WHAT IS SUBSTANCE USE?
Substance use refers to the use of any substance that is ingested/consumed and changes how the mind or body works. Commonly referred to as drugs, they are defined as something taken into the body via ingestion, inhalation, absorption or injection. There are three categories of drugs: legal (e.g., alcohol, cannabis or tobacco), illegal (e.g., cocaine or ecstasy), and pharmaceuticals (e.g., antibiotics or pain relievers).
WHAT IS THE SUBSTANCE USE CONTINUUM?
Drugs are neither good nor bad; they are simply a substance. It is the ways in which they are used that determine the consequences. This is illustrated by the Substance Use Continuum (see below). People can use different types of substances for different reasons, at varying levels, at different times in their life.
No Use
Some youth will decide ‘this is not for me.’ Maybe they are not interested in trying a drug or are concerned about possible consequences (e.g., cost, fear of getting caught, friends don’t think it’s a good idea, etc.).
Beneficial Use
This refers to using medications, either over-the-counter or as prescribed by a doctor, to improve one’s health or treat a condition.
Experimentation
Many (but not all) young people begin to experiment with substances in their teens. Not every young person who uses alcohol or other drugs will develop a problem. Maybe they don’t like the feeling, or maybe the cons outweigh the pros. Experimenting with a substance includes some risk because the user lacks the familiarity and experience to reduce risks.
Casual/Lower-Risk
Some young people like the feeling of being ‘high’ or like having a couple of drinks now and again. They can choose when they use, set limits on their use and stop when they want. When they use, there aren’t too many negative consequences. They ‘use’ once in a while and consider their use to be ‘social.’
High Risk/Harmful Use (Misuse/Abuse)
Some young people become more involved with using alcohol and other drugs. ‘Using’ becomes the focus of what they do when they party or hang out with others. They might spend a lot of money on alcohol or other drugs. As a result of their use, they can start to have problems with friends, family, school and/or work. They may no longer feel good about their use. When young people continue to use despite the problems it creates, they can be considered harmfully involved with drugs. Youth who are harmfully involved with substances often benefit from help to stop or reduce their use to a safer level.
Substance Use Disorder
Some young people actually become dependent on alcohol or other drugs. At this stage, their body is accustomed physically and psychologically to the drug and they might need it to feel normal. Youth can also develop ‘psychological dependence’ on a drug, which happens when someone feels the necessity to use substances to function and cope with stressors. Or, they feel they ‘need’ a drink or drug to face certain situations. When young people develop a dependency, they almost always need help to stop using.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) defines substance use disorder as “a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.”
The DSM-5-TR helps clinicians determine how much of a problem a substance use disorder is, depending on identified symptoms. A substance use disorder can be categorized as mild, moderate or severe. There are 11 areas that are often examined to assess the impact and severity of substance use in youth:
- Uses Larger Amounts/Longer/More Often
Taking the substance in larger amounts or more frequently than previously. Is the youth using more substance more often to get the same effect? - Repeated Efforts to Control Use or Quit
Wanting to cut down or stop using substances but not managing. Has the youth unsuccessfully tried to quit or cut back their use? - Time Spent Using/Finding Substances
Spending a lot of time getting, using or recovering from the use of a substance. What does an average day / week look like compared to before substance use started? - Cravings and Urges to Use the Substance
Cravings can vary in length and intensity. Is the youth experiencing cravings (aka a strong urge to use)? How much time do they spend thinking about using? - Ignoring Important Roles
Is the youth failing to meet responsibilities at school, home, work or extracurricular activities because of substance use? - Social or Relational Problems
Is the youth hanging out with new peers or struggling to maintain healthy relationships? Has their substance use caused relationship problems or conflicts with others? - Giving up Important Activities to Engage in Substance Use
Has the youth skipped / stopped doing activities they once enjoyed in order to use the substance? - Risky Use
Is the youth using substances again and again, even when it puts them in danger? Is the youth using substances in ways that are dangerous to themselves and/or others? - Physical or Psychological Problems Related to Use
Has substance use led to physical health problems, such as headaches or alcohol poisoning, or psychological impacts, such as depression or anxiety? - Tolerance
Does taking the same amount of the drug produce a diminished effect? Or, does the youth seek increased amounts of the substance in order to feel intoxicated/high?
- Withdrawal
Depending on the drug that has been used and the length of use, withdrawal symptoms can range in severity from mild to very severe. Is the youth experiencing withdrawal symptoms which can be relieved by taking more of the substance?
*The DSM-5-TR provides information on substance use in places like Canada. However, different sociocultural beliefs (behaviors and mental processes partly shaped by social and/or cultural contexts) can influence how people think about substance use and abuse. When identifying problematic substance use, it is important to remember that culture can impact how drugs and drug use are understood.
When we talk about the most ‘popular drugs,’ we are referring to those drugs used most often by the largest number of people. The Canadian Student Tobacco, Alcohol and Drug Survey (2021-2022) tells us that the two most popular drugs used by youth are alcohol and cannabis. It is important to remember that the data on alcohol, cannabis and medication reflects youth who have used these substances sometime in the identified year. It does not tell us about the frequency of use, nor how much is being used each time. Some youth may have used a substance only once, while others may be struggling with dependence.
