9.1 Health Promotion

When we look at Health, we understand that there are many moving components that we need to look at.  Health inequities include looking at the social determinants of health and the impact of policy development that shapes our health.

Health promotion for people / who are impacted communities impacted by substance use?  “Health promotion in the substance use field works at a broader level than substance use prevention, with the aim of strengthening health, well-being and resiliency, reducing stigma, and addressing the root causes of harmful behaviours” (Canadian Centre of Substance Use and Addiction, 2014, p. 1).  This could be through affordable housing initiatives, playground development, school-based nutrition programs and more.  Health promotion benefits individuals as well as communities and can be a strategy for supporting both people who use substances and people with a substance use disorder.

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Health promotion programs look broadly at communities and societies; health promotion programs may target individuals or communities.  For example, harm reduction programs are part of a robust health promotion strategy to support individuals who use substances.

Prevention and Early Intervention

Addiction prevention and early intervention are important to reduce substance use and substance use disorders in Canada.

Recognized as an important pillar of the continuum of health, “part of Health Canada’s role is to increase awareness among youth of the dangers of experimenting with illicit drugs, and to assist parents in keeping their kids drug-free” (Government of Canada, 2016, para. 2).  Here is an example from Western Health, in Newfoundland and Labrador  Mental Health Promotion & Substance Use Prevention School Health Promotion Resources PRIMARY: KINDERGARTEN – GRADE 3 (Western Health, 2021).

There are many prevention programs that focus on preventing substance use and substance use disorders.  Some programs focus on substance specific prevention like alcohol, cannabis, and opioids.  Other programs aim to prevent specific types of use, for example, inhalation versus injection use.  Some programs are specific for vulnerable groups based on age, gender, and ethnicity, as well as factors like mental health, while others focus on community and society.  There are a variety of factors, both risk and protective elements, which exist within each of these contexts.  For programs to be effective, as we have discussed in previous chapters, they must look beyond the substance use to the intersections with health.  Researchers suggest a mix of prevention interventions is required to address substance use disorders in communities and societies.

Prevention programs should consider comprehensive solutions that fit the needs of their communities and population, within a gender and cultural context and taking into consideration unique local circumstances, including community readiness. Some interventions may be evidence-based, while others may document their effectiveness based on other sources of information and empirical data.

Many programs in Canada are focused on preventing substance use as well as preventing use from becoming a disorder. These programs typically focus on age, and more specifically youth.

Substance Use and Youth

The early use of substances increases a person’s chances of developing a disorder as substance use often begins in adolescence (Schulte & Hser, 2014). Young people aged 15 to 24 are more likely to experience mental illness and/or substance use disorders than any other age group (Statistics Canada, 2015). The risk of substance use increases greatly during times of transition. For a youth, developmental stages may result in higher risk-taking behaviour (Schulte & Hser, 2014). A certain amount of risk-taking is a normal part of adolescent development; the desire to try new things and become more independent is healthy but it may also increase the risk of experimentation. The parts of the brain that control judgment and decision-making do not fully develop until people are in their early or mid-20s (Winters & Arria, 2011).

When youth enter high school, research suggests youth encounter greater availability of substances (Dalhousie University, 2013). According to the Canadian Centre on Substance Use and Addiction (2005), approximately 62.3% of youth aged 15-17 engaged in early use of alcohol and 29.2% in early cannabis use over a year period. The research indicated that “among those under age 20, smokers were 14 times more likely to consume alcohol than were their non-smoking peers and were also more likely to engage in binge drinking (five or more drinks on one occasion)” (Canadian Centre on Substance Use and Addiction, 2005, p. 24).
Using substances at an early age has more potential to disrupt brain function in areas critical to motivation, memory, learning, judgment, and behaviour control (Winters & Arria, 2011). Studies also show the harms associated with early substance use include death by overdose and car accidents (Schulte & Hser, 2014). Preventing early use of substances may reduce the number of people who develop a substance use disorder, and it may also reduce early mortality. Data from Public Safety Canada (2018) found that childhood physical abuse is a strong predictor of substance use and those who are abused are more likely to develop a substance use disorder. Researchers, community advocates, and agencies have developed numerous interventions to address risk and protective factors for substance use. Each program may or may not work depending on the audience, the location, and the strategy. Public Safety Canada (2018) has suggested each program must be tailored towards the audience as there is no one-size fits all when it comes to prevention programs.

Prevention Programs

Prevention programs funded in Canada work towards “increasing awareness and knowledge about the risks of problematic substance use and reducing the desire and willingness to obtain and use drugs” (Government of Canada, 2019).

Prevention programs can focus on not only helping individuals develop the knowledge, attitudes, and skills they need to make good choices but address the larger systemic issues that impact their ability to understand the choices they make, focusing on risk reduction and health promotion.  The programs are designed for various ages and can be used in individual or group settings, such as the school and home.  Examples of a prevention program includes the Nova Scotia Municipal Alcohol Policy (Canadian Centre on Substance Use and Addiction, 2017).

Early Intervention Programs in Canada

As information about substance use and substance abuse disorders grows, so have intervention strategies.  The “Just Say No” Campaign and other programs focusing on how to refuse substances failed to address the determinants of health and their connection to substance use and abuse.  Programs today focus on not only helping individuals develop the knowledge, attitudes, and skills they need to make good choices but address the larger systemic issues that impact their ability to understand the choices they make.  For example, the Canadian Drugs and Substances Strategy includes prevention, treatment, harm reduction, evidence and enforcement, as well as funding for these initiatives (Government of Canada, 2019).

Two examples of early intervention programs in Canada include Project SUCCESS (Schools Using Coordinated Community Efforts to Strengthen Students) (Conduent, 2021) and ALERT (Tucker et al., 2004).  These programs focus on various intervention levels, including working with youth who have experimented with substances to those who are using substances more frequently.  Using evidence to develop programs is essential for success.  Please review Canada’s evidence base to view how programs gather data.

For diverse populations to benefit from prevention and early intervention programs, culture, gender, ability, and language must be considered at every step when developing and then implementing these programs.