NSCSW Connection Fall 2022: Self-medication

THE ETHICS OF ALLYSHIP

NSCSW Conference & Annual General Meeting

Online, May 12-13 2023

Our annual conferences create opportunities for members of the Nova Scotia College of Social Workers and others in our communities to connect, plan, discover, and share knowledge. We hope to see you again next year.

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Contact N Siritsky at nsiritsky@nscsw.org

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C NNECTION C NNECTION

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Phone: 902.429.7799 Fax: 902.429.7650 Web: nscsw.org

LAND ACKNOWLEDGMENT:

The NSCSW is in Mi’kma’ki, the ancestral and unceded territory of the Mi’kmaq, whose inherent rights were recognized in the Peace and Friendship Treaties that were signed from 1725 to 1779.

This series of treaties did not surrender Indigenous land, resources or sovereignty to the British Empire, but instead established rules for an ongoing relationship between nations. The treaties were later reaffirmed by Canada in Section 35 of the Constitution Act, 1982, and remain active to this day. The NSCSW joins our members and our communities in the labour of reconciliation, and we are grateful to live and work together as treaty people in Mi’kma’ki.

Next issue: Winter 2023

Fall 2022 | Volume 5, Issue 2

CREATIVE DIRECTION & DESIGN: Brittany Pickrem, Branding & Design

EDITORIAL COMMITTEE:

Rebecca Faria (College Staff) Bernadette Fraser (RSW) Michelle LeBrun (PP) Christine Merrigan (RSW) Dermot Monaghan (RSW) Annette Samson (RSW) Margaret Schleier Stahl (RSW) N Siritsky (RSW, College Staff) Hannah Stewart (RSW) Rachel Smith (RSW, Committee Chair)

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COVER PHOTO: Untoxicated Queers

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Connection is © Copyright 2022 by the Nova Scotia College of Social Workers, and also reserves copyright for all articles. Reproduction without written permission from the publisher is not allowed.

CULTIVATING MENTORSHIP Become a Candidacy Mentor

WELCOME TO NSCSW April-October 2022

IN THE COMMUNITY Remember to Ask Why ADVOCACY More Than a Diagnosis

SPOTLIGHT Celebrating Our Community

ETHICS IN ACTION Moral Distress & Collective Advocacy RESEARCH Renaissance of Psychedelic Therapy

EDUCATION The Substance of Social Work

FEATURE Bearing Witness

Social work & Self-Medication

Alec Stratford, MSW, RSW Registrar/Executive Director

This issue’s focus on self-medication reflects our understanding that the use of chemical substances and distracting behaviours cannot be understood in isolation from the larger social context. This is at the core of our advocacy efforts. We advocate because we recognize that our members, and the communities that we serve, deserve better. The research, training and experience of our professional community compels us to affirm that changes in policy are desperately needed.

We are grateful to all our members and community allies who graciously shared their perspectives with us.

Our feature piece on page 26 collects the voices of many different people who support people from equity-seeking groups; from varied experiences a strong consensus emerges that current mainstream approaches do not work for many people in their communities.

Turn to page 11 to read a call for compassion from practitioners, and to page 16 for an exploration of how to resolve the moral distress that can arise from working within flawed systems.

On page 18 learn about the ways that psychedelic therapy research might be relevant to social work practitioners.

A social work educator from nearby Newfoundland calls for the creation of a new harm reduction collective on page 20, and argues for stronger inclusion of harm reduction in social work curricula.

Finally, we introduce you on page 12 to a preview of our next advocacy campaign that will debut in 2023, More Than a Diagnosis, which seeks to advance change within Nova Scotia’s addictions and mental health systems by amplifying stories from our communities.

I am so proud of our community for their willingness to engage in deep exploration of this important issue with enthusiasm, determination, curiosity, compassion, and grace. The primary mandate of NSCSW is to protect the public, but I am also continually reminded that it is a privilege to work with and for the social workers of Nova Scotia.

CULTIVATING MENTORSHIP

Candidacy mentors are an important link in the model for professional development within the membership of the Nova Scotia College of Social Workers. We would like to thank these mentors who have guided Social Worker Candidates through the successful completion of candidacy since April.

Janice Aitken

Taylor Barei Jacqueline Barkley Jenine Bateman

Kathy Bourgeois Courtney Brown Catherine Callaghan Amanda Cameron Brett Cameron Janet Cochran

Daisy Coleman Joline Comeau

Denise Crowell Kathleen Dodds

Alesandra Earle Lambert Deborah Erickson Coleen Flynn Anne Hoyston Nicole Hughes Paul Jenkinson Cindy Knapton Emma Lamptey Emily Lane Joline LeBlanc

Mary MacEachern

Kimberley MacLean

Lana MacLean

John MacNeil Michelle MacRae Meghan Mulcahy Alicia Nolan Dawn Peters

Lisa Richard Jillian Roach Pamela Roberts Megan Saunders

BECOME A MENTOR

Valerie Shapiro Michelle Stonehouse March Taylor-Burns Amy Theriault Michelle Titus Beth Toomy Michelle Jennifer Warburton Nicole Warren Thomas Williams

Mentorship is underscored by a climate of safety and trust, where candidates can develop their sense of professional identity.

We offer optional mentor training for members of the College, in the form of a self-directed online course. We also provide resources to help mentors support candidates’ learning throughout their candidacy.

To learn more about the rewards of being a mentor, visit candidacy.nscsw.org/mentors

CONGRATULATIONS & WELCOME

New Private Practitioners, Registered Social Workers, & Social Worker Candidates

Approved by NSCSW Board of Examiners April – October 2022

PRIVATE PRACTICE

Jey Benoit

Satie Borden

Melissa Bowman

Thea Clarke

Sarah Cowans

Rachel Derocher

Mackenzie Ells

Marian Farrell

Jennifer Fougere

Kalip Fraser

Jennifer Gracie

Matthew Hayes

Marsha Hudson-Ash

Marie Elizabeth Kavanaugh

Alexa Kroon-Canning

Anne LeBlanc

Anneliese MacPherson

Darcey Maillet

Amanda Matthews-Porter

Kristy Miller

Amber Newton

Brittany Orav-Lakaski

Amy Pinnell

Hanaa Rashid

Heidi Rodgers

Mario A. Rolle

Kristen Veinott

Rendell Witzell-Ratelle

Laura Young

REGISTERED SOCIAL WORKERS

Temitope Abiagom

Erin Baillie

Dayna Barnes

Melissa Blanch

Shandrea Bowes

Michelle Chisholm

Christa Clayton Meghan Corvec

Kristin Crowe

Tara Downey

Sarah Elson

Melissa Fanning

Krsitina Fifield

Kalip Fraser

Kyla Fraser Carrie Frazier

Jena Gilliland

Norma Gould Marissa Hadley Haley Heist

Jerrica Jackson Marisa Janes Katelyn Junus Laura Knight Tamsyn Loat Yvette Lombard Christine Merrigan Colin James Morrison Natasha Mosher Evelyn Mosher-Sabine April Peckham Emma Pringle Boutilier Nicole Ring Aliya Rubin Gillian Schmid Aziza Selim-Omar Cassandra Sinyerd Samantha Spencer Emily Spidle Kaitlyn Strickland Marsha Tanner Chao Tian Michelle Van der Meer Chantal Vien Michelle Williams Melissa Williams Meghan Youden

