Navigating the Grey Areas: The Sorites Paradox and the Language of Addiction

I remember my first day on a crisis mental health team like it was yesterday. Anxiety had taken hold of me—my heart raced, my hands trembled slightly, and my mind buzzed with the weight of responsibility. Then it happened: my first assessment of the day. A 35-year-old man had been booked in the day before, and I had only a brief handover from a senior colleague. “Don’t worry, it’ll be a quick one,” they said. “He’s misused alcohol for years; he’s an addict. Just refer him to substance use services and discharge him.”

I nodded, eager to appear competent, but something about that interaction stayed with me long after the assessment was over. It wasn’t just the casual nature of the referral or the urgency to move him through the system—it was the language. Misused alcohol, addict—terms tossed around so easily, yet loaded with meaning. These words shaped how I viewed this man before I had even met him. They framed him not as an individual with a unique story and circumstances but as a stereotype, a case to be processed.

Years later, I find myself reflecting on that moment, especially since a colleague recently used almost the exact same language, nearly 15 years on. It made me wonder: What does it actually mean to misuse something? When does substance use cross the line into misuse? And at what point does misuse become addiction? More importantly, when do we begin to label someone as an addict?

The truth is, these distinctions are far from clear-cut. Our language seems to demand definitive categories, but reality isn’t always so accommodating. This brings me to a concept I’ve found helpful in unpacking these questions—the Sorites paradox (Shelby, 2016).

The Power of Language in Shaping Reality

As I began my career, I didn’t immediately grasp how deeply the words we use shape our perceptions. But reflecting on that first assessment—and countless others that followed—I now see the invisible power of language. The words we choose don’t just describe reality; they actively shape it. Labels like “misuse,” “addict,” or “junkie” don’t merely reflect a person’s actions or choices—they create an identity. These labels influence how others see the person in front of them and, perhaps more critically, how that person comes to see themselves.

This is where the Sapir-Whorf hypothesis comes into play—a theory suggesting that the structure of a language affects its speakers’ worldview (Whorf, 1956). In essence, language doesn’t just reflect what we think—it shapes what we are capable of thinking. When we use terms like addict, we reduce a person to their relationship with a substance. John isn’t John anymore; he’s an alcoholic, a label that suggests a fixed identity, overshadowing every other aspect of his life. The language we use freezes people in place, boxing them into categories that can be incredibly difficult to escape.

Consider this: would you see John differently if he were described as a person struggling with substance use rather than an addict? The first description allows for nuance, for the possibility of change, for the recognition that John is more than his addiction. The second locks him into a narrow definition, where his entire identity is overshadowed by his relationship with alcohol. This distinction may seem subtle, but its consequences are profound. The language we use not only shapes how others see John but can also influence how he sees himself.

I recall another instance early in my career when I assessed a woman named Lisa. She had been referred to us after an overdose. In the referral notes, she was described as a “repeat offender” who “refuses to engage.” The language painted a picture of someone uncooperative and undeserving of empathy. But when I met Lisa, I found a person in deep pain, grappling with trauma and isolation. The labels in her file had obscured her humanity.

These experiences made me realise that language is often a blunt tool for navigating the complexity of human behaviour, and nowhere is this more apparent than in the realm of addiction. Just as the words we use can stigmatise and confine, they also reveal the underlying ambiguity of addiction itself. This is where the Sorites paradox becomes a powerful lens through which to understand the shifting, vague nature of addiction and the labels we assign to it.

Introducing the Sorites Paradox

So, what exactly is the Sorites paradox? Originating from ancient Greek philosophy, the term “sorites” derives from the Greek word for “heap” (Sōritēs). The paradox poses a simple but perplexing question: if you have a heap of sand and remove grains one by one, at what point does it stop being a heap? Conversely, if you start with a single grain of sand and continue adding grains, when does it become a heap? The paradox highlights the problem of vague predicates—terms that lack clear boundaries.

This philosophical puzzle is surprisingly relevant to addiction. Just as there’s no clear moment when a ‘non-heap’ becomes a ‘heap,’ there’s no obvious point at which substance use becomes misuse or when misuse becomes addiction. Consider this: if someone drinks socially once a week, no one would label them an addict. If they drink a little more frequently, say a few times a week, we might still think of it as within normal bounds. But what happens when they start drinking every day? Is that the moment it becomes a problem? Or is it when they begin drinking alone, using alcohol to numb emotional pain? At what point do we apply the label of addict?

