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Most people know at least one person with a substance use problem. At the same time, most people know at least one person who uses alcohol or other drugs but doesn’t have a problem. How is this possible? Why do some people misuse or become addicted to substances and other people don’t? How can some people who use alcohol and other drugs have good careers and relationships, while others lose everything that is important to them? Substance use is not a simple matter, and everyone’s situation is different.
How widespread is substance use?
We live in a society where substance use is common. Most of us drink coffee, tea or other products that contain caffeine to boost our energy. Many of us use over-the-counter or prescription medications when we are sick or in pain. Many of us drink alcohol when we are hanging out with friends or celebrating a special event. Lots of us smoke cigarettes, and even more of us use cannabis (marijuana). A small number of us regularly use cocaine, club drugs (e.g., ecstasy and methamphetamine), heroin and other illegal drugs.
Substance use varies in degree and risk. Everybody knows it can be harmful if a person drinks too much alcohol, smokes cigarettes for a long time, or becomes dependent on crack cocaine. But even too much caffeine can cause health problems. In the same way, improper use of prescription medication can be risky and sometimes deadly.
Beneficial Use | Â Experimental Use | Social Use | Â Harmful Use | Â Dependent Use |
Use that has positive health, social or spiritual effects. |  Use normally limited to 1—3 times where youth are trying out the experience, maybe out of curiosity. |  Moderate and occasional use that does not greatly increase health or social risks. |  Use that creates major health or social problems. People who continue to use substances despite negative effects may have a problem with substance use. |  At this stage, the body is used to the substance so it might be needed to feel “normal.†|
If all substance use is risky, why do we take the risk?
Humans have been using different substances for different reasons for thousands of years. Most of the time people use substances responsibly and for adaptive reasons. They may use substances to:
help ease pain or anxiety
increase energy
stimulate creativity
become less self-conscious
make a social situation better
In many of these situations, the benefits of using the substance are perceived to be greater than the risks. For example, a person may choose to take pain medication even though there are negative side effects. Another person might use alcohol or cannabis to relax after work even though doing so could be risky for their health or otherwise (e.g., if they use too much or use too often, if they are arrested for possession, etc.).
When people use alcohol or other drugs for maladaptive reasons, their risk of harm is higher. Some of these reasons might include:
escaping from people or problems
coping over the long term with things they don’t like in their daily lives
relieving boredom
satisfying curiosity about their limits
In other words, depending on how people use alcohol and other drugs, and how often they use them, there are different levels of risk. Substance use can be regarded as ranging along a continuum from low-risk and sometimes beneficial use (e.g., opiate use for addressing acute pain), through potentially hazardous use, to clearly harmful use (e.g., opiate injection using a non-sterile needle leading to infection).
Is it possible to maintain a healthy community when people use substances?
In a healthy community, the way people use substances is mostly beneficial, experimental or social. In these situations the risk of harm is low. But a community must provide an environment that enables the healthy development of all its citizens and promote healthy attitudes and behaviours in order to minimize substance-use problems. Healthy, balanced, aware people very seldom use substances in hazardous ways. Therefore, the focus of community leaders should be on strengthening community rather than on getting rid of substances or punishing people who are having problems with substance use.
What are the risks and harms linked to substances?
Risk and harm refer to the result of substance use. However, the pattern, volume and mode of use of a substance have an effect on risk, too.
Problematic use:
chronic use—regular or everyday use of drugs, including tobacco and alcohol, can cause illness and death.
use of large amounts of a drug—high doses of alcohol lead to intoxication with increased risk of injury or death; high doses of cocaine can lead to heart problems.
injection use—intravenous use of a drug can result in acute toxicity related to dosage. It is also associated with infections and, depending on injection practices, can result in the spread of blood-borne diseases.
Circumstances that significantly raise the risks of use:
intoxication—excessive use of alcohol or other drugs.
regular use—a pattern that leads to tolerance or the need for more of a drug in order to feel the same effects.
dependence—when a person feels they physically and/or emotionally need a drug in order to function in their daily lives.
Many people falsely believe that substance-related harm is largely caused by people who are dependent on alcohol and other drugs. But evidence suggests that at least half of all health and social harms in society are caused by people who are not dependent. Acute health and social harms from intoxication (overdose, violence, injury, relationship stress, etc.) are much more common, particularly among youth, than chronic harms (illness and disease from long-term elevated use).
What are some ways we can minimize substance-related harm?
1. Understand that substance use is a cultural reality.
Addressing risks and harms requires a comprehensive approach that includes participants from all sectors in the community.
