Focus

Confronting the negative spirit

Does harm reduction have a place in Aboriginal communities?

By Anne Ptasznik

“A spiritual awakening is when you start seeing the good in yourself without any mood- or mind-altering chemicals,” says Joyce Paul, an elder and executive
director of the Rising Sun Rehabilitation Centre, a treatment centre serving First Nations people in Eel Ground, New Brunswick. “It’s a gift to be alive. It doesn’t enhance your life, your ability to be a better parent, son or daughter by being on anything.”

Paul, who has herself been sober for 25 years, believes that abstinence is the only option. She sees no room for harm reduction with alcohol, given the Medicine Wheel teachings that focus on physical, emotional and spiritual well-being, and that see alcohol as a negative spirit that disrupts the body’s natural balance.
The debate around harm reduction, a concept started in Western society, has a long history, but nowhere perhaps is it more heated than among Canada’s Aboriginal communities, particularly when it comes to alcohol, which has a unique role in Aboriginal history.

Alcohol was introduced to Aboriginal communities at the same time that colonization was eroding their traditional way of life. “People have been robbed of their culture, their values, traditions, language, parenting, that sense of belonging, and don’t know who they are,” says Paul. “When they pick up that first drink, it becomes a key.”

Like Paul, many Aboriginal treatment programs and communities today adopt models of abstinence and prohibition for clear reasons: the destructive impact of the introduction of alcohol on the lives of Aboriginal peoples and the devastating level of alcohol and other drug abuse in some communities, says Colleen Anne Dell, Research Chair in Substance Abuse at the University of Saskatchewan. Most treatment centres established in the 1970s by Canada’s National Native Alcohol and Drug Abuse Program adopted an abstinence-based medical model because that was the norm.

But abstinence and harm reduction are not the black-and-white issue some make it out to be. To begin, there is much divergence of experience among Aboriginal communities in Canada – the First Nations, Inuit, the Aboriginal people of Arctic Canada, the Métis, people of mixed First Nations and European ancestry. Susan Manitowabi, a professor at the School of Native Human Services at Laurentian University in Sudbury, Ontario, says that people’s perspectives on alcohol vary, depending on their degree of assimilation and how affected they were by colonization.

Dell agrees, adding that not all harm reduction measures apply to all Aboriginal peoples and communities. Some argue that alcohol and other drugs are incompatible with their values and traditions, whereas others view it as “making sure that people live with the least harm in their life.” Some Aboriginal treatment centres provide harm reduction programs, such as needle exchanges, but take an abstinence approach when it comes to alcohol. Ultimately, says Dell, developing effective policies and programs must be directed by communities themselves.

A big step forward is the work of the National Native Addictions Partnership Foundation in Muskoday, Saskatchewan, which is currently developing a harm reduction position paper. Sharon Clarke, executive director of the organization, which represents Aboriginal addiction treatment services across Canada, sees harm reduction and abstinence as complementary rather than opposing philosophies and hopes the document will reconcile them with Aboriginal worldviews. While their ultimate goal remains abstinence, Clarke sees harm reduction as part of a continuum of care from prevention to awareness to abstinence, based on the principles and values of “strong families, interconnectedness among ourselves, compassion and respect, trust and honesty.”

Manitowabi supports this approach. She says that sometimes people are excluded from cultural events like pow-wows if they use alcohol because it is considered a negative spirit. She advocates a gentler approach, allowing people into events but asking them to leave the substances behind. “Sometimes people are looking for an answer, a way to heal themselves,” she says. “If you close the door on them you never have that opportunity.”

In the 1990s, Manitowabi helped to develop an alcohol management policy on the Wikwemikong Unceded Indian Reserve in northern Ontario. The policy outlined where and when alcohol could be served, among other requirements, such as prohibiting last call at events. Evaluations found that community attitudes towards the policy became increasingly positive over time and that violence, vandalism and drinking in public areas decreased. “When you promote abstinence the problems go underground,” says Manitowabi. “If you have good controls in place, people don’t go underground; they are still enjoying alcohol, but in a controlled manner.”

Dell stresses the need for responses to be community driven and culturally appropriate. She cites the Mamisarvik Healing Centre, an Inuit-specific residential substance abuse program in Ottawa, which offers clients the choice of stopping or reducing their substance use. The Alkali Lake reserve in British Columbia has taken a harm reduction approach to its ban on alcohol. Heavy drinkers received food vouchers instead of social assistance funds and users were rarely exiled. The Western Aboriginal Harm Reduction Society in Vancouver runs an alcohol maintenance program where homeless people with mental health issues receive small amounts of alcohol to divert them from more harmful substances. Dell says that in Aboriginal communities, where the individual and community are integrally tied, harm reduction is not just about the individual’s choice; it is linked to the broader community.

Ultimately, Dell says that reducing harm requires dealing “with the underlying factors that lead to problematic alcohol use by improving social, health, political, and economic well-being and poverty.” Only then will that cherished balance truly be restored.

For more information: Harm Reduction Policies and Programs for Persons of Aboriginal Descent. Visit the Canadian Centre on Substance Abuse web site at www.ccsa.ca and do a keyword search.