Curation Plan
Curation Plan
Embedded Files
Web-based resources are abundant, with information appearing at your fingertips all the time. I am constantly searching for new information based on professional projects, personal knowledge gain or just gathering social perspective. As I discussed in the prior exercise, I do not always store this information effectively, leading to difficulty finding it when it is required. I have appreciated reading the posts and have gained some new tools through this exercise.
In my personal life Pinterest is my go to for content curation. I use it for recipes, for hair and fashion inspiration, any DIY projects, color pallet inspiration, sewing tutorials and this list goes on (https://pin.it/3THQ5Fm). As I was preparing to write the post I used my handy Pinterest to look up online content curation tips and tools, I have to say I was impressed with all the tools out there. I was struggling with finding the correct fit for my professional/ school portfolio. After seeing all the post about Zotero and the suggestion for Diigo I decided to download both. Donna LaForce I am with you on your strategy to see which will be the better fit, it may just turn out to be both.
Another tool I have been using is Microsoft OneNote. My husband brought this to my attention when I was setting my computer up to start this course. It is not where I have been saving any online resources, but it is where I have been preparing these posts, keeping me on track and organized. Here is a link for your viewing if interest, School the content is the same as posted!
Social Media Plan
Social Media Plan
Social media has opened an array of connections between people. It has made sharing your personal and professional opinions very easy, leading to the possibility of reacting, without full regard to the implications of your share (Ventola, 2014). One's presence on social media reflects how they want to be seen. To guarantee that reflection on social platforms is a good representation of oneself, you need to consider what message is being portrayed, and who can see that message (Ventola, 2014). An appropriate presence on social media is one that you are happy to share with anyone, without any question about the interpretation of the content.
When considering your profession, on top of your own personal moral grounds, your social media presence becomes even more important to audit (Ventola, 2014). The College of Physicians and Surgeons of Ontario (CPSO) has a social media policy setting out guidelines for proper social media conduct which takes into account the impact on professional reputation and discourages engagement in disruptive behaviours (CPSO, 2022). The College of Nurses of Ontario (CNO) has practice standards for all nurses to uphold. These standards outline professional conduct responsibilities. Nurses must act with integrity, maintain public confidence by being accountable for their practice, and maintain appropriate boundaries (CNO, 2023). All health professionals are obliged to uphold their professional standards, in any public forum or platform where there can be a direct link to their professional role. However, I do not believe as a professional you are obliged to speak up in public.
References
College of Nurses of Ontario. (2023). Practice Standard: Code of conduct. https://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf
College of Physicians and Surgeons of Ontario. (2022). Social media. https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Social-Media
Ventola, C. L. (2014). Social Media and Health Care Professionals: Benefits, Risks, and Best Practices. Pharmacy and Therapeutics, 39(7), 491–520.
Modernizing the Canada Health Act
Modernizing the Canada Health Act
The Canada Health Act (CHA), federal legislation for universal health insurance coverage, was established in 1984 after years of executing various provincial hospital service acts (Health Canada, 2023). The criteria in this act were grounded on criteria established in the 1960s and have not been significantly adjusted since (Hill, 2022). According to the Canada Health Act (1985), “the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” (p. 5). This statement seems all-encompassing, describing the entire health of every person however, the greater detail of the act falls short of providing direct guidelines for each province and territory to uphold.
In the field of mental health and addiction care, the CHA’s definition of “medically necessary” care does not move outside the hospital or physician-delivered model (CHA, 1984; Canadian Mental Health Association (CMHA), 2021; Khaliq, 2021). Without federal direction or funding around required health services supporting mental illness and substance use problems, each province and territory is left to determine what they will prioritize and fund. The lack of clarity around “medically necessary” services and “reasonable” access to these services lends to open interpretation and a lack of national standardization. Understanding the CHA is a so-called blueprint for how each province will set up their own health insurance stipulations based on its needs, does not negate the impact on Canadians by leaving mental illnesses out as a health entity. Progressing to modernizing national standards, the Canadian Mental Health Association (2021) has committed to advocating for mental health as a human right working towards national standards and supporting viewing mental health as an equal entity to physical health.
