HEALTH REPORT: Concurrent mental and substance use disorders in Canada

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Individuals who have both a mental and substance use disorder at the same time are more likely to experience poor psychological health, use more health services and report unmet needs than a person with only one type of disorder.

These findings are from a new study on the prevalence of concurrent disorders in Canada, released in today’s Health Reports. The study is the first to use the 2012 Canadian Community Health Survey—Mental Health to examine the demographic and socioeconomic characteristics, health status and health care service use of people with concurrent disorders. The study estimates that 282,000, or 1.2% of Canadians aged 15 to 64, experienced mental and substance use disorders concurrently in the previous year, that is, at least one mood/anxiety disorder and at least one substance use disorder.

Almost all (91%) of those with concurrent disorders reported high psychological distress, significantly more than those with a mood/anxiety (79%) or a substance use (34%) disorder alone.

Overall, individuals with concurrent disorders were more likely (76%) to use health services, such as care for mental health or substance use, compared with those who had a mood/anxiety (67%) or substance use (21%) disorder alone. Despite higher use, these individuals had greater odds of reporting unmet or partially met needs for mental health care after controlling for demographic and socio-economic factors and number of chronic conditions.

For more information please visit:

“Concurrent mental and substance use disorders in Canada” is now available in the August 2017 online issue of Health Reports, Vol. 28, no. 8 (Catalogue number82-003-X).

This issue of Health Reports also contains the article, “Needs for mobility devices, home modifications and personal assistance among Canadians with disabilities.”

Fathers and alcohol consumption during pregnancy

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Alcohol consumption during preconception and pregnancy is generally considered to be the prospective mother’s responsibility, with many current international alcohol policy guidelines recommending the reduction or non-use of alcohol by pregnant women. However, research suggests that decisions about alcohol use can often be influenced by others, in particular the prospective father.

The National Drug Research Institute did research on the father’s involvement in alcohol exposed pregnancies. This study was initiated due to factors such as; the Australian Alcohol Guidelines, and ‘mothers guilt’. Interestingly, over the past decade the guidelines have changed the recommendations for women’s alcohol consumption during pregnancy from 2 standard drinks per day to no consumption being the safest option. The responsibility has been solely pressed on women and have not focused heavily enough on the social determinants that support the consumption of alcohol during pregnancy.

The findings of the research identified that 75% of women who do drink during pregnancy are consuming alcohol together with a partner. Of these women, 40% of drinking episodes are initiated by male partners. The fact that male partners are social facilitators of alcohol consumption nearly half the time is concerning.

The key message this research is trying to convey is that decisions about alcohol use during preconception and pregnancy are not the sole responsibility of women but occur within the context of the home and the broader social environment. More complex policy is required to assist in reducing alcohol-exposed pregnancies and increasing the potential for healthy pregnancies, and fetal and infant outcomes.

Retrieved from: http://actonalcohol.org.au/fathers-and-alcohol/

FASD Justice and Reconciliation: Tough Questions, New Collaborations

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Final Report- FASD Justice & Reconciliation (final 07-17)

Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term used to describe a spectrum of physical, neurological, cognitive, socio-emotional, and behavioural impairments that may result from prenatal exposure to alcohol. In addition to these impairments, secondary challenges (such as involvement with the criminal justice system) may be experienced in the absence of appropriate supports and services. FASD is often discussed in the context of the criminal justice system, as individuals with FASD are understood to be overrepresented in the justice system.

In 2015, the Truth and Reconciliation Commission of Canada released 94 Calls to Action, directed at various levels of government and to all Canadians. TRC Calls to Action 33 and 34 specifically address FASD. The Calls to Action provided an opportunity to bring together policy makers, front-line workers, parents/caregivers, and students to discuss how the TRC can be considered in justice practices. The Symposium took a holistic look at how justice programs at the local and national level may incorporate culturally-appropriate programming. This included discussions on how individuals and families can be best supported in the community and, when necessary, in the justice system.