SOCIAL WORK CANDIDATES

Alexander Aaron Anna Aguayo Tasha Anderson Kendra Baltzer Paul Beaudoin Emma Beaudoin David Beretta Mathew Bergeron Madeline Bernard

Victoria Boutilier

Monica Boyd Mallory Breneol Teri Buffett

Kylie Bullerwell Robyn Buote Shauna Burke Chelsea Butler Zachary Cameron Jessica Chant Sharon Chapman Tarryn Chatz Rose Cassandre Collins Katherine Cripps Molly Crosby Kristen Cudmore Jenna Cunningham Katelyn Currie Mirelle d’Entremont Melissa Dillman Brayden Doucet Lindsey Drake Theresa Driscoll Maya El Haddad Cara Fabre

Amanda Fenton Paige Field Lesley Finch Ngum Fonutchi Brittany Foran Allison Fraser Maya Fry Sandra Gauthier Kelly Godfrey Carlos Gomes Juliana Gomes Pontes Trusha Gordon Taylor Halloran Katelynn Hashem Susan Hill Jennifer Horne Mairi Hughes Mckay Shelley Ibbotson Brooke Johnson Bijo Joseph Karen Kehoe

Klaus Knierim Paige Korth

Arvinder Lakhi Gabrielle Lambert Melissa LeBlanc Dawn Leblanc Janvier Lesjeans Sarah Liberty Suresh Lukose Kaylie Mackeen Andrea MacKinnon Mareena Mathew Preston Matthews Jessica McCann Breton McVicar Emma Meulenkamp Hannah Moore Tate Morrison Elaine Mousseau Cyril Mudakkalil Heidi Muise Kassandra Myer Aisha Okpo Michael Olenik Stacey Oliver Ramesh Pandey Jasmine Paul Chantal Paupin Breanna Peters Jennifer Robinson Leah Salsman Krista Schnare Jalyssa Shadbolt Rupesh Shrestha Mary Snow Jessica Steele Kendra Sweet Megan Tobin Alicia Tompkins Kristal Tucker-Clarke Jobin Varghese Hailey Weldon Kamla Williams Rebecca Wood

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REMEMBER TO ASK WHY

Pathways to societal healing

Substance use is one of the most polarizing topics in today’s society. It is often regarded through a moral lens, meaning it is either right or wrong, or the person is either good or bad. It can manifest as self-medication when substances are misused as an attempt to manage the troublesome symptoms of a mental health disorder or other chronic health condition. Although understanding the what of self-medicating is important, the more pressing issue is: why are more and more people using self-medication as a way to cope in today’s society?

We live in a world that often creates the condition of suffering.

Whether this is through lived experiences like intergenerational or personal trauma, societal woes like living through a global pandemic, war, layers of oppression and discrimination leading to stigma and bias, and/or the multiple inequalities that influence the social determinants of health, suffering can be found all around us. These stigmas can become deep rooted in an individual, leading to a drain on their mental health and overall wellbeing. Escaping from this felt experience can seem like an attractive option. Substances, early on, can be a potential pathway to escape, and may be an individual’s attempt to feel better. Unfortunately, remaining on this pathway can lead people to further suffering.

Addiction expert, physician, psychologist, and author Dr. Gabor Mate famously says the more important question we need to be asking people is not “Why the drug?” but “Why the pain?” If we can help an individual understand why they are running from their authentic self, we are in a better position to help them reconnect with themself and engage in the hard work of breaking the cycle of self-medication.

Self-medicating and substance misuse are often seen as an individual’s struggle. I believe that what is really needed to stem the tide of addiction is a shift to thinking about self-medication and substance misuse from the lens of societal recovery Examining the way that we are with each other, how we treat people, and how we are with ourselves may help us realize

the truth in author Jonah Hari’s message: “the opposite of addiction isn’t sobriety, the opposite of addiction is connection.”

Adolescents, who are sometimes overshadowed in this discussion, are not immune to self-medicating. Adolescence can be a time of experimentation with a wide variety of experiences, one being the use of substances. The pressure youth face in adolescence is an exhausting list. Along with the perils of ‘normal’ adolescent development, it is also a time of longing to belong, and the development and redevelopment of personal identity that can be toppled by societal pressures. For some adolescents this can be a smooth transition that supports the development of resiliency and character. For others, this can take a toll on mental health and overall wellbeing.

Our brains are wired to remember what feels good, so we do not easily forget that dopamine gives us a little rush. If an individual feels miserable about themself, if their mental health is riddled with low mood and anxieties, if they have experienced chronic and complex trauma, the benefit of feeling good again through self-medicating might outweigh other considerations. Therefore, it is important to debunk the myth of ‘gateway drugs’ and turn the conversation towards gateway experiences

As psychologist and author Dr. Bruce Alexander discovered through his Rat Park experiment, it is not the drug itself, but a person’s cage that leads to struggle with addiction and/or self-medicating. Self-medication behaviours and strategies are a by-product of not being able to say aloud “I am struggling,” ‘I am not doing alright,” “I am not fine,” or “I need help.” I believe we need to expand our view on addictions to include the discussion around why people use and maybe when why some people develop struggles with addiction while others can remain as social or recreational users. It is time to start talking about pathways to the deconstruction of these cages so that we can move forward with societal healing.

JEFFREY THOMS, MSW RSW, is a mental health professional who works with young people and their families in Halifax, Nova Scotia.

MORE THAN A DIAGNOSIS

Statistics tell us that we are at a crisis point: addiction and mental health problems are at an all-time high. Social workers, along with countless other health care professionals are burning out. Too often, not unlike the clients we serve, we also may turn to unhealthy coping strategies to try to keep moving forward.

For all of us humans, it can feel like we are all running on a treadmill that is getting faster and faster with each new crisis.

Hurricanes, mass casualty events, pandemics, inflation, managerial policies of severity and funding cuts… the harder we work, the more it seems like things are getting worse. It is not surprising that so many people want to give up. Growing numbers of us are turning to self-medication, addiction and other strategies to try to numb themselves just enough to try to make it yet another day.

Our NSCSW social justice committee, in partnership with Dr. Catrina Brown and her research team, recently organized

a mini-conference on mental health and social justice. The researchers confirmed the findings that had been presented in our 2021 Repositioning report about social work’s place within Nova Scotia’s mental health system, and have continued their inquiry across Canada. Nearly every social worker employed in the field of mental health and addictions is experiencing severe moral distress because their skills are not being utilized appropriately. Rather than working to help clients understand the historic and systemic roots of their feelings and challenges, these clients are diagnosed and medicated. If they do receive counseling, their “therapy” consists of being told of the cognitive fallacies in their thinking, and they are encouraged to engage in “behavioural activation” to makes them forget their problems.

We believe that the time has come for our profession to transform adversity into opportunity. Social workers are uniquely positioned to lead social change, and yet often, are amongst the most challenged to do so, for precisely the same reason: we live and work at the intersections of oppression and liberation. We are drawn to theories that rely upon strengths-based principles, but sometimes forget to see how that applies, not just to our clients, but to ourselves and the systems within which we function.

Every day, we behold the injustices of systemic racism, queerphobia, oppression and institutional colonization, bearing witness to the enduring impact of intergenerational trauma, and advocating for those at the margins of society.

Every day, we behold the injustices of systemic racism, queerphobia, oppression and institutional colonization, bearing witness to the enduring impact of intergenerational trauma, and advocating for those at the margins of society.

