Saskatchewan is currently in the throes of an addiction crisis and Dr. Kara Fletcher wants to humanize those living with substance use disorders.
By Lynette Piper for SHRF and the University of Regina
The person who reaches out for that jolt of morning caffeine or likes to unwind after work with a glass of wine may seem worlds away from the desperate soul who breaks into homes and steals to feed their voracious addiction. But Dr. Kara Fletcher thinks we’d do well to look at both a little differently.
Fletcher, a social work assistant professor at the University of Regina’s Saskatoon campus, is on a mission to humanize the lived experience of those living with substance use disorders – a term she says is much kinder than “addict,” “junkie,” or “abuser” – in order to convey the understanding that we all experience challenges in life, and that we all rely on some form of coping method to deal with the stress.
Fletcher, who is also the director of the Social Policy Research Centre, a registered social worker, and an accredited couples and family therapist, was recently encouraged to see how perceptions are changing when Joe Biden’s son, Hunter, was questioned by an ABC news anchor for “being in and out of rehab seven or eight times.”
“I was so impressed with the way he took the anchor to task and told her to ‘Say it nicer’ – not in a combative way, but to educate her that he sought treatment for a health issue, like most people, and now was doing well.”
Fletcher believes strongly that words matter.
“I recently completed a study with 10 individuals attending outpatient treatment for substance use and 10 clinicians providing counselling. I heard multiple stories of how disempowering the language around substance use can be. If you’re not ‘clean,’ then you’re somehow dirty and morally reprehensible. In Hunter Biden’s case, it was almost like multiple episodes of treatment indicated a personal failure, when, in reality, relapse is simply a part of the journey.”
Read more from Dr. Fletcher about the need to say it nicer
SASKATCHEWAN’S METH CRISIS
Fletcher sees a social hierarchy with substance use, and is working to change that. “In our society, alcohol is accepted, and so is cannabis, more or less, because they’re legal. Yet, if you’re using meth, you’re seen as dirty, horrible, and disgusting,” she says. “We tend to divide society into an us-versus-them mentality, and the only way we find ourselves caring about substance use disorders is if we’ve been personally touched by them. Yet we need to care. If we don’t understand why so many people are turning to crystal meth or dying of fentanyl overdoses, then how can we empathize with the person in the street having a psychotic episode?”
Saskatchewan is currently in the throes of an addiction crisis. According to a recent study published in the Canadian Journal of Psychiatry, about 14 per cent of Saskatchewan residents have an addiction to drugs or alcohol – the highest per-capita rate of drug and alcohol addiction in the country.
According to police in both Regina and Saskatoon, there is evidence that crystal meth use is exploding. The blue-tinged crystal rock is used as a stimulant that is either smoked, or crushed and injected. While much attention has been paid to the nation’s opioid crisis (nearly 400 people died of an opioid overdose in Saskatchewan in 2020, double the fatalities since 2018), police say meth use has flown under the radar. Meth is an “upper,” whereas fentanyl is an opiate or “downer” similar to morphine, but 50-100 times more potent. Some users rely on meth and fentanyl in a vicious cycle of getting high on the “upper” and then using fentanyl to come back down.
Constable Matt Ingrouille of the Saskatoon Police Guns and Gangs Unit says he’s seeing more meth, and it’s affecting kids as young as 10.
“Everyone can afford to be a dealer these days, with massively cheap product coming in,” Ingrouille explains. “While people think of Breaking Bad, with meth being cooked in rundown trailers using locally sourced chemicals and supplies, the bulk of the meth hitting Saskatchewan actually comes from highly sophisticated labs in China and Mexico, with drug cartels moving it into Vancouver, up to Edmonton, and down into Saskatoon. Kids are getting addicted because it’s so cheap. One-tenth of a gram of meth used to cost $20. Now you can get high for $5.”
THE ROOT OF THE PROBLEM
Solving the drug problem, according to Sergeant Robin Wintermute of the Saskatoon Police Drug Unit, isn’t going to happen overnight. “Police aren’t going to arrest our way out of this,” he says bluntly. “We have 12 investigators and there’s no shortage of work. We need to continue building community partnerships and get at the root cause of the problem,” he says, citing poverty, racism, and unresolved trauma that need to be addressed.
Constable Ingrouille agrees.
As a self-professed harm-reductionist and founder of Say Know (a play on the abstinence-only ‘say no’ approach that points instead to knowledge and understanding as the answer), Ingrouille believes people will eventually become non-users if more focus is placed on meeting the needs of the person first.
That’s where Kara Fletcher comes in. “We have to dig deep and understand the whys of drug use and really be willing to listen, because it’s affecting all of us,” she says, especially since the pandemic has compounded mental health issues.
“We need to shift our line of questioning from
‘Why the addiction?’ to ‘Why the pain?’”
“In the first phase of a study I’m working on, funded by a Saskatchewan Health Research Foundation (SHRF) Establishment Grant, we found that in Saskatoon fewer youth aged 18 to 24 are attending mental health and substance abuse services compared to older cohorts,” Fletcher notes with concern.
