Profile - Substance Abuse Treatment and Rehabilitation in Canada

Annotated bibliography

Through the course of this project, a number of non-peer-reviewed Canadian articles relating to treatment effectiveness came to our attention through a search of the National Clearinghouse on Substance Abuse, a general solicitation undertaken during the survey of treatment and rehabilitation programs, and discussions with a number of government officials. This is intended to be an illustrative rather than exhaustive inventory of Canadian articles, studies and reports that have been produced across the country in the past several years.

ABORIGINAL PEOPLES COLLECTION (1992): The Native Inmate Substance Pre-Treatment Program: A demonstration project . Solicitor General of Canada, User Report 1991-11, Supply and Services Canada, Cat. No. JS5-1/3-19160-9.

This demonstration project was set up to address the need within the justice system for education and training in cross-cultural awareness, addictions and the treatment process. The purpose of this demonstration project was: to develop a Native pre-treatment program model and manual for implementation in correctional institutions; to develop treatment centre guidelines for treating the Native offender; to field test and evaluate the Native pre-treatment program model and manual; and to develop a public relations brochure on the treatment program model and manual. The demonstration project was divided into four phases: research and development; pilot testing of program model; program final development; and community research. The treatment model involved eight weeks of intensive treatment and educational activities, a four-year continuum of care plan, one-to-one counselling opportunities, and a disease model orientation which emphasized sobriety and education. The program model was pilot tested at two federal correctional institutions in British Columbia with positive outcome.

ADDICTION RESEARCH FOUNDATION (1997): Co-occurring Mental Disorders and Addictions: Scientific Evidence on Epidemiology and Treatment Outcomes. T o r o n t o : Addiction Research Foundation.

This report provides a summary of available literature on co-occurring addiction and mental health problems in order to examine implications for services in Ontario. It followed a needs assessment conducted in this area by the Addiction Research Foundation. The stated concern was to ensure that services for clients with concurrent disorders are as effective, efficient and cost-effective as possible. The searched literature revealed that findings are too weak to demonstrate the superiority of any particular model of treatment or service organization. At present, an empirically based model for integrated treatment is not available, and there appears to be no clear scientific evidence to support the choice of an integrated treatment system over other alternatives. Recommendations to improve current services included better referral and coordination between agencies, examination of agency exclusion criteria, and the provision of staff training in assessing, referring and treating co-occurring disorders. The report stresses the need for empirical evidence for effective treatment models, and more research in epidemiology, service demand, patterns of co-occurring disorders, and service organization and utilization. It identifies an urgent need for sound clinical trials across the full range of co-occurring disorders and co-morbid population groups.

ADDICTIONS FOUNDATION OF MANITOBA (1995): Rural and Northern Youth Intervention Strategy (RNYIS) Project: Final Report . Proactive Information Services Inc.

This project was developed in 1993 to address information and counselling needs of high school students in 18 schools across the province. The report provides a detailed evaluation of both project implementation and outcome. Indications were that most schools accepted an early intervention approach to chemical dependency at Grade 9, and recommended it for Grades 7 and 8 or lower. The number of self-referrals increased, as did informal discussion with counsellors. A significant reduction in alcohol use was found among students when comparing pre- and post-treatment questionnaires. The most important benefit indicated was that students were provided with counselling. Students also became more aware of alcohol and drug policies in their school.

ANISHINAABEG MEDICAL PROFESSIONALS (1993): Okunongegayin: Challenging Chronic Solvent Abuse. Demonstration Project Final Report, and Summary of the Demonstration Project Final Report, Ontario Ministry of Health.

This demonstration project was financed by the Health Innovation Fund in collaboration with the Lake of the Woods District Hospital, Kenora and Wabaseemoong Independent First Nations, Whitedog. Okunongegayin, meaning "breath of life," describes a dynamic model for healing illnesses associated with substance abuse, especially solvents, in small Northern communities. It was seen to be both a therapeutic program, and also a model for collaboration and partnership among the agencies, institutions and communities involved with chronic solvent abusers. Over the two-year program, about 80% of the 136 clients were between 15 and 29 years of age, and most were poly-drug abusers, with 86% using solvents as their drug of choice. Treatment was offered in a bush camp, to help clients make changes in a context connected with daily life. With improved health, change was rapidly effected. The project promoted family and community involvement, flexibility and innovative ideas to facilitate change within the context of community life.

