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Alcohol and Substance Use Problems in Children and Youth: Guide for Caregivers

Summary: Many children/youth experiment with alcohol and drugs, and some of them will go on to develop problems from excessive use. Fortunately, there are many things that parents and caregivers can do to support their youth. This includes proactively spending one on one time with your child/youth, to build up a close, trusting relationship where your child/youth can feel comfortable talking to you, without fear of getting in trouble. Should you be concerned however, do not hesitate to see a professional (such as a family physician or paediatrician) to talk about your concerns.
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David's Story

Up until this school year, David was a regular teen who goes to school and hanging out with his friends. Recently, he's been moody and irritable all the time. His grades have been dropping, and his parents are certain that he's come home intoxicated or high at least a few times. His parents wonder about drug problems, but they just don't know what to do. David's been so irritable and withdrawn  that everyone in the family feels like they're walking on eggshells....

What are Alcohol and Substance Use Problems?

Many children and youth have tried drugs and alcohol. Surveys have reported that by the end of high school, 80% of students have tried alcohol, 49% have tried marijuana, and 29% have used a street drug other than marijuana (Johnston, 2002).


"What's the harm? Don't a lot of people try drugs or alcohol?"


Although many youth who try alcohol or substances will not go on to develop problems with addiction, there is a sizeable percentage that do go onto develop problems. According to the study Drug Use Among Ontario Students: 1977-2007

  • 61% of students have tried alcohol, and 29% have tried illicit drugs (street drugs such as marijuana). 
  • 19% of students have hazardous levels of alcohol use, and 15% have drug use to the point where it is causing problems. 

Alcohol and drug use is something to be concerned about because it is linked to a variety of problems such as:

  • Early sexual activity
  • Skipping or dropping out of school
  • Violence and aggression
  • Early use of alcohol and drugs increases the chance that a person will have problems with addictions later in life.

Alcohol and drugs are particularly damaging to children and youth because their brains are still developing and maturing.

Types of Alcohol and Substance Use

There are three main patterns of alcohol and substance use:

  1. Alcohol or Substance Use: Using alcohol or other drugs occasionally, but without developing: a) physical tolerance, b) withdrawal symptoms, or c) social or emotional problems.
  2. Alcohol or Substance Abuse: Using alcohol or other drugs to the point where it is causing problems physically, socially or emotionally.
  3. Alcohol or Substance Dependence: Using alcohol or substances to the point where the person's body is physically dependent on the drug. A person is dependent when they must keep using alcohol/drugs in order to keep from having withdrawal symptoms, and if they miss having alcohol/drugs, their body goes into withdrawal.

Common Drugs

Common substances that can be abused include:

  • Alcohol: Used because it can often cause pleasurable feelings as well as reduce anxiety and/or stress. Unfortunately, excess use can cause mood and anxiety problems, impair memory, coordination and judgement.
  • Marijuana: Used by people because it can cause temporary pleasurable feelings. Unfortunately, continued use leads to problems with concentration, learning and even paranoia. 
  • Stimulants: Stimulants are a class of medications which include amphetamines. methylphenidate (aka Ritalin), as well as caffeine. Cocaine and crack are also found in this category. Stimulants are used because they can (temporarily) improve mood, and increase energy, alertness and concentration. Indeed, prescription stimulants such as Methylphenidate can be very helpful for certain conditions, as long it is monitored by a doctor. Unfortunately, stimulant abuse can lead to depression, mood problems, and paranoia.
  • Inhalants: Inhalants are chemical vapors that you breathe that cause mind-altering effects which some people find enjoyable. Unfortunately, inhalants damage brain cells along with other vital organs such as the heart, kidneys, liver and muscles.
  • Hallucinogens: Hallucinogens include drugs such as LSD (acid), psilocybin (mushrooms), ecstacy and ketamine. They are used to create mild ti intense mind-altering effects including changes in perception, feelings of emotional warmth and energy. Unfortunately, negative effects can include terrifying hallucinations, severe depression, overheating and death
  • Opioids: Opioids are a class of medications which include morphine, codine, oxycodone as well as street drugs such as heroin. They are used because they can (temporarily) create feelings of euphoria or extreme happiness. Doctors may prescribe opioids to relieve pain. Unfortunately, opioid abuse can lead to nausea, physical dependence, mood problems, and death.

Why Do People Use Drugs?

