Literature Review

Evaluation Strategies in Aboriginal Substance Abuse Programs: A Discussion

I. Statistical and Contextual Overview

Of all the manifestations of ill health that are seen in Aboriginal peoples, the reality of substance abuse may illustrate the most convincingly, the need for a convergence of the four components of well-being - physical, emotional, spiritual and mental - in ensuring the health of a community and a person. In Aboriginal tradition, the health and well-being of an individual flows, in large part, from the health and social make-up of the community ¹. This infers that not only must substance abuse be understood in terms of social behavior, but that its solutions lie in collective action of the communities.

Substance abuse has been described as a manifestation of 'alienation' of Aboriginal peoples, whereby their traditions and styles of life are significantly different from, and not accommodated by the patterns of Canadian society ². The results of the enormous cultural change such as that inflicted upon Aboriginal peoples by European invasion, are a cause of disorientation and anxiety which pervades the inner reaches of the human spirit ³. Although a direct connection between cultural change and prevalence of substance abuse (and other forms of ill health) in scientifically validated terms is rare, studies have linked rates of alcoholism and violence in Aboriginal communities to the decline of traditional modes of living from environmental impacts such as that from mercury contamination and major hydroelectric development ⁴. These observations, and the contemporary history of socio-economic conditions among Aboriginal people suggest that substance abuse is a coping strategy for poverty, unemployment, poor health, low educational levels, low or absent community economic development, and negative residential school experiences and other imposed actions which served to break apart families or relocate whole communities. In its final report, the Royal Commission on Aboriginal Peoples' (RCAP) identified the three dimensions of community health that need to be changed so that the health and well-being of Aboriginal people can be improved:

• poverty and social assistance
• shelter, water and sanitation facilities, both individual and community infrastructure
• environmental conditions, including pollution and land and habitat degeneration ⁵.

Although the above theory of the psycho-social and economic origins of substance abuse is widely accepted, other suggested theories have been advanced, including that Aboriginal peoples have an inherent genetic and biological basis for alcohol addictions, or that the use of alcohol is a cultural-based attempt to seek "visions" in altered states of consciousness ⁶. The effects of the introduction of alcohol by European explorers, fur traders and merchants have been described as similar to those from smallpox and other infectious diseases, in that Aboriginal people had no immunity to alcohol. In this context, immunity would have been afforded by social norms and experiences that would have provided protection against over-consumption ⁷. Substance abuse then can flourish if there are no societal values that view such abuse as negative or destructive behavior, particularly if society is tolerant of the use of intoxicants.

Kim Scott's research has itemized the reasons that Aboriginal people have given for substance use or abuse. These include social pressure, use as a coping strategy, cultural loss, defiance, boredom, and the self-fulfilling prophecy that "drinking is Indian." ⁸ An alcohol and drug abuse study in Saskatchewan included consultation with the National Native Alcohol and Drug Abuse Program (NNADAP) project staff on the subject of the causes and consequences of its abuse. The respondents ranked the following pre-determined factors in order of importance (most important to least important):

• lost cultural identity
• poverty and unemployment
• lack of social opportunities
• low education levels
• availability of the intoxicant
• lack of recreational opportunities
• peer group pressure, and
• family pressure.⁹

A large study on predictors of substance use among students in a small urban community in Manitoba found that the number of friends that adolescents reported as using drugs was the strongest predictor of substance use (alcohol, drugs, solvents) for both Aboriginal and non- Aboriginal students. Peer attitude also was a predictor of all types of substance abuse among Aboriginal students.¹⁰

Epidemiology

Social indicators comprise the main source of data from which researchers have described substance abuse and its effects. Of these, the most common indicators have been Aboriginal mortality and morbidity, specifically the high rates of death from injury and poisoning including suicide, and alcohol-related diagnoses and discharges. Other commonly cited social indicators include rates of incarceration and alcohol sales.

