It is hard to believe that it has been one year since the first COVID-19 lockdowns occurred in the US and Canada. Over the past year, many people’s daily routines have completely changed as they physically and socially-distance from others. While this distancing has been crucial to reduce COVID-19-related deaths, a question that scientists and practitioners have been facing is “Have there been harmful effects on alcohol use and related deaths?” Let’s look at the data together and see what’s the matter.
Over the past year, many bars and restaurants have had to limit “drink-in” services. At the same time, many rules around alcohol sales and delivery have laxed (cocktail delivery – anyone?) and alcohol vendors have been deemed essential services.
It is not possible to know for sure if the pandemic has changed drinking. This is would require a study where we control people’s exposure to pandemic-like conditions and give them alcohol to see what happens (aka an experiment). What we do know, however, is that in some regions during certain periods of the pandemic there have been increases in the sale of alcohol. Of course, based on this alone, we do not know if people are drinking that extra alcohol they have purchased or if it is now part of a new pandemic trend of building a wine cellar.
We also know that people are telling us they are drinking more. In an online survey of 320 Canadian adults who drink, some individuals reported increased alcohol use when the pandemic started . Some people reported greater increases in drinking than others, such as individuals who had children under the age of 18, had greater depression, or were less socially connected to others. An important question is why are certain people drinking more during the pandemic?
Tears in Your Beer
While alcohol use is often thought of as a social activity, how has social distancing and the pandemic affected people’s alcohol use?
The COVID-19 pandemic is a stressful ongoing event affecting the lives for many people. For quite some time, researchers have argued that feeling stressed, sad, or anxious can lead individuals to use substances (like alcohol) to cope with those unwanted feelings. Consistent with this idea, research supports that individuals who were more likely to report drinking alcohol to deal with negative emotions during the pandemic were most likely to increase their alcohol use. Drinking to cope with negative emotions also was associated with experiencing consequences from drinking, such as being unhappy, getting in trouble, doing impulsive things, and harming relationships.
A Short-Term Solution that can create Longer-Term Problems
Attention has been drawn to recent increases in “deaths of despair” that include deaths from alcohol and other drug overdoses (as well as liver disease and suicide). For instance, in Ontario, there was an increase in opioid-related deaths after the state of emergency was declared in March 2020 (see page 5 ). While there are many possible explanations for this increase, one possibility that has been put forward is that the sudden and then ongoing stress of the COVID-19 pandemic has led individuals to drink to cope and this can fuel an increase in drinking and potentially harms from drinking (such as overdose and alcohol-related liver disease).
As the COVID-19 pandemic continues to burden us with considerable stress and worry, alcohol serves as only short-term solution to a longer-term problem. As stated by Koob and colleagues (2020):
“Alcohol can temporarily dampen negative emotional states, providing short-term relief…Over time, [changes to the brain] reduce the relief that is provided by alcohol and increase emotional misery between episodes of [alcohol] use.”
In other words, alcohol may help relieve distress in the short-term, but in the longer term, it can make distress much worse.
Finding Other Ways to Cope
Given the potential physical, emotional, and financial costs of drinking, alternative ways of coping with COVID-19 related distress are needed. It is important to find options that will work for you and your current pandemic lifestyle. It may not be easy, but your mind and body may thank you later for finding alternative ways to relax and take a break.
Here are some options that you could try!
Enjoy a different beverage: your favorite soda, a warm tea, or an indulgent hot chocolate
Find another way to temporarily escape: have a bubble bath, listen to your favourite album, or watch a new show
Develop new ways of coping: practice mindfulness, start a new exercise routine, go for a walk
Reconnect with others: plan a virtual game night or simply catch-up with others by phone
Where can I find out more about reducing my drinking?
Every day you pick up a delicious ice cream cone on your way home from work. But this time you decide it might be better to skip a few days, maybe for health reasons or to save some money. It’s been a couple of days when you pass by the ice cream shop and notice that this treathas been on your mind all day, making it hard to concentrate at work. You notice a strong craving for one and you’re finding yourself feeling irritable without one. You think, “What’s going on? Do I have a problem?”.
