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Can Fam Physician
Vol. 54, No. 7, July 2008, pp.1000 - 1000.e7
Copyright © 2008 by The College of Family Physicians of Canada
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Clinical Review

Healing the community to heal the individual

Literature review of aboriginal community-based alcohol and substance abuse programs

Ashifa Jiwa, MD CCFP
Family physician and addictions worker at St Michael’s Hospital in Toronto, Ont, and in a First Nations community in northwestern Ontario

Len Kelly, MD MClSc FCFP
Practising family physician and an Associate Professor of Family Medicine at the Northern Ontario School of Medicine and McMaster University in Sioux Lookout, Ont

St Natalie Pierre-Hansen
Research intern at the Northern Ontario School of Medicine and for FedNor in Sioux Lookout

Correspondence to: Dr Len Kelly, Box 489, 79 5th Ave, Sioux Lookout, ON P8T 1A8; telephone 807 737-3803; fax 807 737-1771; e-maillkelly{at}mcmaster.ca

OBJECTIVE To understand the development of culturally based and community-based alcohol and substance abuse treatment programs for aboriginal patients in an international context.

SOURCES OF INFORMATION MEDLINE, HealthSTAR, and PsycINFO databases and government documents were searched from 1975 to 2007. MeSH headings included the following: Indians, North American, Pacific ancestry group, aboriginal, substance-related disorders, alcoholism, addictive behaviour, community health service, and indigenous health. The search produced 150 articles, 34 of which were relevant; most of the literature comprised opinion pieces and program descriptions (level III evidence).

MAIN MESSAGE Substance abuse in some aboriginal communities is a complex problem requiring culturally appropriate, multidimensional approaches. One promising perspective supports community-based programs or community mobile treatment. These programs ideally cover prevention, harm reduction, treatment, and aftercare. They often eliminate the need for people to leave their remote communities. They become focuses of community development, as the communities become the treatment facilities. Success requires solutions developed within communities, strong community interest and engagement, leadership, and sustainable funding.

CONCLUSION Community-based addictions programs are appropriate alternatives to treatment at distant residential addictions facilities. The key components of success appear to be strong leadership in this area; strong community-member engagement; funding for programming and organizing; and the ability to develop infrastructure for long-term program sustainability. Programs require increased documentation of their inroads in this developing field.


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Diane Kelsall
CFP 2008 54: 963. [Full Text]  





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