Literature Review ADMH 2020

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1 Literature Review Samantha Ledamun Humber College Research & Writing on Issues ADMH: ADMH-2020 Tami Rankin November 12, 2023

2 Contents Introduction ..................................................................................................................................... 3 What are the determinants that lead to Indigenous youth substance use? ................................................ 4 Literature Review ............................................................................................................................ 4 Themes .................................................................................................................................................... 4 Colonialism and Systemic Racism ........................................................................................................................ 4 Social Suffering & Suicide .................................................................................................................................... 7 Western vs Indigenous approaches to Substance Use ........................................................................................... 7 Reflection ................................................................................................................................................ 8 Conclusion ....................................................................................................................................... 9 References ..................................................................................................................................... 11

3 Introduction My topic of study for this literature review focuses on Indigenous youth and high-risk substance use throughout North America. This area of study includes various factors that contribute to Indigenous youth using substances, impacts on Indigenous youth using substances, systemic racism, colonialism, western approaches to substance use, cultural approaches to substance use, and the gaps in Canada’s healthcare system. There are a lot of reasons why I was drawn to this topic and the main reason being: knowledge. When I was growing up in school, we did not speak too much of Indigenous culture or heritage. We spoke about the history of Canada, the Hudson’s Bay Company, trading, Indigenous people in the form of existence, but we did not speak about the genocide that has occurred in Canada for centuries. We would set out on field trips in the winter to conservation areas where we would go on nature hikes, learn about science, go snowshoeing, see people wearing animal fur, learn all these cool techniques to be one with nature – but not once did we specifically indulge or speak about Indigenous culture. As of 2021 when the unmarked graves in Canada started to appear, this is when I started to question the education, I grew up learning. Having friends who are Indigenous tell me about their lived experience with substance use throughout their lives really intrigued me to want to learn more about how to further education myself as a settler and as an ally, on how I can support these youth as a social service worker. This topic is relevant to today, as Lavalley et al. (2018) stated that in 2017, Canada had 4000 opioid-related deaths, and Indigenous peoples accounted for 10% of those overdose deaths. This is now seen in some Indigenous communities in Canada, as a state of emergency. (Mertz & Meilleur, 2023). This is only becoming more of a challenge for these communities.

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4 What are the determinants that lead to Indigenous youth substance use? This research question is important because it explores all the factors that affects the outcome of Indigenous youth substance use. It is important to highlight all the factors that influence these youth to start using substances, the impacts it has on the youth, the families, their communities, how we as a western society approach substance use with Indigenous youth and why these youth are considered high-risk when using substances. Another important reason why this research question is important is because the healthcare and social services systems are still discriminating against these communities and continuing to re-traumatize Indigenous youth with strict substance regulation policies. It is important to shine a light on how these youth are being treated within our healthcare system and to break the cycle of colonialism and systemic racism and pay attention to the mortality rates as there are generations being entirely wiped out. I am hoping to learn on how to be a better ally, social service worker, and more on incorporating Indigenous cultural approaches to substance use when working with these youth. Literature Review Themes Colonialism and Systemic Racism While researching this topic I was finding that this was the main factor leading Indigenous youth to use substances, whether they experience it directly or are themes of intergenerational trauma

5 in their families. Indigenous youth have a higher rate at experiencing child maltreatment and are often involved with the child welfare system . Toombs et al., 2023 states; “ Among those who reported a parent history of RSA, individuals were 3.0 times more likely to engage in monthly or greater illicit substance or prescription drug abuse. For individuals with two-generation RSA, they were 1.9 times more likely to fall in the higher illicit use category.” There is a clear pattern between substance use, mental health & residential schools. Indigenous youth who are living off the reserve, either because they choose to or they are attending school in a larger city, are more likely to use substances to cope with feeling of isolation, experience discrimination, violence, loss of cultural identity, loneliness & other trauma they have experienced while being off their reserve (Toombs et al., 2023). Using substances to cope with their mental health is also something in some communities like Thunder Bay, Ontario, Indigenous youth are still a target for the police system Hay, T. (2018). Furthermore, Thunder Bay for the past 10+ years has been experiencing murder with Indigenous youth & the police system isn’t taking accountability. Indigenous communities continue to experience racial injustice, victim blaming and police brutality. Families of these Indigenous youth are requesting an inquest be done for the victims of these hate crimes & the police service was using their substance use as a scapegoat to not properly investigating these murders (Hay, T. 2018). Indigenous women are overrepresented in street-based sex work due to historical and current colonial institutions (Bingham et al., 2014). In 2020, a Royal Canadian Mounted Police (RCMP) officer stroked heinous acts of violence towards a 22 Inuk man in Nunavut, for no reason at all (Public Safety Canada, 2021). These acts of hate, violence and discrimination is like what happens in Thunder Bay, Ontario & is the one of main reasons Indigenous youth turn to