At this point, you might wonder if you’re experiencing withdrawal symptoms by cutting back on this ice cream, like what might happen when someone who has substance or drug issues cuts back on their use. For example, when someone who often drinks a lot of alcohol cuts back on their drinking, they may feel uncomfortable or ill. They may experience anxiety, nausea, and sweating . These symptoms that happen when substance use is reduced is called withdrawal. Even though withdrawal is well-known for substances, it is not well understood for food, despite food being necessary for survival and being readily available for many people, often in large quantities.
But why is this important? Some theories of why people develop substance problems (described more below) focus specifically on withdrawal symptoms. For these theories to apply though, understanding if withdrawal even exists for foods is important to know. This blog post reviews the current scientific evidence to answer the question: Can we experience withdrawal symptoms when we cut back on certain foods?
What is food addiction and how does withdrawal fit in?
Withdrawal is one symptom of many that people can experience when they have a substance use disorder, or more commonly known as an “addiction” . The idea that food can also be addictive has attracted more scientific attention in the last decade and since the publication of a questionnaire called the Yale Food Addiction Scale or YFAS [2–3]. Before this questionnaire, there was no standard way of measuring “food addiction” . This is the idea that people experience the same symptoms of drug addiction, including withdrawal, when eating a lot of highly processed foods that are high in fat and sugar, like ice cream, cookies, chips, burgers, and sugary drinks . Examples of food withdrawal include experiencing irritability, sadness, headaches, fatigue, difficulty concentrating, or cravings when eating less of these foods.
Although food addiction is not an officially recognized disorder among scientists, the idea is not new. Some people do identify themselves as a “food addict”  and might join self-help programs such as Overeaters Anonymous, which has existed since 1960 . Additionally, food addiction does appear in the media [7–8]. Symptoms such as overeating are often described, but others such as withdrawal are overlooked. Given this long history, do we have the evidence to back up the idea that people can experience food withdrawal?
What does the science say about food withdrawal?
The research on food withdrawal is mostly limited to animal studies, anecdotes among humans, and responses to the YFAS. One review of studies published in 2009 found that when rats were fed a diet of sugar and this food source was removed, the rats displayed symptoms similar to heroin withdrawal, such as aggression, teeth chattering, paw tremor, and headshaking [9, 10, 11]. In a more recent review of studies published in 2018, again only animal studies were discussed in the context of withdrawal . The authors noted that given that the body’s responses to food are smaller than those to drugs, withdrawal symptoms might be present but not as noticeable in humans.
Reports of sugar and other processed food withdrawal among humans, such as headaches and fatigue, have largely come from observations of people cutting back on these foods or from self-help books and websites [10, 12, 13, 14]. Although this anecdotal information is important, it has not been observed under controlled scientific conditions . As a result, it is unclear if the withdrawal symptoms are a result of abstaining from certain foods, or if they are due to other factors, such as other lifestyle changes. An example of a controlled study would be randomly assigning individuals with food addiction to either: 1) abstaining from eating certain foods, or 2) not abstaining, and observing both groups over a period of time, perhaps in a controlled laboratory setting. If withdrawal symptoms emerge for the first group and not the second, then this would suggest that the withdrawal is caused by abstaining from certain foods, assuming that this is the one main variable that differed between the two groups.
Lastly, the research team behind the YFAS  pointed out that 19-30% of people in the community [4, 16] and 26-55% of patients with eating-related issues [17–18] who completed the YFAS did report withdrawal symptoms. However, like the anecdotal information, these studies were not experimental and so these withdrawal symptoms could be related to other factors.
Developing a questionnaire to measure food withdrawal
Recognizing that there was no standard way to measure food withdrawal in humans, the research team behind the YFAS developed and tested the Highly Processed Food Withdrawal Scale or ProWS . A total of 231 online participants who attempted to cut down on highly processed foods in the past year completed the ProWS. They were asked when four symptoms (described below; see Figure 1 for two of the symptoms) were at their most intense following the cutting back attempt. These symptoms were chosen because they are seen in withdrawal across most drugs of abuse [1, 15].
The researchers found that overall, 55% of participants reported having cravings, 35% felt irritable, 27% felt tired, and 27% felt down after cutting back. These symptoms peaked after 2-3 days, except for sadness, which was at its worst after 4-5 days (see Figure 1). The authors mentioned that this pattern is similar to what might be seen with withdrawal from marijuana and cigarettes [19–20] and provides early evidence for withdrawal from highly processed foods . This information may even help healthcare providers who are helping people cut back on processed foods, as clinicians can give information about withdrawal symptoms, set expectations for how long they last, and suggest strategies to manage them .
