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Addiction response feeble

ALEC STRATFORD Alec Stratford is the executive director/registrar of the Nova Scotia College of Social Workers.

Brian Comer, the new minister of Mental Health and Addictions, has his work cut out for him.

He and his team need to work quickly to address the ailing mental health and substance-use systems in our province. While access to mental health services continues to be the political priority, we cannot diminish the importance of robust public policy and programming around issues of substance abuse, particularly as we emerge from the pandemic.

So, how can the new minister steer Nova Scotia’s substance-abuse policy and programs to better meet our province’s growing and complex needs?

As the Nova Scotia College of Social Workers’ paper Repositioning Social Work in Mental Health illuminated, substance-use policy and programming didn’t receive sufficient political attention under the previous government. Top-down decision-making, and a limited understanding of the devastating impact Nova Scotia’s tattered social safety net has on recovery resulted in policy and programming that sees substance use primarily a biological concern and negates the social and political impact on prevention and recovery.

Nova Scotia Health (NSH) has overly relied on at-home detox programs, which provide little social support for clients and caregivers, beyond medical needs. This may work for folks who have access to safe housing, social and family support, food security and transportation, but that isn’t everyone’s reality.

When deployed inappropriately, such programs can place a huge burden on families, compromise care quality and jeopardize recovery. While there has been some acknowledgement of the social impacts on recovery — reflected in last year’s provincial budget to tackle more social needs through the creation of community hubs — overall, the culture at NSH has resulted in devaluation of addiction-specific knowledge. This has produced an inadequate strategy for service provision, and subordinated addiction services to mental health services.

This culture at NSH has also led to the demise of crucial substance-abuse services. Of note is the loss of 24-7 detox beds and longer-term inpatient services, which have been closing across the province. Substance-abuse services are increasingly privatized, so only those who have resources can access them. This must end.

Nova Scotia’s Housing First programs haven’t expanded since 2015, when 50-60 spaces were funded. Opioid strategy has advanced somewhat, with more harm-reduction strategies coming online, but overdose prevention sites haven’t progressed quickly enough; tenders to expand beyond the one site in Halifax only went out in February 2021.

The federal government hasn’t moved nearly fast enough towards removing the unnecessary and harmful criminal justice approach to substance use.

During the recent federal election campaign, only the NDP and Greens were calling for decriminalization of possession of illicit drugs for personal use. Decriminalization was essential to Portugal’s success with decreasing drug-related overdoses per million citizens to less than a sixth of the European Union average.

Since the COVID-19 pandemic began, many people are reporting increased substance-use concerns. According to recent surveys conducted by Leger on behalf of the Canadian Centre on Substance Use and Addiction and the Mental Health Commission of Canada, these concerns are greater among females in households with young children under the age of 13.

In this survey, 37 per cent of female respondents indicated increased use of alcohol, 48 per cent reported an increase in cannabis use, and 18 per cent reported an increase in problematic/risky alcohol use. This compared to male respondents who reported a 26 per cent increase in alcohol use, 37 per cent increase in cannabis use and 28 per cent problematic/risky alcohol use.

Equally as concerning is the recent report by Child First Canada which states that children’s hospitals have reported unprecedented admissions for suicide attempts, eating disorders and substance-use disorders.

So, how can our new minister address these concerns?

He’ll need to challenge the dominance of the medical model and topdown approaches in substance-use policy and programming. Treating substance use as a disease has its place, but we cannot build all programming and policy through this lens. Standardized approaches to care will not and have not worked, and must be reshaped with the support of local decision-making guided by service users and providers in each community.

The minister needs to view substance-use care through a biopsycho-social lens and embrace strong intersectional thinking. This means ensuring strong connections between health and social care, such as the expansion of housing first and harm reduction programs with robust wraparound services.

The Managed Alcohol Program out of the North End Community Health Centre is a clear and shining example of a bio-psycho-social approach to substance use; it administers pre-set daily doses of liquor to clients, managing alcohol withdrawal like medicine, while social workers wrap support like housing and social support around clients.

Programs like this need to be scaled up in collaboration with community partners. Similar programs, coupled with a strong push to the federal government to decriminalize illicit drug possession, are integral to the robust substance-use strategy that we need in Nova Scotia.

The minister must also give priority to authentic community collaboration, particularly to address current anti-black and anti-indigenous racism and the enduring legacies of enslavement and residential schools. This means working closely with these communities, training and recruiting diverse practitioners, dismantling white supremacy in health and social care, and ensuring Black and Indigenous leadership within the health and social service sectors.

We also know that gender influences substance-use experiences. The minister must make sure that gender-specific services that address co-existing issues of mental health, substance use, and trauma are present and accessible across Nova Scotia.

Finally, the minister must focus on prevention, and work across silos to rebuild our social safety net. Child care, labour standards like paid sick days, low wages, precarious work, devastatingly low-income assistance rates, and viewing housing as a market commodity rather than a right — all must be addressed. Centering Nova Scotia’s social determinants of mental health will support a coherent and effective response to substance use.

Social workers are key to these solutions, and the new minister must employ their full scope of practice and utilize opportunities to link critical clinical practice with community-based work, advocacy, programming and policy. Unlocking this potential is key to developing the strategy, policies and programs we need to tackle rising substance-use issues.





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