References
Canada Health Act, R.S.C, C-61985 (1985). Retrieved from https://laws-lois.justice.gc.ca/eng/acts/C-6/page-1.html#h-151484
Canadian Mental Health Association. (2021, December 10). Brief. Mental Health as a Human Right: CMHA’s Vision. https://cmha.ca/brochure/brief-mental-health-as-a-human-right-cmhas-vision/
Health Canada. (2023). Canada health act: Annual report.
Hill, M. (2022). The coming earthquake: Canada Health Act transformed medicare. But 38 years on, it’s failing us. National Post. https://nationalpost.com/news/canada/canada-health-act-failing
Khaliq, Y. (2021, December 3). Khaliq: The Canada Health Act is failing people with mental illness. Ottawa Citizen. https://ottawacitizen.com/opinion/khaliq-the-canada-health-act-is-failing-people-with-mental-illness
Health Systems Involved in Substance Use and Addiction Care
Health Systems Involved in Substance Use and Addiction Care
The field of substance use and addiction uses federal and provincial health systems, along with non-governmental organizations and multiple stakeholders, including lived and living experience individuals, to create strategies around improving health care and health outcomes for people who use substances.
In 1988, an Act of Parliament created the Canadian Center for Substance Use and Addiction (CCSA). This was set up to provide evidence-informed leadership at a national level and help create solutions to address health harms related to substance use (CCSA, 2023).
In Ontario, in 2019, the Mental Health and Addictions Center of Excellence Act was enacted. With this in place, the hope is to provide all Ontarians with mental health and addiction support without barriers. A 10-year investment of $3.8 billion ($1.9 billion from the province, $1.9 billion from the federal government) was promised for a comprehensive and connected mental health and addiction system within Ontario (Minister of Health, 2022). With the financial support of this commitment and with the lead of the new Mental Health and Addictions Center of Excellence, a Roadmap to Wellness was introduced in 2020 (Minister of Health, 2022).
In addition to the federal and provincial acts, advocacy networks help advance health equity and decrease barriers to health improvements for many people, including people with substance-related concerns. Alliance for Healthier Communities (n.d) is one organization that helps to promote and advocate for policy change to reflect a more inclusive society. Harm Reduction Nurses Association (HRNA) (2023) is an organization advocating for evidence-based health policies around reducing the harms associated with substance use while maintaining the rights and dignity of those who use substances.
Not having a system that supports recovery or services in place to access help when needed, will continue to contribute to the burden placed on the healthcare system. Having organizations, as mentioned above, provides a platform for change and advocates for healthier people and healthier communities.
Mental health and addiction concerns across Canada come with a significant economic burden, not just on the healthcare sector but also on economic productivity. Many people cannot attend work due to impaired mental health or an addiction-related concern or cannot obtain further education due to these same concerns.
References:
Canadian Centre on Substance Use and Addiction. (2023). Our focus. About us. ( https://www.ccsa.ca/our-focus
Ministry of Health. (2023, May 03). Roadmap to wellness: a plan to build Ontario’s mental health and addictions system. Addiction and mental health. https://www.ontario.ca/page/roadmap-wellness-plan-build-ontarios-mental-health-and-addictions-system#section-8
Harm Reduction Nurses Association. (2023). About the harm reduction nurses association. About HRNA. https://www.hrna-aiirm.ca/about/
Alliance for Healthier Communities. (2023). About us. https://www.allianceon.org/About-Us
The Definition of Health
The Definition of Health
Are we ready for a change?
Are we ready for a change?
In 1946, the constitution of the World Health Organization (WHO) was drafted, and in 1948 this constitution came into power (WHO, 2014). With this came a set of foundational principles which would drive the promotion and protection of health, for all people. The definition WHO put forward stated: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (2014)." The question now is, is this definition of health still relevant?
The WHO definition alludes to the fact that one needs to be entirely whole to obtain true health. The state of disease is not the only factor in this definition however, it does not support a weakened physical or mental state as being any form of healthy (Sartorius, 2006). Continuing to define health as complete well-being sets many individuals, communities, and entire societies up to fail (Krahan et al., 2021). Based on that alone it is time to expand on the definition of health.