However, this early study is limited because it does not report how many people experienced more physical symptoms such as nausea, night sweats, hot flashes, and headaches . Furthermore, because scientists have not identified a specific substance or ingredient that is addictive across different foods , withdrawal symptoms may actually vary depending on the food. For example, eating less candy might lead to different physical effects, such as low blood sugar, that you may not see if you ate less cheese . Additionally, given that the dieting attempt could have been at any time in the past year, participants may not have always remembered accurately . Using biological tests (for example to measure stress hormones) might provide more objective evidence of withdrawal symptoms . Future studies will need to look at how withdrawal symptoms unfold in real-time, in controlled laboratory settings, and using other measures.
What can we say about food withdrawal at this time?
To return to the question of whether or not we experience withdrawal symptoms from cutting back on certain foods, the answer is maybe. The limited evidence we have points more to psychological symptoms, such as cravings, and not physical symptoms, such as nausea. However, psychological symptoms are still incredibly impactful. In fact, there are few physical symptoms when withdrawing from substances such as tobacco [1, 15]. If someone you know has tried to quit smoking, you know how irritable or anxious they can get right after quitting!
Why is understanding food withdrawal important? Some theories about how people develop addictions depend on the idea that people use substances (or in this case, eat food) in order to feel relief from unpleasant withdrawal symptoms that develop after using that substance repeatedly . These theories are called negative reinforcement models of drug motivation . For these theories to apply to food addiction though, we still need a better understanding of withdrawal from food or we need to consider other theories. Negative reinforcement models within the past 20 years have now been expanded to focus more on psychological rather than physical withdrawal symptoms, as well as unconscious motivations resulting from learning repeatedly that use results in relief [22, 23]. Substance use may also be about escaping distress from one’s environment, and not just distress due to withdrawal symptoms . For example, you may grab that ice cream after work because of cravings, because of habit, or because you had a stressful day. Given the limited evidence of food withdrawal, these other factors may be more relevant to developing food addiction. Regardless of the source of distress, drug-induced or environmentally prompted distress may result in similar internal cues in the body that can trigger substance use .
Another theory is the incentive sensitization theory of addiction . This theory argues that the brain has two separate but related systems responsible for “liking” (pleasure) and for “wanting” (called incentive salience) [24, 25]. This “wanting” is an unconscious desire for rewards and cues that signal these rewards , such as fast food and fast-food advertising. Seeing such a cue may motivate someone to get in line for a burger. This model suggests that with repeated drug use, the brain changes such that processes responsible for “wanting” drugs become more sensitive . Research shows that one can “want” something without “liking” it and vice-versa . It appears that drugs of abuse, food, and gambling can hijack our “wanting” system; that is, “wanting” can increase and “liking” may stay the same or even decrease . Tolerance to a drug occurs when it is no longer pleasurable, and it can lead to escalation of drug use as one searches for that initial pleasure . Processed foods may trigger initially strong “liking” and “wanting” responses, resulting in overeating, which can further increase “wanting” of these foods and their cues . Human and non-human animal research appears to support this theory when applied to food  and substances such as alcohol . Given the currently limited evidence for food withdrawal, the incentive sensitization theory may better explain food addiction when compared to negative reinforcement models.
Understanding what is driving food addiction is important for creating effective treatments and policies related to eating, which is why more research is needed before making any conclusions and recommendations. It is also important to remember that research on food addiction and withdrawal is still in its early stages. The YFAS was published in 2009, the ProWS was published in 2018,and the ProWS for children was published in 2020 [2, 15, 27]. With more research, we will hopefully better understand if and how people experience withdrawal symptoms when cutting back on certain foods. At the moment, it is unclear but there is some promising evidence!
You are still unsure if you have a problem with ice cream or not… Maybe the craving was not so much an effect of not eating ice cream but other things, like seeing the ice cream shop sign, having a stressful day at work and usually eating to relax, or something outside your awareness. Who knows! You think, “Maybe if I ride this craving out, it will go away. Let me do something else relaxing like read that book at home instead.”.
