What do you call someone who “who habitually lacks self-control as to the use of alcoholic beverages”? 

They’re an “alcoholic,” according to Rhode Island General Law.

But the state’s statutory language surrounding alcohol use and treatment could soon change thanks to the recent passage of bills in both chambers of the General Assembly. 

“We don’t talk that way anymore. We don’t think that way anymore. Yet it’s still codified into our statute,” said Rep. Jennifer Boylan, a Barrington Democrat, during a March 5 hearing of the House Committee on Health and Human Services. 

The bill she introduced that night, H7736, saw successful passage May 7 during a House floor vote. On Thursday, May 9, the Senate unanimously passed Bill S2087 by Sen. Joshua Miller, a Cranston Democrat. The twin bills allow revision of how state law defines alcohol disorders and their treatment. 

“These statutes have not been approached for revision in over 40 years,” Miller said on the Senate floor. “There are many flaws in it, including commitment to public hospitals where the actual commitment doesn’t exist, the beds do not exist. And the language is embarrassing to the departments and those involved as providers.”

Both bills direct the Rhode Island Department of Health and the Department of Behavioral Healthcare, Developmental Disabilities (BHDDH) and Hospitals to coordinate proposed revisions that would align the state’s law books with best practices by Jan. 1, 2025.

Miller previously worked on the Governor’s Overdose Commission and has sponsored other bills relating to substance use in the past. This is Boylan’s first bill relating to substance use. 

“I challenge you to find someone who doesn’t know anyone who has this problem (alcohol use disorder),” Boylan said in a recent phone interview. “It’s a problem that a lot of people struggle with, and I think our statutes should be updated to be more modernized.” 

Person-first language

Many doctors and advocates consider terms like “alcoholic” stigmatizing and loaded. Both the National Institute on Drug Abuse and Centers for Disease Control and Prevention suggest using “person with alcohol use disorder” in keeping with a person-first approach to language use.

The notion of self-control as the main motivating factor in one’s drinking is contrary to clinical understanding, which sees alcohol use disorder as a more complex pattern. 

“Yes, there is an element of choice when a person first starts drinking. For some people, however, a mix of genetic and environmental factors facilitates a transition, often without full recognition, to increasingly heavier drinking,” according to a core resource document from the National Institute on Alcohol Abuse and Alcoholism. 

Now the bills have to pass in opposite chambers, said Larry Berman, a House spokesperson, in an email: “In other words, the House now has to pass Sen. Miller’s bill and the Senate now has to pass Rep. Boylan’s bill. Once each bill passes in both chambers, they will be transmitted to the Governor.”

Boylan said on the phone that she’s “very hopeful” the bill will land on the governor’s desk this year. And on the Senate floor, Miller said the simultaneous OK is an improvement over previous years. In the 2023 legislative session, Miller’s bill secured Senate approval. But its momentum ended when it was referred to the House Committee on Health and Human Services.  

“I’ve had this bill for several years without any action on it on the House side,” Miller said. “The House passed it a few days ago, which will be a great relief to those involved in deciding in June what passes and doesn’t pass, [who] won’t have to hear from me about ‘Why didn’t this bill pass?’ Because it’s so simple and so important.”

The identical bills add only six sentences to existing statutes. Miller’s bill generated no discussion on the Senate floor. In the House, Minority Leader Mike Chippendale wondered if Boylan’s legislation would also change other instances of outdated language buried in state law.

“There are other sections in the law…where we use the term ‘habitual drunkard,’” Chippendale said. “I think obviously that sounds a little bit more offensive than ‘alcoholic.’” 

Laws on taverns, cookshops and oyster houses, for example, lump together “Drunkards, wastrels, and minors” as prohibited from entry into these businesses. Business owners face possible fines if they count among their customers “any common drunkard or person addicted to the intemperate use of spirituous or intoxicating liquors.” The section was first written in 1896 and most recently updated a century later in 1996. 

“Would this also change that or would that be something that we perhaps overlooked and will change later?” Chippendale asked Rep. Susan Donovan, who chairs the House Committee on Health and Human Services and presented Boylan’s bill.   

“I’d have to refer to counsel. I would hope that it would change all of those terms,” Donovan said.

Last year, Gov. Dan McKee signed into law legislation sponsored by Sen. Jonathan Acosta that replaced terms like “mentally retarded,” “alcoholic,” and “drug abuser” with less stigmatizing language. That legislation targeted different sections of state law, however. Boylan said her bill hones in on a very specific section of state law. 

Because circumstances can change

Beth Lamarre, executive director of the Rhode Island chapter of the National Alliance on Mental Illness, wrote via email how stigmatizing words like “alcoholic” can hold “a negative connotation, because of how alcoholism/alcohol use disorder has been viewed throughout time.”

“It also spotlights the issue, as though it is that person’s only characteristic,” Lamarre said. “Describing someone as having an alcohol use disorder, on the other hand, describes a circumstance or a situation, one that can be changed.”  

Other states have also begun to read the fine print surrounding spirits. “It’s hard to say how many states have replaced their language entirely, but we have noticed more states using AUD (alcohol use disorder) in current legislation,” said Karmen Hanson, a senior fellow in the National Conference of State Legislatures’ health program, via email.

Legislatures where similar legislation has been introduced include Connecticut, Maryland, Colorado, Massachusetts, New Jersey and the Virgin Islands, but Hanson noted “that’s not a reflection of everything that may be out there.”

Global opinions differ on people-first language, although what words are used also owes much to the disability being described. England’s national health agency, for example, prefers “disabled people” to “people with a disability” — a choice underlined by an argument that society makes barriers for people with disabilities, rather than the disabilities themselves. This alternative, known as identity-first language, is also common among autistic and deaf people in the United States, according to the National Institutes of Health.

Regardless of what language one uses, disability advocates seem to agree that the overall idea is ensuring people feel comfortable speaking up about their struggles.

“Words matter, and how we talk about someone’s health (including and especially behavioral health) can make the difference in whether they feel supported in getting the treatment and help they need,” Lamarre said.