ARCHIBALD, C., OFNER, M., PATRICK, D., STRATHDEE, S. ET AL. (1996): The Point Project: A Study of Risk Factors for HIV Infection among Vancouver's Injection Drug Using Community: Summary of Final Results. British Columbia Ministry of Health.

The Point Project was launched in 1995 to identify the underlying reasons for the rapid increase in HIV infection in injection drug users. The purpose of the study was to identify risk factors in this community. The project was conducted in two phases: in-depth interviews were conducted with 16 participants, and qualitative information from these interviews was used to create a questionnaire for a case-control study, in which 89 injection drug users who had just been diagnosed with HIV were compared to 192 persons who had tested HIV negative on two occasions. Findings included: a perception of increased severity of addiction problems in Vancouver in the past few years; a social and demographic profile of a transient population, with early onset of injection drug use, injection of both cocaine and heroin, and frequent use of services; and needle sharing and increased risk of infection. The project recommended the need for safe and stable housing, harm reduction education, including education for needle exchange and outreach, safer sex education, mandatory training for police personnel, methadone programs, mental health outreach and the need for research into the management of cocaine addiction.

BEAUDOIN, C. (Unpublished): Differences Among AFM Clients with Respect to History of Parental Alcoholism . (Draft) Faculty of Medicine, University of Manitoba.

Fifty-six percent of AFM clients sampled in the 1992-93 Winnipeg health and drinking survey indicated having an alcoholic parent. The effects of having at least one alcoholic parent on demographics, severity of alcohol problems and on a variety of personality measures were assessed for this sample of 451 men and women. The analysis revealed that there were no differences in demographics, but that differences in the extent of alcohol-related problems and personality features were quite pronounced. Specifically, those with at least one alcoholic parent reported a greater number of family and social problems related to their drinking than those with no parental history of alcoholism. Those with an alcoholic parent experienced more anxiety and nervousness, had a weaker self-concept and a greater tendency toward aggressive and impulsive behaviours. Male clients tended to be significantly more negatively affected by the presence of an alcoholic parent than the female clients. Based on a six-month follow-up which captured 70% of the original sample, it was found that those clients with an alcoholic parent were significantly less likely than other clients to be abstaining or drinking responsibly, leading to a recommendation that the Foundation consider tailoring its programs to address the particular issues of clients with at least one alcoholic parent.

BEAUDOIN C., (1997): A Comparison of In-treatment Female Alcoholics and Female Alcoholics from the General Population. (Draft) Faculty of Medicine, University of Manitoba.

The Addiction Foundation of Manitoba was interested in determining if there were any differences between the females entering AFM treatment programs and female alcoholics not in treatment identified in a general population survey. Demographically, there were no differences observed in the two groups. However, differences were observed in other respects, with those having been in treatment showing more severe drinking and drinking-related problems and a greater likelihood of maladaptive personality characteristics. The author speculates that the differences observed between the two groups may be the reason why individuals enter treatment in the first place.

BLOOD, L. (1995): Choices Program: A Treatment Outcome Study: Preliminary Results. Nova Scotia Department of Health, Drug Dependency Services.

This report gives the preliminary results of the CHOICES program, by reviewing data collected on 130 adolescents who completed the program. The program, which has been operating since 1990 in Nova Scotia, comprises a range of services for adolescents who are harmfully involved with alcohol and other drugs. It offers outpatient services, and inpatient and day treatment intervention programs. Data were collected pre-treatment, post-treatment and 12 months after discharge, using the Adolescent Alcohol Involvement Scale, the DAST-10, measures of self-esteem, family relations and peer relations. The average age was 16 years, with 65% male, 35% female. The degree of substance abuse was found to be well within the clinical range. Overall, pre-post treatment comparisons found increased self-esteem, reductions in behavioural problems, improved family and peer relations, and reduction in alcohol, cannabis, and solvent use and abuse.

BRITISH COLUMBIA MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS (1996): Outcome Measures for Alcohol and Drug Services: A Resource for Program Evaluation.

The report outlines components of program evaluation and outcome evaluation and gives a summary of steps usually taken in program evaluation and a sample of a program evaluation report outline. The guide also provides sample outcome measures for agencies in the Alcohol and Drug Services (ADS) System of Care, as a foundation for conducting outcome monitoring or outcome evaluation.

