Advertisement

Abstinence Versus Harm Reduction: Considering Follow-up and Aftercare in First Nations Addictions Treatment

  • Kimberly A. van der Woerd
  • David N. Cox
  • Jeff Reading
  • Andrew Kmetic
Article

Abstract

Research on alcohol and substance use in First Nations populations frequently describes the nature of the problem, and the severity of the risk factors, but seldom addresses possible interventions and the effectiveness of the treatments that clients do engage in. This paper reviews a participatory evaluation of the 6-week residential ‘Namgis Treatment Centre (NTC) program in Alert Bay, British Columbia. Intake files (n = 218) were reviewed for clients who participated in 17 different 6-week sessions over a period of two and a half years. The assessment included a telephone follow-up survey, developed in conjunction with all of the NTC staff, for clients who had been out of treatment for 3–37 months (n = 91, 52.7% male and 47.3% female participants). In total, 24 clients (26.37%) were abstinent at the time of the interview, and 67 clients (73.6%) had had a relapse on average 155.29 (SD = 167.77) days after completing treatment. Cox regression univariate and bivariate analysis revealed that pre-treatment variables were not associated with time to relapse or what happened after relapse (abstinence again, harm reduction or resuming pre-treatment consumption levels). However, the greater number of supports the client had, the more likely they were to be completely abstinent, and the less supports the client had, the more likely they were to completely relapse. NTC staff and community members were consulted on the implications of the data, and recommendations were shared with NTC policy makers. Based on the findings of this project, it is apparent, that in this context, follow-up and aftercare are critical for effective treatment.

Keywords

Substance abuse Treatment outcomes Aboriginal Program evaluation 

Notes

Acknowledgement

Funding for this research was provided by the Canadian Institute of Health Research (CIHR) - institute for Aboriginal Peoples' Health (IAPH) BC Aboriginal Capacity and Development Research Environment, the Social Sciences and Humanities Research Council of Canada, and a CIHR - IAPH Operating Grant (Dr. Reading).

