Addressing barriers to addiction recovery services in the Northwest Territories, Canada

ABSTRACT

The Northwest Territories, Canada, has high rates of alcohol- and drug-related hospitalisations and deaths. There is considerable debate over how to provide substance use recovery services in this region, due to its small, culturally diverse population. The aim of this study was to examine demographic differences in ethnicity, gender and sex for individuals in the barriers to accessing services, supports to stay in recovery, and reasons they struggled to stay in recovery. A total of 439 respondents completed online and paper-based surveys on their experiences accessing recovery services in the Northwest Territories. A mixed methods approach was applied, in which Fisher’s exact test was applied to test for statistically significant demographic differences in quantitative responses, and themed analysis was performed using deductive coding using written survey responses. Several statistically significant demographic differences were identified in barriers to services, supports to recovery, and barriers to staying in recovery. Cultural incongruity, and the importance of social support to substance use disorder recovery, were identified as key themes that emerged in qualitative analysis. There is a need for community-based, culturally safe, and family-inclusive holistic supports at the community level to address substance use issues in the NT, including more informal confidential supports and efforts to reduce stigma and normalise and celebrate recovery.

Introduction

The Northwest Territories (NT), Canada is one of three Canadian territories located above the 60^th parallel. The NT has a population of approximately 45,000 people spread out over 1.1 million square kilometres, living in 33 communities ranging in size from under 50 residents in some of the smallest communities, to 22,000 in the capital city, Yellowknife [1].

Problematic substance use is an ongoing concern in the NT. Rates of hospitalisations entirely caused by alcohol were 1,253 per 100,000 population in 2023–2024, 4.6 times the Canadian average and the highest rate in the country [2]. Costs associated with substance use-related harm are also higher in the NT compared to the rest of Canada, with healthcare, justice, lost productivity and other associated costs calculated to be $5,080 per person in 2020, nearly four times the Canadian average of $1,291 per person [3]. While alcohol has been the most common source of substance use related harm in the past, the availability of illegal drugs has been increasing steadily within the NT, with increases in fentanyl-related hospitalisations and deaths observed throughout the region since 2019 [4] and a rate of police-reported drug offences four times higher than the Canadian average [5].

Work in the NT has been ongoing in each of the four pillars of the Vancouver model for addressing alcohol related harm: prevention, enforcement, harm reduction, and treatment (MacPherson, Mulla & Richardson, 2006). The NT tabled an Alcohol Strategy in 2023, with recommendations for actions under all four pillars [6] and a number of harm reduction services are in operation, including a residential managed alcohol program, an opioid maintenance therapy program, and widespread distribution of naloxone kits and training materials. In recent years, numbers of both drug violations and often related offences, such as firearms offences, have been increasing in the NT [7], with commitment from the Premier to expand enforcement resources [8].

The fourth pillar of the Vancouver model, treatment, has been the source of extensive debate around which approach to treatment will best serve the population of the NT. The availability of recovery services in the NWT varies by community, with all communities having access to mental health counselling services and some communities having peer-support programs, like Alcoholics Anonymous (AA), and periodic culture-based healing camps. However, since 2013, there has been no formal substance use disorder treatment centre in the NT, and anyone wishing to attend residential treatment for any type of substance use disorder must travel outside of the territory, to southern provinces, to access this service. While there are some proponents of building a new in-territory residential substance use disorder treatment centre, others point to the limited capacity, long wait times, and lack of specialisation that has led to the closure of earlier attempts at operating treatment centres in the territory [9].

As the NT is home to multiple Indigenous cultures and has eleven official languages [10], it is unclear whether a single residential-style treatment centre could ever meet the treatment needs of this diverse population. Many common approaches to substance use disorder treatment, including inpatient treatment, counselling modalities, and peer-support models, are grounded in Western ways of knowing and individualist cultural norms [11–13]. Cultural incongruity is a concept that has been described as a lack of cultural fit between the personal values of an individual, and those of an institution [14]. Cultural incongruity has been studied in the context of access to post-secondary education for racialised students [15] veterans [16] and students from low socio-economic backgrounds [17], as well as in the context of access to healthcare [18], psychiatric care [19], and behavioural health services [20]. The misalignment between western treatment approaches and Indigenous culture, and the diversity of Indigenous cultures in the north, indicate that multiple culture-specific approaches may be needed to effectively address substance use disorders in the NT.