6 drugs (Hay, T. 2018). Indigenous youth also have higher rates to being arrested and have challenges with the justice system. Of all youths who are prosecuted in federal courts, 32% are placed in a secure facility; of these 74% are Indigenous (Sittner et al., 2012). While still on the topic of systemic racism, Indigenous youth experience barriers to accessing social supports & experience discrimination in healthcare. The recreation of trauma in medical settings that stem back to colonial genocide from the residential school system. There is high rates of bias and prejudice Indigenous youth are experiencing within the medical field from medical professionals, especially related to addictions. There are so many youths who have shared their lived experiences found in the research, for an example as found in the research done by Smye et al., 2023: “ One of the things I do have problems with is she [doctor] is too busy. I went there my last appointment, my appointment was at one, I didn’t get out of there till five and I was really, really sick too. I had a high fever, I think my temperature was 39 or something, I can’t remember but I didn’t care, I just kind of laid back on her couch and stuffed my face with what they had sitting there…I drank a whole pile of juice.” If youth are living on reserves in a rural community, they are having to go to bigger cities/hospitals that offer the detox treatments. This often is leaving youth with unmet medical needs, driving them more to relapse or being socially isolated from their families/communities. This is often a factor for youth to continue using substances, to reduce harm done to them by the western medicinal system. The article I found on Global News speaks about Treaty 6 First Nations in Alberta declaring a state of emergency over the rising opioid deaths (Mertz & Meilleur, 2023). Treaty 6 is supposed to guarantee health care for Indigenous communities, and states that federal government must provide ongoing health care. Indigenous life expectancy is decreasing due to the opioid crisis and

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7 the lack of harm reduction services. Alberta Health Services collected data that disclosed the life expectancy of Indigenous Albertans went from 71 years in 2017, to 63 years in 2021 (Mertz & Meilleur, 2023). According to the Confederacy of Treaty 6 First Nations, death rates have increased after supervised consumption sites were shuttered, and 71 First Nations have declared an opioid crisis, but only 22 to 24 have received money (Mertz & Meilleur, 2023). Social Suffering & Suicide Lack of social services, social isolation from family while in treatment, living with mental health and addiction, and resources for substance use disorder are all factors that can lead Indigenous youth to die by suicide (Lehti et al., 2009). Residential trauma, systemic racism, barriers to accessing proper healthcare and factors – and they can also be impacts to Indigenous youth dying by suicide. Canadian males have a higher rate of suicide attempts & youth in the arctic have alarming rates of suicide, or suicidal attempts (Lehti et al., 2009). A few of the risk factors for Inuit youth include substance use, friends/family dying by suicide, abuse, and social isolation (Lehti et al., 2009). Western vs Indigenous approaches to Substance Use There is a ton of research on the different treatment methods and approaches to Indigenous youth substance use. Residential treatment programs like the Youth Solvent Addiction Program (YSAP) offer cultural supports to substance use among Indigenous youth (Dell & Hopkins, 2011). But even the YSAP program is stating there is a lack of cultural and spiritual service available to youth. The youth feel more engaged when they are re-connected to their culture while practicing absence or harm reduction (Dell & Hopkins, 2011). Practices such

8 as the 7 Grandfather Teachings, the Medicine Wheel, sweat-lodges, ceremonies, and access to their cultural traditions while healing had equally as high rates as western approaches to substance use treatment in these youth. Reflection Some of the gaps I found in the research are that there is a lack of studies conducted on specific themes revolving around Indigenous youth substance use over the years. More cultural and healing treatments did not come into effect until 2000-2011, so we are missing gaps in the 80’s and 90’s when illegal substances throughout North America were used more frequently Rowan et al. (2014). There also is a lack of studies done in other states in the U.S and other parts of Canada, as only 19 studies were done (58%) and Canada (52%). In Rowan et al. (2014), most of the research in this study were done in California or Ontario. It did not include the arctic where most of the Indigenous youth are indulging in high-risk methods and substances. What I was curious about while doing this research is how these Indigenous youth cope with their concurrent disorders or dual diagnosis of mental health and substance use. Do they relapse? Do the western treatments work better in the long-term? Some of the questions I found raised in the research are related to policy makers, social determinants of health & why there are data being disaggregated. An increasing corpus of research contends that traditional therapies, which are mostly based on Western individual-level behavioural change frameworks, are culturally incompatible with Indigenous perspectives (Barker et al., 2017). The main structural/socioeconomical factors that are influencing this situation vary.