2. Understand how problem substance use develops.
People misuse alcohol and other drugs for a variety of reasons. For instance, they may simply want to see how far they can push their limits (e.g., young people experimenting with substances they really like). They may be celebrating something (e.g., a birthday or a promotion) and feel justified in overdoing it. Some people use excessive amounts of alcohol and other drugs in order to temporarily escape physical, mental and/or emotional problems (e.g., abuse, depression, anxiety, post-traumatic stress disorder, a recent break up, the death of a loved one). Whatever the reason, problem substance use should be recognized as one of the following:
a reflection of a community’s values and attitudes. Consider, for example, how drinking to excess is generally accepted at graduation parties, sporting events, and many other social occasions.
a symptom of a much larger problem in the community. For example, think about how street-involved youth, homeless people or sex workers may have come to be living and/or working on the streets and using substances.
In exploring how and why their substance use problems developed, communities will be better able to understand what can be done to address both the substance-related problem itself and the larger issues that sit behind it.
Digging deep and questioning the aspects of our culture and way of life that allow alcohol and other drug problems to fester is an important part of understanding how we can begin taking some social responsibility for allowing some of us to get into trouble with substances. This is not to suggest that personal responsibility plays no role in problematic substance use. It is to suggest, however, that enhancing BOTH personal and collective responsibility will be necessary in order to create real solutions to harmful substance use.
3. Understand human behaviour and influences.
Individual behaviour does not occur in a vacuum. A variety of influences—from genetic to social—shape our behaviours. These influences include:
basic needs (e.g., affection, food, shelter)
biology/genetics (e.g., disabilities, health, hormones)
community/environment (e.g., neighbourhood, policies/laws, weather)
family (e.g., culture, family support, values)
media (e.g., advertisements, music, video games)
personal goals (e.g., grades, image, morals)
resources (e.g., money, time, transportation)
social (e.g., friends, role models, teams/clubs)
A variety of influences contribute to an individual’s decision to engage in a potentially unhealthy behaviour, or to avoid it. Among these is the degree of pleasure or value an individual obtains from the behaviour. This varies from individual to individual and is mediated or intensified by a range of other personal, social and environmental influences. An individual’s perception of short- or long-term health risk will also influence their decision. Short-term or more immediate risks often have a bigger impact than long-term risks. For example, the potential for bad breath may be a greater deterrent to smoking than the chance of developing lung cancer.
4. Understand that knowledge alone is not enough to change behaviour.
Having information is not the same as using information. That is, knowledge alone does not guarantee that people can or will change their behaviour. For example, most people know smoking is both unhealthy and the leading cause of preventable death in Canada. Yet almost 20 per cent of adults continue to smoke. Similarly, most people who misuse alcohol, medications or illegal substances know they may be risking their lives when they overdo it, and possibly the lives of others, and yet some continue to use substances in hazardous ways on a regular basis. People need more than knowledge to change their behaviour. They may need practical tools to help them cut down or quit using substances. They may need supports in the form of medical services, mental heath services, housing, etc. And they may even need the help of businesses and the legal system. For example, the responsible actions of both tobacco retailers and legislative bodies have contributed to a reduction in smoking rates in Canada. Similarly, some retailers have helped reduce inhalant use and methamphetamine production by restricting access to certain household products in stores.
5. Understand that connection is key.
Human beings are by and large social creatures. It is in our nature to want to belong—to a family, a group, a community, a nation, and so on. When a person loses their way in the world (because of neglect, abuse, substance use, mental health problems, etc.), they may behave in a way that makes mainstream people think they to prefer to exist on the fringes of society. But the truth is that being “out there†only works for users when they’re able to find others “out there,†other marginalized people with whom they can connect.
Studies show that exclusion from school, work and other facets of mainstream society tend to make substance use problems worse. Therefore, the key to addressing substance use problems is connection, whether the issue involves at-risk youth, adults with hazardous drinking patterns, or seniors who are dependent on prescription medications. Communities that foster inclusion of all members, that promote personal and collective responsibility and that enhance empowering social support for those in need are more successful in dealing with even the most severe substance use issues quickly and effectively.
6. Understand that more protective factors = healthier community.
Risk and protective factors influence behaviours related to mental health and substance use. Risk factors have a direct influence on the likelihood of unhealthy behaviour. Protective factors mediate or moderate those risks. Some of the key risk and protective factors are:
Risk Factors | Protective Factors |
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The more protective factors a community has, the healthier its citizens are. Therefore, one of the goals of a community should be to increase the number of protective factors or assets. The importance of genuine connectedness at the personal and societal levels is clearly evident from the list of risk and protective factors above with its absence contributing significantly to risk and its presence enhancing protective factors at all levels.
For more information on substance use, contact the Alcohol and Drug Information and Referral Service at 1-800-663-1441 (toll free in BC), or 604-660-9382 (in the Lower Mainland).
You can also visit the Centre for Addictions Research of BC at www.carbc.ca. See more information sheets about substance use and mental health issues at www.heretohelp.bc.ca.
