Understanding and challenging stigma related to alcohol use and Indigenous people

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Summary

In this episode, award-winning journalist David P. Ball and First Nations Health Authority’s Medical Officer, Mental Health and Wellness, Dr. Nolan Hop Wo discuss the impact of stereotypes related to Indigenous people and alcohol use. Together, they speak with Beryl Parke, a Traditional Wellness Worker at First Nations Health Authority. Beryl is from the Haida Nation and belongs to the Sangalth Stastas Eagle Clan and is currently working in the Kwakwaka’wakw Territory on the lands of the We Wai Kai people in Cambell River, BC. Drawing on her personal experiences and knowledge from practicing in remote First Nations communities, Beryl discusses the importance of alcohol harm reduction and compassionate substance use care.
 

Learning Objectives

1. Identify common misconceptions related to alcohol use and Indigenous people, recognizing that these misconceptions are a result of colonialism.
2. Discuss strengths-based approaches to supporting individuals interested in reducing the harms associated with drinking alcohol or who want to reduce or stop drinking.
3. Understand that alcohol use disorder care exists on a spectrum, including harm reduction and managed alcohol programs.

 
Lineup

In this episode, you’ll hear:

• 2:02 – Dr. Nolan Hop Wo, Co-host – Medical Officer for Mental Health and Wellness, First Nations Health Authority
• 7:07 – Beryl Parke, Guest – Indigenous Traditional Wellness Worker/Social Worker, First Nations Health Authority

 
Clinical Pearls

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

1. Supporting someone with an alcohol use disorder or someone who engages in high-risk drinking requires flexibility in approaches. Take the time to explore what harm reduction, treatment and recovery may look like from your client’s perspective. This support can be facilitated by meeting people where they are at, being non-judgmental, and fostering a trusting, caring relationship with clients.
2. To gain a more nuanced perspective on Indigenous Peoples and their relationship with health care, you need to understand colonialism and how it continues to impact Inuit, Métis, and First Nations peoples, as well as recognizing the ways in which Indigenous Peoples have survived and mobilized through self-determining community action, strong local leadership, and place-based knowledge. An example highlighted by Beryl in the episode is the intersection of language and colonialism; she uses the term “Indigenous/Traditional Wellness Worker” instead of others that may elicit strong memories and/or uncomfortable feelings within Indigenous communities (e.g., social worker). The use of the title “Indigenous Wellness Worker” is strength-based while freeing itself of some of the associated colonial notions of health care and social services.
3. When appropriate, consider managed alcohol programs (MAPs) as an option for clients navigating an alcohol use disorder. MAPs can allow people to receive care and community and provide an opportunity for practitioners to build trusting relationships. MAPs can include access to stable and measured doses of alcohol which reduce withdrawal symptoms and the risk of alcohol withdrawal seizures. As a clinician, consider ways in which you could help support your community in developing and/or adapting its models of care around the community’s needs, acknowledging the need for community-led and Indigenous-led MAP programming.

 
Resources

Indigenous harm reduction and alcohol use care

• Getting Help: Information for specific populations (HelpWithDrinking.ca)
• Kílala Lelum Urban Indigenous Health and Healing Cooperative
• QomQem Coastal Connections
• List of treatment centres funded by the National Native Alcohol and Drug Abuse Program (NNADAP)
• Overview of MAP sites in Canada (and beyond)

Reports and policy briefs

• Aboriginal Coalition to End Homelessness (ACEH). Indigenous pathways to health and wellbeing: Managed alcohol program feasibility study. ACEH. 2018.
• Aboriginal Standing Committee on Housing and Homelessness (ASCHH). A selective literature review on managed alcohol programs and Indigenous healing methodologies. ASCHH. 2017.
• BC Ministry of Health. In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care. November 2020.
• Communities Alliances and Networks (CAAN). Indigenous harm reduction = reducing the harms of colonialism. 2019.
• Sansone G, Fallon B, Vandermorris A, Swardh K, & Blackstock C. Effectiveness of interventions for the prevention and treatment of substance use disorders among First Nations, Métis and Inuit populations. 2022. Toronto, Ontario: Policy Bench, Fraser Mustard Institute of Human Development, University of Toronto.
• Truth and Reconciliation Commission of Canada. Honouring the truth, reconciling for the future: Summary of the final report of the Truth and Reconciliation Commission of Canada. 2015.
• UNDRIP. United Nations Declaration on the Rights of Indigenous Peoples. New York, NY. 2007.