Age

Substance use among youth is associated with unintentional and intentional injuries and mental health problems, and problematic substance use in youth can evolve into more severe harm over time [21]. Substance use problems in youth differ from those in later adulthood in that risky or problematic substance use in youth may be driven by transient developmental and peer-related factors (e.g. self-discovery, peer pressure) that will lessen over time without intervention [22]. As well, the normalisation of substance use among youth and the shorter timeframe of their substance use history may cause them to have fewer negative social, personal or health consequences than older adults [23]. While there are various cut-offs used to define the age that someone is no longer considered a “youth”, Statistics Canada uses 15 to 34 and this definition aligned with the age categories used in the original survey (16–19 and 20–34) [24]. For the purposes of our analysis, youth was defined as ages 16 through 34 inclusive.

Gender

Substance use and substance use treatment needs also differ based on gender. For instance, a study in California found that women are more likely to seek treatment from non-substance use-related settings, such as mental health treatment services, indicating that having a range of substance use options may have a greater impact on women with substance use disorders than men [25].

Indigenous ethnicity

The importance of culture is often stressed in substance use interventions for Indigenous peoples, both due to the healing found in reconnecting with culture and identity impacted by colonisation and the legacy of residential schools, and the continued harmful impacts of racism and structural violence often encountered by Indigenous peoples when seeking mainstream services [26,27]. The need for culturally safe substance use services has long been an identified gap in services in the NT [28; 29]) and we anticipate that Indigenous people with experiences of problematic substance use and recovery report a lack of services reflecting their culture and language as a barrier to accessing services, and access to cultural activities as a supportive factor in their recovery. However, it is unclear whether there are other, modifiable factors that differentially impact Indigenous and non-Indigenous individuals in their recovery.

Acknowledging that there is ongoing debate about, and numerous barriers to, substance use treatment, the Government of the Northwest Territories (GNWT) Department of Health and Social Services conducted a survey in 2021 to gather information from individuals who had accessed, tried to access, or considered accessing, addiction recovery services. The initial survey report provided helpful insights into factors that impact access to services, and factors that impact people’s ability to maintain their recovery [30]. However, the data was not analysed to test for differences in age, gender or ethnicity. The objective of this paper is to analyse demographic differences in responses about barriers to accessing services, and factors that impede or support successful recovery among residents in the NT.

Methods

The NT Recovery Experiences Survey was advertised to NT residents online and via radio, inviting people with lived experience of accessing or trying to access recovery services in the NT to respond. The survey was available online from February 15^th to 31 March 2021, and paper copies were collected until 20 April 2021. A total of 439 respondents completed the survey, and 230 respondents included written responses to open questions. A mixed methods approach was used in this analysis, in which written responses in the survey were analysed qualitatively to provide context to the quantitative findings on age, gender and ethnicity-based differences in barriers to and supportive factors for recovery. Ethical approval was granted by the Aurora Research Institute (ACREC #23–07).

Quantitative analysis

Independent variables

Respondents were assigned dichotomous variables based on demographic characteristics. Respondents who stated that their age was 16–19 or 20–34 were classified as youth and those who stated they were 35–49, 50–64, or 65 and above were classified as older adults. The analysis for gender was conducted on two sets of dichotomous variables; the first was for respondents who identified as women vs. men and other genders, and the second was for respondents who identified as men vs. women and other genders. The number of respondents who identified as another gender was too small to allow for independent analysis. Indigenous identity was measured in the original data as Indigenous or non-Indigenous. Respondents were excluded from the analysis in any category where they did not provide a response (e.g. “prefer not to say” or leaving the response blank).

