“Substance Use Health” is a concept developed by CAPSA, a member of Dianova International, and interview with Gord Garner, Vice President of Strategic Partnerships
This text has been adapted from “Understanding Substance Use Health: A Matter of Equity” – download brochure
The Community Addiction Peer Support Association, or CAPSA, was established in Ottawa, Canada in 2013 in an effort to bring people with lived and living experience with substance use out of the shadows and into the community, so as to shed light on issues related to substance use.
In Canada, CAPSA is a leader on the topic of stigma, its impacts on people who use substances and/or have a substance use disorder, and on identifying and correcting instances of systemic stigma imbedded in organizations.
CAPSA works with various organizations to provide education around substance use, the stigma associated with substance use disorders, and the use of person-first language to reduce stigma and discrimination. To achieve these goals, the organization works with subject matter experts with a lived or living experience of these issues.
As part of its engagement with people who use substances, the organization developed the Substance Use Health concept which endeavours to: meet the needs of people where they are, stigma free; achieve equitable access to healthcare programmes and services, and support evidence-based information on substance use and substance use disorders.
Interview with Gord Garner, Vice President of Strategic Partnerships at CAPSA, by Dianova’s representatives
What is substance use health?
For many, physical health and mental health have come to be viewed as a continuum or spectrum, with multiple supports for lifelong wellness, without presumed disease. Yet, the term ‘substance use’ is often used as a synonym for addiction or substance use disorder (SUD). This stereotype merely frames substance use in and of itself as an acute disorder, which it is obviously not. In reality, substance use health, similar to physical and mental health, also occurs across a continuum – see diagram below.
In Canada, 78% of people aged 15 and older reported alcohol use, 22% reported psychoactive pharmaceutical use, 18% tobacco use, and 15% other types of psychoactive substances. In Europe, an estimated 19% of the 15-24 year olds reported using cannabis in the past year, while almost 60% of all people aged 15 and older reported alcohol use and 25% tobacco use.
Such figures seem to indicate that substance use is relatively common, at least in Western countries, this is the reason why stigma- and judgement-free language about substance use health should become a priority that helps us move away from presumptions that associate substance use with disorders and bad/harmful actions.
Empowering people to achieve their self-defined health goals
In Canada, alongside this shift to substance use health has come a renewed push for policies, programmes, services and supports that are evidence-based and designed to empower people in achieving their self-defined health goals. Client-partnered care and outcomes, which stress integrated and individualized care, shared decision-making and non-judgmental therapeutic empathy, have been implemented across physical and mental health care services. In the field of substance use health care, it has been suggested that a similar model based, among other elements, on support for self-identified goals, would help to: remove barriers to accessing care, improve the social determinants of health, and facilitate culturally safe trauma-and-violence-informed care.
Abstinence, a goal among others
CAPSA and its partners believe that deprioritizing abstinence as the primary success outcome of substance use health care is needed in order to focus on self-defined wellness goals alongside additional metrics. This vision, which includes multiple recovery pathways, will remove the barriers that oftentimes prevent people experiencing more complex issues sur as SUD and co-occurring disorders from freely seeking the help they need.
CAPSA’s goal is to inform a national conversation on these issues, help advance health system-level innovation in substance use health care, and establish a client-partnered public health model that works within the substance use health continuum. This approach, already developed by CAPSA with the “All People All Pathways” programme, takes into account the multiplicity of individual pathways and offers people a save, non-stigmatizing environment.
At Dianova, we believe that CAPSA’s substance use health concept should not only contribute to the evolution of the public health model but also to a change in perceptions. For this reason, Dianova supports all approaches that help bring the stigmatization of substance use to an end, and joins the movement to remove barriers and other inequalities that prevent people from accessing the care they need.
 Statistics Canada 2021 – 2017 survey, not including people who are residents of the Yukon, Northwest Territories and Nunavut, nor full-time residents of institutions
 European Drug Report 2022: Trends and Developments (EMCDDA)
 Global status report on alcohol and health 2018 – (WHO)
 Prevalence of tobacco use among adults in the WHO European region
 Community Catalyst et al., 2021
 Marchand et al., 2019