SOMBA K'E/YELLOWKNIFE
When Sahtu MLA Norman Yakeleya made the decision to get sober over 25 years ago, he knew he would have to leave his home in Tulita to do it.

Currently, medical withdrawal management services are only available at Stanton Territorial Hospital in Yellowknife and Inuvik Regional Hospital. The Salvation Army in Yellowknife offers residential withdrawal management for six people at a time. The Department of Health and Social Services is considering making it a territorial program. - Meagan Leonard/NNSL photo What is a standard drink? 341 ml (12 ounce) bottle of 5% beer, cider or cooler 43 ml (1.5 ounce) shot of 40% hard liquor (vodka, rum, whiskey, gin, etc.) 142 ml (5 ounce) glass of 12% wine - Source: Canadian Public Health Association

Yakeleya told News/North deciding to address his alcoholism was only the beginning. After completing the 42-day treatment program at Poundmaker's Lodge in St. Albert, A.B., Yakeleya said he returned to the NWT and had to spend many evenings alone to avoid slipping back into the culture of drinking.

"Number one is you have to learn how to deal with your friends that you partied with last weekend and then this weekend decided not to after getting sober," he said.

Although Yakeleya has successfully maintained his sobriety, others in the NWT are not so lucky. Alcohol withdrawal management, or medical detox, is often the first step in the path to recovery but in the territory, those services are only available in Yellowknife and Inuvik – people seeking full rehabilitation programs must leave the territory.

And according to a review of withdrawal management services conducted by the Department of Health and Social Services last year, the chance of expansion is unlikely, despite alcohol and drug consumption continuing to increase in the NWT over the last decade.

In 2014, 430 people were hospitalized 615 times as a result of alcohol and drug-related issues at a cost of $7.5 million annually.

Although a number of gaps in service were identified, such as vacant addictions and mental health positions, non-existent mobile services and only two available locations for detox treatment, the department says the current system is adequate and represents the extent of resources available.

Sara Chorostkowski, manager of mental health and addictions services for the Department of Health and Social Services, said the level of service currently offered is "appropriate" for a Northern context.

She said accommodating medical detox in every community would be unrealistic as the cost to fly in staff or have them permanently on hand would be considerable. Due to the nature of addiction, she added, it is difficult to say whether current services are operating successfully.

"The definition of success is not defined by us, by the department or by anybody else," she said. "The definition of success is defined by the person and there's no one definition of what success is."

Earlier this year News/North reported some community mental health and addictions counsellor positions had been left empty for up to 10 months – essentially leaving people in those communities dependent on a 24-hour helpline. Yakeleya said helping people get sober requires a more aggressive approach.

"There is a lack of any kind of real support for our people who so much want to get help," Yakeleya said.

Services in most communities include screening, assessment, referral and follow-up care, with nurses and addictions counsellors serving as the primary service providers. However, even in Yellowknife, the RCMP are often the first point of contact for those experiencing the symptoms of withdrawal, particularly if they are being disruptive.

The Salvation Army in Yellowknife also offers a residential withdrawal management program with accommodation for up to six people. Chorostkiowski says the GNWT has considered taking over and expanding the program but nothing definitive has been established.

"The report mentioned the possibility of potentially making the social withdrawal management program at Salvation Army a territorial facility," she said. "We are going to be engaging with the Salvation Army and discussing whether it's an option."

However, even if this becomes a reality, some are doubtful it will solve the problem of alcohol abuse in the territory.

Born-and-raised Yellowknifer Julia Christensen is a research fellow at the Institute of Circumpolar Health and has conducted studies in the NWT on factors influencing homelessness. She says the current Salvation Army model is problematic due to its close proximity to temptation. Likewise, she says when people experiencing withdrawal symptoms access hospital emergency rooms, generally it is out of desperation and not a desire to change. Because many of these people are homeless and without support, she says once detox is complete, they are thrust back into the same situation they left and the cycle repeats. In a place like the Salvation Army where withdrawal treatment is adjacent to the emergency shelter, the issue is compounded.

"It is much too close for comfort to friends and social activities that are not supportive to sobriety," she said. "For many it is a cycle between withdrawal management and the shelter and back again."

She added wait times for services in Yellowknife and Inuvik can be lengthy, even with a referral.

"There is often a lag time of days or weeks between asking for a referral and then actually being flown to treatment during which time, a person might change his or her mind and subsequently reject treatment," she explained, adding what happens after withdrawal management should be the government's focus.

"Withdrawal management only deals with one small part of the overall picture of addiction – the actual physical dependency," she said. "What happens when an individual returns to their community is crucial."

Christensen says expanding withdrawal management services, even if it were possible, is not going to address the problem and in this way, the review is misleading.

"We can have the most innovative withdrawal management services in the world but without adequate housing, those services will fail," she said.

That being said, Yakeleya emphasized there needs to be a greater understanding of cultural approaches to healing on the part of western governments – what works in a southern city, might not be the best approach for a community like Norman Wells.

"We have steered away from the meaning of working with each other," he said. "There's certainly people in the communities who are equipped to help people in different types of situations … but because of regulations, criteria and liability, government gets in the way of really helping people."

He says the issue needs an injection of creativity – simply saying it's good enough, is not enough.

"For them to say, this is all we can do, this is not working – it's insanity," he said. "It's part of the drinking and alcoholic insanity – to keep doing the same thing over and over expecting different results."

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