People can use alcohol and drugs for different reasons. Its easier to help someone with alcohol and drug use if you figure out their reasons because then you can 1) agree with them on their reason (i.e. their goal) for using (which helps form trust with them), and 2) then find a healthier to get to that same goal.


Common reasons (and corresponding solutions) include:

  • Boredom, curiosity, and desire for fun. If this is the case, then you can help your youth to find better ways through other activities (e.g. sports, arts, etc...)
  • Peer pressure, and wanting to fit in with a peer group. If this is the case, then you can support your youth to find healthier ways to get peer acceptance. Or help your youth find a different set of peers.
  • Dealing with stress at home, work, school or relationships. If this is the case, then you can work with your youth to
    • Identify those stresses, and
    • Find ways to reduce those stresses, and
    • Cope better with them.
    • It may turn out that you are part of that stress. If so, its actually a good thing -- now you can do something about it.
  • To deal with an underlying condition such as depression, anxiety, insomnia, or poor concentration. Unfortunately, although a street drug may help temporarily, they invariably cause more problems in the long run. Examples include the depressed teenager who uses ‘ecstasy' and marijuana to improve his mood. The university student with anxiety and insomnia that copes by using alcohol. Or the high school student who discovers that nicotine and marijuana help improve his focus. If this is the case, then it would be important to find healthier ways to deal with any underlying condition. Start by seeing your child's physician.


Studies show that many teens will at least experiment with alcohol and drugs. Don't be discouraged; there many things that parents and caregivers can do to reduce the risk:

  • Learn what you can about drugs and drug use in children and youth. There are many good websites for this, such as the National Institute for Drug Abuse in Bethesda, Maryland ( or the Centre for Addiction and Mental Health in Toronto,Ontario ( See the end of this article for more links.
  • Build a good relationship with your children BEFORE they are teenagers. Spend positive quality time with them while they are still young and want to spend time with you!
  • Eat at least 1 meal a day together as a family. This can definitely be challenging with today's busy schedules, but is important. Studies have shown that families which have at least one meal a day together, have children who are less likely to have drug or alcohol problems (though it is not yet known whether this is actually a cause or effect).
  • Learn ‘how to talk so your children will listen, and how to listen so that your children will talk'... Allow them to talk about their feelings freely. Don't lecture or give long monologues. Create a supportive environment so that your children will feel comfortable talking about the stresses and issues that they face.
  • Build self-esteem and self-confidence in your child, which will help your children resist peer pressure and be able to ‘say no'.
  • Look for persistance, and praise it. Find times when your child has worked hard at something, no matter what the outcome. If your child succeeds, then praise your child, but emphasize the effort, not the outcome. For example, if your child studies hard and gets good marks, emphasize the hard work, not the good marks. Similarly, if your child works hard but gets a poor mark, nonetheless remember to still praise the effort.

    This teaches your child the importance of hard work and persistence, which in the long run, is the more important strength to have.

    If you do need to give constructive criticism, then criticize the behaviours or actions, and not your child. It's the behaviour that needs changing; not your child.
  • Teach your child the ability to make his/her own decisions. Whenever possible, give your child the opportunity to make his/her own choices, as opposed to simply telling them what to do. Later on, when faced with peer situations, this independence will help your child make his/her own decisions rather than relying on others.
  • Keep your children in healthy pursuits such as sports and hobbies, to reduce boredom and lack of things to do. Do activities with your children to strengthen your relationship with them.
  • Teach your child how to deal with strong emotions and feelings. Let your child know that unpleasant feelings such as mood swings, will get better and won't last forever. Model how to control mental pain or tension without the use of tobacco, alcohol, or other drugs.
  • Teach about peer pressure and acceptance. Talk to your child about how it is important to be able to be yourself, and that a real friend accepts you for who you are. Real friends do not make you do drugs just to feel accepted.
  • Teach about your family's values. Explain to your children about how to decide between right and wrong. Teach them how these are your family's values, no matter what other families might have. Teach about your family's rules, which are an extension of your family's values.
  • Be clear about family rules for use of tobacco, alcohol, and other drugs.
  • Explain to your teen that when they demonstrate trustworthy and responsible behaviour that privileges and trust are the result. Communicate clearly what you expect about drug use, and what the consequences of use will be.