CENTRE INTERNATIONAL DE CRIMINOLOGIE COMPARÉE POUR LE COMITÉ TOXICO-JUSTICE, Persistance en traitement et impact de réadaptation des personnes toxicomanes judiciarisées admises à Domrémy-Montréal / R apport 5, mars 1995, 46 p.

This study compares the impact of the rehabilitation program on clients subject to judicial control and those who are not. It shows that, for both groups, the impact is the same for people staying in their programs for the same length of time. The study does reveal, however, that persons subject to judicial control in treatment in Domrémy-Montreal abandon their programs earlier than those who are not subject to judicial control. The overall findings of the study confirm those of previous studies, i.e., that the best indicator of the impact of treatment is the time spent in treatment. This is a very major study, considering that treatment services are being requested increasingly by the courts for persons with alcohol or drug problems.

COMITÉ AVISEUR SUR LA RECHERCHE ET L'ÉVALUATION EN TOXICOMANIE: Avis no 1, Les priorités de recherche dans le domaine de la toxicomanie, Québec, MSSS, mars 1992, 8 p. et 2 annexes.

The Advisory Committee is made up of representatives from the following organizations: the Conférence des Régies régionales, la Fédération des centres de réadaptation en toxicomanie du Québec, the Association des hôpitaux du Québec, the Fédération des CLSC , the private sector, universities and the Department of Health and Social Services. This committee has assumed an important role in the development and promotion of research into alcoholism and drug addiction in Quebec. It was created in the early 1990s and has a mandate to:

• give opinions to the Department of Health and Social Services on the areas of development of research in drug addiction;
• promote partnerships between the fields of research and development. To this end, it cooperates closely with the Conseil québécois de la recherche sociale (CQRS) to develop links between these areas and to consolidate them in the two alcohol and drug addiction research teams;
• promote the transfer of knowledge from the research area to the intervention area and vice-versa.

The result of a broad-based consultation with interested parties throughout Quebec, this paper presents the result of research priorities which the advisory committee believes are the most important. The priorities include knowledge of those clients and populations at risk, development of evaluative research of programs, analysis of professional practices in alcoholism and drug addiction, and the contribution of natural and community environments. Appendix 2 of the paper contains the findings of the consultation on the priority research and development orientations.

COMITÉ AVISEUR SUR LA RECHERCHE ET L'ÉVALUATION EN TOXICOMANIE: Avis no 2, Les questions relatives à la toxicomanie au sein de l'enquête sociale et de santé de 1992 (Enquête Santé Québec), Québec, MSSS, mars 1992, 7 p. et 2 annexes.

This is a notice of intent to officials heading up the Santé Québec survey to improve the data pertaining to alcoholism and drug addictions to increase the knowledge of alcohol and drug consumption habits of Quebec residents. It is a proposal to improve the alcoholism-drug addiction facet of the social and health survey of 1992. It recommends that those in charge of the Santé Québec survey add two objectives to the social survey (i.e. to preserve comparability with the other surveys both inside and outside Quebec, and to gather information on the social determinants of consumption to support the development of preventive action).

COMITÉ AVISEUR SUR LA RECHERCHE ET L'ÉVALUATION EN TOXICOMANIE: Avis no 3, Le point sur les besoins d'enquêtes épidémiologiques en matière de toxicomanie au Québec, Québec, MSSS, mai 1993, 14 p. et 2 annexes.

This notice deals with the need for epidemiological data and the survey procedures to be emphasized. The findings are based on extensive consultations with Quebec, Canadian, American and European researchers and Quebec data users. This paper contains clarifications of user needs, the status of surveys, parameters for the structure of epidemiological databases for alcoholism and drug addictions, and advisory committee recommendations pertaining to improvement of data banks and transmission of data.

DESJARDINS, N., KISHCHUK N.M OUELLET F., PERRAULT N. L'évaluation de programmes en alcoolisme-toxicomanie : Un cadre de référence, Montréal, août 1996, 106 p. (Document de travail).

