Psychology

Northerners Need New Approaches to Addictions

A study completed by counselling psychologist Marja Korhonen for the Ajunnginiq Centre has painted a picture of Inuit alcohol abuse similar to that of aboriginal people in northern Saskatchewan. She found that abstinence rates are higher in Inuit communities than in non-native communities but that the rate of binge drinking is also higher. This finding parallels those of a study completed while I was Director of Health and Social Development for the Federation of Saskatchewan Indian Nations during the 1980s. In that study we found that Saskatchewan Treaty and Status Indian populations are no more likely to be chronically addicted to alcohol than are non-natives. But we found that the rates of binge drinking (being more or less continuously drunk for a period of days) and problem drinking (drinking for the purpose of getting drunk resulting in legal or social problems) were much higher. The Korhonen study, completed in 2004, also found that the standard approach for treating alcohol abuse, based on the Alcoholics Anonymous disease model, was ineffective for a majority of aboriginal binge and problem drinkers. She recommended that alternative approaches be made available to northerners.

Many northerners believe that when you drink you drink to excess. Korhonen recommended building new normative behavior where drinking is not expected to lead to drunkenness and drunkenness is not tolerated. This is not a matter of police enforcement, but of communities setting and enforcing their own standards as part of a process of community development.

She recommended that treatment for people with drinking problems be individualized to suit the client. Harm reduction involves coaching those who have decided to drink, to do so in ways that will not result in legal or social problems. Guided self-change and motivational interviewing, both of which emphasize the client's power to choose, have been shown to be effective. Self-help groups like Rational Recovery, the Moderation Movement, and Self-Management and Recovery Training were recommended, and because these programs are not yet available in Nunavut, Korhonen posted their websites. Generally she found that counselling services offering both reduced-drinking strategies and abstinence have higher success rates than those that offer abstinence only because clients can choose. She also pointed out that success outcomes of treatment centers is no better than outpatient programs even for severely addicted drinkers.

My own training in Rational Addictions Counselling emphasizes abstinence if the client cannot drink responsibly. Often clients tell me that they can cut down their drinking and drink responsibly any time they choose. I invite them to show me. Either they succeed or they do not. If they succeed there is no problem. If they do not succeed then they need to consider abstinence.

Drinkers often have an inner voice Jack Trimpey, the founder of Rational Recovery, calls “the beast” telling them that when they get into problems it is not their fault, or that they cannot control their drinking. Drinkers who blame others for their alcohol abuse are attempting to pass responsibility for themselves to those others. Their mistaken belief is that no matter what they do it is someone else’s duty, usually parents, spouses or other family, to take care of them. Those who claim that they cannot control their own drinking are setting themselves up for relapse. They may “try” to quit, believing, deep down, they are powerless to do so thus avoiding the decision to quit.

Korhonen points out that the majority of problem drinkers eventually become social drinkers. There are some, however, who must make the decision to become abstinent, and this means deciding to live with the discomfort of whatever stressors may have triggered the drinking behaviors. Many drinkers will say that their drinking is a form of self-medication for earlier hurts. That may be so, but until they make a decision to do something about their drinking, counselling for those earlier traumas will not be successful.

Korhonen’s report: Alcohol problems and approaches: Theories, evidence and northern practice, may be ordered from the National Aboriginal Health Organization.