Sartorius (2006) described three definitions of health:
“The first is that health is the absence of any disease or impairment. The second is that health is a state that allows the individual to adequately cope with all demands of daily life (implying also the absence of disease and impairment). The third definition states that health is a state of balance, an equilibrium that an individual has established within himself and between himself and his social and physical environment.”
The last definition outlined by Sartorius (2006) provides a person-centred approach to health, allowing a person to live beyond their illness.
A definition put forward by Krahan et al. (2021) builds on the previous definition and states, “Health is the dynamic balance of physical, mental, social, and existential well-being in adapting to conditions of life and the environment.” This definition incorporated the complexities of our current health demographic and societal climate. It promotes health within the context of the pressures and influences in everyday life, the reality of chronic disease, complex medical and mental health-related illnesses, and the acceptance of variability. It supports health on a continuum, a more recovery-based approach that does not rely on the completeness of well-being (Krahan et al., 2021). It also promotes the necessity for access to resources, and places emphasis on the impact environmental and social influences have on health. This is a more current definition of health incorporating all aspects of a person, ultimately having a greater influence on health practice and policy.
References:
Krahn, G. L., Robinson, A., Murray, A. J., & Havercamp, S. M. (2021). It’s time to reconsider how we define health: Perspective from disability and chronic condition. Disability and Health Journal, 14(4), 101129. https://doi.org/10.1016/j.dhjo.2021.101129
Sartorius, N. (2006). The meanings of health and its promotion. Croatian Medical Journal. 47(4), 662-664.
World Health Organization. (2014). Basic documents, 48th ed. World Health Organization. https://iris.who.int/handle/10665/151605
Social Determinants of Health: Why it Matters in Primary Health Care
Social Determinants of Health: Why it Matters in Primary Health Care
A person's health can be influenced not only by their actions, or inactions but also by social, economic, physical, cultural, and environmental factors. These influences are labelled as determinants of health (Canada, 2001). The World Health Organization (n.d) mentions how the social determinants of health can have an even greater influence on a person’s health than their independent choices and health care.
When looking at the determinants of health for this week's blog post I zeroed in on an article by Webster et al (2019), which focused on the primary care setting and treating people with complex needs. I found this to be an interesting ethnographic study. It focused on how primary care providers described their care and frustrations when working with complex chronic conditions. The intended focus was to be on complex chronic pain, but the results were varied, and the interviews brought some interesting findings forward.
In the findings section of this article, Webster et al (2019) describe how many physicians referred to “social issues” as creating complexity in their patients. They further outlined physician’s responses about their comfort in caring for the “medical” side of a patient's presentation, but their lack of comfort when it came to the social concerns as this was beyond their scope. The interviewees continuously described “complex patients” as having struggles with poverty, trauma and inadequate mental health care. There was mention of patients being de-legitimized due to behavioural issues and placing labels on them like drug seeking. There was also mention of placing the health complexities back on the patient and not looking at the system that is causing these health inequalities.
If primary care providers do not have the scope or ability to provide care around the complexities of a person's surroundings and the vast influence social and environmental factors have on health, then how are they able to truly help people? Furthermore, if they are not equipped with the knowledge and resources to address these “social issues”, or have policies that support this approach, these patients will continue to be “difficult” to manage as they fall outside the biomedical model.
References
Canada, P. H. A. of. (2001, November 25). Social determinants of health and health inequalities [Policies]. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Webster, F., Rice, K., Bhattacharyya, O., Katz, J., Oosenbrug, E. & Upshur, R. (2019). The mismeasurement of complexity: provider narratives of patients with complex needs in primary care settings. Journal of Equity in Health, 18(107),1-8. https://doi.org/10.1186/s12939-019-1010-6
World Health Organization. (n.d.). Social determinants of health. Retrieved October 17, 2023, from https://www.who.int/health-topics/social-determinants-of-health
Biopsychosocial as the Model for Addiction Care?
Biopsychosocial as the Model for Addiction Care?
The opioid crisis and its extreme impact on the healthcare system have been common headlines in the media and public health reports. With all the public health awareness and media attention, the treatment and challenges of drug use and drug-related substance use disorders have become a strong topic in social and political settings. Opinions on what is best for people and for society tend to rise when these discussions surface. This brings me to this week’s blog post, a multilevel model for health, the biopsychosocial model of addiction.
