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Substance Abuse and Addiction-Related Word Associations


Over time, the language we use to describe the world and communicate with one another has changed substantially. As “tweet” becomes an everyday word and “iPod” gradually supplants “CD,” certain terms go out of style while new words emerge from the latest ideas and concepts. The evolution of language isn’t new – it’s been happening for thousands of years.

So what does the history of language usage tell us about how the conversation around addiction and substance abuse has changed over time? Like any other topics, drug addiction and alcoholism have been the subject of major fluctuations in both cultural attitudes and scientific knowledge – Sumerians were writing about herbal medicines as early as 1700 B.C.1 Using the Corpus of Historical American English (COHA) compiled by Brigham Young University, we’ve examined trends in the discussion of drugs over the past 200 years. This COHA collection contains 400 million words in total, spanning 115,000 textual sources, including spoken transcripts, from 1810 to 2009.2

We searched COHA for 14 common words related to substance abuse and addiction and charted their frequency in COHA since 1815. We then gathered the surrounding context for each of these words by collecting all words within 10 words before and after each occurrence. To identify the top ten words used in proximity (also known as the “most characteristic” in the graphs below) to each substance abuse- and addiction-related word, we identified the words appearing most in the surrounding context that were not common prepositions, pronouns and conjunctions. Take a look at our findings to see how the words we associate with substance abuse and addiction have changed throughout history.

While many of the terms we studied hit their peak in the latter half of the 20th century, “addicted” got a strong start in the early 1800s. In that era, the word was commonly used in conjunction with “habit” and in condemnations of “vices” as well as any frowned-upon “practice” or “pursuits.” As alcohol abuse became a growing problem throughout the 1800s, mentions of “intemperate” and “intemperance” became increasingly frequent in the vicinity of “addicted,” likely linked to the spread of anti-alcohol temperance societies. Throughout that time, “addicted” also showed a strong connection to “gambling.”

In the 1900s, the term increasingly became abbreviated to refer simply to an “addict,” and it reflected concern about the addictive properties of nicotine. And in the mid-1970s, nearby mentions of “crack” skyrocketed in connection with the growing crack cocaine epidemic – as of 2009, “crack” was the most commonly used word near “addicted.”

Unlike “addicted,” commonplace usage of “addiction” appears relatively recently, peaking after the 1960s. From that time to the present, “drug” takes the lion’s share of related words, and “heroin,” “narcotic,” and “narcotics” make appearances as well. More recently, “abuse” has been frequently mentioned alongside “addiction,” and use of “sexual” has become more common as the concept of sex addiction has grown in recognition. Notably, unlike the previous chart, “crack” does not appear here, suggesting that phrases like “crack addicted” or “addicted to crack” are more common than “crack addiction.”

Mentions of “alcohol” have grown steadily from 1810 to the present, but until 1900, the term was paired with “drugs” almost exclusively. At that point, terminology from scientific literature such as “wood” alcohol and “denatured” alcohol began to appear as well as later industrial uses for alcohols involving “cellulose” and “shellac.”

“Tobacco” grew steadily throughout the 1900s in connection with vice taxes and the Bureau of Alcohol, Tobacco, Firearms, and Explosives. And unexpected terms such as “expressions,” “harsh,” and “scenes” appear due to movie guides by the Christian Science Monitor, which examine films for potentially problematic content – including alcohol usage.

While “alcohol” was typically connected to chemistry, film, and regulatory agencies, “alcoholic” tends to be more closely linked to the substance itself. Alcoholic “drink,” “drinks,” and “liquors” all start off strongly in the 1800s, and by 1900, “beverage,” “beverages,” and “beer” appeared as well. The majority of these terms, as well as the alcoholic “content” of drinks, have persisted to the present.

“Alcoholism” made its debut in the lexicon around 1900, associated almost exclusively with “crime” and “dreams” – coincidentally around the time that Sigmund Freud’s “The Interpretation of Dreams” was published. However, the association with crime was soon eclipsed by concern over “chronic” alcoholism and “death”/”deaths” related to alcoholism, which ballooned in the 1920s during the height of the prohibition movement.

Fortunately, “dysgenic,” a reference to discredited theories of eugenics intended to breed traits like alcoholic tendencies out of the human population, quickly tapered off into obscurity. As of the 21st century, alcoholism is now most frequently understood as an issue of “abuse,” “addiction,” and “disease.”

Unlike most other terms we studied, “cocaine” barely appeared at all until the 1970s when the drug became more prevalent in the U.S. Prior to that, mentions of cocaine were uncommon and obscure, largely focusing on its medical usage as an anesthetic. This led to an association with terms such as “insensitive” for the numbness it produced, “morphine” and “heroin” (other widely used anesthetics and painkillers at the time), and “opposition” from those who considered it too dangerous – leading to its later replacement by novocaine, a safer anesthetic.

As cocaine went mainstream, there was increasing concern over those who “sniff” the drug as well as any dealer who “pushes” the substance on drug users. And once mentions of cocaine hit their peak, discussions were dominated by the term “drug” and comparison to other major classes of illicit substances such as “heroin” and “marijuana.”

The term “drugs” was mentioned at relatively low levels before skyrocketing from 1950 to the present, and it’s now the most commonly used word of the group that we analyzed. Up to 1850, it was usually used along with “food,” “medicine,” and “spices,” referring to various classes of imported goods. Its medical associations continued to grow, and terms like “dr” “curative,” “chemists,” and “quinine” (an antimalarial drug) were closely linked to the word from 1850 to 1900. By the 21st century, “drugs” are most commonly mentioned in conjunction with its singular form “drug” as well as “alcohol,” grouping drugs and alcohol together as substances of abuse and addiction.

