Although expert guidelines have recommended terminology clinicians should use while treating people with substance use disorders, few studies have examined terminology preferences among persons receiving methadone treatment.
This is an important area of investigation because patient expectations and preferences can impact treatment outcome. People who misuse substances experience significant stigma in their lives. Anticipated stigma from clinicians can reduce the chances of people entering and remaining in methadone treatment, an evidence-based intervention comprising methadone medication and counseling. Even when they enter treatment, individuals with opioid use disorder encounter stigma. Language is an important conduit of this stigma. Soliciting patient input and feedback regarding language use has the potential to reduce stigma in treatment.
A new study by researchers at Yale School of Medicine; the University of the South; Brigham and Women’s Hospital, Boston; and Quinnipiac School of Medicine published in Journal of General Internal Medicine found that patients receiving methadone treatment prefer that clinicians use medically accurate and person-centered terminology.
Participants were 450 patients who were receiving methadone treatment for one month at the APT Foundation, Inc., one of the largest providers of medication for opioid use disorder in Southern New England. Participants completed surveys that asked:
- “How do you prefer counselors to describe the problems you are seeking treatment for?” (i.e., presenting problem preference);
- “How do you prefer counselors to refer to you?” (i.e., collective noun preference);
- “How do you prefer counselors to describe you?” (i.e., personal descriptor preference).
Patient terminology preferences were consistent with current expert guidelines. “Addiction,” “substance use,” and “substance abuse” were the highest-rated presenting problem preferences. “Client,” “patient,” and “guest” were the highest-rated collective noun term preferences, while “person with an addiction,” “person with substance use disorder,” and “substance-dependent person,” were the highest-rated personal descriptor preferences.
Greater preference for the term “addict” was associated with 12-step program partiality. There were also significant differences in terminological preference based on age and self-identified race.
"These new findings are notable since -- consistent with current expert guidelines -- patients receiving methadone treatment appear to prefer that clinicians use medically accurate, person-first, and destigmatizing terminology," said Declan Barry, PhD, associate professor of psychiatry and in the Child Study Center at Yale School of Medicine, and senior study investigator.
Mark Beitel, PhD, research scientist in the Child Study Center and assistant clinical professor of psychiatry, said, “Future research may benefit from examining in more detail possible demographic differences in terminology preferences among this highly stigmatized patient group and their implications for clinical practice.” Beitel is co-author of the study.
Marina Gaeta Gazzola, MD, a recent graduate of Yale School of Medicine, was the study's first author. Other Yale-affiliated co-authors were Lynn Madden, PhD (Internal Medicine); Oluwole Jegede, MD (Psychiatry); and Ziaoying Zheng, BS (a recent graduate of Yale College).
Emma Maclean, BA (University of the South); Katharine Cammack, PhD (University of the South); Iain Carmichael (Brigham and Women’s Hospital, Boston); Emma Bergman, BS (Quinnipiac School of Medicine); Kathryn Eggert LCSW (APT Foundation); and Teresa Roehrich (APT Foundation) were also co-authors.