Substance Use Disorder

Before I get started, I want to be clear that the different agencies do very valuable work in helping people with substance abuse problems, sometimes with very limited resources. While it may not seem like it sometimes, the amount of effort that is put into this by case management staff, peer support staff, therapists, and doctors is sometimes quite a lot. This does not always equal success. Sometimes the way the system is structured seems to put up roadblocks, and sometimes a person in need of help may not be ready to accept it. There are also many people who have been able to get their lives on a better track, and this is among the reasons many of use would like to go to work day to day.

That being said, there are some ridiculous aspects to substance abuse diagnosis.

Those of us who are not licensed as a therapist or doctor or social worker, may be told by our supervisors to diagnose clients with a substance use disorder, even though the use may be light. So, if the person says that he has maybe a beer after work two days a week, we may have to diagnose him with an alcohol use disorder. We may think this is overstating things, but we have a job to do. A person who reports having a medical marijuana card, issued by the state, may end up diagnosed with a cannabis use disorder even though the use is prescribed by a doctor according to state law. If we complete an assessment, with the information that someone drinks maybe a beer or two a week, after work, and we don't diagnose with an alcohol use disorder, then the supervisor may us we made a mistake in not giving the diagnosis. It may be a "tut tut" or it may be a sharp rebuke that puts us in fear of our jobs.

It might feel hypocritical, or just silly. Some of us may enjoy some drinks on the weekend, with friends, and may not feel like an alcohol use disorder is in play. These workers probably don't have an alcohol use disorder.

Some of the workers may drink a lot, overnight, weekends, holidays, and may have an alcohol use disorder. This may be treated as more of a joke within the company. A worker may come to work with the smell of alcoholic sweat, from last night's partying, and not face any issues from supervisors (although the clients may comment on this). Some agencies may even have employee parties that feature alcoholic drinks.

Under the circumstances, to come to work, and have to diagnose a client with an alcohol use disorder, for having an occasional beer after work, seems ridiculous. The use does not in any way seem equal to that of someone getting drunk every day and having serious problems in everyday life, unable to hold a job, or abusing her family. The order to diagnose a client with a cannabis use disorder, for eating a very small amount of a marijuana edible to help with PTSD symptoms, as prescribed by a doctor under state law, does not seem right. This use does not seem the same as that of someone who smokes so much marijuana that he can't stop using without severe anxiety. It seems to dilute a very real problem that other people actually have. We may as well consider a person with a healthy diet to have a gluttony disorder because she occasionally enjoys food.

Substance abuse in society is a very real and serious issue. Heroin addiction, alcohol abuse, methamphetamine abuse, cocaine use, pain pill abuse, all of these and more are really problems with very real consequences for persons, their families, their friends, their patients. But to have to consider it equal with non-problem use seems stupid. It's just another one of those things that we're told to do that we just have to smile at, nod, be agreeable, or at least maintain a carefully neutral face over. We don't want to seem like we have a bad attitude and paint targets on our backs.