The Word "Addict"
Why I use it, and think you should too.
The argument I make in this post is that addict activism is important and necessary. But I’m going to start by talking about a different activist community altogether: the Deaf liberation movement.
Why do I do this? Deaf activism was among the first major political disability movements worldwide. Its proponents have achieved significant policy goals (the passage of the ADA, for one) and dramatic hermeneutical change (for instance, the increasing popularity of ASL and the use of the capital-D term “Deaf”). It is as successful a disability rights campaign as ever there was; much disability activism is modeled on it. So I’ll follow suit.
Representation and community agitation
The 2011-2017 sitcom Switched at Birth was the first mainstream TV show to star multiple Deaf and hard-of-hearing actors. It also features Deaf activism as a central plotline throughout its five seasons. (In one episode, Deaf and hearing students occupy their school in a nod to the Gallaudet protests.) The casting directors in Switched at Birth paid careful attention to Deaf representation: Deaf characters are played by Deaf actors. The alternative—offering Deaf roles to hearing actors—is known as “hear-washing,” and its criticism by the Deaf community predates the show by a long time. Similar standards exist for other marginalized communities. “Whitewashing” of racialized characters is by now an established cultural concept, and fat activists highlighted Brendan Fraser’s wearing a fat suit within their laundry list of well-deserved criticisms of The Whale.
There are, of course, those who dismiss this impetus because acting is about pretending to be different or whatever. I’m not going to argue against that here. My point is that the impetus is broadly popular. If your show features a marginalized character, people think, that part should be offered first to actors of that identity.
With a glaring exception: Mad, intellectually disabled, and addict characters. Indeed, Switched at Birth features three addict central characters, none of whom are played by addict actors (at least not openly).1
Regina Vasquez, the mother of one (both? Not sure how switched-at-birth parental politics work) of the switched girls. Her alcoholism is a central storyline across multiple seasons of the show. Vazquez is played by Constance Marie.
Toby Kennish, the older child of one of the families. His gambling addiction constitutes a short arc of season 1, and Regina, the established addict, is dispatched to deal with it. He’s played by Lucas Grabeel.
Simone Sinclair, an alcoholic and the frenemy of one of the switched girls. Again, her alcoholism is a season 1 plotline (although she vanishes in later seasons).
The audience of Switched at Birth is given to understand from the get that the Deaf community celebrates Deafness. In one scene, Marlee Matlin signs “Not hearing loss; Deaf gain”; early episodes address, through the device of cochlear implants, the tension between the Kennishes and the Deaf culture-enmeshed Vasquezes. Sure, there are Deaf characters who aren’t happy about being Deaf, or want to integrate into the hearing world. But these tensions are treated justly and cathartically in the context of the show, always centering Deaf experience. Never is it a foregone conclusion that CIs are good, or that congenitally Deaf people should get speech therapy.
The addict representation is not treated in this way. All three characters’ addictions follow the relapse-or-recede binary: characters established to have an addiction history either dramatically return to active use or else just move on and the addiction is never referenced again. Regina’s case is both—she relapses dramatically, gets caught, and then her alcoholism becomes irrelevant!
Honestly, I could write a whole post on Regina alone. She’s already long sober when the story starts—she “pulled her life together” to take care of her daughter. But she relapses. In one of the show’s many bizarre and superfluous alternate reality episodes, Regina has Tragically Died of Alcoholism; in another, it’s shown she never would have gotten sober if the babies had not been switched. Yeesh.
Switched at Birth was the most disability-progressive mainstream show on the air when it ran, and possibly since. But my own comments here are the only time I’ve ever heard anyone bring up these critiques. And the representation deficit persists. Even Single Drunk Female, a show created recently by an alcoholic and entirely about twelve-step recovery from alcoholism, stars a nonaddict. In fact2, the only addict actors in the show are Ally Sheedy, who plays a profoundly unlikeable nonaddict, and Bob the Drag Queen, who guest stars as herself for a single episode. The representation problem generalizes to the way these identities are discussed. The crip community protested the ending of Million Dollar Baby for implying people with spinal cord injuries should just die, but there is no similar backlash when a Mad or addict character is suicidal (which happens in more media than I can name).