Surveys on alcohol and drug use are a more direct method of obtaining information in this area, however, published survey research rarely discusses the validity and reliability of the survey instruments used. Other limitations to survey data include poor response due to apathy or non-participation, western-Aboriginal cultural differences which complicate communications, data collection and interpretation, heterogenicity (of Aboriginal origins) in the grouping which makes up a survey sample, and and an overall lack of identification or participation of urban Aboriginal populations in national surveys.¹¹

1. Alcohol Use

Alcohol consumption has been identified as a major problem in Aboriginal communities, both through research surveys and during the RCAP consultation process. A survey conducted in 57 First Nations communities in Manitoba in 1984-85 used a rating scale from "no problem" to "major problem" to rate mental health problems. Eighty-six percent of the communities rated alcohol abuse as a major or serious problem. Solvent abuse was reported as a major problem in 7% of these communities. An indication of the magnitude of social dysfunction in these communities was suggested by the high percentage of communities reporting other problems as a concern: anxiety (72% a major concern), general violence (70% major), spousal abuse (69% serious or major) and child abuse (51% serious or major).¹²

The results of the Manitoba survey was substantiated by the 1991 Aboriginal Peoples Survey which found that 73% of Aboriginal persons on reserves and settlements thought that alcohol abuse was a problem in their community. As well, family violence was a problem in 44%, drug abuse in 59% and suicide in 35% of these responses.¹³

An Ontario study using 1985-86 data quantified alcohol consumption in counties, and compared those counties with reserves to those without reserves.¹⁴ Counties with reserves had an increased alcohol consumption rate compared to the remaining counties. Using regression analysis, the presence of reserves explained 25% of the variation in alcohol consumption in the province. A further 35% of the variation was explained when adding in socio-economic and demographic variables. There was a direct relationship between decreasing income level and alcohol consumption, as every extra $1,000 in income tax per return was correlated with a 0.3 litre reduction in absolute alcohol consumption.

The APS questioned Aboriginal people about their consumption of alcohol, and has provided interesting results, in that a high usage of alcohol was not reported. The survey which is based on self-reports has shown that a lower proportion of Aboriginal people than Canadians generally drink daily (2% Aboriginal versus 3% other Canadians) or weekly (35% Aboriginal versus 46% other Canadians). As well, abstinence is almost twice as common among Aboriginal people (15% Aboriginal versus 8% Canadian). Furthermore, the APS showed that alcohol consumption is highest among those with the most education and income, among men, and in the age groups younger than 55 years of age.¹⁵ Similar results in which abstinence was more common among Aboriginal people was seen in self-report surveys in the Yukon ¹⁶ and in Cree communities in northern Quebec.¹⁷ These latter two research initiatives also found that among persons who consume alcohol, heavy drinking was more common than moderate consumption.

In 1984, the Federation of Saskatchewan Indians conducted a survey of alcohol and drug use among 898 adults and 385 high school adolescents, who lived either on or off reserve.¹⁸ In total, 39 of 68 bands across the province were surveyed. Among the adult population, 83.9% had used alcohol in the past year, and 34.6% reported regular drinking. Binge, chronic or problem drinking was reported by 37.7%. In the adolescent population, although the usage of alcohol in the past year was high (74.2%), only half as many reported regular drinking as with the adult population (14.8%) and alcohol abuse, as measured by binge, chronic or problem drinking was seen in 11.4% of these self reports.

The Northwest Territories Health Promotion Survey in 1989 which provided a grouping of Inuit and Dene respondents reported a prevalence of non-drinkers and heavy drinkers in the Aboriginal population.¹⁹ This was confirmed in the 1996 edition of the survey, as only 60.1% of NWT Aboriginal persons stated that they had drank alcohol in the past year (compared to 85.2% among non-Aboriginal persons) and heavy drinking was reported in 33.0% of Aboriginal persons (compared to 16.7% in the non-Aboriginal population).²⁰ In a similar vein, the APS found that within the Aboriginal sub-groups, Inuit were more likely to report abstinence than the Indian or Metis groups. Inuit also differed from the Indian and Metis in that they most often reported that alcohol abuse was not a problem in their communities.²¹

Although the reason for the discrepancies between the level of concern expressed about alcohol abuse and the self-reporting of consumption that has been reported in this section is unknown, possible explanations could include drug education and treatment program success, community norms which preclude substance abuse or conversely, an under reporting of consumption by respondents.

2. Drug Use

There is little available information on the use of prescription or illicit drugs by Aboriginal people. As will be covered below under treatment centres, there appears to be an increasing use of narcotics and prescription drugs in clients admitted into treatment, however use of these substances has historically been secondary to alcohol consumption.

