Beyond Stigma: How Researchers May Trigger Drug Users

Harm reductionists have long called on journalists, politicians and treatment providers to adopt non-stigmatizing language when speaking about people who use drugs. Despite such efforts to reduce drug users’ feelings of shame and stigma, they can still be harmed by language from other sources.

Some crystal methamphetamine users report that their cravings can be triggered by the communication strategies of researchers and service providers, found—among other things—a June 11 Harm Reduction Journal study examining the attitudes of anti-retroviral therapy (ART) patients towards smartphone-based research.

Researchers can survey future participants (quite literally) wherever they’re at through smartphone-based questionnaires on drug use and ART adherence. But this presents the challenge of adapting their language and framing to fit the demeanor and disposition of a participant with whom they are not physically present.

The Harm Reduction Journal study participants were concerned that receiving messages from a hypothetical app asking directly about their meth use could detract from their recovery. “I’m more inclined to think that askin’ that question may cause some people who might be tryin’ to stop to relapse,” one participant told researchers.

People addicted to methamphetamine, like other drugs, are vulnerable to “cue-induced” cravings. These include paraphernalia, like bubble pipes used to smoke it, as well as verbal and visual cues. These can “cause significant impacts,” wrote Iranian researchers in 2010, on how people manage their use.

Throughout harm reduction history, people who use drugs have innovated approaches to positively impact their own lives. The HRJ participants were no different, providing a number of suggestions for future researchers to better conduct smartphone-based studies around drug use.

One meth user recommended reframing how drug use questions are asked. Instead of asking a future study participant if they had used drugs in a given time period, the researchers could instead inquire about abstinent days, the person suggested. “Have a check mark where you can mark how many days you been clean. Thirteen, fourteen. Have you missed—if you’re not clean, just X or somethin’… use a more positive term.”

Another suggested that future questions refer to drug use through non-representational images. “Have two faces. A good or a bad. Then just have those faces determine whether—meaning, did you use, or did you not use? … What color are you today? Then just pick—if you use that day, you just pick a certain color.”

Language can greatly influence drug users’ wellbeing. Service providers with “poor patient insight into triggers of drug use,” the study authors write, “can contribute to a framework that is inadequate for providing timely intervention to patients.”

Interestingly, one 2019 study showed that people in recovery who use language considered to be stigmatizing, like “addict,” do not have more negative outcomes as a result—underlining the difference between language that is used to self-identify and language used by others about impacted people. “Language may have only a marginal impact on individuals in recovery,” wrote its four authors, “although professionals and the general public should continue to avoid using stigmatizing labels.”

Service providers and researchers are duly encouraged to abide by the language guides, like those published by the National Institute of Drug Abuse (ironically) and Changing the Narrative. Their lexicon could benefit from avoiding dogmatic vocabularies if they truly wish to meet people who use drugs where they’re at.

Photograph of a patient with a doctor by Zachary Drucker via The Gender Spectrum Collection/Creative Commons