Introduction

Introduction

In Canada, as well as other countries like the United States, “attitudes towards individuals with addiction are heavily moralized”^[1] with a focus on the responsibility of an individual to heal themselves.  This concept of substance use as a moral failing has resulted in laws and policies that harm rather than support people who live with a substance use disorder.^[2]  Kulesza et al.^[3] suggest substance use may be better understood by examining the intersection between multiple social identities (racial/ethnic minority, women) and structural inequalities.  College educators can help students understand the impact policies, laws and regulations have on individuals and families through curriculum designed with an intersectional lens to look at gender, race and substance use.

The subject of substance use is complicated.  There are various agencies that address substance use, from the Government of Canada, Correctional facilities, Public Health, Canadian Centre on Substance Abuse, The Centre for Addiction and Mental Health, National Native Alcohol and Drug Abuse Program, and various health authorities, private agencies, and businesses as well as non-governmental organizations across the country.  Each of these agencies has a mandate to address substance use in some way, from individual treatment through to incarceration; and while these agencies have some power in how substance use is treated, each of these agencies focus on substance use differently, some recognizing systemic injustices and others focusing on morality. There is a tremendous amount of information on substance use and various perspectives that agencies promote as well as the overall western approach to understanding and treating substance use disorders.  As I have taught about substance use, I have had to ask myself, do I understand the intersections between substance use, gender, and race?  How can I help build a more comprehensive curriculum, and how can I help students build on their experiences and knowledge in this curriculum?  Students may learn about challenging laws and health policies and advocating for change to support marginalized groups, which require deep compassion for those who struggle with substance use.  They may build on their understanding of systemic power and acknowledging cultural values to challenge the systems that put people at risk of substance use and substance use disorders.  This process can begin by understanding the micro and macro forces that shape substance use in Canada. As Brookfield notes, “even if we realize that our problems are reflections of structural contradictions that we can do little about individually, knowing that we are not their cause is crucial to our well-being”.^[4]  Many of the issues related to substance use are systemic, for example, poverty and violence^[5] and though they may not be resolved by your students, their understanding can help them improve their practice as future social services workers.

Addressing stigma is also necessary in order to challenge inequities.^[6][7][8]  Stigmas are negative attitudes and beliefs which often lead to “labeling, stereotyping, separation, status loss, and discrimination”,^[9] and are prevalent in the field of substance use. Some authors even suggest that stigma is an underlying factor in substance use, that “stigma figures in the social construction of substance use”.^[10]  Citizens are affected by substance use, directly and indirectly, individually, and societally; and by understanding this, stigmas associated with substance use may decrease; “both scientists and mental health advocates have long suggested that an increase in the lay public’s understanding [of substance use] … may reduce discrimination and prejudice”.^[11] Greater understanding of stigma may help reduce systemic inequities related to race and gender.

Purpose

The purpose of this project is to help students critically explore substance use in Canada. Using a critical epistemology, “a disclosure of the crossing/tension between being and power”^[12] and a feminist pedagogy, which “focuses on the thoughts and experiences of individual students and tries to create an open learning community where mutual dialogue and empathy is valued”,^[13] this text will address the role of gender, race, and stigma within substance use.  It allows for compassion, critical reflection, and greater understanding of systemic forces, in hopes of improving services for those living with a substance use disorder.  It is a compendium for college students; it will help students further their understanding of substance use by tackling the historical context, feminist and critical race theories, and western and non-western points of view in order to support the further development of critical thinking skills.  Brookfield suggests that “to think critically is mostly defined as the process of unearthing, and then researching, the assumptions one is operating under, primarily by taking different perspectives on familiar, taken-for-granted beliefs and behaviors”.^[14]  This OER will help students explore their assumptions about substance use.

Theoretical Framework of the Project

In order to make changes to systems of power, students should have an awareness of how those systems exert power.  Brookfield suggests that by using critical theory, we are able “to identify, and then to challenge and change, the process by which a grossly iniquitous society uses dominant ideology to convince people this is a normal state of affairs”.^[15]  Approaching this project from a place of critical theory, identifying how systems perpetuate substance use becomes important: “Critical perspectives generally assume that people unconsciously accept things the way they are, and in so doing, reinforce the status quo”.^[16]  Developing greater awareness of how the systems function will enable students to work with people who struggle with substance use.