Moreover, the Symposium drew attention to the need for programs that are attentive to the broader contexts that impact Indigenous peoples with FASD, particularly when in contact with the justice system. Indigenous voices and programs were at the centre of the discussion. Justice programs that have solidly incorporated Indigenous perspectives were also explored—from smaller community-based projects to larger programs embedded in province-wide judicial initiatives. The goal was for participants to be exposed to programs from across Canada, to gain a broader understanding of the complexity of issues when discussing FASD in the justice system and to be introduced to new tools and networks to respond to the TRC Calls to Action.

The Symposium featured six presenters who led an exploration of how justice system programming supports people with FASD, focusing on the experiences of Indigenous individuals. This included the perspectives of parents, front-line community workers, and diagnosticians. Participants engaged in discussions focused on current practices, future directions, and the path forward. From the feedback collected throughout the event, Dr. Stewart’s research team has produced 6 key findings and 18 recommendations for moving forward.

Key Findings and Recommendations

1 Culturally and Historically-Informed Practices

Participants noted that there is often a lack of culturally and historically-informed programming for individuals with FASD across systems.

Recommendation 1: Develop relationships between agencies and Indigenous communities.

Recommendation 2: Develop training focused on the TRC and the history of residential schools and colonialism in Canada for agencies.

Recommendation 3: Explore the potential for culturally and historically-informed practices within the health system.

2 Trauma

Participants recognized the role of trauma in the lived-experience of individuals with FASD, particularly in relation to the potential for re-traumatization within the justice system.

Recommendation 4: Develop and distribute training on trauma-informed practices.

Recommendation 5: Establish the capacity for trauma to be incorporated as a mitigating factor in sentencing.

Recommendation 6: Develop outreach and training material for frontline health professionals about practices surrounding diagnosis and care.

3 Advocacy

Participants discussed the ways in which individuals with FASD, families, and support agencies can advocate for greater awareness of FASD and confront the stigma surrounding FASD.

Recommendation 7: Facilitate collaborative spaces that are inclusive and welcoming of candid discussions.

Recommendation 8: Create spaces for individuals with FASD and caregivers to engage directly with policy-makers and program managers.

Recommendation 9: Facilitate spaces for individuals with FASD and families to access training.

Recommendation 10: Implement and integrate changes to programs and practices that honour Indigenous perspectives.

Recommendation 11: Establish keeping families together as a top priority informed by Indigenous perspectives.

4 Resources

Participants expressed that, while some jurisdictions have demonstrated success in establishing supports for individuals with FASD and their families, there are substantial gaps in services particularly in rural or remote communities.

Recommendation 12: Identify wise practices that best support individuals with FASD across the lifespan informed by Indigenous perspectives.

Recommendation 13: Prioritize community driven requests for supports and services with an emphasis on sustained funding.

Recommendation 14: Fund culturally appropriate diagnoses, mentorship, and respite for families, lifeskills and mentoring for individuals, and ongoing support that changes across the lifespan.

5 Interagency Collaboration

Participants noted that a primary challenge to the provision of appropriate supports and services to individuals with FASD is the “silo effect” (agencies working in isolation) which prohibits effective collaboration.

Recommendation 15: Facilitate regular opportunities for interdisciplinary teams to come together to share resources.

Recommendation 16: Strike working groups comprised of federal, provincial/territorial stakeholders, and policy-makers in collaboration with Indigenous communities to implement TRC Calls 33 and 34.

6 Challenging Systems and Policy

Participants noted many barriers to individuals with FASD accessing services, including the need for maternal confirmation and justice-specific concerns (such as conditions of release and use of legal jargon).

Recommendation 17: Complete a program and policy review through a TRC lens to make appropriate modifications to programs, practices, and protocols.

Recommendation 18: Undertake a review of culturally modified/culturally appropriate diagnostic practices to modify or enhance current diagnostic practices.

