Monthly Archives: September 2017

Alcohol or Drug Use During Pregnancy

mha

During pregnancy, everything you eat, drink, or take into your body affects you and your growing baby (fetus). Pregnant women often need to make changes to have a healthy pregnancy, such as eating better or exercising. But one of the most important things you can do when you are pregnant is to avoid alcohol and drugs.

Alcohol and drugs can cause problems for you during your pregnancy and when it is time for your baby to be born. They can also affect your baby both before and after he or she is born. They can:

  • Affect your baby’s size.
  • Affect how your baby’s heart, lungs, and brain work.
  • Cause lifelong learning, emotional, and physical problems for your child.

Using alcohol and illegal drugs is not safe for you or your baby.

If you use alcohol or drugs, the best time to stop is before you get pregnant. But sometimes pregnancy is unexpected. Since drugs and alcohol can harm your baby in the first weeks of pregnancy, the sooner you can stop, the better.

Even some over-the-counter and prescription medicines aren’t safe to take when you’re pregnant. Tell your doctor about all the drugs and supplements you take. He or she can help you decide what medicines are safe to take during pregnancy.

How do alcohol and drugs affect pregnancy?

Substance Possible effect on mother Possible effect on fetus, newborn, and child
Alcohol
Cocaine
Ecstasy
  • Effects not known
  • Long-term memory problems
  • Learning problems
Heroin
  • Seizures
  • Addiction, withdrawalsymptoms after birth
  • Breathing problems
  • Small size at birth
  • Physical and mental development problems
Inhalants
  • Life-threatening breathing problems
  • Convulsions or seizures
  • Coma
  • Low birth weight
  • Problems with how bones form
  • Learning problems
Marijuana
Methamphetamine
  • Low birth weight
  • Heart and lung problems
PCP/LSD
  • Confusion
  • Delusions
  • Hallucinations
  • Risk of overdose
  • Withdrawalsymptoms after birth
  • Learning problems
  • Emotional problems
  • Behaviour problems

Alcohol or drug misuse: How to stop

You may already know that alcohol and drugs can harm you and your baby. But it can still be hard to stop. Changing your behaviours isn’t easy. Some people need treatment to help them quit using drugs or alcohol. Here are some things you can do:

Take the first step. Admitting that you need help can be hard. You may feel ashamed or have doubts about whether you can quit. But your treatment can be successful only if you make the choice to stay sober. Remember that many people have struggled with these same feelings and have recovered from substance use problems. Quitting now will help you and your baby.

Tell someone. If you can’t stop drinking or using drugs on your own, tell someone that you need help. There are people and programs to help you. Your doctor is a good place to start. He or she can talk to you about treatment options. Your doctor may be able to give you medicines that can ease withdrawal symptoms. Or he or she may be able to find a hospital or clinic that you can go to for treatment.

You might also want to tell a friend or loved one. Having someone on your side that you know well, telling you that you can do this for yourself and your baby, is a very important part of recovery.

Make changes to your life. It can be hard to stop using alcohol or drugs when it has become a part of your life. You may need to make changes to your routine, like not being around certain people, or not going to places where you used to drink or use drugs. Ask friends and family to support your changes.

Consider counselling. Counselling helps you make changes in your life so you can stay sober. You learn to cope with tough emotions and make good choices. You may get counselling in a group or one-on-one.

Join a support group. Groups like Alcoholics Anonymous (AA) and Narcotics Anonymous were formed to help people who want to stop doing things that add no value to their lives. You may have more success quitting if you share your story, hear the stories of those who may be struggling and those who have successfully quit, and find someone to partner with.

Retrieved from: https://myhealth.alberta.ca/health/Pages/conditions.aspx?hwid=ae1198&#ae1199

Child Abuse Can Impair Brain Wiring

p0336c93For the first time, researchers have been able to see changes in the neural structures in specific areas of the brains of people who suffered severe abuse as children.

Difficulties associated with severe childhood abuse include increased risks of psychiatric disorders such as depression, as well as high levels of impulsivity, aggressivity, anxiety, more frequent substance abuse, and suicide. Severe, non-random physical and/or sexual child abuse affects between 5-15 % of all children under the age of 15 in the Western world.

Researchers from the McGill Group for Suicide Studies, based at the Douglas Mental Health University Institute and McGill University’s Department of Psychiatry, published research in the American Journal of Psychiatry that suggests that the long-lasting effects of traumatic childhood experiences, like severe abuse, may be due to an impaired structure and functioning of cells in the anterior cingulate cortex. This is a part of the brain which plays an important role in the regulation of emotions and mood. The researchers believe that these changes may contribute to the emergence of depressive disorders and suicidal behaviour.