The truth is, much like the heap of sand, addiction is a continuum, not a binary state. The transition from occasional use to misuse and then from misuse to addiction happens gradually. Yet, our language forces us to draw hard, often arbitrary lines. We say someone “misuses” a substance or that they’re an ‘addict’, as if there’s a clear point where they’ve crossed over into that territory. But, as the sorites paradox illustrates, the boundaries are not so clear-cut.

Just as with the heap of sand, the problem lies in the vagueness of our definitions. The labels we use are often ill-defined, yet they carry significant weight. They shape policies, influence treatment approaches, and affect how society views and treats individuals.

Case Study: The Story of Sarah

Let’s consider Sarah. At 25, she’s a social drinker, enjoying a glass of wine with friends on weekends—nothing unusual, and certainly nothing society would label as a problem. Over the years, her life becomes more stressful—work pressure mounts, relationships become strained, and she finds herself reaching for a drink to unwind. It starts with just one glass after work, but as time goes on, that glass becomes two, then three, until she’s drinking a bottle of wine most nights. Soon, Sarah’s drinking begins to interfere with her sleep and mood, but she reassures herself that it’s still under control.

Here’s where the sorites paradox comes into play: at what point does Sarah go from being a casual drinker to someone with a problem? Is it the night she first drinks alone? The moment she finishes her first full bottle in one sitting? When she begins relying on alcohol to cope with emotional pain? Or only when her drinking starts affecting her job or relationships?

The answer isn’t clear, and that’s exactly the point. Addiction doesn’t happen overnight, just as a heap doesn’t form with a single grain of sand. Sarah’s journey into problematic drinking is gradual, and at no specific moment does she suddenly become an ‘alcoholic.’ And yet, at some point, society—or even Sarah herself—will apply the label. But when is that point? This is the essence of the sorites paradox. The language we use to define addiction often forces us to draw hard lines where none exist.

This process is made even more complex by the power of language. If Sarah is described as a ‘social drinker,’ the label feels harmless, even positive. But if one day she overhears someone refer to her as an ‘alcoholic,’ that word carries a heavy weight. It defines her, overshadows her other qualities, and locks her into an identity she may not even recognise in herself. The label suggests a static condition, but Sarah’s relationship with alcohol has been anything but static—it has evolved gradually, much like the grains of sand that form a heap.

Stigma, Language, and the Sorites Paradox

The sorites paradox doesn’t just reveal the ambiguity in defining addiction—it also shines a light on how this vagueness can contribute to stigma. When we assign labels like ‘addict’ or ’junkie,’ we oversimplify a complex, gradual process into a fixed, stigmatising identity. These labels don’t reflect the nuanced reality of substance use; instead, they reinforce negative stereotypes, reducing a person to their relationship with a substance. And once that label sticks, it can be hard to shake.

In the same way that we can’t point to a single grain of sand that turns a pile into a heap, we can’t pinpoint the moment when occasional substance use becomes addiction. Yet language forces us to make a decision. We draw lines in the sand, so to speak, and say, “This person is an addict,” often based on arbitrary criteria like frequency of use or type of substance. This simplification not only misrepresents the individual but also opens the door to judgement and discrimination.

Labels like ‘addict’ do more than just describe—they carry with them a whole set of assumptions. They imply moral failure, personal weakness, and an inability to change. Once someone is labelled as an addict, society tends to see them through that single lens, often ignoring the broader context of their life: their struggles, their successes, and their potential for recovery. The person is reduced to their addiction, as if it’s the only defining feature of their existence.

Returning to Sarah’s story, imagine if, after a year of increased drinking, she is labelled an ‘alcoholic.’ The moment that label is applied, her entire identity can be subsumed by it. She’s no longer seen as Sarah, the capable, multifaceted individual with a range of experiences. Instead, she’s Sarah, the alcoholic. That label becomes a shortcut for judgement, and the complexity of her situation is reduced to a single word.

This language-driven stigma has very real consequences. Studies have shown that healthcare professionals are more likely to view people negatively when they’re described as “substance abusers” rather than ‘people with substance use disorders’ (Kelly & Westerhoff, 2010). This subtle shift in wording can influence the care they receive—or don’t receive. The stigma surrounding addiction can also discourage people from seeking help. Research indicates that many individuals with substance use issues delay treatment because they fear being judged as morally flawed or fundamentally broken (van Boekel et al., 2013). The sorites paradox helps us understand why this happens: because language creates false certainties out of uncertain, gradual processes, we end up creating rigid, stigmatising labels that don’t align with the lived reality of addiction.