    You will need to think about:
  • What are your expectations around drug use? Are you willing to tolerate some experimentation? Are you willing to allow your child the opportunity to use alcohol under supervised situations? On the other hand, you may have a zero tolerance policy. 
  • What are you going to set as consequences? Removal of privileges? Grounding? For how long? And if you do set a consequence, make sure its something you can enforce, because otherwise you lose credibility. For example, setting a rule that your child has no contact with a certain classmate at school may seem reasonable theory, but be careful about setting that rule if you cant enforce it.
  • Model how you want your children to behave. Actions speak louder than words. Always ask yourself, "What message am I sending to my children?"

For example:

  • Don't use any street drugs yourself.
  • Don't brag, or tell ‘war stories' about your own alcohol or drug use, either now, or in the old days. (If you really want to tell them, at least wait until they are adults...)
  • Be aware of your own alcohol or drug use, even if for legal substances. For example:
    • Do you offer alcohol to guests when they visit? Have your children ever seen you drunk? Do you ever drink and drive yourself?
    • Do you ever use medications for minor aches or pains? If so, what are your children learning?
      If you answered yes to any of these questions, then ask yourself: What are my children learning?
  • Don't wait until you have "the drug talk" with your child. Talk about alcohol and drugs on a regular basis. When the theme of substances comes up (either on television, in movies or in real-life), take advantage of these situations to talk about drugs with your child. For example, if you see a drunk person in a movie or in a restaurant, talk about it afterwards with your child.
  • Educate your child about common myths such as "everybody drinks" or "marijuana won't hurt you."
  • Work together with the other parent. Regardless of whether or not you are still together with the other parent, do your best to talk with the other parent so that you can both send a consistent message to your child about drug use.
  • Work with others in your community, such as parents and the school. If needed, work with the parents of your children's friends. A powerful way to stop a child from using drugs is to stop his friends from using them too.
  • Teach Your Child To Say No. Give your child some tips on how to respond if someone offers him/her drugs.

    Some sample phrases are provided here just to illustrate, but you'll probably have to ask your child what wording would be 'cool' in his/her peer group:
  • Ask questions. E.g.: "What is it?" "Where did you get it?"
  • Say no firmly. E.g.: "No thanks!" "NOT!" "PASS!"
  • Give reasons. E.g. "... I'm not into that." "I'd rather not get into @#@$"
  • Suggest other things to do. E.g. "How about we...  hang out at the mall instead? See what the others are up to... Play (a game)..."
  • Leave if the others still want to do drugs. E.g. "Okay, I'll see you guys later then!"

Make family rules that help your child say "no." Talk with your child about your expectation that he will say "no" to drugs. Explain what will happen if he breaks these rules. And of course, follow through if necessary.

Drugs and the Media

The media has a large impact on children's perceptions about alcohol and drug use. With alcohol and tobacco companies spending billions of dollars a year, alcohol and nicotine products are among the most commonly advertised products in North America. Worse yet, young people are the primary targets of many of these ads, which suggest that using alcohol or cigarettes will make you more popular, sexy and successful.

Help your teenager understand the difference between the misleading messages in advertising and the truth about the dangers of using alcohol and tobacco products.



  • Talk about ads with your child. Help your child understand the real messages being conveyed.
  • Teach your child to be a cautious consumer that doesn't simply believe whatever a commercial or ad says.
  • Watch your child's TV shows and movies to make sure that they aren't glamorizing the use of tobacco, alcohol, and other drugs.


  • Don't allow your child to wear T-shirts, jackets, or hats that promote alcohol or tobacco products.

Is My Child Using Drugs? Signs of Substance Use Problems

Here is a list of things that might possibly indicate that your child is having problems with drug and alcohol use:


Emotional symptoms

  • More irritable or angry, which may lead to more arguments at home
  • Sudden mood swings

Problems functioning

  • At school, missing school or dropping grades. With work, missing work or problems with work performance. At home, problems with meeting responsibilities, chores and home expectations.
  • Changes in social life: 
  • Changes in friends with new friends, but not wanting these new friends to visit home and not wanting parents or talk to these new friends

Physical symptoms

  • Problems focusing or paying attention. 
  • If actively intoxicated or high, you may also see signs such as slurred speech, memory impairment, incoordination, and impairment of attention; smell of alcohol, smoke or other substance on your child's breath or clothing.
  • Smell of alcohol, smoke, or other chemicals on your child's breath or clothing

