Overview

Some people who drink alcohol or use other substances, including prescription or over-the-counter medicines used in ways they are not intended, may develop substance use disorder. This means that a person uses these substances even though it causes harm to themself or others.

A person who has substance use disorder will have two or more of these symptoms:

• Using more of the substance or using it for a longer time than they ever meant to.
• Not being able to cut down or control their use.
• Spending a lot of time getting or using the substance or recovering from the effects.
• Having a strong need, or craving, for the substance.
• Not being able to do their main jobs at work, at school, or at home.
• Continuing to use, even though the substance use hurts their relationships.
• Substance use becomes the most important activity to do.
• Being unable to see situations where using substances is dangerous, such as when caring for children or driving.
• Using the substance even though they know it's causing health problems.
• Needing more of the substance to get the same effect or getting less effect from the same amount over time (tolerance).
• Having uncomfortable symptoms when they stop using the substance or use less (withdrawal).

Substance use disorder can range from mild to severe. The more symptoms of this disorder you have, the more severe it may be.

A person might not realize that their substance use is a problem. They may use alcohol or substances in small amounts. They may go days or weeks between drinking or using substances. They may not consider that substance use becomes a problem when it causes harm and puts them or others at risk.

Substance use may be a person's way of trying to self-treat another condition, such as depression, anxiety, chronic pain, or trouble sleeping.

Using alcohol or substances may put others at risk. For example:

• Using alcohol while pregnant puts the baby at risk for problems from fetal alcohol syndrome. Alcohol may affect the baby's growth and development, behaviour, and ability to learn.
• Children who are exposed to substance use in the home may experience mental health conditions, such as depression and anxiety. They may have a tough time at school because they experience behavioural problems or trouble with learning. And they may be more likely to develop substance use disorder.
• Alcohol and substances may affect a teen's brain development. They can also affect emotional and social development. Substance use can cause changes in a teen's alertness, perception, movement, judgment, and attention. This can make it harder for teens to think, learn, reason, and make healthy choices.

People who use alcohol or substances may be more likely to engage in risky behaviours. For example, they may not use condoms during sex. Or they may have more than one sex partner. This increases the risk of unintended pregnancy and sexually transmitted infections (STIs). They may drive after using alcohol or other substances. This increases the risk of injury or car crashes.

If you are concerned about your substance use, talk to your doctor or other healthcare provider. If you are concerned about someone else's substance use, call the Addiction Helpline at 1-866-332-2322.

Alcohol

Alcohol is part of many people's lives. It may have a place in cultural and family traditions. So it may be hard to know when someone is drinking too much. If you choose to drink alcohol, try to drink less. It's important to remember that drinking alcohol is not risk-free. Your risk of harm from alcohol is:

• Low if you have 2 standard drinks or less per week.
• Moderate if you have between 3 and 6 drinks per week.
• High if you have 7 or more drinks per week. (Each additional standard drink increases the risk of alcohol-related consequences.)

Teens who use alcohol are more likely to use tobacco products and to experiment with cannabis or other substances.

Over time, drinking alcohol may cause health problems, like high blood pressure, problems with digestion, and liver, heart, brain, and nervous system problems. It may also cause sexual problems, osteoporosis, and cancer.

The use of alcohol with medicines or other substances, including cannabis, is not recommended. It may increase the effects of each substance. Using alcohol along with opioids increases the risk of opioid overdose.

Recreational substances

People may use substances for recreational purposes: to get "high", relieve stress, or cope with physical and emotional pain. People who use cannabis, cocaine, opioids, LSD, ketamine, meth, or other substances may develop substance use disorder.

Substances come in different forms and can be used in different ways. They may be smoked, snorted, inhaled, or taken as pills. They may be put in liquids or food. They may be put in the rectum or vagina or be injected with a needle.

When people are in situations where substances are used, there is a higher risk of becoming the victim of sexual assault or violent behaviour.

Prescription and over-the-counter medicines

Some people misuse prescription medicines, like opioids (such as Oxyneo and Dilaudid), benzodiazepines (such as Valium and Xanax), and stimulants (such as Adderall). Some over-the-counter medicines, such as cold medicines that have dextromethorphan in them, can also be used in ways they are not intended. An OTC example is cold medicines with dextromethorphan.

Inhalants

Glue, shoe polish, cleaning fluids, gas, and aerosols are common products with ingredients that can also be used to get a "high."

Health and safety risks of alcohol and substance use

When you use alcohol or other substances, you may be putting your health and safety at risk.

Alcohol or substance use can:

• Make car crashes more likely. If you drink or use substances and drive, you can easily hurt yourself or others.
• Lead to unprotected sex and/or becoming a victim of sexual assault. This can lead to unplanned pregnancy and sexually transmitted infections (STIs), including HIV.
• Increase the risk of overdose, injury, and death.
• Cause you to be less self-conscious, which can make you do or say things you wouldn't usually do or say. This can lead to problems with friends and family. It may also cause legal problems like being arrested for impaired driving or assault.
• Affect your work or schoolwork. It can cause you to lose your job or drop out of school.
• Change how you feel about your life. It can lead to depression and suicide.
• Cause mood swings and affect your sleep and your ability to think, learn, reason, remember, and solve problems.
• Harm many organs and systems in the body, such as the liver, pancreas, heart, brain, digestive system, and nervous system.
• Contribute to the development of some cancers, such as cancers of the mouth, throat, larynx, esophagus, liver, colon, and breast.
• Cause high blood pressure, stomach problems, or sexual problems.
• Cause harm to a developing baby (fetus) if alcohol or other substances are used during pregnancy.

