Is It Time to Dump “Substance Misuse”?

Written By Lisa Gardener

Language matters. But perhaps not in the way we sometimes think.

Within the drug and alcohol sector, “substance misuse” remains one of the most common labels used in policy documents, commissioning frameworks, government reporting, regulatory systems and treatment services. It’s the language of the institution that looks down on us wagging the finger of disapproval, it is so familiar that many of us barely notice it anymore.

But interestingly, when looking at alcohol-related deaths, the Office for National Statistics (ONS) glossary does not actually define misuse. Instead, it uses the term within a statistical definition, explaining what counts as an alcohol-specific death while never explaining what constitutes "misuse", how it differs from "use", or whether it refers to dependence, harmful use, intoxication, heavy drinking or something else.

A similar issue appears in OHID's annual Adult Substance Misuse Treatment Statistics. The report title uses the term substance misuse, but the content largely discusses people in treatment for specific substance-related problems. It describes alcohol, opiate, crack cocaine, cannabis and other treatment needs, but does not define misuse itself.

That raises an interesting question:

If "misuse" is the defining label for an entire treatment system, where is it actually defined?

It feels as though "misuse" may have lost whatever technical definition it once possessed and now functions primarily as a culturally loaded descriptor. Rather than a clearly defined scientific term it seems to cling on in order to provide a vague sense that someone must have done something wrong.

The use of "misuse" in official sector language is clearly not intended to be overtly offensive. The issue is that it is vague, poorly defined, rarely used by the public, increasingly out of step with modern health terminology, and still carries that unsettling undertone of personal fault or responsibility.

An increasing number of organisations, practitioners and people with lived experience are questioning whether the term still serves a useful purpose. Perhaps more accurately, many people now openly resent it.

What are we actually saying?

When we say someone has a "substance misuse problem", what exactly are we saying?

Most people would never describe themselves as "misusing" alcohol or drugs in everyday conversation. They might talk about drinking more than they want to, struggling with dependence, using substances to cope, experiencing addiction, or wanting help to change. The language of misuse exists largely within professional systems.

Whether intended or not, the word points towards the individual rather than the wider context. It suggests a misuse of choice, rather than acknowledging the complex interaction between health, trauma, poverty, mental health, social conditions, inequality, environment and human coping mechanisms.

‍ So why do we continue to use misuse? Or are we misusing ‘use’?

The problem isn't a single word

Research on language and framing (how we describe things) suggests that changing one word alone will not transform public attitudes.

A single use of the term substance misuse is unlikely to cause measurable harm. But language works cumulatively.

“Language is powerful, but it's not a magic bullet... framing effects are relatively small, so changing your message frame will likely have only a modest impact on your audience. Of course, if a message spreads through a large enough population, even marginal returns could yield a significant real-world impact.”

Flusberg SJ, Holmes KJ, Thibodeau PH, Nabi RL & Matlock T (2024). The Psychology of Framing: How Everyday Language Shapes the Way We Think, Feel, and Act. Psychological Science in the Public Interest.

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Words repeated thousands or millions of times across policy documents, treatment services, commissioning specifications, inspection reports, funding bids, websites, media coverage and everyday conversations help shape how society understands an issue.

Language creates frames. Frames influence assumptions. Assumptions influence attitudes. And attitudes influence behaviour.

The question is not whether one official report using the term "misuse" causes stigma. The question is what happens when an entire system repeatedly describes drug and alcohol problems through language that implies wrongdoing.

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What could replace it?

‍Multiple language guides including our own provide alternatives and indeed many organisations have moved away from the term and now describe themselves as providing Substance use services, Drug and alcohol treatment services or Drug and alcohol recovery services.

‍None of these alternatives is perfect. But the goal is not linguistic perfection. We just want language that is more accurate, less judgemental and better aligned with what we know about human behaviour.

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A tale of two strategies

‍The contrast at national strategy level is particularly striking.

‍The UK Government's 10-year drugs strategy, From Harm to Hope, uses the term drug misuse extensively. The phrase appears in the title of the GOV.UK policy category ("Drug Misuse and Dependency"), throughout discussions of the economic and social costs of drugs, and repeatedly across the strategy itself. From a language perspective, misuse is treated as an accepted and largely unproblematic descriptor. The term appears 49 times throughout the strategy, while substance use appears only 13 times, often when referring to approaches adopted by Scotland, Wales or Northern Ireland.

‍By contrast, Scotland's 2026 strategy, Preventing Harm, Promoting Recovery, takes a noticeably different approach. Rather than centring its language around misuse, it consistently refers to substance use, alcohol and drug harms, recovery, wellbeing, human rights, trauma and inequality.

‍In the Scottish strategy, substance use appears approximately 95 times, making it the dominant descriptor throughout the document. By comparison, misuse appears only six times, largely in references to historical policies, official statistics or existing system terminology rather than as the preferred way of describing alcohol and drug issues.

‍To be fair, From Harm to Hope does also use the phrase substance use, but comparatively rarely and often when describing the approaches of devolved administrations.

So the difference is not just linguistic. It is geographic and political.

The UK Government strategy's preferred term - drug misuse - centres the act of using a substance incorrectly. It is a word that directs attention towards the behaviour of the individual. The suggestion that this is primarily a problem caused by an individual's actions and therefore primarily for the individual to solve. Essentially, it is a ‘You Problem’.

The Scottish strategy's preferred language - substance use - is more descriptive and less judgemental. It creates space to discuss trauma, poverty, mental health, inequality and social exclusion. It’s an ‘All of Us Problem’.

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A discussion worth having

‍Perhaps the most important question is not whether "substance misuse", as the official terminology of the institutions of the drug and alcohol sector, is objectively right or wrong. It is whether the phrase helps or hinders the culture we are trying to create.

‍If we want a system that recognises substance use as a health issue, understands the impact of trauma, encourages people to seek support and challenges stigma wherever it appears, then our language should move in the same direction.

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What do you think?

  • Is "substance misuse" still a useful and neutral term?

  • Does it unintentionally reinforce blame and personal responsibility?

  • Should the sector adopt alternative language?

  • If so, what should replace it?

The Anti-Stigma Network would welcome your views.

‍Sometimes the most important conversations start with the words we take for granted.

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References

Photo Credit

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Lisa Gardener
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