Dependent variables

Three survey questions were used to assess demographic differences in experiences accessing recovery services. In the first, respondents were asked to identify reasons that they could not access the services they wanted and asked to select all reasons that applied. The second asked respondents why they had difficulty maintaining their recovery. This question was asked to a subset of respondents (n = 203) who stated that they had experienced a recurrence of substance use or otherwise struggled to stay in recovery. The third asked respondents to identify factors that assisted them in their recovery. The list of available responses to each question can be found in Figure 1.

Figure 1.

Survey questions and possible responses.

Statistical analysis

Fisher’s exact test was used to test the null hypothesis that there were no differences in the frequency that barriers, challenges and supports to recovery were identified between demographic groups, and results were reviewed for statistically significant differences. Fisher’s exact test was chosen due to the small overall sample size and the awareness (based on the initial survey report) that some dependent variables have few “yes” responses, meaning that many of the 2 × 2tables were likely to have small expected values. Statistical analysis of quantitative data was conducted using R [31].

Qualitative analysis

Themed analysis was conducted in ATLAS.ti [32]. Respondents’ written comments were grouped based on demographic factors (age, sex, ethnicity) and then coded. Deductive coding, based on results found in the quantitative analysis, was used to analyse the qualitative data, with some inductive coding added in later rounds based on themes that appeared repeatedly in the survey responses. Qualitative analysis findings were reviewed by a supervisor with expertise in qualitative methods for consistency. As all statements were made by unique individuals, person numbers were not applied to quotations.

Results

Quantitative results

In response to the question, “Why were you unable to access the services you wanted to access?” Indigenous respondents were statistically significantly more likely than non-Indigenous respondents to respond that the service was not available in their community, that they didn’t know how to access the service, or that they were not aware of the service. Indigenous respondents were also more likely to state that they were concerned that people would find out, judge, or gossip about them, that they were not able to take time off work, that there was no option for their families to attend with them, or that family and friends were not supportive. Indigenous respondents were more likely than non-Indigenous respondents to state that the available services did not reflect their cultural beliefs, or that they were not available in their first language. Youth respondents were more likely than older adults to state that they could not access a service because it was not available in their community, or they were not able to take time off work. Respondents identifying as women were more likely than men and other genders to respond that they could not access a service because it was not available in their community, or they were not aware of this service. Women were also more likely to respond that they could not access services because there was no option for families to attend together, they did not have childcare available, and family and friends were not supportive. When this analysis was repeated for respondents identifying as men compared to women and other genders, men were less likely to report that the service was not available in their community, that there was no option for families, or that there was no childcare available, as barriers (Table 1).

Table 1.

Why were you unable to access the services you wanted to access?

	Odds Ratio (OR)	Confidence Interval (CI)	p-value
Indigenous (v. Non-Indigenous)
This service was not available in my community	1.80	1.17–2.78	0.0069
I didn’t know how to access this service	2.11	1.29–3.51	0.0017
I was not aware of this service/support	2.24	1.30–3.92	0.0025
Worried people would find out/judge me/gossip about me	2.00	1.10–3.72	0.0184
I was not able to take time off work	2.41	1.18–5.19	0.0103
No option for families to attend together	5.33	2.25–14.61	<0.0001
Did not reflect my cultural beliefs	4.41	1.58–15.23	0.0013
Family and friends were not supportive	1.93	1.09–3.48	0.0171
Not available in my first language	9.60	1.43–419.85	0.0113
Youth (v. Older Adults)
This service was not available in my community	1.72	1.07–2.77	0.0195
I was not able to take time off work	2.07	1.02–4.14	0.0303
Women (v. Men or Other Gender)
This service was not available in my community	1.95	1.23–3.13	0.0034
I was not/am not aware of this service/support	1.84	1.03–3.38	0.0359
No option for families to attend together	3.00	1.27–8.24	0.0064
Did not have childcare available	13.02	2.06–541.88	0.0006
Family and friends are not supportive	2.02	1.08–3.96	0.0260
Men (v. Women or Other Gender)
This service was not available in my community	0.58	0.34–0.96	0.0325
I was not/am not aware of this service/support	0.36	0.11–0.95	0.0384
No option for families to attend together	0.12	0.01–0.78	0.0128