Self-Care

If you are concerned about your own or another person's substance use, learn what steps to take to start your recovery.

Ways to reduce harm from substance use

Using any substance has risks and side effects. There are things you can do to reduce your risk of serious health problems and injuries caused by substance use.

• Avoid risky situations and activities. Don't drink or get high and drive, and don't get in a car with a driver who has been drinking or using drugs. Go out with a friend you trust.
• Make a plan to get home safely. For example, choose a designated driver, take a rideshare (like Uber of Lyft), have money to pay for a taxi or bus fare, or call someone you trust for a safe ride home.
• Check with your doctor or pharmacist about whether over-the-counter or prescription medicines you take interact with alcohol or other drugs you use. Ask if there are things you can do to make using alcohol or other drugs less risky. They may tell you it is not safe to drink or use other drugs while you take these medicines.
• Don't use alcohol or drugs if you're pregnant or trying to get pregnant. These substances can increase your baby's chance of being born with a birth defect or fetal alcohol syndrome.
• Find healthy ways to try to make yourself feel better. Spend time with people who support your recovery. Go to mutual support group meetings. Find new hobbies or ways to exercise. Volunteer, read, or spend time in nature. Find activities that do not involve alcohol or drugs.
• Be aware at all times of your surroundings and the people around you.
• Limit how much you use alcohol or other substances. The more you use, the greater the risk of getting sick, hurt, or in trouble.

Reducing harm from alcohol

• Have a meal or snack before or with your drink.
• Drink slowly. Having more than 2 standard drinks per occasion is linked with an increased risk of harm to yourself and others, including injuries and violence.
• Have a glass of water or other non-alcoholic, caffeine-free beverage (such as a soft drink or fruit juice) between drinks.
• Always watch your beverage carefully or have someone you trust keep an eye on it if you need to step away. Accepting a drink in an open container from someone who is not a bartender or server is risky. You do not know what may have been added.

Reducing harm from drugs

• Ask your pharmacist or doctor whether any of your current medicines can cause dependence.
  • Be especially careful with pain medicines (such as opioids) and medicines to calm you or help you sleep. Follow your pharmacist and doctor's instructions about how much and when to take the medicines. It is risky to take more medicine than the doctor prescribed.
  • Make sure that your doctors are aware of medicines prescribed by another doctor. Use only one pharmacy when getting your prescriptions filled.
• Don't share needles, syringes, and other equipment (such as cookers, cotton, cocaine spoons, or eyedroppers) with others if you use drugs. Make sure you trust the people you get your supplies from. Be sure the supplies haven't been used before. It is risky to share equipment because you can come into contact with infected blood. This means you can get serious infections like HIV, hepatitis B, and hepatitis C.
• Talk to your doctor or pharmacist about a take-home naloxone kit. Naloxone helps reverse the effect of opioids. A kit can help, and can even save your life, if you have taken too much opioids. You can get a naloxone kit without a prescription at most drugstores or through a community based naloxone program.
• Be aware of who you get your drugs from. Drugs can vary greatly in strength depending on who you get them from.
• Be aware of how a drug might affect you, especially if you stopped using the drug and then started using again. You may not be able to handle the same amount of the drug as you could before. Start low and go slow.
• If possible, go to a supervised consumption site to use drugs. This is a place where you use drugs in the presence of trained medical staff who will help if something goes wrong. Go to https://www.canada.ca/en/health-canada/services/substance-use/supervised-consumption-sites/status-application.html to find a site near you.

Ways to help yourself or someone else

• Do not ignore the problem.
• Know the signs of addiction. These include being unable to cut down or control use, continuing to use even though it hurts a person's relationships, and having problems at work, school, or home.
• Call Health Link at 811 or make an appointment with a doctor or other healthcare provider, such as a counsellor, to learn about recovery and the kinds of treatments available.
• Find out when mutual support groups where you live meet. There are also online meetings. Alcoholics Anonymous (AA), LifeRing, Narcotics Anonymous (NA), or SMART Recovery help members to stay in recovery. Al-Anon provides mutual support for family members and friends. Alateen provides mutual support for teens who are affected by someone else's use.
• When you are supporting someone, talk to them about whether they see the way they use as a problem and if they want to make changes. Ask if they want help to figure out what to do next or to find support services.
• Often people have mixed feelings about whether they want to change. Keep talking with them about the pros and cons of quitting and staying the same.
• Let others make decisions in their own time. When you pressure them to do things the way you would, they will likely say that they do not want to change. Everyone has to figure out what works for them in their recovery, including how quickly they want to do things.
• Provide support for the other person during detox or other treatment.
• Help set up community services in the home, if needed. Older adults may benefit from services like home care, nutritional programs, transportation programs, and other services.
• If you are invited to, help your friend or family member with decision-making. One effect of using substances is that people may have a hard time with understanding or remembering information, telling others about decisions they made, or getting services and support they need.
• Check out what services are available in your area.
  • If you work, talk to your human resources department about getting a referral to your employee assistance program, if your employer offers it.
  • Call Health Link at 811 to learn about what kinds of treatment services are available where you live.

When to call for help during self-care

Call 911 if the following occurs during self-care at home:

• You feel you cannot stop from hurting yourself or someone else.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away.

• Call or text Canada's suicide and crisis hotline at 988.
• Kids or teens can call Kids Help Phone: 1-800-668-6868 or text CONNECT to 686868.
• Go to the Talk Suicide Canada website at https://talksuicide.ca or the Kids Help Phone website at https://kidshelpphone.ca for more information.

Consider saving these numbers in your phone.

Call a doctor or go to the emergency department if you have symptoms that are uncomfortable, start to happen more often, or become more severe.

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