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Navigating abstinence-based perspectives in substance use care can be complex. Within Indigenous communities, these complexities also intersect with the impacts of colonialism. Abstinence-based perspectives may arise or align with Indigenous teachings, they may stem from imposed colonial values, or both may be true. It is important to recognize that there are a variety of explanations for why abstinence-based approaches may be promoted, and that these can offer a healing path for individuals when aligned with Indigenous worldviews.

In this episode of the Addiction Practice Pod, award-winning journalist David P. Ball and First Nation Health Authority’s Medical Officer of Mental Health and Wellness, Dr. Nolan Hop Wo, discuss abstinence-based approaches to substance use care. We also hear from Keshia Cleaver, Harm Reduction and Program Advisor with The Four Directions Team at First Nations Health Authority, on why abstinence-based perspectives are common in some Indigenous communities, and how to meet communities where they are at with harm reduction.

Learning Objectives

  1. Identify potential benefits and harms of abstinence-based approaches to substance use care.
  2. Discuss how abstinence-based perspectives are related to colonialism, recognizing the impact this has had within some Indigenous communities.
  3. Describe how harm reduction and abstinence-based approaches can work synergistically, with a consideration of how these strategies can be culturally relevant and effective for Indigenous people.


In this episode, you’ll hear:

  • 2:15 – Dr. Nolan Hop Wo, Co-host – Medical Officer for Mental Health and Wellness, First Nations Health Authority
  • 9:43 – Keshia Cleaver, Guest – Provincial Harm Reduction Advisor, The Four Directions Team, First Nations Health Authority

Clinical Pearls

Here’s what listeners can take away from this episode:

  1. Indigenous harm reduction involves undoing and unlearning colonialism. One way to translate this into clinical practice is to reconceptualize what constitutes risk factors for addiction issues. Being of First Nations, Inuit, or Métis ancestry is not a risk factor for addiction; the impacts of colonialism, including the Indian residential school system and the sixties scoop, as well as racism, can lead to trauma that may also perpetuate substance use-related issues.
  2. Appreciate protective factors that enable resiliency within Indigenous communities, such as knowing one’s Indigenous language or being connected with an Indigenous organization. Both of the above pearls involve intimate knowledge of Indigenous patients including our cultures and both shared and personal experiences. To gain a deeper understanding of your client, it is useful to involve an Indigenous liaison worker or a person who has a similar role. They will also be able to help connect both you and your client with additional supports and information.
  3. Harm reduction and abstinence-based programs are not opposing ideas, but rather they are on a spectrum and can complement each other. Spend time listening to clients, to better understand their experiences and expectations, especially when discussing treatment options. The key is being non-judgemental with an earnest desire to explore a client’s ideas and hopes with them. It is the relationship and trust that we create with our clients that allows us to provide optimal care.


Indigenous programs and resources

Connecting with Indigenous patient navigators and liaisons


Indigenous films and podcasts on related topics


Credits: Art and music

Episode cover art by Brianna Bear.

Brianna Bear is based in the traditional territory of the Lekwugen, place to smoke herring, lands of the Songhees and Esquimalt nations in Victoria, BC. Brianna started first as an artist, and now has more than fifteen years of experience. She began learning under her grandfather, Skip Dick’s, younger brother, Butch Dick. Afterwards, she branched out into discovering her roots and design through her cultural connections to Songhees & Namgis formline design.

Today working as one of a few Indigenous female artists within her traditional territory of the Songhees people, she has worked on murals, logos, small business designs, small event designs and more. Brianna believes in telling stories through her design.

Music by Justin Delorme/Chippewa Travellers (“Determination”) and Handsome Tiger/Chippewa Travellers (“Healing” and “SummerBlues”). Available on Nagamo Publishing. Licensed by Nagamo Publishing Inc.