Drug addiction has been thought of under many different models, two such models are the moral model and the biomedical model (Skewes & Gonzalez, 2013). Both have limited views when looking at addiction. The moral model places full fault on the person for starting something and not being able to stop it, or not having the will to disengage (Skewes & Gonzalez, 2013). The biomedical model only looks at biology or genetics as contributing factors to disease (Skewes & Gonzalez, 2013; Engel, 1992). Both these models miss the social, environmental, and system-level influences on health and addiction. Engel (1992) looked past the biomedical model of health and proposed a shift in the entire model, stating that “the dominant model of disease today is biomedical, and it leaves no room within its framework for the social, psychological, and behavioral dimensions of illness.” The biopsychosocial model for health care was proposed, taking a more person-centred approach to medicine and what influences illness past just biology (Engel, 1992). Even though there are no tested hypotheses for a biopsychosocial model of addiction, as Skewes & Gonzalez (2013) pointed out, the biopsychosocial model fits addiction care far superiorly to the biomedical, disease-focused model of health.
When looking at addiction care, treatment and recovery, the biomedical model does not come close to touching on the external factors that influence how substances can negatively impact a person's life. Accepting that biology and genetics are only part of the complex puzzle of addiction, and that social, cultural, environmental, and psychological factors carry weight in a diagnosis of substance use disorders, leads us to a biopsychosocial model of health for addiction care (Skewes & Gonzalez, 2013; Becoña Iglesias, 2018). Taking all aspects of a person’s life into consideration when working on treatment approaches and what is best for their own recovery journey is addiction care. There are many facets to why someone uses a substance and even more that contribute to substance use disorders. Continuing down a disease-focused or finger-pointing model of care will not address the entire image rather, it will only look at the outline.
References:
Skewes, M. C., & Gonzalez, V. M. (2013). The biopsychosocial model of addiction. Principles of addiction, 1, 61-70.
Engel, G. L. (1992). The need for a new medical model: A challenge for biomedicine. Family Systems Medicine, 10(3), 317–331.
Becoña Iglesias, E. M. I. (2018). Brain disease or biopsychosocial model in addiction?: Remembering the Vietnam Veteran study. Psicothema.
Chronic Disease and Substance Use
Chronic Disease and Substance Use
The most relevant chronic disease/disorder in my practice is substance use disorder (SUD), also known as addiction. Substance use itself has a substantial impact on the risk of developing many chronic medical diseases like cancer, chronic obstructive pulmonary disease, HIV, liver disease and heart disease, but it is also an independent chronic disorder with substantial health cost impact in Canada.
Pearson et al. (2013) described that in 2012, 4.4% of the general population had reported a substance use disorder within the past 12 months. Of those reported the highest rate was for alcohol abuse or dependence at 3.2% (Pearson et al., 2013). Ratnasingham et al. (2012) released a report stating, “The burden of mental illness and addiction in Ontario is more than 1.5 times the burden of all cancers, and seven times the burden of all infectious diseases”. Alcohol use had a significant impact on the burden of illness, both morbidity and mortality, representing 88% of all deaths caused by addictions, as reviewed in this report (Ratnasingham et al., 2012).
Many factors can contribute to SUD, including genetics, socioeconomic status, environment, and adverse childhood experiences (Centers for Disease Control and Prevention, 2022).
In my work area, we practice harm reduction on an entire spectrum from use all the way to abstinence. Person-centred care is imperative when working with people who are struggling with the negative impacts of substance use, therefore, this is the other pillar of our care delivery.
Regarding best practices and current recommendations, we leverage works from the RNAO, the Canadian Centre on Substance Use and Addiction, and the Ministry of Health and Long-Term Care. I have listed the guideline documents in my reference section for your viewing.
