Introduction
Drug addiction, especially substance abuse and alcoholism, has long plagued the Indigenous society in Canada (Cao, jr., & Liu, 2018). This problem was declared as the leading mental health problem among the Québec's natives in 2002, which has resulted in the suffering of the Aboriginal population living in deplorable conditions within and off the Canadian society reserves (Cao, jr., & Liu, 2018). More often, people with drug and substance addiction (PDDs) exhibit symptoms that affect the central nervous system. The effect leads to the addicted individuals experiencing tolerance, and in the absence of the substance, they display withdrawal symptoms (Bartlett, Brown, Shattell, Wright, & Lynne Lewallen, 2014). Despite the unique sets of the mental health challenges facing the Canadian natives, in a 2002/03 survey report, over 70% of these first nations adults (15 and older) living within or off the reserves felt in balance mentally, physically, emotionally, and spiritual (Khan, 2008). The survey report also found out that the Aboriginal people who had been diagnosed with a related mental health problem were much more likely – compared to the rest of the Canadian population – to seek professional help. About 17% of the indigenous population sort for professional advice compared to the 8% national average (Khan, 2008). Unfortunately, the dominating solo physician practice has been slowing things down in the treatment, intervention, and care management for this population. Thus, this paper endeavors to identify and explore a holistic metal health nursing approach to drug and substance abuse for the Aboriginal Canadian community.
The First Nation's loss of culture and language resulting from the oppression and colonization by Western dominance has led to an intergenerational shock that has been experienced by a vast majority of the native communities. Unfortunately, this contact has significantly influenced the wellbeing and health of the communities (MacMillan, MacMillan, Offord, & Dingle, 1996). The National Household Survey reported that the indigenous population as of 2016 was estimated at 1,400,685 (4.3% of the Canadian population) comprising of the Metis, Inuit, and the First Nations population (Cao, jr., & Liu, 2018). The continuous marginalization and discrimination of the Aboriginal population demonstrate the related sensation of recreation use and seeking easily accessible and affordable drugs and substance use for sedation, euphoria, hypnosis, and analgesia (Cao, jr., & Liu, 2018).
Substance use addiction and alcoholism, as mentioned early, has been considered the leading contributor to mental health issues among the Aboriginal population in Canada. Studies show that economic conditions, social factors such as unemployment, and population increase. According to Cao et al. (2018), fetal alcohol syndrome (FAS), was more prevalent among the native Canadians compared to non-natives children. A more substantial portion of the First Nations population reported of most substances including marijuana, lysergic acid diethylamide (LSD), hallucinogens and other solvents; besides, the use of inhaled toxicants was also considered a significant health issue among the Native population (Cao, jr., & Liu, 2018).
The increasing abuse of substance and alcohol consumption continues to pose numerous threats to the wellbeing of the Native community. For instance, suicide rates among the Aboriginals are three times higher than those of the non-natives. In a survey carried from 1986 to 1990 reported that 37 per 100,000 native youths died from suicide. Depression, other social and mental health problems, as well as crime, violence, separation, and financial disruption, are among the most common consequences of drug and substance abuse. It is thus very crucial for the health care provider to understand the impact as well as the connection between these health determiners and the need to develop a holistic approach to the Natives' health. While the primary contributors to substance addiction and alcoholism are social and economic factors, the First Nation population has also mainly been influenced by cultural-specific factors such as loss of language, racism, connectedness to their land, cultural diffusion, as well as residential school abuse (Sullivan, 2013). In regards to the above factors, the following nursing approaches have been identified as practical solutions for the Native population.
Harm Reduction approach
This nursing approach emphasizes on the compassionate care of persons with addiction. Addiction, in most cases, results in enhanced vulnerability by altering the normal functioning of the neural substrates that mediate a positive reinforcement (Imkome, 2018). Nurses and general health care professionals play a pivotal role in treating and caring for persons with addiction. By incorporating harm reduction and evidence-based approaches, yield a far much more excellent opportunity in the treatment and successful recovery from addiction (Bartlett, Brown, Shattell, Wright, & Lynne Lewallen, 2014). Thus, nurses and other caregivers interacting with the addicts need to show compassion and have a positive attitude towards their patients. It is also equally crucial for the nurses to promote the wellbeing of the patient by implementing a treatment plan that does not conflict with the addict's beliefs, customs, religion, or ethnicity. Under the Nursing code of conduct, the harm reduction approach emphasizes the nursing value and ethical responsibility (Canadian Nurses Association, 2017).
