Brianne Peters
Research Specialist, CAPSA
Substance use continues to be an outlier in the Canadian health care system, and it affects more of us than you think.
In Canada, we have a collective aversion to talking about alcohol and other substances when it comes to our health. It’s a curious aversion given that many of us use them so regularly. We scrutinize anything that comes close to our bodies, so why are substances any different?
Perhaps more curious is the blame or pity we feel toward people who experience declining health because of their substance use — as if they should have known better when, in fact, most of us don’t know any better either. Systemic stigma and silence around substance use continue to have significant consequences on our health — regardless of how much or what type we use.
Understanding Substance Use Health in Canada
Three quarters of the population (23.7 million people) uses substances in Canada. In 2023, CAPSA, the Canadian Centre on Substance Use and Addiction (CCSA), and Leger surveyed more than 4,000 people from the general population who spanned the spectrum of substance use — some used regularly, others not at all. We wanted to find out:
- What people know about their substance use and health;
- Where they turn if they want to change or manage their substance use in some way; and
- If they’re being offered health information or supports.
The data revealed that most people don’t talk about substances in the context of health. Not surprisingly, 83 per cent have never asked a health care professional about their substance use and 62 per cent have never been asked.
When questioned why people were reluctant to talk to their health care providers, there were some common responses: “They didn’t ask, so I didn’t either,” “I was embarrassed,” “I don’t have an addiction (substance use disorder),” and “I didn’t know if they had the answers.”
Overcoming stigma and false beliefs
Where do people turn instead? Sadly, more than 70 per cent don’t know where to go. Of those who did, less than one per cent thought their doctor could help. More people relied on the media, their own research, and family and friends for advice.
Relying on these information sources has consequences. Take alcohol as one example. Of those surveyed, 86 per cent were unaware that over seven drinks per week put them at high risk of early death from high blood pressure, cancer, liver disease, and digestive issues, as examples. Almost all respondents were surprised to learn that nine million Canadians are at high risk. We simply don’t know what we don’t know when it comes to our Substance Use Health.
Almost a quarter of respondents also falsely believe that substance use disorder is a choice. This belief justifies othering the almost five per cent of people with substance use disorder into their own “addictions” category, where they’re made very aware of their ill health and all the stigma that comes with it. In the process, everyone else is presumed healthy and left to their own devices to make decisions in the absence of credible information. In this system, everyone loses.
Looking forward
There’s some good news. Close to 80 per cent of people surveyed believe we all need access to more Substance Use Health information and supports, and that it’s an urgent issue. In response, CAPSA created a Substance Use Health framework. It lays out strategies for moving beyond an illness-based system to one that includes the health of the whole population across a spectrum — as we do with mental and physical health.
The framework is being adopted by health agencies, researchers, policymakers, schools, universities, and employers across the country. It has been presented to the United Nations and as supporting evidence for Canada’s National Standards for Mental Health and Substance Use Health, and Bill S-232 — Health-Centred Approach to Substance Use Act.
CAPSA and the CCSA recently launched a follow-up national survey where people shared how they’d like to see Substance Use Health promoted. Early analysis reveals some promising ideas to better inform and better serve people in Canada.
If you’d like access to the full surveys or learn more about Substance Use Health, visit capsa.ca or email [email protected].
