<v ->Hi, my name is Dr. Sarah Wakeman.</v> I'm an addiction medicine and general internist at Mass General Hospital, an Associate Professor of Medicine at Harvard Medical School, and Medical Director for Substance Use Disorders at Mass General Brigham. And I'm excited to talk to you today about this topic, Changing Language to Change Care: Stigma and Substance Use Disorder. I have no relevant financial relationships with ineligible companies to disclose. The overarching goal of PCSS is to train healthcare professionals in evidence-based practices for the prevention and treatment of opioid use disorders, particularly in prescribing medications, as well as the prevention and treatment of substance use disorders. At the conclusion of today's talk, I hope that you will be able to describe three examples of stigma in the way the medical system approaches people with substance use disorder, understand the importance of using medically appropriate language for substance use disorder, and use accurate and person-centered terminology when discussing substance use disorder. My outline for today, we're going to talk first about the fact that substance use exists along a continuum, that substance use disorder itself is a prevalent but very treatable health condition, and that stigma has resulted in huge gaps between science and clinical practice, and importantly, that language can be a perpetrator of stigma. Many of you will be well aware of the fact that we are in the midst of a worsening overdose crisis that is one of the major public health crises of our time. Obviously, COVID and the current pandemic has drawn much of our attention, but simmering in the background is the worsening overdose crisis, where we've surpassed 100,000 American lives lost per year to drug overdose, which is the highest we've ever seen in the history of this country. More people are dying from drug overdose than the peak number of people who died from HIV at the height of HIV crisis, and the peak number of people who died from car accidents or gun violence. So when you hear words like crisis or epidemic, the reason for that language is really the toll that the overdose crisis is taking on Americans and U.S. life expectancy. And one of the things that's so tragic about the overdose crisis is that all of these deaths are preventable. No one should die from an opioid-related overdose. We know how to reverse an overdose when it happens, we know how to keep people who are using drugs safe from dying from overdose, and importantly, we know how to identify and treat the underlying condition of substance use disorder for people who have that. And although much of the attention is focused on the drug overdose crisis, it's not only drug use disorder that's causing worsening morbidity and mortality, we're also seeing rising rates of alcohol-related morbidity and mortality. You can see on the right, increasing rates of mortality related to alcohol use across the population with a recent acceleration in the time period the end of the study leading up to 2016, and there's early data there have been increasing rates of heavy drinking in some populations since the onset of the COVID pandemic, as well. So when we step back and think about substance use and preventing harmful consequences of substance use, it's important to first acknowledge that substance use exists along a continuum. So although we'll talk a lot about substance use disorder and much of our language conversation will be related to that, most people who use substances like alcohol or other drugs never develop a substance use disorder. And some of the health consequences that can go along with substance use can occur irrespective of meeting criteria for substance use disorder. So if you look at the pyramid on the left from a seminal article by Dr. Rich Saitz in the New England Journal of Medicine, the sort of pyramid of the patterns of alcohol use across the population where a significant percentage of people, 50% in the last national survey on drug use and health, don't use alcohol at all in the past month. And then when we think about the continuum of use, so there's lower risk use, risky use, or unhealthy use, all the way up to alcohol use disorder, and we can see consequences along that continuum, as well. I think many of us are familiar with this continuum when we think about alcohol use, as it is a more socially accepted substance, and don't think of the same continuum when we think of other drugs like heroin or cocaine. And it's important to note that all substance use exists along a continuum, and most people who use drugs, including drugs that are not socially accepted, also never develop a substance use disorder. And so that sort of continuum can range from no use, to lower risk use, or even use of positive side effects, all the way up to unhealthy use that doesn't meet criteria for a substance use disorder, but is causing medical or other consequences in someone's life, and then substance use disorder, which we can diagnose and which we think of a lot in the context of PCSS and treating people with substance use disorder. So what is a substance use disorder? Well, first it's important to note that my first word here is treatable. It is a treatable condition. For many people who meet criteria, certainly for moderate to severe substance use disorder, it can be a chronic health condition. And the sort of defining characteristic is compulsive drug or alcohol seeking and use despite harmful consequences. So