Colleen Anne Dell

Classification of abused inhalants

Many hundreds of household and industrial products can be volatilized readily and are subject to abuse. Inhalant abuse research has been hampered by a lack of consensus on whether or not there are subclassifications of abused inhalants based on chemical structure, form or intended use of the product or pharmacological properties. This paper discusses strengths and weaknesses of various approaches to classification of inhalants and suggests areas for future research in this area. It is concluded that classification of inhalants by form or product types is not useful for scientific purposes; rather, subclassification of inhalants should be based on a yet-to-be-determined combination of chemical and pharmacological similarity and shared patterns of abuse. One of the ways in which we can improve our understanding of inhalant abuse is to obtain more detailed information on individual products and chemicals, their patterns of use and the geographical distribution of their use.

Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study

BackgroundCultural interventions offer the hope and promise of healing from addictions for Indigenous people.a However, there are few published studies specifically examining the type and impact of these interventions. Positioned within the Honouring Our Strengths: Culture as Intervention project, a scoping study was conducted to describe what is known about the characteristics of culture-based programs and to examine the outcomes collected and effects of these interventions on wellness.MethodsThis review followed established methods for scoping studies, including a final stage of consultation with stakeholders. The data search and extraction were also guided by the “PICO” (Patient/population, Intervention, Comparison, and Outcome) method, for which we defined each element, but did not require direct comparisons between treatment and control groups. Twelve databases from the scientific literature and 13 databases from the grey literature were searched up to October 26, 2012.ResultsThe search strategy yielded 4,518 articles. Nineteen studies were included from the United States (58%) and Canada (42%), that involved residential programs (58%), and all (100%) integrated Western and culture-based treatment services. Seventeen types of cultural interventions were found, with sweat lodge ceremonies the most commonly (68%) enacted. Study samples ranged from 11 to 2,685 clients. Just over half of studies involved quasi-experimental designs (53%). Most articles (90%) measured physical wellness, with fewer (37%) examining spiritual health. Results show benefits in all areas of wellness, particularly by reducing or eliminating substance use problems in 74% of studies.ConclusionsEvidence from this scoping study suggests that the culture-based interventions used in addictions treatment for Indigenous people are beneficial to help improve client functioning in all areas of wellness. There is a need for well-designed studies to address the question of best relational or contextual fit of cultural practices given a particular place, time, and population group. Addiction researchers and treatment providers are encouraged to work together to make further inroads into expanding the study of culture-based interventions from multiple perspectives and locations.

From benzos to berries: treatment offered at an Aboriginal youth solvent abuse treatment centre relays the importance of culture.

First Nations and Inuit youth who abuse solvents are one of the most highly stigmatized substance-abusing groups in Canada. Drawing on a residential treatment response that is grounded in a culture-based model of resiliency, this article discusses the cultural implications for psychiatrys individualized approach to treating mental disorders. A systematic review of articles published in The Canadian Journal of Psychiatry during the past decade, augmented with a review of Canadian and international literature, revealed a gap in understanding and practice between Western psychiatric disorder–based and Aboriginal culture–based approaches to treatment and healing from substance abuse and mental disorders. Differing conceptualizations of mental health and substance abuse are discussed from Western psychiatric and Aboriginal worldviews, with a focus on connection to self, community, and political context. Applying an Aboriginal method of knowledge translation—storytelling—experiences from front-line workers in a youth solvent abuse treatment centre relay the difficulties with applying Western responses to Aboriginal healing. This lends to a discussion of how psychiatry can capitalize on the growing debate regarding the role of culture in the treatment of Aboriginal youth who abuse solvents. There is significant need for culturally competent psychiatric research specific to diagnosing and treating First Nations and Inuit youth who abuse substances, including solvents. Such understanding for front-line psychiatrists is necessary to improve practice. A health promotion perspective may be a valuable beginning point for attaining this understanding, as it situates psychiatrys approach to treating mental disorders within the etiology for Aboriginal Peoples.