If you are wondering if you have food addiction symptoms, the YFAS and ProWS, the questionnaires of food addiction and food withdrawal discussed in the article, are freely available by the researchers here. However, if you are experiencing eating-related issues that are distressing for you, it may be helpful to talk to your doctor, as there are mental health professionals who can assess and treat eating disorders. For a description of eating disorders, treatments, and resources, visit the Canadian Mental Health Association, Ontario Division.
Naish, K. R., MacKillop, J., & Balodis, I. M. (2018). The concept of food addiction: A review of the current evidence. Current Behavioral Neuroscience Reports, 5(4), 281-294. https://doi.org/10.1007/s40473-018-0169-2
Gearhardt, A. N., Corbin, W. R., & Brownell, K. D. (2016). Development of the Yale Food Addiction Scale Version 2.0. Psychology of Addictive Behaviors, 30(1), 113-121. https://doi.org/10.1037/adb0000136
Avena, N. M., Rada, P., & Hoebel, B. G. (2008). Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience & Biobehavioral Reviews, 32(1), 20-39. https://doi.org/10.1016/j.neubiorev.2007.04.019
Wideman, C. H., Nadzam, G. R., & Murphy, H. M. (2005). Implications of an animal model of sugar addiction, withdrawal and relapse for human health. Nutritional Neuroscience, 8(5-6), 269-276. https://doi.org/10.1080/10284150500485221
Gearhardt, A. N., Corbin, W. R., & Brownell, K. D. (2009b). Food addiction: An examination of the diagnostic criteria for dependence. Journal of Addiction Medicine, 3(1), 1-7. https://doi.org/10.1097/ADM.0b013e318193c993
Ifland, J. R., Preuss, H. G., Marcus, M. T., Rourke, K. M., Taylor, W. C., Burau, K., Jacobs, W. S., Kadish, W., & Manso, G. (2009). Refined food addiction: A classic substance use disorder. Medical hypotheses, 72(5), 518-526. https://doi.org/10.1016/j.mehy.2008.11.035
Hauck, C., Weiß, A., Schulte, E. M., Meule, A., & Ellrott, T. (2017). Prevalence of ‘food addiction’ as measured with the Yale Food Addiction Scale 2.0 in a representative German sample and its association with sex, age and weight categories. Obesity Facts, 10(1), 12-24. https://doi.org/10.1159/000456013
Gearhardt, A. N., White, M. A., Masheb, R. M., Morgan, P. T., Crosby, R. D., & Grilo, C. M. (2012). An examination of the food addiction construct in obese patients with binge eating disorder. International Journal of Eating Disorders, 45(5), 657-663. https://doi.org/10.1002/eat.20957
Meule, A., Hermann, T., & Kübler, A. (2015). Food addiction in overweight and obese adolescents seeking weight‐loss treatment. European Eating Disorders Review, 23(3), 193-198. https://doi.org/10.1002/erv.2355
Budney, A. J., Moore, B. A., Vandrey, R. G., & Hughes, J. R. (2003). The time course and significance of cannabis withdrawal. Journal of Abnormal Psychology, 112(3), 393-402. https://doi.org/10.1037/0021-843X.112.3.393
Hebebrand, J., Albayrak, Ö., Adan, R., Antel, J., Dieguez, C., de Jong, J., Leng, G., Menzies, J., Mercer, J. G., Murphy, M., van der Plasse, G, & Dickson, S. (2014). “Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior. Neuroscience & Biobehavioral Reviews, 47, 295-306. https://doi.org/10.1016/j.neubiorev.2014.08.016
McCarthy, D. E., Curtin, J. J., Piper, M. E., & Baker, T. B. (2010). Negative reinforcement: Possible clinical implications of an integrative model. In J. D. Kassel (Ed.), Substance abuse and emotion (p. 15–42). American Psychological Association. https://doi.org/10.1037/12067-001
Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review, 111(1), 33-51. https://doi.org/10.1037/0033-295X.111.1.33
Robinson M. J. F., Fischer A. M., Ahuja, A., Lesser, E.N., & Maniates H. (2015). Roles of “wanting” and “liking” in motivating behavior: Gambling, food, and drug addictions. In E. Simpson & P. Balsam (Eds.), Behavioral neuroscience of motivation. Current topics in behavioral neurosciences (Vol. 27). Springer. https://doi.org/10.1007/7854_2015_387
Cofresí, R. U., Bartholow, B. D., & Piasecki, T. M. (2019). Evidence for incentive salience sensitization as a pathway to alcohol use disorder. Neuroscience & Biobehavioral Reviews, 107, 897-926. https://doi.org/10.1016/j.neubiorev.2019.10.009
Schulte, E. M., Smeal, J. K., Lewis, J., & Gearhardt, A. N. (2018). Development of the Highly Processed Food Withdrawal Scale [Author’s interpretation adapted from Fig. 1. Time course of highly processed food withdrawal symptoms]. Appetite, 131, 148-154. https://doi.org/10.1016/j.appet.2018.09.013
By: Arielle Dryer, Vincent Santiago, and Aleksandra Usyatynsky
You lurch awake in the early hours of the morning with a searing pain in your lower back. Being so sedentary during the pandemic has been making your muscle pain worse. You pull out your ibuprofen bottle from your nightstand and are surprised to see it’s running low. “Maybe I’ll see my doctor, just in case,” you think.
