Does Something Have to Be a Disorder Before It Matters to Our Health?

Most of us are used to thinking about substances in fairly simple terms. Either there is a problem, or there is not.

But our health does not always fit neatly into those two categories.

We can drink alcohol without having an alcohol use disorder and still need to know how it affects driving, sleep or a medication we take. Cannabis can be part of our lives without a cannabis use disorder and still raise questions about anxiety, concentration or how we feel the next day. We might take a pill that did not come from a pharmacy and have no idea that it contains another substance.

None of those experiences, by itself, means we have a substance use disorder.

There is still something about our health worth understanding.

There is a lot of room between “nothing to think about” and a diagnosis.

Dr. Kima Joy Taylor asks us to pay attention to that space.

A substance use disorder is a health condition with specific clinical criteria. When there is reason to consider one, understanding what is happening and what kinds of care may help can matter enormously. But a diagnosis is not what makes substance health relevant.

We already understand this in other areas of health. We can learn that our blood pressure is higher than usual without immediately knowing what it means. A headache can be worth paying attention to without assuming it signals a serious condition. We notice, ask questions, gather information and decide what, if anything, deserves more attention.

We can bring that same thinking to substance health. Different experiences can call for different information.

Dr. Taylor describes situations that make the distinction surprisingly clear. We do not need to know whether someone has an alcohol use disorder before we know that driving after drinking can be dangerous. We do not need a diagnosis before it is useful to understand what is in a substance, how it might affect us, or whether it could interact with something else we take.

Once we stop asking only whether something is a “problem,” there are many other useful questions available to us.

What effect is this having on me?

Is anything different from what I expected?

Has something changed over time?

Is there a risk here I did not know about?

Is this something I want to understand better or bring up with my healthcare provider?

These questions do not assume that something is wrong. They give us information we can use.

Dr. Mishka Terplan, an addiction medicine physician, makes an important distinction here. Most adults have used a substance at some point, while only some develop a substance use disorder.

“Use is just use.”

A substance use disorder is something more specific. It is a health condition with clinical criteria. Simply using a substance does not tell us that someone has one.

We do not have to decide what something means before we get curious about it This may be one of the most useful things about thinking in terms of substance health.

·         If our teenager tells us they tried cannabis, we can have a conversation about what happened, what they experienced and what they know without immediately deciding what that experience says about them.

·         If we notice that alcohol has been affecting our sleep differently, we can wonder about that without first deciding whether our drinking is a “problem.”

·         If a medication is affecting us differently than it once did, we can mention it to our healthcare provider without knowing why.

Sometimes what we learn will lead to another question or a change we want to make. Sometimes it will not. And sometimes what we notice may be part of a larger pattern that deserves more attention. We do not have to know which one it is before we begin.

A question worth taking with you

When something involving a substance catches our attention, we can try beginning somewhere other than:

Is this a problem?

A different question may tell us more:

What would be useful to understand about what is happening here?

A diagnosis matters when there is one. But we do not need a diagnosis before our health is worth understanding.