Use of Language in Recovery

(0:08) Christina Lanier: Welcome back to Justice to Healing. I'm the co-host Christina Lanier and co-director of the National Drug Court Resource Center. Also with me today is the other co-director and co-host Kristen DeVall. Thanks for tuning in. Today we are talking about an important topic, and that's the use of language in the context of the criminal justice system, treatment, and recovery. We are very excited to have Michelle Gunn as our guest today. She's the director of Recidivism Reduction Services and RESET, the Re-Entry Systems of Effective Treatment at Coastal Horizon Center in Wilmington. Welcome, Michelle! 

(0:42) Michelle Gunn: Thank you so much. It's great to be here. 

(0:44) CL: We're excited to have you. Can you tell us just a little bit about yourself and your background before we get started? 

(0:51) MG: Absolutely. Again, my name is Michelle Gunn. I'm actually from Wilmington, North Carolina. I grew up here, so I am truly a Native. I've seen the community certainly grow in the years that I've been here and I've seen, at times, when I wanted growth and unfortunately was not able to see it. The criminal justice system as well as the recovery system is truly important to me simply because it has impacted many people that I know. It has impacted family members, it has disproportionately impacted people who look like me. So I am truly invested in the language that people use to describe not only myself but my loved ones, my community, and my friends. So again, thank you so much for inviting me today. 

(1:52) CL: Thanks Michelle. We're really excited to have you here as well. So we thought we would start off with just a brief discussion of the research that looks at the influence of language and how language impacts individuals, especially in the area of treatment and recovery. So one of the things that we know from research is that about 10% of individuals in need of treatment actually access that treatment. And the reason is that they feel that stigmatized language that is often directed at them keeps them from seeking that help. So when we focus on language within treatment recovery and even the criminal justice system as a whole, we have to think about the words that we use, how they influence an individual's behavior. For example, using words like “addict,” “substance abuser,” “somebody with a mental health disorder,” may be calling them, having a different term to use for them. They really, the blame and the judgment that is directed at the individual is one that is directed at them as, “they have a problem and it is their fault.” So when we're talking about individuals, one of the things that the research talks about is really comparing these conditions such as substance use disorder with other types of conditions or diseases, and so thinking about them as a disease versus a moral issue or something that's wrong with the individual. What do you guys think about that? 

(3:35) MG: I absolutely agree. I think that language is extremely important simply because in the criminal justice system, people are not their worst mistake, nor should they be defined by it. Whenever we're talking about substance use I think it's important to use people-first language or person-centered language. So if someone, for an example, has used heroin in the past or has used crack in the past, I have certainly heard people say “crack addict,” I've heard people say “crackhead,” I've heard people say “heroin addict.” But if we simply start the phrase by “a person who” – so it could simply be, “a person who has a substance use diagnosis” – that allows, first of all, for us to humanize the person and so if we start there, I think that that is the pathway to a lot of things changing. So not only in that particular example; an example that I see very often, especially in grants as well, we ask individuals, or on the application, “what's your drug of choice?” And using that phrase and/or terminology implies that that person had a choice in that matter and chose to be marginalized, chose to have individuals think about him or her a certain way, but that isn't a choice for that person. So I think that if we ask the person, for an example, “what substance has caused you the most harm?” “What substance do you want to stop using?” I think if we pay particular attention to the language that we use, individuals will access treatment and the percentages that access treatment won't be as low as you stated before. 

(5:49) Even with that, I want the opportunity to narrate my own story. I don't want you telling my story. I am the person who best knows what's best for me. And so I see that a lot of folks don't take that into consideration. I also think that language not only interrupts the human connection that people have, but it interrupts the human capacity of people. We have individuals that may have a substance use disorder in every field, whether it's an attorney, whether it's a doctor, whether it's a teacher, and we know that these individuals certainly have human capacity to achieve a lot. However, we oftentimes discard individuals whenever they have a substance use disorder. We oftentimes discard individuals when they have a criminal history; and then we further complicate it by the language that we use. We call individuals “offenders.” We call individuals, you know, “robbers,” “murderers,” (CL: “felons,”) certainly defining them by their worst mistake. So if we were to imagine, whenever we use the word “felon” or “offender” or “addict,” what pictures automatically generate in our head? What pictures do we see in the media? Certainly that has an impact. And so one way, I think, certainly to help individuals and to support individuals, is certainly about humanizing them, and we start with using the language that truly humanizes. 