Please don’t misunderstand me. I’m not shitting on the Deaf stars of Switched at Birth for insufficiently agitating for my community. That would be unfair. The reason that, for example, I don’t use “tone-deaf” as a pejorative is that Deaf activists have explained how it harms Deaf people. So why is it the case that this critique has become popular in a way mine hasn’t? Why is it by now a well-established norm that Deaf actors should play Deaf characters; why is the notion that neurodivergent characters should be preferentially cast in the same way gaining steam? There a well-understood framework in which much crip representation operates, which requires that disabled characters be shown at least sometimes to rejoice in their identity. Why is none of this true for addiction?
I think the reason’s pretty obvious. Activism for people with atypical relationships to substances and processes isn’t a thing the way Deaf or neurodivergent activism is. Other disability activists can’t be expected to understand unmade arguments. For that, we need an activist program for our community, which in turn requires a name for ourselves. I think we already have a name. It’s the word I’ve been using—“addict.”
The word “addict”
I’m arguing here that we should reclaim the term “addict.” There are only two counterarguments that anyone ever makes. They come across as meaningfully different, but I think they’re basically levied by the same group of people.
The word “addict” is stigmatizing. Pick a different word. (Implied: it’s all well and good to advocate for these people; just call them something else.)
You should not in fact be advocating for the group of people you call “addicts” because (a) addiction is a medical condition best handled by doctors, not something to celebrate; or (b) you should be advocating for drug users at large rather than a small subset of them.
In this post, I’ll talk about 1 and 2(a).
Is “addict” stigmatizing?
Sure. The word “addict” has a long history of pejorative use that continues today. I don’t dispute this; it’s just irrelevant.
“Pick a self-descriptive term that hasn’t been weaponized against you” is an unreasonable and ahistorical purity test. “Fat,” “Mad,” “crip,” “queer,” and “Deaf” have a long track record of being used as insults. But they are now the words activist communities call themselves. If you’d like to go tell a group of disabled people not to say crip, or inform bisexuals that that word used to be a medical diagnosis, or clutch your pearls when a group of trans women jokingly call themselves transsexuals, knock yourself out. They will mock you, and they’ll be right to do it.
Maybe some words, on the basis of intra-community agreement, shouldn’t be used. If I started referring to myself and others by some pejorative term for bisexual, over the protestations of other bi activists, that could be critiqued. But addicts overwhelmingly self-describe as such.3 And they do so for a reason. To describe oneself as an addict is to invoke the addict experience: the interiority of having a relationship to a substance or process in light of which you have been subjected to disdain and punishment. Positioning oneself with respect to oppression is the first step toward agitation. If you can’t do that—if you cannot pick out a category created by marginalization and describe yourself as within its locus—then you cannot issue calls for change. We need to discuss ourselves as a group, and for that we need a word. The precise word doesn’t matter, but it matters very much that there be one.
When I said criticisms (1) and (2) actually run together, this is what I meant: critiquing word choice has a chilling effect. Criticism of identity terms is often levied cynically, and in such cases, can reveal underlying motivations. (Who, nowadays, are the people arguing that queer people shouldn’t self-describe as such because it’s offensive? Gender-critical people. Why? Because “queer” can capture trans people and “gay” can’t.) This is my biggest problem with people who interrupt my sentence “addicts are marginalized in ways XYZ” to say “Whoa whoa whoa, you can’t say that word!” It doesn’t feel like an attempt to stop addicts from calling ourselves that. It feels like an attempt to stop us from organizing. Because if we can’t use a phrase that describes how we differ from other people, then we cannot describe the unique oppressions we face, nor mobilize against them.
So we need a term for ourselves. (I think “people with atypical relationships to substances/processes” is too long.) The term has to satisfy two criteria, which will be referenced in the following. First, it cannot linguistically incorporate the idea that being such a person is bad. It’s fine for it to have been used pejoratively in the past, and it will certainly be in the future—you’ve heard of the euphemism treadmill. But the term can’t etymologically mean “Bad at XYZ.” (Think “problem drinker,” “gender dysphoric,” or “sexually deviant.” Those phrases establish categories—drinking patterns, gender, sexual orientation—and then mark out a bad subcategory.) Second, the term must capture all and only the people I’m trying to describe (“people with atypical relationships to substances/processes”).
