Reconsidering the Term “Patient” in Alcohol and Other Drug Treatment Settings

Introduction

Language in healthcare is not neutral. ¹ It shapes relationships between individuals and services, frames expectations, and signals underlying values. ² Within alcohol and other drug (AOD) treatment, the term patient remains widely used; however, its continued use may not align with the principles of person-centered care that increasingly guide contemporary practice. ³ This commentary examines the historical use of the term patient in AOD treatment, reviews evidence on how language shapes individuals’ experiences and clinician responses, and proposes revising terminology within measurement frameworks as a practical step toward person-centered care—while also acknowledging the challenges of establishing universally acceptable alternatives.

Evolving Models of Care

The terminology used in AOD treatment has evolved alongside broader shifts in how substance use is understood. Historically, problematic substance use was framed as a moral failing, with individuals often positioned as blameworthy, weak, or socially deviant. ⁴ The medicalization of addiction marked a significant and necessary transition away from such moral framing, repositioning AOD use as a health condition requiring treatment rather than punishment. ⁵ Within this context, the term patient served an important function: it legitimized care, supported more compassionate understandings of addiction, and aligned AOD treatment with broader health systems. ⁶

Contemporary AOD treatment increasingly reflects person-centered models of care. ⁷ These approaches emphasize autonomy, collaboration, dignity, and the active participation of individuals in shaping their own recovery journeys. ⁸ Rather than positioning people as passive recipients of expert intervention, person-centered care recognizes them as partners in care, with knowledge, preferences, values, and goals that are integral to decision-making. ⁹ Although the term patient does not inherently preclude collaboration, it originates from and remains embedded within a biomedical framework that historically situated individuals as recipients of care. ¹⁰ Its continued use may therefore carry residual meanings that sit uneasily alongside models of care that emphasize agency and partnership. In AOD treatment, the term patient may reflect an earlier stage in the evolution of care that does not fully capture contemporary commitments to collaboration and personhood.

Concerns about the term patient are not new. Writing in a medical context, Neuberger ¹¹ argued that the term may reinforce a passive role characterized by suffering and reliance on expert care, which is inconsistent with active participation in care. This article ¹¹ generated considerable debate, with subsequent commentaries offering differing and strongly held views on the appropriateness of the term. ¹² Across this discussion, a recurring theme was the importance of asking individuals how they prefer to be addressed. These exchanges illustrate that questions about language, power, and participation in care have long been recognized, even within medicine itself. ¹³ The continued use of the term patient suggests that the shift toward person-centered care remains incomplete.

Language Shapes Experiences and Clinical Practice

The language used in care influences how individuals experience treatment and may reinforce or challenge existing power dynamics. ¹⁴ Within AOD treatment, where engagement and collaboration are central, this is particularly relevant. Evidence suggests that stigmatizing or deficit-focused terminology contributes to internalized stigma, reduces self-efficacy, and shapes expectations about recovery, ¹⁵ particularly in AOD contexts where stigma is already pervasive. ¹⁶ This is further supported by research demonstrating that terminology used in addiction contexts can significantly influence both explicit and implicit bias. For example, Ashford et al ¹⁷ found that terms such as “substance abuser” were associated with more negative judgments and greater perceived blame compared to person-first alternatives such as “person with a substance use disorder.” Similarly, a Delphi study identified strong consensus that person-first and recovery-oriented language is preferable in AOD treatment, while terms perceived as defining or labeling individuals were considered stigmatizing. ¹⁸

Conversely, respectful and person-centered communication is associated with greater engagement, stronger therapeutic relationships, and increased satisfaction with care. ¹⁹ Research examining terminology preferences in healthcare settings beyond AOD further highlights that the term patient is not universally experienced as appropriate or acceptable. While patient is often preferred in general healthcare settings, alternatives such as client are more commonly endorsed in mental health and psychosocial contexts, ²⁰ suggesting that preferences are shaped by the nature of the care relationship. Forms of address also play an important relational role, with individuals reporting greater satisfaction when addressed according to their preferences. ²¹

Language also shapes clinician perceptions and responses. Rather than simply reflecting underlying attitudes, terminology can act as a cognitive frame that influences how individuals are understood and how care decisions are made. Experimental research demonstrates that language can alter attributions of blame and recommended responses, ¹⁵ while stigmatizing language in clinical documentation has been shown to negatively influence clinician attitudes and decision-making. ¹ These effects have practical implications. A meta-analysis found that when individuals received positive, person-centered address, they demonstrated higher satisfaction, greater treatment completion, and modestly improved clinical outcomes. ²² Taken together, this body of evidence suggests that language is not incidental to care; it contributes to how individuals engage with treatment, how clinicians conceptualize those they support, and how collaborative or hierarchical the care relationship becomes, thereby influencing treatment outcomes.

What Should We Call People in Treatment?

Given the influence of language on both experience and practice, determining how individuals are referred to in AOD treatment becomes an important practical consideration. If the term patient may be misaligned with person-centered AOD treatment, identifying an appropriate alternative is not straightforward. Terms such as client, consumer and service user are already used across AOD and related fields, each reflecting different assumptions about the nature of care relationships.^23,24 Client may convey agency and partnership, consistent with counseling and social care traditions, ²⁵ but can also evoke transactional interactions. Service user or consumer emphasizes engagement with systems yet may feel impersonal or bureaucratic. ²⁶ Broader terms such as person or people in treatment may better foreground humanity and avoid role-based identities, but can be less precise in some clinical contexts.