Crucial insulation for nerve fibres builds up during first two decades of life

For the optimal function and organization of the brain, electrical signals used by neurons may need to travel over long distances to communicate with cells in other regions. The longer axons of this kind are generally covered by a fatty coating called myelin. Myelin sheaths protect the axons and help them to conduct electrical signals more efficiently. Myelin builds up progressively (in a process known as myelination) mainly during childhood, and then continue to mature until early adulthood.

Earlier studies had shown significant abnormalities in the white matter in the brains of people who had experienced child abuse. (White matter is mostly made up of billions of myelinated nerve fibres stacked together.) But, because these observations were made by looking at the brains of living people using MRI, it was impossible to gain a clear picture of the white matter cells and molecules that were affected.

To gain a clearer picture of the microscopic changes which occur in the brains of adults who have experienced child abuse, and thanks to the availability of brain samples from the Douglas-Bell Canada Brain Bank (where, as well as the brain matter itself there is a lot of information about the lives of their donors) the researchers were able to compare post-mortem brain samples from three different groups of adults: people who had committed suicide who suffered from depression and had a history of severe childhood abuse (27 individuals); people with depression who had committed suicide but who had no history of being abused as children (25 individuals); and brain tissue from a third group of people who had neither psychiatric illnesses nor a history of child abuse (26 people).

Image shows a preteen girl sitting next to a window.

Impaired neural connectivity may affect the regulation of emotions

The researchers discovered that the thickness of the myelin coating of a significant proportion of the nerve fibres was reduced ONLY in the brains of those who had suffered from child abuse. They also found underlying molecular alterations that selectively affect the cells that are responsible for myelin generation and maintenance. Finally, they found increases in the diameters of some of the largest axons among only this group and they speculate that together, these changes may alter functional coupling between the cingulate cortex and subcortical structures such as the amygdala and nucleus accumbens (areas of the brain linked respectively to emotional regulation and to reward and satisfaction) and contribute to altered emotional processing in people who have been abused during childhood.

The researchers conclude that adversity in early life may lastingly disrupt a range of neural functions in the anterior cingulate cortex. And while they don’t yet know where in the brain and when during development, and how, at a molecular level these effects are sufficient to have an impact on the regulation of emotions and attachment, they are now planning to explore this in further research.

Retrieved from: http://neurosciencenews.com/neural-connection-child-abuse-7572/ 

McGill University “Child Abuse Can Impair Brain Wiring.” NeuroscienceNews. NeuroscienceNews, 25 September 2017.
<http://neurosciencenews.com/neural-connection-child-abuse-7572/&gt;.

 

Violence, Trauma, and Substance Use

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Background on the Connections
I have come to believe that trauma is the problem, and substance use the solution . . . until the solution becomes the problem. 
~ Addictions counsellor

 

Evidence is building on the contribution of abuse and trauma to mental illness and substance use problems in women, and in turn, the benefits of trauma-informed approaches in reaching and assisting them. A recent Canadian study involving six women’s treatment centres from across Canada found that 90% (n=55/61) of the women interviewed reported childhood or adult abuse histories in relation to their problematic use of alcohol 1. In general it has been noted in the literature that as many as 2/3 of women with substance misuse problems report a concurrent mental health problem such as anxiety and depression, and they also commonly report surviving physical and sexual abuse either as children or adults 2.

The implications of these interconnections are significant and affect not only emotional health and well-being, but all areas of women’s lives including their physical health and mothering. Experiences of violence and trauma are linked to central nervous system changes, sleep disorders, cardiovascular problems, gastrointestinal and genito-urinary problems, as well as reproductive and sexual problems. A study of birth mothers of children with Fetal Alcohol Syndrome found that 100% had histories of serious sexual, physical and/or emotional abuse and 80% had a major unaddressed mental illness 3. Yet, surprisingly little attention has been given to the needs of mothers with co-occurring mental health disorders and trauma. The image below illustrates how trauma can be central to women’s experience of substance use, mental health problems and experience of ongoing violence.

  1. Brown, C. The pervasiveness of trauma among Canadian women in treatment for alcohol use. in Looking Back, Thinking Ahead: Using Research to Improve Policy and Practice in Women’s Health. 2009.
  2. Logan, T., et al., Victimization and substance abuse among women: Contributing factors, interventions and implications. Review of General Psychology, 2002. 6(4): p. 325-397.
  3. Astley, S.J., et al., Fetal Alcohol Syndrome (FAS) primary prevention through FAS Diagnosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol & Alcoholism, 2000. 35(5): p. 509-519.

