Learn about Substance Use
"Rather than discouraging discussions of drug use during pregnancy,
we should be looking upon them as an opportunity to bring about positive, long-lasting change in the life of the mother and child,
through effective treatment and support services."
- Loretta Finnegan, MD, and certified badass
Watch this C-SPAN video from December 19, 1987 - AIDS and Intravenous Drug Use
Witnesses testified on treatments for intravenous drug users, pregnant women and infants.
How does your body process medicine?
Have you ever wondered what happens to a painkiller, like ibuprofen, after you swallow it? Medicine that slides down your throat can help treat a headache, a sore back, or a throbbing sprained ankle. But how does it get where it needs to go in the first place?
Céline Valéry explains how your body processes medicine.
How do drugs affect the brain?
Most people will take a pill, receive an injection, or otherwise take some kind of medicine during their lives. But most of us don’t know anything about how these substances actually work. How can various compounds impact the way we physically feel, think, and even behave? Sara Garofalo explains how some drugs can alter the communication between cells in the brain.
What is substance use?
Substance use refers to the use of psychoative substances.
These can be things you eat, drink, inhale, absorb, or inject.
Psychoactive substances, also called psychotropics, are chemicals that change the way the body, brain, and nervous system work.
Substances are neither good nor bad; they're molecules.
Substances can both improve our health and wellbeing and cause harm.
Many substances have therapeutic (health improving) effects.
And in the wrong amount, almost any substance can be toxic.
Why do people use substances?
Substances can change the the way we feel and think. Substance use can affect our perceptions, moods, and consciousness. They can lead to intoxication, which is a temporary change in how you normally feel, think, and act.
People use substances:
to treat medical conditions
to alleviate pain and discomfort
to enhance the positive effects of another substance (synergistic)
to eliminate or diminish the negative effects of another substance (antagonistic)
to be more productive
to cope with overwhelming feelings
to feel connected
to alter their perceptions
to experience pleasure
What is the difference between using medications and using drugs?
Usually when we talk about the difference between using medications and using drugs we are talking about a difference in context. In other words, we're talking about the setting, time, place, mode of use, and who is using the substance.
In the academic, scientific literature this is called "set and setting." See, "Constructing drug effects: A history of set and setting."
Here are some examples of how the same substances are seen in different contexts:
Hydromorphone is a useful medication post-surgery and when administered in the hospital under supervision, but the same substance - heroin - is illicit when bought "on the street."
Consuming the same alcoholic beverages is legal or illegal depending on how old you are.
Alcohol use was illegal in the United States for more than 12 years during Prohibition. Now it is not.
Cocaine was legally available and could be an ingredient in everything from colas and home remedies until 1914.
Possession of equal amounts of powder cocaine and crystalized (crack) cocaine are treated differently under criminal law even though they are essentially the same thing. The only difference is how you use them (the mode of administration = snorting, injecting, or smoking).
Cannabis use is legal or de-criminalized in some U.S. jurisdictions but illegal in others - and always illicit under federal law.
Cannabis can be prescribed for medicinal use in some states but not others.
Ritalin and Adderall are acceptable when used in pill form and taken orally, but are considered unacceptable "drugs of abuse" when crushed into a powder and snorted.
You are more likely to be punished for ANY substance use - legal or illicit - if you are young, pregnant, parenting, single, poor, un-housed, incarcerated, queer, trans, Black, Indigenous, or a person of color.
This is why it's important to remind ourselves that every medication, every drug, every behavior can both provide benefits and present risks.
Our challenge is to significantly reduce or eliminate the risks of using them.
We need to help each other find ways to meet our needs.
We need more choices - not fewer.
We need to safer options that provide equal benefit.
REMEMBER: There are good reasons why people use substances Many provide very real therapeutic benefits. They work. That's why people use them.
Why say "substance use" instead of "drug use"?
We think "substance use" is more inclusive and accurate - and it is value-neutral.
What is substance dependence?
Some people use the terms “addiction” and “dependence” interchangeably.
But substance dependence is a medical term and is not the same as addiction.
Substance dependence and tolerance are expected physiological responses that occur with prolonged exposure to certain substances. Tolerance is when the body becomes accustomed to the presence of a substance and requires higher doses to achieve the same effect. Dependence is when the body displays signs and symptoms of withdrawal when the substance is absent.
What is addiction?
Addiction can occur without being substance dependent. Addiction may involve:
using substances despite negative consequences
being unable to stop using substances
neglecting obligations because of substance use
When discussing infants with substance exposure, it is important to avoid the word
addiction. Addiction refers to a set of behaviors that infants are incapable of performing, such as drug seeking and neglecting responsibilities. Infants are not addicted; they have prenatal substance exposure and may have physiological dependence.
What is Harm Reduction?
There is no universally accepted definition of harm reduction. One simple way to define it is to say that Harm Reduction is the acknowledgement that anything we choose to do carries risks - and that there are things we can do to minimize those risks.
For example, the safest way to avoid a car accident is to avoid cars.
Don't be a passenger in a vehicle.
Stay away from places where there are cars and avoid people who drive them.
If you do these things you can significantly decrease your odds of being in a car accident.
But what if you choose not to do these things?
How can you reduce the risks of negative consequences associated with cars and their use? You can become licensed to drive.
You can wear a seatbelt and observe agreed upon speed limits.
You can require that vehicles are manufactured and operated in accordance with safety standards.
You can expect that if these shared standards aren't followed, that there is accountability.
When we talk about Harm Reduction and substance use, there are some principles you want to understand.
The National Harm Reduction Coalition says Harm Reduction:
accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them
understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others
establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies
calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm
ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them
affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies which meet their actual conditions of use
recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm
does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use
All people should be treated with dignity.
Support - not punishment - leads to meaningful change.
Seeking pregnancy care shouldn't be dangerous.
Everyone has a right to make their own healthcare decisions.
The best providers work with patients to help them reach their goals.
Consent is an ongoing conversation.
We need to advocate for and protect parents, babies, and families.
“There is no such thing as a baby... a baby alone doesn’t exist. What exists is always a 'nursing couple': a baby plus someone who takes care of them."
- Journal de la psychanalyse de l'enfant Volume 5, Issue 2, 2015
Polysubstance Use: Using more than on thing at a time
By nature, most people are polysubstance users.
We probably take more than one medication.
We might drink coffee and use benzodiazepines.
We may use alcohol and we smoke cigarettes.
We use cannabis and take dietary supplements.
We drink grapefruit juice when we take our medications.
We use opioids and take prenatal vitamins.
Because of this it's important for us to know how the substances we use interact.
When we combine substances we may:
reduce their benefits
amplify their effects
put our lives in danger
What Happens When You Mix Drugs?
Which of the following is risky behavior: a person taking cholesterol medicine with grapefruit juice? Or a person taking Acetaminophen before going out for drinks? Or a person on blood thinners who takes an aspirin? Turns out, all of them are risky. Each has inadvertently created a drug interaction that could lead to serious complications. Céline Valéry describes the dangers of mixing substances.
Joelle Puccio, Director of Education
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