When asked about reasons for struggling in their recovery, there were no statistically significant differences between Indigenous and non-Indigenous respondents. Youth were more likely to report struggling to maintain their recovery overall, or that they struggled due to a lack of planning for their recovery. Women were more likely to respond that they struggled due to a lack of supports and services in the community, challenges within their family, or fear of losing custody of their children. Conversely, men were less likely than women or other genders to respond that they struggled in their recovery for those reasons, as well as less likely to respond that they struggled due to a lack of supportive social networks or difficulties getting or maintaining housing (Table 2).

Table 2.

What has caused you to struggle to maintain your recovery?

	OR	CI	p-value
Youth (v. Older Adults)
Struggled to maintain recovery	2.28	1.19–4.61	0.0099
No recovery plan in place/lack of planning for recovery	1.96	1.03–3.77	0.0323
Women (v. Men or Other Gender)
Lack of supports and services in my community	2.09	1.13–3.92	0.0131
Challenges within my family	1.88	0.97–3.71	0.0493
Fear of losing kids	3.06	1.08–10.78	0.0229
Men (v. Women or Other Gender)
Lack of supportive social networks	0.44	0.22–0.84	0.0114
Lack of supports and services in my community	0.35	0.18–0.67	0.0008
Difficulties getting or maintaining stable or adequate housing	0.33	0.13–0.75	0.0040
Challenges within my family	0.46	0.22–0.94	0.0258
Fear of losing kids	0.33	0.08–1.02	0.0482

When asked what helped in their recovery, Indigenous respondents were more likely than non-Indigenous respondents to state that religion or spirituality, cultural values or traditions, and their relationship to land or the natural environment were important. They were also more likely to respond that relationships with family, friends, and other people in recovery were important. Youth were more likely than older adults to respond that they found smartphone apps, reading successful recovery stories, engaging in art, poetry, writing or other creative activities, and family relationships helpful in their recovery. Women were more likely than men and other genders to state that nutrition, meditation or mindfulness, yoga, and relationships with friends were important for their recovery (Table 3).

Table 3.

What has helped you in your recovery?

	OR	CI	p-value
Indigenous (v. Non-Indigenous)
Religion or spirituality	2.37	(1.44–3.98)	0.0003
Cultural values or traditions	4.45	(2.58–7.93)	0.0000
Relationship to land or natural environment	3.31	(1.96–5.72)	0.0000
Family relationships	1.81	(1.17–2.83)	0.0061
Relationships with friends	1.92	(1.19–3.15)	0.0061
Relationships with other people in recovery	1.64	(1.02–2.66)	0.0401
Youth (v. Older Adults)
Smartphone apps	2.68	(1.55–4.62)	0.0002
Reading about successful recovery	1.8	(1.04–3.10)	0.0270
Art, poetry, writing or other creative activities	2.87	(1.27–7.34)	0.0080
Family relationships	1.65	(1.02–2.67)	0.0328
Women (v. Men or Other Gender)
Nutritional plan or diet	2.4	(1.33–4.51)	0.0020
Meditation or mindfulness practice	2.11	(1.24–3.71)	0.0039
Yoga	2.87	(1.27–7.34)	0.0080
Relationships with friends	1.83	(1.09–3.14)	0.0173

Qualitative results

Two themes were identified in this analysis that provide context to the quantitative findings – cultural incongruity, and the role of community in treatment and recovery.

Cultural incongruity

Both Indigenous and non-Indigenous respondents stated that available services were not reflective of their culture. Indigenous respondents wanted to see services that were Indigenous-led, land-based and incorporated the entire family in the treatment process. As one Indigenous woman wrote, “there is nothing Indigenous-focused or if there is, not enough people know about it”. Other respondents commented that there were not enough community and land-based programs, and that the programs are not long enough to meet the needs of their people. Indigenous respondents commented on the need for holistic healing that involved the whole family, which required being close to home: “we need more services in our home communities or regional hubs so that families can heal together”. Repeatedly, respondents mentioned the need for connection to culture and for treatment to take place in connection on the land within their traditional territory. A mistrust of southern, non-Indigenous service providers with Western educational backgrounds, no northern life experience, and Western, colonising approaches to addictions treatment, was also present in multiple statements.

