“You can’t do it for us, you can only do it with us” Understanding substance use in Indigenous communities and how to help

Samantha Johnstone, Yasmine Noureddine, Elena Kastoras, and Jenna Vieira

Indigenous peoples are much more likely than others to experience mental health issues, including substance use disorders.¹ In fact, 16% of Indigenous peoples reported drinking heavily on a weekly basis, compared to only 7.9% of other Canadians.¹ On top of that, over 50% of Indigenous survey respondents reported using at least one illegal drug in the past year, compared to less than 1% of the general Canadian population.¹ 

A substance use disorder can be understood as when a person experiences a loss of control over their use of drugs or alcohol, misses important social and work-related events, and experiences cravings for the substance that can’t be ignored.² Not only can facing a substance use disorder make it really hard for a person to cope with the demands of everyday life, but it can also worsen their mental health. This is particularly likely to be the case for Indigenous peoples.

A long history of colonization, racism, and other forms of discrimination have led Indigenous peoples to experience difficulty in accessing the same quality of healthcare, social services, and opportunities that other Canadians receive.³ Because the voices of this community have been silenced by discrimination for so long, it is important to listen to their personal challenges, opinions, and needs rather than imposing Western ideas of assistance on them.

Taking a look at Indigenous substance use and mental health

Focusing in on a subgroup of Indigenous peoples – university students – reveals that they are indeed at an increased risk of experiencing substance use disorders and other mental health issues.⁴ Researchers conducted a survey of 34 thousand Canadian students in hopes of determining if universities are meeting the needs of Indigenous students.⁴ As it turns out, they are not. Indigenous students were overwhelmingly more likely to be diagnosed with depression and anxiety.⁴ They also reported more self-harming behaviours and a longer history of suicide attempts.⁴ This is likely due to the lack of access to healthcare and poverty⁴ caused by years of colonization, oppression, and loss of cultural connections.⁵

So how does this relate to substance use? Well, the increased psychological distress faced by Indigenous students means that those who do engage in binge drinking or smoking are more likely than their non-Indigenous peers to have comorbid mental illnesses.⁵ Comorbidity simply means that two disorders are occurring at the same time in one person. Researchers have identified a few ways in which comorbidities can develop:

• Substance use can increase the risk of developing a mental illness, like depression, due to changes in the brain.⁶ 
• Some people may try to self-medicate to deal with symptoms of their mental illnesses. This can increase the risk of becoming dependent.⁶
• Common genetic risk factors can increase the risk of both substance use and mental health problems.⁶

Having to cope with a mental disorder and a substance use disorder at the same time can make it really hard to recover from either illness. This is concerning, as Indigenous students in the 2019 study also reported greater levels of binge drinking and drug use than their non-Indigenous peers.⁴ Along with the reports of overwhelming psychological distress, it is clear that Indigenous students are suffering to a great extent. Specifically, we see that Indigenous students who use substances have more negative outcomes and greater levels of psychological and social hardships compared to non-Indigenous students.⁵

How can clinicians use this information?

It is important for clinicians to recognize the inequalities faced by Indigenous students and ensure that comprehensive assessments are conducted. This means that instead of just diagnosing the substance use disorder, clinicians also have to ask about psychological distress and assess the risk of suicide, to get to the full picture. But once we have the full picture, what do we do with it?

1. Offering culturally appropriate services:

We emphasize that culturally appropriate services need to be available for Indigenous students. When healthcare is culturally appropriate it integrates the patients culture into delivery of the service while maintaining dignity and recognizing social and economic hardships.⁷ One way this can be achieved is by having Indigenous counsellors onsite that can help students maintain their cultural identity even when they are away from home.⁴

2. When to step in: 

Indigenous counsellors can also help to maneuver decisions about when to provide treatment. Cultural differences play a role in deciding what does (or does not) constitute a substance use disorder. Western definitions of disordered substance use may not translate to what Indigenous communities see as problematic. For example, traditional ceremonies in Indigenous cultures often use tobacco ², and it would be inappropriate to characterize this practice as disordered. We also know that Indigenous communities have not yet established a definition for binge drinking.⁴

3. Proper diagnosis means better treatment:

Interventions, like sweat lodge ceremonies, address Indigenous mental health while promoting a holistic model.⁸ Holistic interventions heal the mind, body, emotion, and spirit in an integrated manner⁸, which is essential when treating comorbidities. These interventions are beneficial in improving mental health and reducing substance use. More importantly, Indigenous students have reported that they prefer these types of services over standard ones.⁴ 

4. Not only for students:

Although this study specifically focused on university students, comorbid substance use and mental illness are common in Indigenous communities.² We can use this research to push for changes in government policies and practices. When Indigenous leaders have control over their health services, are able to use their traditional languages, and maintain cultural identity, there are notably lower rates of substance use and suicide.⁴ Supporting Indigenous self-governance is an important step in addressing the inequalities and hardships that Indigenous peoples face.

How can you and I help?

