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An estimated 21 per cent of Canadians, about six million people, will meet the criteria for a substance use disorder at some point in their lives, . Despite the prevalence of the disease, a swirl of misinformation and social stigma still surrounds it.

For Spencer Krahn, ’17 BSc, a family physician with an enhanced certification in addiction medicine, a volunteer experience during his undergraduate studies helped him recognize his misconceptions. Every Tuesday, he spent his evenings at , a non-profit in northeast Edmonton, chatting with community members who dropped in for a break from the cold.

“Sitting there with people over a cup of coffee and hearing about their lives — those relationships were so important to help change my views,” says Krahn. “People with addictions, just like people with other health diagnoses, are mothers, fathers, children. They come from all walks of life.”

Today, Krahn works on the at the Royal Alexandra Hospital in Edmonton, a multi­disciplinary team that supports patients with substance use disorders. He passes his experience along with five insights to better understand addiction.

1. It’s Not a Choice

“In the past, we used to see addiction as either a moral failing or a flaw in character. Addiction was seen as a choice,” says Krahn. “It’s not a choice. It’s a medical and mental health condition.”

When a person uses an addictive substance, they experience an initial release of dopamine — a neurotransmitter that sparks feelings of happiness and satisfaction. But over time, addiction hijacks the dopamine system and alters the brain’s chemistry, requiring more and more of the substance to experience those positive effects, says Krahn.

“When I’m talking with my patients, they don’t look at their substance as something they enjoy anymore. It becomes a daily grind to acquire it just to try to feel normal again.”

2. Trauma Takes a Toll

A growing body of has found a connection between adverse childhood experiences and the risk of developing an addiction. These experiences are traumatic events that occur during childhood, including neglect, abuse or household dysfunction. Just one of these experiences increases the likelihood of developing a substance use disorder.

“This kind of chronic stress can actually modify how a child’s genome is expressed to make them more susceptible to addiction,” says Krahn.

3. Legal Substances Pose a Risk

“We have a misconception that just because things are legal or easy to access, it means they’re not harmful,” says Krahn. “The majority of harms arise from using legal substances. Worldwide, the burden of alcohol use is about three times larger than all illegal substances combined.”

In 2020, alcohol and tobacco use alone cost the Canadian public over $30 billion, taking into account lost productivity, health care, criminal justice and other smaller direct costs, .

4. Supervised Consumption Sites Save Lives

When people talk about these sites, they often misunderstand how they actually work — and the outcomes for those who use them, Krahn says. “The sites provide connection and safety.”

Supervised consumption sites do not distribute substances, says Krahn. People bring in their own drug and use it themselves. Health-care professionals are on-site to provide education, social service access, hygienic supplies, wound care and immediate medical care in case of overdose. “They also connect patients to treatment and recovery support,” he says.

Over the last four years, health professionals at administered the rapid reversal medicine naloxone to more than 17,000 patients who had overdosed, according to federal government tracking. There were zero fatal overdoses on-site. “These sites save lives and ultimately provide each person with additional opportunities to receive treatment and enter our recovery-oriented systems of care,” says Krahn.

5. Resilience Remains

We need to examine our own biases when it comes to the assumptions we make about people with addictions — and how they should be cared for, says Krahn.

“Stigma, bias and racism do play into our perceptions of addiction,” he says. “But people know what they need. Actually listening is what changed my views about how to help.”

Krahn recalls sitting with people at the Mosaic Centre and realizing just how much he had to learn from them.

“I wasn’t looking at people who were powerless. I was looking at people who had survived so much, whether it was trauma, physical health challenges or immigrating to Canada. I recognized through relationships that these folks have such resilience and strength.”