This report is the result of a subsidy given to the Montreal-Centre Public Health Branch by the Department of Health and Social Services. The purpose is to provide officials organizing programs, decision makers and other parties in the alcoholism and drug addiction field with various tools to evaluate the programs. Specific objectives are to make those in related fields aware of the contributions, conditions and terms of program evaluation, and to equip the intervention and evaluation fields with a proposed accessible frame of reference, which can generate valid, original and useful evaluations. Basic definitions and definitions of types of evaluations are found in the first part of the report, along with the three major approaches in program evaluation. The second part deals with the context of evaluation and process. The authors describe a few points of reference when conducting an alcoholism-drug addiction-related program evaluation.

GOUVERNEMENT DU QUÉBEC, MINISTÈRE DE LA SANTÉ ET DES SERVICES SOCIAUX: Normes de reconnaissance pour les organismes offrant des services d'aide et de soutien aux personnes alcooliques et toxicomanes, avril 1994, 89p.

This report describes a series of standards intended to ensure the quality of services for vulnerable people (i.e. those grappling with drug addiction problems). These standards cover administrative components, aid and support services and physical facilities. In total, more than 120 quality indicators have been identified to evaluate and guarantee the quality of services offered.

GOVERNMENT OF NEW BRUNSWICK. Standards for Addiction Services, in: Standards for Hospitals in New Brunswick . (Draft) Fredericton, June.

This document was developed to guide the delivery of addictions services by the seven regional hospital corporations in the province. The standards approach addiction as a bio-psycho-social problem and adopt the principle of least-to-most intrusive intervention depending on need. The standards cover a "continuum of services" that includes training and prevention. Problem gambling is also understood to be covered by addiction services. Issues addressed in the standards include criteria for admission, safety and security, family involvement, use of protective drugs, and pregnancy and addictions. The document includes a bibliography with 69 citations.

GRIFFITHS, C.T., GLACKMAN, W., ESPERSON, T., DAVIES, G. (undated): Programs and Services for Urban Native Indian Alcohol and Substance Abusers: Initiatives, outcomes and issues. Burnaby, B.C., Simon Fraser University, School of Criminology.

This report reviews the availability and effectiveness of alcohol and substance abuse programs and services for urban Native Indians. The majority of programs in Canada are community- or reserve-based, operating in rural areas, and have little relevance for individuals living in urban areas. In reviewing the current literature, the authors found no data on urban Aboriginal people which could be used as a basis for developing treatment programs and services, and they were unable to judge treatment effectiveness from the current programs. They identified a lack of understanding of the etiology of Native drinking, with no studies which documented the variations in drinking styles among Native Indians in rural or urban areas. Problems include lack of systematic data collection, small sample sizes, poor methodology and lack of information on the cultural, psychological and socio-economic factors related to alcohol and substance abuse among this population. The authors suggest that the treatment of urban Native Indian alcohol and substance abusers cannot be undertaken in isolation from the larger socio-economic and environmental context within which Native Indians live. They recommend holistic programs, in which regenerated spiritual values foster abstinence after treatment has ended, and the development of positive social support networks combined with educational and economic opportunities.

GUYON, L., GEOFRRION, Y: La toxicomanie au Québec : Bilan des études épidémiologiques faites depuis 1990, MSSS, mai 1997.

This report discusses the work performed in the past 10 years to delimit the phenomenon of alcoholism and drug addiction in Quebec and to take action. It provides data on the prevalence rate, socio-economic characteristics and related factors and highlights. The report has been divided into three parts: the general situation of alcohol, drug and prescription drug consumption; alcohol, drug and prescription drug consumption in specific groups; and problems associated with alcohol, drug and prescription drug consumption.

HADEN, M. (1997): Program Evaluation Report: The Central Clinic. Alcohol and Drug Services, Ministry for Children and Families, Province of British Columbia.

This report provides a descriptive evaluation of five program areas (orientation group, intake assessment, education group, support group, one-to-one treatment). A range of domains was evaluated, showing the programs to be very effective in helping clients to achieve abstinence, reduce substance use, improve emotional, psychological and spiritual health, gain understanding of substance misuse, feel welcome and receive an orientation. Clients report that the programs are somewhat effective in improving physical health, social and family relationships, and employment/school situation.

HARVEY-JANSEN, Z'A. (1995): Adolescent Treatment: Excellence Through Evaluation. Alberta Alcohol and Drug Abuse Commission.

