SMART Recovery News & Views, Winter 2003, pp. 5-6
I ran a two-day workshop organized primarily by several white members of the Saskatchewan National Native Alcohol & Drug Abuse Program Providers. These individuals have been convinced that the exclusive emphasis on 12-step and disease-based programs for First Nation peoples does not address the sources of widespread native substance abuse, and is in fact counterproductive.
Addiction treatment is now the primary native industry in Saskatchewan and elsewhere in the Canadian West. Treatment has developed an inertia as providers cling to the prevailing approaches, built around AA’s 12 steps, which they have been practicing and from which they derive income and status. Very few, if any, providers in the First Nation would argue that there has been improvement in native substance abuse. Rather, quite the contrary is true, and new areas of abuse, including IV and other narcotics and cocaine use and solvent abuse by the young have arisen to join traditionally severe alcohol problems.
I and other behaviorally, cognitively, and socially oriented addiction theorists and practitioners have faced a gut-level, basic opposition to our approaches when we are brought into First Nation settings. This is despite the fact that my approach, called the Life Process Program, has appealed to those like my hosts who agree that addiction is best seen as a futile effort at coping for people deprived of the means to deal effectively with their environments. We seek solutions in native values, including traditional self-reliance and pride, which run counter to the ideas of powerlessness and addiction as an inborn disease. Given the basic incapacities of their clients, Life Process emphasizes needed skills, like those involved in work and family relationships.
In adapting the 12 steps to First Nation needs, some reserve treatment providers have actually made it resemble the Life Process approach at least as much as it does the traditional 12 steps. For example, one native man told me that his group only practices four of the 12 steps. Of these four steps they supposedly practice, they have discarded the notion of powerlessness (the first step) because it runs contrary to First Nation pride and because it discourages clients. They then revise the second step, submitting to a higher power, into being at one with the universe, a holistic approach more consistent with traditional teachings. One of my hosts joked, “It’s the First Nation Two Step.”
The First Nation peoples have an inherent suspicion of new “harm reduction” strategies, of which needle exchange or clean needle programs and methadone substitution are the best-known. In the first place, these seem like an external imposition (of which, of course, the 12 steps are the primary example). Any suggestion of cultural imperialism naturally raises their hackles. In the second place, staggering under widespread substance abuse and addiction problems, natives see anything that seems to accept continued drug and alcohol use as potentially disastrous to the First Nation.
In particular, native providers can point to many examples of readily obtained methadone which is diverted to illegal users, including the young. Among the deficiencies they perceive are the lack of assessment (so that non-addicts can get methadone and then sell it), of medical administration (so that natives take large amounts home, many miles from the providers), and of supportive auxiliary therapy. All of these are predicates in Health Canada’s protocols for methadone maintenance therapy, but MMT is rarely given the means to be fully and successfully implemented.
When I present harm reduction to audiences of hostile providers, I begin by asking two fundamental questions – What percentage of substance abusers do they believe are currently involved/succeeding in treatment? Would they welcome treatment outcomes involving continued use if it led to fewer criminal, health, psychological, family, and work problems for the user? It is hard to come by negative answers to these things (that is, answers opposing harm reduction principles).
In the First Nation setting, even where I found sympathy on basic principles, the native providers were highly resistant to acknowledging the value of my insights. Some (men especially) felt that, to do so, would be somehow to cede power over their ideas to a white outsider. My solution was to put myself in their same position, by telling them that I was an outsider in my own nation, and that I had come here to find independent people who questioned the cultural values that tried to sell powerlessness to people.
When I asked providers at the end of our sessions (and my hosts noted how many stayed for the entire two days) if they were optimistic about the future, answers typically were that things are so bad “that we will either be destroyed or get better.” A well-presented alternative is not only much needed, but would be welcomed if it could be melded with native providers’ own suspicions of and modifications to the white man’s medicine, which has brought them sickness with no cure.