have THAT talk About Substance Use Health

Last updated: April 19, 2024

Many people consume substances. 

Most Canadians will consume some kind of substance in their lifetime.

Just like Physical or Mental Health, our Substance Use Health can vary from one day to the next as we are faced with different circumstances. People deal with stressors and challenges in different ways. Some people may find themselves consuming more substances or experiencing challenges with their substance use during times of increased stress.

Addictions and Substance Use Disorders are treatable medical conditions, not a moral failing, and certainly not a choice. 

Treatment and preventative measures for Substance Use Disorders are effective.

Unfortunately, stigma is one of the biggest barriers preventing people experiencing challenges with substance use from seeking help or health care, or even just telling the people in their life that they are struggling. 

The Spectrum of Substance Use 

The Spectrum of Substance Use was developed through a partnership between Ottawa Public Health (OPH) and the Community Addictions Peer Support Association (CAPSA), as a tool to help all of us talk about our substance use health. It has evolved and may continue to evolve in the coming years to accommodate new information, as research in this area continues to emerge.

The spectrum includes no use, substance use and the development of a Substance Use Disorder. It is based on the evidence we currently have on substance use and addiction. However, it is not linear and is not meant to read as a process, where a person progresses from one stage to another. But rather, it presents different options and people can identify with different points on the spectrum at anytime. It is meant to be inclusive of everyone - those who consume substances and those who do not. Anyone should be able to identify themselves within the spectrum on any given day.

Spectrum of SU

Please use the following citation for referencing: Ottawa Public Health & Community Addictions Peer Support Association. (2021). Spectrum of Substance Use Health. Ottawa Public Health 2019-2022 Strategic Plan.

Developed through a partnership between OPH and CAPSA, the spectrum of SUH is a tool to help all of us talk about our substance use health. 

No Use
  • There are many reasons why someone might wish to not consume substances (i.e. cultural considerations, athletic training, etc.)
  • One thing we can do is be allies to people and not make them feel uncomfortable if they choose not to consume. It can be very difficult for people to say no and refuse, and if they do, we can support them by: 
    • Respecting their choices,
    • Not commenting or questioning them,
    • Backing them when they are being questioned or pestered by someone else, etc.
  • We encourage everyone to explore and practice ways of saying no that feel authentic to them.
    • Examples of refusal techniques include:
      • Saying "No Thanks" plainly and confidently – simple but effective, the “no thanks” technique without a lot of arguing and explaining is often the best and easiest response.
      • Changing the subject or suggesting a different activity - by thinking of something else to do, you are also offering other people an “out.” You might be surprised who might take you up on it.
      • Use humor or make a joke - sometimes a witty one-liner or well-timed joke can lighten a serious mood and help deflect the attention.
      • Make an excuse or give a reason why you cannot participate. Sometimes backing up the “no” with evidence can give it more power (I.e. you can state a health problem or say that it will interfere with your sports training)
      • Walk away - if all else fails (and you can do so safely), remove yourself from the situation that is making you uncomfortable
  • BreakingFreeOnline is one tool that can be particularly helpful for those practicing refusal skills. It is a free virtual care tool available to all Ontarians. 
  • And if you are looking for tips on having conversations with youth about refusal skills, here is a great resource for youth: Youth Connections Ottawa
Beneficial Substance Use
  • The beneficial use of substances results in positive health or social outcomes, for example:
    • The use of prescription or non-prescription medications, as directed, for pain management
    • The symbolic use of substances during religious services or spiritual ceremonies    
  • There are important considerations that come with the beneficial use of substances (i.e. safe storage and disposal of the substance, proper handling, potential side effects, etc).
  • OPH's Secure Your Meds website has information on how to keep medication safe as well as where to return unused or expired meds
Lower Risk Substance Use
  • There are ways to consume substances that reduce the risk of health and social consequences 
  • But Lower Risk consumption does not mean no risk, there are risks when consuming any substance and in any quantity
  • Even in moderation, substances can have an impact on our health and wellbeing.
Problems Occurring with Substance Use
  • Problems can occur when consuming a substance, but people do not choose to consume substances in a problematic way, but rather they start to notice problems occurring with their substance use. This could look like:
    • Unintentionally hurting oneself or others while under the influence of a substance
    • The use of a substance interfering with a parent’s ability to respond to their child’s needs
Substance Use Disorder (SUD)
  • Substance Use Disorders are treatable medical conditions, not a moral failing, and certainly not a choice. 
  • Like for other medical conditions, there are many complex health and social factors that contribute to the development of Substance Use Disorders
  • What tends to get overlooked is that treatment and preventative measures for Substance Use Disorders are effective. Generally as successful as treatments for other chronic medical conditions.
  • Recovery is possible and attainable! Hope and compassion go a long way in supporting those who are struggling.
  • For more information on supports available in our community: Mental Health and Substance Use Resource List
  • Addiction refers to a complex medical condition that involves changes to brain circuitry resulting in altered functioning of a person’s reward, motivation, stress, and executive function systems
  • Addictions can be linked to certain behaviors (such as gambling), while SUDs are very specific to substances
  • Addictions are characterized by the four “C”s: 
    • Use becomes Compulsive
    • Continues despite harmful Consequences
    • Is accompanied by Cravings
    • And a sense of loss of Control
  • If any or all of the four Cs resonate with you about a particular area of your life it is a sign of strength to reach out for help or to speak to your health care provider.