Non-Indigenous respondents, conversely, felt excluded from treatment options and that there was a lack of services available to them; as one non-Indigenous woman stated, “the services available in my community were very clearly only available to Indigenous people”. Another non-Indigenous respondent, speaking to her brother’s experience, said “the Indigenous wellness programs and on-the-land programs have supported his friends but are not always available to him or welcoming to him”. One non-Indigenous respondent stated that the services offered were unclear and difficult to access, and another mentioned that medical service providers do not have enough education on the options available to treat addiction. Like Indigenous respondents, non-Indigenous respondents called for localised treatment options and inclusion of family members: “keep families together working on not only the sole person struggling with addiction, but … the mental health of your family”.

The role of community

The importance of social support for successful recovery, and the impact of a lack of social support, were frequently cited in open responses. On the positive side, people mentioned relationships with spouses, parents, children and friends as important to their recovery; one respondent wrote that the biggest factor supporting her recovery was “creating a safe circle, that propagated my want to be sober”. Both Indigenous and non-Indigenous respondents cited peer support through AA as an important tool in their recovery. One respondent highlighted the role of community in supporting youth who weren’t ready for recovery: “How do we reach kids who won’t participate in therapy themselves? You build up the adults around them to provide therapeutic care on a daily basis”.

Conversely, respondents talked about the lack of social support as an impediment to successful recovery. Both Indigenous and non-Indigenous respondents spoke of feeling pressured to drink by their social circles: “My social circle all uses drugs and alcohol as entertainment. Its normalised. People get together to drink not to visit”. Multiple people mentioned loneliness in their recovery; one respondent stated “my husband and I are alone in our sobriety. Friends no longer maintain a friendship, so we are not invited to a lot of events”. Respondents mentioned that all social life in the community focused on alcohol: “Everything revolves around alcohol. Fundraising, social gatherings, sports etc”. One person stated that they felt they had to leave the NT and move to a place that had “a sober community” to maintain their recovery.

Another way that community impacted recovery was through gossip – both experiences of being talked about, and the fear that this could happen. While some respondents described AA as a lifeline that was essential to their recovery, others stated that gossip prevented them from accessing support: “there are continual rumours coming out of the AA group so I didn’t feel safe utilising this”. Respondents talked about breaches of confidentiality by employers, counsellors and health services staff, with one saying, “staff are related and like to gossip”. Existing dual relationships and concerns about confidentiality were cited by respondents as barriers to reaching out for help when needed: “it is hard to expose yourself and not have people talk about your situation”. Respondents described hearing gossip from service providers, and experiencing consequences to their employment after seeking help, showing that these concerns are well-founded.

Discussion

We found in our survey that residents seeking recovery services in NT desire a shift away from formal recovery supports to more localised, holistic services that include families and cultural knowledge and traditions Indigenous respondents in this survey were nine times more likely to state that options available to them did not align with their cultural beliefs. While a considerable amount of work has taken place in the NT to improve cultural safety within health care services and increase the availability of culturally appropriate substance use and mental health programming [33,34]. government services will always struggle with meeting cultural needs simply because they are required to serve the population as a whole, including Indigenous peoples, settler populations, and recent immigrant and refugee populations from a wide range of cultures. Given the diversity of cultural backgrounds of people needing services, tailoring service provision, beyond working to address racism, increase cultural humility and honour culture-based requests, may be beyond what can be achieved by generalist health, mental health and addictions services. A meta-analysis of Indigenous treatment programming found parallel diversity in culturally based substance use treatment programming, with evidence suggesting these interventions also improve overall wellness for Indigenous peoples struggling with substance use issues [35]. Cultural incongruity with substance use disorder services would be most effectively addressed by supporting Indigenous governments to develop and implement community-based services.

