Talking about Substance Use, Misuse, and Abuse
While teaching this topic, it is important to be aware of learners’ own experiences and decisions regarding substance use but also the potential influences of those around them (including friends, siblings, parents, and the broader community). When talking about substance use, misuse, and abuse it is important that learners have a clear understanding of what is meant by “substances.” Substances are more commonly known by young people as “drugs”. There are many different types of substances, or drugs, that young people may use. Caffeinated energy drinks, cannabis, alcohol, tobacco, over-the-counter drugs, and prescription medications are some examples.
The personal connections that young people have to different substances can have a profound impact on their beliefs and values. Stereotypes and beliefs may also have an impact on learners in many different ways, ranging from those whose faith does not allow the use of certain substances to those for whom drug use is an established element of their lives. These assumptions and beliefs can impact the perceptions of risk that young people may have about certain substances as well as their decisions to use specific substances. For instance, many young people often do not think of alcohol as a “drug”, given its legal status in our society. In actuality, it is the most common substance used by teenagers and when young people drink in hazardous ways they may underestimate the dangers of doing so. Educators can support learners by providing factual information on the specific risks associated with different types of substance use and how to reduce the harms associated with those risks. (Educators may wish to read the overview by Parent Actions on Drugs that provides adults with information on various types of substances, as well as the risks associated with the use of each substance at parentactionondrugs.org.)
Youth perceptions of whether their peers use substances or not can also impact their own choices around substance use.11 Often, young people overestimate the extent to which their peers use substances. In Ontario, over one-third of learners in Grades 7 through 12 reported using no drugs at all in the past year. Before beginning a discussion with young people about substances, educators might check in with them about their perceptions of drug use as this can help provide a context for them about actual substance use among their peers. In addition, before broaching discussions around substance use with young people, educators can also benefit from knowledge about the current substances that youths may be using or misusing so as to ensure that conversations around potential hazards are appropriate and relevant. (More information on youth drug use is available in the Ontario Student Drug Use Survey Highlights report available at camh.ca.)
In addition, the educator's clarity and understanding about differences among the concepts substance use, misuse, and abuse are important when discussing these issues with learners. "Problematic substance use" is a term that refers to the use of substances in potentially harmful ways. It includes both substance misuse, which is the use of substances in ways that are illegal or not recommended medically, and substance abuse, which involves excessive use of substances despite the physical, mental, emotional, social, legal, or economic harm that this may cause to oneself or others. Educators can support learners by avoiding assumptions, listening for cues that indicate they may need support (e.g., a learner showing negative changes in their behaviour and thinking), and assisting them in seeking additional support where needed.
Addressing the Connections between Substance Use and Mental Health
Problematic substance use, mental health, and mental illness are often closely connected. The Ontario Student Drug Use and Health Survey notes that 7% of Ontario students between Grades 7 and 12 experience a combination of at least three of the following problems: psychological distress, hazardous drinking, anti-social behaviour, and a drug use problem. Although problematic substance use, mental health problems, and mental illness may often co-exist, it is important to note that one doesn’t necessarily cause the other. In some cases, the causes may be quite different, or all may be caused by a common factor, which could be genetic, developmental, or environmental. For example, traumatic events (an environmental factor) can lead to both mental health issues and problematic substance use. In other cases, mental illness may contribute to problematic substance use: alcohol and drugs may be used as a means to cope with a mental illness but may make the symptoms of the illness worse. By identifying potential linkages between mental health and substance use, educators can help youths identify when their moods might impact decisions around substance use and also instruct them on how substance use can alter a young person’s behaviour and thinking.
Best Practices in Substance Use Education
There are many variables at play when making the decision to use, or not use, a substance. The “Just Say No” approach to substance use education is an abstinence-based approach that instructs young people to abstain from substance use, but the approach may not resonate with young people. This finding is consistent with research that suggests the “Just Say No” approach is too simplistic and not helpful for young people or others who might be trying to decide whether or not substance use would be a problem for them. The “Just Say No” approach may not acknowledge the developmental reality that young people sometimes make decisions based on emotions and impulses. Instead, best practices in substance use education suggest that educators can have an impact on learners’ views, attitudes, and, ultimately, decisions by providing on-going opportunities for discussion and learning about substance use, misuse, and abuse informed by the best available evidence. Moreover, it is important to begin these conversations early so that young people have an opportunity to prepare and practise how they might make healthy choices around substance use.
 Centre for Addiction and Mental Health. (2002). Programs that work with youth. Retrieved from http://www.camh.ca/en/education/Documents/www.camh.net/scoop_sheet_programs_work.pdf
 Joint Consortium for School Health. (2009). Addressing substance use in Canadian schools. Retrieved from http://www.jcsh-cces.ca/upload/JCSH%20Substance%20Use%20Toolkit%20Classroom%20Education%20v1.pdf
 Canadian Centre on Substance Abuse. (2007). Substance abuse in Canada: youth in focus. Retrieved from http://www.ccsa.ca/Resource%20Library/ccsa-011521-2007-e.pdf
 Boak, A., Hamilton, H.A., Adlaf, E.M., & Mann, R.E. (2013). Drug use among Ontario students, 1977-2013: Detailed OSDUHS findings. Retrieved from http://www.camh.ca/en/research/news_and_publications/ontario-student-drug-use-and-health-survey/Documents/2013%20OSDUHS%20Docs/2013OSDUHS_Detailed_DrugUseReport.pdf
 Centre for Addiction and Mental Health. (2009). Building teacher confidence and comfort about substance use and abuse: Grades 1 to 10. Retrieved from http://www.camh.ca/en/education/teachers_school_programs/resources_for_teachers_and_schools/Pages/curriculum_buildingconfidence.aspx
 British Columbia Ministry of Health Services. (2004). Every door is the right door. Retrieved from http://www.health.gov.bc.ca/library/publications/year/2004/framework_for_substance_use_and_addiction.pdf
 Boak, A., Hamilton, H.A., Adlaf, E.M., Beitchman, J.H., Wolfe, D., & Mann, R.E. (2014). The mental health and well-being of Ontario students, 1991-2013: Detailed OSDUHS findings. Retrieved from: http://www.camh.ca/en/research/news_and_publications/ontario-student-drug-use-and-health-survey/Documents/2013%20OSDUHS%20Docs/2013OSDUHS_Detailed_MentalHealthReport.pdf
 Canadian Mental Health Association. (2014). Fast facts about mental illness. Retrieved from https://cmha.ca/about-cmha/fast-facts-about-mental-illness#.Vqk3yEAsDSg
 Parent Action on Drugs. (2014). Parent action pack. Retrieved from: http://parentactionpack.ca/wp-content/uploads/2014/12/Parent-Action-Pack-December-2014-Version.pdf