References
Canadian Centre on Substance Abuse. (2005). Substance abuse in Canada: Current challenges and choices. https://www.ccsa.ca/sites/default/files/2019-04/ccsa-004032-2005.pdf
Centers for Disease Control and Prevention. (2022, March 2). Addiction medicine primer. https://www.cdc.gov/opioids/addiction-medicine/primer.html
Ministry of Health and Long-Term Care. (2018). Substance use prevention and harm reduction guideline. https://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Substance_Use_Prevention_and_Harm_Reduction_Guideline_2018_en.pdf
Pearson, C., Janz, T., & Ali, J. (2013). Mental and substance use disorders in Canada. Health at a glance. https://www150.statcan.gc.ca/n1/en/pub/82-624-x/2013001/article/11855-eng.pdf?st=BUYw4fVV
Ratnasingham S, Cairney J, Rehm J, Manson H, & Kurdyak PA. (2012) Opening eyes, opening minds: The Ontario burden of mental illness and addictions report. Institute for Clinical Evaluative Sciences and Public Health Ontario. https://www.publichealthontario.ca/-/media/Documents/O/2012/opening-eyes.pdf?rev=050adbe2dff34ffe8a162a546cfd4d08&sc_lang=en
Registered Nurses’ Association of Ontario. (2015). Engaging clients who use substances.
Alcohol Use: Making an Informed Choice
Alcohol Use: Making an Informed Choice
Harms related to substance use in Canada are substantial and place a large burden on our system with costs coming in at $49.1 billion (Canadian Substance Use Costs and Harms (CSUCH), 2020). These costs are split between loss of productivity, healthcare costs, criminal justice costs, and other costs like research and prevention strategies (CSUCH, 2020). Looking at the overall cost, healthcare costs accounted for 27.3% in 2020 (CSUCH, 2020). Alcohol-related healthcare costs continue to escalate, with an average cost of $165 per person. These societal costs, continue to drive the need for data collection, surveillance practices and prevention strategies.
Chronic diseases have many influences. Some are modifiable, like the consumption of alcohol. The risks associated with alcohol consumption have been an ongoing public health focus, leading to an update of Canada’s Low-Risk Alcohol Drinking Guidelines (Canadian Centre of Substance Use and Addiction, 2023). Data around the burden of disease, along with the latest evidence helped inform the creation of this public health guidance document. It was a new approach to delivering this message, focusing on Canadians having the right to make an informed decision. The level of risk associated with any alcohol consumption is outlined, allowing all people to make a decision on what level of risk they are willing to live with. This approach may help people feel more empowered to discuss their actual alcohol consumption with their healthcare provider and may allow a more open dialogue to make changes.
Reference
Canadian Centre on Substance Use and Addiction. (2023). Canada’s guidance on alcohol and health. https://www.ccsa.ca/canadas-guidance-alcohol-and-health#canada-s-guidance-on-alcohol-and-health
Canadian Substance Use Costs and Harms. (2020). Substance use costs in Canada in 2020. https://csuch.ca/substance-use-costs/current-costs/
Cultural Safety: We Can Do Better
Cultural Safety: We Can Do Better
In working in a quality improvement and education role in addictions healthcare, bias and discrimination are constantly in discussion. In the acute care setting, where I primarily work, it has been a challenging time in trying to shift the negative, bias-driven, "I know best" approach to patient care and move towards acceptance and a patient-centred or person-driven approach.
When I look at my own practice setting and think of the disproportionate health inequities for Indigenous peoples, I think of misinformation, conscious and unconscious bias, and racism-driven care. My focus in addiction care, where most, if not all, our patients are heavily discriminated against. I see how bias drives impressions and decisions, like thinking people's “choices” got them where they are and that they need to “help themselves” to get better. On top of this discrimination and misinformed thoughts, our indigenous patients are even further impacted due to racism.
Horrill et al. (2021) write about cultural safety and trauma-and violence-informed care as frameworks to help combat the negative healthcare interactions and experiences of Indigenous peoples. Three domains, structural, interpersonal, and intrapersonal are discussed in detail, outlining the many areas of influence in healthcare and how nurses have a role to play (Horrill et al., 2021). McCallum & Boyer (2018) looked at two reports that demonstrate the horrific inequalities toward Indigenous peoples in the Canadian healthcare system and how these lead to the continued mistrust of the system. Duong, D. (2021) discusses moving further than just cultural sensitivity training, even though this is a great starting point, and making a system that is actually inclusive.
The last resource I reviewed was a podcast that touched on Indigenous health in Canada. My favourite quote was: “I think the average Canadian, who doesn’t really learn a lot about Indigenous people except those really facile, very shallow stereotypes, doesn’t quite see the beauty of us … I wish sometimes Canadians didn’t see us as a social problem or as their poor cousins down the road, that they would see us truthfully in our complexity. And in that complexity is a lot of beauty and honour and resilience”.