FASD, JUSTICE & RECONCILIATION: TOUGH QUESTIONS, NEW COLLABORATIONS n FEBRUARY 22 & 23, 2017 n EXECUTIVE SUMMARY

 

 

Mothers advocating for drug addiction awareness

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Airdrie mother Shawna Taylor (right) is bringing public awareness to the effect drug addiction has on families by talking openly about her 19-year-old daughter Kenedee’s (left) struggle with fentanyl addiction.
Submitted/For Rocky View Publishing

Two local mothers are bringing awareness to the rippling effect drugs leave on families by sharing the stories of their own children enveloped in the throes of addiction.

Opening a public discussion about drug addiction is how mothers Shawna Taylor of Airdrie and Christina Sackett of Crossfield first connected.

“There are so many families being affected,” Taylor said. “I think the stigma is so incredible that people are embarrassed to come forward. It took us a long time.”

Taylor has been married to her husband Jeff for 23 years and said the two raised their daughter, Kenedee, and son, Nathan, to respect curfews and stay away from drugs.

“I was super naïve,” she said. “I thought because I told them that, and they listened to me for almost everything else, that they wouldn’t try anything.”

In May 2015, however, Taylor said she began noticing changes in her 17-year-old daughter. She was out a lot, falling asleep often, but Taylor thought it had to do with getting a new boyfriend and stressing about graduation.

Kenedee became noticeably thinner and began distancing herself from the family, spending a lot of time in her bedroom, Taylor said.

“She just kept blaming everything on depression,” she said.

Suspecting drugs, Taylor said she took her daughter to the family doctor a few times but was told it was probably just “teenage angst.” The truth, however, wouldn’t be known until May 25, 2016. While waiting for the results of a urine test at Rockyview General Hospital, Taylor said her daughter looked to her from her hospital bed and finally said, “They’re going to find something. They’re going to find fentanyl.”

“There’s a point in your life where it will never be the same,” she said. “That was the point for us.”

For Sackett, there was no suspicion her 15-year-old son, Myles Card, was using drugs before she found evidence of opioids in his room. Myles struggled with mental health issues and Sackett said the family was so focused on getting him help for that, they had not realized he already started to self-medicate.

Soon after, Sackett said her son’s demeanour changed as the addiction worsened.

“It was horrible,” she said. “Like most parents, I didn’t know a lot about drugs or any of that kind of stuff. The more I reached out for help, the more I got turned away.”

Her son’s drug addiction was “played down” by numerous medical professionals, Sackett said. This included doctors telling her opioids were difficult for adults to get so there was no way her son could be doing that type of drug. Sackett also claimed a mental health worker helping Myles dismissed needles she found in his room as merely a means to kill himself instead of being linked to drugs.

“Myles was a kid who came across as very polite and very well mannered,” she said. “He’s not what a stereotype of a ‘junkie’ would look like.

“(His addiction) got ignored for so long until it was so bad that he was basically on death’s doorstep.”

The Taylors experienced a similar disconnection from help.

Kenedee was released from hospital only one day after discovering she was addicted to fentanyl because the doctors claimed the withdrawal wouldn’t kill her, Taylor said.

“I don’t know much about addiction,” she said. “I thought, now that we know, she’ll just stop doing it. I was still in denial.”

Kenedee tried to confront her addiction through the Calgary-based Aventa Centre of Excellence for Women with Addictions. By the start of 2017, however, Taylor said her daughter began using again.

On the night of Jan. 14, Kenedee began what Taylor feared was an overdose.

Taking her daughter to Airdrie Urgent Care, Taylor said she experienced a less than helpful interaction that caused her to drive Kenedee to the Peter Lougheed Centre in Calgary herself.

After seeing her daughter need two doses of naloxone to stabilize and a third four hours later made her realize she should have called an ambulance in Airdrie. Aventa then informed the Taylors of a treatment using the opioid suboxone to treat opioid addiction. Taylor said her daughter has since gone through three months of treatment and has applied to move into the second stage of recovery.