Social work is a profession that listens, deeply.

We can hear the resounding call for justice in the individual cry for help, as well as in organizational and systemic strategies to either respond or silence this cry. Our collective task is to connect these dots: to link our advocacy efforts with our therapeutic interventions and group work. We must listen, connect and sift through the different voices and perspectives, to clearly identify those voices, theories and labels that serve to maintain the status quo, and amplify those voices and perspectives that are working to shift us toward justice and wellness.

We are therefore advocating for a profound shift in the way mental health services are currently being delivered, away from addressing mental health concerns as if they were purely biological and medical conditions, or ones that short-term individual counseling can resolve alone.

• We believe that no amount of individual, short-term behavioural therapy or pharmaceutical medication will be enough to fully help someone whose struggle against systemic barriers of poverty, oppression and discrimination has led them to a place of hopelessness.

• We believe that our well-being is inextricably linked with the well-being of every other living being, and the wellbeing of the eco-system within which we live.

• We also believe in the therapeutic benefit of clients recognizing the root systemic causes of their symptoms of distress.

• We affirm that any policy to address mental health services in Nova Scotia must be part of a plan that centres the social determinants of health.

• We request that all policy be developed, grounded in the voices and perspectives of first-voice community members, clients and other stakeholders.

Committed to social justice and community organizing, values at the core of our profession, and armed with compassion for our clients and a passion for change, our profession has the potential to represent a tremendous threat to those in power.

This is the power of social work: our ability to listen, our ability to connect with others, and our ability to see the connections between individuals, organizations and communities. What sets social work apart from all other disciplines is this ability to hear the thematic connections between the micro, mezzo and macro dynamics. We are the connectors and the brokers. We are the ones who make the connections between individuals and community resources. And in this, lies the resilient triumph of our profession.

While individually, our voices may sometimes be silenced, we have the ability to turn our individual setbacks into a powerful network of advocacy, specifically thanks to our unique social location and diverse skillsets. We are not alone. There are thousands of us. And each of us are embedded in communities, and working with clients who are embedded in communities.

We will therefore be launching a campaign in 2023 that invites our community to share their stories of why they believe change is both necessary and possible, and why each of us — whatever our challenges or strengths may be — deserves to be seen as more than a diagnosis. Stay tuned to learn more about how you can participate.

We have tremendous power- if we stop internalizing our distress and medicating it, but rather join together with so many others who have been silence, repressed or oppressed. Let us reclaim our voice, and in so doing, fight back from the pathology, alienation and fragmentation that maintains the status quo.

CELEBRATING OUR COMMUNITY

We are proud and gratified to recognize the contributions of social workers in our province every year! We gathered this fall to honour our award winning social workers and committed community allies, as well as our amazing volunteers, committee chairs, and all of the dedicated social workers in Nova Scotia who contribute to our profession and enable us to advance our mission.

Our guest speaker at this year’s virtual awards gala was Robert Wright, RSW, who spoke passionately about embracing the dynamic tension between professionalism and activism.

Jim Morton has been contributing to service delivery in the public and private sectors as a clinician, administrator and consultant for almost five decades. Those who know him soon learn of his commitment to the idea that no individual human being can be understood apart from their connections to family and community and that the world’s abundance must be shared fairly amongst all of us.

Jim is deeply grateful for his membership in the social work community and for the guidance, support, collegiality and friendships he has been privileged to enjoy since joining the Nova Scotia Association of Social Workers in 1975.

Three priorities guide Jim’s life: family (his own and family systems theory); literature (what would life be like without Middlemarch, Under the Net or My Antonia?); and politics, where canvassing a neighbourhood, making a fundraising call or organizing an NDP election campaign are his effort to build social work values and an end to poverty into legislation. The words of J.S. Woodsworth’s (one of the first social work educators in Canada) inspire Jim’s thinking about our profession and politics:

“We are thankful for these and all the good things of life. We recognize that they are a part of our common heritage and come to us through the efforts of our brothers and sisters the world over. What we desire for ourselves, we wish for all. To this end may we take our share in the world’s work and the world’s struggles.”

CASW Distinguished Service Award

JIM MORTON

Ronald Stratford Memorial Award

Ryan Gould is Mi’kmaq, and was born and raised in Membertou, NS. He is the 38-year-old father of six beautiful daughters. I have my best friend, and an amazing woman by my side Samantha Smith. A journeyman plumber for 11 years, Ryan is an accomplished tradesperson and business owner, and serves as the apprenticeship coordinator for the Mi’kmaq Economic Benefits Office in Membertou.

Ryan is also the co-founder and president of the Membertou Men’s Society (MMS), a non-profit organization aimed to raise awareness, provide loving support, and reduce barriers to services, for Indigenous and nonIndigenous men of all ages who may be struggling with mental health or addiction challenges. It is in that capacity that we met Ryan, as he spoke at our inaugural Advocacy Day in March 2022.

Proud and grateful to be five years sober from cocaine and alcohol, Ryan now volunteers and serve on the board of directors for many amazing local charities, including Three Brothers Project, Worth Living, The Breton Ability Centre, Canadian Mental Health Association, Roots of Hope, PC Party Diverse Communities Committee, and Membertou Inter-agency Committee .

David William Connors Memorial Award

Alexandra tells us that she became a social worker largely by accident. After completing an undergraduate degree in English and philosophy and a graduate degree in philosophy, she then realized there were very few jobs that enabled or encouraged people to think and argue about ethics and the human condition. At that point she was encouraged to apply to the Dalhousie School of Social Work, and completed an MSW.

Since then, she has been a clinical social worker for the child and adolescent mental health team on the south shore. Both in the public system and in her private practice, Alex has worked with and learned from colleagues in multiple disciplines, particularly about the context of people’s lived experiences and how these affect their involvement with the services provided by mental health practitioners and as social workers.

EARLE-LAMBERT, RSW

Alex considers herself incredibly privileged and humbled to spend her days holding space for the experiences of individuals, and being able to play even a small role in improving the lives of children and their families. She believes that people are doing the best they can with what they have; witnessing their desire and hope to overcome adversity continues to drive her.

Social Justice Ally Award

This award recognizes a member of our community – specifically someone who is not a social worker – who has used their position or social standing to advocate for the role of social workers in serving the public good, and who advances our ethical mandate to work toward the establishment of equity and social justice. We are grateful that Tristan was able to join us as a panelist for our inaugural Advocacy Day in March, and again during our conference in May.

Tristan engages in research and advocacy for first voice led (emic) approaches to social systems change. Some common themes are housing, youth services, and accessibility. His “work” builds on his experiences with mental illnesses, addictions, and homelessness, through the lens of his identities as an autistic, disabled, and queer person.

Tristan is also in the fourth year of therapeutic recreation at Dalhousie, which has helped him to more effectively communicate with service providers both professionally and as a client. Tristan shared with us that he is grateful for the opportunities to advocate for meaningful inclusion of people the systems were built to exclude. He is aware of his privilege as a white settler student and trans man, and uses it to amplify marginalized voices into leadership positions.