Changes in behaviours

  • Periods where there is obvious intoxication, dizziness, or bizarre behavior 
  • Change in dress, appearance or grooming 
  • Loss of interest in things that s/he used to enjoy doing. 
  • Withdrawal for long periods into his/her own room 
  • Loss of interest in physical hygiene, manner of dress or hygiene 
  • Secretive and suspicious behaviour, such as being secretive about one's bedroom (out of fear of drugs being discovered) 
  • Wearing of sunglasses even when its not appropriate (in order to hide red eyes) 
  • Wearing of long-sleeved clothing even in summertime (to hide possible injection marks) 
  • Drug paraphernalia or drug items at home, e.g. pills, cough syrup bottles, tin foil, spoons, pipes, syringes 
  • Needing more money (in order to buy drugs), which may lead to 
  • Borrowing money from others
  • Always asking for more money 
  • Stealing items from home school or work
  • Money (or possessions) going missing from the home, siblings or parents. 
  • Disappearing items from home which your son is pawning off 
  • Your child may report ‘losing' his/her possessions, which are in reality being sold in order to help pay for drugs. 
  • Signs that your son may be stealing (or selling drugs) might include 
  • Always having cash
  • New expensive gadgets like iPods that were a "gift" from a friend
  • Frequently staying out very late

Parents Guide to Teenage Parties

If your teen is giving a party:

  • Plan ahead. Go over party plans with your teen. Help your teen to plan possible activities (e.g. games, or sports) so that people won't be bored. Most teens won't want to have activities rigidly planned out, but it is nonetheless good to have options available.
  • Keep the numbers of party goers to a responsible number, and don't let the numbers get out of control. One rough guide is no more than 10-15 teens for each adult. At least one adult should be present all the time; ask for help from other parents if you need it.
  • Set a guest list. The party should be for invited guests only. Don't let uninvited people show up. Uninvited guests can increase the risk of alcohol and drug use, fights or property damage.
  • Set a start and stop time for the party. Check local curfew laws to help guide in figuring out the stop time.
  • Lay down some "Party Rules". Discuss them with your teen before the party. Rules should include the following:

• No alcohol or other drugs.

• Lights are left on at all times.

• Certain rooms of the house are off-limits.

  • Know that you are responsible for keeping people safe at the party, and immediately afterwards. In most jurisdictions, you are responsible for anything that happens to a minor that has been served alcohol or other drugs in your home. In other words, if someone gets drunk at the party, and you let him/her drive home, and if s/he gets into an accident, then you are responsible.
  • Help your child to understand that s/he is ethically responsible for this too, so that s/he can help you with enforcing limits to keep people safe. Guests who bring tobacco, alcohol, or other drugs to the party should be asked to leave.
  • If people show up intoxicated or end up intoxicated, call their parents to make sure they get safely home.
  • Be there. Ideally, find a spot where you can be at the party, such as by helping to serve food and drink. Otherwise, be nearby somewhere else in the home.

If Your Teen Is Going to a Party:

  • One common recommendation to parents is that you call the host's parent to offer your help with the party (which at the same time helps confirm that there is a party). At the same time, you could ask whether or not there will be a responsible adult around, and what the alcohol/drug policy will be. Because this is often not possible however, another option is the following...
  • Talk to your teen about the party and problem-solve together. In the spirit of encouraging your teen's own judgement, talk together about the party, about possible risks, and how to deal with them. If the risks were too high, then it might be better to not go at all.
  • ‘Do you know where your child is?' Ask for the address and phone number for the party. Have your teen call you if the location of the party changes.
  • Does your teen know where you are? Let your child know where you will be during the party.
  • Ensure your teen has an exit strategy. Make it easy for your teen to leave the party at anytime, for example by making it easy for your teen to call you at any time, e.g. cell phone or change for a phone call. Remind your youth to NEVER to ride with a driver who has been drinking or using drugs.
  • Stay up and greet your teen when he or she gets home, so that you can find how s/he is doing and about how the party went. If your teen doesn't want to talk about it right then and there, then find some other mutually agreeable time.

