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Treatment & Support Services Project
Final Report
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February 2010
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TREATMENT AND SUPPORT
SERVICES
PROJECT REPORT

February 2010






Catherine R. Bruyere
Edward Yerxa
For
The Treatment and Support Services Project
Couchiching First Nation





Funding Provided By:
Health Integration Envelope
Aboriginal Health Transition Fund
First Nations and Inuit Health Branch
Health Canada

















© Couchiching First Nation 2010

Couchiching First Nation
R.M.B. 2027, R.R. #2
Fort Frances, Ontario
Canada




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FORWARD

I am pleased to present "The Treatment and Support Services Project Report.¨ This document
is groundbreaking research on the substance abuse treatment needs of select Aboriginal
communities in the Rainy River District. This report represents the combined efforts of the staff
of the Treatment and Support Services of Couchiching First Nation, the membership of
Couchiching First Nation and our district Aboriginal and non-Aboriginal partners.
For too long, Aboriginal communities have had definitions of need imposed on them by
government and external institutions. In this report, we examine our own substance abuse
issues within the context of our own constructs of family, community and culture. The report also
contains recommendations resulting from community focused dialogues with grass roots
Aboriginal community members.
I want to commend Couchiching First Nation for initiating this project. In late 2007, Couchiching
conducted a community assessment which revealed the depth of drug abuse in the community.
The findings were disturbing and strengthened our resolve to seek solutions to a problem
endemic among our young adults. Couchiching's leadership took a stand against prescription
drug addiction and established the Treatment and Support Services (TSS) to coordinate
resources and planning to meet the drug abuse challenge.
Once the TSS was formed, it became evident the drug issue is not unique to Couchiching. It is
a problem affecting all segments of the Aboriginal community, both on and off-reserve. This
prompted TSS to invite other Aboriginal communities, First Nation and urban, to participate in a
study to examine the scope of the problem and to identify people's treatment needs. Some First
Nations chose not to participate and Couchiching went forward with those Aboriginal
communities that responded favourably to the invitation. The TSS mandate and goals were
amended to reflect the wider focus. The Project's mandate became "to improve the physical,
mental, spiritual and social well-being of Aboriginal residents of the Rainy River District, and
their families.¨ Its goals were revised to include identifying ways to increase Aboriginal
participation in treatment services planning, delivery, management and policy development, as
well as, to improve Aboriginal access to treatment services.
I want to recognize the role the Technical Working Group (TWG) played in providing
professional expertise to the project. The TWG included representation from Couchiching First
Nation; the Anishinaabeg of Naongashiing First Nation (Big Island); the Gizhewaadiziwin Health
Access Centre; the Rainy River District Substance Abuse Prevention Team; the Northwestern
Health Unit; the Centre for Addiction and Mental Health (CAMH); Ontario Region of the First
Nations and Inuit Health Branch, Health Canada and, the Northwest LHIN (ex officio). Without
its sustained and focused effort, this work would not have been possible. I want to thank the
individual TWG members for their personal contributions to the research. Your guidance is
greatly appreciated and acknowledged. I also want to thank their respective Boards and First
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Nations' Councils for the support they showed in appointing them as representatives to the
TWG.
As Project Coordinator, I brought to the table some 30 years of experience in social services
including 20 years of direct work in the field of addictions and treatment. I am indebted to my
many teachers who helped shape my professional philosophy, ethics, and practice. These
teachers also guided me in my human journey. They helped me to know who I am, helped me
get in touch with my potential and gave me the tools to do the work. I am grateful for their
contribution to both my professional and personal life.
I did not complete this project on my own; I was part of a team. Together, we were able to do
collectively so much more than any one person could hope to do on their own. Each member of
the Treatment and Support Service project team brought their own unique capabilities and
background to the project. All rose to the occasion and made my role as Project Coordinator
more defined and focused. They formed the project's foundation and I would be remiss if I did
not thank them for their work.
First, I want to acknowledge Percy Bird who was with us in 2007 during the initiative's early
development. Percy helped to conceptualize the project and he was instrumental in helping us
acquire its developmental funding. He has also been a skilled resource during the project's
implementation.
Darren Harper was a member of the project team until November 2009. I want to acknowledge
his part in accessing project funding and his role as Technical Advisor to the team. I appreciate
his many contributions and wish him well in his new endeavours with other projects.
Cathie Bruyere acted as the team's Needs Assessment Consultant. She was indispensible
during the project's implementation. Her qualifications and impressive resume includes health
policy development and health planning at the tribal, territorial, national and government level.
With her specialized knowledge in community health development, she helped design the
project methodology. She also provided informed critique throughout the project's
implementation and she framed this project report.
I want also to acknowledge Ida Linklater for her role as the project's Administrative Assistant. As
the project expanded and its activities widened in their reach, influence and affect, Ida acted as
a consistent central hub for all our activity. Her sound management of all the project's
administrative tasks kept us on a steady forward course. We could not have proceeded without
her valuable support and expertise.
I would be remiss if I did not give heartfelt thanks to all the Elders that participated in the project.
Through their guidance, culture was not just a component of the project but rather, it defined the
project. The Elders ensured culture played a central role in all of the Treatment Support
Services team's activities. The Elders and drum were present at all project sponsored
community gatherings. The Elders were instrumental in guiding the youth program agenda. The
project acknowledges both the youth and Elders as a valuable resource to the project.
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I also want to thank our funder ÷ the Integration Envelope, Aboriginal Health Transition Fund,
Health Canada. Ontario Region and Thunder Bay Zone of the First Nations and Inuit Health
Branch believed in the project and demonstrated faith, confidence and support in our ability to
deliver what we proposed. The project strengthened our working relationship with them. This
relationship will continue into the future as we work collectively to achieve the strategic goals set
before us by the project and the Aboriginal communities.
The project methodology was critical to the project's successful outcome. It required us to
engage people in dialogue about real issues; things they don't normally talk about. Focus group
participants, as well as, those who engaged the project team in informal dialogue provided
indispensible insights into the realities of their life circumstances. People openly shared their
thoughts, feelings, fears and hurts about events occurring in their homes and communities.
Their level of openness is a testament to our strength and resilience as a people.
It was a challenge for the project team to meld the raw data with snapshots of people's real life
struggles, fears and experiences. Central to the process was the creation of an environment of
safety, trust and respect which allowed community members to share their very personal
stories. This sharing only occurred because the project team respected and dignified their
human experience in a nonjudgmental accepting manner. People shared because they wanted
others to learn from their life's journey and because they have hope in a better future for their
families and communities.
As you read this report, please remember the statistics presented are more than mere numbers.
They represent the life realities of your neighbours, friends, or family members. The statistics
are the emotional bruises and experiences of real people - real survivors.
I want to acknowledge the support the Couchiching leadership provided to the project. They
were there to lobby with government and they were present in meetings with the community. As
with all community initiatives, the leadership plays a vital role in determining the project's
outcome. Without the support of leaderships, an initiative will fail. For the most part,
Couchiching's Council and senior management gave me a free hand to move the project
forward. Their belief in the project gave us confidence. I feel humbled by their level of trust. I
thank them for all they have done for the project.
On a personal note, in all my employment history, I have never had the opportunity to work in
my home community. I was uncertain in the beginning how things would play out. Now, I
believe my apprehension was more about the gravity and enormity of the work ahead of us. As
the tasks became more defined, I found the project's accomplishments exceeded all my
expectations,
It is Couchiching's intention that this report benefits all Aboriginal people. The report contains a
series of recommendations for future action. There is also other information within the body of
the document that will be of value to all concerned stakeholders. This report may be used by
those Aboriginal and non-Aboriginal service providers and funders who desire to improve the
social environments of the Aboriginal service population.
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This is an exciting time for the Aboriginal participants of the project. We have a very powerful
document that can be a vehicle for change. It was our goal to generate a report that would be
user friendly for everyone. We wanted a document that gives the average community member
a voice. It is a tool which effectively captures the issues and presents a true representation of
the reality and consequences of substance abuse in the Aboriginal community and in the
District.
In closing, please accept my thanks on behalf of the project team for the opportunity to serve
our Aboriginal people and community through this innovative work. I can speak for the team
when I say that it is truly an honour to do this kind of work.

Chi-Miigwetch!
Ed Yerxa, Coordinator
Treatment and Support Services Project
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Acknowledgements

This document was developed by the
Treatment and Support Services Project,
sponsored by Couchiching First Nation.
The Project Team consisted of Ed Yerxa,
Project Coordinator; Darren Harper,
Technical Advisor; Catherine R. Bruyere,
Needs Assessment Consultant; and Ida
Linklater, Project Administrator. The Project
was undertaken with the guidance and
assistance of the Couchiching Chief and
Council, the Community Advisory
Committee and the Technical Working
Group.
The Project Team would like to thank:
Elder: Bessie Mainville, Couchiching First
Nation
Couchiching Band Council & Staff:
Chief Charles McPherson
Councillors:
Christine Jourdain
Nick Mainville
William Perrault
Clint Perrault
Richard Bird

Staff:
Louis "Smokie¨ Bruyere, Band Manger
Dale Morrisseau, former Band Manager
Val Norris, Band Financial Officer
Susie Jones, Finance Clerk
Aleta Bruyere, Finance Clerk

Technical Working Group:
Shanna Weir, Executive Director,
Gizhewaadiziwin Health Access Centre
(Chair)
Hugh Dennis, Coordinator, Rainy River
Substance Abuse Prevention Team
Becky Holden, Health Educator, North
Western Public Health Unit
Albert Calder, NNADAP Worker,
Couchiching First Nation
Issac Big George, Community Wellness
Worker, Anishinaabeg of Naongashiing
Michelle Ott, Program Consultant, Provincial
Services ÷ Northern Ontario, Centre for
Addiction and Mental Health
Lynne Baxter, Manager, Addictions, Ontario
Region, First Nations and Inuit Health
Branch, Health Canada
Couchiching Community Advisory
Committee:

Donna Perrault
Debbie Fairbanks
Eileen Jourdain
Albert Calder
Nicole Perrault Morrisseau
Shelly Morrisseau
Our Partner First Nations/Aboriginal
Organizations:
Mishkosiimiiniiziibig (Big Grassy River)
First Nation Band Council & Staff:
Chief Caroline Copenace
Councillors:
Debra Whetzel
Lynn Indian
Roy Tom
Chris Jack
Gary Tuesday

Staff: Dennis Copenance

Anishinaabeg of Naongashiing (Big
Island) First Nation Band Council & Staff:

Chief Wesley Big George
Councillors:
Robert Handorgan
Carl Big George

Staff:
Val Pizey, Governance Advisor
Elaine Jourdain, Health Director
Issac Big George, Community Wellness
Worker
Joanne Cobiness, NNADAP Worker
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Mitaanjigaming (Stanjikoming) First
Nation Band Council & Staff:
Chief Janice Henderson
Councillors:
Pamela Johnson
Paul Henderson

Staff:
Alex Cochrane, Community Wellness
Worker

United Native Friendship Centre (Fort
Frances) Board of Directors & Staff

Richard Bruyere, President
Armand Jourdain Sr., Vice-President
Richard Bird
Gerri Yerxa
Darren Woods
Donna Bird
Debbie Fairbanks

Staff:
Sheila McMahon, Executive Director
Mandy Olsen, YMAC Coordinator
Natalie Donaldson, Assistant YMAC
Coordinator
Anne Sinclair, Lifelong Care Coordinator
Janet Lee, Care Support Worker

Atikokan Native Friendship Centre Board
of Directors & Staff:

Sandra Sedor, President
Rick Stanley, Vice-President
Debra Bruyere, Treasurer
Fay Clark
Mary Makarenko
Marie Veran

Staff:
Delores Veran, Executive Director
Phyllis Barr, Lifelong Care Worker
Jacqueline Boileau, Wasa-nabin Worker

Sunset Country Métis Board of Directors
& Staff:

Clint Calder, President
Mona Morrisseau,
Gordie Calder, Senator

Staff:
Charmaine Langlais, AHWS Coordinator,
Métis Nation of Ontario

Rainy River District Aboriginal
Addictions Needs Assessment
Surveyors:

Couchiching First Nation:
Chasmine Nastiuk
Debbie Fairbanks
April Bruyere
Tara Yerxa

Mitaanjigaming (Stanjikoming) First Nation:
Alex Cochrane, Community Wellness
Worker

Anishinaabeg of Naongoshiing:
Issac Big George, Community Wellness
Worker
Joanne Cobiness, NNADAP Worker
Mishkosiimiiniiziibig (Big Grassy River) First
Nation
Danika Tom

United Native Friendship Centre:
Mathew Calder, Receptionist

Sunset Country Métis:
Charmaine Langlais, AHWS Coordinator,
Métis Nation of Ontario

Atikokan Native Friendship Centre:
Bonnie Plourde, Board Member
Terry Sabean, Akwe-go Worker

Centre for Addiction and Mental Health
(CAMH):

Dr. Louis Gliksman, Director, Social,
Prevention and Health Policy Research
Department
Brenda Newton Taylor, Research Associate
II/Project Manager
Kathleen Larion, Research Assistant
Marisa Selig, Manager, Research Contracts
Claudio Rocca, Manager, DATIS
Operations Centre
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Michelle Ott, Program Consultant, Provincial
Services ÷ Northern Ontario

Treaty #3 Policing:

William (Bill) Horseman, Records
Management, Auditor

Weechi-it-te-win Child and Family
Services:

Debbie Leonard, Director of Administration
Rodger Chaison, Systems Administrator

Substance Abuse Treatment Programs:

Migisi Alcohol and Drug Abuse Treatment
Centre:
Ruben Wasacase, Executive Director

Sister Margaret Smith Clinic, St. Joseph's
Care Group:
Nancy Black, Program Manager, Mental
Health, Addictions & Problem Gambling
Amy Rubino Start, Intake Worker, Youth
Addiction Services
Marla Hollingsworth, Intake Worker, Adult
Addiction Services

Morning Star & MECCA, Lake of the Woods
District Hospital:
Patti Dryden-Holmstrom, Program Manager
÷ Community Services
Dr. Sandra Saas, Methadone Specialist,
MECCA
Kim Jones, Methadone Support Worker,
MEECA

Crossroads Centre Inc.:
Lisa Govier, Counselling Director

Mental Health and Addictions Outreach, St.
Joseph's Care Group:
David Engberg, Manager, Lakeview
Methadone Clinic.

Dilico Treatment Services:
Karen Marano, Addiction Services Manager
Cheryl Bagnall, Intake Worker
Michelle Solomon, Team leader
Laurel Vescio, Aftercare Worker
Fort Frances Tribal Health Services Inc.:
Eileen Gagne, Manager, Counselling Unit

Atikokan Community Counselling Services,
Atikokan General Hospital:
Susan Girard, Program Manager
Candace Green, Gambling Counsellor
Brad Ricci, Addictions Counsellor

Riverside Community Counselling Services,
Riverside Health Care Facilities Inc.:
Jeff Tillbury, Addictions Counsellor

Changes Recovery Homes Inc.:
Connie Mellon, Executive Director

Ontario Addiction Treatment Centres:
Dr. Michael Varenbut, Co-Executive
Director

Addiction Foundation of Manitoba:
Rick Drennar, Supervisor, Impaired Drivers
Program, Methadone intervention and
Needle Exchange Program, Drug Testing,
Collection Site
Wayne Whalen, Supervisor, Adult Male
Programs, James Toal Centre
Heather Darrach, Supervisor, Women's and
Family Programs
Laurie Magee, Methadone Intervention and
Needle Exchange Program (M.I.N.E.) Ron
Linklater, Prevention and Education
Consultant, Problem Gambling Services

First Nations and Inuit Health Branch,
Health Canada:

Valerie Gideon, Regional Director, Ontario
Region
Jamie Adams, Zone Director, Thunder Bay
Zone
Billie Jean Benisty, Senior Policy Advisor,
Ontario Region
Ida Campbell, Director, Non-Insured Health
Program, Ontario Region
Marnie Mitchell, Regional Pharmacist,
Ontario Region
Lynda Roberts, Project Manager, Addiction
and Accreditation, Ontario Region
Lynne Baxter, Manager, Addictions, Ontario
Region
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Aboriginal Health Transition Fund,
Health Canada:
Yeshodara Naidoo, AHTF Program
Manager/Policy Analyst

Program Evaluation and Performance
Measurement Services, Government
Consulting Services, Public Works and
Government Services Canada:

Melanie Barrieau, Evaluation Consultant

North West Local Health Integration
Network:

Laura Kokocinski, Senior Director, Planning,
Integration, and Community Engagement
Karen Peterson, Senior Planning and
Community Engagement Consultant
Corey Russell, Epidemiology and Decision
Support Consultant






























Focus Group Participants:

We want to acknowledge all of the Elders,
youth, women and men who participated in
our 18 focus groups.

Service Providers' Forum:

We would like to acknowledge all of the
local service providers who attended the
Service Providers' Forum.




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Table of Contents
Forward
Acknowledgements
Chapter 1: Treatment and Support Services Project..............................................................1
Introduction......................................................................................................................1
Project Overview..............................................................................................................2
A. Goal.................................................................................................................2
B. Objectives.......................................................................................................2
C. Project Catchment Area................................................................................2
D. Methodology...................................................................................................2
Phase I: Needs Assessment...........................................................................................3
A. Community Based Survey.............................................................................3
B. Focus Groups.................................................................................................4
C. Health and Social Impact Review.................................................................4
D. Treatment System Mapping..........................................................................5
E. Literature Review..........................................................................................6
F. Service Provider Forum................................................................................6
G. Strategic Recommendations.........................................................................6

Phase II: Implementation................................................................................................7

A. Development of Community-Specific Addiction Treatment
Strategies........................................................................................................7
B. Prioritization and Follow-up on Report Recommendations.....................7
Chapter 2: Socio-Demographic Characteristics......................................................................8
Introduction......................................................................................................................8
Basic Demographics.......................................................................................................8
A. Sample Composition.....................................................................................8
B. Marital Status..................................................................................................8
C. Children...........................................................................................................8
D. Education........................................................................................................9
E. Household Composition................................................................................9
F. On and Off-Reserve Residency...................................................................9
G. Employment Status........................................................................................9
H. Occupations.................................................................................................10
I. Income...........................................................................................................11
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J. Aboriginal Status and Cultural Background.............................................11
K. Ancestral Language, Knowledge and Use................................................11
Chapter 3: Substance Abuse Prevalence................................................................................13
Introduction....................................................................................................................13
Alcohol............................................................................................................................13
A. Drinking History...........................................................................................13
B. Drinking Frequency and Consumption......................................................15
C. Drinking Location and Context...................................................................18
Marijuana........................................................................................................................22
Cocaine...........................................................................................................................23
Illicit Drugs (Excluding Marijuana, Cocaine and Opiates)........................................24
Opiate Use......................................................................................................................26
A. Prescription Opiate Use..............................................................................26
B. Illicit Opiate Use (Without a Prescription).................................................27
Injection Drug Use.........................................................................................................28
Tobacco..........................................................................................................................28
Chapter 4: Trends in Prescription Central Nervous System Drug Use Amongst Four First
Nations in the Rainy River District........................................................................31
Introduction....................................................................................................................31
Utilization of Central Nervous System Drugs.............................................................31
A. Trends in Narcotic Use...................................................................................32
B. Trends in Acetaminophen and Codeine Use...............................................34
C. Trends in Percocet and Generics Use.........................................................35
D. Trends in Oxycontin Use...............................................................................35
E. Trends in Long-Acting Narcotic Use............................................................38
F. Trends in Methadone Use..............................................................................39
G. Trends in Benzodiazepine Use.....................................................................39
H. Trends in Stimulant Use.................................................................................42
Client Safety and Prescription Monitoring..................................................................43
A. Pillar 1 - Warning Messages to Pharmacists............................................43
B. Pillar 2 - Rejection Messages Regarding Drug Therapy Pattern...........44
C. Pillar 3 - Client and Program Level Trend Analysis.................................44
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D. Pillar 4 - Drug Use Evaluation Committee.................................................45
Chapter 5: Aboriginal Substance Use: Causation and Protective Factors..........................47
Introduction....................................................................................................................47
Causation.......................................................................................................................47
A. Unresolved Historical Trauma....................................................................47
B. The Indian Residential School Experience................................................50
C. Intergenerational Substance Abuse...........................................................54
D. Mental Health and Psychological Distress................................................55
E. Child Abuse/Neglect....................................................................................57
F. Low Self-Esteem..........................................................................................57
G. Interpersonal Issues....................................................................................57
H. Escapism......................................................................................................58
I. Prejudice and Discrimination.....................................................................58
J. Peer Pressure...............................................................................................59
K. Boredom & High Cost of Participation.......................................................60
L. "Chasing the High"......................................................................................61
Protective Factors.........................................................................................................62
A. Parental Influence........................................................................................62
B. Drug Education and Awareness.................................................................63
C. Personal Goals.............................................................................................64
D. Hobbies, Sports or Alternate Activities.....................................................65
E. Cultural Values.............................................................................................65
F. Public Perceptions.......................................................................................65
Chapter 6: Impact of Substance Abuse...................................................................................67
Introduction....................................................................................................................67
Harmful Effects of Substance Use...............................................................................67
A. Alcohol - Own Use.......................................................................................67
B. Alcohol - FamiIy Member's Use.................................................................68
C. Drugs - Own Use.........................................................................................69
D. Drugs - FamiIy Member's Use....................................................................69
Physical and Mental Health..........................................................................................70
A. Rainy River District Aboriginal Substance-Related Hospitalization
Data...............................................................................................................70
B. Perceived Personal Health Consequences of Substance Abuse........71
Family Dynamics and Functioning..............................................................................74
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Denial, Enabling and Co-dependency.........................................................................75
The Impact of Substance Abuse on Aboriginal Children.........................................77
A. Substance Abuse in the Home...................................................................77
B. Children as Victims of Substance Abuse..................................................78
Childhood
Abuse..............................................................................................................................80
A. Childhood Assaults by Family Members...................................................80
B. Childhood Assaults by Non-Family Members...........................................81
Child Welfare System....................................................................................................81
Violence and Victimization...........................................................................................82
A. Substance Abuse as a Factor in Criminal Activity...................................82
B. Substance Abuse and Physical, Psychological and/or Sexual
Assaults.......................................................................................................84
!" Domestic Violence...........................................................................84
!!" Violence by Other Person(s) Living in the Home - Victims of
Physical Assault...............................................................................86
!!!" Acquaintance Violence....................................................................87
!#" Community Perceptions of Substance Abuse Violence..............88
Inter-generational Cycle of Substance Abuse............................................................90
Chapter 7: Substance Abuse Treatment.................................................................................93
Introduction....................................................................................................................93
Overview - Substance Abuse Treatment Services....................................................93
A. Provincially-Funded Substance Abuse Treatment...................................93
B. Federally-Funded Indian and Inuit Treatment...........................................96
C. Private for-Profit Treatment........................................................................97
Availability of Substance Abuse Treatment Services in the Rainy River District...97
A. Provincially-Funded Substance Abuse Programs....................................97
B. Federally-Funded Substance Abuse Treatment Programs......................99
Gaps in the Availability of Substance Abuse Treatment Services in the Rainy River
District............................................................................................................................99
A. Withdrawal/Management (Detox)................................................................99
B. Residential Treatment Level 1 & Level 2..................................................99
C. Residential Medical/Psychiatric Treatment.............................................100
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D. Residential Supportive Treatment Level 1 & Level 2.............................100
Aboriginal Treatment Service Utilization...................................................................101
A. Rainy River District Aboriginal Addiction Needs Assessment Survey
(RRDAANAS)..............................................................................................101
B. Aboriginal Use of Provincially Funded Treatment Services FY2007-
2008.............................................................................................................104
C. First Nation Utilization of Federally Funded NNADAP Treatment
Centres........................................................................................................119
Factors That Led Aboriginal People to Seek Treatment.........................................119
A. Enhance Personal Well-Being..................................................................119
B. Recognition of the Harm Being Caused to Others................................120
C. Children - A Strong Motivation Factor....................................................121
D. Negative Life Event...................................................................................122
E. Peer Pressure.............................................................................................122
F. Financial Problems/Job Issues.................................................................122
G. To Improve One's Future...........................................................................123
H. Recognition that Life Had Become Unmanageable and Change Was
Needed........................................................................................................123
I. Negative Motivating Factors....................................................................123
Chapter 8: Perceived Barriers to Treatment........................................................................125
Introduction..................................................................................................................125
The Aboriginal Needs Assessment Survey...............................................................125
Focus Groups..............................................................................................................127
A. Personal Issues - Denial...........................................................................127
B. Personal Issues - Unwilling to Quit Alcohol and/or Drugs....................127
C. Personal Issues - Not Thinking Treatment Will Help.............................128
D. Personal Issues - Thinking you can handle the problem or you can
control your using......................................................................................129
E. Personal Issue - Fear................................................................................129
F. Personal Issue - Stigma............................................................................130
G. Family Issue - Lack of Family Support....................................................131
H. Family Issue - Family Responsibilities....................................................132
I. Family Issue - Fear of Losing Your Children..........................................132
J. Peer Issue - Loss of Friendship...............................................................133
K. Systems Issue - Lack of Awareness of Treatment Options..................133
L. Systems Issue - Cost of Treatment.........................................................134
M. Systems Issue - Funding Support and Quality of Care........................134
N. Systems Issue - Waiting Lists..................................................................135
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O. Systems Issue - Distance to Treatment..................................................135
P. Systems Issue - Treatment Admission Policies.....................................136
Q. Systems Issue - Perceived Ineffectiveness of Community Workers..137
R. Systems Issue - Lack of Youth Treatment Options...............................138
S. Systems Issue - Lack of Gender-Specific Treatment............................139
T. Systems Issue - Lack of Child Care.........................................................140
U. Systems Issue - Lack of Cultural-Based Treatment..............................140
V. Systems Issue - Low Retention Rates.....................................................141
Chapter 9: Treatment Service Elements................................................................................143
Introduction..................................................................................................................143
Pre-treatment..............................................................................................................143
A. Pre-Treatment Assessments.....................................................................143
B. Lack of Awareness of the Referral Process............................................145
C. Pre-Treatment Medical Assessments......................................................146
Treatment.....................................................................................................................147
A. Withdrawal Management/Detox................................................................147
B. Methadone Maintenance Therapy............................................................148
C. Out-Patient Treatment...............................................................................150
D. Residential Treatment...............................................................................150
Post-Treatment............................................................................................................151
A. Aftercare Planning.....................................................................................151
B. Lack of Transitional Housing....................................................................154
C. Lack of Service Coordination...................................................................155
Aboriginal Defined Treatment Services....................................................................155
A. Intervention.................................................................................................156
B. Intake and Assessment.............................................................................156
C. Residential Treatment...............................................................................157
D. Aftercare Program.....................................................................................161
E. Transitional Housing.................................................................................162
Chapter 10: Cultural-Based Treatment.................................................................................164
Introduction..................................................................................................................164
Culture in the Study Communities.............................................................................164
A. Participation in Cultural Events/Ceremonies.........................................164
B. Traditional Spiritual Leadership/Mentorship..........................................166
C. Importance of Traditional Aboriginal Culture and Teachings...............167
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Culture and Substance Abuse Treatment.................................................................169
A. Perceived Importance of Culture in Treatment.......................................169
B. Rationale for Culturally-Based Treatment...............................................169
C. Role of Elders in Substance Abuse Treatment.......................................170
D. Cultural Programming...............................................................................173
Cultural-Based Treatment versus Culturally-Appropriate Treatment.....................175
Aboriginal Control and Ownership............................................................................176
Chapter 11: Strength and Resilience.....................................................................................178
Introduction..................................................................................................................178
Our People....................................................................................................................178
Family...........................................................................................................................179
Cultural Preservation and Resilience.......................................................................179
Communities................................................................................................................179
Aboriginal Identity.......................................................................................................179
Leadership....................................................................................................................180
Willingness to Heal......................................................................................................180
Recommendations..................................................................................................................181
Leadership....................................................................................................................181
Treatment.....................................................................................................................182
Aftercare.......................................................................................................................184
Prevention/Health Promotion/Education..................................................................186
Training.........................................................................................................................187
Enforcement.................................................................................................................188
Investment in Aboriginal Community Strengths......................................................189
Substance Abuse Service Collaboration, Coordination and Integration..............190
Special Needs of the Métis.........................................................................................191
Aboriginal Substance Abuse Funding.......................................................................192
!
#$"!
!
Selected
References...............................................................................................................................193
Appendices..............................................................................................................................200



!"
"
Chapter 1: The Treatment and Support
Services Project
"
Introduction:

In the fall of 2007, Couchiching First Nation, situated outside of Fort Frances, Ontario became
concerned about wide-spread opiate abuse in the community. Following consultations with
community service providers, the First Nation conducted a community-based survey to
determine the scope of the problem and to identify community readiness to address the issue.
Of 140 surveys distributed, 104 were returned. The survey found: 74% of respondents believed
alcohol abuse continues to be a problem in the community; 91% believed illegal drugs were a
problem and 94% believed prescription drug abuse is a problem. The survey also found the
abuse of illicit drugs, prescription drugs and over-the-counter medication was extensive.
Seventy-six (76%) of respondents reported using marijuana and 75% reported using cocaine.
Ninety-five percent (95%) of respondents reported using opiates to get high while 65% reported
abusing codeine-based drugs.
The survey also found the community was ready to address the substance abuse issue. Ninety-
four (94%) supported the development of a residential treatment centre. Fifty-nine percent
(59%) believed substance abuse treatment should be based on traditional cultural values and
norms. Eighty-two percent (82%) said they believed Couchiching's substance abuse problems
are not unique and are shared by other First Nations.
Couchiching's leadership decided to pursue establishing a residential treatment facility. To
ensure the treatment centre's feasibility, Couchiching First Nation determined a more in-depth
study of the of the Aboriginal opiate and substance abuse problem across the District was
needed. It also felt it was important to involve other First Nations and Aboriginal people in the
treatment facility development process. Three (3) First Nations, in addition to Couchiching First
Nation, agreed to participate in the Project along with three (3) urban-based Aboriginal
organizations. In the fall of 2008, Couchiching secured funding from the Integration Envelope,
Aboriginal Health Transition Fund to examine the prevalence of the substance abuse problem,
to assess the existing treatment services capacity to respond to the problem, and to develop
recommendations for enhancing Aboriginal involvement in the design, delivery and evaluation of
drug and alcohol treatment services. The Treatment and Support Services Project was
established in September 2008 and is expected to conclude in September 2010.


#"
"
Project Overview:
A. Goal:

The goal of the Treatment and Support Services Project is:
ƒ to improve the physical, mental, spiritual and social well-being of Aboriginal residents of the
Rainy River District, and their families, suffering from a drug and substance abuse problem.
B. Objectives:

Its objectives are:
ƒ to improve the Aboriginal access to Drug and Substance Abuse Treatment Services;
ƒ to increase Aboriginal participation in the design, delivery and evaluation of Drug and
Substance Abuse Treatment Services;
ƒ to ensure Drug and Substance Abuse Treatment Services are better suited to meet the
needs of Aboriginal people; and
ƒ to improve the integration of federal and provincial funded Drug and Substance Abuse
Treatment Services.
C. Project Catchment Area:

The Treatment and Support Project involves four (4) First Nations ÷ Big Island (Anishinaabeg of
Naongashiing), Big Grassy River (Mishkosiimiiniiziibig), Mitaanjigaming (Stanjikoming) and
Couchiching. It also includes the Métis population affiliated with the Sunset Country Métis (Fort
Frances, Emo, Rainy River and Atikokan) and the urban Aboriginal population serviced by the
United Native Friendship Centre in Fort Frances and the Atikokan Native Friendship Centre. All
of the aforementioned groups participated in the Rainy River District Aboriginal Addiction Needs
Assessment Survey. While the survey was restricted to these populations, some of the service
utilization data included in this report includes all First Nations within the Rainy River District.
D. Methodology:

The Treatment and Support Services Project is a phased initiative. Phase I involves the
development and implementation of a comprehensive Needs Assessment and the preparation
of strategic recommendations based on Phase I findings. Phase II, which will follow the release
of this report, involves the prioritization and implementation of strategic recommendations from
the Phase I Report.
$"
"
Phase I: NEEDS ASSESSMENT:

The Project Team designed a multi-faceted Needs Assessment which included both primary
and secondary qualitative and quantitative research. The purpose of the Needs Assessment
was to identify, to the extent possible, the scope of the substance abuse problem within the
participating Aboriginal communities, as well as, its impact on individuals, families and
communities. An important role of the Needs Assessment was to solicit community members'
views about substance abuse treatment and its effectiveness in meeting the treatment needs of
individuals with substance abuse problems and their families.
A. Community Based Survey:

The Project Team approached the Centre for Addiction and Mental Health (CAMH) to brief them
on the Project and to obtain implementation advice. Following discussions with CAMH, a
decision was made to partner with them on the implementation of a community-based
household survey in the participating First Nations and in the urban communities of Fort
Frances and Atikokan. The survey enabled the Project to obtain quantitative data on the
prevalence of substance abuse and to identify how Aboriginal people interact with the
substance abuse treatment system. CAMH was contracted by Couchiching First Nation to
assist in the design of the survey and to train surveyors. It was also contracted to do the data
entry, analyze the survey data and to prepare reports on survey findings. The reports included
an aggregate of the findings of the survey and community-specific reports.
The Project Team also approached the North West LHIN to solicit their involvement and support
of the Project. The North West Local Health Integration Network (LHIN) agreed to facilitate
access to provincial health utilization data and, in exchange for including LHIN questions related
to addiction and mental health service utilization in the survey, it helped off-set survey costs.
The survey was implemented in the summer of 2009. It was administered to adults over 18
years of age and youth aged 15 to 17 with parental consent. As an incentive, respondents were
given $10.00 for a completed survey. To ensure confidentiality, respondent completed the
survey themselves and placed the survey into a manila envelope which they sealed.
The sealed envelopes were returned, unopened, to the Project office by the surveyors. The
unopened envelopes were then forwarded to CAMH in London, Ontario for data entry and
analysis.
Twelve (12) surveyors were hired and trained to conduct the survey. A total of eight hundred
(800) surveys were printed and seven hundred (700) distributed. Six hundred and four (604)
were returned to the surveyors and forwarded by Project staff to CAMH for data entry and
analysis. Twenty-six (28) surveys were identified by CAMH as unusable. The total overall
response rate, excluding unusable surveys, was 82.6 per cent. Community-based surveys
which achieve an overall response rate of 30 per cent of the solicited population are considered
successful. The response rate of 82.6 per cent is considered exceptional.
%"
"
The community-based survey results have been published in a report entitled The Rainy River
District Aboriginal Addiction Needs Assessment Survey
1
. Readers are encouraged to read
the report for further information on survey methodology and more detailed survey results. The
report is included as an appendix of this document. The findings of the report have been used
extensively in the preparation of this report.
B. Focus Groups:

A series of eighteen (18) focus groups were held to obtain the views of targeted members of the
Aboriginal community. Some focus groups were community-specific while others occurred
regionally.

Seven (7) Elder focus groups were held - one in each First Nation, one in each Friendship
Centre and one with Métis Elders. Aboriginal Elders were identified for inclusion because of
their life experience and their knowledge of the traditional cultural values and norms of the
Aboriginal community.

Because Aboriginal youth are most at risk for substance abuse, seven (7) youth focus groups
were held; one in each of the four participating First Nation, each of the two Friendship Centres
and with the Sunset Country Métis.

Substance abuse impacts men and women in different ways. It was therefore necessary to
examine Aboriginal substance abuse and treatment from the perspective of both genders. Two
gender-specific regional focus groups were held.

To obtain the perspective of Aboriginal people who had been through substance abuse
treatment, a regional focus group was targeted to former and/or current treatment system
clients. A separate regional focus group was also held for Aboriginal clients of Methadone
Maintenance Therapy (MMT).

The Focus Groups were facilitated by Project Staff and flip chart notes and staff notes taken at
each session. Specific questions were asked of each focus group depending on the type of
participants. At the end of each session, participants evaluated the session. Some sessions
were audio recorded. A written report was prepared on each focus group for research reference
and for future inclusion in the community reports. Over 100 individuals participated in the focus
groups.

C. Health and Social Impact Review:

The Treatment and Support Services Project identified the need to quantify the impact of
substance abuse on the Aboriginal populations through District and community-specific
statistics. The lack of agency databases and the lack of Aboriginal-specific data hindered the
data collection process. Several agencies indicated privacy and human rights' legislation
&"
"
prevented them from collecting ethnicity-based data. Nonetheless, the Project was able to
obtain some Rainy River District First Nation-specific data. This included:
x Policing data from the Couchiching Detachment, Treaty #3 police;
x First Nation child welfare data from Weechi-it-te-win Child and Family Services; and
x First Nation Prescription Drug Utilizations data from the Non-Insured Health Benefit
Program, First Nations and Inuit Health Branch, Health Canada.
The Project Team also reviewed substance abuse research to identify the health and social
impact of substance abuse on the First Nations and Métis populations in Canada.
D. Treatment System Mapping:

The Project Team used a multi-faceted approach to examine the substance abuse treatment
system.
Treatment Service Identification:
First, the Team did a review of what substance abuse treatment services were available to
Aboriginal people both within and outside the District. Both provincially-funded and federally-
funded treatment services were documented.
Aboriginal Treatment Service Utilization:
Second, the Team reviewed Rainy River District resident Aboriginal treatment service utilization
patterns. Working with the Centre for Addiction and Mental Health (CAMH), the Team reviewed
Aboriginal treatment information from the Drug, Alcohol and Treatment Information System
(DATIS) operated by CAMH. DATIS collects and reports client demographic and service
utilization data from addiction and problem gambling (provincial) funded agencies.
Aboriginal client demographic and service information was also sought from the National Native
Alcohol Drug Abuse Program (NNADAP), First Nations and Inuit Health Branch, Health Canada
for federally-funded First Nation treatment facilities. The Project Team was advised by Health
Canada NNADAP lacks a national client information system. Each NNADAP treatment program
would have to be contacted directly to obtain the desired information. Letters were sent in
September 2009 to all NNADAP treatment centres and healing lodges in Ontario requesting
aggregate non-identifying statistical information on clients from Rainy River District First
Nations. The data requested paralleled that captured in DATIS to facilitate comparability. The
letters were followed-up with telephone calls to some of the treatment facilities. None of the
NNADAP treatment centres have been able to accommodate the Project's information request.
Several of the facilities said they lacked an internal client management system which could
provide the detailed information on client utilization the Project requested. While some of the
data could be collected through a file review, the centres reported they lacked the manpower
and resources required to do this.
'"
"
Treatment Centre Key Informant Interviews:

The Project Coordinator and Needs Assessment Consultant visited thirteen (13) treatment
programs to obtain an overview of their treatment services, to discuss Aboriginal service
utilization and to identify service provider perspectives on Aboriginal treatment service gaps and
recommendations. Some of the sites offered more than one type of service. The programs
visited included three (3) out-patient counselling services, one (1) withdrawal management
program, three (3) methadone clinics, four (4) residential treatment centres, and three (3)
supportive housing services. One (1) agency declined the invitation to meet and responded by
e-mail.
There were twenty-four (24) addiction professionals involved in the on-site visits. Questions
presented to the treatment programs included what programs they provided, what are the
demographics of the Aboriginal clients who use their facility, how culturally-competent their
services are' what do they believe are Aboriginal treatment needs and gaps, and what
recommendations they have for addressing those needs and gaps.
E. Literature Review:

Approximately, one-hundred (100) documents on addiction, particularly in relation to indigenous
populations, were reviewed in connection with the project. These included international,
national, provincial addiction research reports; reports on different treatment modalities and
studies on best practice. Where appropriate, these documents were used in the preparation of
this report.
F. Service Provider Forum:

A forum involving local health and social service providers was held in October 2009. The
preliminary results of the Needs Assessment were presented. Participants were asked to share
their perspective on Aboriginal addiction treatment issues and needs. They were also
encouraged to share recommendations for service improvement and enhancement. One of the
key results of the forum was a stated commitment on behalf of those present to work with the
Treatment and Support Service Project on Phase II Implementation.
G. Strategic Recommendations:

Recommendations contained in this report were developed with the participation of the
Technical Working Group during meetings held in December 2009, January and February
2010.

("
"
Phase II: Implementation:

Phase II of the Treatment and Support Service Project will follow the release of this report. Like
the Phase I Needs Assessment, the next phase will be multifaceted.
A. Development of Strategic Recommendations:
The Treatment and Support Services Project has made a commitment to the participating First
Nations and Aboriginal organizations to work with them on the development of community-
specific addiction treatment and prevention strategies. Using non-identifying data from the
Rainy River District Aboriginal Addiction Needs Assessment Survey Report and qualitative
information from the focus groups, the Treatment and Support Services Team will develop a
series of First Nation and organization-specific reports. These reports will be designed to
generate dialogue and discussion amongst community members, service providers and leaders
on how best to address local addiction issues. It is hoped through the development of the
community-specific strategies, short, medium and long-term approaches for addiction
prevention and enhanced service delivery will result.
B. Prioritization and Follow-up on Report Recommendations:
The Rainy River District Aboriginal Addiction Needs Assessment Survey Report and the Rainy
River District Aboriginal Addiction Treatment Needs Assessment Report will be used to promote
and encourage dialogue of report findings and to establish a District-wide forum for the further
prioritization and implementation of report recommendations. As noted, the Service Providers
Forum held in October 2009 has already generated interest in the reports and a commitment for
continued Aboriginal community and agency discussion of service improvement.

"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
1
Newton-Taylor, B. & Larion, K. (2009) Rainy River District Aboriginal Addiction Needs Assessment
Survey Report Toronto, ON Centre for Addiction and Mental Health.
8

Chapter 2: Socio-Demographic
Characteristics
Introduction:

The following is an overview of the socio-demographic characteristics of the Treatment and
Support Services Project's study sample. The sample was drawn from the four (4) First Nations
(Couchiching, the Anishinaabeg of Naongashiing, Mishkosiimiiniiziibig and Mitaanjigaming) and
the urban Aboriginal population affiliated with the three (3) community service sites (the Fort
Frances United Native Friendship Centre, the Atikokan Native Friendship Centre and the Sunset
Country Métis). For information on how the study sites and survey sample were selected, the
reader is encouraged to read this report's companion document ±The Rainy River District
Aboriginal Addiction Needs Assessment Survey.
1

Basic Demographics:
A. Sample Composition:
2

There were six hundred and four (604) surveys returned to the Project of which five hundred
and seventy-eight (578) were usable and represent the survey sample.
Forty-three percent (43%) of the survey sample were men and 57% were women. On average,
respondents were 36 years of age. Women were slightly older (mean = 36.3) than men (mean
35.5 years.) Youth aged 15 to 17 comprised 10% of the survey respondents. Almost half of the
respondents were between the ages of 25 to 49 years (47%). Young adults between 18 to 24
years of age represented 22% of the sample, as did those ages 50 and older.
B. Marital Status:
3

Most respondents were married/cohabitating (46%). Forty-two percent (42%) were never
married singles. The remaining 12% were separated, divorced or widowed. Even though 45%
of both men and women were married/cohabitating, a higher percentage of women respondents
were separated, divorced or widowed (15% and 8%). A higher percent of men reported being
single (47% and 39%).
C. Children:
4

Overall, respondents reported having two children (mean = 2.1 children). When those with no
children were factored out, respondents were found to have an average of 3.0 children. There
were no statistically significant gender differences in the number of children, according to the
survey report. However, a higher percent of men than women reported having no children (38%
9

and 21%). Women and men were equally as likely to report having one or two children.
Women were more likely to report having three or more children (42% and 29%). Of those with
minor children under the age of 17 years, 31% reported that their children did not live in their
home. Men were significantly more likely to report not having their children living with them than
women (43% and 24%).
D. Education:
5

Forty-one percent (41%) of respondents indicated that they had not completed secondary
school. Of the remaining respondents, 15% stated that they had graduated high school, 23%
had some post-secondary education, and 21% had completed their post-secondary education
(e.g. college, trade/technical programs, or university). Men were more likely to report lower
levels of education, while women were more likely to report higher levels of education. Forty-
eight percent (48%) of men reported not graduating secondary education, compared with 26%
of women. Twenty-eight percent (28%) of women reported graduating from a post secondary
education institution, compared with 12% of men.
E. Household Composition:
6

On average, there were 3.4 people living in the homes of the survey respondents. Less than
10% of respondents lived alone. Almost half of respondents (47%) reported there were three or
four people living in their home. Twenty-two percent (22%) reported there were five or more
people living in their home. However, there were statistically significant gender differences in
the household composition of some homes. Men and women were equally as likely to report
living with a spouse or partner (54% and 51%), and having other family members living with
them (38% and 30%). Other family members included: siblings, grandparents, grandchildren,
aunts, uncles, cousins, or in-laws. Women were significantly more likely to report the presence
of children in the home than men (62% and 35%). Men were significantly more likely to report
parents living in the home (37% and 24%). The presence of other family members in the
residence may be due to cultural values related to extended families or may be due to housing
shortages in some communities.
F. On and Off-Reserve Residency:
7

Over half of the survey respondents reported living on-reserve (55%). Men were significantly
more likely to report living on-reserve than women (63% and 49%). Of those living off-reserve,
61% reported living in an urban area. Even though men were more likely to report living in
urban areas than women (68% and 57%), these differences were not significant.
G. Employment Status:
8

The Needs Assessment Survey Report indicates that less than 50% of survey respondents
reported being employed whether full or part-time (48%) while 30% reported being unemployed.
Fifteen percent (15%) of respondents were students and 14% were retired, disabled, or not in
the workforce for other reasons. There were statistically significant gender differences in
employment status. Women were more likely to report being employed than men (51% and
10

43%) while men were more likely to report being unemployed than women (41% and 22%).
Women were also more likely to report being students (18% and 10%). There were no reported
gender differences in the percent of men and women who were retired, disabled or not in the
workforce for other reasons (20% and 13%).
Fifty-five percent (55%) of all respondent spouse/partners were employed full or part-time.
However, the spouses/partners of women were more likely to be employed than the
spouses/partners of men (60% and 49%). Twenty-four percent (24%) of the spouses/partners
of unemployed respondents were employed. Of those who were retired, disabled or not in the
workforce for other reasons, 16% had spouses/partners who were employed full or part-time.
Five percent (5%) of respondents who said they were students had a spouse/partner who was
employed. There were minimal gender differences for these latter groups.
H. Occupations:
9

The highest percent of all respondents reported their usual occupation was in health care, social
services, education or managerial professions (38%). Twenty-three percent (23%) were
unskilled and 16% semi-skilled. Fourteen percent (14%) worked in sales/services/ clerical
occupations and 11% worked in skilled trades. Women were more likely to report employment
involving health care, social services, education or managerial occupations (57% and 14%).
Women were also more likely to work in sales, services or clerical occupations (19% and 8%).
Chart 1 shows the usual occupations of survey respondents by gender and percentage.