“When you’re in the throes of addiction, you barely get through 24 hours,” Taylor said. “I’m looking to the future and so is she (but) I don’t go too far. I’m just glad that my child is alive today.”

The stories of families struggling with addiction, however, do not always end on a positive note.

Myles was eventually placed in a residential program for mental health and addiction at the age of 16 through the Calgary-based Hull Services in fall 2013. Sackett said a placement agency looked throughout Alberta for a placement centre that could address both his mental health and addiction problems but were unable to.

Since the residential program was voluntary, she said her son was free to come and go as he pleased. Though he was continuing school and holding down a job, Myles continued to use drugs and died of a methamphetamine overdose in November 2014.

The loss of her son has often made Sackett reflect on all the people in a system meant to help who turned Myles away. She said she wonders if they would have done anything differently if they knew he would be dead of a drug overdose only a year and a half later at the age of 17.

“I would hope that it was just a lack of education and that’s why he fell through so many cracks,” she said. “People need to understand what’s going on and realize it’s not just a parenting issue or a kid acting out. There’s more to it and they need to take it more seriously.”

Drug addiction continues to hold a stigma in society. Sackett said she didn’t want people to know what her son was doing, not because she was embarrassed as a mother, but because she knew people would judge him.

“It’s everyday people like you, or me, or your son, or daughter, or your brother or sister,” Sackett said. “If people can start relating to the people who are dying or becoming addicted, then maybe they’re going to start realizing that could happen to someone they know. It’s not just the bad families or people with problems.”

By: Dustin Ruth

Retrieved from: http://www.airdriecityview.com/article/Mothers-advocating-for-drug-addiction-awareness-20170810

Why It’s Good To Talk With Your Children About Alcohol

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Why is it good to talk to your children about alcohol? …Because your child can adopt a healthier, happier attitude to alcohol the more you talk to them about it.

There are plenty of reasons why we should talk to our children about drinking and sooner you start the conversation the better (although, it’s never too late).

Young children listen to their parents 

Young children look up to their parents and will listen to what you say. With teenagers, it’s natural and normal for them to pull away and make their friends their focus. What their peers think or believe becomes more important to them.

However, what you think feel about them remains central to their lives. They still look for your approval as well as your love, however disdainful they may seem of your opinion.

Children value your advice

Your children may say you don’t understand or know anything… but young people still pay attention to what you say and how you feel. But you need to earn their respect: the more you admit when you don’t know something, the more you listen to them, the more you offer praise when they get it right rather than criticism when they get it wrong, the more likely it will be that they come to you for advice and take it.

If you don’t talk to your child about alcohol, someone else will

There are plenty of people out there who will answer their questions about alcohol or listen to them if you don’t. The problem is that they may be friends who have as confused and inaccurate an idea as they do. Or there might be websites or people on the internet who could lead them astray.

Saying nothing or evading the issue does not mean the questions go away, just that they go elsewhere.

Preventing underage drinking is vital for their health and success in life

Underage drinking really can have an impact on the rest of your child’s lives. It’s never too early to talk about alcohol but it’s also never too late. Even if they have tried alcohol, you can still help them to stop drinking. They need to hear you say you love them and that this is not about you being a killjoy. It’s about your care for them, your desire for them to reach their full potential and be happy.

The more you talk about drinking, the happier they will be

It’s not about ‘having the talk’ because it’s not a one-off lecture. It’s about building the habit of listening to each other and sharing thoughts and opinions, about negotiating and compromising.

When children feel they can come to you about anything and you’ll listen with respect and answer to the best of your ability they’ll stay close and come to you more often.

They’ll already have questions about alcohol

If your children haven’t asked you about alcohol it might be because they haven’t got questions. But it’s just as likely that they’ve already assumed this is not something you feel comfortable talking about.

Don’t forget they learn about alcohol from so many places – if not you then the media, friends, family. They have the questions – they need you to make it clear you will answer them.

Questions you may have

Surely my child is too young to drink?

Clearly you need to tailor what you say to their age. The key is to answer questions and be guided by what they already know, not to blast in with a prepared speech.