continued use despite bad things happening to you. For many people it can involve cycles of recurrence and remission much like other chronic health conditions. And it's deeply impacted by adverse childhood experiences, trauma, environment, exposures, untreated co-occurring psychiatric illness, and genetics, much like many other health conditions, where genetics are one piece of the risk for an individual's vulnerability for developing a health condition, but the other part of that is really environment exposure, and what's happened to someone over the life course. Adverse childhood experiences are an important one to mention, where really there's a strong and clear link between early childhood adversity and risk of subsequent substance use disorder. In terms of language, chronic and severe substance use disorder is commonly referred to as addiction, so you'll often hear those terms used interchangeably. And it's important to note that we also define remission. So much like we can make a diagnosis of substance use disorder with clear objective criteria, we can also define what remission looks like. So early remission would be going 3 to 12 months without meeting substance use disorder criteria, with the exception of craving, and sustained remission is 12 or more months without meeting substance use disorder criteria, with the exception of craving. And so, as I was describing those vulnerabilities and the definition, you may have heard echoes of other health conditions, and it's really important to note that substance use disorder meets criteria for other chronic illnesses. There are many shared common features, including heritability. There's a 40% to 60% genetic risk in terms of individuals' vulnerability for substance use disorder. And also, that influence by environment and behavior. So much like type two diabetes, where genetics plays a role, but also diet, exercise, behavior, environment, all play a role in terms of whether someone expresses that illness or not. Importantly, like other chronic conditions we treat in the medical system, substance use disorder responds to appropriate treatment. This is a highly treatable and good prognosis condition. But unfortunately again, like many chronic illnesses, without adequate treatment, for some people this can be a progressive and even a fatal condition. And again, paralleling other chronic conditions, there's a biological and physiological basis. The condition can be ongoing and long term and can involve recurrences even after someone meets criteria for full or partial remission. The important thing that really separates substance use disorder out from how other chronic conditions are thought about and treated is the deep impact of stereotype and stigma on how we practice when it comes to the medical field and thinking about substance use disorder and importantly, to our society's policies around drug use and people who use substances and have substance use disorder. This is an interview with Dr. Dole, who is one of the physician scientists who discovered methadone as a treatment for opioid use disorder, and he is actually an endocrinologist by training who stumbled into the field of addiction medicine. And in this interview reflecting on his career, he really thought back to the fact that he had to unlearn many of the stereotypes that he'd been exposed to simply by being a member of society. And we are all exposed to these, whether we realize them or not, that people who use certain types of drugs and people with substance use disorder, that they must be weak, that they can't be trusted, that they're dangerous, that they're unreliable, pleasure seeking, and yet these notions are completely false. Despite that, that stereotype of who is the person who uses certain types of drugs, or who is a person with addiction, have continued to drive our clinical practice and our policy, as well as our treatment models for, now really, the past 100 years. And addressing, identifying, and undoing that impact of stigma is crucial if we want to actually change care and improve outcomes. Thankfully, we've seen huge advances in the science of addiction and its treatment. So unlike other health crises like HIV epidemic or COVID where we really had to wait for scientific breakthroughs to understand what were effective interventions and treatments and prevention strategies, we have a wealth of knowledge from science about what works in terms of both preventing and treating substance use disorder. And as Dr. Volkow and Dr. Collins highlight in this New England Journal of Medicine, in the history of medicine, science has always been crucial as we think about addressing public health crises. And addressing the overdose crisis will be no different. We need to embrace what we understand from science and make sure we actually implement it into clinical practice. And yet, despite all of that science, and huge advances, huge investment in research, amazing physicians, scientists, and clinicians, and advocates, and people with lived experience who have been working in this space to show us what works and what doesn't, there continues to be a tremendous gap between what we know and what actually happens in care, where much of what's called treatment in the addiction world would frankly be malpractice if we practiced it for any other health condition. And that there's this big disparity between how we think about, talk about, and care for people with substance use disorder versus other health