0
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11

I. Income:
10

The majority of survey respondents said their income was based on employment (63%). This
was followed by social assistance (25%), employment insurance (11%) and other sources of
income, primarily pensions (13%). Men were more likely than women to report employment
insurance as the primary source of family income (16% and 8%). There were no significant
gender differences for other sources of income.
Thirty-five percent (35%) of all respondents estimated their annual household income was less
than $20,000 per year. Another 26% reported their annual household income was between
$20,000 and $39,999 per year. Eighteen percent reported an income of between $40,000 and
$59,999, and 22% reported an annual household income of $60,000 or more. There were no
significant gender differences in the estimated amount of annual household income.
The Needs Assessment Survey showed that higher income levels were associated with higher
levels of education, employment in professional occupations and full-time employment. Lower
levels of education were associated with lower income, employment in unskilled or semi-skilled
professions, or being unemployed.
J. Aboriginal Status and Cultural Background:
11

Of the total sample, 73% were Registered Status Indians, 5% were Non-status Indians, and
22% were Métis. The survey reported that there was no statistically significant difference in
Aboriginal status between men and women.
Seventy-five percent (75%) of respondents indicated they were Ojibway and 25% indicated they
were Métis. Since the survey questionnaire allowed for multiple responses, there were several
other cultural backgrounds identified including: Cree, Chippewa, Sioux, Oji-cree, Dene,
Shawnee, Mi'kmaq and Mohawk. However, these were most often mentioned in addition to, or
in combination with Ojibway or Métis.
K. Ancestral Language, Knowledge and Use:
12

Ninety-one percent (91%) of respondents reported that their ancestral language was Ojibway.
The remaining 9% listed other Aboriginal language which corresponded to the other cultural
backgrounds identified.
Fourteen percent (14%) indicated that they could fluently speak their ancestral language.
Thirty-two percent (32%) said they could understand their ancestral language when it was
spoken but they could not speak it themselves. Fifty-four percent (54%) of respondents could
neither speak nor understand their ancestral language. There were no significant differences in
fluency by gender.
Statistically, there were significant differences in language comprehension and fluency by age
group. Of the 14% who said they were fluent in their ancestral language, 43% were aged 50 or
older while 45% were between the ages of 25 to 49. Four percent (4%) were aged 15 to 17
years.
12

Thirty-eight percent (38%) indicated that their ancestral language was the language used most
often in the home when they were a child. Even though a majority of respondents stated they
use English most predominately in daily life (88%), 11% said they used their ancestral language
most often in daily life.


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13

Chapter 3: Substance Abuse
Prevalence
Introduction:
Prevalence is an estimate of how common a condition is within a population over a certain
period of time. As a measure, it allows health professionals and health service planners to
determine the likelihood of a population having a certain disease or illness. In this chapter, the
prevalence of substance abuse in the respondents to the Rainy River District Aboriginal
Addiction Needs Assessment Survey (RRDAANAS) is examined. The analysis is based on
participant responses to a series of questions. The substances examined include alcohol,
marijuana, cocaine, other illicit drugs such as opiates and tobacco.
Where possible in this report, survey results were compared with the general Canadian
population using data in the Canadian Addiction Survey 2005.
1

Alcohol:
Alcohol is the psychoactive substance most commonly used by Canadians, including Aboriginal
people.
In the Rainy River District Aboriginal Addiction Needs Assessment Survey (RRDAANAS)
2

respondents, aged 15 and over, were asked about five measures of alcohol use including
drinking history, lifetime and past year drinking and abstinence, drinking frequency,
consumption patterns and compliance with low risk drinking guidelines.
A. Drinking History:
3

Ninety-six percent (96%) of respondents reported having used alcohol at some time in their
lives. There was no significant difference in percentage of men and women reporting lifetime
use (96% and 95%).
The rate of lifetime abstinence was 4%. Women were slightly more likely to be lifetime
abstainers than men (5% and 4%). In the Canadian Addiction Survey (2005), Canadians had a
lifetime abstinence rate of 7%.
4
The Canadian rate of lifetime abstinence was 1.7 times that of
respondents in the RRDAANAS.
Chart 2 shows the age when RRDAANAS respondents said they had their first drink (excluding
occasional sips). On average, respondents had their first drink when they were 13.7 years old.
This compares to respondents in the Canadian Addiction Survey (2005) who reported having
their first drink when they were 15.6 years.
5

14

Of those who used alcohol in their lifetime, 29% said they had their first alcoholic drink when
they were age 12 or less; 32% were 13 to 14 years of age, and 28% were 15 to 16 years of age,
11% were age 17 or over.


The age of alcohol initiation is important because it is an indicator of potential alcohol disorders
later in life. Research indicates that approximately 40% of those who start drinking at age 14 or
under develop alcohol dependence at some point in their lives.
6
Age of initiation also can be
used to target and evaluate alcohol prevention efforts.
When asked "How old were you the first time you were drunk?¨, 22% of respondents who drank
in their lifetime said they were 12 or less years of age; 30% said they were 13 to 14 years old;
31% said between ages 15 and 16 and 17% said when they were 17 years of age or older. The
average age for respondent's first intoxication was aged 14.4 years. Chart 3 shows there was
no significant difference between men and women across or within the age groups.
0
3
10
13
20
23
30
33
Þ
e
r
c
e
n
t
a
g
e
Age of In|t|at|on
Chart 2: Age of In|t|at|on - A|coho|
8y Age Group and Gender
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|on Needs
Assessment 5urvey
13



B. Drinking Frequency and Consumption:
More Canadians (34%)
7
than Needs Assessment Survey respondents (31%) drank one to three
times a week. A greater percentage of Canadians (10%)
8
than Needs Assessment Survey
respondents (9%) drank four or more times a week.
In the 12 months before the RRDAANAS, 71% of the respondents had consumed alcohol and
28% were "former drinkers.¨ This compares to the 79% of Canadians who reported drinking in
the 12 months prior to the Canadian Addiction Survey (2005) and the 14% of Canadians who
were identified as "former drinkers.¨
9
The number of Needs Assessment survey respondents
classified as "former drinkers¨ was twice that of the Canadian rate.
The RRDAANAS provides information about how often and how many drinks respondents drank
and the extent to which they engage in high-risk drinking patterns.
Chart 4 shows the Canadian and Needs Assessment Survey respondents' frequency of alcohol
consumption. Results show that Needs Assessment Survey respondents drank less often than
did the Canadian population. Of those who currently drink, 34% of the Needs Assessment
survey respondents reported drinking less than once a month compared to 23% of the
Canadian population.
10
Fewer Needs Assessment respondents than Canadian Addiction
Survey respondents drank one to three times a month (26% and 33%
11
).

0
3
10
13
20
23
30
33
Þ
e
r
c
e
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t
a
g
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Age of I|rst Intox|cat|on
Chart 3: Age of I|rst Intox|cat|on
8y Age Group and Gender
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|on Needs
Assessment 5urvey
16



Slightly more women (28%) reported drinking one to three times per month than men (24%).
Significantly more males (40%) than women (24%) drank one to three times a week.
12
More
men than women reported drinking daily or almost daily (11% and 7%).
The average number of drinks consumed per week by respondent past year drinkers was 12.5
drinks. Men consumed on average significantly more drinks per week (16.8) than women (9.2).
Of those who reported drinking in the past year, 60% reported drinking 1 to 7 drinks per week.
Forty-six percent (46%) of men past year drinkers consumed 1 to 7 drinks per week compared
to 72% women. Needs Assessment Survey women respondent past year drinkers drank 1 to 7
drinks per week at a rate 1.58 times higher than men respondents.
Chart 5 shows the number of drinks consumed per week by age and gender.
0.0°
3.0°
10.0°
13.0°
20.0°
23.0°
30.0°
33.0°
40.0°
Less Lhan
once a
monLh
1 - 3 Llmes a
monLh
1 - 3 Llmes
a week
4+ Llmes a
week
Þ
e
r
c
e
n
t
a
g
e
Iequency of A|coho| Consumpt|on
Chart 4: Canad|an (CA5) and kkDAANA5 kespondent
Irequency of A|coho| Consumpt|on
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|on Needs
Assessment 5urvey
Canadlan ÞopulaLlon
Aborlalnal ÞopulaLlon
17



In Ontario, the legal drinking age is 19 years old. Of past year drinkers, youth 15 to 17 years of
age reported drinking 6.1 drinks on a weekly basis. Men respondents in this age group drank
significantly more than their female counterparts drank (10.3 and 3.2 drinks per week).
The 18 to 24 age group of past year drinkers, on average, consumed more alcohol per week
than any other age group (14.3 drinks per week). Men respondents 18 to 24 years drank
significantly more than women respondents of the same age (16.3 and 12.4 drinks per week).
Past year drinkers in the 25 to 49 age group consumed only slightly fewer drinks on a weekly
basis than those aged 18 to 24 (12.1 to 14.3 drinks per week). Men in this age group consumed
significantly more drinks per week than women in the same age group (14.9 drinks per week
and 10.0 dinks per week).
In the 50+ age group, past year drinkers consumed on average 8.7 drinks per week. Men
consumed significantly more drinks as did women in the same age group (13.1 and 5.8 drinks
per week).
Wechsler et al. defines heavy drinking as having five drinks or more on a single occasion for
men, and four or more drinks on a single occasion for women.
13
Rates of heavy drinking
amongst the Aboriginal population in the RRDAANAS were alarmingly high. Most Aboriginal
people who report drinking in the past year were heavy drinkers. Many were frequent heavy
drinkers.
0
2
4
6
8
10
12
14
16
18
Male lemale Male lemale Male lemale Male lemale
13 - 17 ?ears 18 - 24 ?ears 23 - 49 ?ears 30+ ?ears
N
o
.

o
f

D
r
|
n
k
s

Þ
e
r

W
e
e
k
Chart 5: Dr|nks Þer Week
8y Age Group and Gender
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|on Needs
Assessment 5urvey
18

Eighty-eight percent (88%) of past year drinkers reported having drank over 5 drinks on one
occasion. Ninety-three percent (93%) of men past year drinkers reported drinking in excess of 5
drinks on one occasion. This is in comparison to 84% of women respondents.
Forty-seven percent (47%) of past year drinkers reported having drank 5 to 7 drinks on one
occasion once a month or more. Sixty percent (60%) of men drank 5 to 7 drinks once a month
or more while 36% of women consumed 5 to 7 drinks once a month or more.
Of those who reported drinking in the past 12 months, 36% of respondents reported having
drank 8 or more drinks on one occasion once a month or more. Significantly more men drank 8
or more drinks on one occasion once a month or more than did women (52% and 24%).
Low risk drinking is defined as no more than 2 standard drinks on any one day or up to nine
standard drinks per week for women and up to fourteen standard drinks per week for men.
On average, past year drinkers drank 12.5 drinks per week. Men past year drinkers drank
significantly more drinks per week that did women past year drinkers (16.8 and 9.2 drinks per
week). Male youth, aged 18 to 24, were the most likely to exceed low risk drinking guidelines
(16.3 drinks per week). Women past year drinkers in the 18 to 24 age group also exceed the
guidelines as did women in the 25 to 49 age group (12.4 and 10.0 drinks per week).
C. Drinking Location and Context:
Past year drinkers were more likely to drink at a friend's home (71%), at home (65%) or at a
party at someone's house (60%) than at a licensed premise (57%). On average, past year
drinkers drank at more than one location (mean number of locations 2.5). When they drank at 3
or more locations, they were likely to consume more alcohol (16.7 drinks) than when they drank
at 1 to 2 locations (8.9 drinks).
Men were likely to consume more drinks on average per week when they drank at home (20.7
drinks per week) or a friend's house (19.9 drinks per week) than they did when they drank at a
party (17.4 drinks per week) or a licensed premise (17.2 drinks per week).
Like men, women were more likely to drink at a friend's home (69%), at home (65%) than at a
party or licensed premise (58% and 59%). Like men, women, on average, drank at more than
one location (mean number of locations 2.5). When they drank at 3 or more locations, women
consumed over twice the amount of drinks (12.8 drinks) than they consumed at only 1 or 2
locations (6.3 drinks).
Regardless of location, on average, men exceeded the weekly safe drinking standard of 14
drinks per week for men (17.2 drinks per week to 20.7 drinks per week). Women drank just
over the safe drinking standard for women of 10 drinks per week (10.2 drinks per week to 11.5
drinks per week).
In the 15 to 17 age group, youth on average drank more drinks at home (11.8 drinks) than they
did at a friend's house (7.5 drinks) or at a party at someone's house (7.1 drinks).
19

Chart 6 shows the mean number of drinks 15 to 17 year old men and women consumed by
location.



Male youth aged 15 to 17 drank more drinks at home (19.1 drinks) than at a friend's house (14.6
drinks) or at a party at someone's house (12.3 drinks). Female youth in the same age group
drank slightly more when they drank at a party at someone's house (3.5 drinks) or at a friend's
house (3.2 drinks) than they did at home (2.8 drinks). As show in Chart 6, male youth aged 15
to 17 consumed considerably more drinks than their female counterparts regardless of where
they drank.
0
3
10
13
20
23
AL Pome AL lrlends AL ÞarLv AL Llcensed
Þremlse
M
e
a
n

N
o
.

o
f

D
r
|
n
k
s
Locat|on
Chart 6: Mean Number of Week|y Dr|nks 15 to 17
Age Group by Locat|on
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|on Needs
Assessment 5urvey
Males
lemales
20


Chart 6 shows the weekly number of drinks for each 18+ age group by gender and by location.
Women past year drinkers aged 18 to 24 years drank slightly more drinks at licensed premises
(15.4) than they did at home (13.7), at friend's homes (13.1) or at parties (11.6). Regardless of
location, women past year drinkers aged 18 to 24 exceeded the recommended guidelines of 10
drinks per week for women.
Women past year drinkers in the 25 to 49 age group drank slightly more drinks at home (12.0)
than they did at a party (10.8), at friend's (9.9) or at a licensed premise (9.5). This age group
drank close to accepted weekly guidelines.
Female past year drinkers, aged 50 plus, drank only slightly more drinks at a party (10.7) than
they did at other locations (9.1 to 9.7). This age group drank below or near accepted weekly
drinking guidelines regardless of location.
Men past year drinkers, aged 18 to 24 years, drank just slightly more drinks when they drank at
home (19.1) than they drank at friends' (18.5), at a party (18.0) or at a licensed premise (17.7).
Regardless of location, men past year drinkers, aged 18 to 24 years old, drank at a level that
exceeds the accepted weekly drinking guidelines for men (14 drinks per week).
Men past year drinkers, aged 25 to 49, drank 25.5 drinks when partying at someone's house.
They drank 1.78 times the amount when partying at someone's house as they did at a license
premise (25.5 and 14.1 drinks). They drank roughly the same amount when drinking at home or
when drinking at friends (17.9 drinks compared to 17.3 drinks). When drinking at home, at
0 10 20 30
AL Pome
AL lrlends
AL ÞarLv
AL Llcensed Þremlse
# of Week|y Dr|nks
L
o
c
a
t
|
o
n
Chart 7: Mean Number of Week|y Dr|nks by 18+
Age Groups, Gender and Locat|on
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|on Needs
Assessment 5urvey
lemales 30+
Males 30+
lemales 23- 49
Males 23-49
lemales 18-24
Males 18 - 24
21

friends or at parties, they consumed alcohol at rates above accepted weekly drinking guidelines
for men.
Men past year drinkers aged 50+ drank within acceptable weekly guidelines for men except
when they drank at parties (16.7). When partying at someone's house, men past year drinkers
aged 50+ drank over twice the amount drank at other locations.
Past year drinkers reported having drunk more often with close friends (64%) than with their
spouse/partner (24%) or a family member (14%). Men past year drinkers drank more often with
close friends (70%) than they did with their spouse/partner (16%) or other family member (15%).
Women past year drinkers show a similar drinking pattern. Like men, women past year drinkers
more often drank with close friends (60%) followed by their partner/spouse (30%) and with a
family member (13%).


Chart 8 shows the percentage of Aboriginal drinkers by persons usually drink with and by
gender.
On average, past year drinkers consumed more drinks per week when they drank with a family
member (18.4 drinks per week) than they did when they drink with close friends (11.4 drinks per
week) or with their spouse/partner (9.8 drinks per week). Men drank significantly more drinks
per week (24.7) when they drank with their family member than they did when they drank with
close friends (16.0) or with their spouse/partner (11.3). Men past year drinkers drank 1.8 times
the accepted weekly drinking guidelines when they drank with their family member. They drank
below the weekly standard when they drank only with their spouse/partner.

0.0°
20.0°
40.0°
60.0°
80.0°
Spouse/
ÞarLner
Close lrlends lamllv
Member
Þ
e
r
c
e
n
t
a
g
e
Þersons Usua||y Dr|nk
W|th
Chart 8: ¼ of Abor|g|na| Dr|nkers by Þersons Usua||y
Dr|nk W|th and Gender
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|on Needs
Assessment 5urvey
1oLal Aborlalnal
Male urlnker
lemale urlnker
22



Women past year drinkers drank more drinks per week (13.1) when they drank with a family
member or their spouse/partner (9.2) than they did with their close friends (7.3). When drinking
with their family members, women exceeded acceptable weekly consumption standards for
women (13.1 drinks versus the accepted standard of 10 drinks per week).
Marijuana:
14

For the purpose of the RRDAANAS, marijuana includes all forms of cannabis including hash
and hash oil. The focus is on lifetime use and use in the past year. RRDAANAS respondents
were asked: "Ìn the past 12 months, how often have you used marijuana (e.g. cannabis, grass,
pot, hash, hash oil)?¨ They also were asked to circle one of nine responses which included:
once or twice, once a month, 2 -3 times a month, once a week, 2-3 times a week, 4-6 times a
week, daily, used by not in the past 12 months, or never used in lifetime. This question
provided the prevalence and frequency of marijuana use.
Seventy-five percent (75%) of respondents reported using marijuana at least once in their
lifetime
15
compared to 45% of Canadians who reported lifetime use in the Canadian
Addiction Survey (2005).
16

A review of the RRDAANAS and the Canadian Addiction Survey (2005) shows that 3.4 times
more Needs Assessment respondents used marijuana in the past year as did Canadian
respondents (48% and 14%
17
). Past year Needs Assessment Survey respondents comprise
66% of lifetime users.
Men respondents were significantly more likely to have used marijuana in their lifetime than
women respondents (84% and 68%). Needs Assessment Survey male respondents also were
more likely to have used marijuana in their lifetime than Canadian males (84% and 50%
18
).
0.0
3.0
10.0
13.0
20.0
23.0
30.0
Spouse/
ÞarLner
Close lrlends lamllv Member
M
e
a
n

N
o
.

o
f

D
r
|
n
k
s
Þersons Usua||y Dr|nk W|th
Chart 9: Mean Number of Dr|nks Consumed Þer
Week 8y Þerson Usua||y Dr|nk W|th and 8y Gender
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|on Needs
Assessment 5urvey
1oLal Aborlalnal
Male urlnker
lemale urlnker
23

Men past year users outnumbered Canadian male past year users by 3 times the rate (56% and
18%
19
).
Women survey respondents were more likely to have used marijuana in their lifetime than
Canadian females (68% and 3%
20
). Four (4) times as many women survey respondents used
marijuana in the past year as Canadian females (43% and 10%
21
).
Fifty-seven percent (57%) of 15 to 17 year old survey respondents said they used marijuana in
the past 12 months. Male youth, aged 15 to 17 years, were more likely to have used marijuana
in the past year than females in the same age group (64% and 52%) but the difference was not
statistically significant.
Of the survey respondents, aged 18 to 24, 65% reported using marijuana in the past year. Men
and women in this age group were equally as likely to have used marijuana in the past year
(65% and 65%).
In the 12 months preceding the survey, 52% of respondents, aged 25 to 49, said they used
marijuana. Significantly more males used marijuana in the past year than females (64% and
45%).
In the 50+ age group, 20% Aboriginal respondents said they had used marijuana in the past
year. There was no statistically significant difference in the number of men and women in this
age group who used marijuana in the past year (29% and 15%).
Cocaine:
22

RRDAANAS respondents were asked: "Ìn the past 12 months, how often have you used
cocaine (e.g. coke, snow, snort, blow)?¨ Again, they were asked to circle one of nine responses
which included: once or twice, once a month, 2 -3 times a month, once a week, 2-3 times a
week, 4-6 times a week, daily, used by not in the past 12 months, or never used in lifetime. This
question provided the prevalence and frequency of cocaine use.
Fifty-seven percent (57%) of Needs Assessment Survey had never used cocaine in their
lifetime. Just over 43% of respondents reported having used cocaine at some time in their life.
Only 11% of respondents in the Canadian Addiction Survey report having tried cocaine.
23

Men were more likely to have used cocaine during their life (54%) than women (36%). Men
respondents were significantly more likely to have tried using cocaine than Canadian males
(54% and 14%
24
).
Aboriginal females were also more likely to have used cocaine during their lifetime than
Canadian females (36% and 7%
25
). Just over 5 times more Aboriginal females than Canadian
females have tried cocaine.
Forty-four percent (44%) of respondents in the 15 to 24 age group reported having used
cocaine during their lifetime compared to 25% of Canadians in the Canadian Addictions Survey
(2005).
26

24

Chart 10 shows the percentage of Needs Assessment Survey respondents by age group that
said they had used cocaine in the past 12 months.
A review of the number of Needs Assessment Survey past year users compared to Canadian
past year users reveals that Needs Assessment Survey respondents were significantly more
likely to have used cocaine than Canadians (18% and 2%
27
).
In the 15 to 17 age group, 16% of respondents reported using cocaine in the past year. More
males in the 15 to 27 age group reported using cocaine in the past 12 months than any other
age group (33%). Males in this age group were 10 times more likely to use cocaine than
females in the same age group (33% and 3%).
Twenty-eight percent (28%) of respondents in the 18 to 24 age group (28%) used cocaine in the
past 12 months. Overall, there were no significant differences in the percentage of male versus
females in this age group who reported using cocaine in the past year (28% and 27%).

In the 25 to 49 age group, 19% of respondents said they used cocaine in the past year. Again,
males in this age group are more likely than females to have used cocaine in the past year
(26% and 15%).
Four percent (4%) of Aboriginal respondents in the 50+ age group reported using cocaine in the
past year. Male Aboriginals in the 50+ age group were more likely to have used cocaine in the
past year than Aboriginal females (6% and 3%).
0
3
10
13
20
23
30
33
Þ
e
r
c
e
n
t
a
g
e
Age Group
Chart 10: ¼ of Abor|g|na| kespondents Us|ng
Coca|ne/Crack |n Þast 12 Months 8y Age and Gender
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|on Needs
Assessment 5urvey
23

Illicit Drugs (Excluding Marijuana, Cocaine and Opiates):
28


RRDAANAS respondents were asked in the past 12 months, how often they used certain illicit
drugs. Respondents were asked to circle one of nine responses which included: once or twice,
once a month, 2 -3 times a month, once a week, 2-3 times a week, 4-6 times a week, daily,
used by not in the past 12 months, or never used in lifetime. This question provided the
prevalence and frequency of use.
Fifty-seven percent (57%) of respondents said they have never used illicit drugs. Thirty percent
(30%) said they had used illicit drugs but not in the past 12 months. The remaining 13% said
they had used illicit drugs in the past 12 months. Former illicit drug users had on average 10.0
years of abstinence from illicit drug use. Women respondents had 11.5 years of abstinence
from illicit drugs compared to 8.7 years for men.
Over half of men respondents (52%) reported using illicit drugs in their lifetime compared to
33% of women respondents. Nineteen percent (19%) of men respondents currently use while
9% of women respondents currently use.
In order to determine age of initiation, the RRDAANAS also asked respondents who used illicit
drugs at what age they first used. The mean age for first using an illicit drug was 17 years of
age. Men first used illicit drugs at a younger age than women (15.7 years and 18.1 years).
Thirty-six percent (36%) of respondents who used reported they first started using illicit drugs
when they were aged 14 years or less. More men respondents reported starting to use illicit
drugs when they were 14 years of age or less than women (41% and 31%).
Of those who reported using illicit drugs, 46% said they began first using when they were 15 to
19 years of age. Of men respondents, 49% began first using when they were between 15 and
19. This compares to 43% of women respondents.
Fewer respondents reported first using illicit drugs when they were in the 20+ age group
(18.4%). Of those who first started using illicit drugs when they were age 20 or more, more
were females than males (26% and 10%).
Chart 11 shows the use of illicit substances by age group and by gender.
26



A comparison of illicit substance use by age group reveals that 24% of survey respondents in
the 15 to 17 year age group have used illicit substances in the past year. Approximately, 6.9
more males than females in this age group reported using an illicit substance in the past 12
months (48% males and 7% females).
In the 18 to 24 age group, 17% of respondents said they had used an illicit substance in the
past 12 months.
29
Again males outnumber females in their reported use (29% and 8%).
Of respondents in the 25 to 49 year age group, 14% reported having used an illicit substance in
the past year. Again, more males in this age group than females report current use (17% and
12%).
Illicit substance use in the 50+ age group is low. Only 3% report current use. In the survey, no
males in the 50+ age group reported using illicit drugs while 5% of females in the 50+ group
reported using in the past year.
Opiate Use:
30

Because opiate use has become such a problem for many Aboriginal communities, opiate use
is highlighted here.
A. Prescription Opiate Use:
Twenty-four percent (24%) of respondents who used illicit drugs reported using opiates with a
prescription in the past 12 months. Twenty percent (20%) had used prescription opiates in their
0
3
10
13
20
23
30
33
40
43
30
Þ
e
r
c
e
n
t
a
g
e
Age Group
Chart 11: ¼ of Abor|g|na| kespondents Us|ng I|||c|t
5ubstances |n past 12 months by Age and Gender
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|on Needs
Assessment 5urvey
27

lifetime but not in the past 12 months and 57% had never used opiates with a prescription in
their lifetime.
Chart 12 shows the percentage of respondents using opiates with a prescription in past 12
months by age group. The age group with the highest use is those aged 25 to 49 (27%),
followed by those aged 18 to 24 (24%). More males aged 25 to 49 used prescribed opiates
than women in the same age group (31% and 24%). More males in the 18 to 24 age group also
use prescribed opiates at a rate higher than women in the same age group (30% and 20%).
While more males in the younger age groups use prescribed opiates than females, this is not
the case in the 50+ age group. In this age group, women used prescribed opiates at a higher
rate than men (26% and 14%).


B. Illicit Opiate Use (Without a Prescription):
Sixty-five percent (65%) of the respondents have never used illicit opiates. Seventy percent
(70%) of women respondents and 57% of men respondents have never used illicit opiates.
Thirty-five percent (35%) of respondents have used illicit opiates at some time in their lives. Of
those respondents who said they tried illicit opiates at some time in their lives, 22% report
having used in the past 12 months. Twenty-eight percent (28%) of male respondents said they
had used opiates without a prescription in the past 12 months while 18% of women respondents
used illicit opiates in the 12 months preceding the survey.
Chart 13 shows monthly opiate without a prescription by age group and gender.
0
20
40
13 - 18 19 - 24 23 - 49 30+
¼

o
f

k
e
s
p
o
n
d
e
n
t
s
Age Group
Chart 12: Cp|ate Use W|th Þrescr|pt|on |n Þast 12
Months 8y Age Group
ka|ny k|ver D|str|ct Needs Abor|g|na| Add|ct|on Needs
Assessment 5urvey
1oLal
Male
lemale
28


Twenty-six percent (26%) of those who said they used illicit opiates on a monthly basis were in
the 15 to 17 year age group. Men respondents in this age group were significantly more likely
than women respondents in the same age group to use illicit opiates monthly (38% and. 17%).
In the 18 to 24 age group, 33% of respondents reported using illicit opiates monthly. Thirty-six
percent (36%) of monthly users were men in the 18 to 24 age group while 31% were women.
In the 25 to 49 age group, 22% of respondents said they have used illicit opiates monthly.
Twenty-eight (28%) of men in the 25 to 49 age group reported having used illicit opiates monthly
compared to 18% of women in the same age group.
In the 50+ age group, 7% of respondents report using illicit opiates monthly. Just over twice as
many men in this age group used illicit opiates monthly women in the same age group (11% and
5%).


Injection Drug Use:
31

Respondents were asked whether they had ever injected illicit drugs in their life and whether
they had injected drugs in the past 12 months. If they responded yes to either question, they
were asked a follow-up question concerning whether they had ever shared a needle, syringe,
cooker/spoon or filter with anyone ever in their lives or in the past 12 months.
Of those who have used illicit drugs, 10% reported having used injection drugs at some time in
their lifetime. A similar percentage of men and women respondents reported having used
injection drugs (11% and 10%).
Two percent (2%) of those who have used injection drugs did so in the past 12 months. More
men respondents than women report using illicit injection drugs in the past 12 months (3% and
2%).
0
10
20
30
40
30
13 - 18 19 - 24 23 - 49 30+ ¼

o
f

k
e
s
p
o
n
d
e
n
t
s
Age Group
Chart 13: Cp|ate Use Month|y W|thout A Þrescr|p|t|on In
Þast 12 Months 8y Age Group & Gender
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|ons Needs
Assessment 5urvey
1oLal
Male
lemale
29

Tobacco:
32

Responders were only asked about smoking and not other forms of tobacco use. Respondents
were asked if they had ever smoked daily, how old they were when they started smoking daily,
whether they currently smoke and how often, the number of cigarettes they smoke each day
and if they are not current smokers how long they had been abstinent. Respondents were also
asked whether they smoked for ceremonial purposes.
Eighty-one percent (81%) of respondents said that they had smoked daily at sometime in their
lives. There was no significant difference between men and women (83% and 79%). Sixty-nine
percent (69%) of those who currently smoke do so daily. Again, there was no significant
difference been men and women who reported currently smoking daily (73% and 66%). Eleven
percent (11%) said they were occasional smokers and 20% said they did not smoke at all.
Sixty percent (60%) of respondents who smoke started when they were 14 years of age or less
while 40% reported they were aged 15 and over when they first started. Slightly more women
reported first smoking when they were 14 or less but there was no statistical difference between
the genders (62% and 57%). An examination of smoking by age group shows the highest
prevalence of smokers is in the 18 to 24 age group (80%) followed by youth in the 15 to 17 age
group (79%), those 25 to 49 (67%) and those 50 and over (61%). There was no significant
gender difference across the age groups. However, 91% of male youth aged 15 to 17 currently
smoke.
Respondents smoked on average 12 cigarettes a day. Fifty-four percent (54%) smoke between
1 and 10 cigarettes daily while 46% smoke 11 or more cigarettes on a daily basis. Women
smoke significantly fewer cigarettes on a daily basis than men (mean 11.1 and 13.3). Sixty-one
percent (61%) of women smoke 1 to 10 cigarettes daily compared to 46% of men.
The respondents who reported having quit smoking were abstinent for an average of 11.8
years. Women were abstinent longer than men but the difference was not significant (mean
13.3 and 9.3 years). Forty percent (40%) of respondents reported having quit for 11 or more
years while 39% had not smoked for one to five years. Women were more likely to report being
abstinent for 11 or more (45%) while men were more likely to report being smoke free for one to
five years (56%).
Twenty-eight percent (28%) of respondents report smoking for ceremonial purposes. Men were
significantly more likely to report smoking for ceremonial purposes than women (35% and 23%).


1
Adlaf, L.M., 8ealn, Þl. & Sawka, L. (Lds.). (2003) ĂŶĂĚŝĂŶĚĚŝĐƚŝŽŶ^ƵƌǀĞLJ;^Ϳ͗ŶĂƚŝŽŶĂůƐƵƌǀĞLJŽĨĂŶĂĚŝĂŶƐ͛
!"#$%&$'()%*%($'+,$%-*#.$,.!/"0$$1.#2'(#+)#$%&$!"#$'+,$.#('-#,$*'.3"0$4#-'5(#,$.#6%.-. CLLawa: Canadlan CenLre on
SubsLance Abuse.
1he Canadlan AddlcLlon Survev ls a naLlonal Lelephone survev conducLed ln 2004 Lo deLermlne Lhe prevalence,
lncldence and paLLern of alcohol and oLher drua use ln Lhe Canadlan populaLlon aaed 13 and over. lL also
ŵĞĂƐƵƌĞĚƚŚĞĞdžƚĞŶƚŽĨŚĂƌŵĂƐƐŽĐŝĂƚĞĚǁŝƚŚĂŶĂĚŝĂŶƐ͛ƐƵďƐƚĂŶĐĞƵƐĞ͘ZŝƐŬĂŶĚƉƌŽƚĞĐƚŝǀĞĨĂĐƚŽƌƐǁĞƌĞĂůƐŽ
examlned as well as Canadlans oplnlons abouL addlcLlon pollcles.
30


2
newLon-1avlor, 8. & Larlon, k. (2009) 7'5+8$752#.$45"-.5)-$9:%.5/5+'($9,,5)-5%+$;##,"$9""#""3#+-$<!.2#8$7#6%.-$
1oronLo, Cn CenLre for AddlcLlon and MenLal PealLh.
3
ln Lhls secreLlon of Lhe reporL, daLa on respondenLs ls based on 1able 3, p. 69 of Lhe 7'5+8$752#.$45"-.5)-$9:%.5/5+'($
9,,5)-5%+$;##,"$9""#""3#+-$<!.2#8=$CLher daLa sources are as clLed.
4
Adlaf, 8ealn & Sawka (Lds.), p. 23.
3
lbld., p. 13.
6
CranL, 8l., uawson, uA. (1997). "Aae aL onseL of alcohol use and lLs assoclaLlon wlLh uSM-lv alcohol abuse and
dependence: resulLs from Lhe naLlonal LonalLudlnal Alcohol Lpldemloloalc Survev.". >$<!:"-$9:!"# 9: 103ʹ10.
7
lbld., p. 27.
8
lbld.
9
lbld., p. 22.
10
lbld., p. 27.
11
lbld.
12
newLon-dĂLJůŽƌΘ>ĂƌŝŽŶ͘WĞƌĐĞŶƚĂŐĞŝƐĐĂůĐƵůĂƚĞĚĂƐ͞ŽŶĐĞĂǁĞĞŬ͟ƉůƵƐ͞Ϯʹ ϯƚŝŵĞƐĂǁĞĞŬ͘͟
13
Wechsler eL al. 1993 as clLed ln ĂŶĂĚŝĂŶĚĚŝĐƚŝŽŶ^ƵƌǀĞLJ;^Ϳ͗ŶĂƚŝŽŶĂůƐƵƌǀĞLJŽĨĂŶĂĚŝĂŶƐ͛ƵƐĞŽĨĂůĐŽŚŽů
'+,$%-*#.$,.!/"0$$1.#2'(#+)#$%&$!"#$'+,$.#('-#,$*'.3"0$4#-'5(#,$.#6%.-. CLLawa: Canadlan CenLre on SubsLance
Abuse. p. 23.
14
ln Lhls secreLlon of Lhe reporL, daLa on respondenLs ls based on 1able 6, p. 74 of Lhe 7'5+8$752#.$45"-.5)-$
9:%.5/5+'($9,,5)-5%+$;##,"$9""#""3#+-$<!.2#8=$CLher daLa sources are as clLed.
13
newLon-dĂLJůŽƌΘ>ĂƌŝŽŶ͕Ɖ͘ϳϭ͘WĞƌĐĞŶƚĂŐĞĐĂůĐƵůĂƚĞĚƵƐŝŶŐ͞ƵƐĞĚďƵƚŶŽƚŝŶƚŚĞƉĂƐƚϭϮŵŽŶƚŚƐ͟ĂŶĚ͞ƵƐĞĚŝŶ
ƚŚĞƉĂƐƚϭϮŵŽŶƚŚƐ͘͟
16
Adlaf, 8ealn & Sawka (Lds.), p. 48.
17
lbld.
18
lbld.
19
lbld.
20
lbld.
21
lbld.
22
ln Lhls secreLlon of Lhe reporL, daLa on respondenLs ls based on 1able 6, p. 74 of Lhe 7'5+8$752#.$45"-.5)-$
9:%.5/5+'($9,,5)-5%+$;##,"$9""#""3#+-$<!.2#8=$CLher daLa sources are as clLed.
23
Adlaf, 8ealn & Sawka (Lds.), p. 61.
24
lbld.
23
lbld.
26
lbld.
27
lbld., p. 62.
28
ln Lhls secreLlon of Lhe reporL, daLa on respondenLs ls based on 1able 6, p. 74 of Lhe 7'5+8$752#.$45"-.5)-$
9:%.5/5+'($9,,5)-5%+$;##,"$9""#""3#+-$<!.2#8=$CLher daLa sources are as clLed.
29
lbld.
30
ln Lhls secreLlon of Lhe reporL, daLa on respondenLs ls based on 1able 6, p. 74 of Lhe 7'5+8$752#.$45"-.5)-$
9:%.5/5+'($9,,5)-5%+$;##,"$9""#""3#+-$<!.2#8=$CLher daLa sources are as clLed.
31
ln Lhls secreLlon of Lhe reporL, daLa on respondenLs ls based on 1able 6, p. 74 of Lhe 7'5+8$752#.$45"-.5)-$
9:%.5/5+'($9,,5)-5%+$;##,"$9""#""3#+-$<!.2#8=$CLher daLa sources are as clLed.
32
ln Lhls secreLlon of Lhe reporL, daLa on respondenLs ls based on 1able 11, p. 81 of Lhe 7'5+8$752#.$45"-.5)-$
9:%.5/5+'($9,,5)-5%+$;##,"$9""#""3#+-$<!.2#8=$CLher daLa sources are as clLed.
31

Chapter 4: Trends in Prescription
Central Nervous System Drug Use
amongst Four First Nations in the Rainy
River District
Introduction:
There is a common held myth that if a doctor prescribes a drug, it must be good for you. Many
people also believe prescription medication cannot be addictive. Neither of these statements is
accurate. Many medications are potentially hazardous if used incorrectly, even over-the-counter
medications. Any mood-altering drug can be addictive, even if the doctor prescribed it. If a
patient does not follow the prescription as directed by consuming the dosage more often or by
consuming more of the drug than prescribed, the abuse can lead to addiction.
Because illegal drug use captures more public attention, it is easy to overlook the role legally
prescribed drugs play in drug addiction. This section of the report examines trends in central
nervous system drug use by members of the four (4) First Nations participating in the Treatment
and Support Services Project (Couchiching, Anishinaabeg of Naongashiing,
Mishkosiimiiniiziibig, and Mitaanjigaming First Nations) who use pharmacy benefits under the
Non-Insured Health Benefit Program. For the purposes of this report, central nervous system
drugs include central nervous system sedatives, narcotics and stimulants.
The Non-Insured Health Benefit Program of the First Nation and Inuit Health
Branch, Health Canada provides medically necessary health benefits for eligible First Nations
people and Inuit. Métis are not eligible for benefits under the program. Coverage includes a
specified range of drugs, dental care, vision care, medical supplies and equipment, sort-term
crisis intervention mental health counselling and medical transportation. The goods and
services that NIHB provides are those not provided either by private insurance plans, provincial
or territorial insured health and social programs, or by other publicly funded programs.
As part of its accountability framework, the First Nation and Inuit Health Branch maintains a data
base containing client information, pharmacy provider information and physician prescriber
information, as well as, drug prescriptions, quantities, dates when prescriptions were filled and
their costs.
Utilization of Central Nervous System Drugs:
The Treatment and Support Services Project, with the approval of the First Nations concerned,
requested non-identifying information on trends in the prescribing of central nervous system
drugs for members of the four (4) First Nations from the Non-insured Health Benefit Program.
32

Health Canada provided data for seven fiscal years, beginning in FY2002-2003 and ending in
FY2008-2009.
1
Ontario Region also provided a brief analysis of the data based on age group
and gender, where appropriate, and on utilization trends. The data was further analyzed by the
Treatment and Support Services Project.
The data included in this section of the report is an under representation of the number of
central nervous system prescriptions provided to members of the four (4) First Nations. The
data only includes those prescriptions paid for under the Non-Insured Health Benefit Program
and does not include prescriptions covered under private insurance plans, provincial or territorial
insured health and social programs, by other publicly funded programs or paid for by cash. The
data includes members of the four (4) First Nations resident on and off-reserve that filled
prescriptions at pharmacies in Kenora, Dryden, Rainy River, Atikokan, Fort Frances and Emo.
For the purpose of the data, "clients¨ are distinct persons, counted once, regardless of how
many prescriptions they have filled.
2
Narcotics include all opiate agonists according to the
America Hospital Formulary Service (AHFS) classification.
3
Long-acting narcotics include those
agents which are designed to be taken twice daily or less frequently such as Oxycontin, MS
Contin, Duragesic patches and others.
4

A. Trends in Narcotic Use:
Chart 14 shows the trend in narcotic use for NIHB clients from the four (4) study First Nations
over a seven year period as recorded by the Non-Insured Health Benefit Program.
5
Both the
number of clients receiving narcotics as well as the quantity of narcotics dispensed increased
until FY2007-2008.
6
Between FY2002-2003 and FY2007-2008, the number of clients receiving
narcotics, as well as, the quantity of narcotics dispensed grew. In FY2008-2009, both the
number of clients receiving narcotics and the quantity of narcotics dispensed decreased.

0
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l?2002-3 l?2003-4 l?2004-3 l?2003-6 l?2006-7 l?2007-8 l?2008-9
#

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a
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I|sca| ¥ear
Chart 14: 1rends |n Narcot|c Use
Couch|ch|ng, 5tan[|kom|ng, 8|g Grassy and 8|g Is|and I|rst Nat|ons
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|ons Needs Assessment
CllenLs 8ecelvlna narcoLlcs CuanLlLv of narcoLlcs ulspensed
33

In FY2002-2003, the average quantity of narcotics dispensed to NIHB clients in the four (4) First
Nations was 357 tablets per person. In FY2006-2007, the average quantity of narcotics
dispensed per client peaked at 510.6 tablets per client and declined in subsequent years. In
FY2008-2009, the average number of narcotics dispensed was 448.6 tablets per client.
Chart 15 shows the percentage of NIHB First Nation clients from the four (4) First Nations by
age group receiving narcotics in 2008.
7
It shows in the 20 to 29 age group, women and men
were equally as likely to receive narcotics (41% and 41%). In the 30 to 39 age group, women
were slightly more likely than men to receive narcotics (31% and 27%). In the 40 to 49 age
group, women and men were again equally as likely to receive narcotics (37% and 36%).
However in the 50 to 59 age group, men were significantly more likely than women to be
prescribed narcotics (50% and 39%) as were men in the 60 to 69 age group (38% and 32%). In
the 70 to 79 age group, women and men were again equally as likely to be prescribed narcotics
(22% and 23%).




10°
20°
30°
40°
30°
60°
20-29 30-39 40-49 30-39 60-69 70-79
¼

o
f

c
|
|
e
n
t
s
Age Group
Chart 15: ¼ of c||ents rece|v|ng a narcot|c
Couch|ch|ng, 5tan[|kom|ng, 8|g Grassy and 8|g Is|and I|rst Nat|ons
2008
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|ons Needs Assessment
° of female cllenLs recelvlna narcoLlcs ° of male cllenLs recelvlna narcoLlcs
34

B. Trends in Acetaminophen and Codeine Use:
Chart 16 shows trends in acetaminophen + codeine use by NIHB First Nation Clients in four (4)
First Nations.
8
Acetaminophen + codeine is used to treat mild to moderate pain.
The number of clients receiving acetaminophen + codeine products peaked in FY2003-2004
and remained fairly constant between FY2004-2005 and FY2007-2008. While the number of
clients receiving acetaminophen + codeine remained relatively the same, the quantity of tablets
dispensed to these clients grew dramatically peaking in FY2006-2007 at 289.6 tablets per client.
In FY2007-2008, the amount of tablets being prescribed per client began to decline. In FY2008-
2009, both the number of clients receiving acetaminophen + codeine and the amount dispensed
declined significantly.