While researchers and clinicians may be the frontline responders to understanding and accurately assessing substance use in the Indigenous peoples and their youth, this doesn’t mean that you can’t contribute in your own way to provide help and support. Some tips on how to do this include⁹:

1. Taking the time to learn about the history of Indigenous people in Canada.

Knowledge of the historical factors that contributed to today’s issues surrounding Indigenous mental health and substance use can provide a better understanding of how and why they are so prevalent. It also allows for a look at how circumstances have changed over the decades, and what still needs to be done to ensure equity and proper care. Checking out recommended books at your local library, as well as sources like podcasts, is a great way to start!

2. Reaching out and building strong connections with the Indigenous peoples, organizations, and communities near your own. 

In supporting the communities, you are supporting everyone who is a part of it, including the older generation, as well as students. These relationships allow non-Indigenous peoples a chance to understand how substance use and mental health are viewed and best approached by Indigenous communities. Checking out your local Indigenous cultural centre and community organizations can be a launching pad for fostering good relations.

3. Knowing what support services and programs are available for Indigenous peoples and their youth.

Familiarizing yourself with the services and programs available helps you to know exactly where to direct your support and allows for more access/reach to what is needed, by promoting the programs and making it known to the wider public that they exist, are available, and would benefit from support from outside of the Indigenous community (as a way of highlighting their importance). Some programs and services include:

• National Native Alcohol and Drug Abuse Program
• Indian Residential Schools Resolution Health Support Program
• Mental Health Counselling Benefits
• Jordan’s Principle
• CAMH Aboriginal Service

You can also get involved and spread awareness by following and interacting with social media pages run by and for Indigenous peoples. Pages such as: Indigenous Youth Voices and Ontario Indigenous Youth Partnership Project!

The mental health and well-being of marginalized groups is the responsibility of all to ensure a well-supported, equal-opportunity community that is free from stigma and risk factors. Given that Indigenous peoples reside all across Canada and broadly experience higher levels of disordered substance use compared to the general Canadian population², supporting your local community is a way to help out Indigenous communities as a whole. Canadians can’t address and fix inequalities for Indigenous peoples; we can only do it with Indigenous peoples.¹¹

References

1. Firestone, M., Tyndall, M., & Fischer, B. (2015). Substance use and related harms among Aboriginal people in Canada: A comprehensive review. Journal of Health Care for the Poor and Underserved, 26(4), 1110-1131. https://doi.org/10.1353/hpu.2015.0108

2. Urbanoski, K. A. (2017). Need for equity in treatment of substance use among Indigenous people in Canada. Canadian Medical Association Journal, 189(44), 1350-1351. https://doi.org/10.1503/cmaj.171002

3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

4. Hop Wo, N. K., Anderson, K. K., Wylie, L., & MacDougall, A. (2019). The prevalence of distress, depression, anxiety, and substance use issues among Indigenous post-secondary students in Canada. Transcultural Psychiatry, 57(2), 263–274. https://doi.org/10.1177/1363461519861824

5. Sittner, K. J. (2015). Trajectories of Substance Use: Onset and Adverse Outcomes Among North American Indigenous Adolescents. Journal of Research on Adolescence, 26(4), 830–844. https://doi.org/10.1111/jora.12233

6. Teesson, M., Degenhardt, L., Proudfoot, H., Hall, W., & Lynskey, M. (2005). How common is comorbidity and why does it occur? Australian Psychologist, 40(2), 81–87. https://doi.org/10.1080/00050060500094605 

7. Caffery, L. J., Bradford, N. K., Smith, A. C., & Langbecker, D. (2018). How telehealth facilitates the provision of culturally appropriate healthcare for Indigenous Australians. Journal of Telemedicine and Telecare, 24(10), 676–682. https://doi.org/10.1177/1357633×18795764

8. Rowan, M., Poole, N., Shea, B., Gone, J. P., Mykota, D., Farag, M., Hopkins, C., Hall, L., Mushquash, C., & Dell, C. (2014). Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study. Substance Abuse Treatment, Prevention, and Policy, 9(1), 34. https://doi.org/10.1186/1747-597x-9-34

9. Pharmacy Connection March 5, 2020 0 C. (2020, June 15). 5 tips on supporting the mental health and wellness of indigenous youth. https://pharmacyconnection.ca/5-tips-supporting-mental-health-indigenous-youth-winter-2020/.

10. Government of Canada, S. C. (2020, October 2). Aboriginal Peoples Highlight Tables, 2016 Census. Government of Canada, Statistics Canada. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/abo-aut/Table.cfm?Lang=Eng&T=101&S=99&O=A.

11. Caron, N. R. (2005). Getting to the root of trauma in Canada’s Aboriginal population. Canadian Medical Association Journal (CMAJ), 172(8), 1023-1024. https://doi.org/10.1503/cmaj.050304

Images

1. Canva (February 2021). [Image of cartoon therapist with patient, patient has a thought bubble with words such as ‘Indigenous’ and ‘Oppression’ in a word cloud]. 

2. Canva (February 2021). [Head of women each have a speech bubble emerging from them; the first head has a sad icon, the second alcohol and weed]. 

3. Canva (February 2021). [Map of Canada with the populations of Indigenous peoples by province/territory. Information from Statistics Canada].