RYAN GOULD

ALEXANDRA

TRISTAN KOWAL

MORAL DISTRESS & COLLECTIVE ADVOCACY

Moving beyond individualization of ethical struggle

As social workers who labour in systems, we are embedded in structures and processes designed to maintain the status quo, what Dorothy Smith (1996) so aptly terms “relations of ruling.” This embeddedness has been exacerbated by changes to the social work profession over the last two decades such as the marketization of social welfare. Our sphere of action as social workers has shrunk alarmingly and we often have little power to address clients’ needs. Support for recognizing, let alone exploring, ethical struggles in the workplace appears to have evaporated under managerialism. Also, organizational discourse often employs middle-class language to frame moral distress as individual rather than systemic and structural.

In the situations of moral distress I have experienced, I have felt frustrated and powerless even when I have acted in good faith to resolve them within the web of relationships in the organization.

Predominantly I have felt torn asunder by tentacles of violence that both pummel from a distance and buffet the workplace. Violence is pervasive in our Western colonialist capitalist society; it is normalized, legitimized, and socially tolerated as the way it is. Think of the everyday violence carried out here in Canada and globally. There is the violence of class and other “isms” perpetuated and legislated by our political and economic institutions, ensuring vast inequalities of income and wealth as well as inequities in access to health care. The violence of the fossil fuel industry and the governments subsidizing it are destroying the Earth and all her living things. And then there is the violence of driving Indigenous peoples from their land and demolishing their “life-worlds” (Ghosh, 2021, p. 67) in the Amazon and elsewhere. We live daily

with the violence of corporations toward labourers, citizens, and the natural world, i.e., mining projects in Canada and abroad, or the recently reported corporate concentration of agribusiness controlling the production, distribution, and pricing of food across the globe. We often fail to connect the violence of the political economy to our experiences of moral distress in the workplace, instead drawing a line about causes at the walls of the organization.

These tentacles of violence encompass the often futile social work task of trying to marshal scarce or non-existent resources for clients, i.e., helping a client find decent and affordable housing or resolve an issue for which there are no cross-institutional policies. Frustration and anger are healthy responses to systemic and structural issues much larger than the individual client. At an organizational level, managers may be unable or unwilling to act or problem-solve to support staff facing moral distress. Violence erupts from a particular set of values to constrict the political choices of politicians and citizens, choke off life-giving public policies, and incapacitate hierarchical bureaucratic systems to disregard workers and clients (citizens). Thus, moral distress generated by such violence cannot be resolved by individual advocacy, by moral courage, or by unrelenting rage because the situations that produce it have their roots in oppressive values, systems, and structures.

An alternative definition of moral distress may help us appreciate the range of emotional responses to moral compromise: “One or more negative self-directed emotions or attitudes that arise in response to one’s perceived involvement in a situation that one perceives to be morally undesirable” (Campbell, Ulrich & Grady, 2018, p. 67). I have certainly experienced the erosion of self-respect, purpose, and even of the life force itself. Feeling powerless, anguished, trapped,

torn, isolated, ashamed, guilty, angry, and contaminated are common to the experience of moral distress and these feelings are usually cumulative. Moral distress can trigger trauma as well as contribute to burnout. We may turn to self-medicating to quell the tumult in our interior, whether to alcohol, drugs (prescription and non-prescription), gaming, or comfort eating, among the many efforts to self-soothe and deal with painful emotions. I contend that if there were nourishing and safe spaces to process ethical challenges in the workplace, our moral suffering would diminish significantly. We might also consider, morally, what concern and respect organizations owe us as employees.

Our moral integrity as professionals must be recognized and fostered by the culture of our workplaces, that is, by an ethical climate (Olson, 2018). The creation of moral spaces such as ethics rounds is one such avenue that can lessen moral distress (Pavlish, Robinson, Brown-Saltzman & Henriksen, 2018). Ethics rounds can promote a moral community in which to clarify values and obligations; learn from difficult situations; encourage creativity; engage in ethics education; strengthen communication; identify the systemic and structural roots of moral distress; and counter powerlessness. Through reflection on, and critical analysis of, our practice, we can gain clarity over time about how we understand and enact our moral agency as well as internal and external constraints on agency. The “systemic dimension” of moral distress can be collectively tackled through action emerging from ethics rounds (Grady et al., 2018, p. 169). Nancy Berlinger suggests collective advocacy by teams in order to funnel the issues to people in the hierarchy with more power to push for change and hold systems accountable (Grady et al., 2018). Such action is integral to social justice practice.

One of our moral strengths as social workers is to do our best for clients and simultaneously, to be ethical for ourselves.

In order to do our best, the scaffolding has to be in place to fulfill our professional commitments. The violence of the political economy saturates social work. What produces moral suffering in us as social workers is always already affecting clients. Carrying this burden in isolation is untenable. Moral distress must be collectivized and critically analyzed, turning the gaze from individual workers to systems and the structural violence endemic to our “modern” and “civilized” world.

REFERENCES:

Campbell, S. M., Ulrich, C. M., & Grady, C. (2018). A broader understanding of moral distress. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 59-77). Switzerland: Springer International Publishing AG.

Ghosh, A. (2021). The nutmeg’s curse: Parables for a planet in crisis. Chicago: University of Chicago Press.

Grady, C., Berlinger, N., Caplan, A., Davis, S., Hamric, A. B., Ketefian, S., Truog, R., & Ulrich, C. M. (2018). Reflections on moral distress and moral success. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 159-171). Switzerland: Springer International Publishing AG.

Olson, L. L. (2018). Building compassionate work environments: The concept of and measurement of ethical climate. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 95-101). Switzerland: Springer International Publishing AG.

Pavlish, C. L., Robinson, E. M., Brown-Saltzman, K., & Henriksen, J. (2018). Moral distress research agenda. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 103-125). Switzerland: Springer International Publishing AG.

Profitt, N. J. (2021). The political language of moral distress. Connection, 4(2), 16–18. Retrieved from https:// issuu.com/nscsw/docs/connection_fall_2021_webready_ final/s/13760458. Smith, D. E. (1996). The relations of ruling: A feminist inquiry. Studies in Cultures, Organizations and Societies, 2(2), 171-190.

Varcoe, C., Pauly, B., Webster, G., & Storch, J. (2012). Moral distress: Tensions as springboards for action. HEC Forum, 24, 51-62.

DR. NORMA JEAN PROFITT, RSW, is a social activist who holds her PhD in social work from Wilfrid Laurier University, and is a former associate professor in the School of Social Work at St. Thomas University. She was the recipient of the Governor General’s Award in 2016.

This piece is a follow-up to her previous article in this magazine; “The political language of moral distress” (Connection, Fall 2021) explored how systemic and structural injustice affect social workers, both as practitioners and as citizens of their communities.”

RENAISSANCE OF PSYCHEDELIC THERAPY

Psychedelic substances have been used for millennia around the world, notably by many Indigenous traditions, for a wide range of purposes such as healing, improved well-being and communing with the divine. Promising scientific research had been carried out during the 1950’s and 1960’s regarding the potential therapeutic benefits of psychedelic substances in treating a wide range of mental health disorders however much of the research ceased when the rhetoric of the “war on drugs” began and these substances became illegal, both clinically and at the street level.

In recent years however there has been a massive resurgence of interest in the therapeutic potential of psychedelic substances as mental health clinicians and clients alike recognize the limits in the efficacy and extensive time frames of traditional treatments such as talk therapy and pharmaceuticals.

