Joining Together to Promote Sensible Alcohol Consumptionby Nicola on 2013-05-12
Community-Based Interventions for the Prevention and
Treatment of Alcohol Misuse among Inuit:
Working Together to achieve Healthier Lifestyles
By Dr Nicola Davies
Over recent decades Inuit have been forced to radically alter their way of life. In particular, there has been great pressure to adapt to Westernized ways of living and thinking, which are often very different from the traditional Inuit culture. Loss of a traditionally independent lifestyle, adaptation to a wage earning economy, the introduction of modern technology, and even conversion by missionaries to Christianity, have all engendered huge changes within Inuit society. Such radical changes over the generations has inevitably taken its toll, with alcohol misuse and increasing rates of alcohol-related suicide being among the consequences (Korhonen, 2005).
Alcohol misuse comes in many degrees of seriousness, from mild to severe. It can also constitute a number of different problems, including alcohol dependence and addiction. Within Inuit communities, however, the most common alcohol-related problem is binge drinking, which in turn is the most prominent health problems within Inuit communities (Aboriginal Healing Foundation, 2007). Binge drinking is different from alcohol dependence (which is commonly known as alcoholism), and does not usually lead to dependence. Nevertheless, it is extremely damaging to both the individual and community alike.
The definition of binge drinking varies, but most definitions agree that binge drinking can comprise as few as five drinks in one session. The essential characteristic of binge drinking is that it results in a large quantity of alcohol consumption over a short period, resulting in drunkenness. Binge drinkers often do not touch alcohol in-between binges, but their overall alcohol consumption is high due to their intensive drinking ‘sessions.’ These sessions overload the body's capacity to metabolise alcohol, causing damage to organs such as the liver and pancreas. This is turn can lead to vitamin and mineral deficiencies and, subsequently, an array of potentially fatal diseases.
The Consequences of Binge Drinking
Binge drinking is also a frequent cause of death from either suicide or accidents. In the harsh climate prevalent in Inuit communities, binge drinking can result in frostbite and pneumonia due to the drinker losing their sense of feeling and awareness while under the influence of alcohol. It can also cause drunken acts of violence or other anti-social behaviour. Violence resulting from binge drinking commonly results in serious harm such as head injuries and fractures, as well as more minor injuries.
In pregnant women, binge drinking can harm the development of the unborn child by a process known as foetal alcohol syndrome. As a consequence, binge drinking is now considered the most dangerous sort of drinking in pregnancy.
Although the overall level of alcohol consumption within Inuit communities is not always especially high, the pattern of binge consumption is widely acknowledged as playing an important role in a variety of social and domestic problems such as family break-ups, abuse, and job loss.
Strategies for Dealing with Binge Drinking
A strategy to prevent binge drinking is the enforcement of byelaws to prevent alcohol being made available in the first place. However, the trouble with such efforts is that when the supply of legally available alcohol is diminished, smuggling becomes a new problem and alcohol consumption still continues. Furthermore, it is questionable whether such drastic strategies are necessary. Indeed, more effective strategies tend to focus on working with the individual drinker to reduce their problem.
Many people recognise after a while that their drinking is becoming a problem, and take steps themselves to bring it under control. There are a range of interventions which can assist in this process, without requiring a major treatment programme. It has been found that people are more likely to accept help with drinking issues when they are given information to help them make their own choices, rather than being confronted in an overbearing way and told that they must not drink. With this in mind, education is important, as is raising awareness of the impact of alcohol misuse and the support available to individuals and families struggling with the problem. As highlighted in a previous article by Christopher Collrin (Representative of the David Lynch Foundation) and Mike Webster (Executive Director, The Society for Building a Healthier Kugluktuk), self-determination is a health indicator for Inuit.
Intervention in the form of brief advice can be very effective in the early stages of an individual’s drinking problem, providing them with advice on how to drink safely and explaining why it is important to do so. This will need to be supported with information on the health risks of excessive drinking, as well as the detrimental impact it can have not only on the individual but on their family and community. Cognitive behaviour treatment can work well alongside information provision, helping a person understand why they feel the need to drink, and then addressing these underlying causes of excessive alcohol consumption.
Brief counselling sessions can have a similar effect. For people who binge drink but do not have other major problems, even as few as three or four counselling sessions can be effective in identifying attainable targets and ways to achieve them. Such targets might include limiting the number of drinks consumed in one sitting, or only drinking on occasions that do not trigger a desire to binge.
For more serious cases, several areas have residential treatment centres designed especially for serving Inuit communities. These offer extended courses aimed at achieving abstinence, or at least bringing the most harmful aspects of the drinker's alcohol misuse under control. Nunavik, for example, has two such centres, one for adults and one for youths, and there are also treatment centres especially for Inuit in Labrador and Ottawa. For a list of alcohol misuse programs and initiatives, visit Inuit Tuttarvingat.
Setting Realistic Goals
An important aspect of modern approaches to the treatment of alcohol misuse is a growing recognition that attempting to enforce abstinence is not always the most effective strategy. Instead, it is better to focus on reducing the level of problems which arises from alcohol consumption. Not all drinkers seeking assistance want to be abstinent, and with binge drinking especially, there is often a good chance of reducing the binge element of the problem without needing to abstain completely. This more realistic and achievable aim also increases the willingness of binge drinkers to accept intervention in the first place.
The growing problem of binge drinking within Inuit societies grew out of the rapid social changes these isolated communities have been pushed towards. The consequences include a subsequent increase in social problems and health complications for many Inuit. However, binge drinking can be addressed through health promotion activities such as education that promotes safe drinking, and psychological interventions such as counselling. Residential or other intensive forms of treatment are not the only option, although may be necessary in severe cases. The important message here, however, is that binge drinkers require community and government support – the prevention and treatment of alcohol misuse require a community-based approach, ensuring individuals do not feel ostracized and alone while working towards achieving a happier and healthier lifestyle.
Dr Nicola Davies is a Psychology Consultant and Freelance Writer with an interest in health and well-being. Her publications can be viewed at www.healthpsychologyconsultancy.com. Alternatively, you might like to sign up to her free blog: http://healthpsychologyconsultancy.wordpress.com/
The Aboriginal Healing Foundation (2007). Addictive Behaviours Among Aboriginal People in Canada. Accessed on 12th May 2013 from: www.ahf.ca/pages/download/28_13222.
Korhonen (2005). Alcohol and Inuit communities: Current Services and New Directions. Canadian Centre on Substance Abuse National Conference.