Can you have a mild substance use disorder (no)

So, I had another 1:1 conversation today, and the topic came up that the previous provider placed in the patient's chart that "may have a mild substance use disorder". Excuse me? Isn't that as impossible as being a little pregnant? You either have substance use disorder or you don't.

Not to contradict myself, but I do describe therapeutic use and substance use disorder as being on the same continuum and I define a third group in the middle. The group in the middle are called, by me, the chemical copers. They are folks that, when properly managed, are able to stay within the guidelines and avoid overt substance use disorder, but they are also the most medically complex of all chronic pain patients because they have issues with limits and boundaries. Only a strong, compassionate provider can keep their desire to treat all their problems chemically from becoming an even larger issue (like substance use disorder). These patients are the ones for which all the safety rules exist in modern pain management programs, like random pill counts, urine drug screens, bringing your pills to every appointment, etc. They are also the most likely to end up on corrective action plans because they WILL push the boundaries, and will often minimize the risk that controlled medications present.

But make no mistake, even these patients are not substance use disorder patients. I tell these patients it is my job to help assure that doesn't happen. No one has a "mild case of substance use disorder." This is just the changing language that is heck bent to move all chronic patients onto MAT because it is easier to manage them on suboxone than traditional opioids, rotting teach and other complications be darned.

All chronic patients should NOT be on MAT; only patients who have proven themselves to genuinely have SUD, and they usually identify themselves by their inability to follow the most basic rules.