This report provides a summary of an evaluation of AADAC's Adolescent Treatment System, which was initiated in 1992. This system provides treatment for approximately 1500 adolescents aged 12 to 17 years through 26 outpatient treatment facilities across Alberta, addressing alcohol and drug use problems. The evaluation comprised five studies, including program model and description of all programs; a survey conducted with referral agents; a treatment staff survey; a review of the recent (1980-93) literature of adolescent and drug treatment effectiveness; and an evaluation of treatment effectiveness. The review offered recommendations to improve treatment provision in the following ways: to match level of care with the client's level of alcohol and drug problems, psychiatric severity, conceptual level and social stability; to assess readiness for change; to ensure provision for residential support in intensive day treatment for adolescents in need of this service; to enhance communication in and about the treatment system; to encourage family involvement; to increase government and other agency collaboration; and to actively explore and incorporate the findings of the evaluation.

KERR, D. (1994): Matching Clients with Substance Abuse Problems to Treatments: A Review of the Literature. Prepared for Alberta Alcohol and Drug Abuse Commission.

In reviewing the literature related to client-treatment matching, the author identifies three types of studies with increasing complexity: general outcome studies; studies of specific treatment approaches; and matching studies. The review discusses methodological difficulties in treatment evaluation, and describes several outstanding treatment studies. Treatment methods which have empirical support are reviewed, based on the reviews of Miller and Hester. Matching variables are reviewed, related to the client (conceptual level, cognitive abilities, locus of control, self-esteem, psychiatric severity, social stability and severity of alcohol problems), and to the therapist (empathy, degree of "fit"). The author notes that reviewers caution that some matches may cause harm. They identify four levels at which matching can occur: before treatment (program-patient); at initiation of treatment (patient setting); during the treatment process (patient treatment); and following primary care (post-treatment environment). The author concludes that matching requires a holistic perspective of the client's relevant issues. Matching is seen as an ongoing process, in which all the interacting variables cannot at present be controlled. Assessment is an important component, as well as well-defined quality treatment which is accurately monitored and reported.

KIMBERLEY, DENNIS (1994): Humberwood Residential Treatment Program Implementation Evaluation and Program Consultation . Drug Dependency Services, Newfoundland & Labrador.

This review consists of an executive summary and process analysis of the province's sole residential treatment program which began operation in 1990. The analyses and recommendations cover assessment, referral, intake and selection, programming, treatment, psycho-social education and activities, policy, staffing, evaluation and cost-efficiency.

McAMMOND, D., SKIRROW, J. (1997): Care, Treatment & Support for Injection Drug U sers: Living with HIV/ A I D S. A consultation report prepared for the AIDS Care Treatment and Support Program, Health Canada.

The purpose of this report was to obtain a better understanding of the issues in serving injection drug users living with HIV/AIDS. The report is divided into three sections: Section 1 used a consultation process of interviews with key informants in Vancouver, Toronto and Montreal. Section 2 comprised an epidemiological study of HIV infection among injection drug users. In Section 3, the current services were examined to determine which clients were being served, what was being done and how it was working. HIV infection appears to be continuing to increase at a high rate in Canada, particularly in women. Present support services noted include needle exchange, outreach primary care, outreach education and support, access to substance abuse and rehabilitation services and access to supportive housing.

Program/service issues included ethical/legal dilemmas, inappropriate services, rigid program entry criteria, limited substance abuse services, lack of adequate housing, inadequate staff training, and correctional and legal issues. Based on the findings, the report proposes a framework for action, based upon a holistic approach, with more responsive clinical services; new or enhanced support services; improved service coordination; improved provider information and training; more responsive housing and residential care; and attention to legal issues surrounding drug use.

NOVA SCOTIA DEPARTMENT OF HEALTH (1996): Outcome Monitoring System: Short-term Residential and Day Programs Procedures Manual .

This manual was prepared by the Western Region of Drug Dependency Services in affiliation with Operations and Regional Support Branch, Drug Dependency, Nova Scotia Department of Health. It describes the procedures for developing an Outcome Monitoring System in short-term residential and day treatment programs. The system was adapted from the Alberta Alcohol and Drug Abuse Commission system. The purpose of the system is twofold: to provide accurate information for government data collection; and to assist in program planning. Central components are client feedback and follow-up surveys. Six steps are provided with detailed information on distributing forms, obtaining consent, administering the client feedback survey, selecting the sample and administering the follow-up survey, and summarizing the results.