The 1989 Northwest Territories Health Promotion Survey reported that among the Inuit and Dene respondents, 30% of men and 16% of women used cannabis in the last year before the survey.²² In the 1996 edition of the survey, unlike alcohol, use of marijuana or hash was greater for Aboriginal persons (27.3%) compared to non-Aboriginal persons (10.8%).²³

A comprehensive and large survey on Aboriginal drug abuse was conducted in Manitoba and comprised Aboriginal (Indian and Metis residents off reserve) and non-Aboriginal adolescents.²⁴ The study accumulated data on four consecutive years from 1990 to 1993. In the fourteen (non-alcohol) drug groupings which were investigated, the Aboriginal group had consistently higher usage rates (expressed as percentages). In particular, these increased rates were statistically significant in either three or all four years for marijuana, non-medical tranquilizers, non-medical barbiturates, LSD, PCP, other hallucinogens and crack. For both LSD and marijuana, the four year Aboriginal average utilization was over three times higher than the corresponding non- Aboriginal utilization.

The FSIN study in 1984 also looked at the issue of drug abuse among the adult and adolescent First Nations population in Saskatchewan.²⁵ In the adult population, 57.3% reported using drugs in the past year, and 26.5% used them regularly. Interestingly, the adolescent results of drug use were similar with 57.3% and 19.1% usage respectively. Drug abuse was measured at 20.7% in the adult population and 8.7% in among the youth. Street drugs and over-the counter drugs were the first and second most often used substances in both groups. Multiple drug use, as well as combined alcohol and drug use, was common. Overall, considering both alcohol and drug abuse (and cross abuse), the study concluded that chronic abuse levels (regular consumption of excessive amounts of alcohol or drugs) were 15% for the adult group and 3% for the adolescents.

3. Solvent Use

A large Canadian study on solvent abuse in Aboriginal children and youth involved 2,850 persons from 25 Manitoba Aboriginal communities and 70 Algonquin high schools from Quebec.²⁶ Overall, 20% of Manitoba children and 15% of Quebec youth reported that they had tried solvent sniffing, with 6% of the Manitoba group and 9% of the Quebec group revealing that they had used solvents past the experimentation phase. A regular use of solvents was reported by 3% of Manitoba children and 2% of Quebec adolescents. The median age of solvent users averaged 12-13 years, in Manitoba however, children as young as 4-8 years old reported sniffing.

The Manitoba study which reported drug abuse in Manitoba Metis and Indian adolescents also investigated solvent abuse. Glue sniffing was higher among the Aboriginal group compared to the non-Aboriginal groups for each of the four years (1990-1993), and glue sniffing was similarly higher in the Aboriginal group for three of the four years.²⁷

The 1984 FSIN study on substance abuse among First Nations in Saskatchewan reported that 18.8% of adolescents in the survey had used solvents in the previous year. Surprisingly, 11.3% of the adult population also reported using some type of solvent.²⁸

In the 1996 NWT survey which asked about a history of solvent use (the survey population was 15 years and older, therefore the survey asked about past behavior including childhood use), the percentage of Aboriginal people who had used solvents was particularly high, at 19.0% (some 24 times the national rate) compared to 1.7% among non-Aboriginal people.²⁹

Profile of Solvent Users

A 1985 study by the National Association of Friendship Centres researched substance abuse among urban Aboriginal youth.³⁰ The study found that almost half of solvent users began sniffing solvents when they were 4 to 11 years old. In order of prevalence, the factors reported to have an association with sniffing included alcohol and drug abuse in the home, family conflict, unemployment, malnutrition or neglect, financial hardship in the home and physical abuse.

Solvent abusers have been described as being more often boys than girls (however female solvent abuse is increasing) who have started abusing at around 9-10 years (the age at onset of use appears to be decreasing), and who have come from dysfunctional families with a history of addiction, and are located in isolated communities. Furthermore, solvent abusers often suffer poor grades or drop out of school, and unemployment, illiteracy, poor housing and a history of physical/emotional/sexual abuse is associated with their sniffing.³¹

The 1994 First Nations and Inuit Community Solvent Abuse Survey questioned solvent abusers in Aboriginal communities. The survey found that most youth respondents began to abuse solvents when they were 4 to 11 years old (49.3%) or 12 to 15 years old (45%). These solvent abusing youth reported experiencing a number of difficulties in their lives. About half faced neglect or malnutrition (43.5%), unemployment (51.7%) and financial hardships (42.3%) at home. About two-thirds were experiencing family conflict (63.5%) or alcohol and drug abuse (67.2)%. Over three quarters of the youth respondents (78.4%) also reported using alcohol.³²