The cycle of stigma is self-reinforcing. The more we rely on language that simplifies addiction into binary terms, the more likely we are to overlook the continuum of behaviours and experiences that fall in between ‘non-addict’ and ‘addict.’ And once labelled, individuals often internalise that identity, reinforcing the very behaviours we seek to change. When someone begins to see themselves as an ‘addict,’ they may feel trapped by the label, believing they are beyond hope or undeserving of support.

But the sorites paradox* teaches us that these distinctions are arbitrary. The line between use, misuse, and addiction is not clear-cut. Yet, society’s language treats it as though it is, perpetuating stigma and impeding recovery. If we can understand that addiction, like the heap of sand, is a gradual and complex process, we can begin to dismantle the harmful language that surrounds it and, in doing so, reduce the stigma that so often accompanies it.

Language in Policy and Treatment

The implications of the Sorites paradox extend beyond individual perceptions and into the realm of policy and treatment. Our healthcare systems and policies often rely on rigid classifications to determine who qualifies for help—and who doesn’t. This binary thinking assumes clear distinctions where none exist, echoing the paradox’s challenge to vague definitions.

Many treatment programmes and policies hinge on arbitrary cut-offs. For instance, in the UK, access to certain addiction services may require meeting specific criteria based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-11). These criteria attempt to categorise substance use disorders into mild, moderate, or severe, but the thresholds can be subjective. A person might need to exhibit a certain number of symptoms over a specific period to qualify for treatment. But what if someone falls just short of that threshold? Are they any less in need of support?

Consider the National Institute for Health and Care Excellence (NICE) guidelines, which recommend interventions based on severity levels. While these guidelines are essential for standardising care, they can inadvertently exclude individuals who don’t neatly fit into predefined categories. This approach ignores the continuum of addiction, much like the sorites paradox illustrates. By enforcing rigid categories, we risk leaving people without the support they need in the early stages of their substance use, when intervention could be most effective.

Moreover, the language used in policies can reinforce stigma. Terms like ‘substance abuser’ or ‘addict,’ sometimes found in official documents, perpetuate negative stereotypes. When policies rely on this language, they contribute to a culture that judges and marginalises individuals, making them less likely to seek help. The UK Drug Strategy 2017, for example, emphasises the importance of ‘building recovery,’ but if the language within such strategies isn’t carefully considered, it can undermine these very goals.

Research shows that when we use less stigmatising language, healthcare providers are more likely to offer compassionate care, and people with substance use disorders are more likely to seek treatment (Kelly et al., 2016). Policies that recognise the continuum of addiction—and reflect that in the language they use—can help dismantle the barriers created by stigma and open up access to care for people at every stage of their substance use journey.

By acknowledging the lessons of the Sorites paradox, policymakers can craft guidelines that are more flexible and responsive to individual needs. This means moving away from a one-size-fits-all approach and towards a system that recognises the nuanced reality of addiction. It also involves training healthcare professionals to understand the impact of language and to use terms that are respectful and person-centred.

Changing the Narrative: A Path Forwardlike’substance

If the sorites paradox teaches us anything, it’s that the lines we draw—whether in language, policy, or perception—are often arbitrary. Addiction, much like the heap of sand, doesn’t emerge from a single moment or act but from a gradual accumulation of behaviours, circumstances, and experiences. Yet, our language tends to ignore this reality, favouring rigid labels that confine rather than clarify.

But the good news is that language is not set in stone. We have the power to change the way we talk about addiction and, in doing so, transform how we approach it in practice. A growing movement towards person-first language—terms like ‘person with a substance use disorder’ rather than ‘addict”—is a step in the right direction. This shift acknowledges that addiction is not a fixed identity but a challenge that people experience, one that can change and improve over time.

By adopting more nuanced language, we begin to unravel the stigma that has long surrounded addiction. The Sorites paradox* reminds us that addiction is not a clear-cut, all-or-nothing condition. It’s a complex continuum, and our language should reflect that. Instead of defining people by their worst moments, we can use language that allows for the possibility of growth, recovery, and change.

This change in language needs to extend beyond personal interactions—it must inform policy, healthcare, and treatment. Policies that recognise addiction as a spectrum of behaviours rather than a binary state can offer earlier intervention, more flexible treatment options, and a more compassionate approach to care. By using less stigmatising, more accurate terms in policy and practice, we can reduce the barriers that prevent people from seeking help.