An ever-growing body of research is exploring the safety and efficacy of a wide range of psychedelic substances such as LSD, DMT, psilocybin, MDMA and ketamine for the treatment of mental health disorders ranging from anxiety, depression, addictions and PTSD to end-of-life anxiety in clients who have been diagnosed with terminal illnesses.

One non-profit organization heading clinical trials is the Multidisciplinary Association for Psychedelic Studies (MAPS) which has been studying the safety and efficacy of MDMA as an adjunct to therapy for veterans experiencing PTSD. Dubbed an “empathogen” and not considered a “classical psychedelic,” MDMA has shown much promise in treating socalled “treatment resistant” PTSD as an adjunct to Cognitive Processing Therapy (CPT) as MDMA’s effects include increased feelings of safety, trust and pro-social experiences that allow the therapeutic relationship to access long defended thoughts, feelings and memories without the client becoming overly dysregulated.

The Johns Hopkins Center for Psychedelic and Consciousness Research has been studying the safety

and efficacy of psilocybin, commonly referred to as “magic mushrooms,” for the treatment of depression and end-of-life anxiety in clients diagnosed with terminal cancers, providing encouraging results.

A particularly interesting study was published in the New England Journal of Medicine in April 2021 by Dr. Robin Carhart-Harris and his team which compared the safety and efficacy of psilocybin and escitalopram, a commonly prescribed SSRI antidepressant medication. The researchers found that the reduction of self-reported depression symptom scores was more significant and occurred more quickly in the psilocybin group than those in the escitalopram group, however larger studies are needed. While this was a small study, comparing the safety and efficacy of psychedelic substances with traditional pharmaceuticals marked an exciting development in psychedelic research.

In May 2022 a phase 2 clinical out of University Hospital Basel in Switzerland found that large doses of LSD were safe and effective in treating anxiety in a rapid manner. In June 2022 a study published in Scientific Reports demonstrated that microdosing psilocybin, the practice of regularly consuming a sub-perceptual dose of a substance, resulted in improved mood and mental health. In July 2022 a study published in Molecular Psychiatry called into question the widely accepted theory that depression is caused by a “chemical imbalance” in the brain, namely the imbalance of the neurotransmitter serotonin. The serotonin theory of depression has been the underlying assumption behind SSRI pharmaceutical treatment for decades and this new review of the literature could lead clients, clinicians and physicians alike to explore other treatment options such as psychedelic therapies. In August 2022 a study published out of NYU offered compelling evidence of the significant therapeutic potential of psilocybin when used as an adjunct to psychotherapy for the treatment of alcohol use disorder.

A Canadian non-profit organization called Therapsil is interested in “the use of psilocybin in the compassionate treatment of end-of-life emotional distress” associated with terminal illnesses, while honouring the Indigenous traditions in which psilocybin ceremonies originated. Therapsil has created a Health Canada approved treatment modality and has been offering psilocybin therapy for clients who have been granted federal permission to have and use psilocybin under a section 56 exemption of the Controlled Drugs and Substances Act.

Therapsil also advocates for expanded access to psilocybin for the treatment of other mental health concerns and for

a move from the exemption model to a regulation model, arguing that Canadians are supposed to have a right to choose their treatments. As of January 2022 Health Canada amended its Special Access Program however the process for clients wishing to access this treatment remains challenging and inaccessible for many.

Continued advocacy is needed to spread awareness, reduce barriers to and challenge long standing stigma associated with psychedelic therapies. Master’s level social workers with training and experience in psychotherapy are able to complete Therapsil’s training program to offer therapeutic support to clients who are receiving psilocybin via section 56 exemptions, though barriers remain for clients wishing to access this revolutionary treatment as several Therapsil trainees including social workers, physicians and nurses were recently denied section 56 exemptions which are needed to complete the experiential component of the training. A large number of clients await this treatment as the demand for the therapy currently outweighs the number of trained therapists.

While social workers do not prescribe medicine, and are not qualified to administer psychedelic substances themselves, research and advocacy in this areas might be considered part of our larger decolonization work. The mechanisms of colonialization – including displacement, forced assimilation, and Eurocentric medical and legal systems – have discredited and criminalized Indigenous wisdom regarding these medicines. As research and practice continue to develop, it’s important that those Indigenous traditions be recognized and honoured without being appropriated.

In safe sets and settings with trained therapists, psychedelic therapy offers a promising and expedited alternative to the treatment of mental health symptoms. As the body of research grows more and more compelling, there is much hope that evidence of safety and efficacy of psychedelic therapies will also serve to challenge the current prohibition model of substance use in Canada, based on the failed “war on drugs” rhetoric, and usher in a trauma-informed harm reduction approach to drug policy that could save lives and improve quality of life, while potentially easing pressures on both the healthcare and the legal systems as calls for decriminalization and regulation continue to grow in volume.

MELANEY WHITE, RSW is a social work clinician in Halifax, Nova Scotia. Her specializations include assessments and therapeutic interventions for people experiencing addiction.

THE SUBSTANCE OF SOCIAL WORK

Notes on the conspicuous underrepresentation of harm reduction & substance use education in Canadian social work curricula

PROPOSITION #2:

Substance use, harm reduction, and the meaningful engagement of people who use drugs represent a conspicuous absence in Canadian social work curriculum. I argue that a praxis-based toolkit is necessary to support social workers to openly embrace - and directly integrateharm reduction in all aspects of policy, pedagogy, and professional practice.

PROPOSITION #1:

Substance use is a core, central issue in literally ALL areas of professional social work practice.

Regardless of the specific sub-field social work practitioners may choose to pursue – from gerontology, to child welfare, to housing – the use of psychoactive substances is a crucially important, central issue in literally all areas of professional social work practice. Be it in the form of older adults mixing up medications, child removal due to parental drug use, or individuals being evicted from social housing due to relapse, substance use is one of the single most critical issues common to every imaginable area of social work policy and practice. As I often inform students from the outset of my course on substance use: “You needn’t go looking for it –regardless of what path you pursue, within your first week of professional social work practice, issues relating to substance use will find you.” Here, student course evaluations have repeatedly called for making this elective BSW course a degree requirement.

Despite its ubiquity in practice, substance use education represents one of the most underrepresented aspects of social work pedagogy across Canada.

Seeking to identify patterns and trends in Canadian social work training and research, Rothwell et al. (2015) conducted content analysis of social work dissertations. Utilizing preestablished topic categories, Rothwell et al. (2015) reviewed 248 social work dissertations published between 2001 and 2011, determining that substance use comprised less than 1% of all dissertations published during this period. Situating substance use as a ‘key practice area,’ Rothwell et al. (2015) noted that Canadian schools of social work have “produced few scholars who can teach […] or produce research” regarding substance use (p.60).

More recent research clearly illustrates the highly marginalized status of substance use education in Canada. In their investigation of ‘the substance of social work’, Smith, Andrews, and Tobin (2019) revealed that an alarming 13% of English-language schools of social work across Canada lacked any content on substance use. Among the 87% of institutions that did, however, the vast majority (96%) were ‘elective’, while less than 5% of course(s) were ‘required’ (Smith, Andrews, & Tobin, 2019). In the absence of strong personal interest, most BSW students in Canada are, therefore, graduating with little, if any, knowledge of harm reduction, or other fundamentally important tools for working with PUD. In other words, the overwhelming majority of BSW grads are thus woefully unprepared to meaningfully engage with people who use drugs (PUD) – a fact that is particularly alarming in light of the devastating impact of covid-19 on skyrocketing overdose rates from coast to coast.