Conversely, some non-Indigenous people shared the perception that services in their community were only directed at Indigenous residents. At present, community counselling services, online counselling services, and facility-based treatment options are available to all NT residents [36]. However, survey responses showed that not knowing how to access a service and not being aware of a service or support, were the second and third most common barriers to service access [30], so this may be due to a gap in communication rather than service availability. It may also be due to a misunderstanding of the meaning of cultural safety within non-Indigenous populations, especially populations that identify as white. A study focused on Indigenous and non-Indigenous users of an Indigenous-focused midwifery service in Toronto, Ontario, found that Indigenous participants and racialised participants conceptualised cultural safety as being part of kinship-based values and continuity of knowledge and practice, while white participants conceptualised culturally safe care in ways that were more focused around client-centred care [37]. Membership in the mainstream, dominant culture can cause it to be invisible to those privileged by it, and neutral in its impact on their life experiences [38]. Thus, cultural safety, despite being beneficial for all service users, may be perceived as something that is “for” Indigenous and other racialised service users. Improving communications service eligibility may help people better understand and access services.

The need for family integration in treatment was identified by both Indigenous and non-Indigenous survey respondents, with both Indigenous people and women being significantly more likely than non-Indigenous people and men to cite families not being able to attend together as a barrier to treatment. This is likely due to a combination of a holistic recognition that the entire family has been impacted by a member’s substance use and needs their own recovery supports, and practical considerations involving childcare. While evidence supports the benefits of family treatment for recovery independent of cultural considerations [39], experiences of substance use disorders and problems in Indigenous communities have identifiable roots in deliberate colonisation efforts that disrupted family structures and relationships [40,p.111]. Residential programming, requiring time away from home, often further disrupts cultural expectations around family responsibilities and community life [20]. Community-based interventions for substance use that involve family, if culturally based and trauma-informed, have the potential to address both substances use problems and intergenerational trauma, and strengthen family connections in the process.

The significance of social support for successful recovery was clear in the survey results. Indigenous respondents were significantly more likely to state that relationships with family, friends, and other people in recovery had helped them, while youth were more likely to state that family relationships were important for their recovery, and women were more likely to say that relationships with friends were helpful. This aligns with previous findings that social support increases individual self-efficacy in maintaining abstinence-based recovery for substance use [41–44]. At the same time, a lack of social support in recovery was a commonly reported concern. Multiple survey respondents, regardless of gender or ethnicity, commented that alcohol use being normalised and expected within their community and peer group made it difficult to stay in recovery. A study by Richmond and Ross [45] that interviewed community health representatives (CHRs) from Indigenous communities across Canada shows that this is a common experience in many small communities, where individuals trying to stay away from addictive substances become alienated and isolated, and may resume substance use because of pressure from, and loyalty towards, family and friends. Survey respondents talked about the loneliness of having to cut ties with friends and family to maintain their recovery; this may impact their ongoing recovery, with loneliness being correlated with both relapse and poor mental health in general [46].

Concern that people would judge or gossip was identified in quantitative responses as a reason that people were not able to access recovery services, with Indigenous respondents being more likely to identify this as a barrier. A study by Krentzman and Glass[47] found that shame about their behaviour in addiction, and fear of gossip about being in treatment, kept people from seeking treatment, and worrying about gossip was enough to cause substance use recurrence. Combined with other social pressures around substance use, this can mean that people must leave their community to be successful in their recovery [48]. This is especially concerning for Indigenous people, who are forced to leave behind elements of community that are important to recovery: connection to traditional culture and family ties [35,45,49]. Later in the recovery journey, gossip can play a dual role. Gossip about positive changes in an individual in recovery can reinforce changes and increase community support (Krentzman & Glass, 2021). Conversely, it can compound feelings of shame related to substance use recurrence and prevent someone from reaching out for help when they are struggling, for fear of destroying the reputational progress they’ve made.