References
Horrill, T. C., Martin, D. E., Lavoie, J. G., & Schultz, A. S. H. (2021). Nurses as agents of disruption: Operationalizing a framework to redress inequities in healthcare access among Indigenous Peoples. Nursing Inquiry, 28(3), 1–14. https://doi.org/10.1111/nin.12394
McCallum, M. J. L., & Boyer, Y. (2018). Undertreatment, Overtreatment, and Coercion into Treatment: Identifying and Documenting Anti-Indigenous Racism in Health Care in Canada. Aboriginal Policy Studies, 7(1), 190–193. https://doi.org/10.5663/aps.v7i1.29343
Duong, D. (2021). Reconciliation in health care must go beyond cultural sensitivity. Canadian Medical Association Journal (CMAJ), 193(7), E256–E257. https://doi.org/10.1503/cmaj.1095919
Maheux, A. (Host). (2021, October 25). Dr. Evan Adams: The state of Indigenous Health in Canada [Audio podcast episode]. In Canadian Health Information Podcast. https://www.cihi.ca/en/podcast/dr-evan-adams-the-state-of-indigenous-health-in-canada
Then to Now: Health and Addiction
Then to Now: Health and Addiction
Addiction care in Ontario is an expanding field with many innovative approaches to care and treatment. Care delivery involves many professions and disciplines interacting, with the hopes of making a dent in what seems like the never-ending fight against substance use disorders (SUD) or addiction. The unfortunate truth is that the battle remains uphill. Stigma continues to be at the forefront of healthcare delivered to people who struggle with the negative impacts of substance use, and many systems in Canada still work against health equity. This paper reviews aspects of health in Canada, from legislation to future directions, with a strong focus on addiction care.
The Canadian Health Act (CHA), the federal legislation for universal health insurance coverage, was established in 1984 after years of executing various provincial hospital service acts (Health Canada, 2023). The criteria in this act were grounded on criteria established in the 1960s and have not been significantly adjusted since (Hill, 2022). According to the CHA (1985), “the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” (p. 5). This statement seems all-encompassing, describing the entire health of every person. However, the greater detail of the act falls short of providing direct guidelines for each province and territory to uphold.
In the field of mental health and addiction care, services are primarily accessed outside of the hospital setting and many do not follow the medical model of care. The CHA’s “medically necessary” hospital services exclude institutions servicing mental health disorders, and further exclude counselling or other therapy-driven care as they are not physician services (CHA, 1984; Canadian Mental Health Association, 2021; Khaliq, 2021). Without federal direction or funding around required health services supporting mental illness and substance use problems, each province and territory is left to determine what they will prioritize and fund. The lack of clarity around “medically necessary” services and “reasonable” access to these services lends to open interpretation and a lack of national standardization.
In 1988, an Act of Parliament created the Canadian Center for Substance Use and Addiction (CCSA) to provide evidence-informed leadership at a national level and help create solutions to address health harms related to substance use (CCSA, 2023). In Ontario, in 2019, the Mental Health and Addictions Center of Excellence Act was enacted as a provincial standard, providing everyone with mental health and addiction support without barriers. Organizations like the two mentioned are fundamental in advocating for the mental health and well-being of people in Canada. This brings us to another important topic: what is health?
In 1946, the constitution of the World Health Organization (WHO) was drafted, and in 1948 this constitution came into power (WHO, 2014). With this came a set of foundational principles which would drive the promotion and protection of health, for all people. The definition WHO put forward stated: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (2014, p. 1)." This definition alludes to the fact that one needs to be entirely whole to obtain true health. The state of disease is not the only factor in this definition; however, it does not support a weakened physical or mental state as being any form of healthy (Sartorius, 2006). Continuing to define health as complete well-being sets many individuals, communities, and entire societies up to fail (Krahan et al., 2021). Based on that alone, it is time to expand on the definition of health.