4. Urban Substance Abuse

There is even less information available on the rates of substance abuse among urban Aboriginal people compared to that obtained for First Nations communities. The 1985 study by the National Association of Friendship Centres found that the majority of centres did not have the capability to maintain records on substance abuse of clients as their clients were visiting the centre for other reasons (employment, housing, education). However 56 of 84 participating centres in the study did complete a questionnaire on types and levels of abuse among their communities. These respondents described severe levels of abuse among all age and target groups, with alcohol being the primary substance. Severe was classified using the NNADAP definition of "abuse is causing individuals to lose the ability to deal with the basic concerns of living - serious problems are occurring in family life, at work, with the law, etc." ³³

Substance abuse was reported by centres among the following groups in their communities as follows:

• 68% reported that abuse was occurring among children
• 89% reported that abuse was occurring among teenagers
• 96% reported that abuse was occurring among young adults
• 76% reported that abuse was occurring among pregnant women
• 77% reported that abuse was occurring among single women
• 77% reported that abuse was occurring among unemployed men
• 84% reported that abuse was occurring among chronic alcoholics
• 77% reported that abuse was occurring among treatment clients
• 68% reported that abuse was occurring among the elderly

5. Mortality

The most common indicator from which to indirectly measure alcohol and other substance abuse is the profile of mortality among First Nations people. Medical Services Branch of Health Canada collects annual data on deaths of Registered Indians by age, gender and cause. Although the methods of data collection and populations surveyed vary among the regions of MSB which limit inter-regional analysis, valuable information is available on national statistics and trends in First Nations mortality. ³⁴

An analysis of overall First Nations mortality in the MSB database from 1979 - 1993 has shown:

• crude mortality rate for First Nations has declined by 21.4% from 7.0 deaths per 1,000 population to 5.5 deaths per 1,000 population. Males have higher crude mortality rates than females, however this gap has been closing throughout this 15 year period.
• the age group which experienced the largest decline in mortality rate when comparing 1979-1983 to 1989-1993 data was 0 - 1 years (45.1% decline), followed by the 5 - 14 years (38%), and 30 - 34 and 40 - 44 years (each 36%).
• the age-standardized First Nations mortality rate was 1.6 times the Canadian rate in 1993, which was similar to the gap of 1.5 times in 1979.

The prevalence of violent death in First Nations communities is regarded as one of the most visible expressions of substance abuse in this population, and is supported by statistical correlations. ³⁵ The 15 year analysis of MSB data has shown ³⁶:

• throughout the 15 year interval, the leading cause of death in the First Nations population has remained injury and poisoning, even though this category has seen a 37% improvement in mortality rates from 243 deaths per 100,000 in 1979-1981 to 154 deaths per 100,000 population in 1991-1993. Injury and poisoning is the catch-all category for deaths that are due to accidental and/or violent including those as a result of motor vehicle accidents, suicide, poisoning/overdoses, drowning, fire, falls, firearms, suffocation, exposure, homicide, industrial accident and aircraft crashes.
• for males, injury and poisoning deaths have remained the leading cause of death, although it has dropped from 42.8% of deaths in 1979-1981 to 32.8% in 1991-1993. For these same two time periods, female deaths due to injury and poisoning have dropped from the primary cause in 1979-1981 (26.1%) to the secondary cause in 1991-1993 (20.0%), as circulatory disease deaths have gained more prominence.
• with respect to age, in 1991-1993 injury and poisoning was the leading cause of death for 8 the age group 1 - 44 years. This category drops to a third ranking for the years 45-64 years and to a sixth ranking for persons 65 years and over.
• Age-standardized mortality rates show that the injury and poisoning death rate was 3.8 times higher in First Nations compared to the Canadian population in 1991-1993. This is virtually unchanged from 1984-1988.
• in terms of potential years of life lost (a quantitative expression of the impact of premature death on a population), overall in 1993 there were 46,037 years lost in First Nations. Of this, injury and poisoning accounted for 55.0% or 25,795 potential years of life lost. On the positive side, in 1989-1993 compared to 1979-1983, 60.9% of the deaths averted (due to a lowering of the mortality rate) was due to the impact of a lowered injury and poisoning death rate.
• a regional analysis for 1991-1993 has shown that in all regions injury and poisoning deaths are ranked first, except the Atlantic and Ontario regions where this category is second behind circulatory disease deaths.