PROPOSITION #3:

Regardless of (a) almost 30,000 deaths in Canada due to the ongoing opioid epidemic from 2016 to 2021 (Public Health Agency of Canada [PHAC], 2022), (b) glaring similarities between the ethical imperatives of social work and the ideology of harm reduction (Vakharia, 2014), and (c) a rapidly growing body of scholarly evidence, national and provincial regulatory bodies demonstrate continued reluctance to embrace harm reduction training.

Community-based and user-driven forms of harm reduction represent a form of living praxis, “creating fluid, in/formal spaces where practice can adapt to accommodate changing community needs” (Smith, 2012, pp. 215-216). Here, the lack of a commonly accepted definition is a strength, although the amorphous nature of harm reduction is precisely why social work authorities are wary of its integration as a core ethical principle. Harm reduction has thus come to represent

a threat to regulatory bodies, which have a vested interest in policing social work’s fundamentally interdisciplinary – and inherently porous – disciplinary boundaries.

Offering what is perhaps the most comprehensive and progressive definition, Harm Reduction International (HRI) acknowledges the contested nature of harm reduction (2022). Similarly “grounded in [social] justice and human rights,” and focused on “working with people without judgement, coercion, [or] discrimination,” the terms ‘harm reduction’ and ‘social work’ are seamlessly interchangeable in HRI’s definition (2022, para. 2). In spite of its obvious complementarity with social work ethics, however, harm reduction remains neglected by social work educators and regulatory institutions. Articulating its commonly accepted principles, HRI (2022) goes on to details other facets of harm reduction that are seemingly incommensurable with social work, including (1) the “meaningful involvement of people who use drugs in designing, implementing and evaluating programmes and policies” and, (2) the goal of providing “alternatives to approaches that seek to prevent or end drug use” (para. 11). Given their implicitly moralizing –and increasingly deafening – silence on this issue, provincial and national social work regulatory bodies should therefore be strongly encouraged (read: required) to adopt standards of practice that ensure harm reduction is embraced as a normalized, central aspect of BSW education at schools of social work across Canada.

PROPOSITION #4:

Substance use education in Canadian social work curriculum shares an uncanny number of characteristics with Canada’s current drug supply, widely characterized as inconsistent, unsafe, and increasingly toxic.

Drawing from the growing body of literature on the intersections between social work and harm reduction, politicized practitioners must begin by calling for the widespread incorporation of harm reduction into all aspects of social work policy, pedagogy , philosophy, and practice, irrespective of any perceived challenges or points

of disconnect. Equally important, however, is the task of establishing what can be referred to as a metaphorical form of safe supply in social work curriculum– a permanent, stable, standardized place for substance use education that is explicitly rooted in harm reduction praxis1

As illustrated by federal and provincial regulatory bodies, who, in turn, govern the conduct of individual social workers across the country, the substance of social work in Canada today is unquestionably fragmented, marginalized, and apolitical. I remain steadfast in my conviction, however, that with sustained, concerted, collective effort, the ideologically toxic state of substance use education in Canadian social work can be overcome through a reorientation of policy, pedagogy and practice that entails two distinct approaches. First, we must all acknowledge the close, complementary, symbiotic relationship between the philosophy of harm reduction and the ethical imperatives of social work in Canada (Vakharia,

1. One recent example of how regulatory bodies such as the Canadian Association of Social Work Educators (CASWE) have started to explore the relevance and application of harm reduction can be seen in the Opioid Use and Opioid Use Disorder Project. Undertaken in collaboration with both the Canadian Association of Schools of Nursing (CASN) and the Association of Faculties of Pharmacy of Canada (AFPC), this project was conducted by a committee consisting of both educators invested in substance use and a group of PUD, who consulted with countless stakeholder groups from across Canada to compose both Interprofessional Education Guidelines on Opioid Use and Opioid Use Disorder, along with a series of web-based training modules “developed for students and faculty […] who wish to learn independently”. To access the guidelines and/or web-based modules, see: https://caswe-acfts.ca/opioid-use-and-opioid-use-disorder-project. Although I was directly involved in all aspects of this work, in order to create meaningful, lasting change, I strongly believe that such initiatives must be transformed into required, everyday elements of social work curriculum.

2014; Vakharia & Little, 2016). Second, it is crucial to both re-establish a permanent, central, required place for substance use education in Canadian social work curriculum, and, moreover, call for the explicit adoption of harm reduction – in all of its complexity, fluidity, and multiplicity – as a core ethical principle of Canadian social work. Ethically, however, these objectives must take place in a relationship of collaborative autonomy with PUD (Cheng & Smith, 2009), involving a fundamental shift in the role of – and relationship(s) to – drug/service users (Smith, 2012). As they undeniably denote a “passive, one-way relationship to capitalist forces of production/consumption” (Smith, 2012, p. 211). here, we might begin by abolishing terms such as client and consumer from social work discourse.

Just as the U.S. Drug Policy Alliance produced Safety First, a harm reduction-based drug education curriculum intended to displace the ubiquitous D.A.R.E. program (Rosenbaum, 2019), in other words, social workers need a substance use toolkit that involves more than uncritically echoing ‘ just say no ’ and/or making repeated referrals to abysmally ineffective 12-step programs (Flanagan, 2014; Martin, 2011). As these objectives will invariably represent a threat to the very foundations of social work as a (paternalistic?) ‘helping profession,’ we must assume that our reorientation efforts will not be initiated in a top-down fashion by the regulatory institutions that govern practice.

If 30,000 opioid-related deaths over a five-year period hasn’t catalyzed change on the part of these authorities, in other words, what will ? Instead, like most historical struggles for social justice, such changes must begin from the bottom up – by Canadian social workers coming together in solidarity to demand change. Following the example of nursing, where politically committed individuals established the national Harm Reduction Nursing Association ( hrnaaiirm.ca ). If only as a forum through which to continue this discussion, I thus conclude with an open call for educators, practitioners, students ,and service users to assist in forming a Canadian Social Work Harm Reduction Collective . As I sometimes playfully, cryptically remind my BSW students: your future is political . During a period in human history when the stakes of passivity and apathy are, quite literally, life and death , be it in the dimensions of policy, pedagogy, or practice, the only remaining question is, therefore, what role will you play?

REFERENCES:

Canadian Association of Social Work Educators (CASWE), Canadian Association of Schools of Nursing (CASN), and Association of Faculties of Pharmacy of Canada (AFPC). (2020). Interprofessional Education Guidelines on Opioid Use and Opioid Use Disorder. Retrieved from https://caswe-acfts. ca/opioid-use-and-opioid-use-disorder-project/

Cheng, R., & Smith, C. (2009). Engaging people with lived experience for better health outcomes: Collaboration with mental health and addiction service users in research, policy, and treatment. Toronto, ON: Ontario Ministry of Health and Long-Term Care. Retrieved from http://opdi.org/index.php/ knowledgeexchange/opdi_reports/

Flanagin, J. (2014, March). The Surprising Failure of 12 Steps: How a pseudoscientific, religious organization birthed the most trusted method of addiction treatment. The Atlantic Monthly https://www.theatlantic.com/health/ archive/2014/03/the-surprising-failures-of-12-steps/284616/

Graves, G., Csiernik, R., Foy, J., & Cesar, J. (2009). An Examination of Canadian Social Work Program Curriculum and The Addiction Core Competencies, Journal of Social Work Practice in the Addictions, 9(4), 400-413. DOI: 10.1080/15332560903212595

Martin, C. (2011, January). The Drunk’s Club: AA, The Cult That Cures. Harper’s, 29-38.

