What is problematic substance use?

Alcohol and drugs are used by many people without encountering problems, despite the risks. Some people can end up drinking or using drugs in ways that create problems for them, their families and the community.

Substance use becomes problematic when it interferes with physical or mental health, schooling or a job, relationships, financial stability, personal safety, and the safety of others (Centre for Addiction and Mental Health 2012).

 What is addiction?

Addiction is a health condition characterized by the inability to stop using despite knowing the harmful consequences and wanting to stop. It involves psychological dependence and/or physical dependence on a substance for normal functioning. One simple way of describing addiction is the presence of the 4Cs:
• Craving
• Loss of control of amount or frequency of use
• Compulsion to use
• Use despite negative consequences

(Centre for Addiction and Mental Health 2012)

According to the National Institute on Drug Abuse, addiction is a “chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her” (National Institute on Drug Abuse, 2016). Research shows that addictive disorders are health conditions and can be treated (Notarandrea, 2018).

What causes problematic substance use and/or addiction?

The causes of problematic substance use and addiction are complex. Nobody chooses to be addicted. It is important to look at problematic substance use within the broader context of the social determinants of health. While a person’s individual circumstances may contribute to substance use becoming problematic, there is a complex combination of systemic, psychological, biological, social, economic, and other factors that create conditions of risk (Canadian Mental Health Association, 2018).

The Social Determinants of Health are the social and economic conditions that play a significant role in wellness and therefore impact problematic substance use and addiction. In Canada, the social determinants of health include:

  • Aboriginal status
  • Disability
  • Early life
  • Education
  • Employment and working conditions
  • Food insecurity
  • Health services
  • Gender and gender identity
  • Housing
  • Income and income distribution
  • Race
  • Sexual orientation
  • Sexual exclusion
  • Social safety net
  • Unemployment and job security

(Canadian Mental Health Association 2018)

When it comes to problematic substance use, the experience of trauma, social isolation and exclusion, and poverty or lack of access to economic resources are the three social determinants of health that present the greatest risk (Canadian Mental Health Association 2018).

Social determinants of health also impact health outcomes for people once substance use has become problematic (Region of Waterloo Public Health and Emergency Services, 2017). People who use substances tend to experience more challenges accessing mainstream health and social services, including being refused services and report issues related to stigma and discrimination as a significant factor (Region of Waterloo Public Health and Emergency Services 2017). The impacts of stigma and discrimination can include loss of self-esteem, fear of seeking treatment, or feelings of isolation (Canadian Mental Health Association, 2018). Lack of housing options for people who use substances increases their risk of homelessness and further vulnerability (Region of Waterloo Public Health and Emergency Services, 2017).

It is important to remember that there is no single set of factors that account for all the complex causes of problematic substance use (Centre for Addictions and Mental Health 2012). Substance use does not discriminate, which means it can impact a person from any socio-economic status, background, profession, ethnicity, or gender.

What can protect against addiction or problematic substance use?

Protective factors include having a childhood with a positive adult role model, being motivated and having personal goals, involvement in meaningful activities, being connected to a positive and reliable community of support (Canadian Mental Health Association, 2018). According to addiction researcher Johann Hari “the opposite of addiction is connection” (Hari, 2015).

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