 

For more information please visit: http://coalescing-vc.org/virtualLearning/section1/connecting-substance-use/ 

Guilt, shame and redemption: coping with Fetal Alcohol Spectrum Disorder

Annette and Daniel

Annette Cutknife holding her 13-month-old son Daniel in November 1989

The past

Annette Cutknife gave birth to her son Daniel on October 31, 1988. Right away, she knew her son was different.

“The moment he was born he did not make a sound. He didn’t even cry, he didn’t make a noise.”

Cutknife had been consuming alcohol consistently through her pregnancy. “There were no posters, there was no information really on the topic. And the myth that I had heard time and time again was that it was okay to drink after three months into pregnancy.”

As Daniel grew, it became harder and harder to pretend everything was normal. Once Daniel started going to school, Cutknife had to face the truth.

“I got confronted by his teacher. She just told me there’s something obviously wrong with him. She had a whole list of things, like cannot pay attention, cannot follow simple directions, cannot understand him when he speaks. And mainly taking off, sneaking off from the classroom…they would have to get a search party to look for him each and every time.”

For Cutknife, that moment of confrontation brought an avalanche of guilt to the surface.

“I was like, oh my god, I’ve been caught. I cannot lie. I gotta face up to it, I gotta suck it up.”

Daniel is one of approximately one percent of Canadians who have been diagnosed with Fetal Alcohol Spectrum Disorder (FASD). FASD covers a wide range of symptoms, including inconsistent memory and recall, decreased mental stamina, impulsivity and poor judgement, inability to predict outcomes.

In Daniel’s case, he was first diagnosed at the age of six as fetal alcohol exposed — a diagnosis on the less severe end of the spectrum.

“I was really rude and ignorant and I lied…and I told them I drank as little as possible, I maybe admitted to four or five times,” says Cutknife. “The pediatrician took me aside and told me point blank, ‘change your attitude’. He wasn’t rude or anything. He was quite nice. He said, ‘we’re here to help you and your son, we’re not here to judge you, so could you please cooperate’.” Cutknife says despite this, she lied to him about how much she had drunk during her pregnancy.

Cutknife herself struggled as a victim of sexual abuse, starting at the age of five and continuing into her teens. She didn’t talk about those issues until she was in her thirties and continued to struggle with alcohol dependence until Daniel was eight.

“Then I hit my bottom.”

She sought help from a medicine man in Saskatchewan in April 1996. “Three rounds of healing sweats, and but for the grace of god I haven’t had a drink since.”

Once he was 16, Daniel was reassessed and diagnosed with partial fetal alcohol syndrome with static encephalopathy, severe receptive and expressive language delay. During the reassessment, Cutknife provided accurate information about her drug and alcohol use during her pregnancy.

The present

Annette and her son Daniel
Annette Cutknife and her son Daniel in September 2013
Cutknife, now 55, lives south of Edmonton in Maskwacis, Alberta. She’s a FASD program coordinator for Samson Healthy Families, an organization that assists moms with prenatal care, particularly for those living what would be considered a high-risk lifestyle that includes alcohol and drug dependence. She helps those who were in her position every day. “It kind of saddens me that despite the amount of awareness we put out there, that it’s still happening.”

She’s also been speaking openly about her own story since 1998 at conferences, workshops, marches and other gatherings to educate people about FASD. In doing so, she’s had to face both positive and negative reactions. “I’ve actually had amazing reactions, saying I’m courageous and humble. I’ve only received two negatives and they’ve really, really…I felt them. One of them was in Winnipeg, someone in the audience indicated that I may have done it on purpose or something along that line.”

“So it’s gotten to the point now where when I receive a whole package of evaluations I don’t even look at them.”

Although she doesn’t drink anymore, Cutknife still grapples with the deep pain of knowing she exposed her son to alcohol prenatally. “Guilt, shame, self-hate, self-condemnation. I just hated myself to the core.”

“I keep hearing…you must forgive yourself, you must move forward, you must do this, you must do that, but honestly, people just don’t know what it’s like. I would say from time and time again I’ve assessed myself. There’s some days that I have good days, maybe 90 percent would be the tops of self-forgiveness. It’s never 100 percent.”

Cutknife says Daniel himself does not have a full understanding of his condition. “I think he’s slowly understanding, very slowly understanding, bit by bit. He understands that he can’t live alone, he can’t live on his own, he needs a lot of help and he’s just not like his friends are. He knows he’s different.”

Daniel is Cutknife’s only child. Now 25, he and his mother share a close relationship. He loves music, and recently took her to a Rod Stewart concert for her birthday.