If they have the questions they deserve an answer.

But won’t it encourage them to drink alcohol underage?

No, it won’t. Talking through an issue properly does not promote irresponsible behaviour. Look at that other subject where people sometimes say you should keep children in innocence. Research shows that children who are given good sex education leave their first steps into sexual experience later than those left in ignorance, and they make safer choices2.

Talking it through does not implant ideas in their head – talk to them and you’ll find out what they already know, which they would have picked up from the world around them.

Won’t they think I’m a hypocrite?

The best example to set your kids is either not to drink or to drink within the recommended Canada-Low-Risk-Alcohol-Drinking-Guidelines-Brochure-en. But telling them they shouldn’t drink when you do doesn’t make you a hypocrite. There is a reason that the Chief Medical Officers recommend an alcohol-free childhood is best. Young people’s bodies, and particularly their brains, are still developing, which makes young people more vulnerable than adults to the risks of even small amounts of alcohol.

It can be a tough discussion to have – most teenagers think they’re all grown up. But they do understand that there are aspects of their life that are different to yours, like studying and taking exams. One of the associated risks of underage drinking alcohol can have a significant impact on memory and concentration.

Won’t my child learn about alcohol in school?

Your child’s school may indeed be covering the subject of alcohol, although it’s not compulsory so they may only be tackling some aspects. It’s an excellent idea to see you and the school as partners adding to what the other is saying and supporting each other. It’s worthwhile asking their school what they are teaching, and encouraging them to cover this important subject in depth.

Asking your child to tell you what they are learning is a good way of opening the discussion. Just leaving it to the school to deal with risks having some of those important questions unanswered.

Your child benefits from knowing they can come to you for more than facts.

Retrieved from: https://www.drinkaware.co.uk/advice/underage-drinking/why-talk-to-your-children-about-alcohol/

Why Americans—Especially Women—Are Drinking More Alcohol

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More Americans are drinking high amounts of alcohol, and the greatest increases are seen among women and older adults, according to a new study published in JAMA Psychiatry.

In the new report, researchers at the National Institute on Alcohol Abuse and Alcoholism compared two large studies of people who self-reported their drinking habits. The first was a study of more than 43,000 adults from 2001-2002, and the second included more than 36,000 adults from 2012-2013.

The number of Americans who said they drank alcohol in the last year increased 11%. High-risk drinking—defined as having four or more drinks per day at least once a week, every week, for a year, and five or more for men—increased almost 30%. Alcohol use disorders increased nearly 50%; they were determined if a person was found to be dependent on alcohol, based on American Psychiatric Association criteria.

Though the figures represent just a snapshot in time, researchers say the increases are higher than what they’ve observed in prior studies.

These increases were apparent in everyone, but they were much higher in women. For men, high risk drinking increased 15% and alcohol use disorder increased close to 35%. For women, high-risk drinking increased close to 60%, and alcohol use disorder increased nearly 84%.

Older adults also appeared to be drinking substantially more than in the past. Among adults age 65 and older, high-risk drinking increased 65% and alcohol use disorders increased close to 107%. These increases were “substantial and unprecedented” compared to earlier surveys, the study authors write.

It is not yet clear why women and older adults had higher increases in this type of drinking, but the researchers have some ideas. Over the years, cultural norms about drinking have changed, and it has become more acceptable for women to drink in similar ways as men, the researchers note. “Increases in educational and occupational opportunities and rising numbers of women in the workforce” may also have contributed to higher drinking levels in the last decade, they write.

Added stress is another factor that might drive anyone, regardless of their sex, to drink more. High-risk drinking was higher among minority groups, and the authors argue that wealth inequality between minorities and whites has widened during and after the 2008 recession, which may have led to “increased stress and demoralization.” Income and educational disparities, as well as “unemployment, residential segregation, discrimination, decreased access to health care, and increased stigma associated with drinking,” may also play a role, the authors write.