Through more interviews, the second phase of this study will help her to better understand their reasons for not attending these specialized programs.
Fletcher’s compassion and unwavering drive to understand addiction have made her a sought-after therapist and researcher working with individuals and families living with substance use disorders. Her research is centred on the fact that past trauma plays a huge role in addiction. “Renowned Canadian physician Dr. Gabor Maté says that developing an addiction is not a choice or a failure of will, but a response to human suffering and childhood trauma,” she says. “When you think about it, a person is self-medicating to deal with their pain and make it through another day, which is almost an act of strength to survive – and yet the addiction blows up in their face. We need to shift our line of questioning from ‘Why the addiction?’ to ‘Why the pain?’”
TOUCHED BY ADDICTION
Fletcher has always had an ability to connect with those who are suffering. She remembers when, growing up in rural Ontario, a fellow Grade 4 classmate was killed in a car accident. “I was the one taking these kids back and forth to the school counsellor to help process their pain,” she says. “I always knew from a young age that I wanted to help others.”
After obtaining her Master’s of Social Work at Montreal’s McGill University, Fletcher worked with families and groups focusing on mental-health issues related to substance use. “That’s when I thought, ‘There’s very little research out there on substance use and relationships,’” she recalls. “It’s what prompted me to return to McGill and pursue my doctorate.”
While Fletcher was working at an inpatient clinic for substance misuse, she recalls a fellow clinician telling her not to talk about past trauma. “I was horrified!” she recalls. “How on earth can we ignore trauma when that’s the crux of the issue?” So she developed her PhD thesis on Emotionally Focused Therapy (EFT), working with couples where one partner presented with a substance addiction.
“Usually, one partner is the helper-fixer who wants to go in and save the other,” she says. “I found that the current treatment structure over-focuses on substance use, where we really need to focus on the social context of the unresolved trauma. Then, rather than saying ‘I need you to stop using,’ we can get to the root of the issue, focus on the unmet needs, and say, ‘I trust you to be there for me,’ and allow the couple to focus on how that can be achieved.’’
When Fletcher teaches her master’s-level course on addiction, she acknowledges that some of her students may struggle with their own past experiences with addiction. “The stats say that in our lifetimes, one in four people will be touched by someone with an addiction. That’s a parent, sibling, or best friend. No one is immune.”
THE HUMAN EXPERIENCE
One of Fletcher’s students is Heather Kernohan, a Saskatoon social worker who has been on the frontlines for 15 years. “What I appreciate about Kara is she’s presenting master’s-level material in a way that really resonates. We’re not just reading academic papers, but listening to podcasts, sharing stories, and reaching out to those with lived experience with crystal meth. Because every batch of meth is slightly different, and because everyone responds to the drug differently, people can have erratic behaviour, or paranoia, or super-human strength, so there’s lots of fear. My job has always been to make sure the person is safe and can get the help they need.”
Kernohan, who is currently on mat leave while completing her grad studies, says she doesn’t understand the approach of people who act as if addiction only happens to someone else. “This whole ‘not in my family so it doesn’t concern me’ attitude has to change,” she says. “We’re all trying to cope with things that are painful to us. There’s really not that big of a divide between numbing your mind with video games or VLTs and taking that next step and using. We all need to escape reality from time to time because we all live with pain. People have to set aside what they think addiction looks like and who it affects, because our human experience unites us all.”
“We need a world where people who use drugs have the ability
to inform drug policy, and have access to safe supply, support,
and resources to live the lives that they want to live.”
While Kernohan has worked with substance users from “every cultural and racial background,” she says systemic levels of oppression and racism are particularly impacting those from marginalized groups, particularly Indigenous people. “When you see people struggling to meet their basic needs such as food and shelter, there’s a lot of pain associated with that, on top of past trauma.”
TALK IT OUT
With meth use at epidemic levels, Kara Fletcher is trying to reach Saskatoon’s most vulnerable youth population, and she’s doing it by meeting these kids on their level, without judgment.
With funding from a Social Sciences and Humanities Research Council (SSHRC) Insight Development Grant, Kara and her team are establishing a podcast for youth to talk about their lived experiences. “Young people need to know that they’re not alone, and that their lives matter,” she says. “Through community partnerships, we hope to support youth as paid researchers so they can share the stories that are important to them. While the podcast is all about what’s happening with the meth epidemic from a youth perspective, it’s also a chance to provide the public with an inside look at what’s happening on the streets, and to better empathize with the world these kids inhabit.”
Fletcher’s project is inspired by The Crackdown, a popular podcast featuring the lived experience of those in Vancouver’s downtown east side. She wants Saskatoon youth to have that same opportunity to shine a light on their experience. “We’ve come so far, but really, we’re just getting started,” she says, envisioning a day when shame and stigma are replaced with compassion and understanding. “We need a world where people who use drugs have the ability to inform drug policy, and have access to safe supply, support, and resources to live the lives that they want to live.”
See this story in University of Regina's Discourse Research Magazine