As you arrive at thedoctor’s office later that day, you notice a new poster on display. “Missing out on your life because of pain? Relief is just a pill away, so you can get back to what really matters.” The logo in the corner looks familiar but you can’t remember where you’ve seen it before…A moment later your doctor glides in.
“Pain acting up again? Today I’m going to try a new drug instead of the over-the-counter stuff. It’s called ‘Strainadol’, you might have seen the poster in the waiting room. They just did a large clinical trial and it’s supposed to be really effective. Is that all for today?”
You leave the office put at ease; the new medication sounds promising!
Research can become biased when one research question or result is favoured over another, intentionally or not. When research is biased it lessens how much we can trust the findings. How can you tell if research is biased? Well, the source of research funding can be an important sign. Like any other project, research often does not happen without the proper funds. Scientists need to buy equipment, pay research participants, and pay the salaries of research staff. Research is often funded by government agencies and non-profit organizations, but it is also funded by private industries. Industry funding is a major way that bias can creep into scientific research.
Have you ever questioned the findings of public health research? You may not have, because we usually trust that scientific research is objective. But when research has the power to influence our policies and the choices set before us in our day to day lives, it’s important to consider who has the power to influence our research.
There are a number of ways that this bias can affect research findings. Let’s say I am a researcher funded by a pharmaceutical company to test their new drug. Compared to my colleague funded by the government, I am more likely to design my study in a way that shows that the drug is effective.1 I am more likely than my colleague to draw stronger conclusions about the drug’s effectiveness, even if we have the same set of results. I am also more likely to only publish the findings that support the drug’s effectiveness.1
Industry funding can also influence research agendas, or the types of questions scientists ask in the first place. This type of bias is less studied, but can be powerful because it influences the rest of the research process and changes what information is available to us. To better understand this type of bias, in 2018 Fabbri and colleagues2 reviewed and brought together studies on how industry sponsorship has affected research agendas across a number of fields like medicine, tobacco, and food. The information presented here is the sum of findings from 36 studies between 1986 and 2017. With the information they reviewed, they answered 3 questions.
1) Does industry sponsorship impact research topics?
The review found that studies with industry funding tended to focus on research with commercial applications that results in more profits for the company. Within the health field, industry sponsorship means more research focused on money-making drugs and devices, rather than on talk therapy, physical activity, or dietary changes.
For example, most industry funded diabetes research focuses on oral medication or devices to measure blood glucose.3 In comparison, non-commercially funded studies research things like the causes, consequences, and complications of diabetes, and nonmedical ways of managing the disease.
One concern is that over-reliance on drugs to solve public health problems can have severe and unintended consequences. For example, the prescription opioid epidemic is partly due to the lack of existing non-drug alternatives to manage pain.4 Now, more than ever, we need to invest in deeper understandings of public needs and problems, rather than quick “band-aid” solutions. Due to the industry focus on their own interests, governments and nonprofits are left as the main sources of funding for these projects.
2) How do industries change what we research?
