Alcohol Use disorders and harm-reduction in indigenous coastal communities of Hudson Bay Northern Canada

Abstract

: Alcohol use disorders are a major contributor to morbidity and mortality across the globe. Binge drinking and suicide have a high prevalence in northern latitudes, including Canada, Alaska, Greenland, and northern Europe. Many factors are associated with alcohol misuse and suicide in these northern regions such as climate, geographic location, history of the population, which in Canada includes colonisation-related harms such as the introduction of alcohol and systematic suppression of native cultures, on-going psychosocial stressors, and governmental policies. Due to the high prevalence of alcohol misuse and suicide in the studied population, the authors introduced contextually relevant Brief Intervention (BI) into the ER and ambulatory care settings as a harm-reduction measure. The impact of BI on binge drinking and suicide is discussed. The co-ordination of BI with other harm-reduction strategies in the region include suicide awareness and intervention training, efforts by provincial and federal governmental agencies using special teams to limit the social and psychological impact of recent suicides in communities, the return of AA groups after a ten-year hiatus, and importantly the establishment of native healing programmes.

Keywords:

• Binge Drinking
• Suicide
• Brief Intervention
• Native Healing Programmes
• Truth and Reconciliation

Ethics approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients before being included in the study.

Data availability

Due to ethical restrictions, supporting data are not available.

Disclosure statement

No potential conflict of interest was reported by the authors.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

The authors acknowledge the support of the Institutional Review Boards of Weeneebayko General Hospital and Queens University as well as the local band councils. All of these entities remained in an oversight capacity throughout the period of our study. The WGH IRB and band councils requested that in any subsequent reports, the specific communities NOT be identified, and patient privacy be scrupulously maintained.

Positionality of the authors

The PI for this study and had experience working with Indigenous populations in northern Canada prior to this study. He is board certified in Addiction Medicine and a specialist in alcohol use disorders at the University of Massachusetts Medical School Worcester. He was recruited by Weeneebayko General Hospital (WGH) and Health Authority to work at the hospital as a senior staff physician and to develop programmes to mitigate chronic and binge drinking, which accounted for nearly 40% of ER visits on weekends. The PI was born and raised in southwestern Nova Scotia, Canada and was educated at eastern Canadian universities in the 1960ʹs and 70ʹs. The corresponding author was born in southwestern Nova Scotia, Canada and was raised in Boston, Massachusetts. His higher education was completed in Canada, Wales, and Germany. Both the PI and the corresponding author are listed in the US Census as Caucasian and American Indian. The third author is a native of England and completed her higher education there in the 1970ʹs.

While all three authors were outsiders with respect to positionality, they were well received and respected by the island and mainland communities.

This study involved all six of the coastal communities of Western Hudson Bay by virtue of people from those communities visiting the WGH ER for medical care while they were on the island. The vast majority of the patients studied belonged to the Moose Cree Nation.

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Arnold Hill, Patricia Benson, and Richard Hill. The first draft of the manuscript was written by Arnold Hill and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. In addition, Cheryl Fry contributed to the design of the brief intervention, trained the ER nurses, social workers, and addiction counsellors to effectively deliver the BI to patients. Charlene Banyan was the physician champion in the ER assisted by other staff physicians. The authors wish to thank the more than 30 Family Medicine residents who participated at the ambulatory care sites during the period of the study. The authors would also like to thank Elizabeth Bojarski O’Conner for critically assessing the final manuscript.

Notes

1. See also Wenger-Nabigon (2010) for the indispensability of native approaches to personal and community wellness across a variety of communities. Danto & Walsh (2017) show the effectiveness of these approaches for the communities of the Mushkegowuk Territory.

2. These records were accessible to the PI as the senior staff physician with prior approval of the chief of staff and the hospital IRB which included band membership. These data are replicable if there were cause to do so.

3. Their data are reported directly to the Department of Indian Affairs and Northern Development. Release of these data to other agencies almost always requires band approval The data in this report are unaltered by any agency.

Additional information

Funding

The authors did not receive support from any organization for the submitted work.