What is substance use and addiction?
Many people use substances such as drugs or alcohol to relax, have fun, experiment, or cope with stressors, however, for some people the use of substances or engaging in certain behaviours can become problematic and may lead to dependence.
Addiction is a complex process where problematic patterns of substance use or behaviours can interfere with a person’s life. Addiction can be broadly defined as a condition that leads to a compulsive engagement with a stimuli, despite negative consequences.i 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).ii 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 consequencesiii
How common is substance use and addiction?
Substance use is quite common on an international scale and statistics vary depending on the substance being consumed. It is estimated that nearly 5% of the world’s population have used an illicit substance, 240 million people around the world use alcohol problematically, and approximately 15 million people use injection drugs.iv
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%. Cannabis, also known as Marijuana, has one of the highest rates of cannabis use in the world, with more than 40 per cent of Canadians having used cannabis in their lifetime and about 10 per cent having used it in the past year.v
While some people may be able to consume substances without resulting in significant harms, some people may experience ongoing substance related problems. In Ontario, it is estimated that approximately 10% of the population use substances problematically. Recently, Ontario has seen a growing trend of harms related to opioid use. Opioids are a class of psychoactive drugs that are often used for pain management. These can include: fentanyl, morphine, heroin, and oxycodone. While opioids are effective for pain relief, and many individuals can use them for short periods of time without concern, this class of drugs has led to harms across the province in recent years, including deaths due to overdose. In 2016 there were 865 deaths due to this substance, equal to an opioid related overdose death occurring in Ontario every 10 hours.[vi]
Substance use and addiction can also be understood as being on a spectrum
People use substances for different reasons, and in varying degrees. For some people there may not be any harms related to their substance use, however, for some there may be negative impacts on their lives. Substance use and addiction can be understood as being on a spectrum, as seen in the model below.
Often the symptoms of problematic substance use 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:vii
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 dependent on these substances. Addiction and substance use are often connected to a person’s lived experience and their behavior patterns.
i 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
ii Canadian Centre on Substance Abuse. (2010). Substance Abuse in Canada: Concurrent Disorders.Retrieved from: http://www.ccsa.ca/Resource%20Library/ccsa-011811-2010.pdf
iii 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
iv World Drug Report. (2015). United Nations Office on Drugs and Crime. Retrieved from: https://www.unodc.org/documents/wdr2015/World_Drug_Report_2015.pdf
v 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
vi Public Health Ontario. (2017). Opioid-Related Morbidity and Mortality in Ontario. Retrieved from: https://www.publichealthontario.ca/en/ dataandanalytics/pages/opioid.aspx#/trends
viii Adapted from Health Officers Council of British Columbia. (2005). A Public Health Approach to Drug Control in Canada. Retrieved from: http://www.cfdp.ca/bchoc.pdf