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From Stilettos to Moccasins: A Healing Journey

Helping women rise above stigma, reclaim identity and overcome addiction

After seven years of gathering evidence, Dr. Colleen Anne Dell understands the importance of identity in helping Aboriginal women overcome drug and alcohol abuse.

"I remember one woman who told us 'For so many years, until I came to this treatment centre, I thought being Aboriginal meant drinking and drugging. Now I'm starting to see that I can be proud of who I am.'"

Working in partnership with the National Native Addictions Partnership Foundation (NNAPF), the University of Saskatchewan's Dr. Dell leads a diverse research team. The group includes academics, elders, community members and, critical to the project, several team members with "lived experience" to help conduct interviews as part of the research process. These team members are Aboriginal women in long-term recovery (five years and up), some of whom have first-hand experience with the criminal justice system.

Since 2005, using this unique team, the group has been conducting research "by, for and with" Aboriginal people instead of "on" Aboriginal people – to address drug and alcohol addiction among First Nations, Métis and Inuit women.

Research: By, for and with Aboriginal people

Researchers often strive to maintain a distance between themselves and the subjects of their research in order to avoid bias and to ensure objectivity. The research subjects provide the data, which the researcher interprets and disseminates. But the Stilettos to Moccasins project attempts to break down this artificial barrier. Through a new collaborative methodology, the project directly embraces women in addiction treatment as part of the research process. These women share their stories with research team members who have first-hand experience in overcoming addiction. The end result is a two-way exchange between researchers and study participants.

Photo courtesy of Mae Star Productions

It is a growing crisis: the number of Aboriginal women in federal prisons has increased by more than 80% in the last 10 years, with more than half identifying a current or previous addiction to drugs. The majority of these women also report a history of physical or sexual abuse and many inflict self harm – cutting their arms or legs.¹

Previous research has suggested that addiction and self harm are often the products of emotional pain and distress rooted in abuse and violence.² Dr. Dell and her colleagues have found that helping women see themselves in terms of their Native culture instead of identifying with their negative coping strategies of drug or alcohol abuse is essential in the "healing journey" to a balanced and healthy life.

"We call it identity transformation," says Dr. Dell. "It's understanding who you are – your spirit, your self-identity, your reason for being. Answering the question: Who am I?"

NNAPF's Executive Director Carol Hopkins, who has partnered with Dr. Dell in guiding the research, adds that "For many Aboriginal women it means overcoming stigma and taking pride in who they are for the first time."

With support from CIHR, Dr. Dell and her team interviewed 100 women undergoing addiction treatment at centres across Canada.

"We had six interviewers and almost all had lived experience," says Dr. Dell. "We called them story-gathering sessions. It wasn't so much about the person sitting there and asking the questions as it was stories being shared on both sides. At the end of each one, each woman was given an oyster with a pearl inside as a symbol of the hope and inspiration for their own healing journey."

Another 30 sessions were held with treatment providers. "About 80% of the providers were also in their own recovery journey, so they had a dual role," says Dr. Dell.

After the stories were collected, it was important to "give the findings back to the women," says Dr. Dell. "Because of the relationship that we developed, they were our priority. We thought 'Why don't we make something accessible like a song and a video?' It was completely different from writing an academic paper, which we also did. But we wanted to give back to the community first. So we created From Stilettos to Moccasins."

Research team members, women who had been interviewed, service providers and government policy makers pitched in for the song, which was written with the help of Violet Naytowhow, a Saskatchewan-based recording artist. "It's powerful," says Dr. Dell. "We are at over 21,000 hits on YouTube. I don't know if we're ever going to have 21,000 hits on our article."

The team also developed a half-day workshop intervention – again called From Stilettos to Moccasins – and produced an information kit for addiction treatment centres, jails and prisons. "It focuses on raising awareness about the role of identity and stigma," says Dr. Dell. "The second goal is to offer hope and inspiration to other women who are in treatment centres. We had 150 kits that went out over a four-month period in 2012 and it's now online."

The research team engaged 14 "community ambassadors" to facilitate workshops across the country. Once a treatment centre has a kit, staff can keep offering the workshop over and over, reaching out to hundreds – and potentially thousands – of women. "A treatment centre in Saskatchewan offers the workshop monthly," says Dr. Dell.

Evidence in Action: Bringing cultural awareness to addiction treatment

To raise awareness about the role that identity and stigma play in addiction, the research team produced an information kit for addiction treatment centres, jails and prisons. The team distributed 150 kits in 2012 and recently made it available for free online.

Photo courtesy of David Batstone

NNAPF's Ms. Hopkins says the project has succeeded because "it's accurate, engaged and captures in a respectful way the voices of Aboriginal women and transforms those voices into something very useful for treatment strategies." The workshops offer treatment centre service providers the resources they need "to offer more in terms of culture" in addressing addiction.

"The cultural element has not often been that evident in terms of practices and policies and the workshop kit has helped fill that gap," says Ms. Hopkins. "Treatment centre workers now have a better understanding of Aboriginal women's needs and are better able to help them."

Kim Tiessen, an addiction counsellor at the Calder Centre in Saskatoon, says the workshop helps women going through addiction treatment link back to the time before they may have felt addiction came to define them. "The workbooks discuss practices within the Aboriginal culture to see how reconnecting with them may have a positive effect on a person's psychological, physical and emotional sense of themselves."

For example, she says, someone might use smudging, in which smoke from sage, cedar or sweetgrass herbs are "washed" over a person as a cleansing or healing ceremony. "It can be a very spiritual way for the women to mentally and emotionally reconnect with their culture."

Dr. Dell and Ms. Hopkins are carrying their work forward with a three-year project called Honouring our Strengths: Culture as Intervention in Addictions Treatment, part of which involves visiting treatment centres across the country to discuss the impact of culture on well-being.

"To initiate the project, we created videos with the Saskatchewan community sharing how Aboriginal culture helped them heal from addiction," says Dr. Dell. "We have also turned these testimonials into a one-day workshop, but this time for service providers. Our pilot testing – with mainly non-Aboriginal service providers in Saskatchewan – told us they were grateful to have that space where they could talk and ask questions about culture and reflect on some of the things that were happening in their clients."

"The workbooks discuss practices within the Aboriginal culture to see how reconnecting with them may have a positive effect on a person's psychological, physical and emotional sense of themselves." – Kim Tiessen, addiction counsellor at the Calder Centre in Saskatoon