Drinking levels in the United States have reached a “public health crisis,” the researchers say, and more effort is needed to address the individual, environmental and societal factors that might be contributing.

By Alexandra Sifferlin

Retrieved from: http://time.com/4893108/alcohol-use-disorder-drinking/

Steering pregnant women away from substance abuse

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Amanda Seymour at the James Bay Community Project: “If we’re able to prevent one incidence of a child from having fetal alcohol spectrum disorder, it’s a lifetime of that child living with that condition.”   Photograph By DARREN STONE, Times Colonist

Victoria program is changing lives by helping pregnant women deal with substance-abuse issues. HerWay Home, run out of the James Bay Community Project, started in January 2013, said program co-ordinator Amanda Seymour.

“Really, our goal is help women improve their own health, so that they have healthier pregnancies, healthier births, so that children can stay with their moms and that the moms can quit or reduce their substance use,” Seymour said.

One hundred women benefited from the program in 2016.

A current participant is Aurora, who was 22 and newly pregnant when she was encouraged to try the program by her sister, who raved about her experience with it.

“I felt kind of shy and I didn’t know if I would want to,” she said.

But she relented and decided to show up, and has been going ever since.

“Honestly, without HerWay I wouldn’t have made it this far, I don’t think,” Aurora said.

“As capable as I think I am as a mother, I definitely need this resource more than I can put into words.

“Especially as a single mom it can be difficult to find help.”

She said she is doing well in recovery, and can talk to other mothers about addiction concerns.

“No one’s going to understand the situation I’m in except another recovering mom.”

HerWay Home offers additional services, as well, Aurora said.

“They helped me fill out my B.C. Housing application, which seemed really daunting to me because I didn’t know how to answer a lot of the questions.” Sarah, 27, said she was steered to the program by an addictions counsellor.

“I was a couple of weeks pregnant when I went to treatment and so I needed the supports when I came out.”

Program staff members have also helped her in other ways, Sarah said.

“I don’t have any family or a vehicle, so the support worker actually drove me to my midwife appointments.”

An evaluation report on HerWay Home shared another participant’s view of the program: “It’s a priority shift from money for drugs to money for rent and food and life and children.”

The report said the program is filling a “critical niche” by working with high-risk women, and has welcomed 50 per cent more women than was expected at the outset.

HerWay Home was favourably compared in the report with other successful programs –— Sheway and Maxxine Wright Place on the Lower Mainland, and Breaking the Cycle in Toronto.

Seymour said that most women come to the program when they are pregnant, but some connect when they have infants.

Referrals and word-of-mouth provide a steady flow of clientele.

“Women can just come in, they can come in through a drop-in group, they can call us,” Seymour said. “Often it’s people in the community like other agencies that hear about us.

“They might call if they come into contact with a woman and ask us to go meet with her.”

HerWay Home was created using a number of other initiatives as models, Seymour said, and it was a long time in the making.

“The community spent years working on it,” she said. “It was led by a public-health nurse at the time, Betty Poag.”

Poag brought together community agencies, Island Health, the Children’s Health Foundation of Vancouver Island and researchers to help develop HerWay Home, Seymour said. The concept is beginning to expand across the country, she said.

One major positive coming from the program is that it can be a key to preventing fetal alcohol spectrum disorder, Seymour said.

“If we’re able to prevent one incidence of a child from having fetal alcohol spectrum disorder, it’s a lifetime of that child living with that condition.”

Reducing the need for children to be placed in the care system is another good outcome, Seymour said.

“The more we can keep families together and keep them healthy, our hope is that those kids can do something different with their lives,” she said. “They may not end up in the same situation when they have kids.”

Plans call for HerWay Home to move this year to Saanich Neighbourhood Place, along with the Young Parents Support Network, to be part of an early-years hub.

By JEFF BELL / TIMES COLONIST

jwbell@timescolonist.com

Retrieved from: http://www.timescolonist.com/life/islander/steering-pregnant-women-away-from-substance-abuse-1.20529843

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