What If We Thought About Substance Health the Way We Think About the Rest of Our Health?

Think about diabetes for a minute.

You do not have to have diabetes to know something about it. Your healthcare provider may check your blood sugar during an ordinary physical. You have probably heard of Type 1 and Type 2 diabetes. You may know that genetics, food, environmental triggers, exercise, medications, family history and other factors can matter, and that what one person needs may be very different from what another person needs.

None of that seems unusual. It is simply part of understanding health.

Dr. Kima Joy Taylor, a physician and longtime health advocate, got us thinking about what might change if we brought that same assumption to substance health.

We already know how to think this way

Dr. Taylor points out that we already understand something important about diabetes: one area of health can include very different experiences. There are different types of diabetes. They can develop differently, and the care that makes sense depends on what is actually happening with a particular person.

As Dr. Taylor puts it: “There are different types of diabetes that present differently.”

We do not expect everyone to become an expert in diabetes or to figure out exactly what is happening on their own. We understand that there is something worth knowing about blood sugar and health, and that healthcare providers can help us make sense of changes or questions when they arise.

Now think about substances.

A prescription medication after surgery. A glass of wine with dinner. Cannabis. Nicotine. Caffeine every morning. A medication someone has taken for years. A pattern that has begun to change. A body that has adapted to the presence of a substance. A substance use disorder.

These are very different experiences. Yet we tend to put them under one enormous heading and talk surprisingly little about the health underneath them.

What might change if we started there?

When substance health is the starting point, different questions become possible.

How is this substance affecting me?

What do I like about what it does?

Has that changed?

Is my body responding differently than it used to?

Could one substance be interacting with another?

Is something I am experiencing worth mentioning at my next healthcare visit?

Those questions do not require a diagnosis. They do not even require concern. They are simply questions about health.

Dr. Taylor offered a wonderfully ordinary example from her own life. After her coffee pot broke and she went three days without her usual coffee, she found herself wondering whether that might explain the headache she had been having.

Sometimes the answers may be reassuring. Other times, we may learn something worth paying attention to or discussing with a healthcare provider. If a substance use disorder becomes part of someone’s health, there will be different questions, different kinds of care and different decisions to consider.

A different starting point can change the conversation

Dr. Taylor returns throughout her work to the importance of something that can sound almost too simple: having a healthcare relationship where there is room to talk honestly about what is happening.

In her words:

“You have a relationship with your client.”

That relationship creates room for conversations that do not have to begin with a diagnosis or with someone already knowing what something means.

Someone might tell a healthcare provider, “I have noticed that this medication does not seem to affect me the way it used to.” Someone else might ask, “Could the way I have been sleeping have anything to do with how often I have been drinking lately?” Another person might simply realize that something they have always thought of as a routine is also something they can ask about as part of their health.

Dr. Kelly Dunn sees the same distinction in the expectations we place on ourselves. When people begin worrying about a substance, she often hears some version of, I should be able to handle this myself. Her comparison is wonderfully ordinary:

“You wouldn’t expect to lower your blood pressure on your own.”

We readily accept that understanding and caring for other parts of our health can involve a healthcare professional. Substance health does not have to be different.

And just as we should expect accurate information, respect and good care when talking with a healthcare provider about blood pressure or another health concern, we should be able to expect the same when talking about substance health. If a provider responds with judgment, misinformation or dismisses our concerns, that does not mean the questions are not worth asking. It may mean we need a provider who can have the conversation well.

None of those conversations tells us what the answer will be. They give us more information to work with, and that gives us more ability to understand and participate in our own health.

Most of us have picked up an enormous amount of health knowledge without ever setting out to study it. We know things about sunscreen and cholesterol, sleep and stress, blood pressure and nutrition because those ideas have been around us for years.

Substances are around us, too. They are in medicine cabinets and coffee cups, restaurants and celebrations, healthcare visits and everyday routines. They interact with our bodies whether or not we have ever thought to call that part of our health.

Understanding substance health does not mean assuming something is wrong. It means having useful information about another part of our health, information that can help us understand our own experiences, make informed choices and have better conversations with the people involved in our care.

That is something all of us deserve the opportunity to understand.

A question worth taking with you

The next time a medication, alcohol, cannabis, nicotine, caffeine or another substance comes up in your life, try setting aside what you think you are supposed to know about “substance use” and ask a simpler question:

What would I want to understand about this if I thought of it simply as part of my health?

You do not have to know the answer. Knowing that it is a health question you can ask gives you somewhere useful to begin.