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l?2002-3 l?2003-4 l?2004-3 l?2003-6 l?2006-7 l?2007-8 l?2008-9
#

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I|sca| ¥ear
Chart 16: 1rends |n Acetam|nophen + Code|ne Use
Couch|ch|ng, 5tan[|kom|ng, 8|g Grassy and 8|g Is|and I|rst
Nat|ons
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|ons Needs Assessment
CllenLs 8ecelvlna AceLamlnophen +Codelne & Cenerlcs CuanLlLv ulspensed
33

C. Trends in Percocet and Generics Use:
Chart 17 shows trends in Percocet and generics use by NIHB First Nation clients from the four
(4) First Nations.
9
Percocets are used to treat moderate to severe acute (short term) pain.
Percocets contain oxycodone and acetaminophen.


Both the number of clients receiving Percocets (and generics) and the quantity of tablets
dispensed peaked in FY2007-2008. In FY2008-2009, both the number of clients and the
quantity of tablets dispensed decreased.
D. Trends in Oxycontin Use:
Chart 18 represents trends in Oxycontin use by members of the four (4) First Nations.
10

Oxycontin is designed for the management of moderate to severe pain when a continuous,
around the clock pain reliever is needed for an extended period of time.
11
Oxycontin is highly
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l?2002-3 l?2003-4 l?2004-3 l?2003-6 l?2006-7 l?2007-8 l?2008-9
#

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t

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G
e
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I|sca| ¥ear
Chart 17: 1rends |n Þercocet & Gener|c Use Couch|ch|ng, 5tan[|kom|ng,
8|g Grassy and 8|g Is|and I|rst Nat|ons
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|ons Needs Assessment
CllenLs 8ecelvlna ÞercoceL & Cenerlcs CuanLlLv ulspensed
36

addictive and needs to be dispensed with caution. Oxycontin tablets are not intended for use as
an "as needed¨ analgesic.



Chart 18
12
reveals in FY2007-2008, the quantity of Oxycontin per First Nation client peaked
(1,264 tablets per client). In FY2008-2009, the amount of Oxycontin prescribed per client
dropped while the number of clients remained steady (988.7 pills per client).
13

In FY2002-2003, the Non-Insured Health Benefit Program added Codeine Contin as a limited
use benefit (LU Benefit) requiring prior approval of the Non-Insured Health Benefit Program
before dispensing. Fentanyl patches changed from an open benefit to a limited use benefit,
requiring prior approval, in FY2006. A product will be designated for limited use when it has the
potential for widespread use outside the indications for which benefit has been demonstrated; it
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l?2002-3 l?2003-4 l?2004-3 l?2003-6 l?2006-7 l?2007-8 l?2008-9
#

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I|sca| ¥ear
Chart 18: 1rends |n Cxycont|n Use
Couch|ch|ng, 5tan[|kom|ng, 8|g Grassy and ka|ny k|ver I|rst Nat|ons
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|ons Needs Assessment
CllenLs 8ecelvlna CxvconLln CuanLlLv of CxvconLln ulspensed
37

has proven effectiveness, but is associated with predictable severe adverse effects; it is usually
a second or third line choice for treatment and is required because of allergies, intolerance,
treatment failure or non-compliance with a first line alternative; or it is very costly and a
therapeutically effective alternative is available as a benefit.
Chart 19 shows the quantity and strength of Oxycontin tablets dispensed to members of the four
(4) First Nations between FY2002-2003 and FY2008-2009.
14


Oxycontin in 60 mg, 80 mg, and 160 mg tablets, or a single dose greater than 40 mg, are for
use in opioid-tolerant patients only.
15
A single daily dose greater than 40 mg, or total daily doses
greater than 80 mg, may cause fatal respiratory depression when administered to patients who
are not tolerant to the respiratory depressant effects of opioids.
16
Chart 19 reveals prior to
FY2003-2004, 80mg tablets were not dispensed to the members of these First Nations. In
FY2002-2003, a minimal amount of 40mg tablets were dispensed. In the following year,
0
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l?2002-3 l?2003-4 l?2004-3 l?2003-6 l?2006-7 l?2007-8 l?2008-9
Chart 19: Cuant|ty and 5trength of Cxycont|n 1ab|ets D|spensed
Couch|ch|ng, 5tan[|kom|ng, 8|g Grassy and 8|g Is|and I|rst Nat|ons
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|ons Needs Assessment
CxvconLln 80ma
CxvconLln 40ma
CxvconLln 20ma
CxvconLln 10ma
CxvconLln 3ma
C
u
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38

FY2003-2004, there was a ten-fold increase in the number of 40 mg tablets dispensed. In
FY2004-2005, the amount of 40 mg tablets dispensed almost doubled that of the previous year.
The amount of 40 mg tablets dispensed peaked in FY2007-2008 and declined in FY2008-2009.
A review of the data from the NIHB program on Oxycontin dosage levels reveals most
Oxycontin dispensed to the four (4) First Nations is 40 mgs.
According to the Regional Pharmacist, the Oxycontin in the lower dosages (5mg, 10 mg and
20mg) is more susceptible to abuse because it is more likely to be diverted.
17
A review of the
dosage data shows 5mg tablets have not been dispensed through the NIHB program to any
member of the four (4) First Nations in the seven years for which data is available. Oxycontin in
the 10 mg dosage dispensed through NIHB has declined in the last two years. Oxycontin in the
20 mg dosage peaked in FY2007-2008 and declined in FY2008-2009.
E. Trends in Long-Acting Narcotic Use:
Chart 20 shows the trends in long-acting narcotic use amongst the four (4) First Nations.
18

Overall, the quantity of long-acting narcotics dispensed to the four (4) First Nations is
decreasing, but Oxycontin is making up an increasing proportion of this category.
19
In FY2008-
2009, Oxycontin comprised 47% of the long-acting narcotics dispensed to the First Nations.


0
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l?2002-3 l?2003-4 l?2004-3 l?2003-6 l?2006-7 l?2007-8 l?2008-9
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p
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I|sca| ¥ear
Chart 20: 1rends |n Long-Act|ng Narcot|c Use
Couch|ch|ng, 5tan[|kom|ng, 8|g Grassy and 8|g Is|and I|rst
Nat|ons
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|on Needs Assessment
CxvconLln - all sLrenaLhs
Lona AcLlna narcoLlcs (nC oxvconLln)
39

F. Trends in Methadone Use:
Chart 21 shows trends in Methadone versus narcotic use for the four (4) First Nations.
20

Methadone is a synthetic opioid and is used most commonly to treat dpendence on other opioid
drugs such as heroin, codeine and morphine. The chart's supporting data reveals as the
number of methadone clients has increased, the number of narcotic users has decreased by a
similar amount.
21




G. Trends in Benzodiazpine Use:
Chart 22 shows the trends in benzodiazepines dispensed to NIHB First Nation clients in the four
(4) First Nations.
22
Benzodiazepines, or benzos, are a group of depressant drugs commonly
290
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320
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l?2006-7 l?2007-8 l?2008-9
#

M
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I|sca| ¥ear
Chart 21: 1rends |n Methadone versus Narcot|c Use
Couch|ch|ng, 5tan[|kom|ng, 8|g Grassy and 8|g Is|and I|rst
Nat|ons
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|ons Needs Assessment
MeLhadone CllenLs narcoLlc CllenLs
40

called tranquillizers and sleeping pills. Some of the most well-known benzos (and their trade
names are: Chlordiazepoxide (Librium), Alprazolam (Xanax), Diazepam (Valium), Lorazepam
(Ativan) and Flunitrazepam (Rohypnol). Three benzodiazepines were de-listed from the Non-
Insured Health Benefit Program in FY2007-8 with current recipients grandfathered in.
23

The chart reveals both the number of clients and the quantity of benzodiazepines dispensed to
the four (4) First Nations have remained relatively stable over the years.
24




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I|sca| ¥ear
Chart 22: 1rends |n 8enzod|azep|ne Use
Couch|ch|ng, 5tan[|kom|ng, 8|g Grassy and 8|g Is|and I|rst Nat|ons
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|ons Needs Assesssment
CllenLs 8ecelvlna 8enzos CuanLlLv of 8enzos ulspensed
41

Chart 23 shows the percentage of clients from the four (4) First Nations receiving
benzodiazepines by age and gender in 2008.
25
The chart shows more First Nations women
than men receive prescrptions of benzodiazepines.
26

Women in the 40 to 49 age group are more likely to be prescribed benzodiazepines than
women in other age groups. Women in the age group are 2.3 times as likely to be prescribed
benzodiazepines than men in the same age group. Approved benzodiazepine use is for anxiety
or sleeping problems, however, some women are given the drug when experiencing trauma,
grief, chronic illness, physical pain, or adjusting to a major life transition.
27
No data is available
on whether the individuals prescribed this drug also receive psychosocial support.




10°
13°
20°
23°
20-29 30-39 40-49 30-39 60-69 70-79
¼

o
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c
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s
Age Group
Chart 23: ¼ of NIn8 C||ents kece|v|ng 8enzod|azep|nes by Age
and Gender
Couch|ch|ng, 5tan[|kom|ng, 8|g Grassy and 8|g Is|and I|rst
Nat|ons - 2008
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|ons Needs Assessment
° of female cllenLs recelvlna benzodlazeplnes
° of male cllenLs recelvlna benzodlazeplnes
42

H. Trends in Stimulant Use:
Chart 24 shows trends in the use of stimulants by members of the four (4) First Nations.
28

Stimulants include all strengths and generics and forms of Ritalin, Dexedrine, Biphentin,
Concerta and Alertec.
29

Both the number of clients and the quantity of stimulants dispensed to the First Nations in
question has decreased steadily over the last three years.
30





0
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I|sca| ¥ear
Chart 24: 1rends |n 5t|mu|ant Use
Couch|ch|ng, 5tan[|kom|ng, 8|g Grassy and 8|g Is|and I|rst Nat|ons
ka|ny k|ver D|str|ct Abor|g|na| Add|ct|ons Needs Assessment
CllenLs 8ecelvlna SLlmulanLs CuanLlLv of SLlmulanLs ulspensed
43

Client Safety and Prescription Monitoring:
The NIHB Program has come under scrutiny of the Auditor General of Canada and the Standing
Committee on Public Accounts for its management of the NIHB program. The Office of the
Auditor General reported to Parliament in May 2006 Health Canada had made little progress on
its 1997 Audit recommendations. Subsequent reports found the Department "slow to intervene
where potentially inappropriate use of prescription drugs was observed and it was not
monitoring the number of prescription drug-related deaths of those covered by its drug benefits
program.¨
31

In February 2007, the Non-Insured Health Benefits Program, Health Canada issued a "Report
on Client Safety Ìmprovements.¨
32
While the majority of First Nations' clients use prescription
drugs in an appropriate way, the NIHB Program has implemented four pillars to client safety that
focuses attention on cases of concern.
A. Pillar 1 - Warning Messages to Pharmacists:
The NIHB Point-of-Sale System warns front-line pharmacists about potential client safety issues
including "drug to drug interaction potential¨, "duplicate therapy¨ (client prescribed a drug from
the same therapy class), "duplicate therapy multi-pharmacy¨ (original prescription filled at
another pharmacy), "duplicate drug¨ (client has received the same drug and has used less than
2/3 of the medical based on the days supply), and "duplicate drug multi-pharmacy¨ (client has
received the same drug and has used less than 2/3 of the medicine based on the days supply;
however the original prescription was filled by another pharmacist). In April 2006, the NIHB
Program added a special warning to warn about the potential misuse of specific drugs including
narcotic-based drug products (opioids such as morphine, codeine, and oxycodone which are
used to relieve pain), benzodiazepines (so-called "minor¨ tranquilizers, sleep aids and anti-
anxiety medications) and methadone (a long-lasting synthetic opioid used to treat pain and/or
opioid addiction).
33
The "potential misuse of prescription drugs¨ warning will appear in
situations where clients access 3 or more benzodiazepines; 3 or more opioids, 3 or more
benzodiazepines and 3 or more opioids; methadone in combination with other opioid drugs.
34

Claims submitted through the NIHB Point-of-Sale system which prompt "drug-to-drug interaction
potential¨ or "duplicate drug¨ or "duplicate drug multi-pharmacy¨ will not be accepted for
payment.
35
In order to submit the claims for payment, pharmacists who receive the rejection
message must provide an override code back to the NIHB Program to explain the action they
took based on their professional judgment, in deciding to dispense the claim.
36
The NIHB
program will pay the prescription in cases where pharmacist chooses to override a rejected
claim.
37

When a warning and rejection message appears, a pharmacist may decline to fill the
prescription or s/he may choose one of eleven override actions. The potential override actions
are:
38


44

Pharmacy Codes for Overriding NIHB Rejection Messages
Consult Prescriber and filled Rx as Written.
Consult Prescriber and Changed Dose.
Consult Prescriber and Changed Instructions For Use.
Consult Prescriber and Changed Drug.
Consult Prescriber and Changed Quantity.
Patient Gave Adequate Explanation, Rx Filled as Written.
Cautioned Patient, Rx Filled as Written.
Consult Other Source and Filled Rx As Written.
Consult Other source, Alter Rx and Filled.
Assessed Patient, Therapy is Appropriate.
Replacement, Item Lost or Broken.

NHIB monitors the number of pharmacy claims flagged with warning messages or rejected by
the point-of-sale system.
B. Pillar 2 - Rejection Messages Regarding Drug Therapy Patterns:
The NIHB Program also provides rejection messages with a pharmacist cannot override.
39

These messages occur when a client's claims history indicates potential misuse or overuse of
acetaminophen-based opioids products (Tylenol 3, Oxycet/Percocet), as well as
benzodiazepines. A pharmacist receiving this message must contact the NIHB Drug Exception
Centre to obtain the Program's approval before the Program will authorize payment of the
medications in question.
40
The Exceptional Claims Centre must follow up with the client and
prescribing physician to authorize the further use of the drug under the Program.
41

As noted earlier, the NIHB Program placed limits on the maximum allowable doses of all
acetaminophen-based narcotic combination products such as Tylenol 3 in 2005.
42

C. Pillar 3 ± Client and Program Level Trend Analysis:
Client Level Analysis and Follow-up with Health Care Providers
The NIHB Program can anonymously identify clients at highest potential risk for misuse of
benzodiazepines and/or narcotic ÷based products.
43
Anonymous client profiles are reviewed by
NIHB pharmacy consultants, all of whom are licensed health care professionals.
44
When
concerns are identified, and where the client agrees, the NIHB Program, makes a direct
intervention with the client's physician and pharmacist.
45
This may lead to changes in how the
client is prescribed certain drugs.
46

The Prescription Monitoring Program
In January 2007, the NIHB Program established the "Prescription Monitoring Program.¨
47

Focusing initially on benzodiazepines and narcotic-based drugs, the Program monitors on an
on-going basis client drug use patterns with respect to the number of physicians visited and the
number of "potential use of prescription drug¨ warnings generated.
48
Clients identified through
the monitoring process may be placed into the Prescription Monitoring Program (PMP) which
43

then requires the client in question to have future claims verified and authorized by a pharmacist
at NÌHB's Drug Exception Centre.
49
If the client or his/her health care providers cannot provide
evidence to support the continuation of drug therapy, the NIHB Program reserves the right not
to pay for the drugs requested.
50

Program Level Analysis, Identification of Issues and Adjusting Program Requirements
NIHB Headquarters actively analyses broad patterns of drug utilization, prescribing, and
dispensing, on an on-going basis. Once an issue is identified, program interventions are made
to prevent recurrence of inappropriate prescription drug use. These interventions may include
removing a drug from an open-benefit status to a limited-use benefit or in certain circumstances;
the drug may be removed from the approved drug list. The NIHB Program regularly issues
bulletins to keep health professionals who serve First Nation clients informed of NIHB policies
and practices.
D. Pillar 4 ± Drug Use Evaluation Committee:
In 2003, the NIHB Program created the NIHB Drug Used Evaluation Advisory Committee "to
provide independent expert advice to improve health outcomes of First Nations and Inuit clients
through effective use of pharmaceuticals.¨
51
It includes health professionals including four First
Nation physicians.
52
It meets four times a year and reviews drug-use trends for NIHB clients
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47

Chapter 5: Aboriginal Substance
Abuse: Causation and Protective
Factors
Introduction:

For many years, it appeared that alcohol abuse/misuse was on the decline in Aboriginal
communities as uncontrolled drinking became less acceptable. Recent studies report that
Aboriginal populations drink less frequently than does the general population (15% Aboriginal
and 8% Canadian).
1
However, research shows binge drinking
2
occurs at a higher rate in the
Aboriginal community than in the general population.
3
Moreover, it appears more Aboriginal
people are using drugs, and many of these are youth and young adults. The Centre for
Addiction and Mental Health (CAMH) reports the documented rate of illicit drug use among First
Nations nationally is more than double the rate of the general Canadian population (7.3% and
3.0%).
4

Statistics on Aboriginal substance use raises the questions: why are Aboriginal people at
continuing risk for substance abuse? Why are Aboriginal youth and young adults turning to
drugs? The Rainy River District Aboriginal Addictions Needs Assessment Survey incorporated
a question on historical loss (also known as historical trauma) and a question on mental health
and psychological distress. Previous research has directly linked these to Aboriginal substance
use. The results of these two study questions, as well as, discussions in the eighteen (18) focus
groups provides valuable insight into the factors which influence substance use in the study
communities.
Causation:
A. Unresolved Historical Trauma:

There has been a lot written about the devastating effects colonization, the outlawing of
Aboriginal languages and spiritual practices, centuries of forced relocation and assimilation, has
had on Aboriginal people. Whether you call it historical trauma, historical legacy, inter-
generational post-traumatic stress disorder or the Indian holocaust, the fact remains these
events have left a lasting imprint on the psyche of Aboriginal people. Whitbeck et al believes
that "the analogy of the Holocaust may not sufficiently convey¨
5
the North American Indian
experience. They note that because North America was their homeland, North American Indians
had no safe place to return to or to immigrate to when they found themselves the victims of
colonial oppression.


48

In Canada, First Nations were forced to cede their historical lands through the treaty-making
process and relocate to reserves. Like their American counterparts, First Nations' people could
not leave their reserves without the approval of the Indian agent and non-Indians were not
allowed to trade with them without the Ìndian agent's consent. They were forced to abandon
their traditional harvesting, hunting and fishing lifestyle in favour of farming or more civilized
white industrial pursuits. With their traditional means of survival diminished and their
movements restricted, they became wards of the state and dependent on government for food,
shelter and health care.

Whitbeck et al characterize the collective experience of North American Indians as "ethnic
cleansing.¨
6
They also hold that what happened to this continent's indigenous people is not an
historical event that occurred sometime in the past. Colonization and acculturation policies
aimed at eradicating Indians persisted for many generations and continue to this day in the
form of on-going encroachments on Indian lands, attempted restrictions on Aboriginal hunting,
fishing and land-use rights, government unwillingness to support Aboriginal self-governance,
loss of language and cultural integrity, and persistent discrimination across all facets of
Aboriginal life. Because Aboriginal people are constantly surrounded by daily reminders of their
historical losses and because they have to remain ever vigilant against new attacks, the
psychological well-being of Aboriginal people is continually being undermined.

Eduardo Duran et al describes historical trauma as "soul wound.¨
7
Braveheart-Jordan, 1995
supports this view. She describes historical trauma as a "constellation of features in reaction to
the multigenerational, collective, historical, and cumulative psychic wounding over time, both
over the lifespan and across generations.¨
8
Dr. Braveheart's research supports the finding that
because historical trauma has gone unresolved and untreated in the Aboriginal population, it is
now manifest in current social pathology involving high rates of suicide, homicide, domestic
violence, child abuse, alcoholism and other social problems.

Historical Loss Scale:

In 2002, the University of Nebraska-Lincoln obtained funding through a grant from the National
Institute on Drug Abuse and the National Institute on Mental Health in the United States to
undertake a three-year longitudinal study involving three Anishinabe (Ojibway/Chippewa)
reservations in the upper Midwest and five Anishinabe First Nation reserves in Canada. One of
the Canadian reserves was Couchiching First Nation, one of our study communities. The goal of
the Giigewin Miikana (Healing Pathways) Project, as it was known, was to "identify culturally
specific resilience and risk factors that affect children's well-being and then to use the
information to guide the development of culturally based interventions.¨
9


The Giigewin Miikana Project included Les Whitbeck as principle investigator. Working with
Elders, the researchers developed a Historical Loss Scale and a Historical Loss Associated
Symptoms Scale. The Historical Loss Scale assesses "the prevalence and immediacy of
thoughts pertaining to historical loss.¨
10
It enumerates perceived losses and asks respondents
how frequently these losses come to mind. The perceived losses included loss of land, loss of

49

language, loss of spiritual ways, residential school, government relocation, and poor treatment
by government officials, loss of trust due to broken treaties, loss of culture, losses from the
effects of alcohol, loss of respect for Elders, loss through early deaths and loss of traditional
ways.

The Rainy River District Aboriginal Addiction Needs Assessment Survey incorporated the
Historical Loss Scale into its survey questionnaire. The Needs Assessment Survey Report
revealed the following.
11


A high percent of respondents reported thinking about historical losses (66% to 85%). Eighty-
five percent (85%) of respondents indicated they thought about the loss of respect by children
and grandchildren for Elders and loss people through early death. Eighty-four percent (84%)
thought of the loss of respect by children for traditional ways, loss of culture and losses from the
affects of alcohol. Eighty-two percent (82%) think about the loss of traditional spiritual ways,
80% think about loss of language, 77% think about loss of land and 77% think about loss of self
respect because of poor treatment by government officials. Seventy-four percent (74%) think
about loss of family ties because of residential schools, 73% think about loss of trust in whites
because of broken treaties, and 66% think about loss of families from the reserve/area due to
government relocation. Chart 25 illustrates these findings.



The Needs Assessment Survey Report indicates there were no significant gender differences
for 7 of the 12 items of historical loss. However, women were more likely than men to report
0 10 20 30 40 30 60 70 80 90 100
Lhe loss of our land
Lhe loss of our lanauaae
loslna our LradlLlonal splrlLual wavs
Lhe loss of famllv Lles because of resldenLlal ͙
Lhe loss of famllles from Lhe reserve, or area, ͙
loss of self-respecL from poor LreaLmenL bv ͙
Lhe loss of LrusL ln whlLes from borken LreaLles
loslna our culLure
Lhe losses from Lhe effecLs of alcohol on our ͙
loss of respecL bv our chlldren and arandchlldren ͙
loss of our people Lhrouah earlv deaLh
loss of respecL bv our chlldren for LradlLlonal wavs
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thinking about the loss of respect by children/grandchildren for elders (89% and 80%), loses
from the effects of alcohol (88% and 80%), loss of people from early death (88% and 80%), loss
of respect by children for traditional ways (87% and 80%), and loss of their culture (87% and
80%).

There were few items that were statistically significant by age group. However, the Needs
Assessment Survey Report highlighted some interesting age-related patterns. Respondents
between the ages of 25 to 49 were slightly more likely to report thinking about these items at
least once a month, followed by those ages 50 or more. Respondents between the ages of 15
to 17 were equally as likely to report thinking about these items as those in other age groups.
Respondents ages 18 to 24 were slightly less likely to report thinking about these items.

B. The Indian Residential School Experience:

One of the most contentious periods in Aboriginal and non-Aboriginal relations centered on
government policies and practices related to residential schools. To appreciate the effect these
schools had on Aboriginal people, it is important to understand their historical evolution and their
linkage with government Indian policy.

During the early European settlement of Canada, several Christian orders tried to establish
schools for Indian children but were unsuccessful. Ìn the early 1800's, the government of Lower
Canada sought to remove Indians from their traditional lands so that European settlement and
expansion could proceed unhindered by the land's original inhabitants. The government
established experimental Indian settlements in what is now southern Ontario to achieve this
desired outcome. In 1828, Lower Canada formalized this resettlement experiment in a policy
that gave rise to the reserve system. The policy proposed establishing Indians in fixed locations
where they could be educated, converted to Christianity and transformed into farmers.

In 1837, the Government issued a report recommending the removal of Indian children from
their parents and communities so that the goal of "civilizing¨ Ìndians could be accelerated. This
tenet was repeated in 1845 in a report to the Legislature by Dr. Egerton Ryerson, Chief
Superintendent of Education. Referring to Ìndian children, Ryerson said, "Their education must
consist not merely of the training of the mind, but of a waning from the habits and feelings of
their ancestors, and the acquirements of the language, arts and customs of civilized life.¨
12
His
report also proposed the establishment of government-funded religious education administered
by the churches and the creation of Indian industrial schools.

By 1850, it became compulsory for every Indian child, age 6 to 15, to attend school. Children
could be forcibly removed from their parents and their parents fined if they failed to cooperate.
In 1920, compulsory attendance was formalized into law.

In 1860, management of Indian Affairs was transferred from Great Britain to the Province of
Canada. In 1867, the Dominion of Canada was established and the federal government given
responsibility for Indians and lands reserved for Indians.
13


S1


Ìn 1879, Nicholas Flood Davin in his "Report on Ìndustrial Schools for Indians and Half-Breeds¨
advised then Prime Minister John A. Macdonald that industrial schools were a better means of
"civilizing¨ Ìndians than were day schools. Like earlier reports on Ìndian education, the Gavin
Report advocated government efforts to "civilize¨ Ìndians focus on their children. Children, he
advised, should be removed from their homes and put in residential schools, as "the influence of
the wigwam was stronger than that of the [day] school.¨ J.A. Mcrae, federal Inspector of Indian
Agencies and Reserves, argued that Indian adults could not be changed from their "present
state of ignorance, superstition and helplessness¨ because they were "physically, mentally and
morally...unfitted to bear such a complete metamorphosis.¨ The churches (Anglican, Catholic,
Methodist and Presbyterian) were duplicitous in supporting the removal of Indian children from
their families. The Archbishop of St. Boniface said Ìndian children should be "caught young to
be saved from what is on the whole the degenerating influence of their home environment.¨ The
churches, of course, had another motivation. They wanted to Christianize Indian children in the
name of God and save them from the pagan and superstitious influence of their parent's
traditional beliefs. Christianity was to supplant Indian spirituality.

By 1896, there were 45 Indian schools in Canada, including 24 industrial schools. In 1907, Dr.
Peter Bryce, the Chief Medical Officer for the Department of Indian Affairs, reported on the
deplorable health conditions in many of the residential schools.
14
The overcrowding, poor
sanitation and lack of medical care in Indian schools had led to the rampant spread of
communicable disease. His report indicated that within five years of entering residential
schools, 35% to 60% of the children were dead.
15
The File Hills Indian Boarding School in
Saskatchewan reportedly had a death rate of 69 percent.
16


Bryce blamed the churches and staff for not looking after the health of their Indian charges. He
also said that the poor health conditions in the schools were the result of confusion between
government and church over jurisdiction for Indian education. The government blamed the
churches for not properly maintaining the schools and for failing to maintain proper sanitary
practices. The churches said inadequate government funding made it impossible for them to
meet acceptable health and facility standards. Indian students were also blamed for their own ill
health. Government and church officials said tuberculosis was hereditary (a common belief of
the time), that it was the result of poor living conditions in the children's home communities, and
because Indians had a weak constitution and a genetic predisposition to illness. Bryce's 1907
report was buried by the government of the day. Its content would not be made public until
1922 when Bryce published it himself in a pamphlet entitled "A National Crime.¨

Samuel H. Blake, the head of a committee investigating the work of missionaries among
Canada's native people, wrote a report proposing the reforming of the native education system.
He wanted the federal government to assume full financial responsibility for the management of
residential schools. His committee also advocated for improved public health in the schools and
a higher quality of education for native students. The committee recommended industrial
schools be abolished in favour of day schools. His recommendations, like those of Bryce, met

S2

with opposition. Writing to Archdeacon J.W. Tims, principle of the Calgary Industrial School,
Blake wrote:

"How in the world you can be satisfied with statistics which show that out of 900 to
1,000 children which pass through our Indian schools, 300 of them pass out of our
hands to the grave within ten to twelve years I cannot conceive except upon the
hypothesis that we grow callous amidst such a frightful death rate.
17
¨

Blake also stated because government failed "to obviate the preventable causes of death, (it)
brings itself within unpleasant nearness to the charge of manslaughter.¨
18


In 1909, the Department of Indian Affairs hired Duncan Campbell Scott as its first
Superintendent of Education. He is reported as saying:

"It is true that Indian children die at a much higher rate in our Indian boarding schools
from communicable diseases ... But such is in keeping with policy of this Department,
which is geared towards the Final Solution of the Indian Problem."

In 1910, the Department informed the churches the industrial schools would be gradually
eliminated and the savings used to pay for higher salaries for better qualified teachers and for
the renovation of existing buildings. Increased federal funding was contingent upon each
school's compliance with newly established sanitary practices. Schools would be paid on a
sliding scale depending on their ability to provide proper sewage disposal, clean water supply,
modern ventilation, health and lighting systems, and hospital facilities for sick students. Schools
had to employ higher quality staff and keep the buildings "free from flies, insects and vermin.¨ Ìn
1913, the Indian Act was amended to give the Superintendent-General of Indian Affairs
authority to develop and enforce sanitary regulations for the prevention of disease, and for the
maintenance of streets, houses, and public buildings. The amendment committed the
government to the provision of medical aid and attention to the Indian population when
necessary to mitigate against disease.

Overall, the quality of education in the Indian residential schools was poor. Most of the teachers
lacked qualifications. Students received little formal education beyond basic math, spelling and
writing. Students spent half of their day in vocational training for more "civilized¨ pursuits such
as farming and carpentry for boys and domestic skills for girls. In reality, much of the
"vocational training¨ they received was designed to defray the cost of their boarding and any
product they made was sold to off-set the school's operating costs. In 1930, only 3 in 100
Aboriginal students advanced beyond grade 6.
19


Corporal punishment was a common and accepted form of discipline. However, discipline often
gave way to outright abuse; abuse that was well known to government and church officials. The
Royal Commission on Aboriginal People reports "head office, school and church files are
replete, from early in the system's history, with incidents that violated the norms of the day.¨
20

The Royal Commission's Report contains numerous testimonies of how Indian students were
savagely beaten by school officials, chained to benches, locked in rooms and denied food.

SS

Sexual molestation was also documented. Many Indian students ran away from the harsh
treatment only to die from exposure during their efforts to reach home. Suicides and attempted
suicides were also reported. The Royal Commission writes "chronic reluctance to challenge the
churches and to insist upon the proper treatment of the children, together with the churches'
persistent carelessness in the face of neglect and abuse by their members, became central
elements in the pattern of mishandling abuse as long as the system continued to operate.¨
21


By the time the last one closed in 1983, approximately 150,000 Indian and Métis students
attended Indian residential schools. While not every child was physically abused in the schools,
all had their lives shaped by their experience. St. Margaret's Ìndian Residential School outside
Fort Frances opened in 1902. It was operated by the Roman Catholic Church and closed in
1974. Several focus group members spoke of the trauma and soul wounding they experienced
in residential school.

'Residential school created a disconnection in our spiritual life. We lost the
connection with our language and the 7 Grandfather teachings. We lost sight of
who we are as Indian people."
'Most of the nuns at St. Margaret's were French Canadian. They called us little
savages. I grew up believing that Indians were savages. They made you believe
that being Indian was something to be ashamed of."
'We used alcohol to deal with our emotions; to numb ourselves to the feelings we
did not know how to handle. We could not have emotions in residential school. If
we cried, we were punished. If we got angry, we were punished. If we missed our
parents, we were punished."
'I was sexually abused in Indian residential school. I never spoke about it. I
couldn't handle it. I tried to deny it. I tried to drink it away. If I was drunk, I didn't
have to think about it. It wasn't until I went to treatment that I could even talk
about it."
'We need truth and reconciliation funds to help us deal with the residential school
issue. People who attended residential school did not talk about their problems.
Our parents refused to talk about it because it was too painful for them. There
was guilt too. Our parents had to send us away; they had no choice."

'The legacy of our experience is being passed on to our children - loss of
language, loss of identity, loss of self-respect and loss of family values. We don't
trust anyone."


In the Needs Assessment Survey, less than 10% of the total respondents indicated they
personally attended Indian residential school.
22
Of those who attended, 83% were ages 50 or
older and 18% were between the ages of 25 to 49. Respondents were more likely to indicate
family members attended residential schools. Most prevalent of these were their siblings (55%),
grandparents (54%), aunts or uncles (50%) and fathers (44%). Just slightly less prevalent were
mothers (36%), great-grandparents (22%), or other family members 30%. Even though many of

S4

them did not personally attend residential school, it was clear in the focus groups they were
impacted by the experiences of their family members.

'I have this problem with their forced religious beliefs. I can honestly say I have
hatred for the church."

'I think of all of the things we lost through residential schools. I wonder how our
communities might have been different if our parents had not experienced what
they did."

'It hurts me to hear these stories."

'The more this stuff about abuse in the residential schools comes out, the more
resentful I feel. You will never see me step into a church."

'I have a negative attitude towards society. Most of the times I'm okay but when I
hear about racism, all these negative feelings bubble up in me."

'I think about what we as Indian people lost - our culture, our language, our
traditions."

C. Intergenerational Substance Abuse:

The Needs Assessment Survey reported 70% of respondents grew up in homes were alcohol
was abused
23
and 34% grew up in homes were illicit substances were abused.
24
Research has
shown that children of parents with alcohol problems have more drug involvement, plus related
mental health and behavioural problems.
25

26
Focus group members spoke of how there was
negative role modeling of alcohol and/or drug use in their homes as they grew up and how this
influenced their use of these substances.
'There was inter-generational use and abuse of alcohol in my family. My parents
abused alcohol and so did their parents. My brothers have had their own
problems with alcohol."
'My parents smoked-up; so I did too. Monkey see; monkey do."
'I started at an early age because it was always around. I was just doing the same
thing my parents were doing."
'It's a learned behaviour. Your parents or older siblings use. Friends and
relatives use when they come over."
'It runs in the family."
'I've never seen any other lifestyle."
'Some parents buy alcohol for their kids. Some parents supply their kids with
marijuana."

SS

'It's normal. Parents do it, so kids do it too."
'Drugs were easily accessible in my home. They were as near as the coffee
table."
'There was no healthy role modeling in my home when it came to drinking."
'There was a family expectation that you use. Everyone in the family used."
'We drank with our parents even before it was legal for us to drink."
'Mentorship....mom and dad used. I used too."
'...just because of what we see. We want to try it too."
'My parents were always drunk. That's why I ended up in foster care."
'It is normalized in the family. Parents are using with kids. It is how kids learn to
socialize."

D. Mental Health and Psychological Distress:
27


The Needs Assessment Survey examined respondent mental health using the General Health
Questionnaire (GHQ), a standardized instrument widely used in survey research. The GHQ
examines indicators of psychological distress measured by 12 items over a time frame of the
past two few weeks. A total score of four or more indicates elevated levels of psychological
distress.
The Needs Assessment Survey found that of the 12 mental health and psychological indicators,
the highest percent of respondents reported feeling unhappy or depressed (30%), followed by
lost sleep over worry (29%), felt constantly under strain (27%), felt they could not get over their
difficulties (25%), felt they were losing confidence in themselves (24%), been unable to face up
to problems (20%), been unable to enjoy normal day-to-day activities (18%), did not feel they
were playing a useful part in things (16%), thought of themselves as worthless persons or had
been feeling unhappy (15%), been unable to concentrate on tasks (14%), and did not feel
capable of making decisions (12%).
Chart 26 shows respondent mental health and psychological distress indicators by gender.


S6



Men were less likely to report feelings of psychological distress across the indicators than
women. Women were significantly more likely than men to have lost sleep over worry (35% and
20%),
The Needs Assessment Survey also asked respondents whether they thought about suicide in
the two weeks preceding the survey. Seventeen percent (17%) of respondents reported they
had. There was no significant difference in the percentage of men and women having suicide
ideation in this period (15% and 1%).
Focus group members spoke a lot about the mental health issues that plagued them during their
lives and said that these stressors contributed in a direct and meaningful way to their substance
abuse.

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S7


E. Child Abuse/Neglect:

'I know I have issues related to fear of abandonment and rejection. I grew up in a
home where alcohol was abused and us kids were always being taken into care or
herded off to relatives."
'I had a lot of shame about my childhood."
'I was physical and emotionally abused when I was growing up. I drank because I
didn't want to think about it."

F. Low Self-Esteem:

'I didn't feel good about myself. I always felt inadequate. I felt I didn't belong or fit
in."
'I had low self-esteem. I was always told that I wouldn't amount to anything. My
mom and dad had no real parenting skills."
'I drank out of self-pity. I drank to forget my childhood, forget my bills, and
forget my marital problems. I felt sorry for myself. It was everyone else's fault. I
was a victim or at least that is what I told myself."
'Girls do it because of their insecurities. They don't like their looks or they are
too fat. Coke helps you keep thin."
G. Interpersonal Issues:

'My family had high expectations of me. I used as a form of rebellion."
'Lack of family involvement and support. No emotional support from family."
'I had guilt over not having my family. I was abusive in my relationship with my
partner. There was a lot of domestic violence. I was both the perpetrator and the
victim of abuse."
'I'd get jealous of my partner. I'd use our problems as an excuse to drink or do
drugs."
'...family break-ups - the separation and divorce. Losing my kids."
'...Witnessing abuse in my family."
'Parents don't like it so you do it. It's a form of rebellion."


S8


H. Escapism:

'I drank for sheer avoidance. It is easier to sit in the bar and get drunk than face
your family."
'I didn't want the responsibilities of life."
'I used to escape reality. I didn't like my life. I looked for myself in the bottom of a
bottle."
'I'm a single parent. I have a lot of stressors in my life - money, raising my child
alone, too much responsibility. I would go out and use because I needed a break.
I needed to forget about it for a little bit."
Several focus group members said that alcohol or marijuana helped them overcome their social
anxieties.
'Alcohol made me feel less inhibited. If I drank, I could overcome my social
anxiety. I felt I was in control when I used. It made me feel good."
'It let me do things that I wouldn't normally do - socialize, dance. If I used
alcohol, I could have fun."
'I'd have to have a drink or smoke a joint before I went out."
'Alcohol made me feel that I was in control."
³I self-medicated before I went out into the world. I felt less anxious and more like
I could handle things better."

I. Prejudice and Discrimination:

Encounters with prejudice and racial discrimination are part of Aboriginal people's past and
current reality. While many people would prefer to believe that racism and discrimination does
not exist, the stories told by individuals in some of our focus groups demonstrate that this is not
the case.
'A bunch of us kids from the reserve were fooling around. This annoyed the
teacher and she said to us: 'You kids are always causing problems.' I asked her
what she meant by the statement 'you kids.' She refused to answer but she knew
what she meant and she knew that we knew what she meant."
'I have lived in the Town of Fort Frances for over fifty years. My parents were
living here when I was born. I always find it amazing that even today, if I get into a
little tiff with a non-aboriginal, inevitably I am told to go back to the reservation
where I belong."

S9

Métis members of the focus group spoke of their unique experience with discrimination.
'When you're a Métis, you are neither white nor Indian. You are not accepted by
either group."
'I felt discriminated against at school. All of the Indian kids hung out together in
their groups and all of the white kids hung out in other groups. As a Métis, I didn't
feel I fit in either group and I was not accepted by either group."
'They called us white Indians when we went to the reserve to visit my father's
family. It was not a term of endearment."
'When you are Métis, you don't quite know who you are and where you fit in.
People tell you that you don't look Aboriginal."
J. Peer Pressure:

Participants in the focus groups, regardless of age or gender, said peer pressure is a major
reason why individuals decide to drink and why they continue to drink into their adult life.
'All my girlfriends drink. It is how you socialize. It is the accepted thing to do."
'Everyone goes to the White Pine to relax and come down after working or
playing sports. It is part of the culture. Guys who work hard deserve to have a
drink or two. You feel you deserve it. It's kind of like a reward. It's also a male
bonding thing."
'Your friends want to go out. You can't say no."
'To socialize....no one wants to feel left out."
In the youth focus groups, participants spoke about the need to fit into their peer group and how
the peer group influences the decision of youth to use.
'You think it is cool. Your friends do it and you want to fit in."
'Guys first start using out of curiosity. You see others doing it. You want to
know how it feels. Everyone wants to try it."
'Girls get initiated into using by their boyfriends. They tell you to try it. You do it
because your pressured into it but you also want to be part of the group and
because you want the guy to like you."
'Everyone does it."
'You see it on T.V. You see the adults on T.V. drinking in the bar, offering people
drinks when they come to their home, having booze at sporting events, having
wine with their meals. Adults use. You want to feel older so you use it too."

6u

'I was introduced to it at an early age by family and friends."
'Females are more pressured by their male friends than their female friends."
'Drugs attract people. You have more friends if you use drugs."
Communities send mixed messages about the acceptability of drinking. The contradictions
were not lost on the youth who spoke about them in the focus groups.
'Our leaders advertise alcohol use. Just look at the bass tournament. The big
event is the beer garden."
'Social events in Atikokan seem to be organized around drinking. They use
drinking to raise funds but many of these events are just an excuse for adults to
get stinking drunk."
K. Boredom & High Cost of Participation:

Both First Nation and Métis youth said that boredom is a major contributor to youth in the Rainy
River District using alcohol and/or drugs.
The First Nation youth said that some of their communities lack any recreational facilities or
places where youth can congregate. While many First Nations organize sports such as hockey
in the winter and baseball in the summer, some youth said that these activities are exclusionary.
Not all youth can "make the team.¨ Most of the team sports are organized for males. The cost
of purchasing needed equipment is prohibitive for single parent families, low income families
and families with several children. Some First Nation youth said that team sports do not interest
them but there are no or few alternatives.
Aboriginal youth in the urban areas also said there is little for them to do with their leisure time.
Again, the focus on organized sports and the high cost of participation, including the cost of
travel to team competitions, restricted access.
Aboriginal youth in Fort Frances complained about the lack of a movie theatre in town. The
nearest movie theatre is situated across the Canada-U.S. border in International Falls,
Minnesota. The youth said that many of them feel uncomfortable crossing the border and
occasionally, feel harassed by custom officers. Some said that going across the border is not an
option for them. They lack a passport or they have a police record.
'There is nothing to do in this community."
'It's something to do. There is nothing to do in this community except
snowmobiling in the winter and baseball in the summer."
'Atikokan is so boring."
'Drugs provide you with some excitement. It's so boring on the reserve."

61

'There are no substance free activities available to youth."
'There is no movie theatre in Fort Frances. It is expensive to see a movie in
International Falls. Youth don't have a passport. You get hassled at the border."
'You can go snowmobiling if you can afford a snowmobile and the gas to run it."
'The cost is too high to do stuff here. It's expensive."
'Boredom. There is nothing to do here. No movie theatre. The skate park has
turned into a drug place."
'You have to have money to play sports. A case of beer is not too expensive."
Adults also said that there is not much for them to do with their leisure time, other than go to
bars or house parties.
'There is just not a lot to do on the reserve. Even if you go into town, there is
nothing to do there. You can go to bingo if you are into that sort of thing."
'You have to have a good income to buy all the guy toys...the snowmobile, the
boat and the Jet Ski. Not too many Indians have the credit for that. So what is the
alternative?"

L. ³Chasing the High´:

Focus group members said that once you start using, it is easy to become addicted to the
feelings that alcohol or drugs produce. You continue to use because you want to keep
experiencing those feelings.
'I used heroin and I wanted to chase the high."
'I liked the feelings it produced. I would just mellow out."
'It would loosen me up and I would feel more relaxed. I liked how it made me
feel."
'It's like being on a roller coaster."
'I liked the affect of drugs. It would make me laugh."
'People do drugs because they like the feelings."
'Guys do drugs for the thrill; because they're curious."




62

PROTECTIVE FACTORS:

In the youth focus groups, participants were asked to identify what factors led youth not to use
alcohol or drugs. The participants identified the following:
A. Parental Influence:

The youth said that parents play a role in influencing their adolescent's life choices. Youth said
it is less likely they would use if they their parents didn't use. It is also less likely they will use or
abuse substances if they have been taught strong family values.
'I was raised to know better. My parents taught me better."
'If my parents found out I would be grounded."
'You would lose privileges."
'I was raised in a traditional family. They would be disappointed in me if I
used."
'You have respect for your parents and for yourself."
'Having parents you can talk to; one's that will listen to you."
'Being raised with strong spiritual beliefs."
'Having family support."
'Having responsibilities around the house."

Youth exposure to parental or family use can also lead them to choose an alternate path for
their own lives.
'I don't want to use because I have seen the harm it has caused in all the
adults around me."
'I've seen what it can do to your family."
'I want to be like a family member I respect."
'I want a better way of living."
'If you witness the consequences of drinking and drug use, you don't want
to use. Things like parents going through drug and alcohol problems. The
death of a parent and seeing people go through withdrawals."