Public Health Agency of Canada. (2022). Apparent Opioid and Stimulant Toxicity Deaths: Surveillance of Opioidand Stimulant-Related Harms in Canada, January 2016 to December 2021 https://health-infobase.canada.ca/ substance-related-harms/opioids-stimulants/ Rosenbaum, M. (2019). Safety First: A Reality-Based Approach to Teens and Drugs. New York: Drug Policy Alliance. https:// drugpolicy.org/resource/safety-first-reality-based-approachteens-and-drugs

Rothwell, D.W. Lach, L., Blumenthal, A., & Akesson, B. (2015). Patterns and Trends of Canadian Social Work Doctoral

Dissertations. Journal of Teaching in Social Work, 35(1-2), 46–64. https://doi.org/10.1080/08841233.2014.977988

Smith, C.B.R. (2012). Harm reduction as anarchist practice: A users’ guide to capitalism and addiction in North America. Critical Public Health, 11(2), 209-221. http://dx.doi.org/10.108 0/09581596.2011.611487

Smith, C.B.R., Andrews, S. & Tobin, C. (2019). The Substance of Social Work: (Re-)Mapping the ‘Place’ of Substance Use Education in Canadian Social Work Curriculum. Primary Healthcare Partnership Forum (PriFor) 2019: Learning Health Systems. Memorial University, Signal Hill Campus, St. John’s, NL, 27-28 June 2019. (Poster Presentation).

Vakharia, S. P. (2014). Incorporating substance use content into social work curricula: Opioid overdose as a micro, mezzo, and macro problem. Social Work Education, 33(5), 692–698. https://doi.org/10.1080/02615479.2014.919093

Vakharia, S. & Little, J. (2016). Starting Where the Client Is: Harm Reduction Guidelines for Social Work Practice. Clinical Social Work Journal, 45, 65-76. DOI 10.1007/s10615-0160584-3

CHRISTOPHER B.R. SMITH, PHD is currently based at Memorial University of Newfoundland (MUN), having previously worked in the U.S. (Philadelphia), Australia (Melbourne), and at various institutions across Canada. Focused on the active involvement of people who use drugs (PUD) in the policies and programs ostensibly developed in their interests, Christopher’s longstanding research agenda is rooted in harm reduction and critical drug studies. Specifically, his recent work entails a critical examination of how substance use education is deprioritized in Canadian social work curriculum, opposition to the contested space of ‘addiction’/treatment, services for PUD in rural/remote contexts, and activism among organizations established by and for PUD.

Readers interested in helping to create a harm reduction collective, as proposed by Smith, are encouraged to reach him at cbrs1977@gmail.com.

Photo supplied by Christopher Smith

Patrick and Liane.

Photo supplied by Untoxicated Queers.

BEARING WITNESS

The stories behind the numbers

DEFINING THE PROBLEM

We’re at the intersection of multiple and compounding crises. Still reeling from the devastating effects of the pandemic, struggling to recover from Hurricane Fiona’s destruction, inflation, housing insecurity, a straining health care system whose workers are burning out, many amongst us are having a difficult time. For those amongst us who were already dealing with a post-industrial decline, and especially for those who have inherited intergenerational trauma and continue to be disproportionately impacted by all of these dynamics due to systemic racism, queerphobia and colonization, it is not surprising that a growing number of individuals self-medicate to cope.

ALTERNATIVE APPROACHES THAT EMPHASIZE CULTURAL SAFETY

I spoke with a number of individuals trying to spearhead change in their communities to better understand the problem, as well as to begin to consider what solutions might actually help make a difference in the lives of all those affected.

Five years ago, Ryan Gould and a group of childhood friends co-created the Membertou Men’s Society, a non-profit organization as a result of the lack of culturally specific services that were available to meet his needs. They offer support to Indigenous and non-Indigenous men in the Membertou area. “We strongly encourage our men to love themselves enough to speak up without being judged, seen as being weak, or vulnerable,” says Gould. “We want to end the stigma against men speaking out about their feelings or emotions.We want to end the stigma of how society is treating, labelling, shaming people suffering from mental health and addictions. This way our men are able to receive the support and services they need to take care of themselves, their family, and when they’re ready the whole community.”

Being able to feel safe to access stigma-free and culturally safe support drove Liane Khoury, health promoter at Nova Scotia Health (NSH) and Patrick Maubert, a Dalhousie BSW student, to co-found Untoxicated Queers.This weekly virtual peer support group for 2SLGBTQIA+ individuals began in the spring of 2020. The project first developed in a social work classroom, but quickly grew to meet what Maubert calls “the absolute huge void in services that are provided.”

Khoury explains: “I feel like for a lot of us, accessing mental health and addictions services, like rehab, detox or whatever they are calling it right now, a lot of us don’t feel safe going there. We don’t know who you would be rooming with, if they’re homophobic, if they’re not, if they’re not comfortable staying in the same room as a queer person overnight. It’s the ridiculousness of the internalized homophobia that most people have, and transphobia and the use of pronouns. … The respect to treat us like humans, and not misname us, dead name us or misgender us.”

“I think we need to queer the system,” Maubert elaborates. “In that, let’s smash that binary, because it’s not working. I have been both a service user, as well as a service provider, in the realm of substance use and addiction. Looking here in Nova Scotia … a facility that is specifically queer and trans, would be a huge help … because it’s scary going into a facility that pretty darn straight, heteronormative, and you just don’t know what the vibe is going to be like. Both from other service users, but more importantly, which I have run into, is the staff who are just blatantly homophobic. Whether it’s overt or an unconscious bias. So creating spaces that are specifically queer needs to happen.”

“It’s soon to be 2023,” Maubert continues, “and we know that there is plenty of research that shows that folks from

the queer community are affected by substance use and addiction on a much higher level than our heteronormative counterparts. Which is pretty shocking and looks at that kind of intersectionality, that combination of shame, shame of our queer identity, as well as the shame of our substance use and addiction. That intersection can really create a real firestorm of a desperation to be able to get the help that has been needed for fear of discrimination. Rightfully so. The amount of discrimination that is shown for both substance users, but also queer service users in the healthcare system, is staggering.”

Even for communities that do have resources dedicated to culturally specific services, the gaps in service, and influence of bias, are significant, leading NSCSW member Afolake Awoyiga to cofound a not-for profit community organization for youth of African descent called Generation 1 Leadership Initiative six years ago.

Through this work she has observed that “systemic and structural barriers disproportionally impact mental health in communities of African descent” including “key systemic and structural barriers that … can limit access for youths and mothers of African descent” in particular, the ”lack of culturally responsive care, geographical and location barriers, cost of mental health and addictions services, racism, discrimination and lack of cultural safety.”

Awoyiga asserts, “We have to do more than educate, and transform all the anti-racist education into action. Social workers and other health care providers need to understand their professional responsibilities for addressing racism. We need to utilize intersectional, African centred, trauma informed, anti-racist, systemic approaches that acknowledge and address the structural, historical, social and economic root causes of the mental health disparities in communities of African descent”.