Articles and books

• Andersen K, Behrendt S, Bilberg R, Bogenschutz MP, Braun B, Buehringer G, Ekstrøm CT, Mejldal A, Petersen AH, Nielsen AS. Evaluation of adding the community reinforcement approach to motivational enhancement therapy for adults aged 60 years and older with DSM-5 alcohol use disorder: a randomized controlled trial. Addiction. 2020;115(1):69-81.
• Aspler J, Zizzo N, Bell E, Di Pietro N, & Racine E. Stigmatisation, exaggeration, and contradiction: an analysis of scientific and clinical content in Canadian print media discourse about Fetal Alcohol Spectrum Disorder. Can J Bioeth. 2019;2(2):23–35.
• CBC News (February 1, 2008). Banning booze won’t solve problems on reserves: chiefs. CBC News.
• Champ J (January 3, 2019). July 27, 1960 – Indians of Saskatchewan get full liquor privileges. Sask Today.
• Gebhard A, McLean S, Denis VS, editors. White benevolence: Racism and colonial violence in the helping professions. Fernwood Publishing; 2022.
• Hill A, Benson P, Hill R. Alcohol use disorders and harm reduction in Indigenous coastal communities of Hudson Bay Northern Canada. Cogent Public Health. 2023;10(1).
• Hyett S, Gabel C, Marjerrison S, & Schwartz L. Deficit-based Indigenous health research and the stereotyping of Indigenous Peoples. Can J Bioeth. 2019;2(2):102–109.
• Knopp Andersen LA, Munk Petersen S, Nielsen AS, & Bilberg R. What is known about treatment aimed at Indigenous people suffering from alcohol use disorder? J Ethn Subst Abuse. 2019;20(4):508-542.
• Lavalley J, Kastor S, Tourangeau M, et al. You just have to have other models, our DNA is different: the experiences of Indigenous people who use illicit drugs and/or alcohol accessing substance use treatment. Harm Reduct J. 2020;17(19).
• Statistics Canada. Status First Nations people in Canada: A snapshot from the 2021 Census. November 23, 2023.
• Sydänmaa BN. Culture saves lives: colonization trauma and Indigenous healing on the East Side. University of Helsinki. 2020.
• Waldram J. (2004). Revenge of the Windigo : The Construction of the Mind and Mental Health of North American Aboriginal Peoples, University of Toronto Press. Toronto, ON.
• Weatherall TJ, Conigrave KM, Conigrave JH, et al. What is the prevalence of current alcohol dependence and how is it measured for Indigenous people in Australia, New Zealand, Canada and the United States of America? A systematic review. Addict Sci Clin Pract. 2020;15(32).
• Wilt J (August 10, 2020). Tracing the geography of Canada’s racist liquor control policies: Alcohol control measures have evolved over time to maintain the oppression and exploitation of Indigenous people. Canadian Dimension.
• Winters E. The impact of Indigenous identity and treatment seeking intention on the stigmatization of susbtance use. Memorial University of Newfoundland. 2019.

Connecting with providers, Indigenous patient navigators and liaisons

• Interior Health: Aboriginal Patient Navigator Service Locations
• Fraser Health: Indigenous Health Liaisons
• Island Health: Indigenous Health Resources
• Northern Health: Indigenous Patient Liaison Program
• Providence Health: Indigenous Wellness Liaisons
• Vancouver Coastal Health: Indigenous Patient Care Quality Liaisons
• Vancouver Coastal Health: Indigenous Patient Navigators
• First Nations Virtual Doctor of the Day Program

Indigenous podcasts and videos on related topics

• All My Relations.
• Indigenous Visions Podcast with Souta Calling Last
• Joke Talk Yell Write with Ryan McMahone
• Nation to Nation
• Warrior Life Podcast with Pam Palmater
• Tailfeathers EM. Kímmapiiyipitssini: The Meaning of Empathy. 2021.
• First Nations Health Authority (FNHA). Taking Care of Each Other: Reducing Stigma [Video]. Published June 27, 2018.
• School of Public Health and Social Policy, University of Victoria. Megan Henderson – Rapid Review: Indigenous Focused Managed Alcohol Programs in Canada [Video]. YouTube. Published June 3, 2021.
• School of Public Health and Social Policy, University of Victoria. Madison Wells- Exploring the Indigenous Homelessness Response with Integrated Alcohol Harm Reduction [Video]. YouTube. Published June 3, 2021.
• CISUR. Webinar: Managed Alcohol Program Sites (MAPS) are Helping People and the Community [Video]. YouTube. Published August 24, 2021.
• CAMH. Managed Alcohol Program: Meeting People Where They Are At [Video]. YouTube. Published November 28, 2021.
• UBC Learning Circle. Exploring the First Year of Progress in an Indigenous-owned Community-based Managed Alcohol Program [Video]. YouTube. Published May 21, 2021.

Credits: Art and music

Episode cover art by Nevada Lynn.

Nevada Lynn is a Red River Métis digital artist studying Visual Art with a focus on printmaking at ECUAD. She lives on the shared, unceded territory of the Skwxwú7mesh Nation and the Lilwat7úl Nation and leverages her creative practice to work in the realms of social justice, climate justice and water protection.
 

Music by Justin Delorme/Chippewa Travellers (“Determination”), Handsome Tiger/Chippewa Travellers (“Healing” & “SummerBlues”) and Mimi O’Bonsawin (“NewDay”). Available on Nagamo Publishing. Licensed by Nagamo Publishing Inc.