This is awesome. I've been waiting for the paper to show up ever since I saw the poster presentation at a meeting last year. Or maybe I just saw a related type of poster because I seem to recall the analysis being particularly critical of general medical doctors? At any rate, this is a pretty important finding because it speaks to the stigma that surrounds certain types of medical problems. This stigma might have serious implications for judicial decision making when crimes are involved, personal health care recommendations / efforts from physicians, etc. The paper is in the queue at the International Journal of Drug Policy.
Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms
John F. Kelly and Cassandra M. Westerhof, International Journal of Drug Policy, In Press, Corrected Proof, Available online 14 December 2009, [DOI]
I was alerted to the publication by the description here at Science Daily.
The investigators randomly distributed surveys to more than 700 mental health professionals attending two 2008 conferences focused on mental health and addiction. The surveys began with a paragraph describing the current situation of "Mr. Williams," who is having trouble adhering to a court-ordered treatment program requiring abstinence from alcohol and other drugs. On half of the surveys, he is referred to as a "substance abuser;" on the others, he is described as having "a substance use disorder," with the rest of the narrative being exactly the same. The survey consisted of 32 statements about Mr. Williams' situation, and participants were asked to indicate how much they agreed or disagreed with those statements.
Subjects were mental health care providers recruited at two substance abuse related conferences in the fall of 2008. The 516 responding subjects completed a series of Likert-scale (1-6; strongly disagree to strongly agree) evaluations of statements such as the following.
His problem is caused by a reckless lifestyle
Mr. Williams is responsible for causing his problem
Mr. Williams' problem is God's will
He should be given some kind of jail sentence as a "wake up" call
Mr. Williams should be referred to a spiritual or natural healer
I believe he will do something violent to others
The judge should increase the severity of the consequences for any further alcohol or drug use
His problem is caused by the way in which he was raised
Mr. Williams could have avoided using alcohol and drugs
The investigators then performed an exploratory factor analysis- a statistical procedure in which the idea is to find groups of statements for which the answers tended to be correlated. From this they extracted three principal statement-grouping factors characterized as "perpetrator-punishment", "social threat", and "victim-treatment". The major focus of the study was on the independent manipulation of whether the narrative described the subject as "a substance abuser" or a person "with a substance use disorder". No group differences were found for social threat ("I would be willing to have Mr.Williams as a neighbor") or victim-treatment ("Mr. Williams' problem is caused by a chemical imbalance in the brain") type of statements. However, the characterization of "a substance abuser" or "with a substance use disorder" did influence responses on the perpetrator-punishment statements ("In order to help Mr.Williams stay on track, the judge should initiate disciplinary action").
those assigned the "substance abuser" term .. were significantly more in agreement with the notion that the character was personally culpable for his condition and more likely to agree that punitive measures be taken
The authors describe the statements which cluster in this perpetrator-punishment group as follows.
Overall, items associated with this subscale appear to convey internal causal attribution and personal culpability, a moral vs. medical solution, suggesting the character has volitional control and might be viewed as a "perpetrator"who is willfully engaging in the behavior and thus more deserving of punishment.
So the take home here is that we should endeavor to focus our descriptors on actions and diagnoses rather than on terms which imply essential characteristics of a person.
The authors do caution that their effect size was pretty small and the connection to real-world decision making unclear. But I buy their argument that since these were substance-abuse experienced mental healthcare professionals, one might expect this to be the floor of the effect. Those such as legislators, judges and even doctors who do not specialize in substance abuse might be predicted to be even more influenced by the way they perceive substance use. If perceiving it as a volitional or moral failing, they are likely to be more punitive and select less therapeutic options, I would argue.
Kelly, J., & Westerhoff, C. (2009). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms☆ International Journal of Drug Policy DOI: 10.1016/j.drugpo.2009.10.010
Massachusetts General Hospital (2010, January 14). Words used to describe substance-use patients can alter attitudes, contribute to stigma. ScienceDaily. Retrieved January 14, 2010, from http://www.sciencedaily.com/releases/2010/01/100113122310.htm