(7:51) Kristen DeVall: I think that's a great point Michelle. And one thing that we should all remember working within the criminal justice system and providing services to folks with substance use disorders, mental health conditions, is that we all want the same thing. We all want recovery. We want folks to achieve their full capacity. And so if we know that language is a barrier to folks accessing treatment as well as being successful in treatment, we need to change that and we need to remove that known barrier. It's simple, right? It's about being conscious and intentional about the words that we use, and how can that facilitate for folks really meaningful, long-lasting change? 

(8:45) CL: Yeah, for sure. One of the things that I found really interesting in the research, and I guess, a bit surprising, was some of the research that looked at how healthcare workers or workers within the healthcare field, even those that are within treatment – the perceptions of those individuals, those workers, those employees of those fields – when they were presented with the word “substance abuser” as a descriptor for someone, and “substance use disorder,” “a person with a substance use disorder” and a vignette. The difference and how those respondents perceived those individuals just based on that one descriptor was, I would say, shocking. When the person was described as a “substance abuser,” they were more likely to be seen as stereotypical, they’re the ones with the problem, maybe even identify them as a criminal. When they were told “a person with a substance use disorder,” then it's tended to medicalize the individual and present the opportunities for treatment and help. And so medicalizing, thinking about this as a medical issue and not applying moralism is really the challenge, I think, across the board. Seeing it as something that is medical, is perhaps a disease in some cases, and being able to get healthcare and clinicians and all of those to see the influence that language can have. One of the articles that we were looking at talked about sticks and stones may break my bones, but words will never hurt me, right? Words hurt, and they matter! They matter. 

(10:55) MG: Yeah, they absolutely matter. You know, just think about, again, the images that come to your mind whenever you use the word “abuser.” Not even “substance abuser,” just “abuser.” So again, defining folks sometimes by their worst mistake or defining folks, or judging folks, based on a medical issue. Certainly there's all sorts of reasons to change that mindset. 

(11:27) CL: And thinking about it, I think [of] the language piece as one that promotes the recovery process. So are we helping the individual to move forward in their recovery process? Are we hindering them with our words? 

(11:48) KD: Michelle, given your experience working in both recovery as well as the larger criminal justice system, can you think of a scenario that really exemplifies why language is important? 

(12:00) MG: Absolutely. When working with individual clients, one particular client comes to mind. A young lady that was justice-involved and also had a substance use disorder. Oftentimes whenever she would come into the office, she would call herself a “crackhead.” She would say that whenever her children were born, that in reference to her children being born, that she had “crack babies.” So as we develop rapport and continue to meet we started talking about the importance of language. So not only your words that I use and that she use[s] but really truly meaning what we say, and so fully embracing that. So I'm not just using it because I am one-on-one with a client per se, really and truly embracing that whenever I'm out in the community, whenever we happen to go somewhere. So again, we continue the discussion and very often continue the discussion. And I remember when I invited her to a community meeting. And during that meeting space we were talking about language, and I think the lightbulb really and truly went off at that particular time. She stood up and she said her name, and she said that today, she is a person and just simply that was all she said. And when we met a little later, she stated that she understood that it was important for her to identify herself by her successes, the strengths that she had, so that her kids can also see her in that manner. 

(14:24) MG: She also began to become a part of that particular group that met on a weekly basis and that group was filled with individuals that maybe were justice-involved, individuals that maybe were or had a diagnosis of substance use disorder, but that group was filled mostly with community members, additional community members. It was filled with (and not two separate the two) elected officials as well. And so she and I both thought that it was instrumental with her being there, because we believe that truly amplifying the voices of people that are closest to the problem allows us to get at the center of the solution. And so included in that, would include, language that we use for individuals that have a substance use diagnosis. It includes language that we use for individuals that are in the criminal justice system. So if we include those individuals into the conversation, they most importantly are able to certainly tell you what their preference is because again, I don't believe in narrating someone else's story. Their story is truly very intricate and I want to respect their story and I want to give them as much support in telling their story as possible. 

(16:18) MG: So in this particular situation, it not only confirmed for me the importance of language, but it also confirmed for me that oftentimes our society thinks that those justice-involved individuals or individuals that have a substance use disorder are on the periphery, and they should be right in the center of making decisions and making policies so that we can truly humanize this issue. And so today, that particular person, she is instrumental in her children's life today, which she wasn’t previously; and she is also instrumental in advocacy in the community and encouraging young women to refer to themselves in the best light possible. So I think that she is truly an extension that allows others to kind of reach her and just simply talk about themselves in a more positive light, which I think was vital to her and it certainly vital to the folks, which is great. 

