More pieces needed to solve the substance abuse treatment puzzle

The Provincial Government is deserving of considerable credit for its recent promise to enrich the capacity of substance abuse treatment in the province. To stem another disastrous strain on our health care system in the next few years, there are a variety of additional pieces that must be added to the substance misuse prevention and treatment policy puzzle. 

Perhaps the most important addition should mobilize resources to address the apparent lack of adequately trained treatment specialists and prevention workers. Another priority should be the establishment of an independent data collection system to evaluate program performance. Neither seem to be in place at this time. 

It appears that, compared with substance misuse, there is no other highly complex bio-psycho-social health problem intervention system characterized by such an inadequate level of professional organization and undeveloped skill requirements of staff. Data collection to evaluate program performance and regular oversight are also begging for development.

An independent performance evaluation process should be immediately put in place to identify the degree to which evidence-based programming and human resource competency are now in place in the current system. On the basis of that research, remedial upgrades should occur.

In addition, a post-secondary training program in the specialized skills required to tackle this multi-dimensional problem should be initiated. Specialties should include therapeutic skills (individual and group), community organization, and public education and media messaging. 

A good start to such an approach would be to support a series of meetings between relevant academic departments at the polytechnical and university level (including the First Nations University of Canada) to consider certificate, diploma, first degree and Master’s level training and credentials aimed at preparing a skilled workforce relevant to the challenge.  The need is indicated by the current and seemingly ever-expanding epidemic of substance misuse and chemical dependency. 

Funding for proceeding in the educational piece should not be prohibitive because existing educational institutions can be engaged to plan and implement the necessary work. Community outreach is a standard function of universities and other post-secondary institutions. Furthermore, first candidates for the relevant training can be drawn from part-time students currently employed in human service roles in government and NGOs (i.e., psychiatric nurses, clinical psychologists, and social workers). In this way, major front-end costs otherwise incurred by emphasizing new, full-time students, could be significantly reduced.

Partnerships in this initiative would be appropriately established with Health Canada and the Canadian Association of Mental Health (CAMH), Saskatchewan branch. First Nations and Metis representative bodies—and educational institutions — should also be included.

Dr. Richard Thatcher is a retired sociologist and community health planning consultant who has written extensively about substance abuse issues.

Time for a Provincial Reset of Substance Abuse Programming

by Dr. Richard Thatcher

Like the old saying, when opportunity knocks, you are wise to answer the door—or something like that.

Clearly, the opportunity to upgrade preventive and remedial responses to substance abuse problems in Saskatchewan is knocking loudly, alerting us to the fact that the time is ripe for a service review.

The establishment of a ministry of mental health and drug abuse services last year must be applauded, as must the support given to the sixteen supervised safe injection sites in the province (although the failure to refund the Saskatoon site is surely a questionable one). Yet while the provincial government has gained ground in framing and planning a intelligent remedial response to cover the wide range of alcohol and drug mis-users in our province, a plan is just ink on paper until it is instituted—and there is much yet to institute. The appropriate distribution of resources along a full continuum of care appears to be seriously lacking. A fundamental reset in preventive and remedial programming is clearly needed at this time.

Consider the fact that in very recent years drug overdose deaths in this province have been accelerating at a frightening pace: 233 deaths in 2020 and 75 thus far in this calendar year. Let’s admit it, we have another epidemic on our hands. If I’m not mistaken, those drug fatality figures do not include all the deaths associated with alcohol intoxication, including assaultive encounters, accidents at work, and traffic fatalities.

A friend of mine whose son had a serious binge drinking problem recently said to me: “Like my older teenage boy’s secretive drink scares the daylights out of me. But it’s hard to get help. There are far more binge drinkers in the province than true alcoholics. But he can’t get treatment anywhere, unless he depicts himself as true drunk.”

Another consideration demanding a program review and service reset at this time is the current effort to simply move the Pine Lodge treatment centre program to another facility, without carefully examining its most effective location or the nature of its therapeutic orientation or curriculum. The program was in hiatus after a fire sacked the building in Indian Head in which it was housed.

Apparently the Pine Lodge program that the current board supports is primarily based on a very traditional 12-step model and there are other programs in the province centered on the same approach. The Pine Lodge program incorporated the 12-step approach into their core treatment model. Such an approach may be a useful referral resource, along with S.O.S., high quality counselors linking the client to supportive interveners, Smart Recovery, Last Door programming and Moderation Management counselling; however, it clearly should not be a direct recipient of public resources: it is not an inpatient treatment model, it is a voluntary, community-based, self-help program.