conditions like heart disease or diabetes or depression. So it's a little thought exercise. What would it look like if we treated other diseases the way we treat substance use disorder? So imagine that you go to a hospital with chest pain and you're found to be having a heart attack. What if you were told that it was your fault because of the choices you'd made, if you were denied treatment because you had done it to yourself, if you were lucky maybe you'd get a list of cardiologists and cath labs to call on your own to somehow find life saving treatment, if you were only given life saving medication if you agreed to first go to counseling or talk to a nutritionist, and worse, if you were actually kicked out of care, kicked out of the hospital if you had ongoing symptoms of chest pain of your heart attack. Obviously, any one of these things would be completely ludicrous if it were applied to someone who was in the throes of an acute and potentially life threatening presentation of cardiovascular disease, and yet, this is exactly what happens too often across the country, in institution after institution, for people with substance use disorder. So what would it look like instead if we treated substance use disorder the way we treat other diseases? Well, then we might change things so that the only prerequisite for getting treatment is simply having a substance use disorder, much like for a heart attack where no matter what emergency room you walk into, what hospital you go to, you are going to receive immediate and life saving treatment and you're going to receive the same bundle of evidence-based options that you would regardless of institution. That treatment would be based on science and delivered with compassion. It would involve shared decision making with patients and be centered on your goals as an individual and a human being, so educating you about what the evidence shows would be most effective, but allowing you to make a choice based on your individual circumstances about what meets your needs and meets your goals. We would create a system that really offers treatment on demand, right, that's what we have in the rest of the healthcare system. You don't get put into an intensive care unit because that's sort of your preference or that's what you can pay for, it's really based on what you need in that moment and in triaging and clinical decision making. And to that point, care would be triaged based on who needs it the most, which unfortunately is often the opposite of the way the addiction treatment world has worked, where people who are most able to access care are those who are most able to advocate for themselves, and sometimes they are less sick, whereas folks who are most vulnerable and most marginalized and most need immediate life-saving treatment are often the least able to get it. You would never be fired for having symptoms of your illness. So just like we would never kick someone out of the hospital because they had another heart attack, why is it at all acceptable to kick someone out of care out of the hospital setting because they continue to use drugs? And patients and families would be given the right and enough evidence to make informed decisions, which simply does not happen now. They would not be expected to navigate a complex system on their own and decide what the right treatment is for them without any science in terms of informing that decision. We would really support them much like we do as clinicians for other health conditions. And importantly, people would be offered a menu of treatment options. So as an internist, I may think that someone should start insulin based on the presentation of their diabetes, but if they are terrified of needles, not ready for that, or don't have a refrigerator, I wouldn't say take it or leave it, if you're not ready for this, then you're clearly unmotivated, you're in denial, come back when you're ready to do what I think you should do. I would talk to them about how can we address barriers and maybe we would start with an oral medication. And start where they are and continue to partner with them towards their health goals and their life goals. So why does care look so different for substance use disorder compared to other health conditions? Well, stigma is one of the driving factors of this. In a World Health Organization study of 18 of the most stigmatized social problems in 14 countries, drug use disorder ranked number one as the most stigmatized social problem, more than anything else, and alcohol is number four. So this is a global issue of stigma, although in the United States, in part because of some of our policies and our history of criminalization, that stigma is really enhanced in how we treat and respond to people with substance use disorder. We know that stigma is associated with poor mental and physical health outcomes amongst people who use drugs. Many people avoid coming into healthcare settings, leave prematurely, delay getting care, because they've experienced stigma when they've tried to access care in the past. And stigma is among the top reasons why people don't access substance use disorder treatment, as well. This has been enshrined in our drug policy and ongoing criminalization of people who use certain types of drugs. The whole point of criminal laws, the whole point of making something illegal is to stigmatize it. And so, in this moment where there's this huge dichotomy where on the one hand we talk about drug use and addiction publicly