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John F. Kelly, Ph.D., is the Elizabeth R. Spallin Professor of Psychiatry in the Field of Addiction Medicine at Harvard Medical School. He is the founder and director of the Recovery Research Institute at Massachusetts General Hospital, program director of the hospital's Addiction Recovery Management Service, and associate director of its Center for Addiction Medicine. Kelly's research explores the importance of language in destigmatizing substance use and improving public health and social policies.
Interact for Health: During your career, how have you seen attitudes change over time toward people struggling with addiction?
Kelly: As a result of the research regarding the causes of addiction and its impact in the neurobiological circuits of the brain, stigma and discrimination against people with substance use disorder—as well as policies associated with addressing these problems—have undergone significant change. We have seen this in the move away from more punitive legislation and laws in the 1980s toward laws that are oriented more toward public health and access to treatment, such as the Mental Health Parity and Addiction Equity Act and the Affordable Care Act. Such changes have been long overdue and are very welcome. We still have a long way to go.
Interact for Health: Where is there still work that needs to be done?
Kelly: Better training and education is needed among our clinical workforce so that they are more equipped to screen, assess, and intervene with these disorders and less likely to stigmatize people who suffer from them. We need more education in medical settings and other clinical training settings for social work, nursing, medical schools and psychology. Integrating substance use disorder care into the education will enhance awareness and increase expertise and confidence in addressing these problems. We also need to shift our terminology in line with new findings and conceptualizations of these disorders that have emerged during the past 30 years. This includes recognizing that these are psychiatric illnesses that center around changes in the neurocircuitry of the brain. This does not mean that people cannot get well. People do recover. In fact, most people recover from these disorders. But we need to educate people as to the nature of these disorders as they affect the brain and impair people's ability to self-regulate behavior.
Interact for Health: People in active addiction or recovery often use stigmatized terms like "junkie" to describe themselves. How do we respect their experiences while also encouraging them to reduce stigma?
Kelly: Regarding terminology that people may use themselves, we cannot legislate against that. What we can do, is to professionally model accurate language that we know is not likely to increase stigma and is also likely to accurately reflect the nature of these disorders. Language changes over time naturally but we can also stimulate change when we know that certain terminology is associated with increasing stigmatization. We have found, for example, that using the term "abuse" and "abuser" is associated with increased stigmatization of people with substance use disorder. Using person first language that is, "a person suffering from or with a substance use disorder," is not associated with increases in stigmatization.
Interact for Health: What can the average person do to change the stigma of addiction?
Kelly: They can better educate themselves about the nature of addiction and also change the way they describe people who have these disorders. Instead of referring to them as "drunks" or "junkies" or "addicts," they can refer to them as people first who may be suffering from one of these conditions. I think it's also good to reach out to someone you may know who has suffered from a substance use disorder and get to know them a little better to find out what it was like and how they recovered.
Interact for Health: What lessons have you learned through your work?
Kelly: Most notably, I was not someone who would have guessed that language has the potential to influence attitudes so profoundly, especially among expert clinicians. We have found that certain terminology -- for example, "drug abuse" and "abuser" -- induces biases even among mental health and addiction experts. So, it has been very important for me to change my language and to advocate for changes in language.
Interact for Health: What about your work most excites you?
Kelly: The possibilities for new discoveries. You have your ideas about your research—questions and the hypotheses associated with them—but oftentimes you uncover and discover new things you didn't expect. This is the nature of science. You never quite know what you're going to find. That is always exciting.
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