A new definition put forward by Krahan et al. (2021) states, “Health is the dynamic balance of physical, mental, social, and existential well-being in adapting to conditions of life and the environment (p. 4).” This definition incorporates the complexities of our current health demographic and societal climate. It promotes health within the context of the pressures and influences in everyday life, the reality of chronic disease, complex medical and mental health-related illnesses, and the acceptance of variability. It supports health on a continuum, a more recovery-based approach that does not rely on the completeness of well-being (Krahan et al., 2021). It also promotes the necessity for access to resources, emphasizing the impact environmental and social influences have on health. This more current definition of health incorporates all aspects of a person, potentiating influence on health practice and policy. It understands that a person's health can be influenced not only by their actions or inactions but also by the determinants of health, which include, social, economic, physical, cultural, and environmental factors (Government of Canada, 2023).
Once the determinants of health are seen as contributing to one's overall wellness, a model in which we care for people with substance use disorders (SUD) and addictions requires the same focus. The common model of disease in healthcare is the biomedical model, which does not embrace any external factors as elements of illness (Engel, 1992). Engel proposed the biopsychosocial model for health care, as it takes a more person-centered approach to medicine and what influences illness past just biology. Even though there are no tested hypotheses for a biopsychosocial model of addiction, as Skewes & Gonzalez (2013) pointed out, the biopsychosocial model fits addiction care better than the biomedical, disease-focused model of health. Accepting that biology and genetics are only part of the complex puzzle of addiction and that social, cultural, environmental, and psychological factors carry weight in a diagnosis of SUD, leads us to a biopsychosocial model of health for addiction care (Skewes & Gonzalez, 2013; Becoña Iglesias, 2018). There are many facets to why someone uses a substance and even more that contribute to SUD.
As previously discussed, many factors contribute to SUD, including genetics, socioeconomic status, environment, and adverse childhood experiences (Centers for Disease Control and Prevention, 2022). These factors do not just influence the diagnosis but also the treatment and management of SUD. Working in addiction health care, practicing a harm reduction approach on an entire spectrum, from continued use all the way to abstinence, is essential. Person-centered care with shared decision-making is necessary when working with people who are struggling with the negative impacts of substance use. Harms related to substance use in Canada are substantial and place a large burden on our system, with costs coming in at $49.1 billion (Canadian Substance Use Costs and Harms (CSUCH), 2020). These societal costs continue to drive the need for data collection, surveillance practices, and prevention strategies. One such prevention strategy focused on the substantial cost associated with alcohol consumption and led to the new Canada’s Low-Risk Alcohol Drinking Guidelines (Canadian Centre on Substance Use and Addiction, 2023). Data around the burden of disease, along with the latest evidence, helped inform the creation of this public health guidance document. This harm reduction approach provides Canadians the right to choose the risk they are willing to live with. Blame and guilt are removed from the messaging, allowing more room for open dialogue around making positive changes no matter the size. Applying this methodology as a public health approach to substance use will help shift how health providers deliver care. Addiction remains highly stigmatized, where most, if not all, patients are heavily discriminated against. Healthcare providers' bias continues to drive impressions and decisions, like thinking people's “choices” got them where they are, and that they need to “help themselves” to improve.
Looking further into the future of SUD and addiction care, the expansion of involving people with lived and living experience (PWLLE), will continue to support informed messaging for the public and health providers (People with Lived Expertise of Drug Use National Working Group et al., 2021; CCSA, 2021; Canadian Foundation for Healthcare Improvement, 2020). We must not perpetuate the stigma and discrimination around substance use but move toward health equity. What better way to move forward than including the correct voice at the table? Having PWLLE as part of health organizations and policy development acknowledges the expertise that only someone who has lived through it can possess.
Not having a system that supports recovery as a spectrum or services in place to access help when needed will continue to contribute to the burden SUDs and addiction placed on the healthcare system. Having organizations and processes, as mentioned above, provides a platform for change and advocates for healthier people and communities. Healthcare providers and PWLLE working as a team to combat health inequities and advocating for funding and support, addressing all the determinants of health while continuing to be innovative in their approaches, are sure to make positive gains in addiction care.
References
Becoña Iglesias, E. M. I. (2018). Brain disease or biopsychosocial model in addiction?: Remembering the Vietnam Veteran study. Psicothema.
Canadian Centre on Substance Use and Addiction. (2023). Our focus. About us. https://www.ccsa.ca/our-focus
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