In the development of this commentary, consultation was undertaken with 7 members of the Network of Alcohol and Other Drugs Agencies (NADA) Consumer Advisory Group (CAG); a lived and living experience advisory body providing input across residential and community-based AOD treatment services in Australia (personal communication, April 15, 2026). Consultation occurred through an open forum and roundtable discussion facilitated by this author, during which members shared their perspectives on preferred terminology used with AOD treatment settings. Consultants described a range of preferred terms, including client, consumer, service user/program user, person, or simply being referred to by their name. There was broad agreement that patient was not a term they appreciated or wished to be identified by. The term was frequently described as implying passivity and a lack of engagement, which the consultants felt did not reflect the active, collaborative, and effortful nature of AOD treatment. These discussions further highlighted the importance of clinicians and researchers asking individuals how they would like to be addressed as a simple first step toward more person-centered practice.

Rather than identifying a single replacement term, these conversations with consumer advisors pointed toward the importance of flexibility, responsiveness, and ongoing dialogue in language use. The consultants emphasized that clinicians should remain fluid in their use of terminology, recognizing that language preferences differ across individuals and contexts. The advisors also expressed a desire not to “police” language, but to sustain broader conversations about terminology in ways that promote trust, respect, and shared understanding. This reflects the discursive nature of language, whereby meanings are shaped through context, relationship, and who has the power to name. As such, the CAG suggested that the language conversation—including directly asking individuals how they would like to be addressed—reflects the kind of reflexive practice necessary for implementing person-centered care, signaling collaboration, dignity, attentiveness, and recognition of the person’s voice within treatment (NADA CAG, personal communication, April 15, 2026). At a broader level, these reflections highlight an ongoing tension: how can services implement person-centered language in ways that are both consistent and responsive to individual preference?

Considerations in Measurement Language: PREMs and PROMs

One area in which this dynamic is particularly visible is in the evaluative tools embedded within healthcare systems—patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). These tools have played a central role in advancing person-centered care by ensuring that individuals’ perspectives inform service delivery, evaluation, and quality improvement.^27,28 As the term patient reflects a medicalized view of AOD treatment, its continued use within ostensibly person-centered measures may be considered contradictory.

This issue extends beyond clinical interaction into the language embedded within research and evaluation systems. Studies examining AOD use literature have found that person-centered language is inconsistently applied, with many publications continuing to use terminology that may be considered stigmatizing or misaligned with contemporary care approaches.^29-32 Given that research language is often translated into clinical practice, education, and policy, these patterns likely contribute to the continued use of non-person-centered terminology within healthcare systems, suggesting that alignment with person-centered care remains incomplete, and considerable work is still to be done.

Reconsidering terminology within these frameworks offers a practical and achievable step for continuing to align language with contemporary models of care. The authors propose that “person-reported” be used in place of “patient-reported,” offering a more consistent and person-centered alternative. Given the visibility and widespread use of these tools, such a shift may represent a small, but meaningful step toward broader cultural change in how people are positioned within AOD care systems. Importantly, the consulted consumer advisors strongly supported changing PREMs/PROMs to Person-Reported measures—with one consultant noting that “we are all people, but we are not all patients” (NADA CAG, personal communication, April 15, 2026).

Challenges and Considerations

A key challenge in moving away from the term patient in AOD services is the limited evidence base to inform alternative terminology. Although there is strong evidence that certain terms (such as “substance abuser”) are associated with increased stigma and negative perceptions,^15,17 there has been comparatively less research examining what individuals in AOD treatment prefer to be called. This highlights an important opportunity for future research and service consultation to better understand terminology preferences and support the use of more person-centered language. At present, there is no clear or universally supported alternative.

There is also a risk that changes in terminology alone may not meaningfully alter care. Without corresponding shifts in how services are delivered, changes in language may be symbolic rather than substantive, or may obscure ongoing power imbalances rather than address them. This is particularly relevant in AOD treatment, where person-centered care emphasizes not only how individuals are described, but how they are engaged, supported, and involved in decision-making. ³³

Practical constraints further complicate efforts to shift terminology. As highlighted in the use of PROMs and PREMs, the term patient is deeply embedded within policy, documentation, research, and evaluation systems. Changing such language therefore requires coordination across multiple levels of service delivery and governance. As such, efforts to move toward more person-centered language must extend beyond interpersonal communication to include the broader structures in which care is delivered, underscoring the potential for meaningful change across systems of care.

Conclusion

In AOD treatment, where engagement, trust, and collaboration are central, the language used to describe people in care warrants careful consideration. The term patient may not fully reflect person-centered approaches that emphasize agency and partnership. Clinical language, however, does not always evolve at the same pace as practice. Continuing to advance person-centered care in AOD treatment therefore includes remaining reflexive in how individuals are referred to, including directly asking people how they would like to be addressed, and ensuring that language embedded within systems does not unintentionally reinforce passive roles or unnecessary power differentials. Language is not incidental to care; it is one of the ways care is enacted.