Men's Mental Health Week: Why the Substance Use Conversation Belongs at the Centre

Canadian Men's Mental Health Week runs June 9 to 15. The campaign rightly highlights the pressures Canadian men face.

Men, on average, are less likely to seek help, less likely to name what they're experiencing as a mental health issue, and more likely to die from the consequences.

What gets less attention is the role substance use plays in that picture. For Canadian men, mental health and substance use are rarely separate stories. They are deeply, clinically, and often quietly intertwined - and in the world of disability and workplace claims, that connection shapes both the file and the outcome.

The Numbers That Should Focus The Conversation

Men account for roughly 74% of apparent opioid toxicity deaths in Canada in the most recent reporting period, according to the Public Health Agency of Canada - a proportion that has remained consistent year over year.

Around 4,500 Canadians die by suicide every year, and the rate among Canadian men is roughly three times the rate among women, according to the Centre for Suicide Prevention. Approximately 21.6% of Canadians - about six million people - will meet criteria for a substance use disorder in their lifetime (CAMH).

Men with substance use disorders are at particularly elevated risk for suicide, and the intersection of substance use, depression, and trauma is one of the strongest predictors of severe outcomes (CCSA, 2024). These are not isolated statistics. They describe a population of working Canadian men for whom mental health and substance use exist on a single continuum.

Why Men's Substance Use Shows Up Differently in Claims

In our assessment work at SOMA, substance use in men's files often arrives indirectly. It appears in:

• Long-duration musculoskeletal claims where pain management has gradually involved alcohol, cannabis, or prescribed opioids - sometimes for years before the claim is opened
• Mental health files where the disclosed presentation is depression or anxiety, but the underlying picture includes regular self-medication that has not been formally diagnosed
• Return-to-work failures where the documented reason is symptom relapse, but the clinical reality includes unnamed substance use
• First-responder and trauma-exposed claims where alcohol use has been treated as workplace culture rather than as a clinical issue

These patterns show up more often in men's files, and they show up later. Men are statistically less likely to disclose substance use voluntarily, more likely to frame distress in physical or behavioural terms, and more likely to first interact with the system through emergency or workplace injury rather than primary mental health care.

The operational consequence: the medical record at intake often understates the picture, return-to-work plans built on a partial picture are more likely to fail, and by the time substance use is acknowledged, recovery is more complex than it needed to be.

Assessment, Not Assumption

The clinical response is not to read between the lines. It is to commission assessment built to surface the full clinical picture. That kind of assessment is structured around:

• A trauma-informed, non-stigmatizing posture - which makes disclosure significantly more likely
• Multi-source data - records, collateral, and where appropriate biological markers, not self-report alone
• A co-occurring focus - substance use, mood, trauma, and chronic pain assessed in interaction, not in isolation
• Functional, not just diagnostic - because two men with the same SUD diagnosis can have very different work capacity
• Defensible documentation - methodology, sources, and reasoning transparent enough to hold up at adjudication, appeal, or in litigation
  

What Employers And Insurers Can Do This Week

• Review long-duration mental health and chronic pain files that have plateaued. Six- to twelve-month plateau files disproportionately involve undisclosed or under-assessed substance use.
• Audit whether your current assessment tools are equipped to surface co-occurring SUD. A general psychiatric IME and a substance-use-informed IME are not the same product.
• Look at repeated RTW failures in men's files - they're a leading indicator that the underlying assessment was incomplete.
• Reconsider how EAP and workplace mental health programs are positioned to men. Programs framed around stress, sleep, performance, and substance use tend to land more effectively than programs framed around mental health alone.
  
  

The Role Of Specialized Assessment

At SOMA, we have built a dedicated substance use assessment practice led by Alexandra Perry, our National Director of Substance Use Policy and Programs - because the volume and complexity of SUD in disability claims has outgrown general-purpose IME models, particularly in men's files.

If your team is managing files where the clinical picture is not yet clear, where return-to-work efforts have stalled, or where the substance use question has not been formally addressed, this Men's Mental Health Week is a useful prompt to ask whether the current assessment lens is the right one.

Contact us to learn more.

Sources: Public Health Agency of Canada - Opioid- and Stimulant-related Harms in Canada; Centre for Suicide Prevention - Substance Use and Suicide; CAMH - Mental Illness and Addiction: Facts and Statistics; Canadian Centre on Substance Use and Addiction - Intersections of Substance Use and Suicide (2024).