(17:39) CL: Wow, that is so great and so powerful. Totally agree that having those individuals as part of the conversation is really key to growing our understanding of lots of things but of the importance of language and how one is defined. 

(18:00) KD: Michelle that example that you gave is a really good one, highlighting the importance of self-perception, and how we see ourselves; and so the question of how and why language is important to the work that is done in treatment courts and the larger criminal justice system has a deeply rooted theoretical foundation. Labeling Theory (and some of you may be familiar with Howard Becker's work) asserts that the definitions of what constitutes deviance or crime is done so by people in positions of power and codified into law. These laws are interpreted and enforced by practitioners within the criminal justice system: police, courts, and corrections. And we know that people's behavior is influenced by the label that is attached to them by society. When we apply the negative labels, as we discussed a few minutes ago, to individuals, several things result. They may increase their association with similarly labeled individuals. 

(18:59) KD: So when we think about a peer group, those are oftentimes folks with similar labels. People might alter their own perception of self and they may change their attitudes and beliefs about the social world, about their position within the social world, their abilities. Moreover, they also may experienced blocked opportunities. There's a lot of evidence around the impact of being involved in a criminal justice system, having a criminal record, negatively impacting one's ability to secure housing, employment, potentially custody of your children. There are real implications for being labeled and having a negative label attached to you. Given all of that, we know that labeled individuals may internalize those labels and engage in what we call a self-fulfilling prophecy, which really means that people start to see themselves in terms of these negative labels. It's almost like putting on a set of glasses and looking at the social world through the filter of these labels and the associated consequences of those labels. We also know that labels and the associated consequences may have a cumulative effect, which may further result in alienation from one's community, one’s neighborhood, one’s family, one’s peer group, because of that stigma associated with the labels. You may be thinking this is all doom and gloom, but not all is lost. Individuals are able to overcome labels but to do so, they must have positive supports that don't subscribe to those labels and also the ability to access opportunities.

(20:33) KD: One example of this in New Hanover County and the city of Wilmington is the Ban the Box. So this is a policy that has been implemented where individuals applying for a job no longer have to answer the question about whether or not they have a criminal history. Removing that question on the job application has allowed individuals with a criminal history to increase the likelihood of securing employment. Changing the language will remove the stigma associated with being involved with the criminal justice system and help facilitate the rehabilitation and recovery processes. 

(21:05) MG: I think changing the language is important, but certainly it's only one step toward humanizing this issue. I also agree with banning the box. I know from personal experience and from individuals that certainly have talked to me about it in our local community. It has been important for individuals because it provides hope for individuals. Instead of completing an application as they did previously that asks those words – “Are you a felon?” “Have you committed a crime in the last seven years?” – certainly words that we don't want to use; the removal of that on the application provided hope for a lot of people. In our community, housing, for an example, is a huge issue. The cost of housing is a huge issue. So people deserve the opportunity to be able to afford somewhere safe to live. And so with New Hanover County and the city of Wilmington banning the box on the application process, it provided that opportunity for people. 

(22:34) MG: So it's more than the language has disappeared from the application. It is providing hope, it is providing opportunities for folks because the collateral consequences of being justice-involved or having a substance use diagnosis reaches all corners and all aspects of our community, of our state, of our world. Individuals with the most basic of human needs, such as housing, were unable to secure housing because of their criminal record. It doesn't matter how long ago that crime was committed. It could have been 10, 20, 30, 40 years ago – individuals are still denied basic human needs because of it. So certainly I certainly agree with Ban the Box and providing opportunities for folks, and providing hope so that folks can not only live out their dream.

(23:50) MG: But as we have worked in this field, I have noticed that unfortunately I may see mom, I may see grandmother, I may see auntie, so I understand that it's extremely cyclic. So in order to stop this generational thing that's going on, I think that we start at language, we start at Ban the Box, we start at humanizing individuals, but we can't stop there because we have truly generations of families who this issue has certainly touched, this issue has disrupted their families and in order for their family to see change, I think those issues that you brought up previously are certainly important, but we just can't stop there, we certainly must continue.

