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

Background Information

NNADAP Review General

The National Native Alcohol and Drug Abuse Program (NNADAP) is now in its fifteenth year of existence as the federal government's primary line of attack to combat alcohol and substance abuse in First Nations communities. As a successor to the less ambitious National Native Alcohol Abuse Program (NNAAP), NNADAP was designed to provide treatment, prevention, training and research services as a comprehensive federal strategy. The blueprint for today's NNADAP program is imbedded in the Cabinet discussion paper, which was submitted to Treasury Board in February 1982 and approved later that year on April 5. It was originally developed as a five-year $154 million program, and has gone through a life cycle which has seen a growth phase, a period of maturity, and more recently, a devolution of the program into communitybased control.

The NNADAP evolved from a pilot project entitled the National Native Alcohol Abuse program, which was approved in December 1974 and was implemented over a three-year period beginning in fiscal year 1975-76. The purpose of the NNADAP program was "to support community designed and operated projects in the areas of alcohol abuse prevention, treatment and rehabilitation in order to arrest and reverse the present destructive physical, mental, social and economic trends."

The program was to provide a balanced professional, paraprofessional and administrative training program to support prevention, maintenance and treatment programs with a cadre of different level positions including advanced and basic level counselors. It was anticipated that this component would be carried out by Indian controlled "stations" as well as through contracted arrangements with established institutions. The document also referred to an accreditation program to maintain appropriate standards and consistency of service delivery.

Research and development support was to be carried out in order to increase the knowledge of the extent and nature of alcohol and substance abuse problems and the effectiveness of program approaches. Also acknowledged was the need for the development of case assessment, management procedures and practices. The issue of developing appropriate case assessment and management procedures and practices was referred to, as was the need for a national case record and information system to provide better monitoring and evaluation of individual cases and program effectiveness.

Within the program support elements discussed in the Treasury Board document, regionally based Indian and Inuit Institutions were envisioned which would offer local communities and organizations support through funding, technical assistance, training, research, planning, coordination and evaluation services. In the original discussion of program sequencing, it was felt that the first priority would be in establishing delivery capacity through Regional Indian Alcohol Commissions as well as the other support elements, such as training, research and development, followed by expansion of community projects and treatment programs. In this concept, multi-year agreements would have been developed with these commissions which would administer projects and provide necessary support to community projects.

NNADAP Design Elements

The program to replace the original NNAAP concepts was to include:

• Non-medical treatment services that were described as post detoxification primary care and counseling intended to focus on social and cultural rehabilitation. The treatment services are also described as involving intensive psychological and therapeutic counseling oriented toward social and cultural rehabilitation typically offered in a 28-day program. In examining potential program elements it was envisioned by the authors of the document that treatment elements would include inpatient residential treatment facilities, halfway houses and communitybased (outpatient) treatment services.
  
  
• Prevention and maintenance activities including professional and paraprofessional counseling. It is pertinent that the original design of NNADAP Prevention and Maintenance programs included a wide range of activities including "advocative, educational and counseling services, provided on either a community-wide or on an individual case basis". The community services included "maintenance" which was to include counseling, self-help and individual and group therapy. The Treasury Board Submission also included reference to"complementary" services, which were to be targeted to family and friends of abusers. In discussing approaches, Alcoholics Anonymous and native cultural and spiritual practices were described as the range of anticipated services.
  
  
• Support activities such as training, research and development, organizational support, capital, and departmental operation and maintenance.

The Original Contextual Environment

The original National Native Alcohol Abuse Program was run as a joint initiative between Department of Indian and Northern Development and Health and Welfare (now known as Health Canada). The Discussion Paper on NNADAP presented by Ministers of National Health and Welfare and Indian Affairs and Northern Development dated February 17, 1982 described the tenuous nature of the program as having generally contributed to a sense of uncertainty among Bands and other participants concerning future funding. This impeded the development of effective support systems at local and national levels. It contributed to a high turnover of personnel, particularly at the community level. There were difficulties in negotiating ongoing funding arrangements with other levels of government and an overall lack of integration with the planning and implementation of comprehensive community socio-economic strategies. The authors drew this conclusion from their extensive consultation processes plus previous reviews including Linklater (1977), Hickling-Johnson (1979) and the Evaluation Core Group Report (1980).

The NNADAP program was implemented prior to government initiatives such as Community-Based Transfer under Health and Welfare, Native Economic Development (later labeled Pathways) by Canada Employment and Immigration Centers, and comprehensive Band Government legislation. Part of the rationale to proceed prior to the approval of these fundamental building elements appears to have been the relatively urgent and visible nature of alcohol and drug abuse among First Nations and Inuit people. This situation is evident from the concentration placed upon the nature, level, patterns, causes and consequences of Alcohol and Drug Abuse, which are carefully described in the NNADAP Discussion Paper.

The NNAAP and its successor program, NNADAP, had their roots in alcohol abuse programming. This is evident from the emphasis placed on dealing with alcohol abuse and is further reflected in the types of information describing the need for the program. There is mention of solvent abuse; however, this description is brief and it is not evident whether it was envisioned that this area of substance abuse was to be a focus for services.

Contribution agreements were used as the initial vehicle for approving funding to communities and organizations. Other funding mechanisms are now available for First Nations and Inuit communities to integrate and coordinate services and programs with alcohol and drug abuse, and any other priorities for that matter.

The NNADAP design did not include services which were considered to be medical in nature such as adult custodial care, detoxification, and trauma treatment, presumably since such services were considered by departmental officials to be services normally provided through the respective provincial health care system.

The program was also clearly not intended to address root causes and contributing factors of alcohol and drug abuse. However there was recognition that the NNADAP program required an emphasis upon leveraging other programs to improve conditions for First Nations and Inuit. There was funding provision for financial and technical assistance, which would promote functional linkages with federal programs and also to develop an integrated system of support drawing on community, provincial, private, and voluntary resources in addition to federal resources. Coordination of services was a considerable issue and focus for northern areas, since the population there is scattered in small pockets across a vast land base.

In discussing the targeting of services, there was mention made of isolated and less developed communities, adolescents and young working adults; urban migrants and women especially those with children or who are pregnant. However, there was more general recognition that all First Nation and Inuit groups face the problem of alcohol and drug abuse.

Major differences are evident between the current situation and the original contextual environment described in the NNADAP Discussion Paper. In 1981/82 there was not seen to be a mandate within Medical Services Branch for mental health services. There was not an understanding of the impact of residential schools upon the First Nations and Inuit population. There wasn't emphasis placed upon the issues of family violence and child sexual abuse. At the time, the NNADAP and the Community Health Representative program were the only programs to have First Nations health care workers available in the health field to deal with a wide array of problem areas. Furthermore, the NNADAP also preceded the development of First Nations managed Child and Family Services, which have become more available at the community level and which have changed the nature of staffing and the resulting levels of compensation offered at the community level.

In the opinion of the Review Team, the original plan outlined in the 1981/82 Discussion Paper presented a plan, which if it had been fully implemented, would have resulted in a much stronger program, than that which is currently available. To a degree, this preliminary blueprint remains useful in examining recommendations for strengthening program elements of the NNADAP in the future.