Industries have a few research tricks up their sleeves to make their products sell. One industry tactic is to focus research attention away from their product’s flaws. For decades the tobacco industry funded research focusing on how genetics puts certain people at risk of becoming addicted to smoking. This helped them make their case against claims that smoking causes cancer.5
Another industry tactic is presenting research results so that they appear believable and trustworthy. The tobacco industry reported that its second-hand smoke research was determined by experts in the field who select research projects based on scientific value. It was revealed that some of these projects were actually chosen by tobacco industry executives and lawyers.6 As you can imagine, these individuals were not as likely to fund projects that could reveal the negative health effects of second-hand smoke. The tobacco research available at the time was used to inform policies that have directly impacted public health.
3) What are scientists doing with the money? What are their opinions?
For scientists who receive industry funding, their research agendas tend to shift away from basic research, which aims to understand the world around us (“Why does this exist?”), towards more applied research with specific commercial applications (“How can we use this?”). In fact, every 10% increase in private funding is associated with a 1.2% drop in a program’s basic research.7 Asking “why” questions is so important because it lays down a foundation for other science to build on.8 As an example, mathematical models used in basic psychological research have been applied to understand how people who use substances make decisions.9
But what do the scientists doing the work think about this shift? It depends on who you ask. Fabbri and colleagues2 found that across a few studies, scientists in academia and industry agreed that there is a risk of research becoming more commercial and applied with industry funding. In one study, industry funded researchers were more likely to think that the funding would lead to new and promising areas of research, whereas those who were not funded by industry were more likely to think the funding would lead to quick fixes, rather than long-term basic research.10
Nonetheless, some laboratories have collaboratively set a research agenda with their industry funders that was both basic and applied, with oversight by company executives and an academic research director.11 Such collaborations may be the key to balancing industry involvement in the future.
What can I do as a research participant?
You might be thinking, “So scientists know that their research is likely being influenced by industry research. What can I do about it?” Here are some tips.
Whenever you’re participating in research, look out for funding disclosures in the consent forms. Who funded the study? Governmental agencies? Private companies?
If you’re unsure, have a discussion with the research staff and principal investigator. Ask about the influence of their funding on the design and publication of the study.
You can also inquire with the institutional Research Ethics Board (REB). The REB is meant to protect the rights and safety of research participants. Their contact information is typically listed on consent forms.
Advocate for greater independent research funding (e.g., by governmental agencies) by lobbying local government officials. In Canada, the government pledged $4 billion in 2018 over 5 years for science across its main funding agencies.12
According to the Government of Canada’s 2018 Panel of Research Ethics,13 REBs are required to have one community member with no affiliation to the institution, so consider joining an REB to represent community voices that are not influenced by industry.
If you’re reading the results from a study in the media, check to see if the funding disclosures are reported. This may mean finding the original publication and/or getting in touch with the researchers.
Remember, researchers are always looking for study participants and you can choose which studies you participate in. Your participation may ultimately guide the development of new products, drugs, therapies, and treatments. So next time you’re at your doctor’s office, wondering about your treatment options, ask yourself: Why is this my best treatment option? Where did this claim come from? Who may be benefiting from me choosing this option?
This doesn’t mean you should be suspicious of all science, but if you follow the money, you might be surprised at what you find.
As you leave the doctor’s office to pick up a bottle of that new “Strainadol” drug that your doctor prescribed, you take another look at the poster. You realize the logo in the corner might be for a pharmaceutical company you saw in the news recently. You think, “Maybe I’ll look up what that clinical trial was all about and ask my doctor more about it.”
Fabbri, A., Lai, A., Grundy, Q., & Bero, L. A. (2018). The influence of industry sponsorship on the research agenda: A scoping review. American Journal of Public Health, 108(11), e9-e16. https://doi.org/10.2105/ajph.2018.304677
Arnolds, S., Heckermann, S., Heise, T., & Sawicki, P. T. (2015). Spectrum of diabetes research does not reflect patients’ scientific preferences: A longitudinal evaluation of diabetes research areas 2010–2013 vs. a cross-sectional survey in patients with diabetes. Experimental and Clinical Endocrinology & Diabetes, 123(05), 299-302. https://doi.org/10.1055/s-0034-1398591
Phillips, J. K., Ford, M. A., Bonnie, R. J., & National Academies of Sciences, Engineering, and Medicine. (2017). Evidence on Strategies for Addressing the Opioid Epidemic. In PainManagement and the Opioid Epidemic: Balancing Societal and Individual Benefits andRisks of Prescription Opioid Use. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK458653/
Barnes, D. E., & Bero, L. A. (1996). Industry-funded research and conflict of interest: An analysis of research sponsored by the tobacco industry through the Center for Indoor Air Research. Journal of Health Politics, Policy and Law, 21(3), 515-542. https://doi.org/10.1215/03616878-21-3-515
“Addict” or “junkie” are some of the words that are used to refer to people who have difficulties with their substance use. These are words used by people in the media (just one for example) and in our communities, and perhaps you have even used them as well. These words should be avoided, and here are some of the important reasons why.
