A substance use disorder is not measured in millilitres. It is eleven behavioural criteria in four clusters, counted over twelve months, and graded mild to severe. Decide which of these patients’ own sentences actually count — then switch modes and rewrite the chart entries that would follow a person through every shift that comes after yours.
Every line below was written by a real clinician somewhere. Open each one for the version that gets the patient treated.
Criteria count and severity
0
Criteria met
0
Statements judged
—
Your accuracy
Start judging
Decide each sentence and the grade will build itself.
How to read this. Quantity, frequency, legality and how long someone has used are not criteria. The diagnosis is functional: what the substance is doing to this person’s control and to their life.
The exclusion students miss. Tolerance and withdrawal do not count toward the criteria when a medication is being taken as prescribed. A person on scheduled opioids after surgery has physiological dependence — normal neuroadaptation, not addiction. Confusing the two produces under-treated pain and a mislabelled chart.
Why the rewrite matters
Language changed the treatment plan in controlled studies. Clinicians reading a vignette about a “substance abuser” recommended more punitive responses than clinicians reading the identical vignette about a person with a substance use disorder. Same patient. Different word. Different care.
The test for any chart entry. Could a camera have recorded it? “Requested analgesia four times in two hours” is recordable. “Drug-seeking” is not — it is a conclusion about motive, and it travels to every clinician who opens the chart after you.
Three swaps to keep automatic. Toxicology results are positive or negative, never clean or dirty. A person is in recovery or has been abstinent for eight months. A person died by suicide — never “committed,” which carries criminality.
And the framing students absorb backwards from the media. People with mental illness and substance use disorders are far more likely to be the victims of violence than the perpetrators of it. When you walk into the room, the base rate says the person in front of you has more likely been hurt than done harm. Let that shape your posture.