What should N.W.T.'s alcohol strategy include? Experts weigh in

The Northwest Territories Health minister wants to put in place permanent, managed alcohol programs at some of Yellowknife's COVID-19 isolation centres as part of the territory's new alcohol strategy.

Yellowknife's sobering centre and day shelter opened its doors in April to 30 homeless adults who were at risk of developing severe complications from COVID-19. For a month, everyone in the program had to stay at the centre, and no one else was allowed in.

Finding ways to provide alcohol so their physical needs are met ... that's obviously an important dimension to this problem.- Julie Green, N.W.T. Health Minister

Physicians tailored individual plans to access alcohol, tobacco and cannabis for all the participants during their stay, giving them portions a few times every day. They also had a place to sleep, socialize and do laundry.

A report from NWTDisabilities Council, written a month later, said four of the participants left their quarantine completely sober, while another 21 participants consumed less alcohol and no illegal drugs by the end of the 30 days.

• Isolation at sobering centre helping people curb alcohol use, organizers say

Health Minister Julie Green said she wants to see this kind of work continue.

"People who are addicted to alcohol usually have a physical addiction that complete cutoff is dangerous, even life threatening," Green said.

"Finding ways to provide alcohol so their physical needs are met [that's] obviously an important dimension to this problem."

Not ruling out expansion to communities

Green said they are looking at the Arnica Inn and the Aspen Apartment complexfor the permanent programs, but emphasized the details still need to be worked out.

Green said there is no plan at the moment to extend this model to communities outside of Yellowknife, but if there's interest then the territory would consider it.

"We're not trying to impose this on a community," Green said. "So if we were going to take it elsewhere, the community would have to agree that they would want to try this."

Green wants this program to be part of the territory's new alcohol strategy.

• Territories get failing grades on curbing alcohol harms: study

The territory started working on an alcohol strategy in the spring after the Canadian Institute for Substance Use Research from the University of Victoria gave the N.W.T.'s alcohol policies some of the worst grades in the country.

Alcohol strategy should address data, patient surveys

Dr. Claudia Kraft, medical director of Stanton Territorial Hospital and an addictions specialist, said more "innovation" from the COVID-19 response, like the managed alcohol program at the sobering centre, should be a priority in the government's upcoming alcohol strategy.

People [from the homeless population] can do really well when we are able to provide them with the right supports.- Dr. Claudia Kraft, Medical Director of Stanton Territorial Hospital

The managed alcohol programs work, Kraft says, because the hospital is seeing fewer patients from the town's homeless population coming through their doors.

"That really highlights for us how people can do really well when we are able to provide them with the right supports," Kraft said.

Still, she said there are other ways to improve medical services for those passing through the hospital.

At Stanton, 15 to 17 per cent of the hospital's emergency visits in the last few months directly involve a substance-related injury or people going through withdrawal,Kraft added. Two-thirds of those cases involved alcohol.

That number doesn't include those who are hospitalized with chronic substance-related health conditions, like liver failure, diabetes or pneumonia, says Kraft.

The territory already has some tools in place, like an alcohol use survey, that physicians use to understand how people are using alcohol. Still,Kraft says recording the information of those with chronic-related conditions could be another way to measure the extent of substance abuse in the territory.

Ask patients the best way to disclose drinking history

As well, doctors screen patients either verbally or through a questionnaire to figure out how much they use alcohol or drugs. Then, doctors will figure out the best advice, guidelines or resources to point out to their patient.

This is part of a typical interaction between doctors and patients, Kraft said but there's room for improvement.

There's so much stigma around alcohol that it really does appear to matter for patients themselves how these conversations are negotiated.- Dr. Claudia Kraft, Area Medical Director of Stanton Territorial Hospital

"We want clinicians to make sure they're asking in the right time and the right place about other substance use, including alcohol," Kraft said.

The territory should be asking families and patients what the best way would be for doctors to approach those conversations, Kraft continued.

For example, the territory could ask patients if they would prefer filling out information about their drinking habits through a tablet in the waiting room instead of sharing that information directly with a doctor.

"There's so much stigma around alcohol that it really does appear to matter for patients themselves how these conversations are negotiated," she said.

Focus on traditional, community-based healing

JC Catholique, a retired social worker and addictions counsellor from utsel K'e, has worked with patients both as a territorial government employee and under local leadership.

Catholique said the territory put up a number of barriers for those looking to get care in the communities, like telling him to only bring clients out on the land during work hours.

When I hear new strategies coming up, what's new about them?- JC Catholique, retired social worker with Lutsel K'eDene First Nation

Catholique acknowledged that the territory is trying to incorporate traditional teachings into the healthcare system, but notes they have "a long way to go."

"When I hear new strategies coming up, what's new about them?" Catholiquetold CBC.

"Are they willing to accept traditional healing, medicines, sweat lodges, fasting?"

Green said she was not aware that there is any "differential access" to the kind of care that people receive in Yellowknife, compared to the rest of the territory.

Green said all Indigenous governments are able to apply to an on-the-land healing fund with project ideas that promote "healing and mental wellness."

Consultations on the new alcohol strategy will start in January, with a completed strategy tabled in the legislature before the end of 2021.