RUSH, B., CHEVENDRA,V., VINCENT, S. (1993): A n O verview of the Drug and Alcohol Registry of Treatment (DART). London, Ont., Addiction Research Foundation.

The extensive use of US treatment programs by Ontario residents highlighted the shortage of some types of treatment services in Ontario and the need for better information for service planning. The Drug and Alcohol Registry of Treatment was developed by the Addiction Research Foundation with province-wide consultation as a three-year demonstration project. It serves two functions: to collect and update information on the availability and accessibility of treatment services, and to report this information to service providers and stakeholders.

SASKATCHEWAN ALCOHOL AND DRUG ABUSE COMMISSION (1992):Meeting the Challenges: The Saskatchewan Model of Recovery Services.

This document outlines the strategic direction of the Saskatchewan Alcohol and Drug Abuse Commission, using what is termed a "developmental model of recovery services," which involves 16 principles and 24 strategic goals. The service proposes to adopt the WHO definition of alcohol and drug use disorders, and defines dependency recovery as an individualized, personal, life-long process that is abstinence-based, with a developmental growth process. The tasks to be completed for recovery are seen to be stage-specific through transition, stabilization, early recovery, middle recovery, late recovery and maintenance. A continuum of recovery services is presented, based on levels of need, from 12-step, self-help programs, through different levels of intensity. Each level is seen to involve more structure and professional services.

SASKATCHEWAN ALCOHOL AND DRUG ABUSE COMMISSION (1993):Drug Treatment and the Needs of Special Populations: Promoting Opportunities for Better Health.

This working paper was prepared by the Evaluation and Research Unit. Special Populations are defined as those who are at higher risk of abusing mood-altering substances. A risk factor is a condition that increases an individual's chance of becoming involved in especially harmful use of substances, including family dysfunction, physical and sexual abuse, mental disability, unemployment, low educational levels, illiteracy, racial discrimination, and poverty. The authors conclude that a traditional addiction treatment approach has not met the special needs of many groups, and that programs are needed which integrate services to address personal problems with those that address broader structural issues, such as unemployment, social welfare and gender inequality. The needs of special populations are reviewed, including women, seniors, street youth, Aboriginal Canadians, dually diagnosed, and individuals with physical impairments. The authors recommend integrating substance use programs into already existing agencies where possible.

SASKATCHEWAN HEALTH (1994): R eview of Provincial Residential Addiction T reatment Services.

This report presents the findings of a review of six residential addiction treatment programs funded and/or delivered by the province of Saskatchewan. Its purpose was to plan future residential addiction services, based on information gathered from addiction professionals and referral sources on the availability and accessibility of existing resources, occupancy rates, home residence of clients and other related data. Each facility is profiled, and referrals reviewed. The reviewers recommended developing a clearer understanding of referral and assessment practices, an increase in community-based and day-patient services before reducing residential services, development of equitable referral practices with other provinces, a review of impaired driver treatment options, consistency across residential programs, and the integration of adult and adolescent treatment programs into one facility.

THOMPSON, J. (1994): Efficacy, Outcome and Alcohol Effect Expectancies as Predictors of Alcohol Treatment Outcome: An 18-Month Follow-up Study. Alberta Alcohol and Drug Abuse Commission.

This study examined the relationship between expectancies and drinking outcome following treatment for alcoholism. The clients (N = 306) were contacted every three months over an 18-month period following discharge. Measures were the Situational Confidence Questionnaire, Outcome Expectancy Scale, Alcohol Effects Questionnaire, and three measures of drinking behaviour (weekly frequency, weekly quantity and average daily consumption). Results showed that discharge self-efficacy expectancies or confidence in being able to resist drinking heavily are predictive of the average weekly frequency of drinking and average weekly quantity over three and eighteen months. The author concluded that positive self-efficacy contributes to successful outcome.

VERMETTE, G. Inventaire analytique de programmes de réadaptation en alcoolisme et autres toxicomanies (tome 1), MSSS, novembre 1996, 234 p. annexe en sus.

VERMETTE, G. Répertoire de programmes de réadaptation en alcoolisme et autres toxicomanies (tome 2), MSSS, novembre 1996, 318 p.