General Advice to Give to Teenagers

  • Hang out with people who don't smoke, drink, or use other drugs.
  • Use the "buddy system" -- team up with a friend. Use a code word to remind each other when it's time to leave a party.
  • If you (as a teen) like to meet new people, suggest trying some of the following activities instead of parties:
    • Free concerts
    • School dances
    • Any sort of extracurricular activities
    • Sports
    • Volunteer work
    • Part-time job
    • Youth group through church or religious group

In the end, you cannot guarantee that your child will always be in a drug-free environment, and you can't be there to monitor your child 24/7. This is why the best strategy is fostering your child's own sense of good judgement, problem-solving and independence.

Impaired driving

Perhaps the most lethal of all the problems that alcohol or substances can cause, is impaired driving.


Motor vehicle crashes are the leading cause of death in those aged 10-24. Driving under the influence of alcohol or drugs is one of the major contributors to those crashes. You might consider a ‘Contract for Life' to help illustrate to your child the seriousness of impaired driving.

Many organizations, such as Mothers Against Drunk Driving (MADD) have excellent examples of the 'Contract for Life'. Web:

If You Are Concerned that Your Child Might be Using Drugs or Alcohol...

You may have concerns that your child is using drugs or alcohol. Before you confront your child however, consider talking to others that know your child, such as friends, relatives and teachers. You don't have to tell them explicitly that you are worried about drugs, but you can still ask them how they find your child, which can be helpful.


When talking to your child, choose a time when your child is awake, alert, and receptive to talking. Give your child a choice about when to talk, e.g. "Do you want to talk now, or later?"


Avoid interruptions, maintain privacy, and STAY CALM. Go over a checklist with your child, highlighting those concerns that have you worried.


  • Do send firm but loving messages such as:
    • "I love you too much to let you hurt yourself." 
    • "I know other people your age use drugs, but I can't let you continue to behave this way."
    • "We'll do anything we can to help you. If tobacco, alcohol, or other drugs are part of the problem, we must talk about it right away."
    • "If you are sad, upset, or mad, we want to help you. But our family will not permit any use of tobacco, alcohol, or other drugs."


  • Avoid saying things like:
    • ​"There's only one reason you could be acting this way -- you must be on drugs."

    • "Don't think you are fooling me. I know what you are doing."

    • "How could you be so stupid as to start using drugs and alcohol?"

    • "How could you do this to us? How could you do this to our family?" 

    • "Where did I go wrong? What did I do to make you start using tobacco, alcohol, and other drugs?"

Remember, if your child is using drugs, s/he needs your help. Don't be afraid to be a strong parent! However, the problem could become too much for you to handle alone. Don't hesitate to seek professional help, such as your pediatrician, a counselor, support group, or treatment program.

How to Help Your Teen If Substance Use or Abuse is Discovered


  • Stay calm. As a parent, you might feel overwhelmed, angry or upset that your child might be abusing drugs or alcohol. But try to stay calm when talking with your child. Do not yell, scream or shout, because doing so will most likely make your child less eager to talk with you.
  • Keep the lines of communication open. No matter how angry or upset you may be, it is important to act in a way so that your child will talk and confide in you.
  • Find a private time to talk to your child privately, and not in a public place or in front of others. If your teen is worried about being embarassed, your teen will simply not talk.
  • If your child is intoxicated or high, wait until your child is sober.
  • Be assertive in sharing your concerns.

a) You might start off with an observation. For example: "I found some pills in your room." "Your marks have been dropping at school, and you've come home high." 

b) Use "I" statements. For example: "I'm really worried about you."


  • Teach your child how to be assertive and say no to drugs. Ways to say no include:
    • "No thanks!"

    • Using an excuse, "Sorry, but I gotta go now! Thanks!"

    • Saying no with a counter-proposal, e.g. "No, I'm not into that. How about we go biking instead?"

  • Set clear rules/expectations, limits and consequences about using. Write them down on paper. Typical expectations might include:
    • No drug use

    • If drugs or drug paraphernalia (e.g. bongs) ever found in the home, they will be confiscated and there will be a consequence, e.g. grounding.

If your rules/expectations are broken, then make sure you have limits and consequences that can be enforced. This includes removal of privileges such as going out (i.e. grounding); television; computer time; etc.

  • Do encourage healthy friendships. Actively support your child's friendships with healthy, non-drug using peers. Involve your child in activities, which will give him/her a chance to meet new (non-drug using) friends.
  • Do monitor your child. A teen who is using drugs will need closer supervision. Common strategies include:
    • Set a stricter curfew
    • Limit contact with drug using friends.
    • Rather than simply giving out cash (which your child could use to buy drugs), you might ask for receipts, or actually go shopping with your child (to ensure that money is not used on drugs).