as a health condition, and it's very popular now to hear people say that we can't arrest our way out of this crisis and that this is a public health problem, and yet our policies and our laws enshrine that in fact we treat this like a criminal legal issue and we punish people, particularly minoritized individuals, when it comes to thinking about certain types of drug use. So what is stigma? Well, "Stigma is a social process linked to power and control, which leads to creating stereotypes and assigning labels to those that are considered to deviate from the norm or to behave badly. Stigma creates the social conditions that make people who use drugs believe they are not deserving of being treated with dignity and respect, perpetuating feelings of fear and isolation." There are really two main factors that influence stigma, and those are cause and controllability. So stigma increases if the notion is that a person is to blame for their condition, that they caused it, and if you think that they could control it, that they could do differently if they wanted to. So stigma decreases when we think well, it's not their fault. So take breast cancer, for example, a condition that doesn't have much stigma and invokes a ton of empathy. Often people's immediate response is, "Oh my goodness, this person, it's not their fault. This is a terrible stroke of bad luck, an awful thing that's happened to them. And they can't help it. There's nothing they could have done to prevent this or to change it." In contrast, again with substance use disorder, often the notion is that it is this person's fault. Again, getting back to sort of our cultural ideology that people who use certain types of drugs have made a bad choice or done something wrong, and we often do think that they could just control it and do better despite the fact that the hallmark of the condition is not being able to stop despite bad things happening to you. And our language reflects that. So if you think about the language we use for other illnesses, we talk about people as being patients, victims, survivors, we talk about them enduring their condition, suffering from it, being a fighter, being afflicted by it, a very different language really, of sort of again, getting back to that cause and controllability, this notion that people didn't cause what they're dealing with, and they can't control it, and we feel tremendous empathy for them. In contrast, when we think about the language we use for people with substance use disorder, it's really full of words that we would never use for another health condition. We use words like abuse and abuser. We talk about people's toxicology testing as being dirty, even referring to someone in remission, using a word we might think is positive, to call someone clean, really implies that someone who's actively using drugs or has active substance use disorder is dirty. And we would never say that for another health condition. So I wouldn't tell a patient, "Your blood was dirty with cholesterol. You're abusing sugar." That sort of language just isn't used when it comes to other types of chronic health conditions. And so if we think about some of the language, in particular, one of the most pernicious terms is the term "abuse". So the term "abuse" is actually derived from a word which means a wicked act or practice, a shameful thing, a violation of decency. And if you think about what other states or conditions or actions we use the term abuse for, it's really violent and horrible, willful acts of commissions. It's associated with behavior like rape, so sexual abuse, domestic violence, thinking about domestic abuse, and physical violence, or violence towards children, like child abuse. These are horrible terms. We don't have any other health conditions where we would use the term abuse for. And this may sound like it's just an issue of semantics or being politically correct, but it's not. It turns out language influences how we think about people, our own biases, and as clinicians it impacts our clinical decision making. And so there is the study where they took highly trained clinicians, PhD level psychologists and masters level therapists, and they gave them a vignette where the only thing they change was whether they describe the person as a person with a substance use disorder or a substance abuser, and then they ask the clinician to make treatment recommendations. And it turns out that when a patient is described as a substance abuser, the clinician is actually more likely to recommend a punitive treatment plan. So that language subtly impacts us and impacts how we think about people. Even terms like clean, which I think many people think of as a positive thing, that you're saying something nice, you're actually implying that someone who is actively using is dirty. So again, this isn't a term we would use for other health conditions. It's the term we use for laundry or for needing to take a bath. And as this social worker commented on Twitter "When coworkers ask me if a client is 'clean', I'll say, 'Yeah, there is no detectable malodor and their hygiene was good. Clothes were laundered and weather appropriate.'" So nice sometimes to use humor to recognize how really problematic and backwards language that we've come to be accustomed to is. Thankfully, the "AP Stylebook", which guides journalists, now recommends avoiding terms like clean, as well as abuse and addict, and we're seeing more appropriate terminology be recommended, which is