(24:55) MG: And so how do I advocate? How do I want to advocate for folks in that particular position? I also heard you earlier whenever you were talking about Becker and Labeling Theory; about people in power kind of make those labels, enforce the rules, and that, in the bigger society is oftentimes what happens. And so it almost creates in my mind, whenever you said that, a caste system, and so, which applies to the language that we use for individuals which further dehumanizes individuals. And certainly we know prominent people have had substance use disorders. We know prominent people who have a criminal history. We know that those individuals had the human capacity to become a lawyer, a doctor, or whatever it is. So what I don't want to do is interrupt that pattern. I want to be able to simply humanize individuals. I want folks certainly to be able to be gainfully employed, to be able to take care of their family. And all of those collateral consequences, I think, are a result of, or partially a result of, the language that we use. Because we have dehumanized individuals. We have in policy used words that whenever people think of them or hear them, it's a negative thought. It is a “person who may commit a crime” or whatever. And so how do we begin to change that perception? It’s something that certainly I think about a lot but I would really love to certainly change the perception of whenever we hear the word “abuser,” whenever we hear the word “addict,” whenever we hear the word “user,” whenever we even sweeten up the pot and say “recovering addict” as if that was better, which it’s not. So certainly I just want to emphasize the positive nature of individuals so, you know, maybe “a person living with” whatever. So, how do we really and truly change language? Not only the language that we speak, the language that we embrace, the language that we hear on media, hear on the television, I think is critically important. 

(28:04) KD: I think that's a great point Michelle, and what you really touched on is the importance of language we use in our everyday lives, the language of policy, it really encompasses all of that. And so this is something that every single one of us can take on as a charge to be mindful of the words that we use and think about the implications of that for people with feelings, people with potential, and sometimes people with potential that they don't even know that they have. And so I think it's a great point. 

(28:38) CL: I think that really leads us to a discussion around perhaps what words should be used or what words do we think would be better than. We’ve referred to a few times the idea of replacing something like “substance user,” “addict” with “a person with a substance use disorder,” or “a person with a substance use diagnosis.” One of the areas that Michelle has enlightened us about as we communicated with her over the years is the idea of changing the individual who may have been incarcerated, taking those words away – “ex-felon,” “ex-offender,” “defendant” – and replacing them with things or words or phrases like, “a person with previous criminal justice experience.” What other ones have you used, Michelle? 

(29:36) MG: “Justice-involved individuals,” but what I generally tell people is that whenever they ask, “so what should I call him? What should I call her?” I always say first, by their name. So if you know them, you should call them by their name. But certainly “justice-involved individual,” “a person with a previous legal history” are all terms that certainly I've used before. And so what I try to do is just think about first, a person, certainly if I don't know his or her name. And then if I know a little bit about that person, so this person who may have served 20 years in prison previously and now he's out of prison: he went to our local community college, received a welding certification, is now employed. Although I know his name, I choose not to say his name, however, what I could say is “the welder,” you know, because I want to pick out certainly the positive aspects of him: “the graduate,” certainly “the degree-earner,” or what. I want to pick out something that is positive about him or her and I don't necessarily always want to highlight what has been a part of that person's life, no matter how big or small, because there are so many more parts to that particular person. So certainly asking the person [how] he or she would like to [be] referred [to], and if that isn't possible at the time, certainly “a person with a substance use disorder,” or if we're talking about a cohort group of individuals and we must describe them, “someone who may have had legal experience in the past” or “legal history in the past.” But I certainly don't want to ever define someone what they declare as their worst mistake. We've all had mistakes. We've all wanted do-overs that we haven't had the opportunity to kind of do over, and if I think of my absolute thing that I would love a do-over on, and haven’t had the opportunity to do it over, but individuals in the public refer to me as that, I don't think that that's right nor is that helpful to me in any way in trying to achieve my goals, my hopes, my dreams, my aspirations. So that's definitely a concern to me that I'm hopeful that as people begin to talk more and more about the importance of language will certainly be addressed. 

(32:43) CL: You know using words, as we've talked about, is really important. One thing that in our work with treatment courts, or drug courts, or recovery courts, depending on the verbiage that's used, is the idea of results from say, a drug screen or drug and alcohol screen – which you all deal with that as well, the work that you do – and I think some people miss the boat on the idea that something is dirty and something is clean, right? The connotations of that, the stigma associated with that is really, really high. So one of the things that we think we can provide is, what's another – and it's not necessarily the fault of the person reporting it, as such, that's how they were trained, that's what they learn – so I see it as our job to say, “okay, that might be how you did it before, but let us help you to use less stigmatizing language.” So when we're talking about things like drug and alcohol screens or your analysis screens, again, whichever word best fits it, we don't want to use words like “a dirty screen” to indicate that somebody perhaps was positive for a particular substance. So think about this: you might want to use a term like, “a positive test result,” or, “a positive urinalysis result.” Similarly when we talk about somebody who perhaps had a negative test result, we sometimes use the phrase “a clean test.” That dichotomy of “dirty” and “clean,” you’re dirty or clean, you’re dirty or clean, again, the imagery that comes with that: just those two words, “dirty” and “clean.”