Medicalization and the inherent subversiveness of taking pride in addict status
So, I don’t think there are good reasons to be against the term “addict” if you already agree activism for the group of people I call addicts should exist. On, then, to criticism #2 from my list above: people who think there shouldn’t be such a thing as addict activism by any name. I’m going to ignore people who think addicts just deserve to be punished—they probably aren’t reading my blog anyway—so let’s turn to the seemingly more sympathetic possibility that I called 2(a). On this view, addict activism (maybe also Mad activism) shouldn’t exist because addiction is a medical condition. Rather than talking about oppression, we should be getting these people into treatment. This is basically an endorsement of the medical model of disability. It maintains that being this type of person consists in being biologically deficient in body/mind. The ultimate goal—what it means for society to do right by you—is to restore you to normality.
There are a bunch of problems with this. First, what qualifies as a medical condition is (gasp!) not objective. This sounds radical, but it’s very obvious. I know it’s annoying to invoke the gotcha “homosexuality was a DSM entry until relatively recently,” but this fact is contextually important—as Ruth Benedict puts it, what is normal is defined in terms of the things we value. But I won’t dwell on that here. My deeper issue is that the medical model is politically counterproductive. It does not have the resources even to instantiate the project its proponents claim to want (helping addicts). It is an internally confused theory, and its adherents are fair-weather friends to us. They’re engaged in a sort of psychodrama where what they really want isn’t to help us but to not feel bad about oppressing us. (I don’t think this is true of all nonaddict addiction clinicians, but I think it is by and large true of uncritical defenders of the medical model.)
To back up a bit, I’ll explain why I think the word we choose to describe ourselves can’t be etymologically constructed in such a way that means we are bad at being people. The widely accepted term for people like me is people with a substance use disorder. The word “disorder” in there attributes an inherent disorderedness to my interiority. But I don’t feel disordered! I don’t think my relationship to alcohol is bad; I don’t even drink these days, so it couldn’t be said to have bad effects for other people. And I don’t mind it personally! I just think it’s statistically atypical. Similarly, fat and Mad activists have criticized phrases like “overweight” and “mentally ill” for packaging in normativity. In fact, probably the best example is the Deaf community’s rejection of the term “hearing-impaired.” Deaf activists say that Deafness is not an “impairment”; their sensory systems aren’t fundamentally worse than hearing people’s. I think disbelieving them would be profoundly hubristic.
Medical language suggests that substance use disorders should be clinically treated, cured, brought back to “normal.” But I don’t want to be the kind of person who can “regulate” my alcohol consumption. That feels like wanting to be a different person altogether, because I would not be myself without my identity. To make another Switched at Birth reference: in the very first episode, Daphne, played by Katie Leclerc, confronts the possibility that she might not have become Deaf if she hadn’t been switched. She signs, “Me, but hearing? Weird.” I feel that same way: the prospect is too alien to be evaluable. I don’t want to be a nonaddict! I just want to not be oppressed.
Deafness is again a good contrast case, because the Deaf community is also medicalized, yet Deaf activism persists. To be fair, I don’t really run in circles with people who believe Deafness is some terrible tragedy, so my anecdotes of such people might not be representative. But at least in my experience they don’t explicitly say Deaf activism is wrongheaded. Why is this, then, a criticism fielded by Mad and addict communities—what makes the difference? You could say “Deaf people aren’t trying to go out and Deafen others, but the addict agenda is exactly that” (which I’m sure a lot of people think), but that doesn’t track. Deaf parents who don’t get CIs for their kids are vilified and subjected to excruciating philosophical debates about choice in the same way addicts are! You could claim Deafness is “ego-syntonic,” i.e. something that contributes to a person’s sense of identity, whereas addiction is “ego-dystonic,” interfering with the person’s real self. But drawing that partition in the first place relies on the ways we’ve been led to think about these ways of experiencing the world. Before the advent of Deaf activism, it was widely accepted that Deafness is ego-dystonic, and many people still believe so. I think the only sensible explanation why people are more receptive to Deaf activism is the obvious one: Deaf activism started in the first place, and persisted in the face of ableism. Its objectives aren’t yet achieved, obviously—but it has influenced the hermeneutics.
A caveat. Like I said, Deaf liberation is not accomplished. I imagine many people still think Deafness is terrible and find Deaf activism essentially cute (“good on you for making the best of it!”) and unthreatening. When the movement makes claims that moderates find uncontroversial, like “don’t make fun of Deaf people and linguistically isolate them,” they’re on board. The minute it oversteps—when Deaf people don’t give their kids CIs, thus countering intergenerational erasure—it becomes dangerous, and the medical model on which Deafness needs to be cured rears its head. “We gave you everything you could reasonably want by not explicitly hating you; your demand for actual equal treatment is a step too far.”
