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How to Change our Minds about Brain Health and Substance Use

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Eliminating the stigma surrounding substance use disorder can bring about a more equitable and compassionate approach to patient care.

There’s a question that people with a substance use disorder are often asked: “Why don’t you just stop?” Some might see that as a fair question — after all, for people with a substance use disorder, substance use is a choice, right? I’m here to tell you that this line of thinking lacks a fundamental understanding of the relationship between our brains and substances. I also see this critical gap in information as a driving force behind the stigma and discrimination that continue to have a direct effect on people’s health.

Establishing the facts

All substance use involves the brain. And even though three out of four of us in Canada use substances to some degree, little is known about the effect of substance use on the brain. Our relationship with substances ranges from no use at one end to a disorder at the other. Most people fall somewhere in the middle, yet few know how their use affects their overall health, let alone their brain.

Neuroscientists have found that trauma, among other factors, can restrict the region of the brain that keeps us well and feeling safe while pushing fear into overdrive. It’s possible that people who develop a substance use disorder are trying to re-set this imbalance by filling the gap with substances, including tobacco and alcohol, to feel better. This damaged wiring of the brain impairs our ability to make healthy choices. Using substances becomes instinctual and part of our need to survive. Choice doesn’t stand a chance. 

A Leger Opinion survey conducted last December for CAPSA and the Canadian Centre on Substance Use and Addiction found that nearly a quarter of participants believe addiction is a choice. Despite this, 80 per cent of respondents believe people need more access to information and health services when it comes to substance use.

More knowledge is needed

Forty-nine per cent of survey participants reported getting their information about substance use from the media. Much of the current information today tends to focus on the disorder end of the spectrum. This leaves many of us without the answers we need to make informed decisions. People also need to know where to go for information about their substance use. People who reach out to health care professionals are often told that they’re simply not sick enough to warrant care. This would be akin to telling a stage 2 cancer patient to come back when they’re at stage 4. 

When it comes to brain health, more research could explain why some people’s brains choose substances as a good coping strategy and others’ don’t. Education can also empower young people to know more about the effects of substances on their developing brains. It can help us know how to nurture resilience by being OK with life’s struggles and building coping skills. Studies in neuroplasticity could inform health programs so we know what to expect from the brain and its power to heal itself. 

Stigma limits our understanding

The gap in information about substances is significant. It’s also dangerous. Not understanding substance use has created the perfect condition for stigma and discrimination. People living with a substance use disorder are often stigmatized heavily, even by their own health care providers. This has resulted in discriminatory systems being built up. It’s time we changed this.

Understanding substance use as a health issue aims to create a safe space for people to question their relationship to substances without stigma. Just like Physical Health and Mental Health, our Substance Use Health doesn’t presume illness. We can better manage substances across our lifespan when the conversation is grounded in client-partnered, integrated, and individualized care with outcomes that focus on shared decision-making and empathy.

How we get there

CAPSA is not a brain organization — we focus on stigma and eliminating barriers to equitable care. And stigma has created barriers, keeping us from knowing more about Substance Use Health. We can learn how to change our minds about substance use. The way forward is simple: provide good information to people so they can make an informed decision, without stigma getting in the way.

The following are six calls to action to help us get there.

  • Enable more research on the impact of substance use on brain health.
  • Increase education and supports across the spectrum of substance use. Resources are needed for everyone, even those who don’t use substances. 
  • Enforce proper labelling of all substances, listing ingredients and dosage. 
  • Have ongoing conversations with your doctor about your Substance Use Health as it relates to your brain health. 
  • Provide better education for doctors about Substance Use Health.
  • Encourage more research on treatment and its ability to restore neuroplasticity and overall brain health.

Together, we can reduce the stigma associated with substance use and promote better health and understanding. 

The following is a snapshot of a survey on Substance Use Health that CAPSA and the Canadian Centre on Substance Use and Addiction conducted with Leger Opinion in December 2022, which involved surveying 4,000 people living in Canada:


of people believe that Substance Use Health is an urgent issue


think people need more access to information and health services


reported getting their information about substance use from the media


still believe addiction is a choice

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