really crucial because journalism and the press are often how these narratives get perpetuated to the general public, and so using appropriate terminology will help change that, and also help reduce stigma. So what are the types of stigmas for substance use disorder? First is stigma from within, so internalized stigma because of all of this external stigma. So people might blame themselves. They might feel hopeless that things will never get better, that they'll never be able to achieve remission. There's stigma within the recovery community. So the very community where people are engaging for support and sort of that shared lived experience, particularly when it comes to medications. So there continues to be stigma that medications like methadone or buprenorphine are somehow less valid pathways to remission and recovery than non-medication-based treatment. That can lead to tremendous stigma and actually impact people's treatment decisions like coming off medication treatment prematurely or not opting to try medication in the first place. People experience tremendous stigma from clinicians and that can range from the language we use and how we treat people to a sense of nihilism, that clinicians may feel like substance use disorder is not treatable, or that this is a recalcitrant condition that people are never going to get well, and that impacts patients and how they see themselves and whether they're able to hold hope or not. And then stigma from the outside, from the public in terms of our policies, our legislation, the way things play out generally in terms of people's employment, their ability to get housing, criminal legal sanctions, surveillance by the child welfare system, many of these really reinforce the notion that substance use disorder is an issue of choice or bad behavior or it's something criminal versus a treatable health condition. So just to give three sort of concrete examples of how this can manifest in ways that really are incredibly impactful to people's health and to their life, one example is that in many cases, patients who are treated with opioid agonist therapy like methadone or buprenorphine may not be accepted to post-acute care facilities like skilled nursing facilities or medical rehab facilities from the hospital. Despite the fact that this has been found to be a violation of the Americans with Disabilities Act, this continues to be incredibly common. We also see this in residential treatment facilities or sober living facilities where patients are told that they can't go to these facilities, either for treatment or for sober living, if they're on medications like methadone or buprenorphine, in part because of that stigma that we just talked about, that they are not considered abstinent, or sometimes it's cloaked more in sort of a technical issue that these facilities can't provide these treatments. Again, all of that is a violation of the Americans with Disabilities Act, but also really deeply reinforces stigma against medication and against substance use disorder. Another example is that in many states, when pregnant people are treated with gold standard treatment, what we would all recommend as the best treatment in pregnancy for opioid use disorder with either methadone or buprenorphine, because of interpretations around what substance-exposed newborn is and what mandatory reporting laws are, in many cases those people and their children are reported at the time of birth for an investigation into child abuse or neglect. So talk about reinforcing stigma and also a disincentive to engage in the most effective treatment we have to keep the pregnant and birthing person and the infant healthy, is that we're telling people, "Oh, the science says you should try this treatment. It's going to really help you. And if you follow our medical advice, we're going to report you for child abuse assessment at delivery." And then a third example would be people who are mandated to treatment as a condition of probation or parole who'll actually be imprisoned for having positive toxicology. So again, if we think of substance use disorder as a chronic health condition that responds to treatment, ongoing symptoms of active illness, like use, should be interpreted as a failure of treatment, not a failure of the person. That indicates that their treatment plan needs to be changed, not that they are bad or to be blamed, and certainly not that they should be imprisoned in a jail cell, and yet, all too often, that continues to happen. So all of these types of stigma can have tremendous impact, so that it erodes confidence that substance use disorder is a valid and treatable health condition for the person, for their family, for the public, it can be a barrier to getting a job, getting housing, relationships, and a range of health interventions we've talked about, like going to medical rehab, getting an organ transplantation, or even the ability to parent. It deters the public from wanting to pay for treatment, and allows insurers and policy makers to create these restrictions and differential approaches to substance use disorder, including in our punitive laws and policy, that would never stand if we were actually talking about another health condition. And it stops people from accessing the services and treatment they need because they feel unworthy and unwelcome. It creates barriers for people to stay in care because they are treated poorly, they feel like they are being judged or discriminated against, and