6S

B. Drug Education and Awareness:

Some of the youth said that the drug education and awareness classes they received have
made them aware of the harmful effects of substance use.
'Because we learn about the harm."
'Groups like this increase our awareness of all the problems associated
with drugs."
'I would be too scared to use."
'It affects your physical ability."
'Doing drugs makes you lazy. You are too impaired to do things."
'Alcohol and drugs affects your education. I can lead you to skip classes
and therefore become suspended or expelled. You would not be able to
graduate. With no education you would not get a good job."
'You might hurt others both physically and emotionally."
'You could kill someone by driving drunk or giving drugs to someone."
'You can get into trouble with the law and go to jail."
'I would be concerned about overdosing."
'I would be concerned about getting raped or pregnant because I did not
know what I was doing when I was high."
'You could become addicted if you start."
'I have seen people that use and I don't want to be that way."
'It's illegal."
'I don't like the affect. I don't like the smell of marijuana."
'I want to live longer."
'I don't like needles."
'You would be at risk of getting diseases like HIV/AIDS."
'I've tried it and I didn't like it. I am scared of it."
'You can see what it does to people. It just makes common sense not to
use."

64

'Hanging around with the right crowd. There is no peer pressure to use
because no one in the group uses."

C. Personal Goals:

A number of the youth said that they have goals and plans. They do not want their future
dreams affected negatively by alcohol or drugs.
'Having goals."
'Believing in yourself; having confidence in yourself and having dreams."
'I don't want my education affected by drugs. I don't want my grades to
drop."
'I want to get a better education."
'I want to stay in top shape. It affects you physically."
'Want to stay healthy."
'Maybe you want to stay in this community and live off welfare for the rest
of your life like all of the users. Not me. I have goals. I have plans."
'Users get lazy. They don't want to do anything but sit around and get
high. They don't have any plans or vision. I want to expand my horizons."
'I want to have a good job. I don't want to live off welfare."
'I want to turn things around in this community and be a positive role
model."
'Take pride in not using. Be a role model."
'You see all these young girls with babies. I don't want to be raising a kid
in my teens."
'Wanting to feel like you are in control of your own life. You are not in your
right mind when you use drugs. People don't know what they are doing. I
don't want drugs to control my life or my future."
'I wouldn't want to spend all my money on getting high."
'Drugs cost too much money."
'I've got better things to do with my money than put it up my nose."




6S

D. Hobbies, Sports or Alternate Activities:

The youth said that being bored and having nothing to do can lead to a decision to try drugs.
They also said that being involved in a hobby, sport or some other type of activity was a
protective factor against drug use.
'Having something else to do so you are not bored."
'I have better things to do with my time like extra-curricular activities -
sports, music or drama.
'Recreation helps me test myself in positive ways."
'You don't have to get drunk to have a good time."
'Keeping busy with other things you enjoy like fishing, hiking, exploring,
swimming, music and dance."
'Being involved in the community."

E. Cultural Values:

Several youth said that they were actively involved in different cultural activities. This and a
belief in traditional values, leads them to not use.
'Following the traditional ways means that you shouldn't use. I respect my
grandparent's and parents' teachings. I believe in keeping the culture."
'I participate in cultural events.
F. Public Perceptions:

Others said they wouldn't use because they did not want people in the community to look down
on them.
'People look down on those who use."
'You get stereotyped if you use."
'Some youth don't use because they are concerned about their
reputations. They don't want to be seen as a screw-up."
'You would be a bum on the street."
!

66


1
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#$112*)/3&45(045#/)650&$*&-"#$%$"&-.205&)*&/%5&75""-&8$$"-&9-""53&Canadian Journal of Rural Medicine
2006;11(1):15-21
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occasion.
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Thommasen Baivey v., Banlon Neil, Thommasen Caiol, Zhang William !"#$%$"&'()*+)*,&%-.)/0&-*'&
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Whitebeck, Les B., Auams, uaiy w., Boyt, Ban B., anu Chen, Xiaojin Conceptualizing anu Neasuiing Bistoiical
Tiauma Among Ameiican Inuian People, Ameiican Iouinal of Community Psychology,: Ianuaiy 2uu4, SS, ¾, p.
121
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Ibiu p. 119
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B54$(/&Toionto, 0N Centie foi Auuiction anu Nental Bealth p. 1S-14.
12
As citeu in: Law Commission of Canaua, Neeus anu Expectations foi Reuiess of victims of Abuse at Native
Resiuential Schools, by Claes, R., anu Clifton, B, (SAuE), (0ttawa: Law Commission of Canaua, 1999)
1S
Constitution Act (1867) (foimeily the Biitish Noith Ameiican Act).
14
Biyce, P.B. B54$(/&$*&/%5&F*')-*&>#%$$"0&$L&@-*)/$.-&-*'&/%5&;$(/%&D50/&:5(()/$()50 0ttawa,: uoveinment
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Canauian Inuian iesiuential school system at
http:¡¡en.wikipeuia.oig¡wiki¡Canauian_Inuian_iesiuential_school_system
16
Spioule-Iones, Negan. Ciusauing foi the Foigotten: Bi. Petei Biyce, Public Bealth, anu Piaiiie Native
Resiuential Schools, Canauian Bulletin of Neuical Bistoiy, volume 12: 1996: p. 21u.
17
Lettei fiom Blake to Tims, Ianuaiy 9, 19u8, Anglican Chuich Aichives, School Files, 19u8 as citeu in:
Spioule-Iones, Negan. Ciusauing foi the Foigotten: Bi. Petei Biyce, Public Bealth, anu Piaiiie Native
Resiuential Schools, Canauian Bulletin of Neuical Bistoiy, volume 12: 1996: p. 217.
18
As citeu in the Repoit of the Royal Commission on Aboiiginal People, Chaptei 1u: Resiuential Schools, p. 19.
19
Piesentation by ueoige Eiasmus, Piesiuent, Aboiiginal Bealing Founuation to the Faculty of Law,
0niveisity of Winusoi & Commonwealth Legal Euucation Association Rounutable, Iune 12-14, 2uuS.
2u
Repoit of the Royal Commission on Aboiiginal Peoples, Chaptei 1u: Resiuential Schools, p. 26.
21
Ibiu p. 29.
22
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Ibiu p. S1.
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P6)'5*#5&$L&P-("3&B)0+ Iouinal of Biug Euucation. vol. 28, n1 p. 19-S7 1998.
26
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-"#$%$"&4($."510?&'-/-&L($1&-&*-/)$*-"&54)'51)$"$,)#&02(653 Biug anu Alcohol Bepenuence volume 6S, Issue 1
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67

Chapter 6: Impact of Substance Abuse
Introduction:
In this chapter, the impact of substance abuse on individuals, families and communities is
discussed using results from the Rainy River District Aboriginal Addiction Needs Assessment
Survey, discussions from the eighteen focus groups and district and tribal health and social
service statistics.
Harmful Effects of Substance Use:
In the Needs Assessment Survey, respondents were asked to rank the harmful effects their own
drinking or drug use had across several domains including: friendship/social life, physical health,
mental health, overall happiness, marriage/home life, work/studies/employment and financial
position. (See the Needs Assessment Survey Report for discussion of methodology).
Respondents were also asked to rank the harmful effects of drug use and alcohol use by a
family member had on his or her (the user's) life across the same domains.
A. Alcohol - Own Use:
1

Approximately, 30% of respondents indicated their own alcohol use had a harmful effect on
each of the life domains. Respondents were most likely to report harmful effects of their own
drinking on their financial position and physical health (32% each), followed by marriage/home
life (31%), overall happiness (31%), outlook on life (30%), friendship/ social life (29%), work,
studies and/or employment (28%), and mental health (26%). There were no significant gender
differences in respondent estimations of the effects of their own alcohol use on these life areas
except in two instances. Men were more likely than women to indicate their own alcohol use had
a harmful effect on their financial position (40% and 26%), physical health (38% and 28%).
Chart 27 shows the self-reported harmful effects of the respondents own alcohol use across the
preselected life domains by percentage.
68



B. Alcohol - FamiIy Member's Use:
2

Survey respondents were more likely to report a family member's alcohol use had harmfully
affected the user's life. Forty-eight percent (48%) stated a family member's alcohol use had a
harmful effect on his/her overall happiness, closely followed by marriage/home life and physical
health (48% each), friendship/social life, mental health and financial position (45% each),
outlook on life (44%) and work/studies/employment (43%).



0 10 20 30 40 30
lrlendshlp/soclal llfe
Þhvslcal healLh
MenLal healLh
Cverall happlness
CuLlook on llfe
Marrlaae and home lfe
Work, sLudles or emplovmenL ͙
llnanclal poslLlon
!"#$"%&'("
)*'#&+,-.+/'#0123+411"$&5+61+78%+93$6*63+:5"
lemale
Male
1oLal
0 10 20 30 40 30 60
lrlendshlp/soclal llfe
Þhvslcal healLh
MenLal healLh
Cverall happlness
CuLlook on llfe
Marrlaae and home lfe
Work, sLudles or emplovmenL ͙
llnanclal poslLlon
!"#$"%&'("
)*'#&+,;.+/'#0123+411"$&5+61+<'0=3>+?"0@"#5A+93$6*63+
:5"
lemale
Male
1oLal
69

C. Drugs - Own Use:
3

Respondents indicated their own illicit drug use had the highest impact on their financial position
(37%), followed by physical health (35%), overall happiness (33%), outlook on life (32%),
mental health (30%), marriage/home life and work/studies/ employment (28%), and
friendship/social life (27%). There was no significant difference in responses between men and
women.


D. Drugs - FamiIy Member's Use:
4

Almost half of respondents indicated illicit substance use by a family member had a negative
effect of his/her life across each of the measured domains. The highest percentage of
respondents indicated a family member's financial position had been negatively affected by their
illicit substance use (48%), work/studies/employment (45%), and friendships/social life (44%).
There were significant gender differences across each of the domain areas, whereby women
were more likely to indicate each area had been affected by another family member's substance
use.
0 10 20 30 40 30
lrlendshlp/soclal llfe
Þhvslcal healLh
MenLal healLh
Cverall happlness
CuLlook on llfe
Marrlaae and home lfe
Work, sLudles or emplovmenL ͙
llnanclal poslLlon
!"#$"%&'("
)*'#&+,B.+/'#0123+911"$&5+61+78%+C#2(+:5"
lemale
Male
1oLal
70


Physical and Mental Health:
Substance abuse related health problems can impair personal functioning, diminish quality of
life, limit productivity and threaten survival.

Alcohol is the most common cause of liver failure in Canada and has been linked to stomach,
oesophageal and pancreatic cancer. Withdrawal from alcohol can cause tremors, seizures and
hallucinations. Marijuana contains more cancer-causing chemicals than cigarette smoke.
Cocaine can cause paranoia, constriction of blood vessels leading to heart damage or stroke,
irregular heartbeat, and death. Heroin can lead to overdoses. Because it is usually injected,
often with dirty needles, it is linked to the spread of HIV/AIDS, Hepatitis C and other blood borne
pathogens.
Substance abuse has also been linked to risk-taking behaviours such as impaired driving, not
wearing seatbelts, having unprotected casual sex, fighting and engaging in other criminal
activity. Risk-taking behaviours can lead to injury and death.
A. Rainy River District Aboriginal Substance-Related Hospitalization Data
5
:

Working through the North West Local Health Integration Network, the Treatment and Support
Services Project examined substance abuse related hospital admissions for Aboriginal residents
of the Rainy River District across three years. OHIP reporting of ethnicity restricted our
examination to First Nation admissions.
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In 2005, there were 22 First Nation individuals admitted to hospital with a total of 26 inpatient
stays, where at least one diagnosis was substance-related. In 2006, this number rose to 31
First Nation individuals with 46 inpatient stays. In 2007, there were 31 First Nation individuals
admitted to hospital with a substance abuse related health problem representing 53 inpatient
stays.
A review of emergency room visits shows in 2005, there were 124 visits involving 78 separate
First Nation individuals with a substance-related health problem. In 2006, the number of First
Nation substance-related emergency room visits increased along with the number of individuals
involved (135 visits by 89 individuals). In 2007, the number of substance-related emergency
room visits rose to 158 visits while the number of individuals declined (80 individuals).
A more detailed examination of the 2007, emergency room visits revealed of the 158 visits, 119
(75%) were alcohol-related; 31 (20%) were for opioids, and the remaining 8 (5%) were for other
substances including cannabis, stimulants and tobacco.
B. Perceived Personal Health Consequences of Substance Abuse:

In the focus groups, numerous individuals spoke about the impact substance abuse/misuse had
on their personal physical and mental health while others spoke of how it affected the well-being
of a loved one.
Abuser's Physical Health:
'I have health problems. I have dental problems due to my heroin use and my
poor nutrition."
'I was hospitalized because of my binge drinking. Some people will not stop until
it kills them."
'Cheap beer makes you sick - real sick."
'I was afraid to quit because I did not want to go through withdrawal."
'You end up with unplanned pregnancies. Sometimes, you don't even know who
the father of your child is."
'You get an STD because you were too drunk to take precautions or you just
didn't care."
'You end up with alcohol-related diabetes. I was put in hospital for it. When I quit
using, my sugars returned to normal."
'People commit suicide or attempt suicide. I know girls who are involved in
cutting themselves."
'I got high blood pressure from too much boozing."
'You have problems with breathing because you have snorted so many pills."
72

'You lose brain cells when you abuse solvents."
'There are so many violent deaths in our communities because of substance
abuse."
'Individuals lose their lives due to addictions."
'I quit because I did not want to die young."
'You physically abuse your body. You have to deal with the consequences later
in life."
Abuser's Mental Health:
'I emotionally shut down when I used. I isolated myself from my family. I felt
totally detached and I didn't care."
'I had nightmares and I was depressed."
'"We used alcohol to deal with our emotions; to numb ourselves to the feelings we
did not know how to handle."
'You don't understand your feelings and you don't know how to connect with
others."
'You are only as sick as your secrets."
'You get addicted to the drama in your life."
'You don't have to be in jail to be in misery."
'I felt suicidal. The more depressed I became, the more I drank. The more I drank,
the more depressed I became. It was a vicious cycle. I just wanted everything to
just go away."
'I hated myself. I could not stand me. I loathed who I had become."
'Even when I was drinking, I felt guilty about what I was doing to my family but I
couldn't stop. Alcohol is so insidious."
'My grandchild has attempted suicide. I don't want to see it happen. When they
are under the influence, they don't know what they are doing."
'When you lose love, honour and respect for yourself, it is hard to get it back.
You begin to think you don't deserve it. You are not worthy enough."
Premature Death:
Alcohol and substance abuse has contributed to the premature death of many Aboriginal people
in the Rainy River District. Focus groups spoke of these losses.
73

'I lost both my parents because of alcohol. '
'I had fourteen brothers and sisters. They are all gone now due to alcohol. I don't
even know what happened to some of them. I am the only one left in my family. I
also lost my parents to drink."
'There have been several boating accidents in this community. I lost three
nephews due to alcohol and drugs."

'I lost my spouse. All this was related to our drinking."
'I worry about my kids being killed."
'Elders worry about the younger generations. People are dying. They are
following the ways of their parents. Some are overdosing. We have lost so many
of our people to substance abuse."
'You never get over the grief. You think about it all of the time. You think about
what might have been and you blame yourself. Would he have been alive if I had
done something different?"
FamiIy Members' PhysicaI and MentaI WeII-being:
The addict's substance abuse impacts the lives of everyone who she/he comes into contact
with. Because the vast majority of substance abusers live in a family setting, the addict's
behaviour has an impact on the physical and mental well-being of spouses, children, parents
and siblings. Families encounter great stress, conflict and anxiety as a consequence of trying to
protect family members from the dangers and harms associated with their substance abuse
while also trying to limit the damage arising from their behaviour towards the rest of the family.

'The health of family members of users is affected directly or indirectly through
worry."
'Parents worry about the addict killing themselves by their own hand or
accidently from an overdose."
'It touches me in my heart. I feel sad. It makes me want to cry. I don't know how
to help."
'I feel helpless and hopeless about the situation. I have fear and concern for my
family."
'I am under constant stress. I never know what is going to happen next."
'You are in a constant state of terror when you live with an adult child who is
using drugs."
'My adult children's use of alcohol and drugs affects me. I confront them and
they get defensive. They tell me I have no right to talk because I was once a
drunk, too."
74


'I don't want to lecture."

'I am hurt by my family members' using. It is the same road I went down."

'I didn't listen to those that tried to help me either."

'If you tell someone to quit, you may not see them for a week but they continue to
use. They hope you will forget about them and what you told them to do."

'I worry about my children even though they are in their 40's."

'You are always trying to balance how you communicate to a loved one who uses.
You balance reaching versus preaching. Care taking versus thinking of yourself."

'My children's using is a great source of family friction."

'My family uses drugs. I feel hopeless. I have concerns for my family. I don't
want to get caught between preaching and teaching."

'I fear for my children and what is happening to them."
Family Dynamics and Functioning:

In the focus groups, former substance users and family members of users spoke of the
significant and enduring impact substance use has on family dynamics and functioning.

'The family is neglected."

'You lose your children, family and siblings. You are isolated from them and they
reject you."

'It separates the family. The family loses its stability."

'Substance abuse breaks down the trust in a family."

'You spend so much time away from your family. You isolate yourself when you
are an addict."

'You lose respect for yourself and for others. Others lose respect for you."

'It separates the family."

'It causes the loss of the love of another."

'You hide and avoid family members who are using."

'You isolate yourself from users."

73

'I lock my door when he comes around. I don't want to deal with him."

'There is a great deal of shame associated with family members who use."

'You don't have a life of your own. You are so wrapped up in the addict's
behaviour."

'There is a loss of trust and self-respect. There is a loss of family values."

'I would end-up giving my son money just to get rid of him. It got to the point
where I did not want him around at all because he always was demanding money
and cigarettes. He always wanted something. He never came just to visit me. I
got to resent him and I would feel guilty; he's my son after all."

Denial, Enabling and Co-dependency:

Families, organizations and whole communities can develop destructive behaviours such as
denial, enabling and co-dependency in reaction to the behaviour of substance abusers.
"Denial¨ can be defined as a refusal to accept or acknowledge the reality of a situation. The
denial may focus on refusing to admit how serious the problem is, how it has spread through the
family, organization or community and affected relationships, and on how the family,
organization or community has contributed to the problem.
6

"Enabling¨ includes behaviours by others that allow people with substance use problems to
avoid the negative consequences of their actions. It can include providing the substance abuser
with money, paying his or her bills, covering up for them, and staying silent in the face of their
repeated inappropriate and destructive behaviours.
7

In an organization and/or community, enabling occurs when the organization or community has
a culture that makes alcohol or substance use expected. This may occur when drinking is
promoted as part of the organization or community's activities e.g.) office parties, fund-raising
efforts or recreational events.
8

Organizations and communities also enable substance abuse when they do not have clear
policies and procedures that encourage the identification and resolution of substance-related
problem behaviours or when they do not follow established policies or procedures.
Enabling also occurs when the community or organization does not provide support
(education/resources, etc.) to assist employers to take effective action in addressing the
negative impact a substance abuser has on the work environment.
"Co-dependency¨ refers to being over-involved in another person's life, having a preoccupation
with other people's behaviour and a sense of guilt when not tending to the other person's needs.
Focus group members spoke about how they and others engage in denial, enabling and co-
dependent behaviour.
76

Families:
'Parents are protecting their children. If you report things, parents attack you.
There is a code of silence around drug use."

'Parents don't want to see it but they know it is there."
'Parents are part of the cover-up. Their children say they need money for
groceries but they know they are buying drugs. They give them money because
they want to provide for their grandchildren."
'The bus driver found pot on the bus. The person's ID was with the drugs but the
parents were in denial the kid was using drugs."
'The parents don't want to help the victim. Parents deny their kid is using."
'It is a cycle of enabling. People blame the community for their kids using. It is
the community's fault because the Band did not do this, that or the other thing.
The Band didn't cause people to use. They need to look closer to home."
'Mothers try to fix things for their children but they end-up enabling them."
'Parents are not strong enough. They end-up supplying them with money they
know is being spent on booze or drugs."
'Parents make it too easy. Kids who should be in high school are just sitting
around on the couch. They drink and use. The parents just let them. Maybe they
just don't care."
'You can ground kids who are stealing your money but people are too scared to
report them. They don't want to accept they may be sending the kid to jail."
'I know I should report my son. It hurts me to think about doing so. Most times I
am too soft and he gets away with it and does it again. I don't want to see him
locked up."
Communities/Organizations:
'There are no clean, sober social things to do in Atikokan. Everything revolves
around booze. It has become a community norm."
'If you don't drink, there is little to do. There is no movie theatre here. The town
supports drinking by promoting it at events like the bass tournament. Just look at
the beer sponsorships."
'Users depend on the Band. The Band enables users. There is a Personnel
Policy but it is not followed. Some staff members don't come to work or they
come in late because they were partying the night before. Nothing is said. No one
is held accountable."
'The Band as an employer is enabling the employees. If you don't show up, no
one cares. It is just enabling the user."
77

'Staff members and council members are using. But we are in denial or we are
too intimidated to say anything."
'Alcohol and drug abuse affects the whole community. We need an open
discussion of the problem. We can't keep pretending we don't have a problem."
'People in the community know who uses. Generally, you know the families."
'We have to stop the denial."
'There are social well-being problems in this community that we have never
talked about or dealt with at home or in the community."
'The drug pushers are protected by the drug users."
'We all know who is transporting the drugs and alcohol. The bootlegger comes to
the community. Everyone knows who it is."
'Drug dealers come to the community on the winter road or on snow machine and
supply the high school kids."
'There is a mountain of issues facing the communities. Drug abuse is just one of
them. The problem is all we do is complain about the situation. We never get
around to actually doing something about it. It is easy to complain but it takes
courage to go out and take some responsibility and try to do something about it."
The Impact of Substance Abuse on Aboriginal Children:

Data from the Needs Assessment Survey, from Weechi-it-te-win Child and Family Services and
focus group discussions indicate the burden of parental abuse/misuse of alcohol and other
drugs falls on their children.
A. Substance Abuse in the Home:

The Needs Assessment Survey found seventy-one percent (71%) of respondents grew up in a
home where someone abused alcohol. In most instances, respondents identified the abuser as
their father (63%), followed by their mother (50%), other family members (39%) and step-parent
(18%). There were no significant gender differences in percent of respondents indentifying
home alcohol abuse or identifying alcohol user relationships. There were however significant
differences between age groups reporting home alcohol abuse. Seventy nine percent (79%) of
respondents ages 50 or older, and 74% of respondents' ages 25 to 49 indicated someone in
their childhood home abused alcohol, compared to 57% of respondents, ages 18 to 24.
According to the Survey Report this indicates a steady decrease in generational alcohol abuse.
9

The Survey also shows thirty-four percent (34%) of respondents grew up in a home where
someone abused illicit substances. Women and men were equally as likely to report this
occurrence (34% and 32%). The drug abuser was most often a non-parental family member
(43%), followed by mother (42%), father (39%) and step-parent (22%). There was no significant
difference in these relationships by gender.
10

78

According to Weechi-it-te-win Child and Family Services, 68% of the children in their care are
there because of parental or guardian substance abuse. Thirty-two percent (32%) are in their
care for other reasons.
11

B. Children as Victims of Substance Abuse:
Parental substance abuse had a direct impact on the health of their children:

'Babies are being born with fetal alcohol syndrome or addicted to opiates."
'I didn't know I was pregnant. I was lucky. My kid is okay but it could have been
different."
'We don't know the long-term effects of methadone on unborn babies."
'We need to know more about drugs and their affects on people. We don't know
the affects of these drugs on infants. We don't even know the long-term effects of
methadone."
ChiIdren's basic needs for food, shelter, education and love are not being met:

'Children lose when you use. They lose their parents, their home and their
schooling suffers."

'When you are on pills, you can't take care of your children because of the drugs'
effects. You are too stoned."
'You have violent outbursts while on pills. The kids see this and hear it. You
abuse your children emotionally and physically."
'I could see the fear in their eyes."
Children role model negative parental behaviours:

"The kids know you are using even if you don't think they know. You are blind to
what the kids see and how it is affecting them."

'Children often role play using drugs and drinking beer."

'Children are role modelling drug use and negative parental behaviours."

'We teach our children to become alcoholics."

'Maybe they are just following what they see their parents doing."

Children may be forced to lie to protect the parent who is abusing drugs:

'Children learn at an early age to cover-up for their parents. There is a family
code of silence."

79

'If you owe your dealer, you have to hide from him; spend a day in the woods.
You might pick-up a weapon. You don't answer the door. You get isolated and
have your kids lie for you."
'You have all this anger, rage, moodiness and paranoia. You believe people are
out to get you. Dealers want their money. You hide and tell your kids to lie for
you. You isolate yourself and your family."
ChiIdren are endangered by their parents' substance abuse:
'You put your kids at risk. I was bringing all kinds of unsavoury people around. I
was placing my children and family at risk due to possible retribution from
dealers."
'I owed the dealers money and they threatened to harm my kids if I didn't pay
them what I owed them."

Children are forced into the care of others:

'We let our responsibilities fall to others when we should be responsible. We let
others worry about and take care of our children."

'There is a loss of parental rights."

'Child welfare gets involved because you are reported to FACs or Weechi. Your
kids are taken into care and you lose your family."

'I blame myself for the loss of my kids."

'Grandparents are raising their grandchildren."

'Parents end up raising their grandchildren or even their great grandchildren."

Children are labelled because of parental substance use:

'Your family is stigmatized. They are labelled due to your alcoholism or drug
abuse."

'I get concerned about other people's opinions of me and my family. Everyone is
so quick to judge. It is not the kid's fault."

'People judge users' children. They make them pay for what the parents do."

'You don't want to punish the children but you don't want your kids going over
there. It is a safety issue. You don't want them exposed to that."

'You get a bad reputation. Your family gets a bad reputation."

80

Childhood Abuse:

When substance abuse occurs in a home, children are more susceptible to abuse. The Needs
Assessment Survey asked respondents aged 18 and over whether anyone in their family or
anyone other than a family member physically, psychologically or sexually assaulted them when
they were a child under the age of 16. Respondents were also asked to identify their
relationship with the perpetrator from a pre-selected list
12
or to write in the relationship to the
perpetrator if she/he was someone other than those listed.
A. Childhood Assaults by Family Members:
13


Fifty-four percent (54%) of respondents reported being assaulted by a family member before
they were 16 years old. In most instances, respondents reported being the victims of
emotional/psychological abuse (54%), followed by physical abuse (40%), threatened with
physical harm (34%), threatened with physical harm with an object (32%), physically assaulted
with an object (31%), sexual touching (23%), and sexually assaulted (11%).
Women were more significantly more likely than men to say they had been the victims of sexual
touching (34% and 8%) and sexual assault (16% and 3%), and emotional/ psychological abuse
(51% and 37%) by a family member. The Survey Report indicates there was no significant
difference between men and women reporting other types of assault.



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Respondents reported experiencing an average of four of the seven types of assault listed.
Almost half (45%) indicated they were the victims of five or more of the seven types of assault.
Women reported experiencing more types of assault (mean = 4.2 and 3.5 types of assault).



Respondents reported being assaulted as children by siblings (55%), other family members
(53%), fathers (49%), mothers (48%), and step-parents (17%). Generally, there were no
significant gender differences in terms of the victims' relationship to their perpetrator. Males
however were more likely to report being assaulted by their father than females (63% and 41%).
Respondents reported being victimized by an average of two the perpetrators listed. Forty
percent (40%) reported being assaulted by three or more of the perpetrators listed. There were
no gender differences in the mean number of relationship categories.
B. Childhood Assaults by Non-Family Members:
14


Forty-four percent (44%) of respondents were victimized by non-family members. Respondents
were mostly likely to report emotional/psychological abuse (35%), followed by physical assault
(28%, threats of physical harm (26%), sexual touching (23%), threats of physical harm with an
object (22%), physical assaults with an object (21%), and sexual assault (14%). Women were
significantly more likely to have been emotionally/ psychologically abuse (40% and 27%),
touched sexually (31% and 11%), or sexually assaulted (20% and 5%) as a child.
Child Welfare System:

According to the Child Welfare League of Canada, Aboriginal children are overrepresented as a
population within children in care. It estimates 30% to 40% of the children in care in Canada are
Aboriginal, yet they make up less than 5% of the country's total child population.
15
According to
Cindy Blackstock, Executive Director, First Nations Child and Family Caring Society of Canada,
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there are three times as many First Nations children in the child welfare system today as there
were at the height of residential school operations in the 1940s.
16


Over 70% of child welfare professionals cite substance abuse as the top cause for the dramatic
rise in child maltreatment since 1986. Children who have a parent who abuses alcohol and/or
drugs are approximately three to four times more likely to be abused and/or neglected than
children whose parents do not abuse these substances.
17
In examining parent risk factors
associated with substantiated child maltreatment, the 2003 Canadian Incidence Study of
Reported Child Abuse and Neglect reported alcohol abuse was identified as a functioning
concern for almost one-third of male and one-fifth of female caregivers.
17
Drug or solvent abuse
was identified as a concern for 17% of male and 14% of female caregivers.
18

Violence and Victimization:
A. Substance Abuse as a Factor in Criminal Activity:
According to the Needs Assessment Survey
19
, forty-three percent (43%) of respondents
indicated substance use has been a factor in their criminal activity in their lifetime, and 10%
reported being involved in alcohol related criminal activity in the past 12 months. Men were
significantly more likely to report substance use and criminal activity than women both for, ever
in life (56% and 33%) and in the past 12 months (15% and 6%).
Thirty-four percent (34%) of respondents had been incarcerated during their lifetime. Women
were significantly less likely than men (20% and 54%) to have been incarcerated in their
lifetime. On average, respondents were incarceration for an average of one year. Seventy-two
percent (72%) reported being incarcerated for less than a year, and 28% reported being
incarcerated for one year or more. The number of years incarcerated for total respondents
ranged from a few days to 13 years. Women reported being incarcerated for shorter periods of
time than men (mean = 0.3 and 1.0 years). Of those who had been incarcerated in their
lifetime, 81% stated substance abuse was a factor in the events leading up to their incarceration
(77% and 84%).
Forty-percent (40%) of respondents reported being placed on probation/parole at some point in
their lifetime. Men represented a statistically significant higher percent than women (56% and
28%). On average, respondents reported being on probation/parole for 2.6 years (range = 0.1
to 27 years). There were significant gender differences in the total number of years on
probation/parole. Women had been on probation/parole for an average of 1.5 years in their
lifetime compared with 3.3 year for men. Seventy percent (70%) of respondents indicated their
substance use was a factor with being placed on probation/parole. A similar percent of women
and men reported their substance use was a factor in being placed on probation/parole (64%
and 74%).
Seven percent (7%) of respondents were on probation/parole at the time of the addiction needs
assessment survey. Women were significantly less likely to be currently on probation/parole
than men (5% and 9%). Of respondents currently on probation/parole, 57% stated their
83

personal substance use was a factor. Women and men (57% each) were equally as likely to
report their substance use was a factor in this event.¨
20

Treaty #3 Police:
A review of Treaty #3 Police Reports for the Couchiching Sub-Division (Rainy River District ÷ 10
First Nations) for the period from 2005 to 2007 shows the following:
x There were 299 reports of Level 1 assaults (simple assaults). Of these, 5 reports were
investigated and determined to be unfounded. In the 21 actual occurrences, 10 charges
were laid.

x There were 88 reports of Level 2 assaults (assaults with a weapon). Of these, 8 were
investigated and determined to be unfounded. In the 86 actual occurrences, 57 charges
were laid.

x There were 7 reports of Level III assaults (assaults causing bodily harm). Of these, 1 was
investigated and determined to be unfounded. In the 6 actual occurrences, 5 charges were
laid.

x There were 126 reports of Disturbance of the Peace. Of these, 20 were investigated and
determined to be unfounded. In the 86 actual occurrences, 9 charges were laid.

x There were 126 reports of Domestic Disturbance. Of these, 21 were investigated and
determined to be unfounded. In the 105 actual incidences, 6 charges were laid.

x There were 32 reports of Break and Enter. Of these, 9 were investigated and determined to
be unfounded. In the 23 actual incidences, 3 charges were laid. It should be noted of the
32 reported incidences of Break and Enter, 27 of these occurred in 2007.

x There were 26 reports of sexual assault. Of these, 5 were investigated and determined to
be unfounded. In the 21 actual incidences, 10 charges were laid.
According to anecdotal information from Treaty #3 Police in many of the above incidences,
alcohol and/or drugs were involved.
There were a number of police investigations directly related to substance abuse/misuse.
x There were 31 reports of Driving While Impaired. Of these, 9 were investigated and
determined to be unfounded. In the 20 actual incidences, 8 charges were laid.

x There were 8 reports of Cannabis Possession. Eight (8) were found to be factual. In these
incidences, 5 charges were laid.

x There were 14 reports of Possession of Other Controlled Substances. Of the 7 found to be
factual, 3 charges were laid.
84


x There were 6 reports of Trafficking in Cocaine. The 6 cases were investigated but no one
charged.

x There were 6 reports of Trafficking in Cannabis. Of the 6 cases investigated, 5 charges
were laid.

x There were 47 reports of Trafficking in Other Controlled Drugs. In the 32 reports determined
to be factual, 2 charges were laid.

x There were 2 reports of the Importation and Production of Other Controlled Substances. Of
these, 1 was found to be factual. There were no charges laid.

B. Substance Abuse and Physical, Psychological and/or Sexual Assaults:

The Needs Assessment Survey reported nineteen percent (19%) of respondents stated they
had been in a physical fight while drinking. Men were significantly more likely than women to
have been in a fight while drinking (23% and 15%). Of those who had been in a physical fight
while drinking. 72% stated these occurred less than once a month, and 28% stated it occurred
at least once a month. There were no gender differences in the frequency of these
occurrences.
21

The Needs Assessment Survey also asked respondents about their experiences with physical,
psychological and/or sexual assault both as a victim and as a perpetrator (see the Needs
Assessment Report for methodology). The Survey Report tabulated the assaults by the
relationship between the victim and the perpetrator of the assault. If the relationship was as
spouse, partner or boyfriend/girlfriend, the assault was defined as "domestic violence.¨ If the
assault occurred in the home and involved individuals that had no domestic relationship, the
assault wad defined as "violence by other person(s) living in the home.¨ Ìf the assault took place
outside of the home by a non-family person, the assault was defined as "acquaintance violence¨
since this type of violence generally occurs between friends, other people they know or have
some familiarity with.
i. Domestic Violence:
Domestic Violence - Victims of Physical Assault:
According to the Needs Assessment Survey
22
, sixty percent (60%) of respondents reported they
had been physically assaulted by their spouse/partner or boyfriend/girlfriend in their adult life.
Twenty-three percent (23%) had been the victims of domestic violence in the past 12 months.
Women were significantly more likely to report being victims of domestic violence than men
(65% and 52%). In the most recent incidence, 57% of the respondents had been drinking while
71% of the perpetrators had been drinking. There were no significant gender differences in
participant reports of whether they or the perpetrator had been drinking.
83

Domestic Violence - Victims of Psychological Assault:
Sixty-five percent (65%) of the Needs Assessment Survey
23
respondents said they had been
psychologically assaulted by a domestic partner in their lifetime. Thirty-four percent (34%) said
the psychological assault took place in the 12 months before the survey. According to the
survey, women were significantly more like to report psychological assault by a partner in their
lifetime (72% and 54%) but were equally as likely as men to report the psychological assault
occurred in the past 12 months (36% and 33%). In the most recent incidence, 42% reported
they had been drinking, and 58% reported the perpetrator had been drinking. Male victims were
more likely than female victims to report drinking during the most recent incident (53% and
36%). There were no differences in terms of whether the perpetrator had been drinking.
Domestic Violence - Victims of Sexual Assault
24
:
Twenty-five percent (25) of survey respondents reported being the victim of domestic sexual
assault in their lifetime while 7% reported being the victim of domestic sexual assault in the 12
months prior to the survey. Women were significantly more likely to report being victims of
domestic sexual assault both in their lifetime (36% and 11%) and in the past 12 months (10%
and 4%). Thirty-eight percent (38%) of the respondents who said they had been sexually
assaulted in the 12 months before the survey were drinking at the time of the assault; sixty-three
percent (63%) reported the perpetrator of the sexual had been drinking. According to the Needs
Assessment Survey Report, there were no significant gender differences in the terms of the
victim or the perpetrator drinking in the most recent sexual assault.
Domestic Violence - Perpetrators of Physical Assault:
Forty-six percent (46%) of the Needs Assessment Survey
25
respondents reported they had
been the perpetrator of domestic physical assault in their lifetime. Thirteen percent (13%) of
respondents reported being the perpetrator of domestic physical assault in the past 12 months.
Women were significantly more likely to report being the perpetrator of domestic physical
assault both in their lifetime (52% and 38%) and in the past 12 months (16% and 9%). During
the most recent incidence of domestic physical assault, 58% of respondent perpetrators said
they had been drinking and 66% said their victim had been drinking. Male perpetrators were
significantly more likely than female perpetrators to report they had been drinking during the
most recent episode of domestic physical violence (71% and 52%). Female and male
perpetrators were equally as likely to say their victim had been drinking during the most recent
domestic physical assault (65% and 69%).
Domestic Violence - Perpetrators of Psychological Assault:
26

Forty-one percent (41%) of respondents said they had been the perpetrator of domestic
psychological assault in their lifetime Eighteen percent (18%) had been the perpetrators of this
violence in the 12 months preceding the survey. There were no significant differences in the
percent of men and women reporting being the perpetrator of psychological assault either in
their lifetime (44% and 36%), or in the past 12 months (20% and 16%). During the most recent
incidence of domestic psychological assault, 51% of the perpetrators reported they had been
86

drinking and 53% reported their victim had been drinking. According to the survey report,
female perpetrators were significantly less likely to report they had been drinking during the
most recent incident (45% and 63%). There were no differences between male and female
perpetrators' reports of whether their victim and been drinking (55% and 49%).
Domestic Violence - Perpetrators of Sexual Assault:
27

Five percent (5%) of respondents stated they had been the perpetrators of a domestic sexual
assault during their adult lifetime while 1% said they had committed domestic sexual assault in
the past 12 months. There were no significant gender differences in perpetrator reports of
domestic sexual assault. This may be due to the small number of respondents. During the
most recent incidences of domestic sexual assault, 63% of perpetrators said they had been
drinking, and all said their victim had been drinking. This result must be used with caution
because of the small number of respondents.
ii. Violence by Other Person(s) Living in the Home - Victims of Physical
Assault:
28


Twenty-four percent (24%) of Needs Assessment Survey respondents stated they had been
physically assaulted in their lifetime by someone living in their home that they did not have a
domestic relationship with. Nine percent (9%) said this physical assault took place in the past
12 months. The perpetrator of the assault may include parents, siblings, aunts/ uncles, cousins,
other family members or friends living in their home during their adult life. There were no
statistically significant differences in the percent of women and men reporting being victims of
these perpetrators for either in their lifetime (23% and 25%) or in the past 12 months (7% and
10%). Forty-three percent (43%) of the victims stated they had been drinking during the most
recent assault and 67% said the perpetrator had been drinking. Female victims were slightly
less likely to report both they and the perpetrator had been drinking at the time of the most
recent physical assault (30% and 18%) than male victims (50% and 71%). The gender
difference however was not statistically significant.
Violence by Other Person(s) Living in the Home - Victims of Psychological Assault:
29

Twenty-five percent (25%) of respondents stated they have been the victim of psychological
assault in their lifetime by someone living in their home who was not a domestic partner. Fifteen
percent (15%) said the psychological assault had occurred in the past 12 months. There was
no gender difference between men and women reporting psychological assaults during either
period. During the most recent assault, 37% of victims stated they had been drinking, and 61%
said the perpetrator had been drinking. Female victims were significantly less likely to report
they had been drinking during the most recent incident (27% and 54%). There were no
significant gender differences in the reporting of whether the perpetrator had been drinking
(54% and 75%).
87

Violence by Other Person(s) Living in the Home - Victims of Sexual Assault:
30

According to the Needs Assessment Survey, twenty-five percent (25%) of respondents sated
they were sexually assaulted in their lifetime by someone living in their home who was not a
domestic partner; one percent (1%) said the sexual assault took place in the past 12 months.
Women were significantly more likely to report being the victims of this type of sexual assault
than men (36% and 11%). Because of the small number reporting past 12 month sexual
assault, gender comparison was not possible for this period. Fifty-six percent (56%) of the
victims reported they were drinking at the time of the assault and 79% reported the perpetrator
had been drinking. There were no statistically significant gender differences in whether the
victim or the perpetrator had been drinking.
iii. Acquaintance Violence:
Violence by Acquaintance - Victims of Physical Assault:
31

The Needs Assessment Survey asked whether respondents had ever been a victim or
perpetrator of violence by or to a non-family person living outside their home. For the purpose
of the Survey Report, this was defined as "acquaintance violence.¨
According to the Survey, forty-six percent (46%) of respondents stated they had been victims of
acquaintance physical violence in their adult lifetime, and 13% stated the physical assault took
place in the past 12 months. Women were significantly less likely to report being the victim
acquaintance physical assault in their adult lifetime than men (41% and 53%), except for in the
past 12 months (11% and 17%). Seventy-one percent (71%) of victims of the most recent
incident had been drinking, and 84% said the acquaintance perpetrator had been drinking.
Women were significantly less likely than men to report they had been drinking during the most
recent incident (62% and 80%), but were similar in their reporting of whether the perpetrator had
been drinking (79% and 89%).
Violence by Acquaintance - Victims of Psychological Assault:
32

In the survey, forty-five percent (45%) of respondents reported being the victim of psychological
assault by an acquaintance in their adult lifetime, and 19% said this occurred in the past 12
months. There was no gender difference for either ever in lifetime (48% and 40%) or in the past
12 months (19% and 18%). Fifty-four percent (54%) of respondents who reported being the
victim of psychological acquaintance assault had been drinking at the time of the most recent
incident while 67% said the perpetrator had been drinking. Women were significantly less likely
to say they had been drinking during the most recent incident (62% and 80%), but were similar
to men in their report of whether the perpetrator had been drinking (79% and 89%).
Violence by Acquaintance -Victims of Sexual Assault:
33

Fourteen percent (14%) of respondents stated they had been sexually assaulted by an
acquaintance in their adult life, and 3% said they had been sexual assault in the past 12
months. Women were significantly more likely than men to report being the victims of
88

acquaintance sexual assault in their lifetime (20% and 5%). Because of the small number of
respondents reporting acquaintance sexual assault in the past 12 months, no gender
comparison was possible. Seventy-two percent (72%) of the victims of acquaintance sexual
assault said they had been drinking at the time of the assault while 77% said the acquaintance
perpetrator had been drinking. The Survey found there was no significant difference between
women and men victims reporting whether they had been drinking at the time of the most recent
incident (71% and 79%) or whether the perpetrator had been drinking (74% and 88%).
Violence by Acquaintance -Perpetrator of Physical Assault:
34

Forty-four percent (44%) of respondents reported they had been the perpetrator of a physical
assault on an acquaintance at some time in their life, and 13% said they had perpetrated a
physical assault on an acquaintance in the past 12 months. Women were less likely than men
to report they had been the perpetrator of acquaintance physical assault in their lifetime (39%
and 52%). Perpetrator gender difference in acquaintance physical assault in the past 12
months was not significant (11% and 17%). During the most recent incident of physical
assault, 67% of perpetrator respondents stated they had been drinking at the time, and 70%
stated their victim had been drinking at the time. There were no significant gender differences
for either whether the perpetrator had been drinking (62% and 73%) or their victim had been
drinking (68% and 71%).
Violence by Acquaintance -Perpetrator of Psychological Assault:
35

According to the Needs Assessment Survey, thirty-seven percent (37%) of respondents
reported being the perpetrator in an acquaintance psychological assault in their lifetime, and
14% reported they had done so in the past 12 months. There was no significant gender
difference in the reporting of being the perpetrator of psychological assault in their lifetime (34%
and 42%) and in the past 12 months (11% and 17%). Fifty-nine percent (59%) of the
perpetrators said they had been drinking at the time of the most recent incident and 60%
reported the victim had been drinking. There were no gender differences between women and
men reporting of whether or not their victim had been drinking (56% and 65%).
Violence by Acquaintance -Perpetrator of Sexual Assault:
36

Three percent (3%) of respondents reported being the perpetrator of an acquaintance related
sexual assault. Seventy-two percent (72%) stated they had been drinking at the time of the
sexual assault and 71% said their victim had also been drinking. Because of low numbers, it
was not possible to report on sexual assaults in the past 12 months or by gender.
iv. Community Perceptions of Substance Abuse Related Violence:
Substance abusers spoke of how alcohol and drugs led them to crime and violence.
'You become the victim or victimizer of violence when you use drugs. It leads to
spousal violence and violence towards your children. You are violent towards the
elderly and even to animals. You take things out on them."
89

'"You engage in criminal activity so you can have money to buy drugs."
'Addicts attack other addicts for their drugs or alcohol."
'I was involved in fighting and blackouts because of my using."
'The drugs made me anxious. I was always angry. I would fly-off the handle at
anyone for any reason, especially when I needed a fix. I didn't care. All I wanted
was the drug so I could feel normal."
Individuals spoke of being victimized when they were using:
"Non-native men take advantage of Indian women when they are drinking."
'I got beat up pretty badly."
'I ended up in hospital. I don't even remember what we were fighting about."
'Dealers threaten you and your family with physical harm if you don't pay your
drug bill. They get you hooked. They get you where they want you."
Family members are often victimized by other family members who abuse substances.
'I am embarrassed by what my family member did - fighting, stealing, barging in
on someone's home."
'Users get confrontational. Parents try to avoid their kids to avoid the
confrontation."
"You are afraid to live in your own home. Are you going to be safe? It is terror
living with adult children who are abusing drugs."
'There is physical abuse - slapping family members around."
'Users intimidate the Elders. They can't protect themselves."
'They go so far as stealing other family member's prescriptions."
'Family members steal their drugs. When this happens, the family member's
medical problems go untreated. Pharmacies will not give refills for medications
people say were lost or stolen."
'If I don't give them money, they won't let me see my grandchildren."
Elders and community members spoke of not feeling safe in their own homes or in the
community.
'I am afraid to be alone at home at night. There have been so many attempted
break-ins."
'Drunk drivers in the community make it unsafe to walk in the community."
'I fear for my own safety because addicts can get out of control."
90

'There is a lot of fighting at these drinking parties. You call the police but it takes
too long for them to come or they don't come at all."
'There is a lot of fighting at Heartbreak Hotel."
'I don't feel safe in the community. Fights occur in the community out in the
open. Parties get out of control."
'You don't feel safe. Someone may kick my door down. Users are looking for
parties and they want rides. They won't go away."
'I am afraid to go out on the weekend. You have to lock your doors."
'Addicts are the cause of the break-ins. We need protection in our own homes.
We feel unsafe."
'People on pain-killers for their old age are becoming the targets of drug users.
They are the cause of the break-ins."
'Elders need to feel safe in their own homes."
'Elders are at serious health risk because of people stealing their medications."
Inter-generational Cycle of Substance Abuse:
The cycle of intergenerational substance abuse involves the recurrence of substance abuse-
related social, behavioural and health problems in successive generations of families. As
previously noted, 71% of the Needs Assessment Survey respondents grew up in homes where
alcohol was abused while thirty-four (34%) grew up in a home where illicit drugs were abused.
Fifty-four percent (54%) reported being assaulted by a family member before age 16.
Observing substance abuse in one's family of origin creates ideas and norms about how
drinking is conducted and how one behaves while drinking. Exposure to violence in one's family
also creates ideas and norms about how, when and toward whom aggression is appropriate.
37

Children also develop expectations about relationships based on their early experiences with
their parents. These experiences are the model for all future relationships.
In the focus groups, participants spoke about how they exposed their children to negative role
modeling because of their own substance abuse. Many of their statements support the view
this early exposure has resulted in a repeating pattern of substance abuse in subsequent
generations.
'Children grow up in that environment and they think it is okay."
'I blame myself. I don't blame my kids for their drinking. I did what my parents
did and now my kids are doing what I did."
'Younger children see that and they want to try it too."
'Monkey see; monkey do."
91

'It is an intergenerational problem. I lost my friends to alcohol. I lost my children;
some to suicide. I lost my parents."
'What I did when I was using affected my family. Now my kids are having the
same problems. What I do now will affect my kids. '
'When I drank, I was not a happy drunk. I was an angry and violent drunk. I now
see the same behaviour in my sons."
'I think addiction is inherited. It is in the genes. I don't believe it has anything to
do with the way I was raised. That is my personal belief."
'It is intergenerational, shame-based behaviour."


