The concept of Community Wellness Development Teams (CWDT) originated in response to widespread illegal use and abuse of prescribed pain killers, principally OxyContin, in the remote First Nation communities of Northwestern Ontario. The team was initially conceived in 2010 as the “Addiction Referral Specialist Team” (ARST) after considerable concern was expressed about the widespread opioid addiction in the north. It was a concern that treatment centres and community-based workers had competence in addressing alcohol abuse, but lacked sufficient knowledge to approach drug abuse. The vision was that a mental health, a substance abuse and a community specialist would visit a community and work with individuals to assist them with their addictions, possibly assist in setting up support groups and possibly refer to treatment centres those who wanted further help. The idea was presented to leaders in the health-care field from the communities. Numerous communities came forward requesting visits from the team, which at that time consisted of 2 practitioners with extensive experience: a community mental health consultant for the northern communities, and an addictions specialist.
What was thought to be a problem that would respond to conventional approaches such as individual counselling and possible referral to an outside treatment program, would soon reveal itself to be much broader, more far reaching, and more debilitating than anything that was originally conceived. The team had many concerns: the extensive use of more than one opioid, the widespread injection use, the high tolerance level, and the length of time people had been addicted. The social disruption in the communities was
extreme: children were not attending school, adult education courses had few attendees and grandparents were assuming responsibility for caring for their grandchildren.
It would be safe to say that many young people in any society experiment with and occasionally abuse substances such as alcohol and marijuana. Some do so because it is a common peer activity and the need for acceptance takes hold. Perhaps the euphoria is the attraction. For others substance use is a relief from feelings of despair and depression that often accompany young adulthood. Some of these young people become dependent on these substances for psychological or even physiological reasons, but most, with maturity, develop healthier habits after a few episodes of imbibing too much and a few uncomfortable days in the aftermath.
The situation is no different in the northern remote First Nations. However, when the substance is a highly addictive drug for which the pain of withdrawal is far worse than the state of mind at the roots of vulnerability to addiction, it is a different scenario. Added to this scenario is the propensity for depression and despair that grips many of these northern First Nations, the isolation, the intergenerational effects of trauma from Residential Schools, the enormous number of suicides in First Nations, the boredom and the unemployment.
Visits to the communities, revealed that almost an entire generation of young adults, ranging in ages from 17 to early 40s was struggling with opioid addictions. In one community, at least 60% of the age group between 15 and 50 was addicted, with the largest group of users being in the young adult, early parenting years. Possibly 80% of this latter demographic alone were addicted. Nursing staff in some communities reported that half of the women who were
pregnant were using opioids.
There were reports of young children having no food to eat, grandparents preoccupied with feeding their grandchildren, empty stores, houses without furniture that had been sold to pay for drugs, increased birth defects and infants of mothers who used opioids born with withdrawal symptoms. One community reported in the course of a few months, dozens of incidents of break-ins, arsons, homicides and suicides. Virtually no generation and no individual went unaffected.
Community members were organizing marches, petitions, vigils outside the homes of drug sellers, protesting the drug abuse in the communities, demanding that councils take action.
Numerous users were consulted in the attempt to understand the phenomenon. Many users were ordinary citizens, many with good jobs and no notable history of trauma or abuse as is often seen with those addicted to opioids. Every drug-user consulted desperately wanted off drugs but found that severe withdrawal symptoms, cravings after withdrawal and pressure from peers and sellers blocked attempts to recover from addictions. Some had left or planned to leave the community to obtain help away from this pressure.
A problem of such magnitude affecting the generation that is bearing and caring for the future generation, as well as constituting the workforce, could no longer be the sole purview of the addictions field. Opioid addiction and its effect on the entire community amount to a public health emergency. It has the potential for far-reaching health and social consequences greater than that of a pandemic infection. It is more than just a disease of individuals: it is a disease of an entire community. It became evident that only an approach that included the entire community, and that was carried out in the community, could possibly make a dent in the problem. The approach needs to encompass more than curing an addiction, but must involve the efforts of everyone from the Chief and Council to the teachers in the school. For this, a pan-community approach had to be devised.
Often people leave the communities for treatment and relapse soon after their return. The reasons are usually cited as lack of community supports and peer pressure. The Addiction and Mental Health Specialists assisted several communities to set up Suboxone community-based withdrawal-management programs that would enhance community support and decrease peer pressure to use drugs by establishing new relationships with peers on the same journey. The positive outcomes of the programming occurring within the communities were overwhelming. One of the most effective aspects of holding these sessions in the communities was found to be the bonding and peer support that took place with those in the program. It was becoming increasingly clear
that treatment in community for any problem could be superior to anything that could be offered outside. It was then decided that the team needed renaming to reflect what it was all about. The name was changed to the “Community Wellness Development Team”.
First and foremost, to assist a community as an outsider, trust must be established. From there, a process of engagement would result in the ability to plan in partnership with the community. The passion to address the addictions situation and to address the roots of the issues that led to it, were impressive. From there, and with support, many things were possible.