One of the ways a subject can be altered—slowly, imperceptibly—is through a gradual redefinition of the terms used in that field. This shift may be glacially slow and can seem to be for all the right reasons. But over time, it can change the way people talk about and even understand the subject. Is this “redefinition creep” that is ongoing today in the field of addiction and recovery broadening our understanding or making it narrower? Is it positive or negative?
One of the ways a subject can be altered—slowly, imperceptibly—is through a gradual redefinition of the terms used in that field. This shift may be glacially slow and it can seem to occur for all the right reasons. But over time, it changes the way people talk about and even understand a subject.
As new people come into a field, they may never know that the words were ever used any differently. And so generational forgetting can occur. The next generation coming into that field may hold completely different concepts and definitions than the prior generation, which engenders an entirely new culture and approach in that field. Newcomers may not even realize there was any other way to view the field.
This has long been occurring in addiction recovery. Once you see the following examples, you may realize you’ve seen this shift happening.
- Instead of “addiction,” we are encouraged to use the term “substance use disorder.” The latter term tends to strictly associate addiction with a mental or physical disorder. It also seems to take the subject of addiction out of the domain of social, personal or ethical responsibility.
- As the term “disorder” is associated with physical and mental ills, this reclassification of addiction as a disorder implies that medical or psychiatric treatment is required for a solution. However, millions of people have recovered their sobriety without medical or psychiatric treatment, by utilizing AA or faith-based programs.
- A 2017 memo from the Office of National Drug Control Policy (along with many, many other documents from official agencies) makes it clear that addiction is a “chronic brain disorder.” This further removes addiction from the domain of social, personal or ethical responsibility as a primary realm and identifies addiction as a problem requiring necessitating medical intervention.
- Instead of “drug abuse,” the National Institute on Drug Abuse and other agencies and professionals recommend that the term “drug use” should be used. Using the latter term aligns with the principles of harm reduction, which supports the idea that drug use can be an acceptable life choice. The word abuse comes from Latin abus- ‘misused’, from ab- ‘away’ (i.e. ‘wrongly’) + uti ‘to use’. It could be argued that avoiding the term ‘abuse’ obscures the reality that people do abuse drugs and that such abuse has negative consequences for themselves and others.
- “Abstinence” has also been redefined. At one time, abstinence only described a person who did not use any drugs or alcohol. Abstinence is now used to refer to a person taking Suboxone, an addictive opioid that is also traded on the illicit market, as long as they refrain from the use of illicit opioids.
- This is not the only blurring of the lines between abstinence and drug use. In some drug rehabs, the use of marijuana may be condoned. In that situation, “abstinence” would include use of a drug that the NIDA said in 2015 was responsible for 4 million Americans suffering from drug dependence. (see https://nida.nih.gov/publications/research-reports/marijuana/marijuana-addictive]
- Further redefinition of “abstinence” is seen in this passage from an “addiction-ary” from Recovery Answers. This group splits up abstinence into several new categories, as you can see here.
- Abstinence: The absence of substance use. However, there are many different types of abstinence. Abstinence is typically interpreted as complete abstinence, defined below:
- Continuous abstinence: not consuming the drug of choice during a specified period of time
- Essentially abstinent: not consuming more than a specified amount of the drug over a period of time
- Minimal abstinence: achieving a minimal period of recovery during a period of time
- Point-in-time abstinence: not consuming the drug of choice at a single point in time (e.g., the past 30 days)
- Complete abstinence: continuous abstinence from all alcohol and other drugs
- Involuntary abstinence: enforced abstinence due to hospitalization or incarceration
The American Psychological Association appropriately defines abstinence as “the act of refraining from the use of something, particularly alcohol or drugs, or from participation in sexual or other activity.” That’s a whole lot simpler.
This phenomenon that could be called “redefinition creep” threatens to modify our thinking and communication without our realizing it and in ways we might not desire. That could result in harmful unintended consequences.