1
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1oronLo, Cn CenLre for AddlcLlon and MenLal PealLh p. 30.
2
lbld p. 31.
3
lbld p. 36.
4
lbld p. 36.
3
L-mall correspondence: Corv 8ussell, epldemloloav and ueclslon SupporL ConsulLanL, norLh WesL Local PealLh
lnLearaLlon neLwork Lo CaLherlne 8. 8ruvere, needs AssessmenL ConsulLanL, 1reaLmenL and SupporL Servlces
Þro[ecL, Couchlchlna llrsL naLlon daLed Mav 11, 2009.
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9:(&;"5#2%&!02(&#$&.33#-,#0$<&*($#"2=&>$"/2#$1&"$3&?0@3(8($3($-%= ÞarLnershlp lor a urua lree Amerlca (2006).
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newLon-1avlor, 8. & Larlon, k. (2009) !"#$%&!#'()&*#+,)#-,&./0)#1#$"2&.33#-,#0$&4((3+&.++(++5($,&67)'(%&!(80),
1oronLo, Cn CenLre for AddlcLlon and MenLal PealLh p. 31.
10
lbld p. 36.
11
Weechl-lL-Le-wln Chlld and lamllv Servlces communlcaLlon, november 2009.
12
1he pre-ƐĞůĞĐƚĞĚůŝƐƚĨŽƌ͞ĨĂŵŝůLJ͟ŝŶĐůƵĚĞĚ͗ŵŽƚŚĞƌĨĂƚŚĞƌ͕ƐƚĞƉ-moLher, sLep-faLher, broLher, slsLer, uncle, aunL,
a female cousln, vour arandfaLher or arandmoLher. 1he pre-ƐĞůĞĐƚĞĚůŝƐƚĨŽƌ͞ĂŶLJŽŶĞŽƚŚĞƌƚŚĂŶĂĨĂŵŝůLJŵĞŵďĞƌ͟
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frlend, male babvslLLer or female babvslLLer.
13
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1oronLo, Cn CenLre for AddlcLlon and MenLal PealLh p. 33.
14
lbld p.33.
13
larrls-Mannlna, C. & ZandsLra, M. ?:#23)($&#$&?")(&#$&?"$"3"<&.&+755")%&0A&-7))($,&B++7(+&"$3&,)($3+&C#,:&
)(-055($3",#0$+&A0)&A7,7)(&"-,#0$D&p. 3.
16
8lacksLock, C. (2003) volces&A)05&,:(&;#(23E&;#)+,&4",#0$+&?:#23)($&#$&?")(, Lncvclopaedla on Larlv Chlldhood
uevelopmenL, CenLre for Lxcellence for Larlv Chlldhood uevelopmenL p 1.
17
Chlld Welfare Leaaue of Amerlca (CWLA) (1997), .2-0:02&"$3&0,:()&3)71&+7)'(%&0A&+,",(&-:#23&C(2A")(&"1($-#(+.
WashlnaLon, uC: AuLhor.
18
1rocme, n., lallon, 8., MacLaurln, 8., uacluk, !., lelsLlner, C.,8lack, 1. eL al. (2003). ?"$"3#"$&B$-#3($-(&6,73%&0A&
!(80),(3&?:#23&./7+(&"$3&4(12(-,=&?B6@FGGH<&I"J0)&;#$3#$1+&!(80),. CLLawa: Þubllc PealLh Aaencv of Canada,
CovernmenL of Canada. Avallable aL hLLp://www.phac-aspc.ac.ca/cm-vee/csca-ecve/lndex-ena.php
19
newLon-1avlor, 8. & Larlon, k. (2009) !"#$%&!#'()&*#+,)#-,&./0)#1#$"2&.33#-,#0$&4((3+&.++(++5($,&67)'(%&!(80),&
1oronLo, Cn CenLre for AddlcLlon and MenLal PealLh p. 37.
20
lbld p. 37.
21
lbld p. 31.
92


22
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23
lbld p. 30-31.
24
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23
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26
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27
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28
lbld p. 31-32.
29
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30
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31
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32
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33
lbld p. 32-33.
34
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33
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36
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37
Sulllvan, ur. 8lLa 9)"75"&B$A0)5(3&K)"-,#-(D&Cn1rack, lnc. 2009 p.6.
9S

Chapter 7: Substance Abuse Treatment

Introduction:
In this chapter, Rainy River District Aboriginal utilization of substance abuse treatment services
is examined. Also discussed are the reasons why participants in the Treatment Focus Group
and the Methadone Focus Group said they sought treatment.
Overview - Substance Abuse Treatment Services:

Aboriginal residents of the Rainy River District can access treatment services provided by
provincially or federally funded substance abuse treatment facilities or by private, for profit,
treatment centres. These services may be located in province, out-of-province, or out-of-
country.
A. Provincially-Funded Substance Abuse Treatment:
The Ministry of Health and Long-Term Care (MOHLTC) is responsible for the delivery of health
services in the province. It recently mandated Local Health Integration Networks (LHINs) with
the planning, integrating, managing and funding of health service delivery in their service areas,
including substance abuse services. Ontario substance abuse services are delivered by
community-based organizations including hospitals, community organizations, non-profit and
for-profit corporations. The cost of treatment in these facilities is paid for by the Province of
Ontario either through direct funding or through the Ontario Health Insurance Plan (OHIP).
In 1999, the Office of Alcohol, Drugs and Dependency Issues, Health Canada
1
reported there
were 384 substance abuse treatment services offered in Ontario. This included 110 outpatient
treatment programs, 55 day/evening programs, 43 short-term residential treatment programs
and 51 long-term residential treatment programs, 61 outreach programs, and 64 walk-in/crisis
programs.
Provincially funded substance abuse services follow a continuum of care which includes:
x Initial Assessment / Treatment Planning :
Initial assessments involves the identification of client needs, goals, characteristics,
problems/and or stage of change. The initial assessment forms the basis for the client's
treatment plan including referrals.


94

x Case Management:
Case management involves the identification of the client's primary worker who will be
responsible for ongoing client assessment, adjustment of the client's treatment plan, linkage
and coordination of needed services, monitoring and support and implementation of a
discharge plan. Case management services are provided at all levels of treatment.

x Community Treatment:

Out-patient community counselling/treatment is provided through individual or group
sessions. It can include such approaches as brief intervention, lifestyle and personal
counselling, relapse prevention, family intervention, follow-up and aftercare.
x Community Day / Evening Treatment:
Community day/evening treatment is a structured, scheduled program of treatment activities
typically provided five days or evenings per week (e.g., 3-4 hours per day) while the client
resides in the community, either at home or in a residential supportive treatment service.
x Community Medical / Psychiatric Treatment:
Focusing on individuals with addiction and mental health issues, this non-residential service
is usually offered either through a structured day/evening program or community treatment.
It involves health professionals such as doctors, nurses and staff specializing in the
treatment of concurrent disorders.
x Withdrawal Management (Detox):
Withdrawal management is also known as detox. It involves assistance with the voluntary
withdrawal from alcohol and/or drugs. Withdrawal management may occur in the
community or in a residential facility designed for this purpose.
Community Withdrawal Management:
In community detoxification, clients reside in the community. The severity of their symptoms
determines the level of professional support they receive.
Level 1 clients can be safely monitored by a staff that is not medically trained. Medical
consultation is provided by a physician, an after-hours clinic, and a health centre or hospital
emergency department. Client/staff ratios do not permit high intensity symptom monitoring.
In Level 2 withdrawal management, clients also can be safely monitored by staff that is not
medically trained. As with Level I, medical consultation is provided by a physician, an after-
hours clinic, and a health centre or hospital emergency department. Unlike Level I, medical
consultation and staff resources are available to consider management of clients on
methadone and clients being tapered from benzodiazepines or narcotics.
9S

In Level 3 community withdrawal management, clients require monitoring by medically
trained staff. Medical consultation and staff are available on a constant basis.
Residential Withdrawal Management:
Residential withdrawal management is provided in a Withdrawal Management (Detox)
Centre, or on an inpatient basis in a hospital. There are three (3) levels of service available.
Level I clients can be safely monitored by staff that is not medically trained. Medical
consultation is provided by a physician, an after-hours clinic, and a health centre or hospital
emergency department.
Level 2 clients can also be safely monitored by staff members that are not medically trained
with medical consultation being provided by a physician, an after-hours clinic, and a health
centre or hospital emergency department. Medical consultation and staff resources are at a
level where clients on methadone and clients being tapered from benzodiazepines or
narcotics can be managed.
In Level 3 residential detox, clients are monitored by medically trained staff. Medical
consultation and staff are available on a constant basis.
x Residential Treatment:
Residential treatment involves the client living in-house with 24 hour access to support.
Included is a structured, scheduled program of treatment and/or rehabilitation activities to
assist clients to develop and practice the skills to manage substance use and related
problems.
x Residential Medical / Psychiatric Treatment:
This in-house treatment is directed at clients who have concurrent disorders (addiction and
mental health) severe enough to require individualized medical/psychiatric care. The
structured, scheduled program of addictions treatment and/or rehabilitation activities
provided assists the client in stabilizing and managing his/her medical/ psychiatric problems,
while also addressing the addiction problem. Clients also have 24 hour access to support.
x Residential Supportive Treatment:

There are two (2) types of residential supportive treatment. Level 1 includes housing and
related recovery/support services such as lifestyle counselling, coaching for activities of daily
living, community reintegration, vocational counselling and mutual aid, provided to clients
who require a stable, supportive environment prior to, during, or following treatment, which
is accessed elsewhere. Level 2 residential supportive treatment provides
housing/accommodation in alcohol/drug-free setting. Addiction services however are not
offered on-site or as part of the housing service.

96

A complete list of Ontario-funded treatment services by continuum of care category is available
through the Drug and Alcohol Registry of Treatment (DART) operated by Connex Ontario
2

Health Information Service located on the web at http://www.dart.on.ca/index.html.
Ontario residents can access substance abuse treatment services in other parts of Canada if
the province in question admits non-residents. In Alberta and British Columbia, residential
treatment programs charge all clients (residents and non-residents) fees to cover room and
board. These fees are generally geared to income and may be paid by employee assistance
programs or other third party insurance companies. Just over half of the treatment programs in
the country accept out-of-province referrals according to Health Canada
3
, with most not
requiring an extra fee.
The Ontario Health Insurance Plan (OHIP) will cover out-of-country residential treatment
services for Ontario residents under certain conditions and only on a prior approval basis. The
Ministry of Health and Long-Term Care has entered into funding agreements with preferred U.S.
facilities to provide residential treatment to Ontario residents. Those facilities are listed on the
web at: http://www.health.gov.on.ca/english/providers/program/ohip/outofcountry/us_preferred
providers/ restreatment_facilities.html.

B. Federally-Funded Indian and Inuit Treatment:
The Government of Canada under the Constitution Act 1867 is responsible for Indians and
lands reserved for Indians. Under this authority, by treaty right and by historical precedence, it
provides some health services to Indians and Inuit. The First Nations and Inuit Health Branch,
Health Canada is mandated with the delivery of these services. Through its mandate, it funds a
substance abuse program and a solvent abuse program targeted specifically to registered
status Indians on-reserve and Inuit.
National Native Alcohol and Drug Abuse Program (NNADAP):
The National Native Alcohol and Drug Abuse Program (NNADAP) is administered by the First
Nations and Inuit Health Program, Health Canada. NNADAP is rooted in a 1975 national pilot
program funded by the Government of Canada. Known as the National Native Alcohol Abuse
Program (NNAAP), it was established to "support community designed and operated projects in
the areas of alcohol abuse, prevention, treatment and rehabilitation in order to arrest and
reverse the present destructive physical, mental, social and economic trends.¨
4
In 1982, the
federal government introduced the National Native Alcohol and Drug Abuse Program
(NNADAP) as a permanent replacement for NNAAP.
Today, NNADAP funds over 550 community-based prevention programs in First Nation and
Inuit communities. While most community-based programs focus on prevention and promotion,
NNADAP workers also engage in addiction intervention, providing assessments, referrals to
treatment centres and pre-treatment orientation. Some programs also provide short-term
counselling and after care. After care services involve support to clients upon treatment
97

discharge and can include ongoing visits, counselling sessions, and referrals to other
community services.
NNADAP also funds a limited number of non-medical treatment services (Medical treatment is
considered to be a responsibility of the provinces.) involving "intensive psychological and
therapeutic counselling oriented towards social and cultural rehabilitation.¨
5
The 52 NNADAP
residential treatment centres across Canada provide inpatient and outpatient treatment, family
treatment and solvent abuse treatment. There are ten (10) such facilities in Ontario.
The Youth Solvent Abuse Program (YSAP):
The Youth Solvent Abuse Program (YSAP) is a community-based prevention, intervention,
after-care and in-patient treatment program which targets First Nation and Inuit youth who are
addicted to, or at the risk of inhaling solvents. There are ten (10) solvent abuse treatment
centres across Canada. Eight (8) centres provide solvent abuse specific services and two (2)
service multi-addictions. Two (2) of these centres are located in Ontario, one (1) in Muncey and
one (1) in Thunder Bay. Services include pre-treatment, treatment, and post-treatment care in
which the families of the youths are involved. The centres also provide information sessions
and training on solvent abuse for community workers to optimize their support to youth.
C. Private, For-Profit Treatment:

There are some privately owned, publically funded, substance abuse treatment programs in
Ontario anyone can access. The Ontario Addictions Treatment Centres (OATC), for example,
operates 25 Methadone Treatment Centres across the province. While privately owned and
operated, OATC bills the Ontario Health Insurance Plan (OHIP) for the services it provides.
Services not covered by OHIP are billed directly to the client.

Availability of Substance Abuse Treatment Services in the Rainy River
District:

A. Provincially-Funded Substance Abuse Programs:

There are four (4) provincially-funded non-profit community-based substance abuse treatment
programs in the Rainy River District. These include:
x Riverside Health Care Facilities Inc. - Riverside Community Counselling Services:

Riverside Health Care Facilities Inc. provides community counselling services through sites
located in Fort Frances, Emo and Rainy River. Services include alcohol and drug assessment
and a community treatment program. The community treatment program includes individual
98

outpatient sessions, guided self-change, relapse prevention, harm reduction, combination of
bio-psychosocial, cognitive-behavioral, solution focused, and motivational interviewing
approaches.
6
The program works with individuals, couples, or families.

x Atikokan General Hospital - Atikokan Community Counselling Services:

Atikokan Community Counselling Services provides alcohol and drug assessment, case
management and community treatment.
7
Its community treatment program includes individual
and family counselling, as well as, group sessions.

x The United Native Friendship Centre:
Funded through an umbrella project of the Ontario Federation of Indian Friendship Centres, the
United Native Friendship Centre's Addiction Program is located at the Friendship Centre in Fort
Frances. It provides culturally appropriate client based initial assessment/treatment planning
and community treatment to Aboriginal people. Its community treatment program includes
counselling, videos and written assignments.
8
Outpatient sessions are provided on an as
needed basis.
x Weechi-it-te-win - Training and Learning Centre:
9


The Weechi-it-te-win Training and Learning Centre, a residential treatment facility, has ten (10)
child welfare beds allotted to the First Nations serviced by Weechi-te-win Family Services.
These beds are designated for youth between the ages twelve (12) and seventeen (17). In the
event any of the child welfare beds are not occupied by child welfare cases, six (6) of the
treatment beds can be used for adolescents addiction assessment and residential treatment for
adolescents who have alcohol and/or other substances combined with mental health issues and
related behavioural, social and emotional difficulties.

There is one private sector, publically funded, treatment program.

x Methadone Clinic, Ontario Addiction Treatment Centres:
In November 2009, the Ontario Addiction Treatment Centres (OATC) opened a Methadone
Clinic in Fort Frances. OATC is the country's largest privately owned network of methadone
clinics. The Fort Frances site is the 25 clinic in its network. In offers intake assessment,
methadone maintenance therapy, observed urines, laboratory testing, addiction counselling and
relapse prevention. The cost of service provision is billed to the Ontario Health Insurance Plan.
The cost of methadone is covered through the Ontario Drug Benefit Plan for eligible clients
(family benefits, welfare recipients, disabled persons, etc.) or through the Non-Insured Health
Benefit Program for eligible First Nation members.
Prior to the opening of the Clinic, methadone clients had to travel to Kenora or Dryden.
M.E.C.C.A. has given their clients from the Rainy River District the option of staying with the
program with the understanding that if they chose to do so, they will have to pay for their own
99

travel costs. Since the Dryden Methadone Clinic is owned and operated by O.A.T.C., many of
their clients from the District may now be transferred to their clinic in Fort Frances.

B. Federally-Funded Substance Abuse Treatment Programs:

There are no federally-funded substance abuse treatment programs currently operating in the
District. Oh-Shki-Be-Ma-Te-Ze-Win Inc. provided outpatient treatment services and referrals
until its operations were suspended in 2007-2008.

Gaps in the Availability of Substance Abuse Treatment Services in the
Rainy River District:

A. Withdrawal Management (Detox):

There are no community or residential withdrawal management services (detox) in the Rainy
River District. Individuals requiring detox must travel to Morningstar in Kenora or to the
Balmoral Withdrawal Management Program in Thunder Bay.

Morningstar, a 40-bed, non-medical care and observation unit for clients in an acute state of
chemical dependency, provides 24 hour detoxification services, 365 days per year. It also
provides withdrawal management support and addiction assessments and referrals. It is
operated by the Lake of the Woods District Hospital. The majority of Aboriginal clients from the
Rainy River District are referred to Morningstar.

The Balmoral Centre is a 14 bed, non-medical withdrawal management service operated by the
St. Joseph's Care Group. Ìt provides a safe place for men and women to withdrawal/detox from
alcohol or other drugs. It also provides 24 hour services, 365 days per year.

B. Residential Treatment Level 1 & Level 2:

There are no residential treatment services for adults (Aboriginal or non-Aboriginal) or for youth
in the Rainy River District. Individuals who need substance abuse residential treatment must be
referred to facilities outside of the District. The nearest facility which services both Aboriginal
and Non-Aboriginal clientele is the Sister Margaret Smith Clinic operated by the St. Joseph Care
Group in Thunder Bay. The Clinic provides residential services to youth, men, women and older
adults.

There are three (3) residential substance abuse treatment programs available to First Nation
people.

Located on the Fort William First Nation outside of Thunder Bay, Dilico Alcohol and Drug
Treatment Centre was established to serve First Nations in the Thunder Bay and Algoma
1uu

District affiliated with its parent organization, Dilico Anishinabek Family Care. Subject to space
availability, referrals are accepted from First Nations in other parts of the province including
those in the Rainy River District. The Centre will also accept Métis referrals and non-Aboriginal
referrals who agree to follow its culturally-based treatment model. Dilico provides short-term
residential treatment to both men and women.

Situated on the Anishinabe of Wauzhushk Onigum Nation territory, the Migisi Alcohol and Drug
Treatment Centre was established to serve the First Nations in the Treaty #3 area. NNADAO
funds the fourteen (14) bed, male and female, treatment centre. Migisi provides a culturally-
based program which includes substance abuse education, case management, individual and
group counselling, professional consultation, and aftercare planning and referral.
Ka-Na-Chi-Hih Specialized Solvent Abuse Treatment Centre a national 12-bed long-term
treatment program for First Nations males between 16 and 25 years old whose lives are
affected by solvent abuse. The program utilizes traditional and contemporary models of
treatment.
C. Residential Medical/Psychiatric Treatment:

No residential medical/psychiatric treatments services situated in the Rainy River District or
anywhere in the North West Local Health Integration Network catchment area for residents
suffering from concurrent addiction and mental health issues. There are two (2) facilities that
offer residential medical/psychiatric treatment in Ontario. Both are located in southern Ontario -
Penetanguishene (Georginawood Concurrent Disorders Program) and Ottawa (Meadow Creek
Residential Treatment, Royal Ottawa Mental Health Centre).

D. Residential Supportive Treatment Level 1 & Level 2:

There are no residential supportive treatment services, Level 1 or Level 2, located in the Rainy
River District. Changes Recovery Homes Inc. operates two (2) Residential Supportive
Treatment Level 1 facilities in Kenora, Clarissa Manor and Del-Art Manor.

Clarissa Manor accepts women who are 18 years of age and over who need a safe, sober and
stable environment while working on their sobriety. Clarissa Manor offers its clients pre and post
treatment assistance with developing healthy lifestyles. Clarissa Manor operates on a 12-step
abstinence model. It also assists clients with community reintegration, vocational counselling,
etc. Women may stay for a maximum of six months.

Del-Art Manor offers men a program similar to that offered in its sister facility, Clarissa Manor.
Men must be 18 years of age to be admitted. The maximum stay for men is also six months.

Crossroads Centre Inc., located in Thunder Bay, operates a recovery home for adult men and
women who are in the early stages of recovery from a substance abuse disorder. It has 14
beds for women and 26 beds for men. The Pre-Treatment Program focuses on treatment
readiness and stabilization. One-on-one counselling is provided a minimum of twice a week.
1u1

Group sessions include: stabilization, handling stress, step group, explorations and discussions.
Crossroads Post-Treatment Program focus on recovery support which includes one-on-one
counselling and group work including relapse prevention, life skills, handling stress, step group,
problem solving, and anger management. Crossroads Centre Inc. is open to males and
females aged 18 to 70 years of age. Its facility in Thunder Bay was relocated recently from Lillie
Avenue to North Algoma Street.

Aboriginal Treatment Service Utilization:
Ìn this section, Aboriginal people's utilization of substance abuse treatment services is
examined. The data used is compiled from the Rainy River District Aboriginal Addictions
Needs Assessment Survey (RRDANAS) and from the Drug and Alcohol Treatment Information
System (DATIS) developed by the Centre for Addiction and Mental Health.
A. Rainy River District Aboriginal Addiction Needs Assessment Survey
(RRDAANAS):
The Rainy River District Aboriginal Addictions Needs Assessment Survey asked addictions
treatment questions separately for alcohol and for other drug use such as whether respondents
had ever been in treatment, the number of times in treatment , the type of treatment they
attended, whether the treatment contained Aboriginal cultural components, and if they used
aftercare services.
Treatment Attendance:
Thirty-six percent (36%) of respondents stated they had been in treatment for alcohol and/or
other substances in their lifetime. Men were significantly more likely than women to report
previous substance abuse treatment (42% and 31%). Over their lifetime, respondents had been
in substance abuse treatment an average of 2.8 times (range = 0 to 15 times). Men and women
were equally as likely to have been in substance abuse treatment over their lifetime. Most
respondents had been in substance abuse treatment less than once during the 12-month period
immediately prior to the needs assessment (range = 0 to 9 times). There were no significant
gender differences. Respondents had also been in treatment less than one time before the age
of 18 years (range = 0 to 5 times), and there was no significant gender differences.
Alcohol Treatment:
Respondents stated who said they had attended alcohol treatment programs did so an average
of 2.8 times in their lifetime (range = 1 to 15 times). Thirty-four percent (34%) had been in
alcohol treatment three or more times in their lifetime. Twenty-percent (20%) of respondents
had been for alcohol treatment in the 12 months immediately prior to the needs assessment.
Forty-percent (40%) had been for addictions treatment before the age of 18 years. There were
no significant gender differences within any of these measures.
1u2

The highest percent of these respondents reported attending inpatient alcohol treatment (54%)
followed by residential treatment (34%), A.A. or other self-help programs (28%), outpatient
programs (23%), and Detox (22%). Men and women were not statistically different in the type
of alcohol treatment programs they attended.



Other Substance Abuse Treatment:
Some respondent attended treatment for other types of substance use an average of 2.2 times
(range = 1 to 12). Twenty-two percent (22%) attended substance abuse treatment (other than
alcohol) 3 or more times. Women attended treatment for other substance use significantly less
often than men (mean = 1.6 and 3.0 times). On average, these respondents attended less than
once in the 12 month-period immediately prior to the needs assessment, and they attended
substance abuse treatment less than once before the age of 18 years. There were no
significant gender differences for either of these.
Respondents who were in treatment were most likely to have attended inpatient treatment
(45%), followed by residential programs (42%), Detox (36%), outpatient programs (15%), and
NA or other self-help programs (13%). Similar percents of men and women attended each of
the types of treatment programs.

0
10
20
30
40
30
60
Chart 31: Abor|g|na| A|coho| 1reatment Ut|||zat|on by
5erv|ce 1ype and Gender (kkDAANA5)
1oLal
Male
lemale
1uS



If respondents indicated they had been in any type of substance abuse treatment more than
once, they were asked to indicated how important a pre-selected list of reasons were for their
relapse or need for additional services. The needs assessment instrument also asked
respondents about the importance of traditional Aboriginal cultural components in substance
abuse treatment, It also asked their opinions of addictions and/or mental health treatment
priorities in their community.
Addictions Treatment While Incarcerated and/or on Probation:
Thirty-four percent (34%) of respondents indicated they had been incarcerated at some time in
their life. Men were significantly more likely than women to have been incarcerated over their
lifetime (54% and 33%). Eighty-one percent (81%) said substance abuse was a factor in their
incarceration. There was no statistical significance in between the percent of men and women
who reported substance abuse as a factor leading to their incarceration (84% and 77%).
Forty percent (40%) of respondents reported they had been on probation or parole at some
time. Seventy percent (70%) of those who had been on probation or parole reported substance
abuse was a factor. Again, there was no statistical significance between men and women (74%
and 64%).
Seven percent (7%) of respondents reported they were on probation or parole at the time of the
needs assessment. More men reported currently being on probation or parole than women (9%
and 5%). Fifty-seven percent (57%) reported substance use as a factor in their being on
probation or parole. There was no significant difference in the number of males and females
who reported substance use as a factor (57% and 57%).
0
3
10
13
20
23
30
33
40
43
30
Chart 32: Abor|g|na| 5ubstance Abuse 1reatment
(Lxc|ud|ng A|coho|) by 5erv|ce 1ype and Gender
(kkDAANA5)
1oLal
Male
lemale
1u4

Respondents were asked whether they had been offered treatment for their alcohol and/or drug
problems when they were incarcerated and/or on probation or parole. Thirty-one percent (31%)
said they had been. Men were significantly more likely than women to report having been
offered alcohol and/or drug treatment (38% and 22%).
Respondents also were asked whether they had been offered mental health treatment while
incarcerated and/or on probation. Eleven percent (11%) reported they had been offered mental
health treatment. Again, more men than women reported being offered mental health treatment
(13% and 9%).
When asked whether the treatment received was effective, only 38% of those who received
alcohol and/or drug abuse treatment thought it was effective. Women were significantly more
likely than men to report the alcohol and/or drug treatment they received was effective (58% and
31%). Twenty-nine percent (29%) of those who received mental health treatment reported it
was effective. There was no statistically significant difference between men and women on this
issue.

B. Aboriginal Use of Provincially Funded Treatment Services FY2007-
2008:

Aboriginal people in the Rainy River District access a wide range of federal and provincially
funded substance abuse treatment services across Ontario. They also access substance abuse
treatment in other provinces and out-of-country.
Limitations of the Data:
The data used in identifying Aboriginal treatment service utilization has a number of limitations
and therefore, it does not accurately represent a complete picture of Aboriginal treatment
service use.
The data used in this section of the report was provided by the Drug and Alcohol Treatment
Information System (DATIS) developed by the Centre for Addictions and Mental Health (CAMH)
for the Ministry of Health and Long-Term Care. DATIS collects and reports client demographic
and service utilization data from addictions and problem gambling treatment services that are
provincially funded. DATIS does not include Aboriginal clients who access federally-funded
treatment services through the National alcohol and Drug Abuse Program (NNADAP) or the
National Youth Solvent Abuse Program (NYSAP). The data also does not include individuals
accessing treatment services in other provinces or in the United States.
DATIS may under record the number of Aboriginal clients accessing treatment because of
problems associated with documenting ethnicity. Ethnicity reporting requires either clients to
self-identify or treatment staff to identify the client's ethnicity. Ìf a client fails to self-identify as
Aboriginal or treatment staff incorrectly report a client's ethnicity, underreporting occurs.
1uS

Some treatment programs chose not to record ethnicity while others may under record the
number of Aboriginal clients they see.
The DATIS information provided to the Treatment and Support Project contained missing
information. This is the result of some treatment programs failing to make entries into some
data fields in CATALYST. CATALYST is a web-based software application used by most
treatment agencies to input their data online and directly to their database. DATIS, in turn, is
responsible for reporting non-identifiable data back to the Ministry of Health, LHINs and any
other interested stakeholders.
Low numbers and privacy requirements make the reporting of DATIS statistics problematic.
Numbers below 5 in total are not reported.
"Open Registrations¨ includes all client type of admissions (client and family member) where a
client received a service in a Ministry funded substance abuse or problem gambling program.
Substance abuse and problem gambling programs provided by an agency and funded by the
Ministry are mapped to one of the Provincial Service Categories to permit the generation of
statistics by Provincial Service Category. If a client is registered in one or more programs in the
same Provincial Service Category during the same admission, those program registrations are
counted as one registration for the Service Category. If a client has one or more program
registrations in this Service Category in one or more admissions during the fiscal year, one
registration to this Service Category is counted for each admission.
The data used is from fiscal year 2007-2008 and therefore represents a "snapshot in time.¨
Because it represents only one year, it cannot be used to identify patterns or trends in
Aboriginal treatment utilization.
FY2007-2008 Provincial Treatment Utilization:
The data presented here includes all First Nations in the Rainy River District not just those that
participated in the Rainy River District Aboriginal Addictions Needs Assessment Survey.
Demographics:
In fiscal year 2007-2008, 56% of the "open admission¨
10
caseload from the Rainy River District
in Ontario treatment services was Aboriginal.
Ninety-two percent (92%) of the Aboriginal treatment open admissions were Registered Status
Indians, six percent (6%) were non-status Indians and two percent (2%) were Métis.
Sixty-five percent (65%) were male and thirty-five percent (35%) were female. In FY2007-2008,
Aboriginal males in the Rainy River District accessed provincial substance abuse treatment
services at a rate almost twice that of Aboriginal females.
Chart 33 shows the FY2007-2008 Rainy River District Aboriginal substance abuse treatment
population by age group.
1u6

The majority of Rainy River District Aboriginal users of provincially funded substance abuse
treatment services were in the 25 to 34 age group (34%) followed by those in the 45 to 54 age
group (30%). Twenty-three percent (23%) were in the 16 to 24 age group while eight percent
(8%) were in the 25 to 44 age group. Individuals under age 16 years comprised three percent
(3%). Persons aged 55 plus comprised only two percent (2%) of the Aboriginal treatment
population.



Twenty-one percent (21%) of those admitted to treatment were married, partnered or living
common law. Sixty percent (60%) were single while seven percent (7%) were separated or
divorced. Thirteen percent (13%) had an unknown relationship status.
One percent (1%) of Aboriginal women admitted to treatment was pregnant at the time of their
admission.
Information regarding Rainy River District Aboriginal treatment client education status in
FY2007-2008 is limited as fifty percent (50%) of the Aboriginal treatment clients had an
unknown education level. Of the fifty percent (50%) whose educational status was recorded,
three (3%) had only an elementary school education; twenty-seven percent (27%) had some
secondary school education and twelve percent (12%) had graduated high school. Of the eight
percent (8%) who went on to post-secondary education, two percent (2%) had some community
college, technical college or CEGEP. Two percent (2%) had completed community college,
3
23
34
8
30
2
0
0
3
10
13
20
23
30
33
40
under 16 16 Lo 24 23 Lo 34 33 Lo 44 43 Lo 34 33 Lo 64 63 Þlus
Þ
e
r
c
e
n
t
a
g
e

o
f

A
b
o
r
|
g
|
n
a
|

C
|
|
e
n
t
s
Age Group
Chart 33: I¥2007-2008 ka|ny k|ver Abor|g|na| Users of
D|str|ct Þrov|nc|a| 5ubstance Abuse 1reatment C||ents by
Age Group (DA1I5)
1u7

technical college or CEGEP; two percent (2%) had some university and two percent (2%)
completed university.
In FY2007-2008, fifty-three (53%) of Aboriginal treatment clients from the Rainy River District
were unemployed and looking for work. Eight percent (8%) were employed full-time and four
percent (4%) were employed part-time. Nine percent (9%) were students or were individuals
involved in retraining. Three percent (3%) were disabled and not working and less than one
percent (0.5%) were retired. Fifteen percent (15%) had an unknown employment status.
Fifty-nine percent (59%) of Aboriginal clients entering treatment had no legal encumbrance.
Eight percent (8%) were awaiting trial or sentencing. Ten percent (10%) were on probation and
less than one percent (0.3%) were on parole. Just over two percent (2%) were incarcerated
and two percent (2%) had an "other¨ legal status. Eighteen percent (18%) had an unknown
legal status.
Eighty-one percent (81%) of Aboriginal treatment clients entered voluntarily. One percent (1%)
had the choice of attending treatment or going to jail. Eight percent (8%) attended treatment as
a condition of probation or parole. Two percent (2%) were required to attend treatment by a
child welfare authority. One percent (1%) attended as a condition set by his/her family. Three
percent (3%) attended treatment as part of some "other¨ condition. Four percent (4%) had an
unknown status.
Addiction Profile:
Chart 34 shows the substances Aboriginal treatment clients used in FY2007-2008 in the 12
months prior to their admission to treatment.
Sixty-six percent (66%) reported using alcohol in the 12 months before treatment. Seventeen
percent (17%) had used cocaine and seven percent (7%) had used crack. Four percent (4%)
reported using amphetamines or other stimulants excluding methamphetamines. Twenty-nine
percent (29%) had used cannabis. Five percent (5%) had used benzodiazepines and one
percent (1%) had used barbiturates. Two percent (2%) had used heroin or opium in the
previous 12 months. Twenty-four percent (24%) had used prescription opioids. Seven percent
(7%) had used a tobacco product. Two percent (2%) reported using an over-the-counter
codeine preparation. Less than one percent reported using an hallucinogen (0.3%), glue or
other inhalant (0.3%), ecstasy (0.5%), and methamphetamines (crystal meth) (0.5%),
respectively. Some Aboriginal clients were admitted to treatment with no presenting substance
use in the past 12 months (0.8%). Fifteen percent (15%) had an unknown substance use in the
previous year.
1u8



Chart 35 shows the presenting substance abuse problem for Rainy River District Aboriginal
populations entering substance abuse treatment in FY2007-2008.
66
17
4
29
3
1
3
24
4
0.3
14
0.3
0.3
7
2
0.8
3
13
0 10 20 30 40 30 60 70
Alcohol
Cocalne
AmpheLamlnes or oLher sLlmulanLs ͙
Cannabls
8enzoldlazeplnes
8arblLuaLes
Peroln/Cplum
ÞrescprlpLlon Cplolds
Cver Lhe CounLer Codelne ÞreparaLlons
Clue and CLher SolvenLs
1obacco
ÞsvchoacLlve uruas
SLerolds
Crack
LcsLasv
MeLhampheLamlnes (crvsLal meLh)
no SubsLance
unknown
Chart 34: ka|ny k|ver D|str|ct I¥2007-2008 Abor|g|na|
1reatment Adm|ss|ons Þast 12 Month 5ubstance Use by
Þercentage (DA1I5)
°
1u9


Thirty-seven percent (37%) of the District's provincial Aboriginal treatment clients in FY2007-
2008 presented with an alcohol only problem. Thirty percent (30%) presented with an alcohol
and at least one other drug addiction. Fifteen percent (15%) presented with a drug only
addiction (excluding tobacco). Four percent (4%) presented with a cocaine addiction and four
percent (4%) had a crack addiction. Twenty-seven percent (27%) presented with an addiction
to cannabis. Three percent (3%) were addicted to benzodiazepines. Two percent (2%) were
addicted to heroin or opium. Twenty-four percent (24%) were addicted to prescription opioids.
Two percent (2%) entered treatment with an addiction to over-the-counter codeine addiction.
Seven percent (7%) were addicted to tobacco. Aboriginal treatment admissions reported less
than one percent (1%) addiction rate to other substances including glue and other inhalants
(0.3%), ecstasy (0.5%), barbiturates (0.5%) and methamphetamines (crystal meth) (0.5%).
Less than one percent (0.8%) of Aboriginal clients admitted to treatment had no presenting
problem. Fifteen percent (15%) had an unknown status.
37
30
13
4
4
27
3
0.3
2
24
2
7
0.3
0.3
0.3
0.3
0.8
13
0 3 10 13 20 23 30 33 40
Alcohol Cnlv
Alcohol and aL leasL one oLher drua
urua Cnlv (excludlna Lobacco)
Cocalne
Crack
Cannabls
8enzodlazeplne
8arblLuraLes
Peroln/Cplum
ÞrescrlpLlon Cplolds
Cver-Lhe-CounLer Codelne
1obacco
Palluclnoaens
Clue and CLher lnhalanLs
LcsLasv
MeLhampheLamlnes (crvsLal meLh)
no ÞresenLlna Þroblem
unknown
Chart 35: ka|ny k|ver D|str|ct I¥2007-2008 1reatment
Adm|ss|ons by Þresent|ng 5ubstance Abuse by Þercentage
(DA1I5)
°
11u

Ten percent (10%) were on Methadone or another opioid substitute when they entered
treatment. Seventy-six percent (76%) were not on Methadone or any other opioid substitute.
Fourteen percent (14%) had an unknown status.
Sixty-five percent (65%) had never injected drugs. Two percent (2%) had injected prior to one
year before admission. Fourteen percent (14%) had injected in the 12 months before their
admission to treatment. Nineteen percent (19%) had an unknown injection status.
Referral Source:
Chart 36 shows FY2007-2008 Rainy River District Aboriginal treatment referrals by source of
referral.
Fifty-nine percent (59%) of all Aboriginal referrals to treatment were self-referrals. Five percent
(5%) were from family and friends.
Eleven percent (11%) of referrals was from the legal system, excluding police. Less than one
percent (0.3%) was from the police.
Three percent (3%) were from a medical agency ÷ hospital. Two percent (2%) were from a
physician/private practitioner. Less than one percent (0.3%) was from a psychiatric
service/hospital.
Three percent (3%) were from a residential treatment service agency. Two percent (2%) came
from an Initial Assessment/Treatment Planning Agency. Community treatment agencies
referred five percent (5%) of the Aboriginal treatment population. Less than one percent was
from a Residential Withdrawal Management Agency (Detox) ÷ Level 1, 2 or 3 (0.5%), a Case
Management Agency (0.5%), Residential Supportive Housing Agency ÷ Level 1 or 2 (0.5%) or
Community Day/Evening treatment agency (0.5%).
One percent (1%) of the referrals was from a social service agency ÷ adult program while less
than one percent (0.8%) was from a social serve agency ÷ child program. Less than one
percent (0.3%) was from a community mental health agency ÷ adult program. One percent
(1%) was from a Women's/Men's Shelter. Less than one percent (0.3%) was for an "other¨
community institution/residential program.
Two percent (2%) of Aboriginal treatment referrals were from a Native (Aboriginal) treatment
service while one percent (1%) was from another Native (Aboriginal) service.
111



Provincial Treatment Category:
Chart 37shows the percentage of Rainy River District Aboriginal clients' use of substance abuse
services by Provincial Service Category. Sixty percent (60%) of District Aboriginal substance
abuse clients used Residential Withdrawal Management Services ÷ Level 2 (Detox). Twenty-six
percent (26%) used provincial Case Management Services while twenty-five percent (25%)
used Community Treatment Services primarily outpatient counselling. Nineteen percent (19%)
used Initial Assessment/Treatment Planning. Three percent (3%) used Residential Supportive
Treatment ÷ Level 1 which includes halfway houses. Two percent (2%) used Residential
Treatment. Aboriginal clients did not use Residential Supportive Treatment ÷ Level 2 (housing
without in-house addiction services), Residential Medical/Psychiatric Treatment, Residential
39
11
3
3
3
3
2
2
2
1
0.8
1
1
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0 20 40 60 80
Self 8eferral
Leaal SvsLem (excludlna pollce)
CommunlLv 1reaLmenL Aaencv
lamllv and lrlends
Medlcal Aaencv - PosplLal
8esldenLlal 1reaLmenL Servlce
Þhvslclan/ÞrlvaLe ÞracLlLloner
naLlve 1reaLmenL Servlce
lnlLlal AssessmenL 1reaLmenL Þlannlna Aaencv
Soclal Servlce Aaencv - AdulL Þroaram
Soclal Servlces Aaencv - Chlld Þroaram
Women's/Men's ShelLer
CLher naLlve Aaencv
8esldenLlal WlLhdrawal ManaaemenL Aaencv - All ͙
8esldenLlal SupporLlve Pouslna Aaencv - All Levels
Case ManaaemenL Aaencv or CLher Aaencv
CommunlLv uav/Lvenlna 1reaLmenL Aaencv
ÞsvchlaLrlc Servlce/PosplLal
CommunlLv MenLal PealLh Aaencv - AdulL Þroaram
CLher CommunlLv lnsLlLuLlon/8esldenLlal Þroaram
Þollce
Þercentage of keferra|s
k
e
f
e
r
r
a
|

5
o
u
r
c
e
Chart 36: I¥2007-2008 ka|ny k|ver D|str|ct Abor|g|na|
1reatment keferra| 5ource by Þercentage (DA1I5)
112

Withdrawal Management ÷ Level 1, any level of Community Withdrawal Management,
Community Medical/Psychiatric Treatment of Community Day/Evening Treatment. This is likely
due to the lack of these services within the District.