Participation in AA has been shown to be beneficial to those seeking sobriety, increasing the likelihood that someone will maintain their recovery as well as providing more general social support [50]. Unfortunately, respondents expressed valid concerns about confidentiality when trying to access this type of support in small community settings. An alternative may be to offer more formal options for peer support, in which people in recovery are formally trained and employed to provide confidential recovery-based services [51]. This model has been shown to be effective in many settings [52–54] and being employed to provide this support creates additional accountability that is not present in voluntary peer support settings such as AA [55]. An example of these efforts within the NT is training offered to people with lived experience of recovery to become “Recovery Coaches”, in Fort Simpson [56], a model that could be applied in a number of northern and rural communities.

The perception of support for sobriety is clearly important for people in recovery, and NT communities are taking strides to reduce stigma and recognise people who are maintaining their recovery. In the past year, celebrations for people coming back from treatment or living in sobriety have been held in Norman Wells, Inuvik and Fort Simpson [57–59]. Holding sober gatherings and celebrating sobriety milestones were suggested by many people as important during the development of the NT Alcohol Strategy [6]. Communities willing to support their members in this way may benefit from information about the impacts of gossip and the importance of confidentiality, and education on other ways to encourage people to seek recovery support. Community Reinforcement and Family Training (CRAFT) is an intervention designed to give concerned significant others (CSOs) such as parents or spouses the skills to influence a loved one’s substance use behaviour in ways that improve their own wellbeing and encourage their loved one to engage in treatment [60–62]. The community reinforcement approach focuses on creating incentives for people with substance use disorders so that reducing consumption or abstaining all together becomes more rewarding than continuing to drink or use, by increasing positive reinforcement and reducing the isolation that often occurs as dependency increases [63]. An Indigenized version of this training is available and may contribute to the development of whole community approaches to reducing substance use-related harm.

Study limitations

This study had several limitations that should be noted when interpreting the results. Community- or region-specific data was not collected as part of the survey. This was a deliberate decision to protect confidentiality, as anonymous survey responses that include community or region can quickly become identifiable in small communities if, for instance, if there are only a few people who are known to have accessed recovery services. However, it limits the interpretation of the study, as available services vary widely between the capital city of Yellowknife, regional centres, and small communities. Another limitation was that the survey was available only in English and French and offered online or in paper format. In 2021, 11.1% of respondents listed an Indigenous language as their mother tongue; this was as high as 70–75% of respondents in some small communities [7]. While the opportunity to work with a translator or complete the survey orally were offered as alternatives, individuals who need these services may have been less likely to respond, particularly due to decreased confidentiality when working with an interviewer and/or translator. Finally, the survey was offered primarily online, with paper copies made available at community counselling offices. This may have been a barrier for individuals in small communities, who may have limited internet access and for whom their may be stigma associated with visiting the community counselling office. A third limitation was the potential for selection bias introduced by the use of data from an anonymised survey open to the public, as individuals with stronger opinions or extreme experiences may have been more likely to complete the survey. Finally, this study was limited by the fact that qualitative coding was completed by a lone researcher and therefore lacks intercoder reliability.

Conclusion

To the initial findings of the NT Addiction Recovery Experiences Survey, this paper adds an analysis of demographic differences in barriers to service access, as well as in elements that are supportive of and threatening to successful recovery experiences. These findings highlight the need for more tailored services that address cultural, gender, and age-specific needs. Work to reduce substance use-related harm should consider that both Indigenous and non-Indigenous respondents felt a lack of cultural relevance and safety in the recovery services available and expressed a desire for holistic family supports. The role of community support was evident in both positive and negative experiences shared by respondents, with social support being essential to successful recovery, and normalisation of substance use, stigma, and gossip acting as barriers to recovery. Fostering community support to create supportive, stigma-reducing environments is already underway in some NT communities and should be expanded to empower communities to take care of their members who are struggling. Community-based recovery supports that prioritise cultural safety, family involvement, and stigma reduction are vital steps towards supporting long-term recovery for NT residents.

Funding Statement

The author(s) have not received any funding or benefits from industry or elsewhere to conduct this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).