The Implications of How Substance Use is Understood
True or False: Substance use is solely a personal failure or moral weakness.
Trauma—physical, psychological, or sexual—is often the root cause of long-term anxiety, depression, and PTSD, which are strongly linked to substance use. Viewing substance use solely as a personal choice shifts focus away from underlying causes, fostering blame and stigma.
True or False: In Canada, alcohol, tobacco and marijuana are legal and are a source of government tax revenue.
True. Other substances, such as crack cocaine and heroin, are illegal, are the sources of illegal profit-making, and are considered in popular thinking to be extremely dangerous.
True or false. Not all people who use substances experience stigma and discrimination.
True. The socio-political and ideological contexts shape the harms individuals experience, particularly through the extent to which they experience substance use stigma and discrimination.
True or False: Healthcare providers should learn about the context and population they serve.
True.
True or false: The terms substance use, substance abuse, addiction, and dependence are adequately used in healthcare settings.
False. Some terms are more pejorative than others, with "addiction" carrying the greatest stigma and being the most overused. It often refers to compulsion and dependence, but its meaning and usefulness are debated.
Describe the role of supervised consumption sites in Canadian healthcare.
They provide a safe space for drug use, reducing overdose risk and connecting individuals to health services. However, this strategy depends on the political party governing Canada.
True or False: heavy substance use is a symptom of other pre-existing problems and circumstances.
True. Heavy substance use is a symptom of other pre-existing problems and circumstances. Viewing only heavy substance use prevents nurses from having a comprehensive health history.
True or False: Nurses should be clear about why gathering information, and convey reasons to assess patients.
True. You might introduce it by saying, “We know that many people use alcohol, but we ask everyone about their alcohol use so that we can provide better pain management.”
Why has the term substance use been preferred in healthcare settings?
Dependence as a label for compulsive, out-of-control substance use has been problematic and confusing to clinicians and (as noted earlier) has resulted in patients with normal tolerance and withdrawal being labelled as addicts.
What impact does criminalization of certain substances have on public health in Canada?
Criminalization can deter individuals from seeking help and contribute to stigma.
In emergency care, why should healthcare providers avoid focusing only on the history of heavy substance use while taking care of their patients?
Patients with a history of substance presented to emergency departments can present a different problem (related or not to substance use).
True or False: It is better to gather information that you may need in the future.
False. Patients are more likely to not disclose accurate information.
Define Harm Reduction.
Harm reduction is a philosophy and a set of programs and services that focus on preventing the harms of substance use, not reducing substance use per se. Harm reduction is evidence-based, approaching substance use as a health issue
How are pharmaceutical companies connected to the drug toxicity crisis?
The drug toxicity crisis, driven by pharmaceutical drugs like oxycontin and fentanyl, led to opioid-related deaths, with worsening trends. Other substances, like benzodiazepines, contribute to fatalities but are not reversible with naloxone.
Describe at least two principles (out of 4) of health assessment and substance use.
1. Health assessments should be health-promoting; 2. Health assessments should consider the patient’s and population’s context. 3. Assessments should be trauma- and violence-informed. 4. Assessments should minimize harm
Why should you be alert for heavy use when people present with a history of violence or mental health problems?
Although most people use substances of some sort, people with a previous history of violence or mental health problems tend to heavily use substances.
Cite 2 out of 3 reasons for the importance of understanding our perspective on substance use.
Answer: health care providers will be more effective if they recognize the influence of wider contexts, including how 1) providers personally understand substance use, 2) how they convey their knowledge and biases and 3) how they act on organizational and social levels (contextually).
Cite two out of 3 possible 09 strategies for Harm Reduction.
1. providing access to safe substances; 2. safe supplies; 3. safe places to use substances; 4. overdose care; 5. supporting decriminalization and/or legalization of drug use; 6. safe housing; 7. income supports; 8. mental health services; 9. pain management services
Describe at least three out of the five “As” for integrating knowledge of substance use in health assessment.
1. Acquire knowledge: replace erroneous assumptions; 2. Anticipate harm that may be caused by your practices, reactions, and judgements; 3. Analyze the impact of policies at the level of organizations; 4. Avoid social judgement about substance; 5. Approach all patients respectfully.
Once you have established a relationship of trust with the patient, you can ask follow-up questions. Which are they (cite at least 3)?
Substances used; Time frame; Amount of substances used? How often? By what route? When was the last time you used it?