Changes in hermeneutics tell people what they should and shouldn’t say, not what they should and shouldn’t believe. I think this explains the onslaught of people who hand-wringingly ask how they could be perceived as against liberation. Here’s a recent op-ed in the Telegraph by a woman who seems confused that her opposition to a trans mural at Costa coffee parses as transphobic: “anyone voicing their intention to boycott the firm are [sic] being cast as ‘anti-LGBTQ.’ I am not anti- any of these.” This seems a strangely self-unaware comment because the piece is very openly anti-trans. It’s full of sneering disdain for trans men in particular, calling their existence “Gen [Z-er] nonsense.” But to the author’s thinking, she can’t be transphobic, I guess because she didn’t walk up to a trans person and call them a slur with hate in her heart. This is a sort of path-of-least-resistance liberalism: you can oppose liberationist demands and still be on the side of progress as long as you call your opponents the nice words.
So I’m cynical about the omnipresent disability-positive rhetoric in the air these days. I think it’s largely disingenuous. The cultural discussion of “mental health” in particular has the progressive imprimatur, but is grounded in the notion that mental unhealth (coextensive with Madness) is bad for you and you should devote a lot of your time to trying to avoid it. The mental health crusade cannot coexist with any meaningful destigmatization of mental illness. People who emphasize that there’s no shame in going to therapy throw around the word “narcissist” like a beach ball. It leaves the impression that any pretensions to compassion were just that—pretend.
Ultimately, this is the reason that leaving the addict identity in the hands of the medical establishment is a bad idea. The positive political content of the medical model inheres in “addicts are sick, and should be given treatment.” But that claim folds like Galloping Gertie when placed in juxtaposition with people’s reactive attitudes toward actual addicts. The softhearted maxim of care cannot withstand the tension between “addicts are bad” and “addicts are sick.” (You could say this for “narcissist” too.) When they come in conflict, the first wins out. “This is immoral, but you shouldn’t be judged for it” is blatantly internally contradictory! The whole content of calling things immoral is judging them. I think this is why the cognitive model of mental illness remains so popular: it establishes a loophole by describing mental illness as a result of patterns of thinking that are within your control. It installs a blame point, upstream of disability. If you’re mentally ill, it’s because there’s an action step you have not taken (therapy, taking your meds, whatever).
This is why I don’t buy the claim that framing addiction as a medical issue is in any way destigmatizing. People tend to think that “you should be blamed for X” and “X is a medical problem” are incompatible, but on the current view, they actually work together. The medical attribution merely adds an extra step, identifying with greater precision what it is that the mentally ill person is to be blamed for. Medicalization pronounces addiction emphatically treatable. The blame-conducive question “Why are you behaving this way?” isn’t eliminated—it’s merely replaced with “Why have you not taken the steps to prevent your behaving in this way?” Not seeking treatment is your fault: the famous paper by Moss and Siegler that I referenced elsewhere on here justifies the withholding of liver transplants from alcoholics on the basis not of their alcoholism, but their failing to seek treatment for it. The opportunity to explain treatment failure through patient “noncompliance” does not help. If you read pretty much any modern article in a psych journal about treating patients diagnosed with Cluster B personality disorders, you see that patient interests are framed as opposed to, and often achieved at the expense of, clinician interests.
Thea medical view of substance use disorder, intended to identify ways nonaddicts can help addicts, does precisely the opposite. The root question that reemerges as primary locus of inquiry is the same one motivating the carceral-clinical seesaw: how are nonaddicts to flourish in a world that we also live in?
It could be argued there’s a fourth such character—Emmett Bledsoe—who overdoses on medications in a manner heavily implied to be intentional. But Sean Berdy, who plays Bledsoe, is in fact openly Mad/mentally ill (although he was not at the time of airing, and although his political commentary about mental illness is much more moderate than the way he discusses Deafness).
I’m leaving out the actor who plays the main character’s sponsor only because she’s in recovery from nicotine.
True, a lot of people who call themselves “addicts” are in twelve-step recovery, and there are all sorts of problems with the twelve-step model. But the word was not invented or reclaimed by these groups alone, and even if it were, that’s irrelevant to whether the larger community should use it.
This really got me thinking and actually affected my language at work (I work at a D &A rehab for women). Thank you.