Student: Courtney Hore
Supervisor: Paul Robertson (Psychologist/Māori Health Lecturer), Rawiri Bates (CMP - Maori Case Manager), Wiki Crofts (CMP - Pukenga Atawhai: Maori Health Worker)
Sponsor: University of Otago
Emerging evidence suggests integrating culture and addiction treatment increases patient engagement, satisfaction and an increased ability to detect risk of relapse through early intervention. The Whanau Clinic of the Christchurch Methadone Programme enables Maori clients to receive treatment in an environment embracing the values and practices of Maoridom. This project aimed to gain information about the experiences of clients to help evaluate and improve the services provided by the Whanau Clinic. It will also contribute to the limited information base currently available on addiction in indigenous peoples and effective treatment strategies.
An international and national literature review was conducted producing much information on methadone, Methadone Maintenance Therapy (MMT), indigenous peoples and addiction but little on culturally integrated treatment for addiction.
This project was conducted within a Kaupapa Maori Research (KMR) framework promoting recognition of Te Ao Maori (the Maori world) and validation of Maori knowledge. It supports models of Maori health that better address Maori needs on a physical, social and cultural level. KMR requires relationships to be formed between the researcher and participants (whanaungatanga) to facilitate full participation in the research .
Qualitative data was collected using semi-structured interviews with eight Maori participants from the Whanau Clinic. This approach was consistent with KMR principles as it allowed participants to “express their experiences fully and in their own terms” . Thematic analysis enabled primary issues to be identified and further discussed.
The major themes identified included;
- Addiction and MMT
- Maori and methadone
Methadone was viewed by participants as stabilising their addiction but also as restrictive in terms of commitments to and dependency on the treatment programme. Their reason for substance abuse was attributed to their past, the people they associated with, a lack of guidance and a lack of connection with their culture and identity, which is addressed in the Whanau Clinic. There was consistent commentary of broken homes and a history of substance abuse/crime from adolescence through to adulthood. Being Maori was identified as defining the client's identity, values/beliefs and where they had come from.
Many of the participants regarded methadone as a 'white man's medicine' but the only alternative currently available to addresses their addiction. None of the participants identified a connection between their experience of Maoridom and substance abuse. They were able to describe the positive aspects of Maoridom they had embraced since becoming part of the Whanau Clinic and identify how this aided their rehabilitation. They felt the Whanau Clinic provided the support, stimulation and comfortable environment that the mainstream programme lacked. The participants identified several areas for development including promoting an environment that provides guidance and encourages connection with their culture and identity. They felt this important for establishing a sense of belonging and a firm foundation from which they could then address their addiction.
In summary, analysis of this qualitative data has shown that clients of the Whanau Clinic are supportive of the culturally integrated treatment they are receiving and feel it has aided their rehabilitation. They identified specific ways in which this was true for them as individuals and possible future improvements for the programme. This information is being used in the evaluation and further development of the Whanau Clinic. It will also contribute to the current limited information on addiction in indigenous peoples and effective treatment strategies, particularly in the area of opioid substitution