So, I wanna now shift gears a bit, talk about stigmatizing language. So really, really important, the language that we use when we address patients, and when we address clients. And this is a very basic example of what I'm talking about. This was, Skaggs was a baseball player, fairly popular. The headline is actually that Skaggs' death, he died, the loss is still a tragedy, despite it being related to drugs, like as if it's. And this is like a USA today. And they're basically saying, even though this guy used drugs, it's still sad that he died. This is crazy. Imagine if you replaced drug use with cancer, that it's still tragic, even though he died of cancer, obviously. So this is what it's like. That there's such a stigma. That we actually have to preface it that if you don't say it's still a tragedy, people might actually think it's not a tragedy that maybe he deserved to die, or maybe this is not a sad thing, because it was a drug use related death that somehow this is no longer sad. It's truly remarkable that this is so prevalent, that this is how people think about it. And in that context, I'll bring up a third question. So, if you think about your friend or your neighbor, which would you think they'd be more openly willing to discuss with you, and with other members of their community? A, after years of battling a heroin use disorder, their teenage son tragically died of an overdose, or after years of battling with cancer, their son tragically died of cancer. Which do you think people would be more open to discuss with their friends and colleagues and their community members, and which one might evoke more sympathy for them? Something to think about. And a lot of people for A might even be ashamed if their child had a drug problem. They might not even wanna talk about it. It might be hidden. If they were a public figure and people found out that their son or family member had a drug problem, that might be fodder for people in the news to try to smear them. But probably not if they had cancer. Nobody would insult someone because their child had cancer. They would probably feel bad for that person, even if they were on opposite sides of the aisle. But if someone found out that their loved one or child had a drug problem, that would likely be fought or not only is it not sad, but it's a reason to start insulting. So it's really, really sad how this disease process has become so stigmatized. And again, another example, if you have a patient in the hospital with visitors, and loved ones coming in all the time, would get well cards and balloons, flowers, and gifts in the room, what medical condition do you picture? If you picture it to be the person who has an alcohol problem, or maybe someone who has cancer. And again, this is because of the stigma. This is because of what people do when they have a drug, or an alcohol problem. I see the bad behaviors, which are manifests of the addiction. And so do you. In the legal system, people with drug and alcohol problems do bad things, and those bad things lead us to believe that they're bad people, and they're making bad choices, and they're doing bad things, and they should be punished, and they don't deserve our sympathy. And to some degree, there is a level of personal responsibility, to another degree, this is a disease process, which is hijacked their brain that's convinced them to do these things. So along that vein, the more you feel that this is a personal choice, the more likely you are to stigmatize this person. The more likely you are to believe that this person is operating under the disease process, that the disease is convincing this person to do bad things. The less likely you are to stigmatize them. And the more likely you are to try and get this person into treatment. Stigma is a degrading and debasing attitude of the society that discredits a person or group because of an attribute. Stigma destroys a person's dignity. It marginalizes affected individuals. It violates basic human rights. It markedly diminishes the chances of a stigmatized person of achieving full potential, and seriously hampers pursuit of happiness and contentment. So again, what I mentioned here is that if you look on the left, whatever this person is doing is not their fault. They're not controlling it. It's a disease process. This is not something to stigmatize. The more you perceive this as the person's fault, they're controlling it. They're choosing to do it, the more likely you are to see this as something that they deserve, or that we're gonna have a stigma associated with this, because it's something that they deserve. When we think about stigma, we use certain language that can be pejorative, and lead to things that don't really help. Addict, user, junkie. They need to get clean, addicted babies. These are all words that we commonly use. To some degree, the patients or the clients might use this to themselves. My name is so-and-so and I'm a drug addict, or I'm an alcoholic, or I'm addicted to something. If they choose to do that, while speaking about themselves in the room of a group, that's very different than a doctor or a professional, or someone else referring to them in that way in a courtroom or in a doctor's office or something like that. So we wanna be very careful and not to say, well, if they refer to themselves as an alcoholic, I'll go ahead and call them an alcoholic too. In some ways, that's not healthy. And there's a couple of examples, which are quite remarkable. They looked at 516 mental health professionals. These are people who you would think would not be prone to stigmatize people you would think. They gave these mental pretzels vignettes, and the vignettes were identical. It was just a description of a scenario. They were identical, except for one said, the person they were describing was a substance abuser. And the other, the person they were describing was an individual with a substance use disorder. That's the only difference. Everything else in the blurb was exactly the same. And then they surveyed the readers, and they asked them questions about their attitude and opinions about the person, the subject of the vignette, and those who read substance abuser thought that this person was more culpable, and more deserving of punishment. Again, even though the entire rest of the story was exactly the same. They did a similar thing for lay people, and they, again, same exact vignettes, one substance abuser, one an individual with a substance use disorder. And these are the things that substance abusers. These are the things the lay people felt about substance abusers. They recommended punishment. They recommended jail as a wake-up call. They perceived them as a social threat. They had a personality problem, and they should overcome the problem without help, because it's their choice. People with a substance use disorder, the lay people were more likely to perceive them as needing treatment by a doctor, and having a problem that's genetic, or something that is a disease process. Just by simply