of all of the drug-related problems we face (like, say, mass incarceration of people who use drugs, or epidemic rates of opioid-related deaths), whether one calls a person an “addict” seems not to rank.

But like so many other words, “addict” is a loaded and fundamentally stigmatizing term. Many of us know a person we might call an addict – usually a person who has disappointed or hurt us, and whose memory may be unconsciously elicited whenever we hear the word. Or maybe there’s a novel, or a film, or an episode of Law and Order we vividly recall when we hear “addict,” and we can’t shake the sense that a certain character was out of control, irresponsible, abusive, or just plain bad. These immediate, negative associations color everyone we paint with the “addict” brush.

There is so much stigma that the American Psychiatric Association omitted “addiction” when it released the DSM-5, given the word’s “uncertain definition and potentially negative connotation.” While the NHSEB cases are apparently sensitive to the stigmatization of drug use and drug users, they also feed into that stigmatization via indiscriminate use of the terminology of “addiction.”

But beyond stigma, the word “addict” is dehumanizing. It leaves no room for a person, but refers just to a condition, or a disease, an activity – or maybe our attitude toward people who engage in some activities. Human beings are reduced to a single aspect of their lives, and due care is not given to other aspects of their identity or experience.

These are some of the reasons the Associated Press advised writers to stop using the word “addict” in 2017, discouraging phrases like “he’s an addict” in favor of “he uses drugs.” This subtle shift draws a distinction between the person and the condition or behavior, and subtly signals that readers ought not conflate these.

Of course, these linguistic shifts are often grammatically inelegant, and “addicts” gets at a close enough approximation of what we mean when we want to refer to, for instance, people with substance use disorders. But “addict” elides many morally relevant distinctions: it interchangeably means a person who uses illicit drugs, a person who uses any drugs, a person who has a physical dependence on a drug, a person who uses drugs problematically, a person who meets various diagnostic criteria . . . I could go on.

As I judged these cases during yesterday’s tournament, many of the questions from opposing teams and other judges aimed to home in on what the word addict even meant, as a precondition for evaluating the normatively relevant aspects of the case: Is it OK to commit someone with a substance use disorder but not someone who non-problematically uses illegal drugs? Is it permissible to give financial incentives to cigarette smokers who agree to be sterilized? Ought we assume that the subjects of these cases suffer from some reduced capacity to exercise autonomy in light of their classification as “addict?”

Perhaps this was the sort of dialogue which the organizers of the NHESB hoped to facilitate with these questions. But it is nonetheless notable that a more meaningful conversation might have taken place had all participants started with an understanding of the experiences of the persons depicted in these cases, and the conditions which these cases meant to convey.

Of course, accurately describing the lived experiences of people who use drugs won’t resolve the numerous injustices associated with the drug war (if only the mass incarceration of millions of people were so easy to undo). But using respectful, accurate, and compassionate language prepares us to engage in rigorous conversations about what we owe each other as human beings – the kinds of conversations that are necessary if we want to improve access to substance abuse treatment for people who want it, change unjust drug laws, make reparations to persons and communities harmed by the criminalization and stigmatization of drug use, and guide high school students in thinking about difficult moral problems. We can all do better when it comes to choosing our words carefully, and that includes the NHSEB.

If the NHSEB’s overall aims and impact were any less positive, it would not be worth pointing out this dark spot. But because there is so much value and potential in this project, we ought to seriously consider how future tournaments can be improved.