Kua warea te Māori e te tarukino, e te whakapōauau
Substance misuse and addiction in Māori
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A weed from far away
Te Rau Hinengaro, the New Zealand mental health survey (2006) revealed that substance misuse disorders (mainly alcohol and cannabis) are experienced by over one quarter (27%) of Māori in their lifetime, second only to anxiety disorders (31%).1 Substance misuse disorders were the third* leading cause of hospitalisations for mental health disorders among Māori males (82 per 100,000) between 2003 and 2005.2
Substance misuse disorders commonly co-exist with other mental health problems. Te Rau Hinengaro identified that 40% of those with a substance misuse disorder, also had an anxiety disorder and 29% had a co-existing mood disorder.1 It has been reported that up to 95% of people receiving treatment for substance misuse, e.g. in community alcohol and other drug (AOD) units, have co-existing mental health disorders.3
Misuse of multiple substances and co-addictions are common.
Substance misuse is associated with:
- Other mental health disorders
- Chronic general health problems
- Accidental and intentional injury and death
- Violence
- Criminal offending
- Negative work, educational, social and financial consequences
- Risky sexual behaviour
- Adverse effects on foetal development
- Negative child and adolescent outcomes from parental substance misuse
Primary care is well placed to recognise and address substance misuse and addictions, and provide early intervention and general management.4
Identifying and discussing substance misuse
Raising the subject of substance misuse and addiction with any patient presents challenges for many clinicians. Barriers may include the perceived sensitivity of the subject, fear of harming the therapeutic relationship, reluctance to document illicit drug use and time pressure. Discussion is dependent on the acuteness and complexity of the presenting complaint and the priority given to multiple other health issues for discussion.4
Cultural fluency enhances communication
A lack of confidence in the area of cultural fluency can further complicate addressing addiction-related issues with Māori.
| Cultural fluency is defined as appropriate application of respect, empathy, flexibility, patience, interest, curiosity, openness, a non-judgemental attitude, tolerance for ambiguity and sense of humour. It implies a cultural familiarity and enhances the communicators understanding of cultural context and the degree to which a message is received and understood.5 |
The key aspects of cultural fluency are acknowledging differing definitions of health and wellbeing, supporting choice of treatment approaches and presenting health care (and options) in a culturally responsive manner.
Cultural fluency goes beyond sensitivity, awareness and cultural safety. It can include, for example, understanding how or by whom decision making is made in a whānau, and considerations of how Māori values, beliefs and experiences might impact on the establishment and maintenance of a therapeutic relationship.
Framework for managing substance misuse and addiction
Māori are a priority population for identifying and managing substance misuse and other addictive behaviours. Primary care intervention is effective and important.
- Be aware that substance misuse and addictions are common problems
- Be alert for opportunities to discuss substance misuse and addiction and consider routine screening when time allows
- Be culturally aware
- Use direct, open questions
- Reassure that information will remain confidential
- Offer hope and support
A general framework for identifying and managing a substance misuse disorder is set out in Table 1. Treatment is usually shared between general practice and specialist care teams.
| Table 1: Key treatment goals for substance misuse disorder (adapted from Todd, 2010)3 | |
| Identification |
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| Early treatment |
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| Middle treatment |
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| Late treatment |
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| Independence |
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Characteristics of discussion about substance misuseA recent study of GP consultations in New Zealand, revealed significant issues surrounding discussion about the misuse of alcohol and other drugs (AOD). Opportunities for discussion were not acted upon in one quarter of the consultations. When use of AOD was discussed, it was observed that both GPs and patients had a degree of discomfort, and changed the subject when it became too uncomfortable. GPs were often seen to talk down the importance of the topic or suggest a change in substance intake, but not necessarily to the recommended safe levels.4 Alcohol and tobacco were most commonly discussed and cannabis use was not discussed at all.4 AOD issues were generally raised by the patient or identified in the context of presenting symptoms or in screening for related symptoms. AOD was not the primary reason for presentation in any of the studied consultations.4 |
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