Global Issues in Volatile Substance Misuse

This special issue of Substance Use & Misuse addresses the public health issue of volatile substance misuse (VSM), the inhalation of gases or vapors for psychoactive effects, assessing the similarities and differences in the products misused, patterns, prevalence, etiologies, and impacts of VSM by examining it through sociocultural epidemiology, neuroscience, and interventions research. The Canadian, US, and Australian guest editors contend that, when compared with other drugs used at a similar prevalence, VSM has attracted relatively little research effort. The authors and editors call for further research to develop evidence-based policies and comprehensive interventions that respect culture and context-specific knowledge.

Looking Back 10 Years After the Arbour Inquiry Ideology, Policy, Practice, and the Federal Female Prisoner

The decade of the 1990s can be marked as one of major dissension, conflict, and change within federal corrections for women in Canada. In this article, the authors reflect back on this period of time by examining the correctional ideologies, policies, and practices that were operating in the Canadian federal prison for women. Finding these policies and practices to be inherently gendered and punitive in nature, it is argued that punishment was at the time and continues to be the cornerstone of the regulation of women prisoners, and that it takes a specific, gendered form that relies on the deployment of traditional patriarchal conceptions of femininity. Drawing on interviews with correctional personnel and analyses of correctional policies and the Arbour Inquiry transcripts, this article reconstructs Correctional Service of Canada’s (CSC) responses to incarcerated women’s “unfeminine” behavior, specifically women’s self-harming behavior and their violence against others, as overly disciplinary. It is proposed that CSC’s ideological foundation, as well as the practices and policies that were operating both at the time of and following the incident at the Kingston Prison for Women that resulted in the Arbour Inquiry, remain deeply entrenched in an oppressive hierarchical structure of gender inequality. This structure fails to question how traditional conceptions of femininity shape policies and practices. It has also aided in the construction of a new genre of “misbehaved” women in corrections, which in turn has been used to justify the harsh regulatory treatment of federally sentenced women. Without challenging its traditional gender ideologies, CSC is unable to offer any alternatives to its punitive practices, which continue to operate.

Research as Cultural Renewal: Applying Two-Eyed Seeing in a Research Project about Cultural Interventions in First Nations Addictions Treatment.

This article explores the application of two-eyed seeing in the first year of a three-year study about the effectiveness of cultural interventions in First Nations alcohol and drug treatment in Canada. Two-eyed seeing is recognized by Canada’s major health research funder as a starting point for bringing together the strengths of Indigenous and Western ways of knowing. With the aim of developing a culture-based measurement tool, our team carried out an Indigenous-centred research process with our interpretation of two-eyed seeing as a guiding principle. This enabled us to engage in a decolonizing project that prioritized Indigenous methodologies and ways of knowing and knowledge alongside those of Western science. By concentrating on Indigenous governance in the research process, our project supported efforts at Indigenous cultural renewal. Two illustrations are offered, our team’s reconceptualization of Western derived understandings of data collection through Indigenous storytelling and our research grant timeframe with Indigenous knowledge gardening. This article contributes to the Indigenous research and policy literature which is lacking documentation about how Indigenous communities and research teams are benefitting from two-eyed seeing.

Qualitative investigation of barriers to accessing care by people who inject drugs in Saskatoon, Canada: perspectives of service providers.

BackgroundPeople who inject drugs (PWID) often encounter barriers when attempting to access health care and social services. In our previous study conducted to identify barriers to accessing care from the perspective of PWIDs in Saskatoon, Canada: poverty, lack of personal support, discrimination, and poor knowledge and coordination of service providers among other key barriers were identified. The purpose of the present investigation was to explore what service providers perceive to be the greatest barriers for PWIDs to receive optimal care. This study is an exploratory investigation with a purpose to enrich the literature and to guide community action.MethodsData were collected through focus groups with service providers in Saskatoon. Four focus groups were held with a total of 27 service providers. Data were transcribed and qualitative analysis was performed. As a result, concepts were identified and combined into major themes.ResultsFour barriers to care were identified by service providers: inefficient use of resources, stigma and discrimination, inadequate education and the unique and demanding nature of PWIDs. Participants also identified many successful services.ConclusionThe results from this investigation suggest poor utilization of resources, lack of continuing education of health care providers on addictions and coping skills with such demanding population, and social stigma and disparity. We recommend improvements in resource utilization through, for example, case management. In addition, sensitivity training and more comprehensive service centers designed to meet PWID’s complex needs may improve care. However, community-wide commitment to addressing injection drug issues will also be required for lasting solutions.

