Alcohol is being used as medication for some alcoholics on north Vancouver Island. It might seem counter-intuitive at first glance, but it’s a well-researched harm reduction strategy aimed at preventing potentially life-threatening effects of withdrawal.
The worst symptoms of alcohol withdrawal are seizures and delerium tremens — a sudden onset of psychosis, hallucinations, mood and/or behaviour changes that can last for days. They are both medical emergencies and can cause severe damage, even leading to death.
A daily dose of alcohol that’s just enough to stave off withdrawal, but not enough to get drunk on, is delivered to clients by health care professionals.The ultimate goal is for people to live fulfilling lives while managing the disorder.
“A client can go from struggling with alcohol use disorder to functioning with alcohol use disorder. They can live a happy and fulfilling life,” said nurse Alexa Bisaillon who’s running the Gwa’dzi Managed Alcohol Program with outreach worker Cathie Wilson.
Gwa’sala-‘Nakwaxda’xw First Nations in Port Hardy started the north Island’s only managed alcohol program on late September. Indigenous people in the area with an alcohol use disorder diagnoses could be eligible, though it’s a case-by-case assessment. Alcohol use disorder is a medical diagnosis, defined as a chronic relapsing brain disorder where the person cannot control alcohol use even though it’s ruining other parts of their life.
Every day when Bisaillon and Wilson drop off the dose, they’ll spend time with the client checking in on other aspects of life. Daily in-person connections are a core aspect of the strategy that’s focused on holistic health. Transforming a condition that controls someone’s life into something that can be managed takes more than just medication, they say.
“The opposite of addiction is not sobriety, it is connection,” said addictions and harm-reduction journalist Johann Hari. His words ring true for Wilson, who hopes that as Gwa’dzi clients get their alcohol use disorder under control, they can begin to renew relationships that have been damaged because of their addiction.
For someone with severe alcohol use disorder, finding alcohol is a powerful urge that eclipses other essentials, such as eating, drinking water, taking medication or paying rent. If a client doesn’t need to worry about where to get alcohol, they are gradually able to pay attention to the rest of their life.
An ideal outcome, Bisaillon said, is like this. “Someone has been struggling with alcohol use disorder for several years, is intook to the program and finds that happy medium dose of alcohol. They’re in the program for 10 years, and never experience withdrawal. Maybe they’re able to reconnect with their kids, with family and friends. They can hold an apartment for the first time in who knows how long. Maybe they get a part-time job. And they stay in the program and have a daily connection with us.”
It’s clearly not a quick turnaround program; Bisaillon and Wilson envision clients getting this level of support as long as they need it, potentially the rest of their lives.
Getting off alcohol doesn’t need to be the goal either, they said. “This is why detox doesn’t work for a lot of people, because you’re hit with sobriety immediately and it can be terrifying,” said Bisaillon.
“There are lots of reasons people drink, and being able to think straight for the first time in however many years can be really scary.” This is where the daily check-ins and connection to other health supports like counselling, become extra important.
Port Hardy RCMP are also on board; Corporal Chris Voller has updated policy so that if a Gwa’dzi client is in RCMP custody, they will be allowed to receive their daily dose of alcohol and a check in from Bisaillon and Wilson.
Outside of custody, the RCMP supports the program but Voller said violations of the law or public safety will not be excused.
“We will absolutely support this program where able, but will not condone those who may purposefully, or throughout their battle with addiction, make a mistake and abuse it in a manner that lends to criminality,” Voller said.
“After years in policing, I know that addicts make mistakes, and it needs to be expected. Supporting them in their journey to a healthier lifestyle is important. We will be patient and fair, while balancing the greater community’s needs with those of the individual clients.”
Voller often points out the importance of “culturally competent policing,” which in this case means being aware of the traumas that can lead to alcohol-based addictions.
“A large number of the clients we serve here in Port Hardy are residential school survivors, and/or suffered through forced community relocation, as well as the many who are secondary victims of multi-generation traumas associated to both,” he said.
To those who may balk at letting people access alcohol in police custody, Voller asks, “Would you withhold insulin from a diabetic?” Of course not, and preventing the medical emergency of severe alcohol withdrawal should be treated similarly. Withdrawal in police custody is time-consuming from a police resourcing perspective. An officer has to take the patient to the hospital and stay with them; time that could be spend doing more proactive police work, Voller said.
“If it helps the client, assists our resourcing, and strengthens relationship with key stakeholders, it would be irresponsible not to support it,” he said.
Bisaillon and Wilson were hired by Gwa’sala-‘Nakwaxda’xw to start and run the program, which is being funded by the First Nations Health Authority for at least its first five years.
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