changing the words, which is quite remarkable about everything else is the same in that context. So, just to highlight how important language is, this is a paper in JAMA, the Journal of American Medical Association. I highlighted underlined a few things here. This really drives home the point of how words matter, and the things that we say really influence what happens to the patients and the clients. This came from the White House Office of National Drug Control Policy. And you can see what I underlined here is stigma isolates people. It discourages people from coming forward in treatment. It leads clinicians knowingly or unknowingly to resist delivering evidence-based service. So we are taking our stigma. We're taking our view of people as having a choice, and making bad choices and sort of deserving bad things, because of this. And we're turning that into stigma, which then directly affects how the clients and the patients are able to receive treatment. So when we get down to it, the words on the left are the words that when we perceive people as having a choice, and making bad decisions and doing things on purpose, when we think of it in that way, we start to think of it as this is an addict. This is a junkie. This is someone who has a problem. This is some of the dirty urine. This is a person who's failing. These are negative. These words have a negative connotation, and tend to come when we have a negative view of the client or of the person. And these negative views come when we believe that what the person is doing is a choice, as opposed to things on the right. When we believe that this a person is simply suffering from an illness, we tend to think differently. We tend to describe the patient and the clients differently. We tend to use different language. This is a person with an opiate use disorder, not a junkie, but a person with an opiate use disorder. This is a disease process, not a bad habit or a problem. This is a drug addiction. This is a negative, or this is a true problem, a true disease, and not something that the person is choosing to engage in. Now, I understand that in your line of work, you are gonna see a consequence of this process that sometimes does deserve a little bit of punishment, because there's victims associated with what happens. If someone steals, if someone drives drunk, if someone hits somebody, whether or not the disease drove them to do it, there's victims of that crime. So, it's really important to understand that, yeah, sometimes if someone does something against the law, whether it be while they were suffering from their addiction or not, sometimes there does have to be a consequence. And I understand that, and there are victims to those crimes. But the important piece to remember is that, if this person is being driven by a substance use disorder, that substance use disorder needs treatment. And if we can combine that punishment piece, which may or may not need to be there with the treatment, you can't forget about the treatment piece. If we can combine them, that person is gonna have a much better outcome than if we just punish someone. We can't punish away a disease, and we can't punish away an addiction. If someone has cancer, and that cancer caused them to hurt somebody in some way, and we punished them for hurting somebody, we wouldn't expect the cancer to go away, because we punished their symptom. the things that happen, the theft, driving while intoxicated, these things that are occurring, they're symptoms of an illness. And if we punish away those symptoms, we have not addressed the underlying illness. So, really important, when we're thinking about treatment, we're thinking about punishment. We're thinking about the whole system. What can we do to help this client? The best thing is, if someone has the disease of addiction, the best thing to do is an approach that involves treatment of some kind. Now, I'm gonna say one thing about trauma, because so many of your clients are gonna have experienced trauma, some experienced trauma before they ever had an addiction. And it was many times what led to their addiction. And other times they experienced trauma while they had their addiction. People got beat up. Someone wrecked their car in a horrible accident. Sometimes someone had a physical or a sexual abuse or assault. A lot of traumatic events happen to people with substance use disorders at some point in their life. So it's really, really important as you're addressing the clients. And you're thinking about a holistic approach to how to recover this person, how to recuperate this person, how to rehabilitate this person, what is the best approach? Sometimes it involves trauma informed care, and thinking about that side of their treatment. There's a really good resource that one of the judges I worked with guided me to, and I have it here on this slide. And I encourage everybody to pull that up, and to look through that, because there are many things to learn about with trauma informed care, and how we can approach clients in a certain way. And again, judges have a large influence on everyone in the courtroom. You are the leader of that room. You are respected, you are looked upon for guidance and mentorship, and the things you say, people listen to it. So your leadership on reducing stigma, using proper language, and communicating effectively to your clients that we need treatment, and communicating effectively to loved ones, and all of that. And similarly, if you use stigmatizing language, it can be very destructive, because again, people are looking to you for guidance and mentorship and look to you with respect. And if you're speaking a certain way about people, then they would perceive that as being fine for them as well. So again, the judges play a very important role in the lives of our patients and clients. And I strongly encourage you to use some of the things I tried to teach you today, put that in your back pocket, understand a little bit about the disease process, and move forward with that. The other things you can do is a triple AP and PCSS, and Opiate Response Network, these are all ways that we can help you. A triple AP is an organization, the American Academy of Addiction Psychiatry is an organization that is incredibly committed to working closely with everybody in the legal world. Please call us and ask for help and work with us closely, build relationships with regional and local treatment providers. Talk to the doctors in your area, know who prescribes things, build relationships, stay up to date on the latest things and utilize the services for national organizations, a lot of national organizations in all of our fields. So I will stop with that. I hope that this was a valuable for you, and we appreciate everything that you do for your clients and for our patients. For free localized education and training designed to meet your needs, contact the Opioid Response Network.

stigmatization of language

substance use disorders

non-stigmatizing language

trauma-informed care

legal system