“He’s in a concert phase right now,” says Cutknife.

Soon they’’ll be going to a Katy Perry concert — Daniel’s third. “We’ve gone to Vegas to see Katy Perry and Justin Timberlake,” says Cutknife. They’re thinking of going again in December to see Shania Twain.

Annette and Daniel’s photos on Facebook show a strong, loving connection. “I know for me, I’ve sacrificed my entire life making sure he’s well taken care of and that what I’ve done to him…I’ve ensured that I’ve corrected it as much as I could.”

And for other mothers of children with FASD or mothers-to-be, Cutknife has a message to share. “I would share my experience with my son that he was very medically fragile and I certainly wouldn’t want them to experience that, to feel what it’s like to see them suffer. We’re not here to judge you at all, we’re here to help you as much as possible to help yourselves.”

Retrieved from: http://www.camh.ca/en/hospital/about_camh/newsroom/CAMH_in_the_headlines/stories/Pages/Guilt-shame-and-redemption-coping-with-Fetal-Alcohol-Spectrum-Disorder.aspx#.WciV1pCMWJJ.facebook

28 days on the land: Is this the future of addictions treatment in Nunavut?

kathleen-hogaluk-and-eva-avadlukKathleen Hogaluk, left, and her mother, Cecilia, at the addictions treatment program in Cambridge Bay. (Kate Kyle/CBC)

Kathleen Hogaluk is nervous about what the next 28 days will bring.

The 36-year-old single mother of seven from Cambridge Bay, Nunavut, has struggled with alcohol on and off for years.

But it was after her eldest son died by suicide five months ago that her binge drinking accelerated.

“Sometimes I can go for weeks without eating and seeing my children,” said Hogaluk, weeping. Weekly counselling sessions weren’t enough, she said, and leaving her children to get treatment in the south wasn’t an option.

Now Hogaluk is getting help on her own terms: in her home community.

Cambridge Bay addictions camp

The mobile treatment program is held at a camp eight kilometres from Cambridge Bay. (Kate Kyle/CBC)

Mobile treatment

After nearly two decades without a residential addictions treatment facility in Nunavut, the community of Cambridge Bay has found its own culturally-tailored solution — a mobile treatment centre.

Hogaluk is one of 16 women taking part in a new program for women, run by the hamlet’s Wellness Centre. A session for men wrapped up earlier this summer.

There have been programs like this in the past, but this is the first to be entirely held on the land. It’s called a mobile treatment centre because the program can be held anywhere.

“I’m willing to do anything in my power to do a program like this,” said Hogaluk.

“I am ready to move forward with my addictions. I want healthy grieving and healing with the loss of my son.”

Cambridge Bay addictions treatment

Kathleen Hogaluk, far right, relaxes inside the main cabin at the mobile treatment centre. (Kate Kyle/CBC)

Travelling for treatment

Nunavut’s only residential addiction treatment facility in Apex, near Iqaluit, closed in 1998, after seven years in operation.

While many communities have counsellors and various healing programs both on and off the land — such as those run by the Ilisaqsivik Society in Clyde River — none of the on-the-land programs are specifically designed to target addictions treatment, according to the Nunavut government.

Most people who opt for a residential treatment experience are sent down south at a hefty financial cost to the government, and often a personal cost to those seeking treatment.

Families visit

Hogaluk with her son Robert. Participants don’t leave the camp but families are invited to visit. (Kate Kyle/CBC)

According to the government, 49 people were sent south for addictions treatment last year.

The Nunavut government has hired a consulting firm to study if the territory should open a trauma and addictions centre in Nunavut or deliver treatment in another way.

Janet Stafford, the director of community wellness for Cambridge Bay, says people in her community can’t wait for a report: they need help now.

Janet Stafford

Janet Stafford is director of community wellness for Cambridge Bay. (Kate Kyle/CBC)

“If we had to wait for a building — if that’s what research is looking at — we might be waiting for a long time,” said Stafford, who describes the need for addictions treatment as high in Cambridge Bay.

She says many people who take the step to get into a southern program often change their minds before completing the lengthy screening and assessment process.

“This is something that is doable,” said Stafford.

Addictions camp

The main cabin is a gathering place during the 28-day program. (Kate Kyle/CBC)

‘It’s the connections’

The camp is eight kilometres from Cambridge Bay on Victoria Island, within sight of the Arctic Ocean.

Clients stay in canvas tents overlooking a rocky beach and fish-drying racks. A two-bedroom cabin on the property has been converted into a healing retreat centre.

During the day, the focus is on clinical programming; the evening is all about cultural healing.