Qualitative assessment of crisis services among persons using injection drugs in the city of Saskatoon

Objectives: Injection drug users (IDUs) are a population that exhibit poor utilization of health services, despite having a greater need for health care than people who do not use drugs. Although several studies have reported reasons for poor utilization, these investigations are usually carried out in large urban centres or outside of Canada. The purpose of this investigation is to examine barriers to accessing care for IDUs in the small urban centre of Saskatoon, Canada. Methods: Data were collected through group discussions and interviews with IDUs in Saskatoon. Two group discussions were held with a total of 13 adults, and 12 youth IDUs were individually interviewed. Qualitative content analysis was performed to determine major themes. Results: Five barriers to care were identified by participants: poor communication with health services; lack of system resources and restrictive policies; insufficient financial resources; discrimination and stigmatization; and social support. Conversely, there were many services that participants found helpful during times of crisis. Conclusion: Many barriers to service access were identified by IDUs. In order to achieve a more complete understanding of access to services in Saskatoon, views of health service providers will be examined in the future.

The creation of the expected Aboriginal woman drug offender in Canada: Exploring relations between victimization, punishment, and cultural identity

This article illustrates how the Aboriginal female drug user is responded to as an expected offender based on the intersection of her gender, race, and class. Drawing on the findings of a national Canadian study documenting the lived experiences of First Nations, Métis, and Inuit female drug users, we argue that the strengthening of cultural identity can potentially disrupt this expected status at both the individual and social system levels. Within the framework of critical victimology, the challenge then becomes to translate this understanding into praxis. In response, we suggest advancing women’s agency at the individual level in the face of disempowering images and practices related to the offender, the victim, and Aboriginality. For change at the system level, we return to Christie’s notion of the need to dismantle the stereotypical construction of the Aboriginal female drug user. We illustrate both levels of change with an innovative form of knowledge sharing, which aims to evoke transformation with respect to individual and socially constructed conceptualizations of identity.

Outcome assessment of a triangular clinic as a harm reduction intervention in Rajaee-Shahr Prison, Iran

BackgroundTransmission of the human immunodeficiency virus (HIV) among incarcerated injection drug users (IDU) is a health epidemic in the Islamic Republic of Iran. Triangular clinics (TCs) were established in prisons as a harm reduction measure to decrease the risk of HIV transmission and other blood-borne infections. The objective of this study was to assess the immediate outcomes of one TC among male IDUs in Iran’s Rajaee-Shahr prison.MethodsThis study was conducted in two stages between 2003 and 2005. In the preparatory stage, focus group data was collected to update the prison’s TC education and medical interventions and construct the self-report questionnaire. In stage two, 150 male IDUs were recruited in a closed cohort study design to assess the immediate outcome of the TC. Participants were measured at baseline and followed up to six months to measure their drug use, attitude toward and knowledge of high risk behaviours, serological conversion for HIV, HBV and HCV, and engagement in risky behaviors. The TC outcomes were determined through random urine analysis testing, a self-administered questionnaire and behaviour report cards, and viral infection testing.ResultsThe findings of the urine analyses indicated a minimal yet consistent decrease in drug use over the six months. The pre and post- self-administered questionnaire data relayed a modest change in IDU risky behaviours associated with sexual practices; this was greater in comparison to the knowledge and attitude measures. It was determined that age may have a detrimental effect as may viral infections (HIV and HBV) on knowledge, attitude and behavior change. Both education and employment may have a protective effect. Data collected from the self-report behaviour cards similarly showed a modest reduction in high risk practices. At the six month follow-up, only one case became HIV positive, 9 HCV and 17 HBV.ConclusionsConsidering that HIV is concentrated among Iranian prisoners who inject drugs at a high level, the results of this study indicate that TCs are a possible effective intervention. However, many prisoners continued with risky behaviors even if they were participating in harm reduction measures, such as methadone maintenance therapy.