An important place to start is to understand stigma.
Close your eyes and take a moment to imagine a recent media story or film that spoke about or portrayed someone who uses substances heavily. Perhaps they shared some negative beliefs and attitudes (or stereotypes) about how this person would behave, what they look and sound like, and what it would be like to spend time with them. The negative beliefs and attitudes towards people with addiction is called stigma.
Stigma is a problem with many health conditions, and we continue to see it with addiction. Stigma can truly hurt people coping with substance use related difficulties in many ways. Research has shown that fear of stigma is one of the top reasons that people choose not to get treatment for their substance use (Table 7.67B).1 When someone gets treatment, stigma can also get in the way of their successful treatment and recovery.2 Unfortunately, we also see that stigma can be an issue for treatment providers who are not properly trained to work with people who use substances.3
There is a ripple-effect of individual’s stigmatizing beliefs. The effects of stigma can go well-beyond the interactions between someone who uses substances and other individuals. People in positions of power may make decisions based on stigmatizing beliefs that can ultimately harm individuals who use substances.
“the legitimate fear around contagion may mean that bystanders or even first responders will be reluctant to administer naloxone to people who have overdosed. And there is a danger that overtaxed hospitals will preferentially pass over those with obvious drug problems when making difficult decisions about where to direct lifesaving personnel and resources.”4
Dr. Nora Volkow
How the words we use promote stigma.
Remember the saying “sticks and stones may break my bones, but words can never hurt me”? Whoever coined this phrase did not consider the effects of stigmatizing language.
Research has shown that the language we use to refer to people who use or have difficulties with substance use can impact how we treat them. One example of this is a study by Goodyear, Haass-Koffler, and Chavanne (2018) where participants read descriptions of people referred to as a “drug addict” versus official terms like “opioid use disorder.”5 They found that there were more stigmatizing attitudes towards individuals labeled as a “drug addict” than those labeled as having an “opioid use disorder.”
It is not hard to imagine how stigmatizing language can play out in a number of real-world settings to make a major impact.
Tips: Use words that describe – not stigmatize.
At this point, you may be wondering, what words could I use to describe these experiences? There are many helpful online resources that describe terms to avoid versus terms to use, and why, such as the primer on Overcoming Stigma through Language.6 Here is a summary of some of the important takeaways:
Use “person-first” language: Put the words that refer to the individual before the words that describe their behaviours or conditions. For instance, instead of using terms like “alcoholic” or “addict”, a person would be described as “person with an alcohol use disorder.”
Use official terms the reflect the condition: Using the medical language can help frame addiction as a health issue and a disease. Therefore, it is best to use official diagnostic language like “substance use disorder” instead of use words like “drug abuse” or “junkie.”
Avoid slang and idiomatic expressions: Using slang to describe an individuals’ involvement with substance use often means that pejorative or biased language is being used (“pot head”, “strung out”, “getting clean”, as examples). Instead, it is best to describe behaviours and experiences with literal terms, like “someone who uses cannabis”, “someone who is intoxicated”, or “someone who is in treatment for their substance use.
This is just the start of the conversation.
Now that you know about the power of words and how to talk about substance use is a less stigmatizing way, it is time to put this knowledge into action! Together, we can make a real impact to reduce stigmatizing language by correctly the words that we use and educating the people around us to use less stigmatizing language.
Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved Sept 28, 2020, from https://www.samhsa.gov/data/
Crapanzano, K. A., Hammarlund, R., Ahmad, B., Hunsinger, N., & Kullar, R. (2018). The association between perceived stigma and substance use disorder treatment outcomes: A review. Substance Abuse and Rehabilitation, 10, 1–12. https://doi.org/10.2147/SAR.S183252
Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare Management Forum, 30(2), 111-116. https://doi.org/10.1177/0840470416679413