“It’s the connections,” said Stafford. “It’s connecting everyone to each other, to the land and to the community.” A connection, she says, that was missing from past programs.

Eva Avadluk

Elder Eva Avadluk, 67, works with program participants in Inuinnaqtun. (Kate Kyle/CBC)

Live-in Inuit guides set fish nets and take participants on hunts for eggs and geese.

Elders such as Eva Avadluk, 67, are on site to help in English and Inuinnaqtun, the regional Inuit language.

Avadluk recalls attending a very different rehab program in the 1990s.

“I had no choice but to speak English, because there was no one to speak Inuinnaqtun,” she said in her language. “But people have choices today, which is very nice and comfortable for them.”

Women set fish nets

Women set fish nets as part of Cambridge Bay’s addictions treatment program. (Kate Kyle/CBC)

And the program is already proving it can work. Three out of six men completed the summer program. The wellness centre considers a 50 per cent completion rate a “success.”

Nearly double the number of women have signed up for the fall session.

The Wellness Centre is looking at opening up the program and tailoring it for other Kitikmeot communities next year, including youth.

Kathleen Hogaluk

‘I know my kids will be happier to see me sober, and I’ll be happier as well,’ says Kathleen Hogaluk. (Kate Kyle/CBC)

Hogaluk knows the program is just the beginning of her healing journey. “I know my kids will be happier to see me sober, and I’ll be happier as well.

“To see my kids sober, that’s the greatest feeling. When I am sober on weekends I say to my mom, ‘I finally get to see the weekend with my kids.”

By Kate Kyle, CBC News

Retrieved from: http://www.cbc.ca/news/canada/north/cambridge-bay-mobile-addictions-treatment-1.4292309

No, Scientists Didn’t Say Drinking Alcohol While Pregnant Is Okay

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There were quite a few headlines making the rounds last week that light drinking during pregnancy “might be okay”. This was apparently based on a recent study.

There’s just one problem – the study most definitely did not say this. Instead, it pointed out how little information we have on the effects of drinking alcohol during pregnancy.

The paper, led by the University of Bristol in the UK, was published in the journal BMJ Open. Looking for data on the issue the researchers found just 24 studies. Although unable to make any full conclusions, the study noted that the effects of drinking a small amount of alcohol during pregnancy “is sparse”. This was apparently enough for some outlets to run with the headline that drinking whilst being pregnant is okay.

It’s even more bizarre given that the literal next sentence of the study recommends not drinking as the best course of action.

“As there was some evidence that even light prenatal alcohol consumption is associated with being SGA [small for gestational age] and preterm delivery, guidance could advise abstention as a precautionary principle but should explain the paucity of evidence,” the authors wrote.

We already know that excessive drinking can be incredibly harmful to an unborn baby. As noted by Popular Science, the problem at the moment is that “we don’t know where the line is”. But we can’t exactly give pregnant mothers alcohol to find out, hence the lack of available data.

“This science paper was not meant for you – it was a call to researchers that this is something that needs further studying,” added Gizmodo.

Abstention is obviously the safest route, but a lot of people do drink while pregnant. One study found that more than 10 percent of pregnant women in the US drink, with a third of those binge drinking (four drinks or more on one occasion). In the UK, the number is as high as 40 percent.

Finding out what effects drinking alcohol has on an unborn baby would be pretty useful so we can supply some solid data on the subject. The NHS in the UK said “the safest approach is not to drink at all while you’re expecting” as the jury is still out.

On issues like this, it’s probably best to trust medical advice, rather than tabloid newspapers. The effects of alcohol on an unborn baby may well be less than we thought, but they could just as well be worse, too. For the sake of a human that has no choice in the matter, it’s probably best to lay off the drink during pregnancy until we know more.

Retrieved from: http://www.iflscience.com/health-and-medicine/no-scientists-didnt-say-drinking-alcohol-while-pregnant-is-okay/

New Infographic for FASD Awareness Day – Prevention means supporting pregnant women

canfasd

For International FASD Awareness Day on September 9th, the CanFASD Research Network, through its Prevention Network Action Team (pNAT) and the Centre of Excellence for Women’s Health, developed this infographic on what we know about alcohol use and preventing FASD. You can download a PDF version here.

CanFASD focuses on all aspects of FASD that impact women, individuals, caregivers, and service providers through its network action teams, each with a different focus – prevention, intervention, research, and policy and service providers. These teams aim to put forth knowledge in a way that is useful to communities and organizations in Canada in developing effective programs and policies.

You can search hashtags #FASDay2017 #CanFASD on Twitter to see examples of what others in Canada, or visit some of our pNAT partners.

 

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