A vast majority of addiction cases are often emotional and uncomfortable subject for both the healthcare provider and the patient. The society and media also play a role in portraying individuals struggling with addiction as criminals, lazy, weak, morally corrupt, and in extreme cases unworthy (Bartlett, Brown, Shattell, Wright, & Lynne Lewallen, 2014). Stigmatization from society also makes nurses susceptible to the view. In this regard, therefore, the Canadian public health agencies developed a holistic nursing approach – the Honoring Our Strengths framework model (Sullivan, 2013), as demonstrated in the figure below – as a foundational approach required to achieve a holistic health and wellness for the Native Canadians, their families and the community as a whole. The model is founded on cultural, strength-based, and, more importantly, a holistic framework for the addicts' healthcare system.
Figure 1: Honoring Our Strengths framework model
Unlike western medicalization, holistic wellness aims to ensure that the holistic health of the addicts in terms of mental health, emotional stability, spiritual and physical balance. Thus, the nurse will require in invocate culture as the central component in this treatment approach. They were incorporating specific cultural elements for the First Nation population that address their cultural needs, spiritual, physical, and emotional needs and their interconnectedness with the mind, body, spirit, and emotions at the same time (Sullivan, 2013).
Incorporating this approach in a multidisciplinary environment in addressing substance abuse addiction and alcoholism, including drug prescription, education, treatment, and follow up interventions should be guided by:
A culturally competent approach. That is, nurses are obligated under the Nursing code of conduct and practice to be aware of their attitudes, perceptions, and beliefs towards cultural differences with the Native population culture (Canadian Nurses Association, 2017). Nurses are required to include both the knowledge of and openness to the cultural realities of the addicts, their families, and the environment. It is vital to note that a negative attitude of a healthcare provider is more likely to harm the care of the patient (JW, et al., 2012). The harm reduction approach advocates for a non-judgmental attitude on the part of the nurse and healthcare provider, especially when working with individuals whose beliefs and customs are deeply rooted in their culture, such as the aboriginals (Bartlett, Brown, Shattell, Wright, & Lynne Lewallen, 2014).
The second concept is a culturally safe approach by extending beyond the cultural sensitivity and awareness in healthcare provision (Sullivan, 2013). For the aboriginal population, their unique set of issues requires more attention to their historical, structural, and cultural differences and their power relationships within care and access to the services. By incorporating an exposure, therapeutic approach in nursing service delivery, diagnosis, treatment, and follow-up interventions should involve an ongoing and self-reflection and an organization's growth for the nurses and the complete healthcare system to respond to the needs of the aboriginal effectively (Sullivan, 2013).
Lastly, the harm reduction approach advocates for cultural relevance in a culturally relevant manner to ascertain any nursing actions is based on culture respect and acknowledges the diversity in communication, beliefs, and traditions of the aboriginals population. In such a healthcare setting, it is often challenging for nurses and other healthcare providers to work with nonprofessionals such as cultural practitioners like elders and priests. Also, the nurse needs to be aware of potential divisions that may arise from the differing knowledge, worldview, jurisdiction, funding, and policies with their professional standards and code of ethics with that of the indigenous governance and traditions. These challenges have to be, therefore, worked through mutually agreeable responsibilities, roles, objectives, and expected outcomes when designing a treatment framework (JW, et al., 2012).
Exposure Therapy Approach
Nurses and the general healthcare providers may also incorporate the exposure therapy technique at the preliminary stage of the therapeutic session. In many cases, this therapeutic approach s particularly essential in the diagnosing stage and also helps the healthcare provider assessing the best strategies and treatment plans to help the patient with an addiction disorder. The method is very useful in improving the patient's manage and 'face' the cause of addiction such as traumatic thoughts, violence, financial difficulty, loss of a loved one, and other social events that could have contributed to the disorder (Hamm et al., 2015). The exposure therapy technique is instrumental in helping patients control their anxiety caused by traumatic events and open up to the healthcare provider.