often they are being treated very differently than other patients with other health conditions, and it can also impact clinicians in terms of our decision making and what we recommend from a treatment perspective. And then importantly, this stigma is so deeply intertwined with ongoing myths and misperceptions about drug use and addiction in our culture. So one myth that we covered a little bit briefly at the very beginning is in misunderstanding about the fact that substance use exists along a continuum. So particularly with non-socially acceptable drugs, like heroin, fentanyl, cocaine, methamphetamine, there is a notion that any use is problematic or that any use must be sort of the same as a substance use disorder, and the reality is that use exists along a spectrum. And it's very important, especially for those of us who are addiction specialists, to not over-pathologize all drug use, and to really think about use in the context of this human being. How is their substance use impacting their life, their ability to function? And in fact, if we think about the DSM-V criteria, that's really what it gets down to is someone using despite negative consequences. If they're not having consequences, if it's not causing problems for them in their life, doesn't mean that there's not health counseling that we might engage in, but does not necessarily mean that they have addiction or a problem related to that substance use. And yet, misrepresentation of drug-related science, the idea, particularly sometimes with neuroimaging, that drugs sort of irrevocably change the brain and are always pathologic in certain cases, can really contribute to dehumanizing stereotypes, to racial disparities, particularly anti-black racism, and harmful practices and policies. So it's really important to prevent the full spectrum of substance use and to talk about that. Another myth that really impacts, I think, the care we provide, and also messages that families get, and the community get, is this notion around tough love. So this idea that tough love helps people get better, that if we just make it really hard on someone, if we kick them out, if we put consequences in place, if we take their kids away, or take their housing away, that that's going to be the thing that's going to cause them to hit rock bottom and make changes. And the reality is that that couldn't be more false. Kindness and compassion are what heal people, and I've always loved this quote by journalist Maia Szalavitz, who's in recovery and who is an expert on drug use and has written a number of books and articles, where she talks about her own experience that really the notion of tough love is so backwards, that she used drugs compulsively because she hated herself and she felt like no one would love her if they really knew her. So how could being confronted about her bad behavior help her with that? How would being humiliated when she'd finally given up the only thing that allowed her to feel safe emotionally help her get better, and that the problem wasn't that she needed to be cut down to size, it was that she needed to be supported and loved, and that actually fear of being treated terribly kept her from getting help long after she realized that she needed it. And yet, we see this be perpetuated all the time, again in some of our clinical models, certainly in our laws and our policies, and in how families are told to respond to their loved one who's dealing with substance use disorder. Another common myth is that addiction is a poor prognosis condition, that most people don't get well. I think for folks who don't have the great privilege and joy of treating substance use disorder, when they think of someone with severe opioid use disorder, for example, I think often the first thing that comes to mind is like, "Oh my goodness, what a tough and recalcitrant condition to treat." And yet, the reality is that treatment works and most people get better. That this is a good prognosis condition. As a general internist who's also an addiction specialist, the sort of amazing life-saving impact of treatment in addiction, particularly for opioid use disorder, is just something we don't see for other chronic health conditions. This was a long term follow-up study of Roger Weiss's POATS trial, which was an initial randomized control trial of buprenorphine for prescription opioid use disorder, and they followed a subset of the cohort out to 42 months. And at the end of 42 months, fewer than 8% of people at that point met DSM-IV criteria for opioid use disorder. That means 92% of people were in remission. That is remarkable, and again, that is not a remission rate we see for diabetes, or HIV, or depression, or heart disease, or any of the other conditions that we're so comfortable treating in medical practice. So what can we do to combat stigma? Well, there is so much that each one of you can do. I've always loved this imagery from the Harm Reduction Coalition with sort of the leafy Tree of Liberation on the left, the anti-stigma side of the tree, and then the barren, leafless, sad-looking tree of stigma. And really, actions, and beliefs, and perceptions that you can take to combat stigma. So if we think about what we enforce as stigma, it's ignoring people's story and projecting our own misperceptions or agenda, requiring mandatory things because we think people won't do something otherwise, only talking about the disease and not talking about actually what the person can control and not enhancing