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October 7, 2010

The tragedy of alcohol related disorders

Reuel S. Amdur

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Human Resources Development Canada (HRDC) held a teleforum on fetal alcohol spectrum disorder (FASD) on September 30. The Canadian Charger was there.

Wendy Muckle, a nurse who heads up Ottawa Inner City Health, was one of two presenters.  About one per cent of Canadians suffer from fetal alcohol syndrome (FAS) or the milder FASD, which lacks some or all of the physical features of FAS.  That is, many people with FASD appear completely normal. Many are undiagnosed, especially considering that it is only fairly recently that the condition was really understood.

Many of the one per cent (30,000 people) were brought up in perilous circumstances, living with their mothers in shelters, for example.  Considering the devastation which rained on Aboriginal societies, it is not surprising that many with FASD are Aboriginal.

Those afflicted are apt to have a history of failure in school and at work.  They often have trouble with the law, leading to jail and prison, and homelessness is not uncommon. 

Muckle said that her agency deals with a number of FASD cases, and this client group typically includes individuals with complex health and mental health issues.  A person may also have problems of drug and alcohol abuse and serious mental illness, as well has physical problems, diabetes, for example. 

While FAS-FASD is the major cause of mental deficiency, often people with FASD are quite intelligent. Yet, they have great difficulty learning from experience and relating to other people and to new situations.  They tend to impulsivity and to be aggressive and even violent.

Muckle emphasized three foci in addressing the problems exhibited by her FASD clients: housing first, harm reduction, and prevention. 

We cannot expect “cure” for people with FASD. 

They are likely to engage in substance abuse.  A harm reduction approach involves helping them to lessen these and other destructive behaviors.  To enable them to sustain housing and to lessen harmful behavior, they require intense supportive help.  This kind of support may be needed permanently.

Ottawa Inner City Health encourages sound family planning, especially for the woman, as it is alcohol use by pregnant women that causes FAS-FASD. They provide women with contraceptives and counsel them around making responsible choices.  Inner City also makes referrals for abortions.

While those with FASD lack flexibility, agencies and staff working with them need flexibility.  People with FASD need help around such issues as handling money and organizing time. 

According to Muckle, prospects for people with FASD are better if they grew up in a stable, nurturing home, had an early diagnosis, never experienced violence, and are now in stable housing.

Those with FASD need a secure environment with flexible rules and a set routine.  Yet, they are apt to experience the chaotic, dangerous environment of shelters.  They need a focus on life skills and coping mechanisms, but in a shelter their focus is on surviving.  Ideally, they should have no access to drugs and alcohol, while in shelter living the access is unlimited.  They need consistent care givers who understand FASD and are able to use a variety of techniques.  Such care givers are not available in shelters.

Work with a person having FASD involves treatment of concurrent disorders, changing the environment, and engaging him in looking at what is going wrong.  There is low expectation for independent living, and yet there is a lack of housing with the necessary supports.  The concomitant conditions frequently encountered, such as mental illness and substance abuse, often end up in relapse. 

The long-term outlook for such people? “Discouraging,” she said.

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