Dr. Silvina Mema
[Excerpt] Alcohol is arguably the most socially acceptable of psychoactive substances. Drinking alcohol is socially acceptable and even an encouraged activity. Some individuals may feel pressured to drink during social gatherings. While social drinking may seem harmless, it can lead to alcohol misuse and addiction.
Many social and health harms can be directly or indirectly attributed to alcohol use. These include acute intoxication, injuries, intimate partner violence, high-risk sexual behaviour, and absence from work. Alcohol can also lead to many chronic diseases, including alcohol use disorder and cancer.
Alcohol was present in over 25 per cent of the 6565 illicit drug toxicity deaths that occurred in British Columbia between 2016 and November 2020.
Sadly, addiction to alcohol and other psychoactive substances is surrounded by stigma. Many still consider these a moral failing or due to a weakness of character as opposed to a chronic disease of the brain.
In the past decade, alcohol consumption rates have been higher in the Interior Health region than the rest of the province, as noted in the 2019 Interior Health Medical Health Officer Report.
First Nations, Métis, and Inuit Peoples
In developing this report, it was recognized that a conventional approach to health needs assessment may not encompass the unique and historical influences on substance use when considering alcohol and Aboriginal peoples.
A new partnership approach is needed, which is collaborative in nature, rests on solid relationships with Aboriginal partners, and serves to emphasize strengths, assets,and resilience. Any approach needs to be based on an understanding of the how alcohol use relates to ongoing complex trauma impacts, racism, power imbalances and colonization.
In the past decade, alcohol consumption rates have been higher in the Interior Health region than the rest of the province, as noted in the 2019 Interior Health Medical Health Officer Report.
Understanding the colonial narrative:
• Prior to European contact, Aboriginal people practised fishing, hunting
and gathering of traditional foods and medicines that led to an active and
healthy lifestyle enriched by ceremonial and cultural practices.
• Colonization introduced devastating impacts to Aboriginal peoples’ health
through forced displacement from their land, disconnection from culture,
family and community, language, ceremony and traditions.
• Alcohol was introduced by European colonizers as a tool to manipulate
Aboriginal peoples in a variety of ways including to purposefully breakdown
family structures, alliances and kinship ties to lower their defences as a
tactic to negotiate and encouraged excessive and abusive consumption.
• Aboriginal people were subject to prohibitory alcohol laws (including but
not limited to the Indian Act of 1876), as an attempt on the part of the
Canadian government to facilitate assimilation.
• The direct linkage between colonization with the historical origins of alcohol
use in Aboriginal populations, and the current effects of anti-Aboriginal
racism and colonial trauma continue to perpetuate barriers to relevant and
appropriate care.
• Being respectful of the lived experiences of Aboriginal partners. A wellintended conventional public health approach can be harmful and retraumatizing when focused only on deficits, without adequately recognizing
historical and current context, and the direct links with health inequity.
• Work that examines the drivers of alcohol and other substance misuse, and that attempts to reduce or eliminate these drivers, will inevitably involve examining: the colonial structures of power, relevancy and cultural safety of services and approaches; systemic and individual racism; and the adverse social determinants of health, including basic services (e.g. water, sewage, education, internet access etc), as well as the geographical location of services.
Self-determination:
• First Nations, Métis and Inuit communities are not a single entity, and that distinction-based approaches are required, as approaches to and perspectives on alcohol and other substances will vary between communities and Aboriginal partners.
• An approach grounded in human rights and committed to the selfdetermination of Aboriginal partners, with respect to the development and delivery of process, policy, services and governance, may be more helpful than a conventional, deficit-based data gathering approach.
• If indicators are to be used, wellness indicators developed with Aboriginal partners would be more appropriate.
Action-oriented:
• There should be concrete timelines for achieving tangible deliverables, in terms of resource allocation, service improvement and self-determination. This involves the transfer
of resources to Nations and the relinquishment of power and control by regional and provincial authorities.
• Further work with Aboriginal partners, to understand the issues and explore solutions, needs to be properly resourced at a level that respects people’s time, effort and lived experience. Primary
care may also be a key partner in this work.
• Ongoing engagement efforts with Aboriginal partners, to further health authority understanding of the issues and explore meaningful approaches to resolution.
• As well, there is required commitment from Interior Health and the Mental Health and Substance Use Network and Operations for ongoing meaningful engagement of Aboriginal partners in
any substance use service planning as determined by Aboriginal partners.
• Within the Substance Use Strategic Framework under development, additional consultation with Aboriginal partners and consideration of Interior Health actions related to the In
Plain Sight report is required to determine specific actions.
Recommendations
- Implement improvements to the substance use system of care
that will:
a. Increase access to specialized substance use treatment by expanding
current services and introducing new, evidence-informed models of care.
b. Enhance care effectiveness by integrating standardized and evidence
based approaches to substance use care throughout Interior Health.
c. Create safer services for people who use substances by reducing stigma
and discrimination throughout the system, and ensuring that services
are culturally-safe and trauma-informed. - Approval and implementation of an integrated approach to harm reduction across Interior Health, in order to ensure:
a. IH services provide an evidence-based approach to alcohol-related care,
treating all clients and families/partners-in-care with dignity, compassion
and in a non-judgemental manner.
b. Staff acknowledges that among people who use substances (PWUS),
abstinence may not always be the goal and that the commitment to
permanent or temporary (while in care) abstinence is not a requirement
for receiving care or treatment. This may mean provision of alcohol or
alcohol replacements as the client may need.
c. Staff shall be aware of and will not use or perpetuate stigmatizing,
stereotyping and racist language, attitudes and behaviours. - Working across Interior Health, to further strengthen relationships and collaborative action with local governments and other community partners to address the determinants of health by:
a. Balancing risk prevention and health promotion by informing policies that reduce alcohol related harms and promote a culture of alcohol moderation.
b. Translating knowledge to inform evidence based interventions.
c. Helping to strengthen protective factors that improve wellness and resilience.
d. Mobilizing collective action to promote, improve and protect community health and wellness.
e. Integrating equity within the social and built environments, leading to improved health outcomes for everyone