For example, initiatives like the ‘Changing the Narrative’ campaign in the UK advocate for media outlets and policymakers to adopt non-stigmatising language. Training programs for healthcare professionals increasingly emphasise the importance of language in patient interactions. These efforts, while still evolving, demonstrate a growing awareness of the issue.

Ultimately, changing the narrative around addiction means recognising the power of words to either confine or liberate. Just as the sorites paradox shows us that the line between substance use and addiction is blurred, we must acknowledge that our language is equally fluid—and we have the opportunity to shape it for the better.

Conclusion

Standing at the crossroads of my first day on the crisis mental health team, I had no idea how profoundly a few words could shape my perception. ‘He’s misused alcohol for years; he’s an addict,’ my colleague had said—a simple, seemingly innocuous statement that carried with it a world of assumptions and judgements. That brief handover didn’t just inform me about the man I was about to assess; it framed him within a narrative that reduced his identity to a single facet of his existence. Fifteen years on, I realise that this wasn’t an isolated incident but a reflection of a broader issue in how we talk about addiction.

The Sorites paradox has illuminated for me the flaws in our language and thinking about addiction. Just as we can’t pinpoint the exact grain of sand that turns a pile into a heap, we can’t definitively mark the moment when use becomes misuse or misuse becomes addiction. Yet, our language insists on drawing these arbitrary lines, assigning labels that often do more harm than good. By categorising people as ‘addicts’ based on ill-defined criteria, we risk overlooking the complexities of their experiences and the gradual progression that characterises substance use disorders.

Language is a powerful tool—it can enlighten and empower, but it can also obscure and oppress. The words we choose shape not only our understanding of others but also their understanding of themselves. When we default to labels that are steeped in stigma and oversimplification, we contribute to a cycle that hinders recovery and reinforces isolation. The man I assessed on my first day wasn’t just an ‘addict’; he was a person with a history, emotions, struggles, and potential—a person who deserved to be seen in his entirety.

The challenge before us is to embrace the ambiguity that the Sorites paradox reveals. Instead of clinging to rigid definitions, we can acknowledge that addiction exists on a continuum, one that defies easy categorisation. By adopting language that reflects this reality, we open the door to more compassionate care, more effective policies, and a more inclusive society. We move away from ‘us’ versus ‘them’ and towards a collective “we” that recognises our shared vulnerabilities and strengths.

Changing the way we talk about addiction isn’t just a matter of political correctness; it’s a tangible step towards dismantling the barriers that prevent people from seeking help. It’s about creating an environment where individuals feel understood rather than judged, supported rather than condemned. By refining our language, we refine our perceptions—and ultimately, our actions.

As I look back on that pivotal first day and all that has followed, I am reminded that progress often starts with a question, a moment of introspection. If we can question the labels we so readily use, perhaps we can begin to see the people behind them. The Sorites paradox doesn’t offer easy answers, but it does encourage us to embrace complexity over simplicity and empathy over judgement.

In the end, it’s not about finding the perfect words but about striving for understanding. It’s about recognising that every ‘grain of sand’ matters in forming the ‘heap’ of our collective experience. By choosing our words with care, we can help build a foundation of respect and hope—one that supports every individual’s journey towards healing.

So, let’s start the conversation anew. Let’s acknowledge the shades of grey in a world that often insists on black and white. And let’s remember that the language we use today can shape a more compassionate tomorrow.

References

Kelly, J. F., & Westerhoff, C. M. (2010). Does it matter how we refer to individuals with substance-related conditions? A randomised study of two commonly used terms. *International Journal of Drug Policy*, 21(3), 202–207.

Kelly, J. F., Dow, S. J., & Westerhoff, C. M. (2016). Does our choice of substance-related terms influence perceptions of treatment need? An empirical investigation with two commonly used terms. *Journal of Drug Issues*, 46(6), 703-712.

van Boekel, L. C., Brouwers, E. P., van Weeghel, J., & Garretsen, H. F. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and Alcohol Dependence, 131(1-2), 23–35.

Whorf, B. L. (1956). *Language, Thought, and Reality: Selected Writings of Benjamin Lee Whorf. MIT Press.

Shelby, C.L. (2016) Addiction. London: Palgrave Macmillan UK. Available at: https://doi.org/10.1057/9781137552853.