The very purpose of AA and other 12-step programs is undermined by its appropriation as a formal inpatient treatment model that can exclude those who are not willing to participate in the 12-step procedures. Surely examples of forced participation in a particular regimen of treatment are ill-advised, much as “conversion therapy” should be a thing of the past. Clever lawyers seeking class action clients or Charter challenges should surely take notice if clients are refused treatment in a public program because they do not accept the philosophy of the 12-step model.

Good reason demands that public programs centered on 12-step based treatment programs – or any other community-based, volunteer peer group program — must have their core therapeutic model replaced and have their client base greatly expanded to include more choices and clients with a wider range of problems. The current programs requiring client obeisance to a a one-size-fits-all treatment model is fundamentally flawed by its curious mixture of faith with rational skill development and its false labelling of clients as having a chronic disease from which they must forever try to recover (A heavy and unnecessary burden to carry until death do us part). Such a belief is falsely presumed by the idea that some people have innate predispositions to drinking (Note, the “alcoholic personality” research has come up dry, despite continued efforts, including the most recent ‘brain wave” research).

The 12-step model is not a good fit with minorities, the poor, women, those who have not ‘bottomed out” and those who do not believe in a higher power. If I’m not mistaken, that’s the majority of people in the province who are experiencing substance abuse problems. Surely they deserve more consideration in treatment program design.

The available evidence makes it clear that, for most mood-modifying substance mis-users, the psychic treadmill introduced by 12-step participation is an unnecessary and false prerequisite for overcoming chemical dependency—and, ultimately, whether in a peer support group or not, overcoming substance abuse is a personal achievement made much more likely by a little help from one’s family and friends.

It is worth noting that most people with substance abuse problems eventually overcome them on their own, without any form of professional treatment or formal peer group support.

While AA has demonstrated its effectiveness for some individuals, its volume of client inclusion is but a small fraction of the population in need.

The question must also be asked in any serious review: Would it not be more appropriate to house Pine Lodge or a replacement treatment centre in or very near to Regina or Moose Jaw where a wide range of potential service supports and human service personnel are available rather in a rural location far from a major centre. And I’ll bet there are many patches of real estate in either city where a treatment centre would be more than welcome. The building housing the previous St. Michael’s Retreat in Lumsden is an especially attractive prospect.

Surely there is a confluence of circumstances at this time which indicate that it is high time to review the scope, potential client coverage and best practices for substance abuse prevention and intervention currently in play in the province. Surely that would readily fit with the wider efforts going forward for which the Provincial Government can deservedly be proud.

Dr. Richard Thatcher– a semi-retired social-psychologist and freelance journalist who has worked as a researcher and policy advisor on substance abuse issues for several decades. He has designed several substance abuse programs and he is the author of 5 books on the subject.

Sombre regret for passing of Limbaugh not warranted: Thatcher

by Dr. Richard Thatcher

Invective inspired by late talk radio host of same ilk as Saskatchewan’s worst

If any of your readers who soak up American opinion commentary experienced a sombre moment of regret for the passing of U.S. radio broadcaster, Rush Limbaugh, they should move passed that sentiment immediately, for it is not warranted. If you have ever heard the angry barking, repetitive rhetoric of this radio “commentator,” you could test the strength of your better self by measuring your capacity to suffer his rancor.

Many Canadians, including acquaintances in the Regina area, found ways to tune in to Limbaugh, but his insulting invective against so many things Canadian should have jolted them into recognizing that he was certainly no friend of our country.

People of this province should not feel secure in their belief that there is not a frightening, homegrown mindset similar to the right wing populism that has raised its ugly head south of the border. I have heard strands of similar thinking from neighbours, distant family members, and on-line comments from locals.

Such ill-informed chatter is not the only evidence at hand. Consider the shameless critiques, ridicule and harassment of our impressive Chief Medical Health Officer, Dr. Saqib Shahab at his family home on Saturday. I’m sure you have driven by the “anti-maskers” on Regina streets and, of course, the “anti-vaxxers” have been emboldened of late.

The troubling antics of Travis Patron, also come immediately to mind. Hailing from Redvers, in southeast Saskatchewan, Patron has been charged with wilfully promoting hate against Jewish people. Patron had his name on the ballot of the Souris-Moose Mountain constituency in the 2019 federal election, representing the registered “Nationalist Party”—a party whose principal mandate was stated as”. . . keeping a European-descended demographic majority” in Canada. This idiotic yet troubling statement ignores the fact that most Jews in Canada themselves came from Europe, of course.

