What is substance misuse and addiction?
Addiction is a complex process where problematic patterns of substance use or behaviours can interfere with a person’s life. While many people use the term substance misuse and addiction interchangeably, the two have separate meanings. Substance misuse can be defined as the harmful use of substances for non-medical purposes and can potentially lead to addiction.i Addiction can be broadly defined as a condition that leads to a compulsive engagement with a stimuli, despite negative consequences.ii This can lead to physical and/or psychological dependence. Addictions can be either substance related (such as the problematic use of alcohol or cocaine) or process-related, also known as behavioural addictions (such as gambling or internet addiction).iii Both can disrupt an individual’s ability to maintain a healthy life, but there are numerous support and treatment options available.
A simple way of understanding and describing addiction is to use the 4C’s approach:
- Loss of control of amount or frequency of use
- Compulsion to use
- Continued substance use despite civ
How common is substance misuse and addiction?
Substance misuse is quite common on an international scale. It is estimated that nearly 5% of the world’s population have used an illicit substance, 240 million people around the world misuse alcohol, and approximately 15 million people use injection drugs.v In Canada, it is estimated that approximately 21% of the population (about 6 million people) will meet the criteria for addiction in their lifetime. Alcohol was the most common substance for which people met the criteria for addiction at 18%.vi In Ontario, it is estimated that approximately 10% of the population have a substance misuse issue. Recently, Ontario has seen a growing trend of people misusing opioids, such as Percocet’s or Fentanyl, which has led to an increase in the number of drug related deaths.vii
Substance misuse and addiction can also be understood as being on a spectrum
Many people use substances to relax, have fun or cope with stressors, however, substance misuse can happen when the use of substances or certain behaviours becomes problematic, which can lead to dependence. The model below is helpful in understanding where a person might be on the spectrum, and what the best options for treatment or support might be. Often the symptoms of substance misuse and addiction can be episodic, and an individual can experience periods of increased substance use as well as periods of control. For example, casual or non-problematic substance consumption might escalate into problematic substance use if an individual is experiencing stressors in their life and using substances to cope. The substance use spectrum can be seen below:viii
A common misconception about addiction is that an individual will immediately get ‘hooked’ if experimenting with an addictive substance. While many substances can be addictive, addiction isn’t caused simply by the substances being consumed. For example, many people who use narcotics for post-operative pain relief do not become dependant on these substances. Addiction and substance misuse are often connected to a person’s lived experience and their behaviour patterns.
i Canadian Centre on Substance Abuse. (December 2009). Substance Use in Canada: Concurrent Disorders. Retrieved from: http://www.ccsa.ca/Resource%20Library/ccsa-011811-2010.pdf
ii European Monitoring Centre for Drugs and Drug Addiction. (2013). Models of Addiction. Retrieved from: http://www.emcdda.europa.eu/attachements.cfm/att_213861_EN_TDXD13014ENN.pdf
iii Canadia Centre on Substance Abuse. (2010). Substance Abuse in Canada: Concurrent Disorders. Retrieved from: http://www.ccsa.ca/Resource%20Library/ccsa-011811-2010.pdf
iv Centre for Addiction and Mental Health. (2012). What is Addiction? Retrieved from: http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/drug-use-addiction/Pages/addiction.aspx
v World Drug Report. (2015). United Nations Office on Drugs and Crime. Retrieved from: https://www.unodc.org/documents/wdr2015/World_Drug_Report_2015.pdf
vi Statistics Canada. (2015). Mental Health and Substance Use Disorders in Canada. Retrieved from: http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11855-eng.htm
vii Howlett, K. (February, 2016). Fentanyl now leading cause of deaths in Ontario. Globe and Mail. Retrieved from: http://www.theglobeandmail.com/news/national/fentanyl-now-leading-cause-of-opioid-deaths-in-ontario/article28832627/
viii Health Officers Council of British Columbia. (2005). A Public Health Approach to Drug Control in Canada. Retrieved from: http://www.cfdp.ca/bchoc.pdf