'Initial Assessment/Treatment Planning Services¨ involves the client and clinician identifying the
client's needs, goals, characteristics, problems and/or stages of change. Ìt also involved the
mutual negotiation of a Client Treatment Plan including referrals as appropriate. As noted,
nineteen percent (19%) of Aboriginal provincial treatment clients used this service in FY2007-
2008. This represents seventy-one (71) individuals or families. Slightly more Aboriginal females
than Aboriginal males used the service. Of the Aboriginal males, 36% were in the 25 to 34 age
group and 31% were the 16 to 24 age group. Of the Aboriginal female clients, 44% were in the
25 to 24 age group. No Aboriginal person in the 65 plus age group used the service.
19
26
23
0
0
0
0
0
0
60
2
0
3
0
0 10 20 30 40 30 60 70
lnlLlal AssessmenL/1reaLmenL Þlannlna
Case ManaaemenL
CommunlLv 1reaLmenL
CommunlLv uav/Lvenlna 1reaLmenL
CommunlLv Medlcal/ÞsvchlaLrlc 1reaLmenL
CommunlLv WlLhdrawal ManaaemenL -͙
CommunlLv WlLhdrawal ManaaemenL -͙
CommunlLv WlLhdrawal ManaaemenL -͙
8esldenLlal WlLhdrawal ManaaemenL - Level 1
8esldenLlal WlLhdrawal ManaaemenL - Level 2
8esldenLlal 1reaLmenL
8esldenLlal Medlcal/ÞsvchlaLrlc 1reaLmenL
8esldenLlal SupporLlve 1reaLmenL - Level 1
8esldenLlal SupporLlve 1reaLmenL - Level 2
Þercentage of Abor|g|na| C||ents
Þ
r
o
v
|
n
c
|
a
|

5
e
r
v
|
c
e

c
a
t
e
g
o
r
y
Chart 37: I¥2007-2008 Add|ct|on 1reatment Case|oad by
Þrov|nc|a| 5erv|ce Category and Þercentage of
ka|ny k|ver D|str|ct Abor|g|na| C||ents
11S

Chart 38 shows Aboriginal Open registrations for Initial Assessment/Treatment Planning
Services by age group and gender in FY2007-2008.



The majority of Aboriginal clients accessing Initial Assessment and Treatment Planning were
between 16 and 34 years of age. Aboriginal women accessed these services at a higher rate
than Aboriginal males.
"Case Management Services¨ involves the designation of a primary worker who is responsible
for the ongoing assessment of the client, adjustment of his/her treatment plan, service
coordination, monitoring and support, discharge planning and client advocacy. Chart 39 shows
Aboriginal Case Management Service utilization by age and gender for FY2007-2008.

0
3
10
13
20
23
30
33
40
43
30
under 16 16 - 24 23 - 34 33 - 44 43 - 34 33 - 64 63 and
Cver
Þ
e
r
c
e
n
t
a
g
e
Age Group
Chart 38: In|t|a| Assessment/1reatment Þ|ann|ng 5erv|ces
Cpen reg|strat|on by Age Group and Gender
Abor|g|na| C||ents of the ka|ny k|ver D|str|ct
1oLal
Male
lemale
114



Twenty-six percent (26%) of the Aboriginal provincial treatment population used provincial case
management services in FY2007-2008. The highest users were in the 16 to 24 age group
(44%) followed by those in the 25 to 24 age group (29%). More Aboriginal females in the 16 to
24 age group used the services than Aboriginal males of the same age (48% and 35%,
respectively.) Of those in the 25 to 34 age group, slightly more Aboriginal females used the
service than Aboriginal males (30% and 27%).
"Community Treatment Services¨ involves individual or group counselling in 1 to 2 hour
sessions approximately once a week. Chart 40 shows Aboriginal treatment clients use of
provincially funded community treatment services by age and gender.


0
3
10
13
20
23
30
33
40
43
30
under 16 16 - 24 23 - 34 33 - 44 43 - 34 33 - 64 63 and
Cver
Þ
e
r
c
e
n
t
a
g
e
Age Group
Chart 39: Case Management 5erv|ces
Cpen reg|strat|on by Age Group and Gender
Abor|g|na| C||ents of the ka|ny k|ver D|str|ct
1oLal
Male
lemale
0
20
40
60
under 16 16 - 24 23 - 34 33 - 44 43 - 34 33 - 6463 and Cver
Þ
e
r
c
e
n
t
a
g
e
Age Group
Chart 40: Commun|ty 1reatment 5erv|ces
Cpen reg|strat|on by Age Group and Gender
Abor|g|na| C||ents of the ka|ny k|ver D|str|ct
1oLal
Male
lemale
11S

Aboriginal females in the 25 to 34 age group were the highest users of this service (46%),
followed by Aboriginal males in the same age group (36%). Thirty five percent (35%) in the 16
to 24 age group used the service. There was no significant difference in male and female use in
the 16 to 24 age group. Community services were used by the 35 to 44 age group at a
significantly lower level than the 16 to 24 age group and the 25 to 34 age group. This group
used services at a rate two and half to three times lower than the younger age groups.
"Residential Treatment Services¨ involve the provision of a structured program of treatment
while the client resides in-house. Chart 41 illustrates Rainy River District Aboriginal utilization of
provincially funded residential treatment services in FY2007-2008 by age and gender.

There were only nine (9) Aboriginals from the Rainy River District who used provincially funded
residential treatment services in FY2007-2008. The majority were females between 16 and 44
years of age.
"Residential Support Treatment Services ÷ Level 1¨ includes housing and related
recovery/support services such as lifestyle counselling, community reintegration and vocational
counselling. Level 1 housing provides a supportive environment prior to, during, or following
treatment which is accessed elsewhere. Included in the service category are pre-treatment
programs and half-way houses.
0
10
20
30
40
30
60
70
80
90
under
16
16 - 24 23 - 34 33 - 44 43 - 34 33 - 64 63 and
Cver
Þ
e
r
c
e
n
t
a
g
e
Age Group
Chart 41: kes|dent|a| 1reatment 5erv|ces
Cpen keg|strat|ons by Age Group and Gender
Abor|g|na| C||ents of the ka|ny k|ver D|str|ct
1oLal
Male
lemale
116



There were eleven (11) Aboriginal treatment clients from the Rainy River District who used
provincially funded Residential Treatment Support Services ÷ Level 1 in FY 2007-2008. The
majority of Aboriginal service users were in the 35 to 34 age group. Of the males using this
service, 80% were in the 25 to 34 age group. Of the females, 50% were in this age group.
"Residential Withdrawal Management Services ÷ Level 2¨ involves detoxification from substance
abuse. It includes clients being tapered from benzodiazepines or narcotics and clients on
Methadone. Chart 42 illustrates by age and gender Rainy River District Aboriginal utilization of
these services in FY2007-2008. During this year, there were 221 Aboriginal people who used
this service.
The majority of Aboriginal clients were in the 45 to 54 age group (46%). The next greatest
users of Detox services were those in the 25 to 34 age group (34%), followed by those aged 16
to 24 (12%). Of the Aboriginal males who used the service, 59% were in the 45 to 54 age group
while 31% were in the 25 to 34 age group. Of Aboriginal females using Level 1 Detox, 46%
were in the 25 to 34 age group while 38% were in the 25 to 34 age group.
Treatment Location:
The majority of Aboriginal treatment clients in FY2007-2008 (70%) accessed provincially funded
treatment services outside of the Rainy River District. Only thirty percent (30%) accessed these
services within the District. This reflects a lack of substance abuse treatment services within the
District and the necessity to make referrals outside the area.
Chart 43 shows the FY2007-2008 Rainy River District Aboriginal substance abuse treatment
clients by treatment program.
0
10
20
30
40
30
60
70
80
90
under
16
16 - 24 23 - 34 33 - 44 43 - 34 33 - 64 63 and
Cver
Þ
e
r
c
e
n
t
a
g
e
Age Group
Chart 42: kes|dent|a| 5upport 1reatment 5erv|ces Leve| 1
Cpen keg|strat|ons by Age Group and Gender
Abor|g|na| C||ents of the ka|ny k|ver D|str|ct
1oLal
Male
lemale
117


Of the Aboriginal clients accessing treatment services in the Rainy River District in FY2007-
2008, eighty-five percent (85%) were registered status Indians, fourteen percent (14%) were
non-status Indians and one percent (1%) were Métis. Males comprised fifty-one percent (51%)
and females forty-nine percent (49%).
Of the Aboriginal clients attending treatment outside of the District, 77% attended treatment in
Kenora. The majority (98%) of these attend programs offered by the Lake of the Woods District
Hospital. Of the Aboriginal people who attended treatment in Kenora, the majority were
registered status Indians (98%). Only 2% were Métis or Non-status Indians.
Nine percent (9%) attended treatment in Thunder Bay. Of these, 73% attended treatment at
programs offered by the St. Joseph Care Group.
Two percent (2%) attended substance abuse treatment services in a location outside the North
West Local Health Ìntegration Network's catchment area.
Outgoing Referrals:
Chart 44 shows where Rainy River District Aboriginal clients where referred upon their
discharge from provincially funded substance abuse treatment services.
0
30
100
130
200
230
300
330
ALlkokan
CommunlLv
Counselllna
8lverslde
CommunlLv
Counselllna
unlLed
naLlve
lrlendshlp
CenLre
1oLal CllenLs
1
o
t
a
|
N
o
.

C
f

C
|
|
e
n
t
s
ka|ny k|ver D|str|ct Agency
Chart 43: I¥2007-2008 Abor|g|na| C||ents vs. 1ota| No. of
C||ents
ka|ny k|ver D|str|ct 5ubstance Abuse 1reatment
Þrograms
1oLal 8eaardless of LLhnlclLv
1oLal Aborlalnal CllenLs
118


Fifty-eight percent (58%) of Rainy River District Aboriginal clients left provincial services without
any outgoing referral. Thirty-six percent (36) had no referrals as their case was still open. Of
those who left with a referral, most (3%) were referred to a self-help group such as Alcoholics
Anonymous and 1% was referred to a Native service, other than a Native treatment service,
Native housing or traditional healer/Elder.
Reason for Discharge:
Only 17% left treatment after having completed their service plan. The majority (69%) withdrew
from treatment and notified staff. Seven percent (7%) were transferred elsewhere, other than
hospital. Four percent (4%) either dropped out or were a no show prior to treatment. Two
percent (2%) were involuntary discharged by staff. One percent (1%) left upon the mutual
agreement of the client and the staff. A small proportion left for hospitalization (.4%) or for other
reasons (.9%).

0 10 20 30 40 30 60 70
CommunlLv 1reaLmenL Servlce
CommunlLv uav/Lvenlna ͙
8esldenLlal 1reaLmenL Servlce
8esldenLlal SupporL 1reaLmenL ͙
8esldenLlal SupporL 1reaLmenL ͙
Medlcal Servlces - PosplLal
CommunlLv PealLh CenLre
CommunlLv MenLal PealLh ͙
CommunlLv MenLal PealLh ͙
Soclal Servlce Aaencv - AdulL ͙
Soclal Servlce Aaencv - Chlld ͙
Pouslna Þroaram/Servlces
Self Pelp Croups (e.a. Alcohollcs ͙
CLher
1radlLlonal Pealer/Llders
naLlve 1reaLmenL Servlces
Pouslna - naLlve/non-ÞroflL
CLher naLlve Servlces
no 8eferrals Made on ulscharae
no 8eferrals Made - SLlll Cpen
Chart 44: Þrov|nc|a| 5ubstance Abuse 1reatment 5erv|ces
ka|ny k|ver D|str|ct Abor|g|na| Cutgo|ng keferra|s
by kec|p|ent Agency
Serles1
119

C. First Nation Utilization of Federally Funded NNADAP Treatment
Centres:
Client demographic and service information was sought from the National Native Alcohol Drug
Abuse Program (NNADAP), First Nations and Inuit Health Branch, Health Canada for federally-
funded First Nation treatment facilities. However, the First Nations and Inuit Health Branch,
which is responsible for the program, advised the Project Coordinator NNADAP currently lacks
a regional or national database on First Nation clients seen at NNADAP treatment facilities. The
Project was directed to contact each NNADAP treatment centre to obtain the desired
information. Letters were sent in September 2009 to all NNADAP treatment centres and healing
lodges in Ontario requesting aggregate non-identifying statistical information on clients from
Rainy River District First Nations. The letters were followed up with telephone call to each
treatment facility. To date, none of the NNADAP treatment centres have been able to
accommodate the Project's information request. Several said they lack an internal database.
As a result, files would have to be hand reviewed but since they lack staff, they could not
accommodate the Project's request.
The NNADAP and YSAC data management system has been undergoing a revamping process
since 2000. The goal was to replace the out-dated Substance Abuse Information System
(SAIS) with a state-of-the-art Web-based information management system based on the Oracle
database engine by 2007.
11
The inability of NNADAP regional office or any of the NNADAP and
YSAC programs to meet Project's data needs would appear to indicate the proposed new
system is yet to materialize.
Factors that lead Aboriginal People to seek treatment:

In all of the Focus Groups, we heard treatment success depends upon both on people's
willingness to accept they have a substance abuse problem and their recognition of the need to
change. We also heard some precipitating event or circumstance usually leads people to this
recognition.
A. Enhance Personal Well-being:
Focus group members said there came a point in their substance use when they began to
experience the negative health consequences of their using. Some said they were depressed,
even suicidal. Others spoke of being told by a health professional to quit or die. By seeking
treatment, people hoped to reverse or mitigate the abuse done to their bodies and regain their
personal health.
"It was a life or death situation for me. If I didn't quit, I'd be dead."
'I got snaky. I had the D.T.s and I was experiencing withdrawal symptoms."
'I lost it mentally. I was going crazy."
'I was depressed and on the verge of suicide."
12u

'I was sick and tired of being sick and tired."

'I was told that if I didn't stop drinking, I would get cirrhosis."
'I felt I was too young to die. I had seen family members drink themselves to
death and I did not want that to happen to me."
'I started taking prescription pills because I had a valid health problem. Before I
knew it, I was addicted. I could not stop on my own."

B. Recognition of the Harm Being Caused to Others:
Individuals spoke of eventually coming to the recognition their substance abuse was not only
affecting their lives but also the lives of their families and other community members. They felt
guilty about their behaviour and what drugs and alcohol had caused them do.
'I didn't want to do break-ins to get money for drugs."
'...to avoid the violence. You will do anything to get drugs to prevent withdrawal
including stealing money and ripping off the government. You use the system to
get money for your habit such as trying to get travel grant and abusing social
programs, such as welfare and any other program that will give you money."
'I was tired of abusing my family. Playing the guilt trip and taking their money;
lying and manipulating. I wanted to quit doing those things."
'I wanted to quit stealing people's cheques and committing mail fraud."
'I was getting involved in prostitution."
'I resorted to stealing other people's drugs."
'Avoid criminal activity."
'You lie to the doctors so you can get script. I told them I lost my prescription or
it was stolen. I'd get the prescription filled and use some of the drugs and sell the
others. I was sick of myself. I got sick of my lifestyle and what it was doing to me
and others. The high was not worth it anymore."
'I was blaming the workers, the medical drivers, everyone. If you don't get your
travel grant you are mad at everyone even though you know you want it for
drugs."
'So I wouldn't have to steal to feed my addiction."
'....to control my violent outbursts. I was mad as hell at everyone."
'You have all this anger, rage, moodiness and paranoia. You believe people are
out to get you. Dealers want their money. You hide and tell your kids to lie for
you. You isolate yourself and your family"
121

'You can lose everything. Your children are at risk from dealers who say they will
harm them. I wanted it all to stop."
"There was so much co-dependency going on. My family had become so
dysfunctional."
'Your addiction can lead to murder and suicide."
'Drug use leads to domestic violence. You will do anything for that drug. You'll
spend the family's money so there is no food and bills are not paid. You start
pawning things. You steal things from people."
'You get sick of the things that are happening in your life - the drama. Not having
food, being homeless and not paying bills. You get tired of the addiction. You
don't want the drugs to control your life anymore. You get sick and tired of being
sick and tired."
'When you are an addict, all you care about is getting your drugs. You don't care
about your family and their needs. You develop a tolerance and you want more to
get high or to just feel normal. You will do anything get the drug even hurt the
one's you love if they get in the way."
'I felt so much guilt."

C. Children - A Strong Motivating Factor:
For some parents, particularly mothers, comes recognition of the harm they have caused their
children. Both fathers and mothers feared losing their children to the child welfare system.
Parents were remorseful and felt they had to seek treatment to keep their children and to make
life better for them.
'You put your kids at risk. I was bringing all kinds of unsavoury people around. I
was placing my children and family at risk due to possible retribution from
dealers."
'If you are a woman and pregnant, you want to avoid complications."
'I had to quit or lose my children to the child welfare system."
'I was at risk of losing my kids."
'I wanted to keep my kids."
'I want to avoid having my children taken away. They had been taken into care
and I wanted to get my kids back."
'When you are on pills, you can't take care of your children because of the drugs'
effects. You are too stoned."
'You have violent outbursts while on pills. The kids see this and hear it. You
abuse your children emotionally and physically."
122

'I could see the fear in their eyes."
'"My use affected my children. What they learn at home affects the whole family
for life."
'Both my parents abused alcohol. My father was an alcoholic. When I was
growing up, I told myself I would never be like him. I would never hit my wife or
abuse my kids. I was going to be different but here I was just being like him."

D. Negative Life Event:
Several individuals spoke of a life changing event that made them rethink their substance use
and seek treatment.
'I was raped and assaulted."
'My friend ended up in the hospital with alcohol poisoning. I really thought he
was going to die. I thought that could be me."

E. Pressure from Others:
Sometimes the intervention of family and friends is enough to get someone to seek treatment.
Some focus group members said they were angry when they were initially confronted but they
decided to seek treatment after having time to think about it.
'Peer pressure. My friends told me I was out of control."
'Mom made me do it."
'Get my parents off my back."
'My mother forced me to go. My family had an intervention."
F. Financial Problems/Job Issues:
Substance abuse, particularly drug use, is expensive. Money which would normally go to buy
groceries and pay bills is diverted to purchasing drugs. Focus group members spoke of
recognizing they had a problem when they were faced with financial problems or the loss of
employment.
"I had financial problems and was on the verge of bankruptcy."
'Creditors were calling."
'I had money troubles and was at risk of losing my job."


12S

G. To Improve One's Future:
Some individuals seek treatment because they recognize the only way to improve their future
and to achieve their goals was to stop using.
'"I wanted to repair the relationship with family and children."
'To go to school and get back on track."
'I had put all my dreams and hopes on hold just to get high. I didn't want to see
myself as a druggie for the rest of my life; sitting here on the reserve with every
brain cell I have destroyed. I wanted more from life. I did not want the drug
lifestyle. I wanted to be the person I once was with goals and dreams."

H. Recognition that Life Had Become Unmanageable and Change Was Needed:
People said they sought treatment when they realized their lives had become unmanageable
and they were no longer in control.
'I realized I had a problem and I needed to change."
'My life had become unmanageable."
'I wanted to quit using."
'I wanted to do the smart thing."
'I wanted to live a normal life."
'I knew my life was in chaos. I just wanted to feel normal. I was beginning to
think I would never know what normal was again."

I. Negative Motivating Factors:
As we learned in the focus groups, some people choose treatment for less than positive
reasons.
'I had gotten to think treatment would be a good place to get different
connections, learn about new drugs to try and how I might use."
'Treatment is a good place to network drugs. That was my original thinking. Now
I just want to quit this behaviour."
'"You turn to booze to minimize your withdrawal from the drugs. You end up in
jail or in hospital. Some people want to go to jail so they have a place to stay. I
wanted to go to treatment so I could avoid my dealers."
'I had legal problems. I wanted to avoid going to jail and having to go through
withdrawals there. I went to treatment because of that and to avoid becoming an
informant."
124

'I was having trouble with dealers."
'Dealers were after me. I thought hiding out at treatment would be a good way of
avoiding them."
'I needed a time out. I was doing too much. I need a break but I had no intention
of quitting when I went to treatment."
'I needed to get off the streets. I needed a place to stay."
'So I wouldn't have to go through withdrawals."
'It was an alternative to going to jail. It was part of my sentencing and probation
order."



1
0ffice of Alcohol, Biugs anu Bepenuency Issues. !"#$%&'()*+,-./01')2,+-')3"'/.4'0.)/05)6'7/,%&%./.%#0)%0)
8/0/5/9 Bealth Canaua, 1999 p.8
2
Connex 0ntaiio is a coipoiation which opeiates the Biug anu Alcohol Registiy of Tieatment (BART),
0ntaiio Pioblem uambling Botline (0PuB) anu Nental Bealth Seivices Infoimation 0ntaiio (NBSI0) on
behalf of the Ninistiy of Bealth anu Long-Teim Caie.
S
Ibiu p. 12
4
As citeu in National Native Alcohol anu Biug Abuse Piogiam (NNABAP) Ȃ ueneial Review 1998 Ȃ Final
Repoit.
S
Ibiu
6
Biug anu Alcohol Registiy of Tieatment, Connex 0ntaiio.
7
Ibiu.
8
Ibiu.
9
Weechi-it-te-win web site: http:¡¡www.weechi.ca
1u
Dz0pen Aumissionsdz iefeis to client aumissions to an agency which is eithei newǡ oi a caiiyoveiǤ This
iepiesents the caseloau uuiing a fiscal yeai as it compiises all aumissions that have been open foi at least 1
uay uuiing the time peiiou.
11
Thomas, ueialu. Canaua Centie on Substance Abuse. 255%1.%#0)3"'/.4'0.):05%1/.#"-)%0)8/0/5/()20)
;0<%"#04'0./&)*1/09 0ttawa, Naich 2uuS, pp. 1u-11.



123

Chapter 8: Perceived Barriers to
Treatment
Introduction:
This chapter examines Aboriginal survey and focus group participants' perspective on barriers
to substance abuse treatment. The data in this chapter is drawn from two sources. The
quantitative data is from the District Aboriginal Needs Assessment Survey. The qualitative data
is based on focus group discussions.
The Aboriginal Needs Assessment Survey:
In the District Aboriginal Needs Assessment Survey respondents were asked to consider a time
when they felt they needed treatment for substance abuse and from a pre-selected list of 20
items indicate how important each item was for them as barriers to substance abuse treatment.
The following chart illustrates their responses in percentage.

The highest percent of respondents indicated their thinking they could handle the problem
without treatment was an important/very important barrier to their seeking treatment (51%).
This was followed by not thinking they needed treatment at the time (44%), were not ready to
stop using alcohol (42%), were not ready to stop using drugs (41%) and did not think the
treatment would help (41%). Respondents were less likely to indicate parents would not allow
them to go to treatment (19%), there was a charge for treatment and they could not afford it
0 10 20 30 40 30 60
Was a charae for LreaLmenL, could noL afford lL.
Þroaram was Loo far awav.
Could noL flnd proaram offerlna Lvpe of LreaLmenL wanLed.
Were noL readv Lo sLop uslna druas.
uld noL Lhlnk vou needed LreaLmenL aL Lhe Llme.
uld noL Lhlnk Lhe LreaLmenL would help.
uldn'L wanL oLhers Lo flnd ouL vou needed LreaLmenL.
Spouse/parLner would noL allow vou Lo ao for LreaLmenL.
1he proarams were noL aender speclflc.
lrlends dlscouraaed vou from aeLLlna LreaLmenL.
!"#$%&'()&*+$,+-.+/&0#$$-+$1&23&4561%#7,+&8651+&2$+#%9+7%
° 1oLal
126

(21%), their spouse/partner would not allow them to go for treatment (21%), the programs were
not gender specific (23%), and the programs offered mixed gender treatment only (25%) as
important/very important barriers to their seeking treatment for substance abuse.

Overall, a higher percent of women indicated each of the items were important/very important
barriers to their seeking treatment than men. Items with significant differences between women
and men included they were not ready to stop using alcohol (50% and 36%), they did not want
others to find out they needed treatment (45% and 30%), they did not have child care (43% and
26%), they could not find a program offering the type of treatment they wanted (43% and 26%),
not having transportation to get to a program (41% and 27%), and the programs were not
gender specific (28% and 18%).


0 10 20 30 40 30 60 70
Was a charae for LreaLmenL, could noL afford lL.
uld noL have LransporLaLlonL Lo proaram.
Þroaram was Loo far awav.
Pours proaram operaLed were noL convenlenL.
Could noL flnd proaram offerlna Lvpe of LreaLmenL wanLed.
Were noL readv Lo sLop uslna alcohol.
Were noL readv Lo sLop uslna druas.
uld noL know where Lo aeL LreaLmenL.
uld noL Lhlnk vou needed LreaLmenL aL Lhe Llme.
1houahL vou could handle Lhe problem wlLhouL LreaLmenL.
uld noL Lhlnk Lhe LreaLmenL would help.
CeLLlna LreaLmenL havlna a neaaLlve effecL on [ob.
uldn'L wanL oLhers Lo flnd ouL vou needed LreaLmenL.
uld noL have chlld care.
Spouse/parLner would noL allow vou Lo ao for LreaLmenL.
?our parenLs would noL allow vou Lo ao Lo LreaLmenL.
1he proarams were noL aender speclflc.
Þroarams offered mlxed aender LreaLmenL onlv.
lrlends dlscouraaed vou from aeLLlna LreaLmenL.
Þroaram noL based on LradlLlonal values and bellefs.
!"#$%&':)&*+$,+-.+/&0#$$-+$1&23&4561%#7,+&8651+&2$+#%9+7%&0;&<+7/+$
° Women ° Men
127

Focus Groups:
There were several focus groups in which participants were asked to comment on barriers to
treatment. The Youth Focus Groups were asked the question: What are the barriers that
prevent Aboriginal youth with a substance abuse problem seeking treatment? The Men's
Focus Group was asked: What barriers prevent Aboriginal men with substance abuse problems
from getting treatment? The Women's Focus Group was asked a similar question: What barriers
prevent Aboriginal women with substance abuse problems from getting treatment?
Many of the findings from the focus group parallel those identified in the District Aboriginal
Needs Assessment Survey.
A. Personal Issues ± Denial:
Focus group participants said a prerequisite to treatment was admitting and accepting you have
a problem. Ability to admit to one's addiction was also identified as a predictor of the potential
success of treatment. "Ìf you don't believe you have a problem, you are wasting everyone's
time.¨ Participants said people have to go to treatment for their selves and they must be willing
to change their addictive behaviours. They have to want recovery. They should not go to
treatment because someone else wants them to or because it is court mandated.
³You don't want to admit you have a problem."
'Denial. Don't want to go. They don't care."

'I didn't think I needed help. I thought my life was just fine. I didn't see I had a
problem. I was okay. I didn't believe I was harming anyone. All my friends were
drinking. I was no different from any of them."

'I didn't know I should get help. I didn't see the problem."

'I didn't think I had a problem. I had the attitude that what I did with my life was
my business. I didn't use on the job. I supported my family. What I did when I
went home at night and on the weekends was no one's business but my own. I
was very much in denial I had a problem. Treatment was for people who could not
manage their drinking. That wasn't me."

'Everyone told me I should quit. My mother told me my drinking and drugging
was getting out of hand. I told everyone to mind their own business. I didn't have
a problem. You can't make anyone quit especially if they don't believe they have a
problem."

B. Personal Issues ± Unwilling to Quit Alcohol and/or Drugs:
Focus group members identified several factors linked with people's unwillingness to quit
alcohol and/or drugs.
128

Many individuals are unwilling to change the addictive lifestyle they have become involved in.
The addictive power of alcohol and drugs is such that individuals could not easily give up their
cravings for these substances. Many of the Methadone clients admitted they liked the feelings
associated with getting high. They also associated their drug use with having fun. Several said
at one time they could not imagine their life without drugs.
Several individuals confessed to selling drugs. They said initially they were unwilling to quit
using drugs because it was how they made their money. They liked being able to make "easy
money.¨ They said they didn't like the idea of having to work hard for their money. One
individual mentioned it was not uncommon for some drug dealers to walk around the reserve
with thousands of dollars in their pocket on welfare day.
'You don't want to change your lifestyle."
'You like drugs. You are afraid of having to change."
'The physical and psychological cravings are too strong."
'You are too addicted. You crave the drug."
'Too lazy. It is easier to sit around and get high. Treatment would be too much
like work."
'Too high to care about going to treatment."
'I liked the feelings I got when I was high. It made me feel good."
'You fear losing the addiction. You don't know if you can live without it. You are
comfortable in your own crap."
'What would I do for fun?"
'You are not interested in quitting because you like being high and because you
earn your money from selling drugs. It is an easy way of making money."
'You have to be motivated to go to treatment. You lack the willpower."
C. Personal Issues ± Not Thinking Treatment Will Help:
Several focus group participants said they often questioned whether treatment would work for
them. More often than naught, they believed the addiction was too strong for them to
overcome. Several individuals said they came to believe they were somehow unworthy of
treatment. These feelings gave rise to a sense of hopelessness. Thoughts of suicide arose.
Most of these feelings were attached to their low self-esteem.
'The addiction is too strong. You feel you are too far gone. You're too drawn
out."
'You have given in and given up."
129

'You don't think anything will change so what is the use."
'Treatment is not helpful. I have been to treatment and it didn't work."
'You think it is too late. You feel incompetent."
'It would be too much of a challenge. I don't think I'd be up to it."
'They don't believe in themselves."
'You feel incompetent. You can't do anything right. You don't think you will
succeed in treatment."
'You feel you will fail just like you failed in everything else."
'You think the wrong way. You begin to think you are not worth it."
D. Personal Issues: Thinking you can handle the problem or you can
control your using:
Participants said substance abusers suffer from the mistaken belief they can control their
addiction and they can quit whenever they choose to do so. Several used Alcoholics
Anonymous terminology saying many individuals are unwilling to admit they are "powerless
over¨ alcohol or drugs.
'I didn't think I had an addiction problem. I could handle my drinking. There were
plenty of times when I didn't drink. I could go weeks at a time without drinking."
'I only drank on weekends. I never drank during the week because I had to go to
work."
'You feel you can quit on your own."
'I never thought my life was out of control. I still don't think that. I just got tired
of going out on the weekends. I had a family and I was getting too old for the
craziness but I always thought I could handle my drinking. I didn't see my
drinking as a problem even though I was drinking most weekends. I still don't
think I had a problem."
E. Personal Issues ± Fear:

Focus group members identified fear a major barrier to Aboriginal people seeking treatment. It
did not matter whether the fear was based on the unknown, people's misconceptions of
treatment or real facts.

In every Youth Focus Group, individuals expressed anxiety over the types of people they might
encounter in treatment. They characterized addicts as scary and menacing. They could not
conceptualize individuals in treatment are very much like themselves.

Focus group participants who had never experienced treatment feared being forced to go
through withdrawal.
130


People also feared having to address the issues underlying their addiction. People said they
drank to forget about their past and their issues. They felt treatment would force them to
discuss "their secrets¨ and confront their past.

'Your perception about what treatment is like."

'You are concerned about the other addicts."

'I was afraid of the other people I would meet in treatment."

'I would be too scared to go. I would be scared of the people in treatment, scared
of the staff and scared of having to go through withdrawal."

'You are scared for your safety. You are scared of the people that are there and
the staff."

'The unknown.....you don't know what is going to happen. You have no control."

'Afraid of the doctors."

'We don't want to deal with our issues if are using to cover-up abuse. We are
afraid to come clean and deal with our underlying issues."

'I had secrets...lots of secrets. Secrets about what was occurring in my family as
I grew up. Secrets about the not so nice things I did in my life. I didn't want
people to know about them. These secrets were why I used. I didn't want to have
to face them in treatment."

'I didn't want others to know what had happened to me. I didn't trust anyone
because of what had happened."

'I feared if I admitted I had a drug problem and I was living a drug lifestyle, the
police would get involved."

F. Personal Issues ± Stigma:
There is a strong social stigma about people who have an addiction problem. Addicts are often
concerned about what others will think of them. They fear being judged.
Youth said families have a hard time admitting their kids have a substance abuse problem
because of their concern about what others might say. Addicts not only feel ashamed of their
addiction but they project these feelings of shame onto their families. They don't want others to
think badly of their families. They don't want their children to suffer the stigma of having parents
who use drugs or alcohol.
Youth were concerned about what their friends would think if they admitted having a problem
that required treatment. They felt they would be labelled as a "loser¨ and possibly be made fun
131

of. Females, on the other hand, said women who have a substance abuse problem are looked
down by society and by some members of the medical community.
Substance users were concerned about how people label them and how they are prejudice
towards them because of their race. They spoke of their concern about being labelled as "just
another drunken Ìndian.¨
'Your family would rather hide that you have a problem. They would rather sweep
things under the rug than admit there is a problem."
'You're ashamed because you have a problem. You feel shame for your family."
'People will make fun of you."
'You are afraid of what others will think."
'You are afraid of being labelled."
'Once a druggie, always a druggie."
'Social stigma...It is bad enough when men are alcoholics but people think even
more poorly of women who have a drinking problem."
'You are too embarrassed to seek help for your addiction. You are embarrassed
you let your life get to this state."
'There is a stigma attached to those who use pills."
'You are seen as weak willed, a loser."
'There is prejudice towards those with an addiction. People make all kinds of
assumptions and judgements about you."
'There is no support from the medical community. Doctors don't understand
addictions and have negative perceptions of women who use."
'There are many non-Natives who see you as just another drunken Indian. They
don't think of you as human."
G. Family Issue ± Lack of Family Support:
Participants in the Treatment Focus Group and the Methadone Focus Group said some families
did not or do not support their treatment goals. They spoke of family denial and family
resistance to individuals leaving home to get treatment.
Youth Focus Group members said lack of parental support would deter them from seeking
treatment. One youth in particular told of his mother coming to get him out of treatment
because she did not think he had a problem and because she was embarrassed about him
being there.
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The lack of spousal and partner support also influences whether an individual chooses to seek
treatment. Individuals said their spouse/partner initially opposed them seeking treatment
because of their own desire to continue drinking or using.
'My family did not want me to go and I really did not want to leave my family."
'No support from family, friends and the people in their immediate surroundings."
'My family was in denial about my problem. They wanted to minimize it. They
kept saying my drinking was not all that bad."
'Your family criticizes you. You are looked down upon for going to treatment.
You get negative rather than positive support."
'You are scared of telling your parents you are using and you need help."
'You are concerned your family will not approve. You wonder what will happen
when you get home."
'My mother came to treatment and took me out of there."
'Your spouse does not want you to go."
'A controlling spouse."
'My wife did not want me to go to treatment. She was still using. She wasn't
ready to quit and so she didn't want me to quit either."
H. Family Issue ± Family Responsibilities:
Many individuals said family responsibilities are one of the greatest deterrents to seeking
treatment. They felt obligated to ensure their family was being taken care while they were in
treatment. Women in particular were concerned about their family responsibilities.
'I had to think about how my family was going to survive when I was gone. Where
was the money going to come from? Who was going to pay for the groceries?"
'As a woman, you have family responsibilities. You can't just up and abandon
your kids while you go off to treatment. You have to take care of your spouse and
your kids."
I. Family Issues ± Fear of Losing Your Children:
Women Focus Group attendees said they feared losing their children to the child welfare system
if they admitted to having a substance abuse problem. They said while they understood child
welfare agencies have an obligation to protect children, they also believe agencies should have
a goal of keeping families together. They said the child welfare system should be more
supportive of parents who want treatment.
'I was afraid of losing my kids. If you put your children into temporary care while
you seek treatment, you can't get them back when you complete treatment.
133

Workers require you to be substance free for six months or more before you can
get your kids back."
'I was afraid of FACS. You risk getting your children taken away if you admit you
have a problem."
J. Peer Issue ± Loss of Friendships:
Peer pressure and group attachment was identified by many of the Youth Focus Group
participants as a reason why they might not seek treatment. They were very concerned their
friends will think badly of them and they will be made fun of or rejected by their friends.
'There is more peer pressure to stay home and not go to treatment."
'Friendship and loyalties."
'Friends tell you not to go. They don't encourage you to go."
'No support from peer group."
'You are afraid of criticism from your friends. People will talk about you. They
call you names like 'loser" if you want to quit."
'People put you down."
'They call you a quitter and they tell you that you think you are better than them.
They tell you that you think they are losers."
'Friends will make fun of you."
'Loss of friendship. It would be too lonely if you did not have friends."
'You may be rejected by your peers because you are not cool anymore."
'You need to find new friends after coming home from treatment. It is hard to
make new friends especially in a town where there is nothing to do. You are afraid
of getting lonely because you can't talk to your old friends anymore if those
friends are still using."
'You fear losing your friends because you are abandoning that old lifestyle. They
feel you are abandoning them"
K. Systems Issue ± Lack of Awareness of Treatment Options:
Focus group members said they lacked information about what types of treatment are available.
According to Focus group members, treatment centres/programs do not do enough outreach
into the community. They do not inform potential clients about the types of treatment they offer
and how to access them. First Nation members are reliant on NNADAP workers or other
referral programs to direct them to the appropriate treatment service.

'They don't know where to go for help."
134

'You don't know how to get help."
'You don't know what kind of treatment you need or what is available."
'You are reliant on other people telling you what kind of treatment you need. I
was told I had to go to residential treatment. I wasn't told I had the option of going
to outpatient counselling."
L. Systems Issue ± Cost of Treatment:
Some focus group members said Aboriginal people's lack of money restricts their ability to
access treatment. Métis focus group members were critical of federal government policies that
enable First Nation members to get their transportation costs to treatment covered while Métis
are denied the same benefit.
'There is no funding for Métis to attend treatment. First Nations have their way
paid and their treatment cost is covered."
'Health Canada and First Nations pay for Indians to travel to treatment but there is
no funding for those who live off-reserve and no funding for Métis."
'Where you live, on-reserve or in town, determines whether you receive financial
support. If you live off-reserve, you don't get the cost of treatment paid for. Only
those living on-reserve can get their treatment paid for."
'Government policies restrict access to treatment. NIHB policies restrict where
you can go for treatment and whether they will pay for you to get there."
'There is no funding for Métis who need treatment or for Indians who live off-
reserve."
'Treatment is too expensive."
'No coverage for beds for Métis, except two in Thunder Bay."
'It is too expensive for most Métis unless you have some form of health
insurance."
'Government and band transportation policies."
'Transportation is hard to find. It costs money. You get $92.70 from the Band. It
is not sufficient if your driver wants a hundred."
'No transportation; no access."
'There is a double standard. Health Canada pays for First Nations but not for
Métis."

M. Systems Issue ± Funding Support and Quality of Care:
In one focus group, a participant said his lack of money restricted what treatment centre he
could attend. He would have preferred to go to Hazelden but the Non-Insured Heath Benefit
133

Program policies required him to attend the nearest NNADAP treatment facility. He said there is
no consideration given to whether or not the NNADAP treatment centre provides quality care or
whether the treatment provided was matched to his treatment needs. He said unless Health
Canada can guarantee NNADAP treatment centres are accredited and its staff credentialed, the
Non-Insured Health Benefit Program should provide funding to enable their clients to obtain
quality treatment elsewhere.
'Some NNADAP treatment centres are not accredited like many other treatment
centres. I think Health Canada may be forcing First Nations people into receiving
second rate treatment by requiring us to attend the nearest NNADAAP treatment
program without any consideration given to the quality of care they provide."
N. Systems Issue ± Waiting Lists:
Individuals may lose motivation if they have to wait for a month or two before they are admitted
to residential treatment. One participant said he used the waiting list as an excuse to go out
and drink. He said he thought he may as well "take one more kick at the can.¨
'There are no treatment beds available."
'Waiting lists are too long."
'You have no place to go. Treatment is not available when you have the desire
and the need to go because of waiting lists and costs."

O. Systems Issue ± Distance to Treatment:
The location of treatment services can influence an individual's willingness to seek treatment.
Many Aboriginal people, especially those without government transportation support, lack the
money to pay for their travel costs. Distance to treatment and lack of living expenses hinders
the ability of family and friends to visit those in treatment. Women participants were particularly
concerned about the lack of visits from their children. Several clients said distance and cost
prevent family members from participating in their treatment. Individuals said they would be
more inclined to seek substance abuse treatment if it was provided closer to home.
'Distance."
'There are no local treatment programs."
'There are no conveniently located treatment programs. Treatment centres are
too far away from family and friends."
'I was lonely in treatment because my family was so far away. I often thought
about giving up and quitting."
'Families cannot participate in the client's treatment because it is too costly for
them to get to the city and pay for hotel and meals."
'It is too far away from my family. We need a local treatment centre."
136

'If we had a treatment facility locally, it would have lots of clients. People don't
want to leave their families to go away for treatment. We need a facility that will
treat the drug problem amongst the youth."
Methadone Treatment:
'Time lost from job to go to methadone treatment in Kenora or Dryden."
'It's hard to travel to Kenora when I'm in school. It disrupts my education."
'Urine testing must be done once a month. In Dryden, you have to go twice a
week - Tuesdays and Thursdays for people from Fort Frances. That's two hours
there and two hours back twice a week. How can you live a normal life?"
'Travel takes so much time away from my job. It is hard to maintain a job."
'We need a local methadone clinic. It is so stressful trying to arrange
transportation. I am always concerned about traveling those roads in winter."

P. Systems Issue ± Treatment Admission Policies:

People who attended the Treatment Client Focus Group and the Methadone Focus Group said
treatment centres restrict access to treatment. This may be because the treatment centre lacks
the expertise to treat some types of addiction i.e.) opiates. There are treatment centres that will
not admit people who are on Methadone because of risks associated with their care. Treatment
centres do not want to assume the liability of having Methadone on the premise.
There is a wide held view amongst focus group participants and some NNADAP workers that
people have to be substance free to be admitted to some withdrawal management programs.
To quote one participant: "You have to be detoxed to attend Detox.¨
'Treatment centres will not take you if you have a pending court date."
'If you are on any kind of medication, you have to come off of it."
'Some treatment programs will only accept referrals from the medical
community."
'You have to be clean to go to detox."
'Most treatment programs will not take people who are on Methadone."
'The NNADAP treatment programs in our area will not take people on
Methadone."
'Hospitals won't treat heroin addicts."



137

Q. Systems Issue ± Perceived Ineffectiveness of Community Workers:

Many adult focus group members cited situations when community workers hindered their ability
to obtain treatment and maintain their sobriety.

Some community workers were seen as biased and prejudicial in their interaction with
substance abusing clients. They are perceived as bringing their personal values and beliefs
about addiction into the provider-client relationship. Some said worker biases and prejudices
have their roots in a pre-existing negative personal or family history with the client. Because of
perceived worker bias, some focus group members preferred to seek assistance from agencies
outside of the community in which they live.

Focus group members were also critical of NNADAP workers who cling to the abstinence model
of addiction treatment. Methadone clients were particularly critical of workers who imposed their
biases on clients who chose harm reduction.

Community workers were also criticized for their lack of team work and service coordination.
Child welfare and addiction workers were identified as working at cross purposes and failing to
network with each other. Other workers identified were welfare administrators and health staff.

Some community workers were also criticized for breaching client confidentiality by discussing
client information with people outside of the office. One focus group member said charges
should be laid against staff members who reveal client health information or any personal
information they become privy to in the course of their work. Band managers and health
coordinators were criticized for not exercising due diligence when it comes to protecting clients'
personal information.

In one community, band staff was accused of giving band and tribal employees preferential
treatment. The perception is employees are referred to treatment programs outside of the
country while "regular¨ band members must attend NNADAP treatment centres.

Focus group participants said Band Councils need to create an environment of support for
recovery within the community. They need to have Employee Assistance Programs (EAPs).
They also need to ensure that band transportation and welfare policies are supportive of band
members who want treatment. Councils and management must ensure band staffs work
together in a coordinated and integrated manner to assist individuals who want treatment, as
well as, individuals returning from treatment.

Several focus group participants said the criticism of community workers is not always justified.
An expectation exists that NNADAP workers and other health and social service providers are
responsible for resolving all community health and social ills. This expectation is unrealistic
because community workers cannot prevent or control the behaviour of others. Addiction
issues in many communities are long-standing and pervasive. People have to take
responsibility for their own behaviours and their own problems, said one focus group member.
138

Another said, NNADAP workers are in a catch-22 situation. On one hand, NNADAP workers
are blamed for pushing treatment on people. At the same time, they are criticized for not doing
enough to prevent or stop community substance abuse problems.

'I don't have much trust in community workers. They have no skills and are not
very competent."

'Some community workers do not understand addiction. They want to punish
you because you are a druggie."

'Community workers need better training in addictions. They don't understand
addictions and because of that, they are ineffective in helping addicted clients."

'Some workers don't do their jobs. Our NNADAP worker was useless when it
came to getting me help"

'Band workers don't do their jobs. They make getting treatment an ordeal."

'Workers bring their own biases and prejudices to their jobs. I would prefer to get
services outside the community because the workers are more objective."

'I would rather talk to someone who doesn't know me. They have no
preconceived notions about me. They don't know my family or my history."

'Community workers don't trust people who are addicted."

'There is no networking amongst working in support of persons seeking
treatment."

'Community workers breach confidentiality. They need to be held accountable."

'Workers make preferential referrals. If you are band staff, you get to go to
Kentucky. If you are a regular band member, you can't go to specialized
treatment. You go to Dilico or Migizi."

'Chief and Council need to create an environment of support for those wanting
recovery. Band staff need to work together to help you achieve recovery."

'People get confrontational when you tell them they need to go to treatment.
They don't want you to interfere in their lifestyle. On the other hand, you get
blamed for not resolving the community's addiction problem."


R. Systems Issue ± Lack of Youth Treatment Options:
The lack of youth services at all levels of the addiction continuum was raised in several focus
groups. Clients must be 18 years of age or older to be admitted to withdrawal
management/detox, as well as, some residential programs. While community counselling
programs exist, staffs often lack the expertise and experience to deal with youth addiction,
especially opiate dependency. Obtaining referrals to specialized youth programs is often
139

difficult because of waiting lists. There are programs in the U.S. that deal with youth opiate
addiction but it is hard to obtaining funding for such treatment.
There are no self-help groups specifically targeted to youth. Youth feel uncomfortable in adult
A.A. and N.A. groups.
'There are no counselling programs specifically for youth."
'You have to be 18 to get into some treatment programs."
'There are no self-help groups for youth."