Embracing a feminist and critical race perspective will help further unpack substance use for the students.  For example, women have unique needs and feminist theory acknowledges these unique needs.^[17][18][19]  Feminist theory has been at the forefront of new directions in political, social, and cultural theories.  Using the intersectionality of substance use with feminist and critical race theory provides a multi-faceted, culturally and gender responsive perspective, as “recent theoretical work emphasizes the importance of adapting an intersectionality framework to achieve better public health-related outcomes”.^[20]Using feminist theory can be critical as it “offers the potential to challenge hidden assumptions and beliefs and thereby effect change in ways that can improve the lives of those who have often been invisible, powerless, or disenfranchised”.^[21]

As a white faculty, it is important to acknowledge my privilege and approach this project from a place of ‘nothing about us without us’.  Material used includes the voices of the groups impacted by substance use.  I have reviewed materials for diverse and unique perspectives to ensure course material is culturally responsive, appropriate, and will not cause harm.  Deeper understanding of various perspectives may impact on the understanding of stigma, substance use, and approaches that are effective for working on substance use in the community.

Gaps in Knowledge

The theories of substance use from a western perspective are evolving.  While a moral theory is still prevalent in much of the population, guides laws like Canada’s Controlled Drug and Safety Act,^[22] and is perpetuated by the media, there has been a shift in the medicalization of substance use disorders.  The recent decriminalization of certain substances and certain amounts in British Columbia^[23] is the beginning of an understanding that substance use is not a moral failing.  As our understanding of substance use continues to evolve, a broader perspective which includes gender, language, culture, trauma, and systemic factors may help us understand and perhaps address some of the societal inequities that put individuals and communities at risk of substance use.  However, there is no panacea, nor any magic bullet and Wright suggests that “if substance use is ‘always already’ part of the metaphysics of western culture, it can be hard to be analytical about specific effects at specific times”.^[24]  This is one piece of a complicated puzzle.

Non-Western Views

Residential schools, relocation, and forced assimilation have had a devastating impact on Indigenous communities across Canada.  Citizens are responsible to learn, to grieve, to develop empathy, and to make change.  Gouthro suggests that we must develop deeper understanding of “inclusion, diversity, and discrimination, to build on and radically challenge existing theoretical frameworks”.^[25]  How has substance use impacted Indigenous, Black, and People of Colour communities?

This text tries to embody Two-eye seeing^[26] by using examples of Indigenous peoples through the National Film Board (NFB), Truth and Reconciliation Commission (TRC), and other Indigenous resources.  Elder Albert Marshall, Mi’kmaq Indigenous Leader from the Eskasoni First Nation, suggests that “learning to see from one eye with the strengths of Mi’kmaq ways of knowing, and from the other eye with the strengths of Western ways and learning to use both these eyes together for the benefit of everyone” (personal communication, February 9, 2021).  Being responsive to Indigenous ways of knowing must include a holistic view by not only sharing stories, but treatment resources like sweat lodges, traditional teachings, and an emphasis on the mind, body, emotion, and spirit connection using the medicine wheel. I will also honor the ways of knowing of People of Color by including a history of the war on drugs, and prohibition, to recognize the racialization of substance use and the power of racism in substance use.

Learning Activities

According to Merriam and Tisdell, “the online or virtual world is a whole culture in and of itself”.^[27]  Having an Open Educational Resource allows for students to interact through technology and reduces barriers to access (the resource is free of costs).  The curriculum has been created with text, quizzes, activities, and questions for reflection, activities designed to improve engagement and critical reflection.  Colucci suggests that using activities “can also be helpful to discuss sensitive topics”^[28]; the topics we will be discussing can be difficult for many of the students. The activities are designed to make them think and question, they may bring up painful experiences.  The curriculum tries to reflect trauma sensitivity.  Students come to the classroom with knowledge that has been shaped by numerous factors, “who we are shapes both how we experience things and what we know, then our histories, our experiences, and our positionalities in society will shape how we meet contemplative practices”.^[29]  Embedding a trauma sensitive approach that respects student’s past, oppressions that they may face/have faced, and traumatic experiences they may have had is critical in properly implementing mindfulness, which is implemented at the end of each chapter.  Using David Treleaven’s^[30] work on trauma-sensitive mindfulness will help students recognize symptoms like withdrawal, anger, tears, disorientation, and encourage them to get support.  Students will be encouraged to be aware of what activates them and how they normally self-regulate.  Students will also be encouraged to engage in self-compassion, so they do not continue to carry trauma-related shame if they are activated.^[31]  Each section has a self-care module that students are encouraged to participate in.

Ethics

As I reflect on this work, I have begun to address my privilege, as well as my experience working in mental health and substance use.  This OER is an opportunity to contribute to a deeper understanding of how we engage with individuals who use substances, who find themselves living with a substance use disorder, and allow for compassion and mindful engagement.  I hope this text will contribute to a deeper understanding of how we understand and engage with individuals, communities and societies experiencing substance use and will lead to a more compassionate approach addressing substance use in Canada.