Center for Addiction Medicine Pioneering a Better Future for Denver
August 30, 2023
“Words Matter” campaign aims to decrease stigma around substance use disorder through language
The Center for Addiction Medicine (CAM) is an innovative example of Denver Health’s integrated approach to health care. CAM brings together Denver Health’s robust range of treatment services within a “no wrong door” model, ensuring that behavioral health and medical providers can meet any person seeking help wherever the patient may present in our system and wherever the patient is in their journey, from safer use to recovery. These providers are integrated within school clinics, community clinics, on ambulances, in jails, and throughout Denver Health’s main campus.
Denver Health has been treating people with substance use disorders for decades. Historically, addiction treatment was a specialty health service separate from primary care settings, which made it difficult to identify and connect patients to proper treatment. Denver Health’s CAM was founded in 2019 by Dr. Judy Shlay and Lisa Gawenus to consolidate services into a singular program.
“There were a lot of good things going on, but they were very siloed and disconnected,” said Shlay, Associate Director of the Public Health Institute at Denver Health and CAM’s Medical Director.
As addiction treatment has evolved, so has the way that medical experts speak about the condition. Substance use disorder is now considered by medical professionals to be a treatable chronic disease, with rates of successful management similar to hypertension and diabetes. Only 10% of people with a substance use disorder access treatment, and stigma is a major barrier to seeking help. To that end, CAM started planning the “Words Matter” campaign in the fall of 2022 to educate Denver Health employees on non-stigmatizing language when speaking about—and especially when speaking with—a person with substance use disorder.
The “Words Matter” campaign operates through the CAM Academy, which provides training and technical assistance to providers inside and outside of Denver Health’s system and expands CAM’s impact to surrounding states. Dr. Hannan Braun, an HIV Primary Care and Addiction Medicine physician at Denver Health, co-leads CAM’s Inclusive and Compassionate Care work group alongside Dr. Shlay.
“We’re educating health care providers and anyone who interacts with patients and writes notes in a patient’s medical record about best practices in language, using terms that are clinically accurate and non-judgmental—language that really understands substance use disorders to be a chronic medical condition like other health conditions we treat,” he explained.
Braun cited a study by John F. Kelly and Cassandra M. Westerhoff published in the May 2010 issue of the International Journal of Drug Policy in which over 500 mental health clinicians were randomized and then asked to complete an identical clinical vignette, the patient alternately described as having a “substance use disorder” or as a “substance abuser.” When the patient was described as a “substance abuser,” clinicians were more likely to judge the patient as having a moral issue deserving of blame and punishment; in contrast, providers randomized to patients described as having a “substance use disorder” were more likely to recommend mental healthcare.
“Even among trained clinicians, exposure to just one word can really change how care is approached,” said Braun.
While “addiction” is an established term, there is a difference between how medical professionals speak about their areas of expertise and how clinicians and patients talk about the condition when it comes to treatment and the people seeking treatment.
“We’re always trying to use person-first language,” explained Brooke Bender, Administrative Director for CAM. “We say a ‘person with substance use disorder’ instead of an ‘addict’ or a ‘person with alcohol use disorder’ instead of ‘alcoholic.’” By acknowledging individuals with substance use disorders as people first, health care professionals acknowledge a patient’s inherent dignity and worth, promoting a sense of belonging, self-efficacy, and trust.
Shlay said that CAM conducted an evaluation of how Denver Health uses language in patient charts and that the results showed that they have some work to do, hence the “Words Matter” campaign.
“Patients can now see their charts,” she said. “If you put in a chart ‘This 49-year-old man is an opioid addict’ versus ‘This person presents with symptoms related to opioid use disorder,’ it changes the whole tone for the person reading about themselves.”
Philanthropy has played a key role in the “Words Matter” campaign. The Singer Family Foundation and Dr. Nancy Gary, a Denver Health Foundation board member, have both given gifts that allow CAM and CAM Academy to conduct this important work. With additional philanthropic support, the campaign aims to reach all Denver Health employees, an essential step in making the “no wrong door” model for health care even stronger.
Presentations, awareness campaigns, and pledges from employees to change the ways they use language are all integral to the “Words Matter” campaign. Once CAM leaders feel they have reached a certain level of education, they will conduct another evaluation to measure how the use of language has improved at Denver Health.
John Mills, Public Health Planner for CAM, explained how Emily Elrick, CAM’s Workforce Development Specialist, and the Inclusive and Compassionate Care work group, prepared a table depicting stigmatizing language alongside recommended language, and identified the Denver Health departments and programs that are a priority for the “Words Matter” campaign. Meeting monthly with a community advisory group comprised of individuals who have lived experience with substance use disorders revealed how important it is to eliminate stigmatizing language from patient interactions.
“One word can stop a person from getting care and can change the trajectory of their life,” said Mills.
Shlay hopes that once CAM has established a viable program of education and training at Denver Health, their model will be one that other organizations can utilize, from analyzing stigmatizing language used to providing education around recommended language suggestions to create culture change.
“This is a start,” said Shlay. “This work will be bigger than just us.”
For more information about CAM’s “Words Matter” campaign, please reach out to CAMAcademy@dhha.org