National Native Alcohol and Drug Abuse Program (NNADAP) - General Review 1998 - Final Report

Results of the NNADAP Review

Stakeholder Expectations

The following information represents a summary of the team's findings with respect to the stakeholders views on various aspects of the NNADAP program that have been investigated as an element of the review. The findings and the draft recommendations represent the study teams view, which has been reached through the field study as well as through reviewing various information available through the mail surveys, the detailed studies, and the regional focus groups.

Perceptions on the level of addictions problems

Finding:

• There is recognition that various forms of addiction including alcohol, illegal drugs, prescription drug, bingo and gambling remains a serious problem at the community level.
  
  
• The use of legally obtained and illegally produced or sold
  alcohol remains a major issue that affects the whole community.

Alcohol

The various stakeholders rated alcohol abuse as the most serious addiction concern at the community level as shown in Table 3 below. This would indicate that although there has been considerable progress in dealing with this particular problem area, there is still a need to focus on services to communities in alcohol prevention, intervention and treatment. There needs to be a renewed focus and commitment, which comes both from Health Canada and First Nations to deal with the illegally produced or sold alcohol. This should be coordinated with law enforcement and crime prevention specialists.

Illegal Drugs

Finding:

• The use of illegal drugs is a rising and pernicious concern at the community level.

The use of illegal drugs is a growing concern as shown in Table 4 below. There are additional implications arising for the community in dealing with various elements of trafficking illegal drugs. During the site visits, particularly the youth indicated that the use of illegal drugs is extremely prevalent among adolescents and young adults. Of particular concern is the effect on the community and its various structures and services by the illegal "infrastructure" required to maintain a supply of such substances within the community. Consideration should be given to the establishment of a task force to examine means of dealing with the issue of illegal drugs. This task force could develop strategies to improve coordination, planning, and funding of community needs.

Bingo

Arising from the field visits and supported by mail survey results as shown in Table 5, is the issue of pervasive attendance at Bingo both on and adjacent to reserves. In most communities, Bingo is seen as a generally harmless recreational activity and as the primary means of supporting sports and other community programs. The problem associated with Bingo is the amount of time spent at these events, which takes away from time spent with family and in particular, children. It is important to capture the feelings of the youth on this subject, since there was frustration and anger that adults choose to spend considerable amounts of time at this activity, which in turn leave the youth without supervision at minimum, feeling neglected and abandoned in the worst case.

Prescription Drug Abuse

Finding

• The issue of prescription drug abuse should be examined.

Other areas of addiction discussed in the field visits and the mail surveys indicate that the areas of prescription drug abuse and gambling follow use of alcohol and illegal drugs in terms of perceived level of problems, as shown in Table 5 below. It is interesting to note, however, that generally speaking the issue of prescription drug abuse was not well understood, and was not seen as a problem of the same nature as alcohol and drug abuse.

However, data obtained from Auditor General's Report on the Non-Insured Health Benefits indicates that prescription drug abuse is a serious concern in certain drug categories similar to solvent abuse. There are certain regions where the problem is more prevalent. A review of the delivery system and a thorough examination of this issue should be carried out. Also consideration should be given in devoting one or more centers to deal with prescription drug abuse and/or to provide training to communities.

Gambling

Finding:

• Gambling is an issue that is on the rise and should be dealt with before it becomes even more pervasive.

In addition, according to discussions during the field visits, gambling was seen as an issue, which is on the rise. While gambling was not clearly an issue at first discussion, once interviewees began thinking about the issue and the different forms that gambling takes, then the seriousness and prevalence of gambling began to be recognized.

There should be an investigation of resources to determine incidence levels, to design appropriate information campaigns, and to provide necessary intervention and treatment services. Discussions should be held with provincial and national beneficiaries of various types of gambling such as lotteries, pull-tabs, and casinos.

Solvent Abuse

Solvent abuse, although ranking a lower mean score as shown in Table 5, remains an area of concern. The community visits reflected a variable and intermittent pattern of solvent abuse. The seriousness of effects of this abuse upon youth must be considered. This issue is discussed further in subsequent commentary.

Incidence and Prevalence Tracking

Health Canada should reinstate a structured research program that would provide a systematic means of tracking and anticipating patterns of addictive behavior. In developing this structured program there should be an implementation committee consisting of persons experienced in research from First Nation and Inuit communities and organizations such as the Alberta Addictions and Drug Abuse Commission. Further, Health Canada, First Nations and Inuit organizations should make a commitment to include addiction questions in the next phase of the First Nations longitudinal health survey.

Expectations for the NNADAP

Findings

• There is a high level of importance assigned to the program.
  
  
• There are broad expectations that the Community NNADAP worker will provide services across the whole continuum of promotion, prevention, intervention, counseling and therapeutic services, and in aftercare and support.

Importance of the program to the community

This high level of expectation was evident both from the field visit interviews with community leadership and from the mail surveys. In the mail survey, the leadership expressed the level of stated need for the program at a mean (or average) of 4.1 on a 5 point scale. Within the total number of leadership respondents for this question, 45% rated the program as extremely important and 34% rated the program as very important. This ranking is consistent with that of other community respondents as shown in the Table 6 below.

Expectation for program emphasis in prevention areas

Finding

• There should be a national social marketing strategy developed by Health Canada and First Nations and Inuit organizations to support program goals in prevention to correspond with the population health model.

In examining whether there should be particular areas of program emphasis within NNADAP, leadership responses to the mail surveys did not place discernible patterns of preference either in promotion and prevention activities or in treatment activities. This is reflective of a general pattern of wide ranging expectations for the areas in which the NNADAP worker is expected to have an impact. Notable exceptions to this pattern of high expectations are two areas; developing policies for use and the regulation of alcohol and providing employee assistance program services to community members.

Examination of prevention activities, Table 7 below, the leadership respondents identify a consistent preference for activities targeted at the age group of adolescents to age 19, followed by children up to age 12. Services to young adults up to age 25 ranks third followed by services to adults over age 25.