Substance Use

Life-Course Approach to Mental Health, Substance Use, and Trauma

Have you heard the phrase “the apple doesn’t fall far from the tree” when comparing children to their parents? Well, there are two main reasons for this. First, there is a genetic component of our personalities and how we will experience mental health through our lifetimes. For example, genes have been found that appear to be associated with an increased risk of a person experiencing depressive or substance use disorders. However, the strength of these associations is not yet fully understood.

Second, humans are wired to learn from their environments, particularly the people in them. In early life, this environment is our parents. As we move into childhood, this environment becomes more involved with those outside our family, such as peers and teachers or other adults. Through adolescence, this environment becomes increasingly influenced by peers, and usually finds an equilibrium in late adolescence and early adulthood. Regardless of what people are in these environments, we will consciously and unconsciously learn from them, particularly in our younger years.

Addiction

“Addiction” is an umbrella term that can describe both substance use disorders and behavioral addictions. Much like many of the other terms we have used in this course so far, language continues to be important. For example, while it is true that someone can be addicted to, say, internet use, not everyone who uses the internet will actually meet the criteria for an addiction. So, what is the definition of an “addiction,” and how does it differ from other behaviours that are not addictions? It depends who you ask. If you ask a psychologist or counsellor, you’ll probably hear a response that includes the definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the set of guidelines these professions use to make diagnoses (the manual is currently in its fifth edition, so the reference is usually the DSM-V or DSM-5). This manual labels an addiction by the problems it causes a person, across 11 domains:

1. Taking the substance in larger amounts or for longer than you meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (also referred to as tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

While the actual nuts and bolts of making a diagnosis is outside the scope of this course, it is useful to know this perspective because it can help understand some of the common effects of addiction. Note that this definition uses the term “substance,” but this could be substituted with the word “behaviour” and be just as relevant. Also note that simply using a substance, or engaging in a behaviour, is not an indicator of addiction. There is a common saying in addiction treatment that “use is not the same as abuse” which, generally, holds true.

So, why do people use substances, or engage in behaviours that cause problems? There are almost as many answers to this question as there are people who answer it.

One answer relates back to our discussion of trauma earlier; if a person finds that a substance intensifies or diminishes an under-aroused or over-aroused response, or numbs out their nervous system all together, and they like that feeling, addiction becomes a risk. Some other answers include:

• Environment – a person is more likely to use if people in their immediate surroundings use. This includes using as a means to “fit in,” such as peer pressure.
• Genetics – while it is not fully understood, some genes appear to be associated with an increased risk of addiction.
• Family history – a combination of environment and genetics, role models in early childhood can influence coping behaviours in adulthood.
• Increased stress – workplace stress, relationship stress, health stress, and existential stress can all contribute to use turning into addiction.

Bottom line: people use substances because they work, at least in the short-term.

Common Substances People Use

When discussing substances, there are two broad categories these substances fall into: depressants and stimulants. Depressants don’t necessarily make a person feel ‘depressed’, rather, they cause transmission of signals in the nervous system to slow down, much like the “under-aroused” response to trauma we discussed earlier. The following list includes common substances, their categorization as depressants or stimulants, their physical effects, and their legal status.

Nicotine – Stimulant

• Examples: Cigarettes, e-cigarettes or “vapes”, chewing tobacco.
• Use: Leads to increased energy and attention, and relieves stress.
• Legal Status: Cigarettes are available to adults over the age of 19 in many retail stores. Some vape products are sold only in designated retail spaces that are age-restricted.

Nicotine is highly addictive, and can cause cardiovascular problems over time. Smoking tobacco products causes other health problems. The health impacts of vape products are largely unknown.

Caffeine – Stimulant

• Examples: Coffee, tea, energy drinks. Also included in some cold and flu medication.
• Use: Increased energy for a short period, increased focus.
• Legal status: Available at many retail locations and not age-restricted.

Is a common contributor to feelings of anxiety; the recommended daily dose of caffeine according to Health Canada is approximately one medium cup of coffee.

Opiates – Depressants

• Examples: Codeine, morphine, fentanyl, heroin, oxycodone, hydromorphone, methadone.
• Use: Relieves physical and emotional pain. Causes a strong feeling of relaxation. Used in medicine to relieve strong pain (which is why fentanyl was developed).
• Legal status: Illegal to produce or sell; possession of small amounts is legal without a prescription.

Responsible for the vast majority of overdose deaths in B.C. Severe withdrawal symptoms make abstinence difficult.

Alcohol – Depressant

• Examples: Beer, wine, spirits. Also included in some food products (cooking wine) and health products (mouthwash).
• Use: Decreases inhibitions, reduces stress. Associated with celebration and socialization in many cultures.
• Legal status: Legal to purchase and possess from licensed establishments by anyone over the age of 19.

Causes serious health and social effects. Responsible for many social harms including impaired driving.

Other Stimulants

• Examples: Methamphetamine, adderall.
• Use: Increase attention and alertness. Increases heart rate and respiration. 
• Legal status: Illegal to produce, sell, or possess without a prescription.

Causes increased activation of the “fight or flight” part of the nervous system.