References

  1. Centre for Global Development. (2006). When will we ever learn: Improving lives through impact evaluation. Washington: Centre for Global Development.Google Scholar
  2. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Academic.Google Scholar
  3. Daisy, F., Thomas, L. R., & Worley, C. (1998). Alcohol use and harm reduction within the native community. In G. A. Marlatt (Ed.), Harm reduction: Pragmatic strategies for managing high-risk behaviors (pp. 327–250). New York: Guilford.Google Scholar
  4. Dixon, B. L. (2007). Assessing program outcomes: a follow-up study of the Tsow-Tun Le Lum First Nations Substance Abuse Treatment Centre. Unpublished Honors Thesis, Simon Fraser University, Burnaby, BC, Canada.Google Scholar
  5. Dornelas, E. A., Correll, R. E., Lothstein, L., Wilber, C., & Goethe, J. W. (1996). Designing and implementing outcome evaluations: some guidelines for practitioners. Psychotherapy, 33, 237–245.Google Scholar
  6. DuPont, R. L., & McGovern, J. P. (1994). A bridge to recovery: An introduction to 12-step programs. Washington: American Psychiatric.Google Scholar
  7. Government of Canada (2002). Aboriginal people: History of discriminatory laws. Retrieved April 28, 2007, from http://dsp-psd.pwgsc.gc.ca/Collection-R/LoPBdP/BP/bp175-e.htm#A.%20Liquor%20Offences(txt).
  8. Green, S. B. (1991). How many subjects does it take to do a regression analysis? Multivariate Behavior Research, 25, 499–510.CrossRefGoogle Scholar
  9. Guno, M. (2001). In the spirit of sharing: honoring first nations educational experiences. Unpublished Master of Arts Thesis, Simon Fraser University, Burnaby, British Columbia, Canada.Google Scholar
  10. Harrison, P. A., & Asche, S. E. (1999). Comparison of substance abuse treatment outcomes for inpatients and outpatients. Journal of Substance Abuse Treatment, 17, 207–220.CrossRefPubMedGoogle Scholar
  11. Health Canada (2004). Aggressive girls: Overview paper. Available online: retrieved August 1, 2004 from: http://www.hc-sc.gc.ca/hppb/familyviolence/html/nfntsaggsr_e.html.
  12. Health Canada (2005). National native alcohol and drug abuse program (NNADAP) review. Retrieved September 10, 2007, from http://www.hc-sc.gc.ca/fnih-spni/pubs/ads/nnadap_rev-pnlaada_exam/index_e.html.
  13. Health Canada: First Nations, Inuit and Aboriginal Health. (1998). Literature review: Evaluation strategies in aboriginal substance abuse programs: A discussion. Retrieved February 10, 2006, from http://www.hc-sc.gc.ca/fnih-spni/pubs/ads/literary_examen_review/index_e.html.
  14. Heather, N. (2006). Controlled drinking, harm reduction and their roles in the response to alcohol-related problems. Addiction Research and Theory, 14, 7–18.CrossRefGoogle Scholar
  15. Humke, C., & Radnitz, C. (2005). An instrument for assessing coping with temptation: psychometric properties of the alcohol abuse coping response inventory. Substance Use and Misuse, 40, 37–62.CrossRefPubMedGoogle Scholar
  16. Kelm, M. E. (1998). Colonizing bodies: Aboriginal healing in British Columbia 1900–1950. Vancouver: University of British Columbia Press.Google Scholar
  17. Kirkness, V. J., & Barnhardt, R. (1991). First Nations and higher education: the four R’s—respect, relevance, reciprocity, responsibility. Journal of American Indian Education, 30, 1–15.Google Scholar
  18. Larimer, M. E., Marlatt, G. A., Baer, J. S., Quigley, L. A., Blume, A. W., & Hawkins, E. H. (1998). Harm reduction for alcohol problems: expanding access to and acceptability of prevention and treatment services. In G. A. Marlatt (Ed.), Harm reduction: Pragmatic strategies for managing high-risk behaviors (pp. 69–73). New York: Guilford.Google Scholar
  19. Linklater, C. (1991). Follow-up and after-care manual. Ottawa: National Native Alcohol Drug Abuse Program.Google Scholar
  20. Maracle, B. (1993). Crazy water: Native voices on addiction and recovery. Toronto: Penguin Books.Google Scholar
  21. Marlatt, G. A. (1985). Relapse prevention: theoretical rationale and overview of the model. In G. A. Marlatt & J. R. Gordon (Eds.), Relapse prevention. New York: Guilford.Google Scholar
  22. Marlatt, G. A. (1998). Basic principles and strategies of harm reduction. In G. A. Marlatt (Ed.), Harm reduction: Pragmatic strategies for managing high-risk behaviors (pp. 3–70). New York: Guilford.Google Scholar
  23. McMillan, J. H. (2004). Educational research: Fundamentals for the consumer (4th ed.). Toronto: Pearson.Google Scholar
  24. Miller, W. R., Brown, J. M., Simpson, T. L., Handmaker, N. S., Bien, T. H., Luckie, L. F., et al. (1995). What works? A methodological analysis of the alcohol treatment outcome literature. In R. K. Hester & W. R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives (2nd ed., pp. 278–291). Boston: Allyn and Bacon.Google Scholar
  25. Miller, W. R., Westerberg, V. S., Harris, R. J., & Tonigan, J. S. (1996). What predicts relapse? Prospective testing of antecedent models. Addiction, 91, s155–s171.CrossRefPubMedGoogle Scholar
  26. Moos, R. H., & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 101, 212–222.CrossRefPubMedGoogle Scholar
  27. ‘Namgis First Nations. (2005). N a m g is first nation guidelines for visiting researchers/access to information contract. BC: Alert Bay.Google Scholar
  28. ‘Namgis Treatment Centre. (1996). ‘N a m g is health centre mission statement. BC: Alert Bay.Google Scholar
  29. Peele, S. (1983). Through a glass darkly: can some alcoholics learn to drink in moderation? The answer, at least in this country, may be more political than scientific. Psychology Today, April, 38–42.Google Scholar
  30. Peele, S. (1985). What treatment for addiction can do and what it can’t: what treatment for addiction should do and what it shouldn’t. Journal of Substance Abuse Treatment, 2, 225–229.CrossRefPubMedGoogle Scholar
  31. Peele, S. (1991). Encyclopedia of drugs and alcohol. New York: Macmillan.Google Scholar
  32. Peele, S., Bufe, C., & Brodsky, A. (2000). Resisting 12-sctep coercion: How to fight participation in AA, NA, or 12-step treatment. Tucson: See Sharp.Google Scholar
  33. Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: applications to addictive behaviours. American Psychologist, 47, 1102–1114.CrossRefPubMedGoogle Scholar
  34. Royal Commission on Aboriginal Peoples (1996). Royal Commission report on Aboriginal peoples. Available online. Retrieved October 5, 2003 from http://www.ainc-inac.gc.ca/ch/rcap/index_e.html.
  35. Sinha, R., Easton, C., & Kemp, K. (2003). Substance abuse treatment characteristics of probation-referred young adults in a community-based outpatient program. The American Journal of Drug and Alcohol Abuse, 29, 585–597.CrossRefPubMedGoogle Scholar
  36. Smith, L. (1999). Decolonizing methodologies: Research and indigenous peoples. London: Zed Books Ltd.Google Scholar
  37. Swisher, K., & Tippeconnic, J. (1999). Research to support improved practice in Indian education. In K. Swisher & J. Tippeconnic (Eds.), Next steps: Research and practice to advance Indian education (pp. 295–307). Charleston: Clearinghouse on Rural Education and Small Schools, ERIC.Google Scholar
  38. Tobias, J. L. (1976). Protection, civilization, assimilation: an outline of history of Canada’s Indian policy. Western Canadian Journal of Anthropology, 6, 39–55.Google Scholar
  39. Vaillant, G. E. (2003). A 60-year follow-up of alcoholic men. Addiction, 98, 1043–1051.CrossRefPubMedGoogle Scholar
  40. van der Woerd, K. A. (1998). A process evaluation and follow-up study of theN a m g is First Nations Substance Abuse Treatment Centre. Unpublished Honours Thesis, Simon Fraser University, Burnaby, BC, Canada.Google Scholar
  41. Waldram, J. B., Herring, D. A., & Young, T. K. (1995). Aboriginal health in Canada: Historical, cultural, and epidemiological perspectives. Toronto: University of Toronto Press.Google Scholar
  42. York, G. (1990). The dispossessed: Life and death in Native Canada. Toronto: Little, Brown.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Kimberly A. van der Woerd
    • 1
  • David N. Cox
    • 1
  • Jeff Reading
    • 1
  • Andrew Kmetic
    • 1
  1. 1.Department of PsychologySimon Fraser UniversityBurnabyCanada

Personalised recommendations