Concurrent disorders (also called dual or co-occurring disorders) happen when a person has both a mental illness (e.g., clinical depression) and a substance use problem (e.g., alcohol dependence). Many types of concurrent disorders are possible. The relationship between the two varies depending on the type of mental illness, the substance(s) used, and the severity of the substance use problem.
Concurrent disorders can present in a variety of ways: active at the same time or at different times, in the present or the past, and with symptoms that vary over time. Concurrent disorders can exacerbate (heighten) each other and lead to poor decisions and/or an increase in symptoms. Concurrent disorders are best treated at the same time, however, mental health treatment will benefit youth even if they’re not ready to stop using.
Many young people will try alcohol, tobacco or other drugs at some point in their lives. Caregivers can prepare themselves with the necessary information and try to manage their own potentially strong feelings about the topic. Youth need to be prepared to make good decisions based on facts, not emotion. Most importantly, do not hesitate to start the conversation – the earlier, the better!
The best prevention is not specific to drugs alone. Here are some tips on addressing substance use and working towards positive health outcomes for young people:
- Get Informed. Learn which substances are being commonly used by young people in your area, including how they work and signs of use. Learn about alcohol and cannabis.
- Talk openly and honestly about both the pros and cons of substance use. Share your beliefs and listen to theirs. Acknowledge the short-term benefits as well as the immediate and long-term consequences of risky behavior, including potential impacts on the developing brain, education and learning, future employment and the increased risk of accidents, violence and arrest.
- Build a Strong Relationship. Stay connected with your child. Do things together. Show them you value their company. Show interest and care re: his/her/their wellbeing. Provide encouragement and support.
- Communicate. Ask questions. Talk, yet listen even more. Try to suspend judgment. Nagging or arguing closes off communication – do everything you can to keep communication open.
- Know Where Your Child Is. Know how they spend their spare time, and with whom. Get to know their friends and their friends’ caregivers.
- Be a Role Model. Set an example of the behavior you want to see in your young person, including your own use of medicine and recreational substances. Explain why you make the choices you do. Help them learn important skills, like decision making and problem solving.
- Encourage Activities. Keep your child busy with meaningful activities, especially those that connect them to the community.
- Plan Family Time. This could include mealtimes, family outings or activities (games, watching a movie together, etc.).
- Be Fair and Consistent. Set firm, fair and consistent limits for your child. Create the consequences for substance use together. Let your child contribute to the discussion.
*As your child ages, your response to substance use will also change. When it is appropriate, discussions about consuming alcohol and cannabis safely and reducing the risk can encourage open communication about use.
Genetic, personal and environmental factors don’t ‘cause’ substance use. Substance use is the result of a complex interplay between genetics and the environment, and may arise within the unique circumstances of each individual.
Many youth deal with challenging situations without using substances. There are protective factors that help youth build resilience, including stable, safe environments and positive family relationships.
If someone in your life is struggling with substance use or addiction, avoid confronting them directly and stay safe. Look for support from another safe, trusted adult. This could be a teacher, coach, counsellor, or family friend, among others.
Check out our infographic: When an Adult You Care About Misuses Substances: 10 Tips for Teens
Learn even more with our booklet: Could My Parent Have an Addiction?
People can overdose on many different types of drugs. Overdose happens when the body is exposed to poisonous levels of a drug, or combination of drugs. At lethal levels, depressant drugs like alcohol slow down breathing, blood pressure and heart rate, leading to respiratory and cardiac arrest. Toxic doses of stimulant drugs, like cocaine or amphetamine, speed up these same systems, causing stroke, heart attack and even death. Combining drugs in any amount can have unpredictable and potentially fatal consequences.
Regardless of the drug or drugs used, it is critical to get help as soon as possible.
Call 911 immediately if:
- The person cannot be roused/does not respond to speech or touch (pinch an earlobe)
- The person’s skin is cold and clammy, or lips and nails are slightly blue
- The person is throwing up without regaining consciousness
While you wait for the ambulance:
- Are they breathing? If not, start rescue breathing. If yes, place in the recovery position.
- If you have Naloxone, administer it. You can administer one dose every two minutes.
- Repeat these steps until the person regains consciousness or help arrives.
If the person wakes up, remain calm and explain that help is on the way. Continue to monitor.
UNDERSTANDING
SUBSTANCE USE
(INFOGRAPHIC SERIES)
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*Special thanks to the CHPS Team at Alberta Health Services and Dr. Rebecca Haines-Saah for their content contributions and review.
SOURCES
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision—DSM-5-TR. American Psychiatric Association: Washington, DC, USA.
- Canadian Centre on Substance Use and Addiction: https://ccsa.ca/
- Drug Free Kids Canada. (2022). Engage in meaningful and effective conversations with your kids on the subject of substance use. https://www.drugfreekidscanada.org/prevention/tips-for-parents/
- Canadian Student Tobacco, Alcohol and Drug Survey (CSTADS) 2021-2022. Summary of Results: https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2021-2022-summary.html
- My Health Alberta. (2021). Alcohol and Drug Use in Young People. Prevention Strategies. https://myhealth.alberta.ca/health/pages/conditions.aspx?Hwid=tp17749