their own self-efficacy, reinforcing these negative beliefs that people with substance use disorder must be lying, that they don't have any willpower, they can't help themselves, and perceptions, like Dr. Dolloff lectured on, that people are not trustworthy, that they're lazy, or sick, or dangerous. In contrast, the sort of anti-stigma side of the tree, the tree of liberation, is really about partnership and engagement, creating plans together with a person based on their goals, asking questions to really understand who they are and what they hope for, sharing resources and education with them, and reinforcing their ability that they can do things, that they are telling the truth, that they care about themselves and their community, and believing those perceptions deeply in our interactions with people, that our patients with substance use disorder and people who use drugs are capable, they are trustworthy, they are caring and to reinforce that. And we can all serve as a role model for these beliefs to reinforce compassion and anti-stigma. We can emphasize the importance of building relationships and trust with people who use substances as an important outcome in and of itself. Empathy, compassion, engagement, are important therapeutic interventions, even if you don't do anything else. Just having that empathic human connection is crucial. We can actually include people with lived experience in the work that we do and conversations about how to design systems of care, and when we are engaging with someone, we can consider how past histories of trauma and discrimination and stigma are affecting that person in that moment. We can respect the autonomy and dignity of the people that we're serving and partnering with. And importantly, I hope I've talked to you enough today that you feel empowered to use person-first and appropriate language that doesn't reinforce stigma. As clinicians and as society members, or administrators, or policy makers, we can drop barriers to care and rethink our models, and how sometimes actually our policies and approaches can be the thing that are causing harm rather than the substance use itself. And then lastly, we can all be upstanders and inspire other people. Like many in addiction medicine, I came to this work because I had an amazing mentor who inspired me, and each one of you watching this video can go forward and inspire someone else. So if we think concretely about what language changes you can make, so you can never use terms like dirty, clean, abuse, and abuser, or terms that label someone as their health condition, like alcoholic, or addict. You can always use person-first language, so the person with a substance use disorder, a person who uses drugs, a person in remission. We can also avoid the term medication assisted treatment. We've talked a lot about the stigma towards medications for opioid use disorder like methadone or buprenorphine, and that term, although it's very common, really insinuates that medication is not treatment, that it's assisting some other magical form of treatment. And it's different than what we do for other health conditions. So we don't talk about diabetes treatment as being insulin-assisted treatment. We just call it treatment, or medication, or insulin. And so to really think about again using terminology that doesn't reinforce stigma against the tools that we know are so helpful and that is more consistent with how we talk about other health conditions. There are great resources out there. This is from ASAM, there's also a guide from NIDA, as well as other institutions, about what terms to avoid, and then what other terms you could use instead. So you'll see that the terms to use are a sort of universally person-first language, and avoid some of those labels that label people as their health condition or that use inappropriate terminology, like abuse or clean or dirty that we wouldn't use for another condition. So with that, I have my references here, which I'm happy to share, and I appreciate your attention today. I want to end by talking about the PCSS Mentoring Program and make you aware of these amazing resources that are offered through PCSS that may be of interest to you. So the mentor program is designed to offer mentoring assistance to clinicians and to allow you to get support addressing clinical problems. You have the option of requesting a mentor from the mentor directory, or PCSS can pair you with one. To find out more, please visit the website to learn more about mentoring. Second, I want to alert you to the PCSS Discussion Forum. This is a forum comprised of PCSS mentors and other experts in the field who will provide prompt responses to clinical cases or questions. There's also a mentor on call each month, and that person is available to address any submitted questions through the discussion forum. You can create a new login account by clicking the image on the side and going down to this link at the bottom. And just want to note the consortium of lead partner organizations that are a part of the PCSS project. You can see here our long list of partnering organizations. And then lastly I'll leave you with some contact information if you have any other questions, or want to learn more about PCSS, or be reminded of any of these resources. Thank you so much for your attention today.

stigma

substance use disorder

medically appropriate language

treatable health condition

myths and misperceptions

impact of stigma

compassionate approach