A detailed analysis of injury and poisoning deaths has shown:

• in 1991-1993, the most common causes of death were motor vehicle accidents (40.5 deaths per 100,000 population), followed by suicide (38.0 deaths per 100,000 population) and poisoning/overdose (16.5 deaths per 100,000 population). Motor vehicle accidents and suicides combined account for approximately half of all injury and poisoning deaths.
• in 1991-1993, although suicides were less prevalent among female First Nations persons compared to males, more females died from poisoning/overdoses.
• the decreased rate of injury and poisoning deaths overall (1979-1981 compared to 1991- 1993) is due to improvements in the rates of death from motor vehicle accidents (39.4% improvement), drowning (56.8% improvement), fires (44.3% improvement) and firearms (78.3% improvement). The death rate due to suicide has not changed, and the poisoning/overdose death rate has increased two fold.
• suicide rates in the youth (age group 1 - 14) have increased by 44.8% when comparing 1979-1983 data to 1989-1993 data. This has been balanced by marginal improvements in the age categories 15-44 years. The majority of suicides occur in the 15 - 24 age group, followed by the 25 - 44 age group.
• the majority of poisoning/overdose deaths occur in the age group 25-64 years. In the time periods 1979-1983 and 1989-1993, these rates have increased significantly in the 65+ age group (3.6 times), the 45-64 age group (2.6 times) and the 25-44 age group (1.8 times).
• suicide deaths among First Nations are staggeringly higher than for other Canadians. For females aged 15-24 years, the suicide rate in First Nations (35.0 deaths per 100,000 population) was almost 8 times the Canadian rate. For the same age group of males, the First Nations rate (125.7 deaths per 100,000), the rate was over 5 times the Canadian rate. In the 25-34 age group, the disparity is reduced to 4.5 times greater for First Nations females and 3.5 times for First Nations males. Whereas the rate for persons younger than 15 years of age is zero in the general Canadian population (this does not imply no suicides occurred, rather the rate was so small it was rounded to 0 deaths per 100,000), in the First Nations population, the rate for both genders averaged 4.0 deaths per 100,000.

A recent study estimated the total number of deaths and hospitalization attributable to alcohol, tobacco and illicit drugs among Canada's Aboriginal population. ³⁷. The methodology for this estimation included information on the relative risk of disease associated with different levels of consumption combined with prevalence data from national surveys which was then adjusted with Aboriginal-specific information on relative risk and prevalence of alcohol, tobacco and illicit drug diseases and causes of death, and age structure of the population. It is estimated that in 1992 there were 299 deaths (205 males and 94 females) due to alcohol and 48 deaths (40 males and 8 females) due to illicit drugs among Aboriginal people in Canada. When translated to rates, these represent considerably higher rates than that seen in the general Canadian population. For alcohol related deaths, the mortality rate was estimated to be 43.7 deaths per 100,000 for Aboriginal people compared to 23.6 for the general population. The rate of death due to illicit drugs was estimated to be over twice as great: 7.0 deaths per 100,000 in the Aboriginal population compared to 2.6 in the general population.

An study of violent death in Saskatchewan for the years 1978-1982 found that violent death accounted for 40% of all Registered Indian deaths.³⁸ Extreme variability was seen in the rates from different geographic areas, with northern groups experiencing far greater mortality rates due to violence than the less isolated southern areas.

Another Saskatchewan study on alcohol use among the Registered Indian population for the years 1985-1987 which was based on the injury and poisoning data from the Medical Services Branch database found that alcohol use was implicated in 92% of motor vehicle accidents, 46% of suicides in the 15-34 age group, 38% of homicide perpetrators, 50% of fire and drowning deaths, 80% of exposure deaths and 48% of deaths in the "other" category. ³⁹

6. Fetal Alcohol Syndrome

Alcohol consumption during pregnancy can result in fetal alcohol syndrome (FAS), and the less severe fetal alcohol effect (FAE). The spectrum of effects of FAS include prenatal or post natal growth retardation, central nervous system abnormalities and facial abnormalities. FAE, which is a milder expression of alcohol damage to the fetus, affects mainly the neurological system, and is seen through hyperactivity, behavioral problems, learning disabilities and social dysfunction. Prenatal exposure to alcohol is now thought to be the leading cause of birth defects and intellectual disability in North America. As well, this prenatal exposure may cause subtle deficits in judgement and reasoning abilities in people with apparently normal intelligence.⁴⁰

The increasing use of alcohol by women of child bearing age has been attributed to the changing role of women in society, the consequences of social and cultural breakdown of Aboriginal people and marketing strategies targeted at alcohol consumption.⁴¹