(34:25) MG: Absolutely. I certainly agree with that. We can also use, “the UDS results indicated use in” whatever substance, “the UDS results indicated no use.” I think, yeah, “dirty” and “clean” are, like you said, the dichotomy of those two words and the implications of that, certainly more far-reaching than just to that particular person. But when and if we see that in documentation as case managers, social workers, therapists, whoever is reading that documentation: the thoughts that may go through that person's mind before the person even enters the room, before the person even enters the session, to see that written – the person is dirty, and/or the person is clean – so I think referencing that is important, as individuals who are seeking treatment don’t need an additional barrier.

(35:36) CL: Those words definitely are important to try and replace. Some other words that we may have heard are things like “junkie” or “druggie,” those types of things, it was mentioned “addict” already; and really thinking about replacing those words with that human-centered, person-first language. When we use those terms like “substance abuser,” “alcohol abuser,” et cetera, I think it really implies that the individual’s making these willful choices and really denies the power of the drug or the substance or whatever that person is having a challenge with.

(36:15) CL: There's another area that we've touched on, is, when it comes to what we've referenced a few times today: “treatment courts,” “recovery courts,” “problem-solving courts.” And so we've really seen a shift in language when it comes to those types of courts and really thinking about, what's the goal of those courts? What are they hoping to achieve? And does an “adult drug court” have a different connotation or a different influence than “adult treatment court?”

(36:54) KD: Yes, so we've seen a shift within the treatment court field to some more recovery-oriented language. For example, instead of embracing this idea of a “juvenile drug court,” a “juvenile treatment court” or a “wellness court.” So really embracing this idea of a change process, of less stigmatizing language, and really putting participants first, right? These are individuals enrolled in programs, with a substance use disorder, a mental health disorder; and so how can the language of these programs either hinder that recovery process or facilitate them? And so I think really, again, as we think about changing terminology and changing the language that we use, keeping in mind what the goals of these programs are, ultimately we want folks to engage in recovery. We want them to rehabilitate themselves or habilitate themselves in some instances. And so how can language, something very simple – doesn’t cost a penny but is so powerful – we know words matter. We know language has meaning, we know language has consequences, and so looking for the ways in which we all maybe contribute to the problem and the ways in which, on the flip side, that we can be part of the solution. We hope today's episode of the justice of healing podcast has been informative. So Michelle, what call-to-action can you give our listeners?

(38:25) MG: I think that the listeners should remember a time this week that they use the word or phrase that was dehumanizing to describe someone, whether they knew that person or not. Unfortunately, we've all done it this week, we have. So think about that and think about today what word or language you could use to describe that person and/or event, because today marks the day that we are all going to be intentional about the language that we use.

(38:57) KD: So listeners, please join us on the Justice to Healing discussion board on the ndcrc.org website to continue the dialogue and to share your ideas for incorporating recovery-oriented language in your personal and professional lives. Michelle, we would like to thank you for being our guest today. We really appreciate your time and expertise within this area.

(39:17) MG: Thank you so much for having me, I thoroughly enjoyed it. Thank you.

(39:22) KD: We hope you will join us on the next episode of the Justice to Healing podcast, and remember: we can all do better.

(39:30) Ben Yerby: To our listeners, we thank you for listening and we hope you enjoyed the show. Be sure to hit “subscribe” to stay updated on the podcast. Follow us on Facebook, Twitter, and LinkedIn to stay engaged with us and check out our website at ndcrc.org. Thanks again. Catch you next time on Justice to Healing. 

(39:45) Disclaimer: The Justice to Healing Podcast is presented by the National Drug Court Resource Center and is supported by the grant number 2019-DC-BX-K002 awarded by the Bureau of Justice Assistance which also includes the Bureau of Justice Assistance, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this podcast are those of the author and do not necessarily represent the official position or policies of the United States Department of Justice.