Heroin wasn’t first synthesized until the latter half of the 19th century, and it doesn’t appear frequently enough for its associated terms to be measured until after 1900. While it was mentioned alongside other painkillers such as “morphine” (also called “morphia”), it also occurred in close proximity to “cocaine,” and it was already recognized as a substance used by “addicts.” “Addiction” soon appeared as well, and it was often discussed along with “marijuana,” another drug that was the subject of great public concern in the mid-1900s. After that, “methadone” and “clinics” achieved some prominence; the terms are associated with clinics providing methadone maintenance therapy to recovering heroin addicts.

The term “illicit” implies a variety of things; it suggests both illegality and social disapproval, and neither meaning is limited to drugs. Within the time span we studied, “illicit” peaks at the beginning of the 1800s, but references to drugs are almost wholly absent. Instead, “illicit” refers to illicit “commerce” and “traffic” (smuggling) and reflecting moral concerns of the time, illicit “love” as well as “intercourse.” Illicit “distilleries” and “distilling” – alcohol production methods – rose to prominence from 1850 to 1900, before being eclipsed by discussion of illicit “liquor” in the prohibition era. As of 2009, the word was mainly used to refer to any illicit “drug,” edging out most other historical terms associated with it.

Across the time span we studied, “intoxicated” peaked in the 1800s, with its frequency declining by more than two-thirds in the present day. During the 19th century, it was used to refer to being intoxicated by “liquor,” but also in a more metaphorical sense – intoxicated by “beauty.” It soon grew to encompass crimes “committed” by those who were intoxicated or descriptions of such people being “committed” to jail. By the turn of the century, it was increasingly used in conjunction with “alcohol,” and as of 2009, it frequently referred to intoxicated “drivers” or those who are “driving” while intoxicated (DWI).

“Marijuana” doesn’t make an appearance until relatively recently, and it doesn’t have enough occurrences to count the words most commonly used in proximity until the 1940s, when the movement to ban cannabis in the U.S. was in full swing. At that time, it was frequently mentioned alongside “heroin,” “opium,” and “cocaine” as well as the number “five.” This may have been a reference to the five prominent leaves on certain marijuana plants. For a brief time, it was also widely described as a “narcotic” and mentioned along with the potent hallucinogen “LSD.” As of 2009, it remained commonly mentioned near “alcohol,” “cocaine,” and “heroin” as well as the more generic “drug” and “drugs.”

As the term “narcotics” has risen in frequency, it’s taken on a distinctly different context. In the 1800s, this broad category was most often referenced with specific substances: “stimulants,” “tobacco,” “opium,” and “alcohol.” However, in the 1900s, it shifted to a more bureaucratic tone, being mentioned in the vicinity of “police,” “indictments,” and “bureau.” More recently, it often appeared next to more generic categories: “drug” and “drugs.”

References to “opium” hit a peak in the 1800s but also in the late 1900s. “Calomel” – toxic mercurous chloride – was commonly administered along with opium in the early 19th century as a treatment for gastrointestinal upset. “Eater” also makes a strong showing due to Thomas De Quincey’s 1821 book, “Confessions of an English Opium-Eater.” And while you might have expected references to classical opium dens to appear commonly throughout the 1800s, it turns out that usage of “den” alongside “opium” grew steadily through the 1900s, likely due to the prevalence of modern-day fiction set in that earlier period.

In contrast to the other terms we studied, “overdose” was uncommon enough that we had to combine “overdose,” “overdosed,” and “overdoses” in order to get a large enough sample. In the 1800s, these terms took on a more clearly medical tone, associated with “doctor,” “effect,” and “accidental.” As medicine progressed, there was a growing connection between overdoses due to “insulin” or another “injection,” and by the 1950s, these terms came to be associated with the risk of overdose from “sleeping pills.” “Digitalis” – a poison that was sometimes mentioned in classic murder mysteries – also appears. In more recent years, these terms were most frequently linked to those who “died” from an overdose of a “drug.”


COHA at Brigham Young University is a curated collection of 115,000 textual sources, spanning fiction, magazines, newspapers, academic journals, and spoken transcripts. These documents are divided by decade from 1810 to 2009. After selecting search terms, we graphed their usage over time as a proportion of all words used in a given decade. We also collected 10 words before and after each instance of the term in a document. We filtered out words occurring in only one document, excluding many proper names. Log likelihood keyness was then used to determine which words were more likely to appear near a given term, such as “addiction,” than to any other word. The top 10 such words were selected and displayed via stream charts, which show how commonly each appears relative to the rest of the words. Because COHA is organized by decade, for each decade, words were assigned to the middle year of that decade – words in the 1940s were assigned to 1945 and so on. The decade years were calculated using a simple smoothing, taking the average of adjacent frequencies – 1940 was the average of 1935 and 1945 and so on. Stream charts do not always span the entirety of 1810–2009; in years where a term infrequently occurred, it was often in proximity to words which were too common to include.

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Seeking Help for Drug and Alcohol Abuse

No matter how we talk about drugs and alcohol over time, one thing is clear: the importance of discussing substance abuse openly. If you’re struggling with an addiction to drugs or alcohol, modern-day treatment can help you break free. Call today at to get the help you need to move your life forward.

Seeking Help for Drug and Alcohol Abuse

No matter how we talk about drugs and alcohol over time, one thing is clear: the importance of discussing substance abuse openly. If you’re struggling with an addiction to drugs or alcohol, modern-day treatment can help you break free. Call today at to get the help you need to move your life forward.

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