Patron had apparently posted an anti-semitic video on YouTube that contained an explicitly hateful anti-Semitic video posting that included Patron.

And for those of you with memories to dust off, you might consider the 1993 tragedy in which Carney Nerland was charged with the killing of a 43 year old Cree man from the Big River Reserve northwest of Prince Albert. He received only a 4 year sentence for manslaughter, partly because he defended himself with a claim that he was actually working for the RCMP in an undercover arrangement. Aboriginal organizations and concerned sympathizers were outraged by the brevity of the sentence, especially after a public inquiry made it clear that Nerland was a committed white supremacist who led the Ku Klux Klan in Saskatchewan. This was interpreted as not only a hate crime but grounds for a murder conviction..

Back to old “Rush.”

I had listened to Rush Limbaugh several times on visits to the United States. His brash commentaries both sympathized with and encourage the type of thinking that has apparently sprouted in all regions of North America—and many in Europe. Each time I heard Limbaugh I was repulsed by both the content and vocal style of his scathing utterances. It was clearly a significant mix in the verbal debris that paved the noxious path that led to the astonishing rearguard presidency of Donald Trump.

Limbaugh began his “career” (for lack of a better word) as a deejay and then sportscaster. While it is rumoured that he had once been a registered Democrat, he was always heavily influenced by his family, which was dominated by lawyers of a conservative bent—and his background was one of privilege. Seeking a radio audience to launch his career success, he found one among persistent malcontents, mostly of “White” ethnicity, who felt threatened by social change and those committed ideologically to one or several aspects of extremist, right wing thinking. His core audience was comprised of those experiencing a quiet, pent up rage–and that rage had not been fully exploited for the purposes of shock commentary. Limbaugh did much to stoke that hypogenous fire of rage, fuelling it with a steady stream of vitriol. The strategy quickly made him a multi-millionaire and spawned dozens of imitators on smaller radio and later on-line platforms across the United States.

In his ideational prospecting, Rush Limbaugh found a motherlode of traditional belligerence to the “welfare poor,” as he called them, Blacks, Asians, gays, women who wanted careers outside the home and/or to control their own reproductive means (the more assertive of whom he called the “feminazis” (n.b., overall, a sweet guy, eh!). He ranted endlessly about any further step forward on the road to social progress, meanwhile symbolically and intimately associating himself with the U.S. flag, and repeatedly stating his devotion to the country’s military.

In the most obscene of alliances, Limbaugh struck gold when he attracted the support of intellectually vestigial denominations of evangelical Christianity. I was amazed by this. While I am no longer “of the faith” (i.e., I was an Anglican in my youth), my fondest memories of the spirit of Christianity were diametrically opposed to the beliefs and verbal frothings of that weird strain of a supposedly loving religion.

Former President Donald Trump ran into this reveller in sadistic undermining of the disadvantaged and was so pleased to have such an outspoken ally that he eventually honoured him with the Presidential Medal of Freedom. Ecch!!! Such a travesty, given Limbaugh’s basic mission was to constrain the march to freedom from prejudice and poverty of so many citizens of his own country.

Together, Trump, Limbaugh and a small army of fellow-travellers reprised U.S. national zealotry, which began with the concept of “American exceptionalism” and the settlers’ dream of “Manifest Destiny.” That same vein of nationalism served to justify a series of ugly strategies with disastrous international outcomes, from nuclear bomb tests which irradiated the Marshall Islands, the nuclear destruction of Hiroshima and Nagasaki, and crippling intrusions into the governance or several central and south American countries.

Thankfully, there have been other competing narratives in modern U.S. history that have resisted the spirt of the ugly discourse and policy framework advanced by the likes of Trump and Limbaugh. The first major one was the abolitionist movement destined to end slavery, soon followed by the civil rights movement, the antiwar movement, Aboriginal resistance and rights’ reclamation efforts, women’s and LGBTQ liberation, and environmental protection. Several of these narratives sit in in direct organizational and ideational antithesis to the reductive extremes of U.S. conservatism that Limbaugh championed.

With all this in mind, it could only be the most saccharine of sentimentality that could authentically purge a teardrop from any eye for the ending of the life of Rush Limbaugh. One’s sadness in the matter should only be drawn from for his toxic legacy, not from his passing. And the local drawn to its messaging should stop, take a breath, and start to carefully examine the toxic mindset they are being drawn into.

Dr. Richard Thatcher is a retired sociologist who spends his summers in Candle Lake