Smashing Myths: Problem vs. Addicted?

I recently worked with a client who had been seeing an outpatient therapist for close to a year before his parents began to feel like minimal progress was being made.

The boy had continued to use marijuana throughout the time working with this therapist.

The mother told me that the therapist had done a substance use assessment with the client, and that the results indicated he had a mild substance use disorder. What he told the mother about that should sound an alarm for parents, mental health professionals, and anyone who works with teens or young adults:

"It’s only mild, so we don’t need to do anything other than what we’ve been doing."

Hearing this, in conjunction with what I observed when I began working with the client, crystallized for me a glaring problem: myths and misconceptions about what it means to have a problem create barriers to effective prevention and intervention efforts.

The Myth of the Line

Most people are familiar with the idea of a “line” that you cross over when it comes to addiction:

• Cross the line and there’s no going back: you have the disease of addiction, you need rehab, and you’ll be in meetings for the rest of your life.

• Stay on the safe side of the line and you’re “OK,” maybe just needing to make “better choices.”

When we first began diagnosing substance use disorders, the original framework matched this thinking. We had two separate diagnoses:

• Substance Abuse — the “mild” side of the line. “Make better choices.”

• Substance Dependence — synonymous with addiction: chronic, progressive, loss of control.

Families and clients usually nod when I bring up the idea of the line that you cross over. Clients are thinking, "Yup, and I haven't crossed over it." Families are hoping they haven't crossed over it yet. 

How DSM-5 Changed Everything

As out understanding of addiction has continued to evolve, so has the framework for how we diagnose substance use disorders, per the DSM (Diagnostic and Statistical Manual for Mental Health Disorders):

• DSM-IV: Substance Abuse or Substance Dependence.

• DSM5: Removed the “line” entirely. Substance Use Disorder became one condition, measured on a spectrum of mild, moderate, or severe.

This shift rocked many of us “old school drug counselors.” Suddenly there was no neat black-and-white box for addiction. And the DSM-5 suggested that even clients on the mild end of the spectrum may show characteristics previously reserved for “addiction.”

At first, this didn’t make sense. But eventually I came to see it as brilliant. Not only did it account for some of the more ambiguous aspects of addiction that, frankly, we used to dance around, but it also created an opportunity to change how we talk about addiction. And changing the conversation is the first step to removing common barriers to intervention and engaging clients more effectively.

From Resistant to Motivated

That’s exactly what happened in this case.

The boy’s mother told me before I met him that he was extremely resistant. His words were:

"He’s just going to tell me I’m a bad person."

Fast forward to the end of our first education session with his parents present. I told him:

"I think you know your substance use is a problem. Something about the way you use cannabis isn’t quite right."

He agreed.

Then I added: "I also think you don’t believe you’re addicted."

Again—he agreed.

I then told him I believed he was right on both counts. A person can indeed have a “problem,” but that doesn’t automatically mean they are in what we might call “full-blown addiction.”

Right in front of me, I watched him shift—from expecting shame, to actually being open and motivated to address his substance use disorder.

And here’s the key: by taking time to explain the DSM-5 framework, he felt validated.

He already knew something was wrong. What he needed was a way to understand that his disorder didn’t automatically mean he was “over the line” into addiction territory. Once that misunderstanding was cleared up, the shame and resistance disappeared.

He even told me how much he appreciated seeing the difference between the old and new models. It helped him accept that he had a disorder—but also reassured him that it’s not a bad thing.

And that’s the point. Misconceptions about what it means to “have a problem” fuel stigma and shame, And as this case illustrates, it's the stigma of addiction that ultimately proves to be one of the biggest barriers to recovery.

Mild Doesn’t Mean Harmless

The more troubling issue in this case is the therapist who told the parents, “It’s only a mild disorder, so we don’t need to do anything different.”

When I heard that, I was appalled. This mindset is why so many people with substance use disorders slip through the cracks.

Many professionals still conflate the old model with the new one:

• Old model = there’s a line you cross.

• New model = spectrum of mild, moderate, severe.

• Conflation: “mild” = “not a problem.”

But “mild” doesn’t mean harmless. It means a disorder is present—and a disorder needs to be managed. The important thing to recognize is that treatment plans vary depending on the severity of the disorder.

In other words, a mild substance use disorder doesn’t automatically mean a trip to rehab. But it does mean a responsible, informed response is necessary.

This distinction was a turning point for this client. Rather than throwing up a blockade of resistance because he was expecting to be shipped off to rehab, he accepted the idea of needing to develop a plan for managing his condition, and did so enthusiastically.

If you’d like to hear me present this case in full—and go deeper into the dynamics of effective substance use intervention—I unpack it all in my latest webinar on early-stage substance use intervention. It’s a chance to see how these insights can improve outcomes for families, providers, and—most importantly—clients themselves.

👉 Watch the replay: Removing Barriers in Early-Stage Substance Use Intervention

Parents: Need Immediate Support?

Concerned about a teen or young adult’s substance use?

PREVENT is a 5-session program designed to motivate young people to face their substance use—and help parents avoid the struggle of resistance.

👉 Learn more about PREVENT