Studies on FAS, and particularly on Aboriginal people are few, and even less are regarded as reliable. Nevertheless, a very high prevalence has been reported in some Aboriginal communities, and it is widely accepted that FAS and FAE among Aboriginal children in some regions are seen at rates above that seen in North American children generally. A review of 10 studies investigating the epidemiology of FAS among American Indians, Alaskan natives and Aboriginal peoples of Canada found that the prevalence of FAS in the Indigenous groups was consistently high across the 10 studies. The reviewer cautioned that the studies had significant restrictions which limited both the confidence in the rates reported and the generalizability of the findings.⁴²

7. Morbidity and Treatment

The above study by Single et al which estimated mortality related to alcohol and illicit drug use also provided estimates of rates of hospitalization due to these activities.⁴³ Regarding alcohol use, Aboriginal persons in 1992 were hospitalized at a rate of 5.1 admissions/1,000 population compared to a rate of 3.0 for the Canadian population. Rates of admissions as a result of illicit drug use were 0.6 admissions per 1,000 population in the Aboriginal population and 0.2 in the Canadian population.

A study of utilization of Ontario alcohol and drug treatment centres by Aboriginal people in 1985- 86 found that their utilization was six times higher than what would have been predicted based on the number of Aboriginal persons in the province and equal per capita use between Aboriginal and non-Aboriginal people.⁴⁴

The National Native Alcohol and Drug Abuse Program (NNADAP) provides prevention and treatment services to First Nations persons living on reserves. These are residential facilities operating on a psychotherapeutic model, incorporating intensive, non-medical, culturally sensitive programming lasting 4 to 6 weeks. These centres utilize a treatment activity reporting system (TARS). A review of data and published information from TARS has provided the following:⁴⁵

• In 1991, alcohol, narcotics and hallucinogens were the most widely abused substances, with alcohol being about 4 times more likely to be abused. The reviewer notes that there may be a lack of standardization in the classification of some of the substances, for example cannabis.
• when 1989 and 1991 data were compared, there are clearly stable patterns of abuse in the institutionalized Aboriginal population including the most popular cross addiction patterns of alcohol/narcotics, alcohol/hallucinogens, alcohol/prescription drugs, and narcotics/hallucinogens.
• based on the 1991 data, roughly 40% of the centres' clients were female, and for both genders, the highest numbers of clients were in the 25-34 age group, followed by the 16- 24 age group and 36-44 age group.
• when analyzed by region from east to west, there is a trend to a smaller gap between the rates of male and female participation.
• on a regional basis, the largest treatment participation in the 25-34 age group. Male participation is consistently greater than female participation for all age categories except children in Ontario. These observations are stable from 1989 and 1991. The reviewer has hypothesized that this could be due to a greater abuse problem among males or greater barriers to female participation in treatment (e.g. child care, social stigmatization).
• approximately two-thirds of those entering treatment completed the program (no significant regional differences). Non-completion of the program is primarily a result of client terminations (68%) and staff terminations (21.5%).

A more recent review of TARS data for 1994-1995 has confirmed the above and also found: ⁴⁶

• there is a suggestion of an increasing trend of narcotics and prescription drug abuse
• female participation in NNADAP programs increased to 45%. The slight narrowing of the discrepancy between the sexes in treatment participation is theorized to result from more female-friendly treatment centres, reduction of attitudinal barriers to women, or a reflection of a greater number of women in need.

8. Incarceration

Aboriginal persons are over represented in penal institutions in all regions of Canada when compared to their percentage in the Canadian population. In 1988-1989, a survey of Aboriginal admissions to provincial and federal custody verified this statement, and found the highest rates of incarceration in the north and in the prairie regions.⁴⁷ In the Northwest Territories, these high rates (86 and 96% for provincial and federal custody respectively) are somewhat balanced by the percentages of Aboriginal people in the general population (63%), however in the Yukon, although there are 28% of Aboriginal people in the population, in federal and provincial custody, the proportion is 50 and 63% respectively. The Saskatchewan Aboriginal population presents an even more dramatic difference: 10% in the population, compared to 52-65% in federal and provincial custody respectively.

In a survey by the Correctional Services of Canada on all offenders at intake, it was found that approximately 75% of Aboriginal offenders were assessed with alcohol problems of sufficient severity to warrant some level of treatment intervention. Over half of this population (53%) also evidenced a drug problem.⁴⁸

9. Homicide

Homicide can also demonstrate social pathology and thus may be used as another indirect indicator of the effects of substance abuse. In 1988, the proportion of Aboriginal peoples being charged with murder was 16.0 per 100,000, ten-fold higher than the Canadian population. Aboriginal persons were also 8 times more likely to die as homicide victims than other Canadians.⁴⁹