I was saddened by AJN's decision to publish this article. Brown lacks even the most basic knowledge of the neurobiology of substance use disorders. People with substance dependence lose the ability to make reasoned decisions about drug and alcohol use, a point explained by Nora D. Volkow, MD, director of the National Institute on Drug Abuse at the National Institutes of Health, almost a decade ago in an editorial in her organization's publication.1

Most upsetting was Brown's decision to describe the nurse as a "junkie." Should we call people with obesity "fat slobs?" Are women with postpartum depression "hysterical"?

The National Council of State Boards of Nursing's Substance Use Disorder in Nursing Manual: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs, which is available free of charge at http://www.ncsbn.org/2106.htm, provides accurate information and "practical and evidence-based guidelines for evaluating, treating and managing nurses with a substance use disorder."

Allowing ignorance and prejudice to determine how we treat our patients and colleagues with substance use disorders is ethically and scientifically indefensible.

Janet Pickett, RN, CARN, CADC

Des Plaines, IL

Author Theresa Brown responds: I appreciate the letter writers' impassioned defense of addicts who are also working professionals. However, except for their dislike of my use of the word "junkie," I don't see a contradiction between their descriptions of addiction and my portrayal of a drug-addicted nurse in the column.

I used "junkie" very deliberately, and then called it an "ugly word" to make it serve as shorthand for our society's generally unforgiving attitude toward drug abusers, particularly narcotics users. It's easy to judge addicts. At the end of the column, I undermine my own use of the word "junkie" when I say there was more to this nurse than just drug abuse-that, in fact, the nurse was a committed professional.

In health care, safety is paramount, and serious mistakes already happen much more often than they should, making the possibility of working with a staff member who is cognitively impaired due to narcotic abuse disturbing and scary.

"Junkie" was a rhetorical gesture, attempted to make a point about how easy it can be to thoughtlessly condemn drug abusers. My apologies if its use in this column appeared to reinforce the kind of judgmental attitudes it was supposed to challenge.

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