Background: The Northwest Territories (NWT), Canada is a vast, sparsely populated region of northern Canada with extremely high rates of alcohol-related harm. The aim of this thesis was to explore how to address alcohol-related harm through policy approaches, treatment services, and harm reduction measures that are effective and appropriate for the culture and context of the NWT.

Methods: This PhD consists of three studies. The first explored the alcohol policy environment and applied a literature review, an online survey, webinar discussions, and validation sessions with municipal and Indigenous leadership to develop a strategy to address alcohol-related harm in the NWT. The second study re-examined the content of an online survey about individual’s experiences of seeking recovery services in the NWT, using a mixed-methods approach to examine barriers to service access. The third study used a community-based participatory research approach to explore the experiences of individuals living in a supportive housing facility that includes a managed alcohol program.

Results: The first study found that alcohol policy best practices need to be considered within the local context where they are to be applied and produced a set of policy recommendations for the Government of the Northwest Territories (GNWT). The second identified barriers to service access, including cultural incongruity of services, and the significance that social support plays in addressing problematic substance use, both as a driver of success and a reason that attempts may fail. The third study produced recommendations to improve services at the residential facility and identified that a sense of choice and control over their life circumstances was more important to residents than any specific health outcomes.

Conclusions: Despite being a unique jurisdiction in Canada, both in population distribution and cultural composition, there are several best practice policy measures that could be applied, or modified, to address alcohol-related harm in the NWT. Policy measures to address alcohol-related harm should be accompanied by grassroots efforts to address challenges individuals face to changing their substance use behaviour, including boredom and loneliness. Considerations about policy measures and substance use treatment interventions should be centred on those most impacted and be tailored to fit cultural considerations and support individual agency wherever possible.