Generally, it’s important to use “person first language” when describing people who are marginalized due to some part of their identity being stigmatized, such as folks struggling with their substance use, people who do sex work, and folks living outside.

Person-first language originates in the mental health consumer rights movement—a push by folks receiving psychiatric care to de-stigmatize and gain rights for mental healthcare consumers.

Person first language was initially developed because people with psychiatric conditions were previously described by clinicians solely in terms of those conditions. Mental health consumers wanted it acknowledged that no matter what people are dealing with, they are still a person before their label, and they deserve dignity, recognition, empathy, and respect.

“Addict” is also a word with immense negative connotations for many. Though the term is supposed to be clinical, if most of us are honest we have heard the term used, often alongside a drug, to explain misconduct or antisocial behavior—as if the problem creates that behavior—even though most of us also know people who use drugs who don’t behave in those ways.

There are also studies showing that using “addict”,” and even more pejorative language like “methhead” or “crackhead,” leads to folks getting dehumanized, reduced to their struggle, mistreated, and, of course, helps ensure they are then far less likely to move forward in change.

The term “addict”—though we acknowledge it is proudly reclaimed by many who feel like the word is an identity that they need to own for themselves—also feels to some people as though it reduces them to one facet of their lives and disconnects them further from other people, making change harder.

So, instead of calling someone an “addict”, Space Hacks will sometimes use the term “person or people who use(s) drugs (PWUD)” because we strongly believe that people who use drugs are, first and foremost, human beings who deserve dignity, recognition, empathy, and respect.

Finally, we would be remiss if we didn’t mention that some folks in the community have expressed a strong preference for people to use the phrase “people who use drugs”, rather than the acronym, PWUD—which we use in writing—in live conversation.

The Problem with PWUD: SUD and OUD vs. Chaotic Drug Use

One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult.

In light of that, and because this work is based on the Principles of Harm Reduction, throughout this document the phrases “chaotic drug use,” “person using chaotically,” and “problematic substance use,” will be used instead of “addict” or clinical terms gaining currency such as substance use disorder (SUD) and opioid use disorder (OUD).

The term “chaotic drug use” is based on a model of problematic drug use created by pioneering harm reductionists Dr. Patt Denning PsyD and Jeannie Little in their groundbreaking book “Over the Influence”.

They created this model because it has become clear from the literature, and the lived experience of drug users, that drug use is more like a continuum that ranges from complete abstinence to recreational use to total chaos.

This continuum model refrains from using the stigmatizing and binary language of “addiction,” with preference for the more accurate description of drug use as a relationship continuum from functional to chaotic, and people who use drugs as physically dependent or not.

This model acknowledges that folks use drugs for many different reasons ranging from spiritual to pathological, and concedes that people’s relationship with drugs depends on a variety of variables including physical health, emotional health, trauma history, age, and many others.

Finally, the harm reduction continuum model acknowledges that people’s use is naturally variable over time—not necessarily on a trajectory toward death. Since drug use is a continuum, we focus on the relationship that people have with their substances of choice at any given time.