This year, FNHA is joining the Canadian Centre on Substance Abuse in observing National Addictions Awareness Week (NAAW). NAAW highlights issues and solutions to help address alcohol and other subtance-related harm. It provides an opportunity for us to learn more about substance abuse prevention, talk about treatment and recovery and bring forward solutions for change.

In recognizing NAAW we would like to share an article on behalf of FNHA's Chief Medical Officer Dr. Evan Adams on Trauma-Informed Approaches for Substance-Use Treatment.

Trauma-informed practice (TIP) is a holistic approach that substance-use treatment providers have developed and are using with many First Nations clients. TIP begins from a place of understanding that First Nations people are overrepresented among those who have experienced psychological trauma, and this is considered in all aspects of policy, planning and service delivery. 

Attempts are made to ensure clients feel safe, have a feeling of control over their own treatment and are included in their care and treatment choices. A trauma-informed practice approach not only benefits people who have lived through trauma, but is also an excellent approach for all clients—as we never know who has experienced trauma. Cultural safety, the work of addressing historical and ongoing power imbalances in clinical encounters through self-reflection, policy and practice change, aligns with a trauma-informed practice approach. 

Psychological trauma is defined as “damage to the psyche that occurs as a result of severely distressing experiences that overwhelm a person’s ability to cope.” Many First Nations peoples have experienced trauma as a result of colonization, residential schools, racism and loss of lands and resources due to the reserve system and discriminatory legislation. Understandably, the grief and anger associated with these traumatic experiences is often passed down from grandparents to parents and on to children. 

The grief or depression of close loved ones deeply affects other family members in myriad ways, even when it is not directly passed down in an obvious way. Using and misusing substances such as alcohol and other drugs are ways some individuals attempt to cope with these painful, overwhelming feelings. TIP does not judge people for using substances to cope with trauma; rather, a trauma-informed approach meets people where they are at, takes a harm-reduction approach, encourages help-seeking to address trauma and supports the development of healthy coping skills to manage or reduce use.

In a TIP, substance-use professionals approach each individual encounter with the awareness that clients may have experienced trauma, that trauma may underlie how individuals interact with health care providers, and that this trauma may affect their behaviours around substance use and abuse. Using a TIP approach, providers may realize that behaviours they previously categorized as “non-compliant,” “aggressive” or “disruptive” were in fact responses that individuals developed to cope with trauma. This understanding changes how providers support clients on their wellness journeys towards healing and recovery, as it makes it easier to build trusting relationships and foster confidence.

TIP doesn’t treat trauma directly but addresses the need for healing from trauma and aims to heal the mind, body, spirit and emotions. This holistic perspective means that it can be a valuable tool when working with First Nations clients who are challenged with substance-use issues. TIP can help individuals understand that their responses to their experiences of trauma are not personal failures, but responses to systemic factors such as colonization that are overwhelming their ability to cope with trauma-related stress in healthy ways. Substance-use treatment providers do this by helping clients see the connections between their experiences of trauma and their choices of coping responses.

The FNHA recognizes that it needs to support First Nations communities in BC to treat mental illness and substance-use challenges in a trauma-informed, holistic way. One FNHA initiative that applies TIP is the Safe Relationships, Safe Children program, which is being delivered in partnership with the Ministry of Health and the First Nations Health Directors Association. The child welfare system has a legacy of colonization and is a long-standing source of trauma for both children and families. The program involves training and practice support for front-line providers working with families experiencing mental illness, substance use and/or intimate partner violence. 

By understanding the role of trauma in the lives of First Nations peoples, substance-use treatment providers can help clients feel empowered to make healthy choices to deal with stress in their lives. TIP can’t change the past, but it can support First Nations people to build a healthier future for the generations to come.

Be healthy and well,

Dr. Evan Adams
Chief Medical Officer, FNHA