Sometimes when we try to be polite or politically correct, we distort the facts. Other times by trying to be precise we seem to be nit-picking.

Take substance abuse. According to a Columbia Journalism Review article, the proper term in the latest Associated Press Stylebook is substance misuse, because abuse sounds judgmental, while misuse is factual: you are using the substance (alcohol or prescription drugs or other) in a way it was not intended.

But what about heroin? It has no current “use” since it is a Schedule I drug banned for all use. On the other hand, it began as a prescription medicine made by Bayer. It was even marketed for children. Is that discontinued market still considered “use” and other uses are “misuse”? Or can we speak of heroin abuse?

Then we are told to refer to a person with addiction rather than an addict. On the one hand, that makes sense. Addiction is a disease, so maybe we should separate the person from the disease. (Similar changes have been advocated for other diseases, such as a person with diabetes rather than a diabetic.) On the other, Alcoholics Anonymous members are told to self-identify as an alcoholic, not as a person with alcohol use disorder.

On the third hand, some people say that is a very real problem with AA and one reason why it is not as successful in the long term as it likes to pretend it is.

But those are mainly semantics. Aside from using more words, there doesn’t seem to be a reason not to go along with the wishes of the AP. The real problem is with another word: dependence versus addiction. They are not interchangeable.

Frequently when looking for statistics on substance use disorder, I find a survey counts together people with addiction or dependence, as if they were the same or almost the same thing. But as CJR points out, you can be addicted but not dependent, and vice-versa.

People with diabetes are dependent on insulin. People with high blood pressure are dependent on Lisinopril or other meds. People with depression are dependent on lithium, Zoloft, or other antidepressants. But they are not addicted to them.

Dependence means physically dependent. They cannot function normally or be healthy without the drug, but that’s not what addiction means.

Addiction is psychological. If you have an addiction, you want a drug, even when you know it is not healthy for you, even when you know it is killing you, even when it no longer gives you pleasure.

Why does that matter? Because when you confuse the two, you think and say idiotic things like: “Taking methadone or Suboxone to get off heroin is just trading one addiction for another”. No, it’s not.

Heroin is an addiction. If you have an addiction to heroin, you crave heroin. As the addiction progresses, you may not be able to function in your life any longer. You may not be able to keep a job, a home, healthy family relationships. Your health deteriorated as you ignore proper diet and hygiene because all you care about is getting high on more heroin.

Methadone and Suboxone (or other forms of buprenorphine) do not get you high. They do however control your addiction cravings so you can hold down a job and a home, maintain friendly relationships, eat and bathe regularly. Most people are able to transition to no drug use over time, but even if they don’t, you can maintain on methadone and buprenorphine indefinitely.

But some folk who don’t understand how addiction works, how maintenance drugs work, read or hear that methadone and buprenorphine are opioids, just like heroin and OxyContin and Vicodin and fentanyl are opioids and decide they are evil and addictive and shouldn’t be permitted in rehabs or prisons or for a prescription.

That’s why it makes a difference.

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