S. Systems Issue ± Lack of Gender-Specific Treatment:
Women Focus Group attendees raised gender-specific treatment issues. None of the NNADAP
treatment centres in the area currently provide a treatment cycle specific to women although
they are planning to do so. The women felt their needs would be better served if men were not
part of their treatment group. Women said they were uncomfortable talking about some issues
such as sexual abuse and domestic violence with men present. Several said there are cultural
taboos about discussing certain issues in front of males.
Both genders said the presence of the other gender interfered with their ability to discuss their
core issues. Men said they often feel a need to protect women while women feel the need to
nurture men. Neither of these behaviours is helpful in a treatment milieu. One focus group
participant said when you are in treatment; you are particularly vulnerable to "nut house
romances.¨
When asked if treatment should be co-ed, most youth were adamantly opposed to it. Like some
adults, youth felt the presence of the other gender could lead to inappropriate sexual
encounters.
'There are no gender-specific treatment programs. You relate better to your own
gender in treatment. You lose focus when the other gender is there. You can't
talk about some issues when men are there."
'If you grow up in a traditional home, you are taught not to talk about certain
things when men are present. It is just not done. In treatment, you are expected
to break that taboo."
'Nut house romances..."
'You would be thinking about wanting to impress the girls rather than focusing on
your treatment."
'You know...sex. You would be trying to hook-up with someone."



140

T. Systems Issue ± Lack of Child Care:
The topic of child care was raised as a treatment access issue. Women said residential
treatment programs do not allow mothers to bring their children with them. Women are reluctant
to leave their children with their spouse/partner especially if the spouse is still using. They felt
their spouse/partner could not be entrusted with the care of the children. Placing the children
with relatives is not always an option especially if substance abuse is pervasive amongst other
family members.
'There are no treatment programs that offer child care."
'You can't go because there is no one to take care of the kids. You can leave
them with your partner because he is using too."
'I wouldn't leave my kids with my mother. I wouldn't trust her to take care of them
for the three weeks I was in treatment."
'I've had several babysitters who failed to show up when I had to go to Dryden. It
is stressful enough trying to balance all the requirements of the program. If you
don't do your urine tests when they require you to, you have to start over again."
'I wish there was a way local self-help groups could provide some form of child
care. It would do a lot to support women in preventing relapse."
U. Systems Issue ± Lack of Cultural-Based Treatment:
A lack of culturally appropriate treatment acts as a barrier to care. Focus groups said they
expect treatment centres to integrate culturally appropriate supports into their treatment
approaches. Many were critical of mainstream programs who failed to hire qualified Aboriginal
counsellors especially when many Aboriginal people have certificates in addiction counselling or
hold bachelor and masters level social work degrees. People said they prefer to work with
Aboriginal counsellors because they are more sensitive to Aboriginal issues and problems.
Focus groups described culturally competent treatment centres as those which base their
treatment methods on Aboriginal values and norms. Programs which use Elders only for
opening and closing meetings or which relegate cultural programming to one week of the
treatment cycle were not seen as culturally competent. Participants in one of the Elder Focus
Groups were critical of NNADAP treatment centres that follow western treatment modalities
while treating culture as an "add-on.¨
'Most treatment programs have no cultural programming such as sweats, naming
ceremonies, etc."
'Treatment programs and services need to reflect the Aboriginal culture."
'Most programs lack a spiritual or cultural component. They have no Native
counsellors."
141

'Treatment programs have more Aboriginal clients but none of the counsellors
are Aboriginal. They have no understanding of our issues and values."
'They say they are sensitive to the Aboriginal clients' needs but they don't see the
connection between cultural trauma and Aboriginal substance abuse. They think
all alcoholics come from the same place but they don't."
'Even some of the NNADAP treatment programs are not culturally-based. They
say they are because they are operated by Aboriginal people had have Aboriginal
counsellors but they don't really understand culture. The only time culture is
mentioned is when they do an opening prayer or the week the Elders are brought
in. Culture is not an add-on. It is not really integrated. Their treatment approach
is predominantly a western one."

V. Systems Issue ± Low Retention Rates:
Individuals who previously attended treatment identified other issues hindering treatment. These
issues include client attitude towards treatment. Individuals also spoke about the treatment
centres' treatment methodologies.
'Stinking thinking; people who are in treatment who keep talking about using."
'Not separating yourself from the old you. You continue to deny you have a
problem or you believe your using was less or different from others."
'Some people in treatment do not want to do good. They bring others down.
They interfere with your efforts to change."
'They shouldn't force people into treatment when they don't want to be there or
they are not ready for treatment. They don't want to change and they just bring
everyone else down. It is hard enough to work your own program. You shouldn't
have to put up with their attitudes."
'Sometimes you meet all the wrong people in treatment such as dealers and new
connections. People teach you new ways of doing drugs."
'I first smoked crack when I was in treatment."
'The isolation; it drives you crazy. That's when treatment is like jail."
'Some treatment centres are not very comfortable. There is nothing to do with
your time. The rooms are lousy. The food is bad."
'When you go to the Methadone Clinic, the counsellor is always talking about
other clients from my area. I really don't think this is appropriate. I wonder if she
talks about me to other people."
'Hot seats; I hated it. I hated being put on the spot."
'The harm reduction model makes you think you can still use."
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'Sometimes treatment centres are not well balanced. People need choices. You
should have the right to be involved in cultural things or not. You should have the
right to see a priest or a clergyman or not. Everyone has their own spirituality. It
is supposed to be God as you understand Him."

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Chapter 9: Treatment Service Elements
Introduction:

In this chapter, issues impacting the substance abuse treatment process are examined using
qualitative information gathered from on-site treatment program visits, focus group discussions,
outcomes of the October 2009 Service Provider Forum and research on best practice. For
clarity, the issues are organized around the themes of pre-treatment, treatment and post-
treatment. Also discussed in this chapter is a preferred model of addiction service delivery
identified by the Aboriginal focus groups.

Pre-Treatment:

A. Pre-Treatment Assessments:
Most treatment centres use standardized assessment tools. The assessment tools help the
client and counsellor identify the client's treatment goals and develop a treatment plan.
Treatment centres prefer clients arrive with a treatment plan but several said they make
exceptions for First Nation referrals. This is because they believe NNADAP workers' and Native
referring organizations lack training in these areas. Inadequate assessments can result in a
misidentification of a client's treatment readiness and/or a referral to the wrong type of treatment
program.
Coerced Treatment:
High client no-shows and high treatment drop-out rates are linked to a lack of client commitment
to the treatment. Some clients are not ready for change. They may be seeking treatment to
appease others including their spouse, family, the courts or the referring worker.
'Many of the people referred to treatment really do not want to be here. They may
have come to appease others. Sobriety is not their main focus."
'There is a need to look at client readiness. Some clients need to go to detox first
or to pre-treatment programming. Better assessments would ensure that clients
go to the right place. They would also determine the client's commitment and
readiness for treatment."
'If a client is not ready for treatment, admitting them just sets them up for failure.
There are high rates of incompletion. Clients who are not ready for residential
treatment have other options. Referring agencies need to look at what can be
done incrementally to help the client."
144

'We do not take clients into the program if they are not ready. Some youth do not
want treatment. They just want to cut back so they have a feeling of having some
control over their lives."
'We have found with our NNADAP referrals, some clients don't make it to the
Clinic. There is a breakdown at the community level in worker and client
communication. Workers need to know where people are in the stages of change.
Are they committed to treatment?"
'While we would prefer clients arrive with a treatment plan, we make exceptions
for the First Nations. We know they do not have the appropriate training to
conduct assessments."
'Between April 1, 2008 and March 2009, we received referrals from 27 Ontario
communities. There were 105 referrals possible. Only 58 of those referrals
followed through; 49 were no shows. Of the 58 who were admitted to treatment
from Ontario, 12 left early. Staff believes that only some of their reasons for
leaving were valid."
'The amount of time spent on processing referrals is lengthy. It is time
consuming and if people do not show up, it is frustrating for the Intake Workers."
'The bed could have gone to someone who is committed to treatment and
recovery."
Focus Group members said the presence in treatment of individuals who do not want to be
there or who are not committed to their recovery has a detrimental effect the ability of others to
achieve their treatment goals. (See Section V: Systems Issue ÷ Low Retention Rates, Chapter
8: Perceived Barriers to Treatment.)
Uninformed Consent:
Some treatment programs believe many Aboriginal clients are unable to make informed
decisions about their treatment because they receive insufficient information about their
treatment options and the treatment process. Most Aboriginal clients are referred to in-patient
treatment and not presented with an option of attending out-patient counselling, if such
counselling is available in their home communities. Clients referred to treatment must be
prepared to deal with their underlying core issues and agree to this prior to admission.
'We find that referring organizations do not explain the realities of treatment to
the client. They do not explain the realities of the client getting back their
children."
'We found in talking to our clients other treatment options have not been
explained to them."
'Clients must understand they will have to deal with their issues in treatment.
They have to agree to this prior to entering treatment."
'Some clients leave during treatment because they cannot or are unwilling to deal
with their core issues."
143

Ìn "Chapter 8: Perceived Barriers to Treatment¨, we reported some focus groups members said
they had not been informed of their treatment options.
Lack of Culturally Appropriate Assessments:
Several participants in the Treatment Client Focus Group questioned whether standardized
assessment instruments are culturally appropriate.
'I don't know if the assessment tools have been tested on Aboriginal
populations."
'When I was getting my assessment done, no one asked me about whether I
followed traditional or western spiritual beliefs. They asked me where I was from
but didn't ask if I used Elders."

B. Lack of Awareness of the Referral Process:
Referring organizations, including some NNADAP workers, do not understand treatment centres
have structured admission policies and procedures. They mistakenly believe their clients can
be admitted the next day or within the week. This is not the case for several reasons.
x Clients entering treatment must be stabilized before admission. Unstable clients do not have
the mental clarity to make informed decisions about their treatment and they are unable to
actively participate in the treatment process. Unstable clients can pose a danger to
themselves, other clients and the staff.

To ensure stability, clients must be substance free for a specified period of time prior to
admission. Where treatment centres admit clients on Methadone, they must be on
stabilized doses.
'Fifty percent (50%) of the clients referred from Ontario are unstable. You cannot
send an unstable person directly to residential care."
'We take Methadone clients but they must be on Methadone for two months prior
to admission. They must be on a stabilized dose."
'Clients on Methadone must be stabilized prior to admission. If they come in on
30 mg., they have to leave on 30 mg. You cannot play with their dosages when
they are in treatment. Changing dosages affects the client's ability to concentrate.
Some become sleepy, irritable or depressed. They cannot concentrate on
treatment."
'Clients going through opiate withdrawal are very sick for at least a month. They
have extreme flu-like symptoms. Treatment is not where they should be."
'It takes clients on cocaine 4 days to withdraw. Clients on alcohol take 7 days.
People on opiates take at least a month. They should be stabilized first. They
cannot be going through withdrawals while in treatment."
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'NNADAP workers need to understand their clients must be 72 hours clean before
admission. If they relapse when they hit the city, we cannot take them."
'We would prefer all clients attend a pre-treatment program. These programs
focus on client stabilization. They are properly assessed and usually get referred
to the appropriate treatment. Clients must have a confirmed treatment date to be
admitted to a pre-treatment program."
x Treatment centres operate on cycles of 21 to 28 days. During the treatment cycle, beds are
committed to registered clients. There are no beds available mid-cycle for new admissions;

x Treatment follows a structured format which builds upon the previous days' lessons and
activities. It would be inappropriate to introduce a person mid-cycle as they would not
benefit from the treatment lessons done prior to their arrival;

x Most treatment centres employ a group process which requires the development of group
identification and trust. Introducing new people into the group mid-cycle disrupts the
group's continuity and trust; and

x Most treatment centres lack the resources (space, beds and staff) to run more than one
treatment cycle at a time.
All treatment centres have a waiting list. They also have their own intake process. Treatment
Centres distribute admission/referral packages to agencies with the understanding they will read
about the centre's treatment methodology and admission policies. Referring agencies are
expected to share this information with their clients. One treatment centre has made the effort
to visit communities to explain its programs and admission policies but cost, distance and
pressures on staff time restricts their ability to do more comprehensive outreach.
C. Pre-Treatment Medical Assessments:
Several treatment centres said a lack of adequate primary health care in some Aboriginal
communities has resulted in clients being admitted to treatment with serious health problems
such as uncontrolled diabetes, seizure disorders, eating disorders, poor dental health and other
chronic untreated health conditions. While most treatment facilities ask clients to obtain a pre-
treatment medical assessment, some of these assessments are inadequate. Centres have
been forced to suspended or terminate treatment while the affected client seeks medical care.
According to DATIS (Drug and Alcohol Treatment Information System) .4% of Rainy River
District Aboriginal clients in provincially funded treatment services were discharged to a hospital
in 2008.
'Clients to the Methadone Clinic often present with complex health issues such as
pregnancy, HIV/AIDS and hepatitis."
'The lack of access to primary care is evident when they come into treatment.
Their state of health is often poor. They may be uncontrolled diabetics. They may
have seizure disorders. Some clients have been diagnosed with cancer while in
treatment. Dental care is poor. We have our Family Health Team which includes
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two (2) nurse practitioners come in every two (2) weeks. They also see sexual
health issues and mental health issues are evident."
'Clients often need glasses. They may have had them at one point but they have
been lost."
'Thirty percent (30%) of women admitted to treatment come with an eating
disorder. Most of these women are Aboriginal."
'We would put that rate higher. Fifty to sixty percent (50% to 60%) of women
present with an eating disorder. We are beginning to see a lot more men now."
'As a residential support service, we do not have the capacity to deal with long-
term mental health disorders."
'A lot of our clients have mental health issues - depression, anxiety, mood
disorders, concurrent disorders and adjustment disorders. Many self-medicate
with alcohol or drugs."
Participants in the Treatment Focus Group also believe it is important all treatment clients
undergo a comprehensive medical assessment.
'My doctor just looked at the form. Asked me a few questions and checked off the
boxes. He didn't do a physical. I didn't have to give blood."
'There has to be medical involvement. The intake assessment should look at
your physical health, check for diseases, look at your diet, see if you have any
mental health issues and see what medications you're on."

Treatment:

A. Withdrawal Management/Detox:
Service providers identified a need for withdrawal management/detox services in the Rainy
River District. Individuals requiring detox must travel to either Kenora or Thunder Bay. The lack
of Withdrawal Management impacts Treaty 3 Policing.
'We have the discretion of laying a charge of public intoxication or taking them
home. If they are from an outlying First Nation, we may have to put them in jail
overnight. If we do not charge them, we are responsible for driving them home
the next day. If they live in a community like Lac La Croix, for example,
transportation there and back can consume a full shift. This is big commitment of
our time and resources."
The Canadian Drug Treatment Strategy has recommended home-based detoxification. Focus
group members were asked whether they thought this could be a viable option for First Nations.
Those who spoke on the issue generally did not support the approach.
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'If you go through opiate withdrawal, you are extremely ill. You need people to
take care of you. It is unrealistic to place this burden on your family."
'I don't know how it would work but I would have concerns. You can go into
seizures during withdrawal. Detox centres have access to medical help. Most
First Nations do not have that type of immediate medical access. I would not
recommend this for First Nations."
While some focus group members did not support home detox for rural or isolated First Nations,
several service providers wanted to maintain this option.
'There are guidelines for home detox coming out shortly. We should not rule this
approach out for First Nations until we see what the guidelines recommend. I
think it might work for some communities."
There also was concern amongst focus group members and service providers that withdrawal
management is not available for persons under age 18 years.

B. Methadone Maintenance Therapy:
Harm Reduction Model:
Methadone Maintenance Therapy (MMT) is a contentious issue in the Aboriginal community.
Many community members and workers do not understand or support the harm reduction
model.
'It is just trading one addiction for another addiction."
'What are the long-term effects of Methadone? No one knows."
'We need to know more about drugs and their affects on people. We don't know
the affect of these drugs on infants. We don't know the long-term consequences
of taking Methadone."
'The goal should be to get people off Methadone."
'Too many people are being put on Methadone. Some have been using opiates
for only a month or two. They should go through withdrawal rather than be put on
Methadone. It is harder to get off Methadone than opiates."
'I am in favour of the abstinence model. Methadone is not treatment. It is just
going from one addiction to another."
Perceived Lack of Community Support for Clients on Methadone:
Methadone clients say it is hard to be on Methadone when you lack community support and you
are stigmatized.
'I get tired of trying to educate people about Methadone. I don't think it is my job
yet people look down on me because I'm on Methadone."
149

'People in the community are ignorant about Methadone. They stereotype the
users as junkies and pill heads. They treat you differently."
'I have to educate people about Methadone all of the time. Some won't even
listen. They look down on you and assume negative thoughts about you."
'Workers' personal biases come into the picture. Their biases should not
interfere with your ability to access treatment or other support services. They
have to put their personal views aside."
'When you go to the pharmacy and you are one of their Methadone clients, staff
watches you because they think you will steal things."
No Local Methadone Program or Urine Test Sites:
Individuals wanting to enrol in Methadone Maintenance Therapy must travel to Kenora or
Thunder Bay for stabilization. Additional follow-up visits to Kenora, Dryden or Thunder Bay are
required on a weekly or monthly basis for case management, urine testing and dosage
adjustment. Clients obtain their Methadone from pharmacies located in Fort Frances and
Atikokan. Carries are available for clients who meet the requirements.
The time commitment required for travel to Kenora, Dryden or Thunder Bay for follow-up, as
well as cost, places stress on the clients.
Some service providers do not support the practice of using teleconferencing for monitoring or
counselling Methadone clients.
'As a service provider, I am not comfortable with the level of risk associated with
doing case management and counselling by teleconference."
'I would not feel comfortable with the approach."
'The tele-health approach in Methadone treatment requires a competent local
case manager. This is not always available."
[Note: OATC opened a Methadone Clinic in Fort Frances in November 2009.]
Few Methadone Clients Receive Psychosocial Counselling:
According to research, Methadone clients have a lower risk of relapsing if they combine
Methadone Maintenance Therapy with psychosocial counselling. Methadone Clinics provide
case management but do not normally provide mental health counselling. Even though clients
are encouraged to obtain counselling, few do so. Without counselling or the benefits of
substance abuse treatment, Methadone clients never confront the underlying issues of their
addiction nor do they acquire the skills necessary to more effectively deal with the daily
stressors of life.
'Ninety-nine percent of clients prefer to go on Methadone rather than go through
withdrawals. Of the clients who go on Methadone, very few commit to
psychosocial counselling."
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'We see very few Methadone clients in our outpatient counselling program."
'If we had the resources, we would hire a social worker to do psychosocial
counselling. As it is, we barely have time to do case management with the clients
who have to travel in."
'The case manager's role is not to do psychosocial counselling. It is hard to do
this via the telephone. We need mental health counsellors or social workers for
this."
No Methadone Support Groups:
Clients identified the need for local Methadone Support Groups. Mothers on Methadone cited a
need for child care support to attend these groups.
C. Out-Patient Treatment:

A lack of staffing and funding restricts the ability of local out-patient counselling programs to do
groups and evening programming. There are no women-specific out-patient treatment services
or services to meet the needs of seniors. It is unrealistic to expect one addiction counsellor to
provide a full range of out-patient treatment services.
There has been no Aboriginal-specific out-patient treatment program in the Rainy River District
since the demise of Oh-Shki-Be-Ma-Te-Ze-Win Inc. The Counselling Unit (formerly Anishinabe
Community Counselling) of the Fort Frances Tribal Area Health Services has attempted to fill
this gap. It is in the process of redefining tribal level addiction services to better meet First
Nation needs.
D. Residential Treatment:

Need for Local Residential Treatment Program:
There is no residential treatment program in the Rainy River District. Aboriginal clients would
prefer a District-based Aboriginal residential treatment centre that addresses both alcohol and
opiate addiction.
Need for Family Treatment Program:
The Project identified the intergenerational nature of substance abuse amongst the participating
Aboriginal community. Despite this, there is no formalized Aboriginal Family Treatment
Program available within the District. Migisi Treatment Centre has attempted to include a family
component in its treatment approach but it reports distance and the cost of travel and lodging
prevents the participation of many families.


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Need for Aboriginal-specific Youth Treatment Service:
Sister Margaret Smith is the only centre that provides youth focused treatment in north western
Ontario. There is no Aboriginal treatment centre in north western Ontario that will admit clients
under the age of 18 years. Wee-chi-it-te-win Child and Family Services will admit First Nation
youth with an addiction issue provided beds are available but it does not operate a formal
addiction treatment program.
Need for Aboriginal Women-specific Treatment Services:
Sister Margaret Smith Clinic provides women targeted treatment services. The NNADAP
treatment centres in the area (Migisi and Dilico) do not run women-specific treatment cycles at
this time. Dilico is in the process of undertaking a consultant's study to identify ways in which it
can enhance its gender-based programming.
Lack of Services for Clients with Concurrent Disorders:
Service providers identified the need for specialized treatment programs for those with
concurrent disorders. There is a visiting psychiatrist in the Rainy River District but providers
believe there is a need for more psychiatric support. Service providers report divisions between
child and adult mental health services are problematic.
NNADAP treatment centres identified the need for more training to assess and address
concurrent treatment disorders. They also need specialized staff to address issues arising from
child sexual abuse.
Lack of Treatment Services for Opiate Addiction:
Few treatment programs accept clients who are on Methadone. Few Methadone clients receive
psychosocial counselling.
NNADAP treatment staff identified a need for resources to respond to changing Aboriginal
addiction patterns. They need to modify their program approaches to deal with opiates. They
also need staff trained in opiate addiction. Their intake and assessment forms need to be
modified. In some instances, their facilities need to be modified.

Post-Treatment:

A. Aftercare Planning:
Aftercare refers to services and supports that treatment clients need to transition back to the
community while maintaining their treatment progress. In the weeks prior to their discharge from
inpatient or outpatient treatment, counsellors encourage clients to develop an aftercare plan
which identifies their recovery and life goals. Aftercare planning also involves a renewed focus
on relapse prevention.
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Treatment service staff identified the following aftercare issues:
Lack of Aftercare Services:
Many rural and First Nation communities lack aftercare services and supports.
'There are no aftercare or support services in referring communities."
'Treatment centres have difficulty finding out what local supports are available in
out-laying areas."
'There is a high turnover of community workers. It is hard for treatment centres
to maintain communication with community workers around aftercare planning
when there is no staffing or program continuity."
'There are communication issues with service providers with respect to transition
plans. If clients go home, they do not have the added supports."
'Treatment centres are an artificial environment. Here, clients have support and
security. It is scary for them to leave because there are not the same kinds of
support in their home communities."
'There is no structured aftercare program in the Rainy River District."
'Clients who do well are those that are in counselling and have supports during
aftercare. Community supports need to be there for them."
'We do letters of referral to aftercare services but the client has to take
responsibility for their aftercare plan. More often the resources are just not there
for them to link to."
'We make referrals to supportive services. We try to link them with recovery
groups or other people in treatment from the same community."
Participants in the Treatment Client Focus Group also raised concerns about a lack of aftercare
services in the Rainy River District.
'There are no jobs or housing once you get out of treatment. Communities talk
about supporting clients but no one visits them in treatment. There are no
supports when you get home. You are on your own."
'There is no one at the community to advocate for you. You are left trying to get
help on your own from the band programs. There is no coordination between
them and you end up frustrated and annoyed."
'There should be a 'Welcome Back to the Community" celebration for those
returning from treatment...a support supper to let them know we are behind
them."
Best practice research is also critical of the way in which aftercare services are delivered to
Aboriginal people. White and Sanders argue addiction recovery management approaches are
based on an acute care model that does not work for people of color. They recommend a shift
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to a sustained recovery management which recognizes addiction as a chronic progressive
disease.
1

'The acute care model 'rests on the assumption that AOD (alcohol and other
drug) problems are self-contained and that individuals have the internal and
external resources to sustain recovery and assume full social functioning
following detoxification and brief treatment. It assumes a foundation of pre-
morbid skills and social functioning. This rehabilitation model promises the client
that he or she will regain prior levels of functioning and status lost via the
accelerating severity of AOD problems. This model is poorly suited for
individuals who have not achieved such prior levels of functioning and who have
no significant support for recovery within their family and social network. This
model is particularly unsuited for those poor communities of color whose
members present with high AOD problem severity, numerous co-occurring
problems, and low 'recovery capital" (internal and external resources that help to
initiate and maintain recovery (Garfield and Cloud, 1999).
2
"
White and Sanders propose the "treatment of severe and persistent AOD (alcohol and other
drug) problems is best done within a sustained recovery management partnership that provides
on-going recovery support and consultation and anchors the recovery process in indigenous
supports within the client's natural environment
3
.¨ They support a recovery management model
where the client is seen as being part of a complex web of family, social and cultural
relationships where each level either can contribute to the development of, help resolve, or
sabotage the solution of the client's problems. In the recovery management model, it is "the
whole ecosystem rather than the individual that is the target of RM intervention.....RM
encompasses the skills of family reconstruction, community resources development, and nation-
building...¨
4

Because people of color often enter treatment at later states of problem severity and with a
greater number of co-occurring problems, White and Sanders find they are ill-served by service
models whose low intensity and short duration offer little opportunity for success.
5
They advise
"communities of color need stable recovery support institutions than can move beyond brief
experiments in recovery initiation towards prolonged recovery maintenance.¨
6

Lack of Referring Agency Involvement:
Referring agencies do not necessarily maintain contact with their treatment referrals. They do
not provide support during the treatment process nor are they involved in provision of post-
treatment aftercare. This may be because they do not have the mandate or because clients
choose not to include them in their aftercare plans.
'There should be on-going involvement from the referring agencies. However, we
find that workers do not stay involved with the client. Some do not have the
mandate."
'We find that some clients and community workers have a history between them.
It tends to be negative. Neither trusts each other."
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'It's a lot of work connecting with the communities around discharge planning. It
is difficult when you feel workers are less than enthusiastic about helping the
client upon their release from treatment."
'Ideally, community workers should be involved. Normally, you would think this
would be beneficial to the client. However, clients have the right to determine who
is involved in their program. Sometimes they do not want the referring agency
involved."
'Fort Frances Probation Services do not maintain contact with their clients once
they are in treatment. Neither we nor our clients hear from them."
'The linkage with community health and social service programs is dependent on
the client. Sometimes it is not possible as these services are not available in their
home community. We do dialogue with workers through telephone conference.
More often, clients leave treatment without community services knowing what the
client's after care plan is."
Level 1 Support Services (post-treatment) say they find it difficult to obtain discharge plans from
treatment centres outside of Thunder Bay, particularly NNADAP treatment centres.
'It is an on-going struggle to get discharge summaries for clients from some
treatment programs outside of Thunder Bay even when they refer their clients to
our post-treatment program."
B. Lack of Transitional Housing:
A lack of transitional housing in the smaller communities in north western Ontario hinders client
recovery. Without transitional housing and its ancillary supports, clients return to the same
environment they left increasing the possibility of relapse.
'Transitional housing does not exist in most communities, especially the First
Nations."
'Agencies in the District need to re-think their housing policies. New beds need to
be made available or existing beds reallocated to those transitioning from
treatment."
Focus group members agree there is a need for transitional housing.
'When you return from treatment, there is no housing available. Single women
get priority over single men."
'We need halfway houses and three-quarter way houses for clients returning from
treatment."
'It is embarrassing to have to live with your parents when you are my age but you
have no choice because there is no housing."
'You can sometimes get a place but it is usually where they put the single men.
They like to party and do drugs. It is not a good place for a person trying to
recover from substance abuse."
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C. Lack of Service Coordination:
Focus group members were concerned about the lack of community and District service
coordination. Service providers said a need for improved coordination exists at all levels of the
continuum including service development and management.
'We are involved in the local substance abuse prevention team, but we are
excluded from the planning and governance of local treatment services. We do
not have a say."
'The federal and provincial governments do not talk to each other at a service
delivery level regarding addiction services. There are jurisdictional and funding
silos that make it difficult to plan community services."
'There is a definite need for improved collaboration and sharing."
The service providers identified ways in which coordination can be improved including:
x District and local tripartite discussions around addiction issues, needs and solutions;

x Establishment of a formal district mechanism for discussion of addiction related issues that
involve all service providers ÷ Aboriginal and non-Aboriginal. Jointly explore the feasibility of
using existing mechanisms (Opiate Taskforce, Inter-agency group) or the need to establish
new ones.

x Development of protocols and Memorandums of Understanding between agencies
regarding referrals and case management;

x Localized training opportunities involving all local service providers;

x Use of interpreters if required;

x Cross-cultural training (Aboriginal to Non-Aboriginal and vice-versa) regarding our "world
view¨; and

x Recognition that all persons within the addiction field are colleagues and we all want what is
best for the client.

Aboriginal Defined Treatment Services:

During the focus group sessions, participants were asked to describe a preferred treatment
model.


136

A. Intervention:

Participants said it may be necessary to stage an intervention with individuals who are in a state
of denial regarding their addiction. If an intervention becomes necessary, participants identified
some guidelines for carrying it out:
x Interventions can be initiated by any caring person(s) including family, friends, sponsors
or counsellors;

x It should be conducted or moderated by a person who has professional expertise and
experience;

x Individuals should be told how their behaviour has affected others and what behaviours
they need to change;

x There must be consequences if the person will not seek treatment. Individuals involved
in the intervention must do what they say they are going to do;

x The negatives must be balanced with positives. It must be done in a way that is not
harmful;

x There must be closure. The individual should not be left hanging; and

x An Elder should be involved if the individual has a strong cultural affiliation.

B. Intake and Assessment:

Focus group members identified a preferred approach to Intake and Assessment.
x The Intakes and Assessments should be professionally done by trained, competent staff;

x The Assessments should be comprehensive and holistic and include:

! Basic demographic information such as name, address, age, gender, marital
status, children, etc.
! History of substance use;
! History of substance abuse treatment;
! Family history including whether family uses and family of origin issues such as
involvement with the child welfare system, etc.
! A complete and thorough medical assessment conducted by a physician/nurse
practitioner that includes physical health, mental health, diet, medications, acute
and chronic illnesses.
137

! A complete and thorough mental health assessment to identify any concurrent
treatment disorders such as anxiety, depression, mental disorders, etc.
! Legal history ÷ involvement with the criminal justice system.
! Spiritual and religious beliefs.
! Cultural engagement ÷ does the person speak an Aboriginal language? Does the
person participate in cultural ceremonies and rites? Does the person participate
in cultural events? Does the individual have an Elder and/or traditional healer
they see for mentoring or treatment? Does he or she use traditional medicines?
How do they describe their cultural association?
! What is the state of the individual's readiness for treatment?
! Are they prepared to deal with their core issues?
! What are the client's treatment goals?
! How supportive is the individual's family and social network?

x The Assessment should include a pre-treatment orientation which includes a discussion
of treatment options, what to expect in treatment and the rules covering each treatment
option. The purpose of the pre-treatment orientation is to ensure the client understands
his or her treatment options and they have an ability to make an informed decision about
their preferred treatment approach.

x Clients should be asked to sign a "Commitment Contract¨ requiring abstinence during
the waiting period if any and, not to use during treatment. They must agree to cooperate
with the treatment process and follow the rules of the treatment facility.

x Most focus group members said ideally all Aboriginal clients should spend a few weeks
in a Pre-Treatment Program where they can be observed and assessed.

C. Residential Treatment:

Treatment Location and Facility:

Elders and a large number of other focus group members said any proposed treatment centre
should be located on a lake or by water as water promotes healing. Youth prefer a location that
is isolated or secluded area so there is no outside interference and so you "have nowhere to
run.¨
It should have a home-like rather than institutional atmosphere. Each client should have his or
her own room rather than share with others. Focus group members did not want dormitory style
accommodations.
138

Others said the treatment centre should reflect the area's Aboriginal cultures. It should
incorporate Aboriginal art and a display of Aboriginal cultural items such as drums, pipes, Métis
sashes and flag.
Focus group members want a facility they can be proud of. They said it should be well-
maintained, clean and sanitary with the grass cut and the snow shovelled. Youth described a
lodge-type facility with meeting rooms and outlying cabins which would house the clientele.
The treatment centre should be Aboriginal owned and operated but should be open to non-
Aboriginal as long as the non-Aboriginals respect the cultural aspects of the treatment program.
The Elders felt non-Aboriginals would benefit from learning about Aboriginal spirituality.
Aboriginal values and belief systems could be used in their own lives.
Youth said it should include a classroom so they can keep-up with their studies. It should also
have tutors.
Some focus group members said the treatment facility should allow smoking.
Treatment Programming:

Focus group members identified the following areas for inclusion in the treatment program:
x Education about alcohol and drugs and their affect on people's minds and body;

x Second stage recovery
7
to deal with core issues including:

! family of origin issues including dysfunctional family relationships; and
! inner child work;

x Addressing interpersonal issues such as establishing boundaries, peer groups, co-
dependency and personal empowerment;

x Development of healthy approaches to stress reduction and management such as
meditation, visualization, massage therapy and development of hobbies;

x 12 Steps, with the first 5 steps being completed in treatment. Clients should also learn
the meaning and significance of the other steps;

x Life skills such as effective communication, taking risks, problem solving, coping with
failure, facing pain, self-reliance, self-motivation, self-esteem, self-responsibility and self-
love;

x Parenting skills;

139

x Family program where the spouse and children can be involved as they are directly
affected by their partner or parent's substance abuse. According to focus group
members, the family needs to understand its role in the addiction process, the issue of
co-dependency, the need for family support in the treatment and post-treatment process,
as well as, how to access their own self-help and supports such as Al-Anon. Family days
should occur mid-cycle and near the end of treatment in advance of discharge;

x Discharge readiness including job readiness (employment aptitude and skill assessment,
resume writing, interview skills), financial/money management (how to budget and get
rid of debt);

x Faith-based counselling for clients who want access. Faith-based approach should
include both mainstream religions and Aboriginal traditional beliefs.

x Treatment should not just incorporate Anishinabe and Métis cultures and values but
should be based on them. Aboriginal values should be reflected in the overall
philosophy and treatment approach and should not be an "add-on¨ or be relegated to a
week of cultural activity. Chapter 10 discusses the preferred cultural model identified by
the Elders and focus group participants.
Treatment Approaches:
Focus group members said residential treatment should be structured but flexible. It should
employ a variety of treatment approaches including:
x Sharing circles or group therapy with regular circle checks in the morning and afternoon;

x Individual one-on-one counselling;

x Role-playing and empowerment exercises so you learn the skills need in recovery;

x Counselling sessions with the client's spouse or partner;

x Family counselling;

x Guest speakers who have had addiction problems and been through treatment
successfully. These individuals could act as role-models or mentors for those currently
in treatment;

x Art/Music therapy;

x Cultural counselling with Elders both in a group and individually;

x A privilege system where a client earns rewards based on treatment accomplishments;
160


x Drug testing both random and voluntary. (Staff should also be tested.); and

x Treatment should be gender-specific not co-ed.

Security:
Individuals with previous treatment experience recommended the treatment centre have
security measures because clients can gain access to drugs through visitors and other clients.
They supported the screening of visitors and the institution of random searches of their rooms
and possessions. They also said treatment clients should be made aware of the security
measures and possible searches when they enter treatment.
Clients should not be allowed to see friends or family for a period of time as family and friends
may provide access to drugs or alcohol and discourage the client from remaining in treatment.
When family and friends are allowed to visit, they should be monitored. There should be no cell
phones allowed.
Leisure Time:
Focus group participants said it was important clients have leisure time in order to get a break
from the intensity of the treatment process. Clients also need to learn how to deal with daily
frustrations in a healthy way. Leisure time activities might include:
x Quiet time where clients can read or watch television, view videos, etc.;

x An on-site library with books, magazines and videos;

x Access to on-site recreational equipment such as pool tables, exercise equipment;

x Organized and structured fun days or outings to movies, bowling, swimming, dances,
etc;

x Culture-related leisure activities including beading, leatherwork, regalia making; and

x Computer access including internet, social networking, and computer games.

Food & Lodging:
Focus group members, particularly the youth, said it is important that the treatment centre has a
home-like atmosphere and clients not be treated "like we are in jail.¨ They want:

x An on-site chef to provide good, nutritious food;

161

x Aboriginal foods such as wild rice, bannock, wild meats, etc.;

x An eating area which is not like a cafeteria;

x Comfortable furniture, especially comfortable beds; and

x Access to a kitchen or area where coffee/tea/juice and snacks are kept. Possibly a
vending machine for drinks and snacks.
Day Care:
An Aboriginal treatment centre should provide on-site day care services for clients' children.
While the focus groups did not mention it, this would require residential treatment facilities to
provide accommodations for children.
Staffing:
Focus group members identified the characteristics they prefer in treatment staff.

x Counsellors should be recovered addicts;

x Counsellors should advocate for the client;

x Be trained and accredited counsellors;

x Skilled in group work and clinical counselling;

x Come from a variety of backgrounds;

x Be Aboriginal;

x Open, non-judgemental, friendly and approachable; and

x Sufficient staff to allow for a team approach and because clients need different people to
relate to i.e.) one person cannot meet the needs of all the clients and clients may relate
better to another counsellor.

D. Aftercare Program:

Focus group members said they wanted a structured aftercare program with formal linkages
between treatment centres and community programs. Treatment centres should:
162

x Use the last two weeks of treatment to focus on preparing the client for sober living and
provide relapse prevention. It should also include a family component as the family has a
major role in client's recovery and support.

x Include a coordinated linkage between the treatment centre and community programs.
Counsellors in the treatment centres need to know about the community and what is
available in terms of aftercare supports. Community workers also need to understand what
happens in treatment.

x Require clients to sign a "Release of Information¨ so the client's Aftercare Plan can be
shared with community workers. There should be someone from community services who
will be the link between the treatment centre and the community services. This person does
not necessarily have to be the NNADAP worker or addictions worker. It can be another
person that the client trusts. This individual would contact the identified person upon release
from treatment. The individual would be responsible for ensuring the coordination of local
services in support of the client's Aftercare Plan. Community workers at all levels need to
ensure confidentiality.

x Ensure an Aftercare Plan is prepared by the client and the treatment counsellors. It should
be based on an assessment of the client's readiness for discharge. It also should define the
client's goals upon leaving treatment. These goals should be realistic and be based on the
strengths of the client;

x Include a linkage to on-going counselling such as mental health counselling;

x Include a linkage to support groups such as Alcoholics Anonymous and Narcotics
Anonymous including the identification of sponsors;

x Include a good maintenance plan with defined daily routines; and

x Ìnclude a formal graduation ceremony in recognition of the client's treatment achievements.
The graduation ceremony should be attended by family and friends. Referring NNADAP or
agency addiction counsellors should attend, if possible. There should also be a community
supper or feast in honour of the client.

E. Transitional Housing:

Because some clients may not be ready to transition directly back into the community, there
should be transitional housing with on-site support services available within the Aboriginal
community. Transitional housing could include half-way and three-quarter way houses. The
support services should include one-on-one counselling, group work and relapse prevention.


163


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164

Chapter 10: Cultural-Based Treatment
Introduction:

This chapter examines Aboriginal respondents' connection with their culture using the results of
the Rainy River District Aboriginal Addictions Needs Assessment Survey.
1
Also examined is the
difference between "culturally-appropriate¨ and "cultural-based treatment¨ as expressed by
Elder Focus Groups and research on Aboriginal healing.
Culture in the Study Communities:

A. Participation in Cultural Events/Cultural Ceremonies:
For the purposes of the Needs Assessment Survey, cultural events included such things as
pow-wows, feasts and gatherings while cultural ceremonies referred to sweat lodges, naming
ceremonies, purification ceremonies and shaking tents, etc.
The Rainy River District Aboriginal Addiction Needs Assessment found sixty-four percent (64%)
of respondents participated in traditional Aboriginal cultural events in the 12 months preceding
the survey. Forty percent (40%) said they participated in traditional Aboriginal ceremonies.
While Aboriginal women were less likely than Aboriginal men to report participating in traditional
cultural events (58% and 67%), both men and women were equally as likely to participate in
traditional ceremonies (42% and 37%). According to the Needs Assessment Report,
participation in both cultural and ceremonial events in the past 12 months varied significantly by
age group.
Chart 47 shows participation in cultural events by age group.

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Respondents between the ages of 25 to 49 were more likely to report participating in cultural
events (71%) than those aged 15 to 17 (65%), those aged 18 to 24 (61%), and respondent aged
50 or older (50%).
Chart 48 shows participation in cultural ceremonies by age group.

Respondents between the ages of 25 to 49 years were significantly more likely to participate in
Aboriginal ceremonial events (48%) than those ages 15 to 17 (29%), those ages 18 to 24 (27%)
and respondents aged 50 or more (39%).
Chart 49 compares Aboriginal respondent attendance at cultural events versus cultural
ceremonies by age group.


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166

Approximately 50% more Aboriginal people participate in cultural events than they do cultural
ceremonies.
The most frequently mentioned reason for not attending Aboriginal cultural events or ceremonial
events in the past year was:
x Not having any cultural events or ceremonies in their communities or not having them held
close to their community;
x A lack of transportation and finances to attend cultural events or ceremonies outside their
community; and
x A lack of information or awareness of events or ceremonies occurring in their community or
area.
An examination of the types of cultural events or ceremonies attended shows, 78% of Aboriginal
respondents attend powwows. Forty-five percent (45%) report participating in seasonal events
and ceremonies such as spring and fall feasts, wild rice harvesting, and other harvesting feasts.
Thirty-seven percent (37%) attend cultural ceremonies and rites such as naming ceremonies,
full moon ceremonies, purification ceremonies, healing ceremonies, and shaking tents. Seven
percent (7%) participate in cultural activities related to addiction and mental health including
healing circles, sobriety powwows and sobriety gatherings. Six percent (6%) participate in
traditional arts and craft activities such as beading or leather classes. Six percent (6%)
participate in political meetings and events such as Treaty 3 meetings, treaty day celebrations
or elections of the Grand Chief. Ten percent (10%) participate in other cultural events such as
storytelling, conference, workshops and teachings.
The data on respondents' attendance at Aboriginal cultural events and ceremonies indicates a
significant proportion of Aboriginal people in the study communities have a close attachment to
their culture. They actively participate in Aboriginal cultural events and ceremonies.
Attendance might be higher if barriers to participation were removed.

B. Traditional Spiritual Leadership/Mentorship:
Twenty-nine percent (29%) of Needs Assessment Survey
2
respondents reported having a
traditional spiritual leader or mentor. Women and men similarly reported having a spiritual
leader or mentor (31% and 25%).
Respondents reported having contact with their spiritual leader an average of 3.4 times in the 30
day period preceding the Needs Assessment Survey. There was no significant difference
between men and women contact with their spiritual leader or mentor (mean = 3.0 and 3.3 in
the past 30 days).
Twenty-three percent (23%) of those with a spiritual leader or mentor did not have contact with
that person in the 30 days preceding the survey. Twenty-five percent (25%) had seen the
person once; 23% had contact twice and 30% had contact three or more times. The number of

167

contacts ranged from as low as 0 to as high as 30 contacts. There were no statistically
significant differences between men (25%) and women (31%).
According to the Needs Assessment Survey, there were statistically significant differences in
whether or not respondents have a spiritual leader or mentor by age group. Chart 50 illustrates
this.


Respondents between the ages of 25 to 49 were most likely to report having a spiritual
leader/mentor (35%), compared with those ages 50 or more (28%), and those ages 18 to 24
(22%). Youth between the ages of 15 to 17 were the least likely to report having a spiritual
leader or mentor (19%). While youth ages 15 to 17 were the least likely to have a spiritual
leader/mentor, it was this age group that had the most contact with a spiritual leader/mentor in
the 30 days preceding the survey (mean 4.2 times).
The most reported reasons for not having a traditional spiritual leader/mentor were:
x Not knowing the people in their community who perform this role;
x Not having anyone in their community who performs this role;
x Not knowing how to approach a spiritual leader or mentor; and
x Issues related to trust and confidentiality.
C. Importance of Traditional Aboriginal Culture and Teachings:

In the Needs Assessment Survey
3
, respondents were asked to rate how important traditional
Aboriginal culture and teachings were to them from a predetermined list of 15 items. Overall,
between 51% and 70% of respondents indicated the selected items were important or very
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168

important to them. By descending order, the following indicators were identified as important or
very important:
x Learning the meaning of traditional events (70%);
x Learning the meaning of traditional ceremonies (68%);
x Participating in cultural events (68%);
x Having more education about traditional spiritual beliefs (68%);
x Knowing your clan (67%);
x Learning more about traditional medicine and healing (66%);
x Being able to speak their traditional language (62%);
x Participating in traditional ceremonial events (62%);
x Learning more about the Creator (62%);
x Having a traditional name (61%);
x Having your colours (61%);
x Renew your traditional spirituality (60%);
x Receiving medical help from a tribal medicine person (54%);
x Learning more about traditional prayer (53%); and
x Learning more about traditional medicine (51%).
There were statistically significant gender differences in survey respondents' rating of
importance across several of the indicators of Aboriginal culture and teachings. In each case,
women were more likely to rate the indicator as important/very important. These included:
x Learning the meaning of traditional events (75% women and 64% men);
x Learning the meaning of traditional ceremonies (72% women and 62%% men);
x Participating in cultural events (72% women and 63% men);
x Having more education about traditional spiritual beliefs (71% women and 60% men);
x Speaking their traditional language (65% women and 58% men);
x Learning more about traditional prayer (57% women and 48% men); and
x Learning more about traditional medicines (55% women and 47% men).
Women may see an indicator as more important/very important because it has traditionally been
their role to pass on cultural teachings to their children.
There also were statistically significant differences in respondent rating of importance for each
of the items across age group categories. As age group increased, so did the ranking of each
item as important/very important. The exception to this was those in the 25 to 49 age group
were more likely to indicate each items was important/very important compared to respondents
in other age groups, including those over 50 years of age.
The survey results indicate Aboriginal culture continues to flourish in the communities surveyed.
The survey also shows Aboriginal people value their culture and their traditions (Anishinabe and
Métis). Aboriginal women continue to identify with their role in transmitting culture to subsequent
generations. Opportunities clearly exist for intergenerational sharing of vital cultural information.