Tips for talking about Substance Use

Tips for talking about Substance Use - downloadable PDF - 288 KB. 

We all experience substance use health. But challenges with substance use can be difficult to talk about. Our relationship to substances can change over time. It is impacted by our biology, environment, stress and life experiences. These changes can occur quickly or gradually, which can make them difficult to notice within ourselves. The four Cs of addiction are a great tool for reflection for anyone questioning their relationship to substances. But perhaps you are worried about someone else (i.e. a friend, family member or colleague) and don’t know what to do. Know that this is perfectly normal. Most of us don’t know what to say in new situations. 

If you are thinking of talking to someone about their substance use health, here are a few tips that could help :

Tip 1: Check in with yourself

Think about your own feelings, worries and experiences. Put yourself in the other person’s shoes. How would you feel receiving this information? This might help you decide the best approach (i.e. speaking face to face, writing a letter, talking by phone, or sending a text message or email).

“How ready am I to have this talk? How can I prepare myself? What is the best way, place and time?”

Tip 2: Pick a calm time and place where both people can feel safe and comfortable

Avoid times or places where you might feel stress or not have privacy.

“I was wondering if I could talk to you about something that means a lot to me. Is now a good time?”

Tip 3: Speak kindly
Sometimes our words can shame people and can make them feel like they do not deserve to receive help. Use language that respects people’s worth and dignity like Person First Language.
Tip 4: Say what you notice without judgment
“I know that things haven’t been easy lately, I have noticed... (say what you have seen or noticed).
Tip 5: Show that you care
“I care about you. I was wondering if you wanted to talk about where you are at? And how I can support you?”
Tip 6: Listen
No one wants more problems in their life. Remember that you may not agree with or like what they say. Be non-confrontational and empathetic. Pay attention to your tone, volume, and body language. Hear their reasons, feelings and what they have gone through, and try to stay in the moment.
Tip 7: Remind them how strong they are
“Its’ ok not to be ok. Challenges with substance use are not a choice. This does not make you a bad person. You are resilient and (list their strengths). Remember that time you (examples of moments of strength)? We all deserve to receive and accept help when we need it.”
Tip 8: Offer help

Offer to connect them with support: AccessMHA is for anyone 16 years of age and older who is looking for mental health and/or substance use/addiction services. 1Call1Click.ca is available to assist infants, children, and youth from birth to 21 years of age, and connects them and their families with the right mental health and addiction services. Visit Mental Health and Substance Use resource list for additional supports and services. If you notice the person has been feeling stressed or the person shares that they are using substances to cope with stress, offer to help them think about other ways to relax.

“There are supports in our community that can help. We could call them together, if you want?”

“I’ve noticed you’ve been feeling stressed lately and was wondering if you wanted to brainstorm some ways to help you relax?”

Tip 9: Be open to talk more...

It is not realistic to expect one talk to resolve anything. Let them know you are there for them.

“I am here for you. I want to support you. Know that you can talk to me anytime …”

Tip 10: Be kind and take care of yourself
Talk to someone you trust or reach out for help yourself if you need it. The person may not be ready to talk or seek help. They may become angry or defensive. While this may feel hard, don’t take it personally. Don’t force it. There is no “perfect way” to do this. Small steps are still steps. This talk could be a step towards increasing their wellness.

Visit Families for Addiction Recovery for more tips on supporting a loved one.

Visit The Community Addictions Peer Support Association (CAPSA.ca) to learn more about how stigma affects people and for stigma related resources.


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