The Department of Health and Social Services recently hosted a workshop in Yellowknife titled “Doorways to Conversation: Substance Use with Girls and Women in Pregnancy and Beyond” featuring keynote speakers Dr. Nancy Poole and Dr. Lorraine Greaves.
Dr. Poole and Dr. Greaves from British Columbia gave a trauma-informed, interactive presentation that speaks to research, practice and policy related to preventing FASD and reducing harms related to polysubstance use in pregnancy.
The workshop was intended for individuals or organizations that interface with individuals of childbearing age and those who are living with mental health and addiction issues. The purpose of the workshop was to inspire and improve the capacity of NWT health and social service providers to discuss alcohol and other substance use with women and their support networks in the preconception and perinatal periods.
Although polysubstance abuse often refers to the abuse of multiple illicit drugs, it’s also inclusive of prescription medications used in nonmedical circumstances.
Dr. Poole is the Prevention Lead for the CanFASD Research Network and the Director of the Centre of Excellence for Women’s Health.
“We are talking about substance use many different substances that are now legal alcohol, tobacco, cannabis and prescription opioids, and how they affect women’s health,” Dr. Poole said. “What we need to do in terms of having discussions about the health effects on women, whether they are pregnant or whether in general. The whole goal of the conference is about starting the conversation.”
The conference Dr. Poole says was also about talking about use as well as misuse and addiction.
“Sometimes in the past, we really focused on addiction only,” Dr. Poole said. “It’s about all levels of views. So it’s really trying to say, you know, people can be different places and we need to be able to have comfort in having these conversations. So it’s not behind closed doors.”
Research tells us that women do not intentionally seek to harm their unborn children. Some women may be unaware of their pregnancy when drinking heavily. Some women have addictions and mental health challenges and find quitting extremely difficult despite pregnancy. Some women have abusive partners who pressure them to drink while
“FASD is a preventable disability, resulting from prenatal alcohol exposure (PAE). Consuming alcohol during pregnancy is not as simple as ‘choosing not to.’ Factors such as addiction, trauma, abusive relationships, misinformation, unplanned pregnancies and lack of awareness may contribute to PAE.”
Approximately 4 per cent of Canadians, or 1.4 million people, have FASD. It affects more people than autism, cerebral palsy and Down’s syndrome combined. However, researchers believe that the number is higher than estimated.
Although research is limited, rates of FASD are higher for those involved in the child welfare and justice systems. FASD is a highly complex disorder, associated with trauma, victimization, and other life adversities – these issues can affect women from all cultural groups.
Dr. Greaves is currently the lead investigator on a Policy-Research Partnership grant related to cannabis use prevention funded jointly by Health Canada and the Canadian Institute of Health Research.
Dr. Greaves says the workshop presented research on the effects of multiple legal substances during pregnancy and postpartum as well as information on harm reduction messaging, effective communication and motivational interviewing techniques.
“Well, we see the same issues all over the country,” Dr. Greaves said. “To be honest, I think one of the differences here is a good thing. And that is that there’s a decided approach to look at all the substances together which is what we call poly substances. And that’s the reality for a lot of women and a lot of men as well.”
Dr. Greaves says perhaps one of the challenges here in the North is just fewer people, lower population, fewer services. And so sometimes that’s a problem for practitioners who are trying to refer people out.
“So those are a couple of the issues that come to mind here,” Dr. Greaves said. “FASD is a preventable disability, resulting from prenatal alcohol exposure (PAE). Consuming alcohol during pregnancy is not as simple as ‘choosing not to.’ Factors such as addiction, trauma, abusive relationships, misinformation, unplanned pregnancies and lack of awareness may contribute to PAE.”
The workshop also supported service providers in becoming gender and trauma-informed and to feel confident/comfortable to engage in empowering conversations regarding substance use Dr. Greaves says.
Many service providers are concerned that asking girls and women about their substance use, especially during pregnancy, will be perceived as judging and shaming women.
Evidence has established that using non-judgmental approaches are key to supporting behaviour change. These approaches emphasize harm reduction and employ collaborative and empathic conversations that respect individuals’ self-determination and understand the underlying issues of substance use problems.
There are conflicting messages about how much alcohol can be safely consumed by pregnant women causing controversy and confusion. .Research and clinical experts in maternal and fetal health recommend that no alcohol is best.