THE ROLE OF SPIRITUALITY AND SELF-DETERMINATION IN RECOVERY FROM DRUG AND ALCOHOL ADDICTION AMONG INDIGENOUS PEOPLE by Heather McQuinn Bachelor of Nursing, University of New Brunswick, 1990 A Report Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Nursing in the Graduate Academic Unit of Faculty of Nursing Supervisors: Grace Getty, RN, PhD; Janice Thompson, RN, PhD, Nursing Examining Board: Krista Wilkins, RN, PhD, Nursing, Chair Kathy Wilson, RN, PhD, Nursing Linda Eyre, BA, MAHED, PhD; Education; UNB This report is accepted by the Dean of Graduate Studies THE UNIVERSITY OF NEW BRUNSWICK September, 2017 ©Heather McQuinn, 2017 ABSTRACT Three-quarters of Indigenous adults living on reserve report that addiction to alcohol and other substances leads to problems within families and other violence. Over the last 40 years, there has been a growing body of evidence linking an individual’s spirituality with health outcomes, especially in the prevention of and recovery from addictions. Indigenous peoples have traditionally viewed spirituality as an integral part of health. Alcoholism and other addictions are self-soothing ways of numbing the “soul wounds” many Indigenous people have experienced as a result of colonialism. The purpose of this report is to examine the literature on the role of spirituality and self-determination in successful recovery from addiction among Indigenous Peoples. Accordingly, the literature on traditional cultural ways of being of the First Nations of eastern Canada has been reviewed together with the effects of colonialism on their wellbeing. The spiritual and cultural influences apparent in addiction recovery have been reviewed in relation to Indigenous Self-Determination, a social determinant of health among Indigenous people. The psychological Theory of Self-Determination, which has been developed in Western therapeutic and academic locations, and tested and used by some Indigenous scholars, has been reviewed in relation to Indigenous Self- determination, as well as spiritual and cultural influences on recovery from addiction. The question that has emerged from this discussion is whether there is room for individual choice of healing approach within the cultural imperative of collective self- determination. Finally, the implications of these findings for nursing practice, research and education are identified. ii DEDICATION To the God who knew and knows the plans He has for me And To the memory of Kenny “Munster” & Davey iii ACKNOWLEDGEMENTS Those who have loved and supported me through this journey— You know who you are. I can no other answer make… but thanks…thanks; and ever, thanks. Shakespeare iv Table of Contents Abstract ............................................................................................................................... ii Dedication .......................................................................................................................... iii Acknowledgements ............................................................................................................ iv Table of Contents ................................................................................................................ v Chapter 1: Introduction to the Health Situation of Indigenous People ............................... 1 Purpose ............................................................................................................................ 1 Objectives ....................................................................................................................... 2 Indigenous Health Statistics ............................................................................................ 3 Situating the Researcher ................................................................................................. 8 Summary ....................................................................................................................... 10 Chapter 2: Literature Review ............................................................................................ 11 Indigenous Traditional Ways of Being ......................................................................... 11 Colonization: Marginalization Through Collective Trauma and Racism ..................... 13 Legal. ........................................................................................................................ 14 Administrative. .......................................................................................................... 16 Ideological. ................................................................................................................ 17 Residential schools. ................................................................................................... 18 The Sixties Scoop and foster home programs. .......................................................... 21 Summary. .................................................................................................................. 22 Spirituality..................................................................................................................... 23 Positive relationships between spirituality/religiosity and health. ............................ 26 Negative relationships between religion and health. ................................................ 29 Traditional Indigenous spirituality, health, beliefs, and practices. ........................... 31 Addictions ..................................................................................................................... 34 Definition .................................................................................................................. 35 Theories related to the causes of addiction ............................................................... 37 Addiction as a spiritual disease ................................................................................. 43 Summary ....................................................................................................................... 45 Chapter 3: Self-Determination .......................................................................................... 47 Indigenous Self-Determination as a Fundamental Global and Local Goal of Indigenous Peoples .......................................................................................................................... 48 Indigenous Self-determination as a determinant of health. ...................................... 51 Ryan and Deci’s Self-Determination Theory. .......................................................... 54 Indigenous autonomy ................................................................................................ 58 Indigenous relatedness .............................................................................................. 60 Indigenous competence ............................................................................................. 60 Empirical evidence of emerging perspectives on SDT in the context of ISD. ......... 62 SDT viewed through the lens of Indigenous Self-Determination and Two-Eyed Seeing ........................................................................................................................ 63 v Summary ....................................................................................................................... 64 Chapter 4: Spiritual Approaches to Addiction Through the Lenses of ISD and SDT as Adapted by Roche and Associates .................................................................................... 66 Alcoholics Anonymous ................................................................................................. 67 Background and program design .............................................................................. 67 The AA formula ........................................................................................................ 69 The role of spirituality in AA .................................................................................... 70 The interplay of spirituality and attendance at AA ................................................... 72 Congruence of AA with ISD and Indigenous worldviews and values ..................... 74 Congruence of AA with SDT in the light of Indigenous worldviews and values .... 76 Incongruence of AA with ISD and Indigenous worldviews and values ................... 77 Incongruence of AA with SDT in the light of Indigenous worldviews and values .. 77 Adaptations of the AA movement to Indigenous populations .................................. 78 Relationship between the Indigenous adaptations of AA and SDT .......................... 84 Traditional Culture as Treatment .................................................................................. 85 Enculturation ............................................................................................................. 85 Cultural and spiritual practices ................................................................................. 88 Indigenous cultural practices and alcohol cessation ................................................. 90 Culture as treatment within ISD ............................................................................... 90 Programs Used in Indigenous Treatment Centers in New Brunswick ......................... 91 NB treatment centres through ISD and SDT lenses .................................................. 94 Addiction Treatment Programs Founded