169

Aboriginal Elders and spiritual leaders/mentors need to proactively reach out to others in the
Aboriginal community to share their cultural wisdom. The Aboriginal leadership, along with
those interested in cultural preservation and renewal, need to further commit to seeking
resources and opportunities which will support the maintenance of and revival of their culture.
Culture and Substance Abuse Treatment:
A. Perceived Importance of Culture in Treatment:
In the Needs Assessment Survey
4
, respondents were asked to rank whether traditional culture
was important in certain aspects of substance abuse treatment. The findings were as follows:
x 70% of respondents said culture was important/very important as part of an aftercare
program;
x 70% of respondents said culture was important/very important to enhance treatment;
x 72% of respondents said culture was important/very important to facilitate recovery; and
x 69% of respondents said culture was important/very important as an incentive for
seeking treatment.
Women were significantly more likely to state traditional cultural components were important or
very important as a part of aftercare programs (79% and 67%), to facilitate recovery (78% and
64%), and to enhance treatment (76% and 63%), and as an incentive to seek treatment (74%
and 62%).
Of the Needs Assessment Survey respondents who said they had attended substance abuse
treatment, only forty-six percent (46%) said their treatment was based on traditional Aboriginal
culture, values and beliefs. Fifty-six percent (56%) said their substance abuse treatment was
provided by Aboriginal treatment counsellors. There were no significant gender differences.
B. Rationale for Cultural-Based Treatment:
In the focus groups, we asked the Elders why they thought it was important to incorporate
culture into treatment.
x "We are Anishinabe"/"We are Métis":

Overwhelmingly, the Elders said Aboriginal culture (Anishinabe or Métis) has to be included in
treatment because 'it is who we are." It is our being and our reality. It is our worldview. It is
that from which we draw our strength and resilience.

x Acknowledge and overcome cultural hurts:
The Elders spoke about historical trauma and its impact on the Aboriginal psyche, how
Aboriginal people have been and continue to be devalued and how Aboriginal people have

17u

suffered cultural loss. Elders say all Aboriginal people have experienced cultural pain. Some
turn to substances because they have not acknowledged this pain and/or they don't know how
to overcome it. They said treatment is a time to deal with cultural pain and to recognize how it
has contributed to who we are as Aboriginal people today.
'The Métis have a lot of hurts that are rooted in our culture."

'It didn't use to be okay to say you were Native."

'We don't know who we are because of all that has happened to us. We have to
talk about these things. Talking about them will help us heal."

'Talking about the pain is the first step in our healing journey."

'We are stuck. We have to heal and move beyond all that pain."
Dr. Yellow Horse Braveheart who first used the term "historical trauma¨ supports the need to
address cultural hurts and "soul wounds¨ as part of substance abuse treatment. She says in
order to overcome historical trauma, Aboriginal people need to:
! Confront the trauma and embrace our history;
! Understand the trauma;
! Release the pain; and
! Transcend the trauma
5
.

x Culture As Healing:
The Elders said 'culture is healing."
'Culture has to be part of treating our people. Participation in purification
ceremonies makes you feel lighter. It brings good dreams and good sleep. It
comforts you. It connects you with other Anishinabe and makes you feel part of
the group."
'The prayers and ceremonies bring the spirits to help you during treatment. The
spirits provide spiritual guidance and direction. This is what Elders do when they
pray. They call the spirits to help you."
'Doing offerings in treatment helps you. You are calling the spirits to help and
you are thanking them for their help."
'It makes you feel whole as a Native person."
C. The Role of Elders in Substance Abuse Treatment:
Elders are generally known as the wisdom keepers. They are teachers, story-tellers, historians,
healers, counsellors, etc. In the focus groups, we asked Elders to identify their role in
substance abuse treatment.

171

The Elders in one focus group recommended the formation of an Elders' Advisory Group who
would be tasked with 'ensuring things are done in the right way - the cultural way."
Additional roles assigned to the Elders included:
x Determining the location of any treatment facility:
The Elders said it is important to consult them before selecting a location for any proposed
treatment centre. Some locations are inappropriate because they are sacred sites, burial
grounds, the site of a negative event or a site that has negative legends or teachings associated
with it. There are sites on Lake of the Woods and Rainy Lake where Anishinabe legends say
negative spirits dwell. Anishinabe are not to go there or they are not to stay overnight. Elders
have historical knowledge of land use and they know the legends or teachings about the land.
'Elders could tell you where to locate the treatment centre. There are spirits in
certain locations. It must be a good location. You have to take it to a shaking tent
and ask the spirits for permission to build there."
'You are told not to go there or to point at the island because doing so could
bring harm."
'It should be built near water because water has healing powers."
x Determining the name of the treatment facility or program:
First Nation Elders in the Rainy River District prefer to use Anishinabe names for their programs
and services. We were reminded in the focus groups that even though Elders may name the
program or facility, the name itself comes from the Creator. Because names have meanings,
the Elders consider what the purpose of the program or facility is before determining its name.
Elders may or may not consult the shaking tent when bestowing a name. Once a name is
given, there is an obligation on the part of the program or facility to "live up to¨ the name. They
also said certain spirits come with a name. Those spirits are intended to act as guides. The
Elders also remind us names are sacred because they come from the Creator. They need to be
treated with respect and honour. We should not shorten Anishinabe names for convenience.
This dishonours the name and its spirit(s).
x Helping design the treatment facility:
The Elders want to be involved in facility design. They said the treatment centre should reflect
Anishinabe cultural beliefs about the structure of healing lodges. It should face a certain
direction and be all on one floor, close to Mother Earth. The Elders also said they want to be
involved in preparing the site before construction.
x Determining the treatment faciIity's program, Acting as cultural advisors and
delivering the cultural program:
The Elders said they should design or at a minimum be involved in designing the treatment
program. The Elders want to ensure culture is correctly incorporated into the centre's operating
philosophy, into how staff is trained, into how the healing program is structured and how culture
is manifested in treatment approaches. The Elders particularly want to ensure any ceremonies

172

and rituals employed by the facility are conducted according to correct cultural protocols, The
treatment centre must use Elders/healers recognized by the Anishinabe/Métis community.
'Elders should build and implement the program."
'Elders carry the traditional knowledge. We should develop the cultural program
to ensure they are based on traditional values."
'You have to use good Elders; not bad Elders. The Elders know who does what.
They know which Elders are good Elders and who is respected."
'You have to use the right people. Elders can tell you who they are. Use only
Ojibway healers."
'You have to use the Elders from around here - Anishinabe Elders. If you bring in
Elders from other places, you disrespect the Elders here."
'It is never okay to bring in an Elder from another tribe. It is disrespectful. It
creates confusion. We are Anishinabe."
'If you do not conduct the ceremonies correctly, you can hurt someone."
'Ceremonies need to be done by our own people."
'Staff need to know the ceremonies. They need to know who the Elders are and
what their speciality is."
'You have to know what you are doing. Teachings should not be blind. You
should know why we do certain things."
'Elders should set-up the program. Elders know what is appropriate."
'We need to design treatment our way. As Elders, we have a cultural perspective.
We know what must go into operating the treatment program."
'There should be a cultural advisor on staff to guide the program and ensure that
things are being done correctly."
x Participating in interventions:
The Elders said they should make themselves available when it becomes necessary to stage an
intervention with a substance abuser.
'If a family is going to do an intervention, they should have an Elder there. The
Elder will ensure things are done in a good way."
'We can help guide interventions."
x Providing counselling and support:
The Elders said through their life experience, including their own history with substance abuse,
they have knowledge they can share with the centre's clients. They can also provide one-on-
one counselling or counselling in groups.


17S

'We can help with the counselling. We can share our own experiences. We can
talk about how we dealt with our problems and issues."

'We can work with the clients and tell them there are different ways to deal with
their problems."

'Elders are counsellors."

'We need to share our life experience and our stories."

'We can share our stories about using and not using. We all make mistakes. We
do the best we can. We stopped using."

'We can tell them they are not bad people. We have all done bad things at some
point. We need to tell them our stories so they will understand we struggled too."

'We should be there to listen to the client and talk with them."

Preferred Attributes of Elders Working In Substance Abuse Treatment:
The Elders identified the attributes they want Elders who work with the treatment program to
exhibit. The Elders should be "non-judgemental." They need to commit to 'be there through
the entire treatment process." The Elders should 'develop relationships with the
treatment clients. Don't just visit." Elders must 'not be enablers." The Elders need to
'recognize their own limitations." They need to 'keep communication lines open and
non-threatening." Elders need to be available but they should 'let the client choose who
they are most comfortable working with." Elders should visit the treatment centre on a
'voluntary basis" to do 'friendly-visiting." They should be from the area and have the 'the
respect of the community." They should be 'trustworthy."
D. Cultural Programming:
In their focus groups, the Elders provided insight into what the cultural programming within an
Aboriginal treatment centre might look like. The Elders said the foundation of the program is the
"Seven Grandfather Teachings." The Seven Grandfather Teachings are associated with the
seven gifts of Honesty, Humility, Courage, Wisdom, Respect, Generosity and Love. The basics
of the Seven Grandfather Teachings are:
To cherish knowledge is to know wisdom;
To know love is to know peace;
To honour all of Creation is to have respect;
Bravery is to face the foe with integrity;
Honesty in facing a situation is to be brave;
Humility is to know yourself as a sacred part of Creation;
Truth is to know all of these things.
The Elders identified other cultural elements that should be incorporated into substance abuse
treatment.

174

x Utilization of the language as much as possible so the spirits know what is being said and
so people can learn the language and know its importance;

x Teaching clients about and giving them spirit names so the Creator and spirits know
who they are;

x Teaching clients about the clan system and its role in Anishinabe society. Teach clients
their obligations under the clan system;

x Teaching and conducting purification and cleansing ceremonies including the sweat lodge
and smudging ( sage and sweet grass) and their associated teachings and protocols;

x Teaching clients about fasting and what its purpose is, when it should be done and how it
should be done;

x Drum teachings ÷ what is the meaning of the drum and how it is to be used and how it is to
be maintained;

x Feather teachings - what their meaning is, why they are used, how to use them, how to
take care of them and your obligations towards them;

x Four Direction teachings (Medicine Wheel) ÷ teachings of the Medicine Wheel and the
Sacred Directions;

x Pipe teachings - purpose of the pipe and how it is used, protocols regarding their use;

x Offerings - purpose of offerings, different types of offerings, how to make offerings, etc.;

x Healing ceremonies;

x Traditional medicine - the different types of medicine, how to gather medicines, how to
make medicines, when to gather medicines, how to use them, etc.;

x Northern Lights Teachings;

x Stages of Life/Rites of Passage Teachings;

x Women's Teachings;

x Jiggle Dress Teachings; and

x Seasonal ceremonies.




17S

Cultural-Based Treatment versus Culturally-Appropriate Treatment:

Because Aboriginal people often say mainstream addiction treatment programs are not
culturally-appropriate, the Project sought the Elders' guidance in determining what is or is not
culturally-appropriate treatment. The Elders accommodated the question and tried their best to
provide an explanation. Observing the Elders' discussions, Project staff saw they were
struggling with the question.
The Elders reiterated "culture is not an add-on." They also said "culture is healing" and
"culture is the basis of everything."
According to the Elders, culturally-appropriate treatment is an attempt on the part of mainstream
society to accommodate Aboriginal needs within the western approach to substance abuse
treatment. The Elders said while this bi-cultural approach to treatment might work for some
Aboriginal people, it is not what they mean when they talk about culturally-based treatment.
The following analogy is an attempt to capture what the Elders are saying.
The Cake Analogy
The western substance abuse system presents the Aboriginal people with a cake. The cake is
white and fluffy and represents substance abuse treatment, but the cake could very well be any
behaviour health program. They say to the Aboriginal people: "We want to share this cake with
you but we know you have problems with this cake. What can we do to make this cake more
palatable to you? How do we make it more culturally-appropriate?"
The Aboriginal people want a share of the cake and they want healing so they say: "You can
hire some Aboriginal people? You can bring in some Elders to do cultural teachings? You can
take people to sweat lodges"? The western substance abuse system thanks them for their input
and they set about making a cake that is more culturally-appropriate. In the end, they come up
with a white cake with some chocolate frosting. The Aboriginal people look at the cake and
agreed it looks better to them but when they try it, they are disappointed. They ask the Elders to
tell them what is wrong with the cake.
The Elders looked at the white cake with its chocolate icing and say the cake is not a good for
Anishinabe people. The Elders say: "Culture is not an add-on. If you bring that cake into our
communities, you are dragging in a Trojan horse. It is not the gift you think it is. The values and
beliefs that are hidden inside the cake are those of its maker. You can dress-up the white cake
in feathers and beads and all of the outward manifestations of Anishinabe culture, but it is still a
white cake. It is the dominant cultures world-view. It is laden with their values, belief systems
and norms. If you bring that cake into our communities, you are risking further acculturation.
You may end up doing our people more harm than good."
If the mainstream treatment system wants to help Aboriginal people heal; they must let the
Anishinabe/Métis people make their own cake. The eggs and the flour they put in the cake are
Anishinabe or Métis values and beliefs. The baking soda is their spirituality. It is this spirituality

176

that will make the cake rise. When the cake is done, the Anishinabe or Métis culture will be in
the texture of the cake. It will be in its flavour. You will not be able to take the Anishinabe or
Métis culture out of the cake even if you want to. Culture will not be an add-on.
The cake made by the Anishinabe or Métis will be different from the cake made by the Cree, the
Mohawk or the Inuit. What the Aboriginal people make may not even resemble a cake as
mainstream society understands a cake to look like but it will be culturally-based.

Aboriginal Control and Ownership:

Control and ownership of substance abuse treatment designed to meet Aboriginal needs has to
be a goal of Aboriginal healing. While control and ownership issues have been linked to the
political goal of Aboriginal sovereignty, we present it here as a requirement for advancing
Aboriginal healing. The Aboriginal Healing Foundation in its Final Report said a necessary
element to heal historic trauma is personal and cultural safety.
6
It said "establishing safety is a
prerequisite to healing from trauma. This includes ensuring physical and emotional security and
providing services in a setting that reflects participants' cultures and traditions.
7
¨ Unsafe cultural
environments are those which diminish, demean or disempower the cultural identity and well-
being of an individual. Substance abuse treatment centres based on the western model do not
present culturally-safe environments for Aboriginal healing because:
x The western model of substance abuse treatment, like other western behavioural health
programs, is based on western values and norms. The western model can act as a vehicle
for the further acculturation of Aboriginal people;

x The western model of substance abuse treatment is predominately delivered by non-
Aboriginal people who have been raised with western values and who have been trained in
the western medical model. No matter how sensitive they may be to Aboriginal culture and
history, they cannot help but deliver counselling in the context of their own value system;

x Aboriginal people who have experienced historical trauma may not be able to undergo
cathartic healing and move beyond the trauma within the western substance abuse
treatment model because:

! The non-Aboriginal counsellors are seen by the client as representative of the
culture of the oppressor;

! Non-Aboriginal cannot address historical trauma in the social context of the
Aboriginal people because of their positioning within the culture of the oppressor;

! Aboriginal people cannot release the pain, anger or resentment they may feel
about historic trauma in the presence of non-Aboriginal counsellors for fear of
offending them;

177


! Some Aboriginal clients may consciously or subconsciously resist dealing with
their historical trauma in the presence of non-Aboriginal counsellors and clients
as a form of defiance;

! Substance abuse treatment generally takes place in an environment where the
Aboriginal client is in the minority. The attitudes of other clients towards
Aboriginal people may make it culturally and personally unsafe for the Aboriginal
client to discuss historical trauma; and

! Western treatment centres do not necessarily have or take the time to fully
explore historic trauma with Aboriginal clients because of restricted treatment
cycle timelines.

x Part of cultural healing is cultural recovery. Cultural recovery involves the reinstatement of
cultural pride, identity and a sense of belonging. A non-Aboriginal treatment centres cannot
help Aboriginal clients reinvigorate their identity or sense of belonging to and within the
Aboriginal community. This can only occur within the Aboriginal culture and the Aboriginal
community.
Aboriginal controlled and operated substance abuse treatment centres are best positioned to
deal with historic trauma because:
! they share the client's history;

! they know innately the pain associated with historic trauma;

! they are culturally-based and are able to use Aboriginal value system and healing
practices to aid in cultural recovery; and

! they provide a culturally safe environment in which the client can reinvigorate his
or her cultural identity and sense of cultural connectedness.


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Chapter 11: Strength and Resilience
Introduction:
When the results of the Rainy River District Aboriginal Addiction Needs Assessment Survey
were tabulated, concern was expressed that the results might be used to further stereotype
Aboriginal people. There also was concern the Aboriginal community might feel overwhelmed
with the seeming intractability of the substance abuse problems identified. The latter was
brought home when, at a community briefing, a young man inquired: "Haven't we got anything
good going for us?¨ He was right to ask the question. There is a tendency in social research to
focus on the negatives and give short shrift to the positives. The Project Team did not want to
conclude this report without responding to the young man's query. From our experience with
the Project, we believe the Aboriginal community has a lot going for it.
Our People:
Ìn the Project's eighteen (18) focus groups, we met over 100 individuals who told their stories. In
doing so, they showed great courage in sharing the intimacies of their life events. Some stories
were sad and painful; others were funny and uplifting. While we gained in our knowledge of
substance abuse in the Aboriginal community, more importantly, we learned about the depth of
personal strength and resilience that lies within our people.
Steve Penny, author of "Hiring the Best People¨, wrote:
What is a Hero?
1

'A hero is someone who shows great courage and strength in the face of adversity.
Courage is not so much the absence of fear, as the deeply held conviction that
something else is more important.
Heroes don't think of themselves as heroes, they just do the right thing.
The inner strength of heroes gives strength to others."
We met heroes of all ages and genders through this Project. Their story telling reminded us that
we are all human. We all make mistakes but we are not our mistakes. We also learned that
everyone has it in them to survive and overcome life's challenges. Our communities are full of
survivors. These survivors are willing to share their histories so we can learn from their life
experiences, if we only ask. Our People are our strength.
Family:
We learned there is dysfunction in some families but we also learned family is of paramount
importance to Aboriginal people. We heard mothers and grandmothers express deep abiding
love and concern for their children suffering from substance abuse. We heard from
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grandmothers who have taken on the responsibility of raising their grandchildren. We heard
individuals say they sought treatment because of family directed intervention. Aboriginal youth
said they were able to resist the temptation of doing drugs because they learned good values at
home and because they had positive family role models.
The extended family continues to play a role in Aboriginal families. The Needs Assessment
Survey found that approximately 30% of respondents reported an extended family member
living with them - siblings, grandparents, grandchildren, aunts, uncles, cousins, or in-laws. Not
only do extended families share resources and supports, they also assist in childrearing and the
passing on of cultural values and traditions. Our families are our strength.
Cultural Preservation and Resilience:
The Needs Assessment Survey found 64% of respondents participated in traditional Aboriginal
cultural events in the 12 months preceding the survey while 40% participated in traditional
Aboriginal ceremonies. Sixty-eight percent (68%) of respondents said participating in cultural
events was important/very important to them. Sixty-two percent (62%) said participating in
traditional ceremonies was important/very important. Sixty percent (60%) said renewal of their
traditional spirituality was important/very important to them. These statistics show that
Anishinabe culture and the Métis culture is alive in our communities and is a source of great
community pride and personal self-esteem.
Our Elders are great examples of both personal and cultural resiliency. They have experienced
historical trauma and personal adversity but they continue to play a positive role in the
preservation of our cultural traditions. Our cultural identity and our connection to our traditional
knowledge, beliefs and practices are an important component in the resilience of our people and
our communities. Our culture is our strength.
Communities:
Our communities are also a source of our resiliency and strength as a People. Everyone we
met in the focus groups had a strong sense of community. First Nation people in particular see
the reserve as "home.¨ Ìt is where they grew up and where they and their extended family may
continue to live. It is where their friends are and where they have social supports. It is where
they have a sense of "belonging.¨ The Métis people have similar feelings for their community.
The Aboriginal "community¨ is a place where Aboriginal people feel personal and cultural safety.
Our communities are our strength.
Aboriginal Identity:
Throughout the focus groups, we heard people talking about the importance of being
Anishinabe or Métis. Aboriginal people identify with their ethnicity. It is very much part of
knowing who we are. Being Anishinabe or Métis, as the case may be, is our strength.

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Leadership:
This Project would not have been possible had it not been for those Aboriginal leaders that
stepped forward and agreed to work collectively to address the issue of substance abuse,
particularly opiate abuse. First Nations worked with Métis and reserves worked with urban
Aboriginal organizations. First Nations from differing tribal areas participated. They were able
to do so because they put aside the jurisdictional and political boundaries that normally
impede cooperation and collaboration. These Aboriginal leaders moved beyond their normal
operating paradigms because they shared a collective desire to improve the well-being of their
members. Good leaders act as change agents.
Willingness to Heal:
In the focus groups, Aboriginal people spoke of personal and cultural losses. Despite the pain
and tragedy they experienced, few dwelled on this. Instead, they spoke of their decision to
make positive changes in their lives and to embark on a healing journey.
Elders spoke of finding the strength to overcome their residential school experience and the
need for truth and reconciliation sessions to further their healing process.
Mothers spoke of intergenerational substance abuse and its impact on their families. They
spoke of their desire to reconcile their relationships with their children. One mother said: "Ì
would tell my children I am sorry for what I put them through. I would apologize and hope they
understand that I did what I knew how to do at the time. I would hope they would learn from
my mistakes.¨
Others, young and old, spoke of embarking on a journey of recovery from substance abuse.
While some continue to struggle with their sobriety on a daily basis, all have made a
commitment to take the journey despite its on-going challenges.
What became evident in our focus group discussions is there is a growing willingness on the
part of many Aboriginal people to begin the healing process. Healing does not occur in
isolation. It needs to be supported and encouraged. If the healing of Aboriginal communities
and Nations is to occur, it will begin with a grass-roots movement of people with the courage
to confront and overcome life's hurdles. Our people have shown they have begun this journey
with optimism and hope in their heart.

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Recommendations
Leadership:

1. Lack of sustained collective Aboriginal leadership on substance abuse:

Primary Identified Problem - Substance abuse is an on-going problem for all Aboriginal
communities in the Rainy River District. Opiate addiction is having a devastating impact on
the health and social well-being of individuals both on- and off-reserve, families and
communities. While some First Nations have taken action to respond to the problem, there
is a need for a more collective Aboriginal strategy which will address issues across the
substance abuse continuum ÷ prevention, intervention, treatment, aftercare and
control/enforcement. Some Ontario Aboriginal political organizations have raised the profile
of opiate addiction in their respective communities. Their issues are now on the radar
screen of the public and government. Similar action is needed in the Rainy River District.

Recommendation:

1,1 Aboriginal leadership prioritize substance abuse on their political agendas by
developing a District-wide Aboriginal Addiction Strategy. The Strategy should
support First Nations and urban aboriginal organizations in helping
community members achieve personal healing and recovery from substance
abuse while also improving the quality of life of Aboriginal families and
communities. The Strategy should:

x Include all Aboriginal populations of the District (First Nations, Métis and
urban populations) as substance abuse does not respect political or
jurisdictional boundaries;

x Address issues across the substance abuse continuum;

x Maximize use of available expertise and resources within the Aboriginal
and non-aboriginal community;

x Maximize use of both federal and provincial funding support; and

x Use the results of the Rainy River District Aboriginal Addiction Needs
Assessment and the Treatment and Support Services Project Report as a
starting point for further discussion and strategy development.
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Treatment:
1. Lack of Cultural-Based Treatment Services in the Rainy River District

Primary Identified Problem - Aboriginal people comprise over 56% of the Rainy River
District's treatment population and they access services both within and outside the Rainy
River District. Despite this, Aboriginal people lack adequate access to cultural-based
treatment services. There are no residential addiction treatment services or withdrawal
management services in the Rainy River District. Aboriginal people want addiction
treatment services provided closer to home. There is also a need for improved client
management systems which track Aboriginal use of treatment services. This is especially
needed within the NNADAP treatment system.

Recommendations:
1.1 Develop culturally-based treatment services in the Rainy River District with
priority given to:
a) The development and implementation of an Aboriginal (Anishinabe and
Métis) residential treatment centre focussing on both opiate and alcohol
addiction; and

b) The development of Withdrawal Management/Detox Services for all
residents of the District.
1.2 Ensure Aboriginal Elders are actively consulted and involved in the design,
development and evaluation of the proposed treatment centre and Withdrawal
Management/Detox Service.
1.3 Ensure that both the proposed treatment centre and Withdrawal Management
Service implement a Client Management System to aid in client tracking and
the measurement of service effectiveness and efficiency.
2. Lack of Gender-Based Treatment Services and Supports for Aboriginal
Women in the Rainy River District

Primary Identified Problem - Environmental and systemic barriers prevent Aboriginal
women from accessing and receiving gender-appropriate substance abuse treatment and
support. These barriers include: lack of child care, lack of gender-specific treatment which
address issues related to violence and sexual abuse, and a lack of recovery support
including transitional housing.




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Recommendations:
2.1 Ensure that the proposed Aboriginal Treatment Centre and Withdrawal
Management Service develop and implement strategies for addressing
gender-based needs as part of their development and delivery plans. Options
might include:
x Implementation of gender-based treatment cycles;
x Provision of child-care;
x Programming to address issues related to sexual abuse and domestic
violence and gender-based victimization; and
x Family counselling and support.
2.2 Develop gender-based support services including self-help groups, life-skills
programs, supportive housing, et cetera; and
2.3 Develop and enhance cultural-based mental health programs in the Rainy
River District for Aboriginal women aimed at addressing issues identified in
the Rainy River District Aboriginal Needs Assessment Survey including
acquaintance and domestic violence, sexual abuse and victimization.
3. Lack of Treatment Services for Aboriginal Youth in the Rainy River District
Primary Identified Problem - There are no cultural-based addiction treatment services
specifically targeted to Aboriginal youth within the District. Individuals under 18 years
cannot be admitted to Withdrawal Management/Detox. Addiction treatment programs lack
staff trained to deal with the special needs of Aboriginal youth.
Recommendation:
3.1 Develop and implement cultural-based treatment services in the Rainy River
District for Aboriginal youth. Options might include:
x Implementation of youth-specific treatment cycles;

x Day treatment programs which include: individual counselling,
family/parent counselling and support, group therapy,
education/academics and life skills development; and

x Provision of out-patient counselling provided by counsellors trained in the
special needs of Aboriginal youth. Youth out-patient counselling should
be available in the evenings, as well as, during the day.



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4. Lack of Support for Abstinence-based Approaches for Treatment of Opiate
Addiction

Primary Identified Problem - Methadone Maintenance Therapy (MMT) is the primary
treatment modality offered to opiate-dependent Aboriginal people in the Rainy River
District. Some Aboriginal service providers and some opiate-dependent Aboriginal people
believe that local health service providers are pushing MMT over rapid opiate detoxification
or opiate step down to abstinence. They believe MMT is being promoted by local health
service providers because government policies present MMT as the gold-standard in the
treatment of opiate addiction, because health service providers lack training in the provision
of step-down programs, and because step-down programs require a substantial investment
of time on the part of health service providers. Abstinence-oriented therapy is nevertheless
an important alternative to MMT.

Recommendation:

4.1 Abstinence-oriented therapies should be promoted to opiate-dependent
Aboriginal people along with MMT. Physicians and other health service
providers should receive appropriate training in step-down to abstinence care
in order to meet the needs of those clients who would prefer this option.

Aftercare:

1. Lack of Structured Aftercare Program for Aboriginal People in the Rainy River
District

Primary Identified Problem - Aboriginal clients discharged from treatment have problems
accessing community-based aftercare support services because of a lack of service
coordination and service availability. Treatment centres report the lack of community-based
recovery services (aftercare) contributes to Aboriginal client relapse.

Recommendations:
1.1 Develop a structured Aftercare Program for Aboriginal People based on the
Recovery Management Model. The key features of the Recovery Management
Model include:
x Active client engagement versus crisis-oriented engagement.
Active client engagement strategies include: community outreach, pre-
treatment recovery support and removal of environmental obstacles to
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treatment service access e.g.) transportation, treatment cost, child care,
etc.
x Individual, family, community and cultural interventions and support;

x Establishment of a Recovery Management Team that is multidimensional
including staff members with a wide-variety of skills and expertise;

x Inclusion of Elders and traditional healers in the Recovery Management
Team;

x Provision of a large menu of service and support activities that are
uniquely combined and supplemented to meet the stage-dependent needs
of people in recovery;

x Sustained monitoring and support versus low-intensity, short- duration
services; and

x Client-Provider relationship based on a partnership-model.

1.2 Establish community-based Aboriginal Recovery Management Teams based
on the Recovery Management Model. These teams would consist of existing
health and social service providers who would be jointly responsible for the
provision of client-driven care to support addiction recovery. The key features
of the approach:
x The individual can access care through any door not just addiction
services;

x The individual is a client of the Aboriginal community services not a client
of one specific community program;

x The client is a partner in his/her recovery;

x Case Management is done by the Recovery Management Team;

x Community services are jointly responsible for the provision of wrap-
around care;

x Support and care is aIso provided to the cIient's famiIy; and

x Care and support is provided on a long-term basis in keeping with the fact
that addiction is a chronic disease subject to the on-going risk of relapse.
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1.3 Work with Aboriginal communities to develop community-defined and
community-specific models of Recovery Management Teams.
1.4 Provide on-going training and support to Aboriginal community-based
Recovery Management Teams.

1.5 Introduce Case Management Software to support Recovery Management
Team coordination and service integration at the community level. Ensure on-
going training to members of the Recovery Management Team.

Prevention/Health Promotion/Education:

1. Need for enhanced prevention and health promotion activities to prevent
substance abuse and reduce associated risks:

Primary Identified Problem- The Rainy River District Aboriginal Addiction Needs
Assessment Survey and Treatment and Support Service Project Report identified the need
for prevention and health promotion activities aimed at the prevention of substance abuse
and the reduction of associated risks. The reports found:

x High rates of alcohol and drug consumption by Aboriginal youth under aged 18 years;
x High rates of binge drinking across age groups;
x High rates of alcohol and opiate consumption of Aboriginal women of child-bearing
years;
x High rates of non-traditional tobacco use by all age groups;
x High rates of physical, psychological/emotional and sexual abuse coupled with high
rates of substance abuse by both victim and perpetrator; and
x High rates of child physical, psychological/emotional and sexual abuse.

Recommendation:

1.1 Fund prevention and health promotion activities aimed at the prevention of
substance abuse and the reduction of associated risks. Emphasize activities
targeted to the findings of the Rainy River District Aboriginal Addiction Needs
Assessment Survey and Treatment and Support Services Project Report.
2. Lack of awareness amongst Aboriginal community members of the signs and
symptoms of Opiate abuse and the pros and cons of Methadone Maintenance
Therapy:
Primary Identified Issue - The Aboriginal community lacks factual, up-to-date information
concerning opiate addiction including what opiates are, what they look like, and the physical,
mental and social signs of opiate abuse. Communities also lack information about
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Methadone Maintenance Therapy and its efficacy in treating opiate addiction. As a result,
Aboriginal Methadone Therapy clients feel stigmatized and discriminated against by
community members and some service providers.
Recommendation:
2.1 Implement community education and awareness sessions on Opiate addiction
and Methadone Maintenance Therapy in the Aboriginal community.

Training:
1. Lack of Up-to-date training for Aboriginal Addiction Workers:

Primary Identified Issue - The skill set and competencies of NNADAP workers in the
Rainy River District need further enhancement to meet their changing workload demands.
Some need additional training to respond effectively to the opiate addiction issue that has
arisen in First Nation communities in the last five years. Treatment service providers have
identified the need to train NNADAP workers and other Aboriginal addiction workers in
conducting client assessments and in developing treatment plans. There is a need for
accredited training that will help ensure Aboriginal clients receive quality services and instil
in non-Aboriginal addiction service providers confidence in the skill-level of their Aboriginal
colleagues.

Recommendation:

Fund accredited training for addiction workers employed by First Nations and
Aboriginal service agencies. Up-grade Aboriginal addiction workers job descriptions
to accurately reflect their duties and responsibilities. Match proposed training to
reflect the skills, knowledge and attributes need to fulfill the revised job
specifications.

2. Lack of addiction training for Aboriginal Health and Social Service Providers:

Primary Identified Problem - Aboriginal clients believe that many Aboriginal health and
social service providers lack up-to-date training in the field of addictions. As a result, they
are unable to adequately meet the needs of Aboriginal clients with substance abuse issues.
Some workers may be introducing personal biases against substance abusers into the
client-provider relationship. The introduction of the Recovery Management Model and the
shared caseload concept into the Aboriginal service environment will require a shift in the
current health and social service delivery paradigm. Workers will require training to facilitate
the proposed shift in service delivery.

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Recommendation:
2.1 Fund First Nation and Aboriginal service agencies to provide addictions
training for their front-line health and social service workers. This training
should include an emphasis on opiate addiction and the Recovery
Management Model.

Enforcement:

1. Inadequate implementation of measures to control the sale and distribution of
controlled substances in the Aboriginal community:

Primary Identified Problem - Aboriginal community members report bootlegging and drug
trafficking is increasing in the Aboriginal community. Aboriginal people believe that the drug
trafficking problem is directly related to motorcycle clubs and Indian gangs. Aboriginal
people are aware that some people on prescribed opiates or on Methadone are selling their
prescriptions or carries. While Aboriginal people claim to know who is involved in
bootlegging, drug trafficking and prescription drug diversion, there is a reluctance to inform
law enforcement for fear of reprisals and/or because a family member may be involved.
Aboriginal community members live in fear because of the increase in drug-related property
crime and assaults. Aboriginal seniors and children are at increased risk for drug-related
crime, neglect and abuse.

Recommendation:

1.1 Rainy River District Aboriginal leaders partner with federal, provincial and
First Nation law enforcement officials to develop viable strategies for
addressing the issue of drug trafficking and associated crime in the
Aboriginal community.
2. There is a need for Aboriginal restorative justice models in the Rainy River
District that combine the need for the protection of public safety and the
recognition of addiction as a chronic disease:
Primary Identified Problem - Aboriginal people want the issue of bootlegging and drug-
trafficking addressed in the interests of public safety. Concurrently, they recognized that
many people engage in bootlegging and drug-trafficking to support their addictions.
Recommendation:
2.1 Rainy River District Aboriginal leaders partner with the federal and provincial
justice system to examine the feasibility of establishing an Aboriginal Healing
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to Wellness Court modelled after Drug Courts and U.S. Tribal Healing to
Wellness Courts.
The Healing to Wellness Court would handle cases involving alcohol and
drug-using Aboriginal offenders through an extensive supervision and
treatment program. The Court would bring the full weight of all interveners
(judge, prosecutor, defence counsel, substance abuse treatment specialists,
probation officer, law enforcement and correctional personnel, educational
and vocational experts, community leaders and others) to bear, forcing the
offender to confront their substance abuse problem.
3. Many community members want mandatory drug-testing of Elected Leaders
and Band employees:
Primary Identified Problem - There are wide-spread reports that some First Nation leaders
and band employees have substance abuse problems. There is concern that the quality of
First Nation governance and service delivery is being compromised by this. Many
community members feel that First Nation governments are enabling these elected leaders
and band employees in their addiction by failing to address addiction in the Council
chambers and the workplace. Community members also are concerned the individuals
involved are acting as negative role models for First Nation youth. Some community
members expressed concern that their band offices are being identified as where you go to
purchase drugs.
Recommendations:
3.1 First Nations implement mandatory drug-testing of all band employees and
elected leaders
1
with due consideration to the protection of human rights.
3.2 Establish and/or implement Employee Assistance Programs (EAP) to assist
band employees in substance abuse recovery. Implementation of EAPs
should be fair and equitable.

Investment in Aboriginal Community Strengths:

1. Need to Invest in Aboriginal Community Strengths and Cultural Protective
Factors:

Primary Identified Problem - In recent years, social researchers have come under
criticism by Aboriginal people for fixating on negative states of Aboriginal human behaviour
e.g. diseases, deficits and disorders. They argue by focussing on the deficit-model,
researchers have promoted negative stereotyping of Aboriginal people and entrenched
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feelings of low self-worth in Aboriginal people and communities. The deficit-model also
forms the basis of government needs-based funding to the Aboriginal community.
Aboriginal communities must drag out a litany of their health and social problems in order to
justify the need for financial resourcing. There is a need for a paradigm shift on the part of
funding agencies. Funders should also invest in the strengths of the Aboriginal community
because it is these strengths (strong cultural identification, extended family, strong
community identification, etc.) that act as protective factors against substance abuse.


Recommendation:
Government must invest in the strengths and protective factors in the Aboriginal
communities of the Rainy River District as part of the strategy for addressing
Aboriginal substance abuse. This might include funding:

x Cultural programming;

x Youth development;

x Aboriginal arts;

x Et cetera.

Substance Abuse Service Collaboration, Coordination and
Integration:

1. Lack of joint Aboriginal and mainstream substance abuse service
collaboration, coordination and integration across the Rainy River District:

Primary Identified Problem - Participants at the Service Provider Forum convened by the
Treatment and Support Services Project in October 2009 identified the need for enhanced
substance abuse service collaboration, coordination and integration across the District.
While Aboriginal people comprise over 56% of the substance abuse treatment clients within
the Rainy River District, there is a noticeable absence of Aboriginal involvement in the
planning, design, implementation and governance of local substance abuse services.
Further, Aboriginal and mainstream service providers identified the need to overcome
jurisdictional boundaries in order to work together to improve the health and social outcomes
of Aboriginal clients. The Service Provider Forum concluded with a commitment on the part
of those presents to work collaboratively on substance abuse issues affecting the Rainy
River District.

Recommendation:

1.1 Build on the outcome of the Service Providers Forum by establishing a Rainy
River District Addiction and Mental Health Network to support improved service
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coordination, collaboration and integration. The membership will be founded on
the principle of equal partnership between Aboriginal and mainstream service
providers. Issues which the Network might address include:

x Improved case management;

x Exploring opportunities for joint training;

x Development of culture-based assessment instruments;

x Development of joint operating protocols, memorandums of understanding,
etc.

x Cross-cultural training;

x Expertise and resource sharing;

x Et cetera.

Special Needs of the Métis:

1. Lack of support for Métis directed solutions for Métis addiction issues:

Primary Identified Problem - The Rainy River District Aboriginal Addiction Needs
Assessment Survey found substance abuse issues exist within the Métis community of the
Rainy River District. Despite this, the needs of the Métis are often overlooked in the
planning, delivery and resourcing of substance abuse programs within the District. Unlike
First Nations, the Métis receive no funding support to access treatment services.
Substance abuse services do not incorporate Métis cultural and traditions nor do they
recognize Métis historic and personal trauma. The Métis have a right to design and
implement Métis solutions to Métis health problems, including addiction problems.

Recommendation:

1.1 Involve the Métis, as equal partners, in the development of an Rainy River
District Aboriginal Addiction Strategy; and

1.2 Support and fund Métis defined strategies for addressing substance abuse
within the Métis community.






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Aboriginal Substance Abuse Funding:

1. Lack of funding to support Aboriginal prevention, treatment, aftercare and
enforcement/control strategies:

Primary Identified Problem - Aboriginal communities within the Rainy River District (First
Nation, Métis and urban) lack sustainable resourcing to address the complexities of the
substance abuse problem facing their people.

Resolution No. 74/2007 of the Special Chiefs Assembly (Assembly of First Nations) held on
December 11
th
to 13
th
, 2007 (Ottawa) called for appropriate funding to First Nations to
combat drug abuse and drug trafficking and to raise awareness at the community level; new
funding for First Nations to enhance and maintain current prevention strategies, and develop
and incorporate suitable rehabilitation and aftercare services; and support to First Nations in
asserting their jurisdiction, laws and policies that take action and reduce or eliminate the
epidemic of drug abuse and trafficking.
The Métis Nation of Ontario has called for self-determination in health supported by
appropriate levels of financial and human resources for Aboriginal-designed, -developed
and -delivered programs and services that respect and promote community responsibility,
autonomy and local control including resources to deal with alcohol-related health
problems.
Recommendation:
The federal and provincial governments provide adequate sustainable funding to
Aboriginal communities in the Rainy River District to address the full continuum of
substance abuse care and to address drug enforcement/control issues.

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"The Long Plain First Nation in Manitoba initiated voluntary testing for Chief and Council and program
managers in July 2005. It is the first aboriginal community in Manitoba to implement drug testing for
Chief and Council candidates to be eligible to run for elected positions."
"
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APPENDICES













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Focus Group Questions

Elders' Focus Groups:

1. How are Elders affected by substance abuse issues in the Aboriginal Community?
2. What are the needs of Elders with a substance abuse issues and how can these needs be
met?
3. What is "culturally appropriate" treatment?
4. What role can Elders play in substance abuse treatment?

Youth Focus Groups:
1. What are the factors that lead Aboriginal Youth to use drugs? Are these factors different for
males versus females?
2. What are the factors that lead Aboriginal Youth to not use drugs? Are these factors different
for males versus females?
3. What are the barriers that prevent Aboriginal youth from seeking treatment for a substance
abuse problem?
4. If Aboriginal youth could develop a substance abuse treatment program specifically for
Aboriginal youth, what would it look like?

Women's Focus Groups:
1. What causes Aboriginal women to abuse/misuse drugs and alcohol?
2. How do drugs and substance abuse/misuse by Aboriginal women impact on their lives and
the lives of their families?
3. How can the needs of Aboriginal women with substance abuse/misuse issues be
addressed?
4. What barriers prevent Aboriginal women with substance abuse problems from getting
treatment?
5. How can substance abuse treatment services be improved to meet the needs of Aboriginal
women?

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Men's Focus Group:

1. What causes Aboriginal men to abuse/misuse drugs and alcohol?
2. How do drugs and substance abuse/misuse by Aboriginal men impact on their lives and the
lives of their families?
3. How can the needs of Aboriginal men with substance abuse/misuse issues be addressed?
4. What barriers prevent Aboriginal men with substance abuse problems from getting
treatment?
5. How can substance abuse treatment services be improved to meet the needs of Aboriginal
men?

Methadone Focus Group:
1. What factors led to Focus Group participants' decision to enrol in a Methadone Treatment
Program?
2. What are the positive aspects of Methadone Treatment?
3. What are the negative aspects of Methadone Treatment?
4. If participants could design a Methadone Treatment Program, what would that program look
like?

Substance Abuse Treatment CIients' Focus Group:
1. What factors led to Focus Group participants' decision to attend a Substance Abuse
Treatment Program?

2. What are the positive aspects of attending Substance Abuse Treatment?

3. What are the negative aspects of attending Substance Abuse Treatment?

4. If participants could design a Substance Abuse Program specifically for Aboriginal people,
what would that program look like?

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Substance Abuse Treatment Services
Treatment Centres/Programs Questions

1. Please provide an overview of your treatment program. (Any written material regarding
your program would also be appreciated.)

2. Please provide us with an overview of the Aboriginal clients accessing your program.
(Demographics; referrals, intake and assessments from Rainy River District; treatment
uptake; retention and withdrawals; discharges; aftercare.)

3. From your perspective as service providers, how would you assess your agency's
competency to provide culturally-appropriate and relevant treatment services to the
Aboriginal population? On what standard or measure do you basis this assessment?

4. From your perspective as service providers, please identify what you see to be
Aboriginal treatment needs and gaps?

5. From your perspective as service providers, what recommendations would you make to
address the Aboriginal treatment needs and gaps you identified?







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SERVICE PROVIDERS FORUM
COUCHICHING BINGO HALL
THURSDAY, OCTOBER 1, 2009

AGENDA

9:00 A.M. OPENING PRAYER
INTRODUCTIONS
OPENING REMARKS:
x Welcome & Purpose of Forum
± Ed Yerxa, Coordinator
Treatment and Support Services Project: Couchiching First Nation
PRESENTATION:
x Project History
x Project Structure & Methodology
x Progress to Date

! Cathie Bruyere, Needs Assessment Consultant
QUESTIONS
10:00 A.M. Coffee Break
10:15 A.M. ROUNDTABLE:
Question 1: How do we improve Aboriginal access to substance abuse
treatment services?
11:00 A.M. Question 2: How do we increase Aboriginal participation in the design,
delivery and evaluation of substance abuse treatment services?
LUNCH BREAK Meal Provided
1:00 P.M. Question 3: How do we ensure that substance abuse treatment services are
better suited to meet the needs of Aboriginal people?
2:15 P.M. Coffee Break
2:30 P.M. Question 4: How can we improve the integration of federal and provincial funded
substance abuse treatment services to better meet the needs of Aboriginal
people?
3:30 P.M. ADJOURNMENT