Effectiveness of Interventions for the Prevention and Treatment of Substance Use Disorders Among First Nations, Métis and Inuit Populations

Issue: What approaches and strategies for the prevention and treatment of substance use disorders (SUDs) among First Nations, Métis and Inuit populations are most effective? 

Background: First Nations, Métis and Inuit (FNMI) peoples in Canada experience greater social and health inequities, leading to a disproportionately greater risk of negative health consequences – including higher rates of problematic substance use and poorer outcomes associated with SUDs. It is important to acknowledge that higher rates of problematic substance use are not a cultural characteristic but rather a logical outcome of cultural genocide – substance use has been applied as a colonial stereotype to dehumanize Indigenous peoples and detract attention from the conduct of state actors perpetrating systemic racism and inequity that gives rise to SUDs. In the current Canadian context, increasing rates of substance use, such as cannabis and opioids, along with rapidly growing FNMI populations have created an urgent public health situation that necessitates effective prevention and intervention strategies to reduce the harms associated with SUDs for FNMI peoples. However, FNMI populations have remained understudied in substance use treatment research, and there is still debate as to whether interventions should follow traditional Western treatment approaches or whether they need to be adapted to be more culturally appropriate and effective. 

Methods: A scan of published literature was conducted to examine and synthesize evidence related to interventions for substance use disorders in FNMI populations. 

Findings: Overall, while there is a substantial range of literature on the topic, limited studies were found on the effectiveness of interventions, highlighting some of the methodological challenges with evaluating cultural interventions. Some key findings that emerged included the importance of culture as part of a holistic approach to treatment and recovery and the value of integrating Western treatment methods with traditional Indigenous approaches to healing and wellness to better meet the needs of FNMI clients. However, it is not yet clear how cultural approaches can be implemented most effectively or which aspects of either culture-based or culturally adapted programs are most successful. Given the distinct heterogeneity among and between First Nations, Métis and Inuit peoples and communities across the country, it is likely that there is no single best approach that would meet the needs of all FNMI clients, underscoring the need for more adaptive, culturally specific and needs-based treatment programs that reflect distinct community circumstances. 

Policy Implications: To overcome the limitations of the available evidence, FNMI peoples and governments, researchers, as well as Executive Summary mainstream governments have identified the need for further research iii in order to develop more effective evidence-based programs and interventions that address the needs of FNMI peoples with SUDs in Canada, including more culturally-based measurement tools and methods. In addition, implications for service providers involved in substance use treatment programs with FNMI populations include greater educational and training efforts to enhance their cultural awareness and competency. More broadly, there is a need for a comprehensive, multidisciplinary approach to prevention and intervention at a systemic level that would address the social and economic determinants of health and well-being. An important next step would involve continued efforts among researchers, practitioners, and policymakers to bridge the gap between Western and distinct Indigenous approaches to health. This would require concrete action to implement solutions that have already been identified through engagement with FNMI communities. In the long term, significant changes to health and social systems are needed in ways that support healthy behaviours and remove barriers to treatment and care for FNMI peoples with substance use issues in Canada.