Spectrum of Use
People use a variety of substances for a variety of reasons. Substances can be prescribed by a medical professional for healing and coping purposes and can also be natural or synthetic substances obtained through legal and illicit trade. Additionally, individuals may use substances for religious or ceremonial reasons, personal enjoyment, or to cope with pain, stress, or trauma. Substance use is different for everyone, and the “spectrum of use” model helps us understand the varying levels of benefit and harm and emphasizes the co-occurrence of polysubstance use.
Polysubstance use refers to the simultaneous use of multiple substances. The term "substances" encompasses more than just illicit drugs like heroin, cocaine, and methamphetamine; it includes alcohol, prescription medications, nicotine products, and many others. It’s common that an individual may engage with more than one substance and for different reasons and at different times in their lives. Substances have various purposes: some act as stimulants, others as depressants; some can aid in managing withdrawal symptoms of another substance, and sometimes, using multiple substances simultaneously can enhance the individual's desired effects. However, the use of multiple substances also increases risk factors.
The first category on the spectrum is non-use - which implies abstaining from all substances. As noted earlier, this phase of use as with the others is not necessarily a static or even a goal level. Individual tolerance and use purpose is unique and non-use, while the least risky for most, is not the necessary level for all people to be at their optimum risk to benefit level.
The next level on the spectrum is beneficial use. This frequently includes taking your prescribed medications. Low consumption of regulated substances can fall under beneficial use, however, every individual is different - low consumption could be beneficial for some and harmful for others. This category on the scale helps us remember that substance use does not imply substance misuse.
The next level on the spectrum is low risk use. This usually includes the consumption of substances that we don’t have adequate research about - the most common being cannabis. Low-risk use also implies casual to moderate use, whereas high risk use implies frequent and regular consumption. Additionally, it is often motivated by stress or trauma, combined with other risky behaviors and substances, and affects the people around the individual as well.
On the far right of the scale is substance use disorder (SUD). This is characterized by a loss of control over substance use despite negative consequences. It involves physical and psychological dependence, compulsive behavior, and tolerance, which necessitates professional intervention and support. This is the level of use that can be the most destructive to individuals and communities. And is also the level where use is least managed and understood. It’s where our work in stigma reduction and education is most critical both for those suffering with addiction and the community of people around them. Understanding the loss of control and need for support at this level is important to building a true recovery ecosystem in our region.
Key takeaways from the Spectrum of Use Model:
People do not automatically move along the spectrum. Someone may use substances casually for years, and never progress to disordered use.
Someone may be at different points on the spectrum for different substances.
Someone may start using for one reason and continue using for another. For example, they may start using to to help them cope with physical or emotional pain, and continue using to prevent withdrawal. When a person develops a dependency, their brain structure changes.
Understanding how someone views their substance use on this spectrum can help foster conversations around supporting their goals and the plan for care.
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