Awoyiga is not alone in recognizing this. Sam Krawec is dedicated to creating alternative and community models of care. Krawec, health case manager for Mobile Outreach Street Health (MOSH), spends his days trying to bridge the gaping divide between existing health care and addiction services and those who need them most.

The MOSH model of care is innovative, but sadly this model is not replicated (yet) elsewhere in the province.

Krawec says that he works “within a harm reduction and social determinants of health framework, which means contending with the ways that barriers to health care are built into the capitalist system and reinforced by patriarchy, white supremacy, and settler-colonialism. The people we serve are diverse and resilient. We serve people who are not served by the current system, who survive and thrive on the margins of it: Women, Two Spirit and non-binary people, Indigenous peoples, Black and African Nova Scotian people, and other oppressed groups. My role is to help overcome barriers to care with marginalised people and improve health outcomes in these communities so we can live and resist joyfully together.”

Tara Downey, who serves as the African Nova Scotian outreach social worker at the North End Community Health

Centre, says, “I feel like self-medication is a way for individuals to escape the reality of what they are going through day-today. Whether that is racism that they are facing, homophobia, all sorts of different things. That self-medication allows them to give them a time-out from having to live that reality. Then, within that, that then trickles down to the addiction and mental health piece, which you’re self-medicating, but then that self-medicating of feeling that warmth turns into the addiction mental health piece. Like a continuous cycle: start medication, start medicating yourself because it feels good. It allows you to step away from what’s happening in the world, but then what I’ve noticed is that there is not a stopping point for that. That is when sometimes it turns into that addiction piece, where then individuals have a harder time meeting those basic needs or day-to-day activities that they normally would do.”

THE ROLE OF STIGMA

Indeed, as Downey affirms: words matter. Terms like “addiction” and “self-medication”, or labels like “addict” or “illicit drug user” are not interchangeable; each conveys a different set of ideas and values, be it pejorative or pathologizing or neutral.

Increasingly, the term “people who use drugs” (PWUD) is being used as part of a larger commitment to destigmatizing this issue. For the Cape Breton Association of People Empowering Drug Users, the stigma surrounding drug use can impair a person’s ability to access services for treatment, as well as the quality of care that they experience from the healthcare system when they do seek services. Furthermore, this stigma impacts their ability to find housing or employment, which further negatively impacts their health and quality of life.

The words that we use create distance between us, keeping us from recognizing the ways in which this issue impacts everyone. Khoury notes that even if for those who don’t identify as having an addiction to a chemical substance, other activities to try to self-soothe during times of stress or crisis, such as “doom scrolling on Instagram is detrimental to your mental health {and are] kind of addicting.”

Maubert adds, “I think we medicate in so many ways. That really comes out a lot in our meetings, whether it be our relationship with food, our relationship with body image, with body dysmorphia, our relationship with spending and excessive use of our phones.”

For all of the people with whom I spoke, there was consensus that effective solutions must be embedded within communities, rather than expecting people to travel long distances to adhere to the scheduling needs of those with power and privilege, namely those employed by the government to try to manage or cure those who are “sick”. The real sickness is not the addiction. The real disease is lack of funding and prioritizing mental health. The real sickness is the systemic and structural injustices leading so many to turn to self-medication to try to cope.

CONNECTING TREATMENT, RESEARCH & LIVED EXPERIENCE

It is clear that there is a deep disconnect between the research on best treatment outcomes, the experiences of those with lived experience and clinicians and the policies currently in place in Nova Scotia.

Maubert says that current services such as those using relapse prevention groups are “so out of touch with the actual needs. … they’re still supporting this old model and this punitive model.

[…] In [a relapse prevention] meeting, they ask every person as they come in, have you used in the last 24 hours? If they say yes, they put them out in the waiting room, and as a group

discuss if it’s okay for them to come in. This is NSHA Mental Health & Addictions. That is completely dangerous.”

“There’s always such a deep sense of shame when I was using in the past,” Maubert elaborated. “There was so much shame that I had brought with me. Shame of how family would see me, friends would see me, my respect in my work, respect in community. So, to be accessing a service that is meant to provide support, if there is any barrier of any kind, and if I’m turned away from that meeting, why would I ever go back or try. If the one place that is meant to help me at my lowest, isn’t there to offer support, then how can I keep up the momentum going if I know they don’t actually believe in me or believe in the work that I can do.”

Tragically, this disconnect between treatment, research and lived experience is contributing to the preventable deaths of far too many individuals, harming their families and communities, and adding to the moral distress of health care providers across the province.

For this reason, growing numbers of health professionals, including the NSCSW, recommend a broad and integrated public health approach to prevention, health promotion (social determinants of health), harm reduction, treatment, and recovery and wellbeing related to opioid use and opioid use disorder. We also advocate for the integration of first-voice advocates into the development of any policy or treatment plan.

Reliance upon chemical substances, be they alcohol or drug use, or other behaviours increased dramatically during the pandemic. For communities already struggling with disproportionately high addiction, like Cape Breton, these numbers are skyrocketing. And it’s estimated that addiction currently costs Canada over 50 billion dollars a year as a result of health care costs, lost productivity, and reductions in health-related quality of life.

And the reality is that this is a community problem: no one exists in isolation. Despite the neo-liberal myth of individualism, and our medical system’s addiction to focusing on the individual at the expense of treating all those impacted by the problem, every social worker knows that behind every statistic is a family and community.

The current reductionist and failing efforts of our still colonial systems can be seen in the lack of holistic and interdisciplinary treatment options that are community specific and culturally safe, reflective of diversity and effective at bringing justice and healing to the communities where these problems are most dire.

False binaries remain encoded in our thinking and in our systems, for example the lack of integration between physical health services and mental health services. The result: a health system that is designed not to treat mental health challenges unless it reaches a crisis point.

Krawec explains his understanding of the problem: “With the options currently available, people who are unwell and traumatised are forced to make hard choices about how to care for themselves. This is the basis of self-medication. People use substances for pleasure, but many people use substances to alleviate suffering related to trauma and mental illness. Often the ‘drug of choice’ is not a choice at all, because using a given substance may be the only way

for a person to relieve intolerable agony and continue living. Recognising this is an essential starting point for improving health outcomes for people who are unwell and traumatised”.

Shame and judgment remain deeply embedded in most government-funded initiatives, which rely on outdated and under-researched treatment frameworks.

Furthermore, the continued criminalization of certain drugs exacerbates the problems that people face, increasing stigma and adding further obstacles to treatment and recovery.

“Decriminalisation is only the first step,” explains Kraweck. ”To really address criminalisation, overdose rates, and the drug poisoning crisis, we need Safer Supply, the provision of pharmaceutical medications to adults who would otherwise rely on illicit street drugs and be exposed to greater risks. People have been calling for a safer supply of drugs for a long time, and there are different models for it. The medical model used at MOSH involves regulated health professionals who can prescribe pharmaceutical drugs to reduce some of the harms related to addiction. … this kind of change is inevitable, but as it takes longer more people are going to die or be criminalised. This is why fighting for social change needs to be part of our harm reduction practice.”

Health care and social service workers, including many of our members, experience moral distress from being tasked with delivering services that do not work, in ways that cause more harm than help, while reinforcing the stigma that makes it more difficult to get help. It is unsurprising that so many health care workers are burning out. The time has come for a real change.

N SIRITSKY, RSW, is the professional practice and advocacy consultant for the Nova Scotia College of Social Workers.

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