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Substance Use

People in all cultures across time have used psychoactive substances as part of their social and religious rituals. In North America, people use a variety of substances to commune with others, celebrate, relax, recreate, and de-stress. Some psychoactive substances are legal and socially acceptable (alcohol) and some are not (heroin, cocaine, crystal meth) and others are somewhere in between (tobacco, cannabis).

Although some substances (such as crack cocaine and tobacco) are more addictive than others, substance use by itself is generally not a problem. Substance use becomes a problem when it results in a pattern of impaired control of substance use, social impairment, and risky use.

Signs of impaired control of substance use include:

  • Taking the substance in larger amounts or use over a longer period than initially intended
  • Repeated failed attempts to decrease or stop substance use
  • Spending a lot of time and effort seeking, obtaining and using the substance
  • Spending a lot of time recovering from using the substance; and
  • Intense craving or desire to use the substance

Signs of social impairment include:

  • Failure to fulfill major roles or obligations at school, work or home
  • Continued use of substance despite serious social or relationship problems caused by the substance use; and
  • Withdrawing from others or dropping out of activities.

Signs of risky use include:

  • Using the substance in dangerous situations; and
  • Continuing to use the substance despite physical damage and/or negative health effects.

In addition to the behaviours, substance use problems are associated with changes in brain chemistry and physiology that result in tolerance and withdrawal. Tolerance is observed when a person requires more and more of the substance to achieve the same effect. Withdrawal is what happens when people use a lot of a substance over a long period of time and then stop using. As the substance leaves the body, people experience a variety of distressing physical symptoms that often drive them to use the substance again.

Controlled withdrawal from serious substance use (detoxification) often requires medical management in an inpatient setting. An important feature of serious long-term substance use disorders are a variety of changes in brain chemistry and physiology that can persist beyond detoxification. These changes in physiology result in repeated relapse and intense drug craving. Understanding these long-term effects is important in effectively managing substance use problems in the long-term.

In addition to legal drugs and illegal street drugs, people can become addicted to prescription medications. Indeed, prescription medications such as opioid pain medications and stimulants are sold as street drugs. People who have substance use problems with prescription medications have the same problems as people who have problems with street drugs.
Substances that can cause problems include alcohol, tobacco, caffeine, cannabis, cocaine, stimulants, hallucinogens, inhalants, sedatives, hypnotics, and anxiolytics.

Substance use problems are very common. People often use substances in an attempt to cope with a mood, anxiety or relationship problem. In fact, it is estimated that approximately 25% of people seeking treatment for a mood or anxiety problem also have a significant substance use problem. Substance use problems are very treatable and, for many, cognitive behavioural therapy (CBT) is an important part of the solution. However, because substance use problems often mask an underlying mood or anxiety problem and require intense intervention including medically-managed withdrawal in an inpatient setting, the first step towards appropriate and effective treatment is a thorough and proper diagnostic assessment from a physician or psychologist.

Why choose CBT Associates?

CBT Associates is a large, well-established and rapidly-growing network of clinics that provides evidence-based psychological services to children, adolescents, adults of all ages, and couples.

We are a highly-qualified group of over 50 psychologists and psychological associates who provide personalized, compassionate, respectful and discreet treatment with the highest level of... Read More

What is the policy for cancelled or missed appointments?

To help us reliably meet the needs of all our clients, we must ask you to provide 24 hours’ notice when cancelling or rescheduling an appointment. Appointments without sufficient notice will be charged the full fee.

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What is a psychologist?


  • Are registered healthcare professionals who are regulated like physicians, surgeons, and dentists.
  • Work with individuals, groups and organizations to promote positive change by assessing and treating psychological problems.
  • Are trained to assess problems accurately using psychological tests and semi-structured interviews.... Read More
What is the difference between a psychologist and a psychiatrist?

Psychologists are closely aligned with psychiatrists as both are highly-trained professionals. Psychiatrists are oriented toward pharmaceutical solutions (some illnesses in fact lend themselves to medication versus talk therapy, such as severe depression or schizophrenia); while psychologists are oriented toward talk therapy as a solution.

Psychologists and psychiatrists both undertake... Read More

What is the difference between a psychotherapist and a psychologist?

The first important difference between psychotherapists and psychologists is the number of years of education and training required to register by each college. The College of Registered Psychotherapists of Ontario requires members to complete any recognized training program in psychotherapy, with 450 hours of direct client contact, and 100 hours of clinical supervision. In contrast, to... Read More

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