What constitutes substance use and addiction?
What constitutes substance use and addiction?
Numerous individuals turn to substances like drugs or alcohol to unwind, enjoy themselves, experiment, or manage stress. However, for some, the consumption of these substances or involvement in specific behaviors may become problematic and can lead to dependence.
Addiction is a multifaceted phenomenon where detrimental patterns of substance use or behaviors can disrupt a person's life. In broad terms, addiction is characterized as a condition that compels an individual to engage with certain stimuli, regardless of adverse consequences. This may result in physical and/or psychological dependence. Addictions can be categorized into substance-related (such as the problematic consumption of alcohol or cocaine) or process-related, referred to as behavioral addictions (like gambling or internet addiction). Both categories can hinder an individual’s ability to sustain a healthy lifestyle, but various support and treatment options are accessible.
A straightforward method to comprehend and articulate addiction is to utilize the 4C's approach:
• Craving
• Loss of control over the quantity or frequency of use
• Compulsion to use
• Continued substance use despite repercussions
How prevalent is substance use and addiction?
Substance use is relatively widespread globally, with statistics varying according to the substance consumed. Estimates suggest that nearly 5% of the global population has experimented with illicit substances, 240 million individuals across the globe face problematic alcohol use, and around 15 million engage in injection drug use.
In Canada, it is estimated that about 21% of the population (approximately 6 million individuals) will meet the criteria for addiction during their lifetime. Alcohol is the most prevalent substance linked to addiction, with an 18% rate. Cannabis, also known as marijuana, records one of the highest usage rates worldwide, with over 40% of Canadians having used cannabis at least once in their lifetime and about 10% having used it in the previous year.
While some may utilize substances without significant harm, others may face ongoing substance-related challenges. In Ontario, an approximate 10% of the population engages in problematic substance use. Recently, Ontario has observed an alarming trend regarding opioid-related harms. Opioids, a category of psychoactive drugs frequently used for pain relief, include substances like fentanyl, morphine, heroin, and oxycodone. Although opioids can be effective for pain management and many may use them short-term without issues, this class of drugs has resulted in widespread harm in recent years, including fatal overdoses. In 2016, there were 865 deaths attributed to this substance, equating to an opioid-related overdose death in Ontario approximately every 10 hours.
Substance use and addiction can also be viewed as a spectrum.
Individuals use substances for various motives and in differing degrees. While some may not encounter any adverse effects from their substance use, others might experience negative impacts on their lives. Substance use and addiction can be conceptualized on a spectrum, as illustrated in the model below.
Symptoms of problematic substance use and addiction often manifest episodically, with individuals experiencing fluctuations between heightened substance use and periods of control. For instance, casual or non-problematic substance consumption could escalate into problematic use during stressful times when individuals resort to substances for coping.
A common fallacy about addiction is the notion that an individual will instantly become ‘hooked’ upon experimenting with an addictive substance. While many substances hold potential for addiction, it is not merely the substances themselves that are responsible for addiction. For example, many people utilize narcotics for post-surgical pain alleviation and do not develop dependencies. The relationship between addiction and substance use is frequently tied to a person's life experiences and behavioral patterns.