9 This can be factors such as social support, employment, income, access to basic healthcare and substance us intervention and prevention supports. From what I have collected, the opioid crisis in Treaty 6 First Nations has been affecting the community in many ways as stated in the factors above, but the main factors are not being able to access harm reduction supports and safe supply (Mertz & Meilleur, 2023). The issues intersect with mental health because not only is it damaging the individuals’ using substances, their loved ones, but it is stemming back to the SdoH I am speaking about with regarding race and racism. Sittner et al. (2012b) states; the approach the government is taking is deeply rooted in colonialism by continuing to create harm within these communities and taking away their access to rapid addiction medicines, supervised consumption sites, and access to healthcare services. Historically, Indigenous peoples were not used to consuming the various intoxicants given by white settlers to this region, and they quickly became reliant on them (Lavalley et al., 2018). Conclusion My hypothesis is that colonialism, lack of social supports and systemic racism are why Indigenous youth have higher rates of substance use. The research has clearly stated that the factors differ between communities, provinces, countries and lived experience. If I were to further conduct this research I would specifically like to focus on western Canada and Thunder Bay, Ontario, as these areas have more overdoses and lack of resources compares to the research studies I have found. I would want to reflect more on my research question, as I felt like there were too many factors and impacts to work within my themes. I appreciate that I took my time

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10 with the research and analyzed every angle, because not every Indigenous youth has the same lived experience. This literature review has shaped my understanding on how to approach substance use and mental health while working with Indigenous youth and communities. I had to look at different perspectives, historical events, using my clinical biopsychosocial model, but also learning more about the cultural treatments Indigenous communities use when healing from substance use. It has helped shaped my social worker lens to be able to adapt to these methods if I am supporting Indigenous clients in the future. It has also shaped my thoughts of Canada’s history with Indigenous people & how my identity as a white settler here may have a heavy presence on Indigenous youth using substances. I hope this research and reflecting I have done will be a stepping stone to having Indigenous youth trust me when handling their substance use in the future, as well as, protecting their cultural/spiritual identities vs creating more trauma and harm.

11 References Barker, B., M.P.P., Goodman, A., M.A., & DeBeck, K., PhD. (2017). Reclaiming Indigenous identities: Culture as strength against suicide among Indigenous youth in Canada. Canadian Journal of Public Health, 108(2), E208-E210. https://doi.org/10.17269/CJPH.108.5754 Dell, D., & Hopkins, C. A. (2011). Residential Volatile Substance misuse treatment for Indigenous youth in Canada. Substance Use & Misuse , 46 (sup1), 107–113. https://doi.org/10.3109/10826084.2011.580225 Goldenberg, S. M., Perry, C., Watt, S., Bingham, B., Braschel, M., & Shannon, K. (2022). Violence, policing, and systemic racism as structural barriers to substance use treatment amongst women sex workers who use drugs: Findings of a community-based cohort in Vancouver, Canada (2010–2019). Drug and Alcohol Dependence, 237, 109506–109506. https://doi.org/10.1016/j.drugalcdep.2022.109506 Hay, T. (2018). Foreclosing Accountability: The Limited Scope of the Seven Youth Inquest in Thunder Bay, Ontario. Canadian Review of Social Policy , 78 , 1+. https://link-gale- com.ezproxy.humber.ca/apps/doc/A595026826/CIC?u=humber&sid=bookmark- CIC&xid=7934c072

12 Lavalley, J., Kastor, S., Valleriani, J., & McNeil, R. (2018). Reconciliation and Canada’s overdose crisis: responding to the needs of Indigenous Peoples. Canadian Medical Association Journal , 190 (50), E1466–E1467. https://doi.org/10.1503/cmaj.181093 Lehti, V., Niemelä, S., Hoven, C. W., Mandell, D. J., & Sourander, A. (2009). Mental health, substance use and suicidal behaviour among young indigenous people in the Arctic: A systematic review. Social Science & Medicine , 69 (8), 1194–1203. https://doi.org/10.1016/j.socscimed.2009.07.045 Mertz, E., & Meilleur, D. (2023, July 11). ‘Our people will die’: Opioid crisis prompts state of emergency in Treaty 6 First Nations. Global News . https://globalnews.ca/news/9821613/opioid- crisis-state-of-emergency-treaty-6/ Public Safety Canada. (2021, September 13). Police violence and Indigenous peoples . https://www.publicsafety.gc.ca/cnt/trnsprnc/brfng-mtrls/prlmntry-bndrs/20200623/014/index- en.aspx Rowan, M., Poole, N., Shea, B., Gone, J. P., Mykota, D., Farag, M., Hopkins, C. A., Hall, L. J., Mushquash, C., & Dell, C. A. (2014). Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study. Substance Abuse Treatment Prevention and Policy , 9 (1). https://doi.org/10.1186/1747-597x-9-34

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13 Sittner, K. J., Whitbeck, L. B., & Prentice, P. (2012). Substance use disorders, comorbidity, and arrest among Indigenous adolescents. Crime & Delinquency , 61 (10), 1311–1332. https://doi.org/10.1177/0011128712466372 Smye, V., Browne, A. J., Josewski, V., Keith, B., & Mussell, W. (2023). Social suffering: Indigenous peoples’ experiences of accessing mental health and substance use services. International Journal of Environmental Research and Public Health , 20 (4), 3288. https://doi.org/10.3390/ijerph20043288 Toombs, E., Lund, J. I., Mushquash, A. R., & Mushquash, C. J. (2023). Intergenerational residential school attendance and increased substance use among First Nation adults living off- reserve: An analysis of the aboriginal peoples survey 2017. Frontiers in Public Health, 10, 1029139–1029139. https://doi.org/10.3389/fpubh.2022.1029139

Literature Review ADMH 2020

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