  • Don't focus on guilt or blame. Try not to waste time feeling guilty or trying to find blame. Focus your energy instead on what you can do now.
  • Don't lecture. Don't get into long lectures and talks about how it used to be when you were a teenager... Teenagers tend to tune out when this happens.
  • Don't minimize your child's drug use; take things seriously. You may have experimented with drugs yourself when younger, but turn a blind eye to your child's use by saying, ‘Everyone does it.' Drugs are much more potent and accessible nowadays, and pose a higher risk to youth than drugs in the past.
  • Don't talk about your own drug use. You may be tempted to talk about your own experimentation when younger, but don't; your child may use this to justify using it him/herself.

How are Substance Use Problems Treated?

Many youth will experiment with substances, but will not go onto have serious problems using. However, for youth who do have problems, there are different types of treatment:

  • Community-based treatment (previously called "Outpatient" treatment ("live at home") is where a counsellor meets with the youth and/or the family, and the youth continues to live at home.
  • Day treatment is usually where a treatment program is combined with a therapeutic school program. The youth attends school at the program, and also receives help with substance use.
  • Residential treatment is a more intensive type of treatment where a youth stays at a treatment centre 24 hrs a day, for at least 21-dayss or longer.
  • Recovery homes (usually for young adults and older) are safe, supportive places to stay after a person has made steps to recovery. They usually provide counselling and help with life skills so that the people can move towards living independently on their own.

What about drug tests? 

Drug tests need to be done in discussion with your doctor or other health professional. Drug tests are not for everyone, but can be very helpful in some families. In these cases, there is an agreement ahead of time that the child will stay drug-free. You can then approach your child for random drug tests. If the tests are negative for drugs, then the child can be rewarded. If the tests are positive for drugs, then there will be a consequence....

When Should We Get Professional Help?

If your child's problems do not improve quickly, then it is best to seek professional help. You might start by contacting your child's physician, or a local drug treatment program.

If You Are Feeling Guilty or Responsible

"I had no idea he was using drugs!"


You may feel shocked and overwhelmed because you had no idea that your child was using drugs. Children and youth can be very good at hiding their drug use, so don't feel bad about it. 


This is quite common for many parents.


"What did we do wrong?"


You may also feel blame and guilt. Try not to blame yourself. Children and youth are flooded with messages to use drugs and alcohol from friends, peers, movies, music and television.... You can't change the past. Focus your energy instead on what you can do now.


Alcohol and drug use is one of the biggest problems facing youth today. Fortunately, there are many things that parents can do:

  • Stay calm;
  • Make sure that as a parent and role model, you don't abuse alcohol or drugs yourself;
  • Have a trusting relationship with your children by being caring, loving, spiritually nurturing, and supportive;
  • Spend time with your child sharing the good and the bad times;
  • Listen when your children talk;
  • Set fair and consistent expectations and rules;
  • Act promptly if substance abuse problems occur;
  • Get professional help if needed.


  • Mothers Against Drunk Driving (MADD) (aka. Les mères contre l'alcool au volant)

Where to Get Help and Information in the USA

For local resources

For information in general


Johnston L et al. Monitoring the future. National results on adolescent drug use: overview of key findings, 2001. Bethesda (MD): National Institute on Drug Abuse; 2002. NIH Pub No. 02-5105.


Ontario Student Drug Use and Health Survey, 2007, Centre for Addiction and Mental Health, retrieved Aug 21, 2009 from

About this Document

Written by the eMentalHealth Team which includes:

  • Members of the Mental Health Information Committee of the Children's Hospital of Eastern Ontario (CHEO) (in Ontario, Canada), an interprofessional group that includes representation from psychiatry, psychology, child/youth care, social work, nursing, and occupational therapy.
  • Robert Polack, Addiction and Mental Health Services at the Sandy Hill Community Health Centre, Ottawa, Ontario, Canada.


Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance. 

Creative Commons License

You are free to copy and distribute this material in its entirety as long as 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes (non-commercial), 3) this material is not altered in any way (no derivative works). View full license at

Date Posted: Aug 29, 2009
Date of Last Revision: Sep 29, 2019

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