Therapeutic Language Dilemmas in SUD Treatment: A Qualitative Analysis for Practice-Based Learning

Introduction
The language used in substance use disorder (SUD) treatment has been extensively debated, with scholars advocating for person-first terminology to reduce stigma. While extensive research has examined clients' perspectives on SUD terminology, considerably less attention has been given to the professional perspective. This study explores how SUD treatment professionals perceive and utilize terminology, introducing the novel theoretical concept of "semantic warning signs" which underscores the interconnection between language, stigma, and identity construction.

Goals and Methods
This qualitative study aimed to understand the meanings and perceived implications of SUD-related terminology from professionals' perspectives. Using a constructivist epistemological framework, we conducted semi-structured interviews with 32 SUD treatment professionals (20 social workers, 6 psychologists, 6 psychiatrists) recruited through purposive sampling. Data were collected between February and November 2023 via in-person and Zoom. Analysis employed Braun and Clarke's reflexive thematic method, with both authors independently coding data and engaging in extensive dialogue to ensure interpretive rigor.

Results
Analysis revealed a complex pattern of "reflective symmetry" whereby each benefit of terminology use was counterbalanced by corresponding limitations across three dimensions: identity formation, stigma management, and clinical utility. Benefits included problem acknowledgment, identity formation, and stigma reduction through medical framing. However, limitations encompassed perpetuating stigma, constraining identity integration, and limited applicability across diverse client populations.

Conclusions
This study reveals the context-dependent nature of SUD terminology, showing how terms often viewed as stigmatizing (e.g., “clean addict”) can be reframed as therapeutic tools. The qualitative approach was essential in uncovering professionals’ nuanced rationales, highlighting how culturally parsed language both aids and limits recovery. These findings underscore the need for adaptable frameworks in global SUD practice. By fostering awareness of language’s dual functions, professional training programs can help clinicians use terminology more strategically—balancing clinical utility, identity reinforcement, and stigma sensitivity.