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Top signs of problematic substance use

More than 2 million Canadians are living with a substance use disorder, according to the Mental Health Commission of Canada, and that number is on the rise.

"Alcohol and drug use can cause physical and psychological dependence, which can lead to a substance use disorder," says Irene Njoroge, advance practice nurse in the Substance Use Service at Women’s College Hospital.

"If the substance you’re using is causing significant problems in your life and has negative effects on your health and despite that, you continue to use it, then you might have a substance use disorder."

Njoroge has supported thousands of people with problematic substance use over the years. "Alcohol is the most common substance people seek help for, followed by opiates," she says. "It often takes a long time before people realize that their substance use has centered itself as a priority in their life."

"Regardless of what is used, the most important thing to know is that substance use disorders often occur due to circumstances beyond one’s control, but they are treatable, just like other chronic illnesses—through medication and psychosocial support including counselling and therapy."

Unfortunately the prevailing stigma often prevents people from seeking help.

"A lot of people feel a huge component of shame and guilt related to their substance use, and they suffer in silence instead of getting help, but their illness is not any different from other chronic illnesses such as hypertension or diabetes," says Njoroge. "People need to know that the shame you feel, the guilt you feel, is because of stigma – and not because you are a weaker or immoral person."

Njoroge says that a substance use disorder is diagnosed based on meeting two or more of the following DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders) criteria:

Signs and symptoms of a substance use disorder

1.  Negative effect on social functioning, including relationships, conflict with others
2.  Not meeting life responsibilities at home, work, or school
3.  Negative effects on physical or psychological health
4.  Using more of the substance, for longer periods of time, or more frequently
5.  Spending a lot of time using or sourcing the substance
6.  Using unsafely such as driving under influence, experiencing a black out or overdose
7.  Not being able to stop or cut back despite trying
8.  Avoiding or giving up activities to take the substance
9.  Cravings including constantly thinking about the substance even if not using
10.  Tolerance needing to take more to feel the same effect
11.  Withdrawal when the drug is stopped or reduced, including psychological and physical symptoms

Njoroge stresses the importance risk factors play in developing problematic substance use, which need to be taken into account when considering treatment. The main predisposing factors are:

  • Family history of substance use
  • History of mental illness
  • History of trauma
  • Cultural factors, for example when the use of a substance is socially accepted

If you’re struggling with substance use or know someone who is, Njoroge encourages finding support and offers this information to help you cope:

  • Fill the void
    "If you’re struggling with substance use, it’s important for you to identify the main factor contributing to your use. What is the void that the substance is filling in you? Once you’ve identified that void, get help and/or fill it with something positive and meaningful to you," says Njoroge.
  • Find meaningful support
    Medication and counselling are tools to help you, but having a sense of connection to another person is essential for long-term support. "Establish what support will look like for you, and try to make a meaningful connection to have that sense of fulfillment," says Njoroge.

If you think you might have a substance use problem, speak with your doctor or healthcare provider, or find a rapid-access addiction clinic across Ontario. 


Woman looking out of a window sadly


This information is provided by Women's College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: Feb. 20, 2019.

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  • A publication of:
  • Women's College Hospital