Month: March 2015

Posted on

Three surprising tips for a healthy pregnancy

The do’s and don’ts of pregnancy can be overwhelming at best. For an expectant parent who is using substances, the rhetoric is clear: just don’t.

But in hearing from parents themselves (during a study entitled Treatment and Prevention of Illicit Substance Use among Pregnant and Early Parenting Women), it is clear that there is a lot more to having a healthy pregnancy than abstaining from the likes of cigarettes, alcohol, opiates, etc.

Looking more closely, many parents who struggle to do the best they can for themselves and their growing families are caught in an awful web of intense and complex socioeconomic challenges, and their perspectives offer a much more nuanced understanding of health and the myriad of factors that impact our well-being.

So here are three fundamental tips for a healthy pregnancy, gleaned from the parents’ stories and lots of reading, which perhaps underlie all other choices for better health.

Tip 1: Break the cycle of poverty

Money may not buy love, but in many ways it can buy health. The numbers show that your chances of falling ill and dying sooner goes up as income goes down. Anyone who has struggled to buy fresh food, running shoes or medicine will know the link between money and health first hand. Parents in our study often saw substance use as a problem when it interfered with the ability to buy healthy food or pay rent – but rarely challenged the socioeconomic factors beyond their control.

The fact is, where you live may decide how soon you die. For example there is 10 year difference in life expectancy between Hope (75.5) and Richmond (85.6). It’s all about avoiding microcosms where opportunities, services and supports are lacking – where whole communities (socially or geographically defined) have slid between the cracks.

For struggling parents, who are often themselves born into disadvantage, the need for wraparound services that help with housing and comprehensive health and social supports is clear. Thankfully in Victoria, HerWay Home is able to meet some of this need, though safe and affordable housing in Victoria remains elusive.

And let’s not forget that one in five children in BC live in poverty (and half of single parents are poor) – with or without having substances in the house. Poor children suffer health consequences that may alter their entire lives. Cripplingly low income assistance payments, low-income thresholds for social service eligibility, and the high costs of housing and daycare are squeezing families in a big way.

Many of the potential harms of parental substance use on young and unborn child are virtually indistinguishable from the harms of poverty. Let it be known that the last word on the ‘crack baby’ epidemic was that poverty hurts kids more than being born to mothers with cocaine addiction.

Health and income inequity are big problems in BC, and any moral charge against mothers who use substances may be better spent advocating to give poor families a fighting chance.

Tip 2: Support healing from trauma

Trauma interferes with recovery from addiction. This is true for many new and expectant mothers, and dovetails with environmental, social and structural factors that make it harder to break the larger cycle of poverty and marginalization.

I’d love to advise avoiding trauma in the first place, but for half of Canadian women and one-third of Canadian men, it’s probably too late. Childhood trauma in particular strongly predicts:

  • Drug, tobacco and alcohol addiction
  • Depression, post-traumatic stress disorder (PTSD), and suicide attempts
  • Having >50 sexual partners, sexually transmitted infections (STIs), and teen pregnancies
  • Physical inactivity and severe obesity (ACE Study).

While pregnancy and becoming a parent can and do bring a lot of opportunities for joy and healing, it’s no panacea. Kate (a mom in our study, pseudonym) said:

“Just because you’re pregnant it doesn’t magically change what’s going on for you and how you’ve been brought up and all the shit that’s happened to you.”

But seeking help is easier said than done. Our health and social services systems are only starting to become “trauma-informed” – which means service providers often overlook trauma as the root of the problem, or even re-traumatize patients with their insensitivity.

Tip 3: Community love bomb

The people around you (and the co-parent you choose) play huge roles in making or breaking your health habits. On the flip side, judgment, stigma and social exclusion can keep a new mom down.

For many parents in our study, keeping sober meant cutting ties with family and friends who were themselves mired in risky lifestyles. In the wake of these deep personal loses, mothers especially were coldly judged for using any substances at all.

Mothers who are struggling to make healthy choices for themselves and their families need to be given more credit for their love and commitment to their kids, and more appreciation for the immensity of the obstacles they face (often with roots in childhood trauma, and other circumstances beyond their control).

Fathers are only sometimes given credit for the role they play, and need to be more consistently acknowledged, encouraged and supported when this role can be a positive one.

Strong communities are built on trust and respect – nurturing these in our services will help support parents exactly where they are, and position us to reduce many complex barriers to health and well-being.

A photo of Samantha Magnus

Author: Samantha Magnus, Research Affiliate, Centre for Addictions Research of BC.

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.

Posted on

Selling Alcohol in Grocery Stores: Hidden Risks and Alternative Options

This post originally appeared on the CAMH blog. While this blog is from Ontario, many of the points are relevant here in BC, now that alcohol sales will soon be permitted in select grocery stores.

In the last few days we have heard about plans to permit the sale of beer and wine in grocery stores in Ontario. For the most part, media reports have made no reference to potential health and safety risks associated with the proposed changes. You would have thought that the reporters were talking about changing the distribution of milk or orange juice in Ontario. What about the possible increase in alcohol-related incidents or negative impact on vulnerable populations — is that not relevant to the discussion?

Alcohol is a drug with a long list of well demonstrated harms associated with its use. How it is sold, marketed and priced impacts the rate of alcohol-related problems. International research over many decades has shown repeatedly that if more alcohol is sold and appropriate checks are not in place, then more harm can be expected. These harms include a range of health and social problems impacting not only the drinker, but others in society. They contribute to the already high costs of alcohol-related hospital care (chronic and emergency), criminal justice responses, and productivity losses.

Currently in Ontario there are about 1,800 places where alcohol can be purchased to be consumed elsewhere, so-called ‘off premise’ outlets. This includes LCBO regular stores, LCBO Agency Stores, Ontario Winery, Beer Stores and a few others. According to media reports, the contemplated changes would add about 400 new outlets – 100 new Agency stores and 300 large grocery stores that would sell beer and wine. This is a 22% increase in outlet density.

Canadian and international research has indicated that an increase in alcohol outlet density is associated with a wide range of acute and chronic problems. While there are many international examples to support this conclusion, a recent one from British Columbia is timely: researchers found that after an increase in private liquor stores (higher density) there was an increase in liver cirrhosis cases.

Once 300 grocery stores have a green light, will not the thousand or so others also lobby for the same access? What about convenience stores? We know from the examples of Alberta and BC that privatization of alcohol sales can result in more relaxed enforcement of laws pertaining to underage purchases – as well as higher mortality rates from suicide and other alcohol-related causes. The proposed plan is a very risky one. An alternative strategy should be developed in consultation with public health experts.

The challenges of eliminating Ontario’s deficit are likely substantial and will require innovative approaches and exemplary decision-making. As the provincial government attempts to raise revenues and “modernize” the sale of alcohol, it should focus on strategies that can achieve that aim without increasing the risk of alcohol-related harm. Possibilities include:

  • Minimum prices on alcohol could be raised
  • Product prices could be based on alcohol content, and taxation protocols could be adjusted, so that there is an incentive for production and consumption of lower-strength beverages
  • Marketing expenditures by the LCBO could be reduced
  • Further efficiencies can be introduced to the LCBO, such as using its buying power to get better prices from manufacturers and wholesalers

The course being discussed by decision-makers, in its current form, seems certain to contribute to an increase in alcohol-related harm and costs. We should encourage decision-makers to choose instead a course that fosters greater public awareness of alcohol-related risks and encourages the reduction of those risks. The health of Ontarians should come first.

Author: Dr. Norman Giesbrecht, Senior Scientist Emeritus, Public Health and Regulatory Policy Section

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.