VERMETTE, G. Inventaire analytique et Répertoire de programmes de désintoxication (tome 3), MSSS, novembre 1996, 58 p. annexe en sus.

VERMETTE, G. Inventaire analytique de programmes d'aide et de soutien en alcoolisme et autres toxicomanies (tome 4), MSSS, novembre 1996, 158 p. annexe en sus.

VERMETTE, G. Répertoire de programmes d'aide et de soutien en alcoolisme et autres toxicomanies (tome 5), MSSS, novembre 1996, 202 p.

The author of this study provides an inventory of detoxification, rehabilitation, aid and support programs in Quebec; develops a detailed description of the programs in each category to illustrate the various types of programs in a structured way; analyzes the characteristics of the programs in each of the categories; and reports on the development of programs to respond in a relevant and effective way to the clients served. Descriptive variables and contextual variables relating to the analytical inventory have been provided for volumes 1, 3 (first part) and 4. Moreover, highlights are cited in each of the analytical inventories, and opinions are offered about those items which, in the author's view, require improvement. Finally, the analytical inventories describe the characteristics of clients served and data on how the program is used and works for each of the organizations or establishments. Volumes 2, 3 (second part) and 5 provide data on organizations and establishments providing aid, support, detoxification and rehabilitation services.

WHYNOT, E. (1996): Health Impact of Injection Drug Use and HIV in Vancouver. British Columbia Medical Health Office.

The purpose of this report was to summarize available information concerning the impact of injection drug use on the Vancouver health system, to describe current efforts to lessen it, and to provide recommendations for future management. The report contains: recommendations from the medical health officer's report of May 1996; current information on injection drug use and HIV in Vancouver; recent and current planning and research initiatives; a summary of community consultations; current interventions and gaps; and recommendations for action. Recommendations include recognizing the prevention and reduction of illness resulting from injection drug use as a priority for the Vancouver Health Board and coordination of funding initiatives. Two objectives were proposed, each with detailed steps to assure implementation: to reduce health risks associated with injection drug use in Vancouver; and to coordinate and improve health, outreach and residential services for injection drug users with HIV and other diseases.

WILBUR, B.D. (1997): Health Standards: Edition 1; Public Health Services and Drug D ependency Services. Nova Scotia Department of Health.

This document was prepared as a tool to assist Nova Scotia Regional Health Boards in service planning and delivery. Health standards are defined as "the minimum acceptable level of service and/or result." Future services will be based on standards and outcome, with identification of core services to ensure that Nova Scotians have reasonable access to services within each health region. The document provides a framework for standards development, and identifies program areas of mental health, acute care, public health, drug dependency, home care and long-term care. The present edition covers only drug dependency and public health services. Service standards are provided in each of the core services for drug dependency and public health. Core services in drug dependency include: prevention and community education (health promotion, training of allied professionals, community development); community-based drug dependency treatment services (assessment, intervention, detoxification day program, therapy/counselling, structured modular programs); regional drug dependency treatment services (assessment, intervention, inpatient detoxification, therapy/counselling, structured orientation, residential rehabilitation, long-term and halfway sheltered treatment); and targeted drug dependency services (adolescent, women, driving while impaired).

ZARCHIKOFF, W. (1992): A Review of Solvent Abuse Literature and Existing Solvent Abuse Programs in North America, and Recommendations to Develop a Training and Solvent Abuse Program for Adolescents in the Northwest Territories, Canada.

This report was prepared for Northern Addiction Services, Northwest Territories. It summarizes and interprets the available literature on solvent abuse from 1985 to the present. It concentrates where possible on Native adolescents. An annotated bibliography of 81 studies is provided. The report recognizes that inhalant treatment has not been compatible within the standard drug treatment system. Treatment strategies must be designed to the particular needs of these clients' symptoms, patterns of use and psycho-social and emotional needs. The report sees a need for simple goals of treatment, targeted to basic health needs, and including staff nurturing, support and patience. It recommends discouragement of confrontation, and enhancement of self-esteem and building of coping skills. It describes a model program to treat adolescents who are solvent abusers in the Northwest Territories. The program's primary objective is to provide the adolescent (age 13-17 years) solvent abuser with a comprehensive treatment program to assist the individual to change his/her present lifestyle to a solvent and drug-free lifestyle. It would offer residential care, behavioural management, a wilderness program and an outpatient and recovery program.