What Do We Mean By Substance Use Health?
CAPSA created the principle of Substance Use Health in 2020 to move away from the illness-based models of substance use and expand our idea that health effects related to substance use exists along a spectrum, including no use. Unlike Mental Health and Physical Health, we have focused best practices, policies, rhetoric, and research around substance use on illness (i.e. addiction, more appropriately called substance use disorder or SUD), resulting in most people not connecting substance use to their health, positively or negatively.
The Substance Use Health Spectrum™
Visually, Substance Use Health can be represented along a spectrum with varying levels of risks and benefits as shown here.
Core Principles Of The Substance Use Health Spectrum™
No matter where a person is on this spectrum, there are certain things that hold true.
Every person has a place on the Substance Use Health Spectrum™. It doesn’t matter how much, how little, how many, or what kind of substance you use.
Substance use has benefits. Substances can bring relief or healing from physical or mental pain. They can be used for ceremonial purposes. These uses can promote health.
Substance use carries risks. Substances affect our health. For example, alcohol, even in small amounts, can cause more than 200 health conditions related to the heart, liver, lungs, brain, and stomach. Understanding these risks help us to make informed decisions about our health.
Health promotion can happen at any point along the spectrum. Like Mental Health and Physical Health, there are strategies to maintain or improve health (not only treat illness) when it comes to substance use. These can include public education, media campaigns, peer support, health screenings, and strategies to realize self-determined health goals (e.g., moderation, abstinence, and harm reduction, as examples).
Stigma can be experienced at every place on the spectrum. People who do not use substances, for whatever reason, may be excluded from social events where others are using substances. People with SUD may be blamed for their illness as if it were a choice. Others may be excluded from information or supports because they do not have a diagnosis of disorder. These are all forms of stigma and discrimination.
Substance Use Health in Action:
CAPSA has now evolved the principle of Substance Use Health into frameworks to begin destigmatizing substance use and improve practices to address people’s health regarding their use. These frameworks seek to:
Talk about how Substance Use Health has implications for all of us – not only people with SUD and in the process, reduce stigma, discrimination and othering.
Provide access to health promotion strategies for all people when it comes to their substance use – regardless of the substance and how much is used;
Recognize the risks and benefits of substance use to make informed decisions;
Reinforce substance use health as a matter of health, not a criminal or moral issue;
Make connections between Substance Use Health, Mental Health, Physical Health, and the broader Social Determinants of Health in our systems of care;
Equitably allocate resources and funding according to need.
To date, Substance Use Health frameworks have been adopted by health agencies, researchers, policymakers, schools, universities, and employers across the country. Substance Use Health principles have been presented to the United Nations and as supporting evidence for Canada’s National Standards on Mental Health and Substance Use Health, and Bill S-232 – A Health-Centred Approach to Substance Use.