Profile - Substance Abuse Treatment and Rehabilitation in Canada

The federal role in substance abuse treatment

The Canada Health Act , passed in 1984, stipulates the criteria for the funding and administration of provincial and territorial health care services. Under this Act, the provinces and territories receive transfer payments to provide insured health services under each jurisdiction's health care insurance plan, including some extended health care services. In order for each jurisdiction to receive a full financial contribution for each fiscal year, its health care insurance plan must satisfy the five tenets of the Canada Health Act : health insurance must be publicly administered, comprehensive, universal, portable, and accessible to all provincial and territorial residents (Statutes of Canada, 1993).

The federal government provides direct funding for treatment and rehabilitation services for such groups as on-reserve First Nations Peoples and Inuit, members of the Royal Canadian Mounted Police (RCMP), members of the Canadian Armed Forces, persons serving a term in a federal penitentiary, and persons who have not lived in a province or territory long enough to receive insured health services. Unlike residents of provinces and territories who are considered "insured persons" under the Canada Health Act , these groups cannot access services under their respective provincial or territorial health insurance plans. The health status of these groups is insured by the federal government directly (Statutes of Canada, 1993).

The federal government provides funding for treatment and rehabilitation services for on-reserve First Nations and Inuit people through the National Native Alcohol and Drug Abuse Program (NNADAP), supported by the Medical Services Branch of Health Canada. Treatment is one of four major program components of the NNADAP program, which is broken down according to prevention, treatment, research and development, and training.

Treatment and rehabilitation services for federal offenders is provided by Correctional Service Canada (CSC). The core of CSC programming involves four levels of treatment intensity to which inmates are matched according to a comprehensive assessment. The CSC also provides programs for long-term offenders, a program for offenders just released from prison to prevent relapse, a gender-specific program for women and the Native Offender Pre-Treatment Substance Abuse Program. All program facilitators receive intensive training, with a certification process applied to training in the men's system.

In 1980, the Department of National Defence (DND) established its own treatment and rehabilitation program, entitled the Addictions Rehabilitation Program (ARP). Until recently, the ARP was available to military personnel and their families through designated military clinics across Canada. However, within a larger restructuring of DND substance abuse services, the one remaining addiction rehabilitation clinic is now located at Canadian Forces Base Halifax. Military personnel not located in that geograhical region must obtain inpatient treatment at civilian treatment centres. According to the new arrangement, client assessment and follow-up will still be provided by each military base.

Treatment and rehabilitation services for members of the RCMP are administered through the Health Services Program. This program provides RCMP members with access to assistance for substance abuse and other personal problems. RCMP and civilian treatment services are utilized, with a Health Services Officer servicing each province and territory, serving a case management role (i.e., assessment, referral and follow-up).

For a number of years, the federal government has sponsored two programs that provide funding support for substance abuse treatment, based on agreements with provincial/territorial authorities:

Alcohol and Drug Treatment and Rehabilitation

The Alcohol and Drug Treatment and Rehabilitation (ADTR) Program is available to the provinces and territories and aims to ensure access to a range of effective and innovative substance abuse treatment and rehabilitation services, particularly those directed to women and youth. These services and programs include detoxification, assessment and referral, counselling/ case management, therapeutic intervention (residential, outpatient and outreach), continuing care/clinical follow-up, research and evaluation, early identification and intervention, awareness and development, special access services and knowledge dissemination.

Employability Assistance Program for People with Disabilities

The Employability Assistance Program for People with Disabilities (EAPD ) replaces the Vocational Rehabilitation of Disabled Persons (VRDP) program. The focus of the EAPD program, an employability-based initiative, is to help people with disabilities overcome barriers to mainstream employment. The program has been designed to support programs and services that help people prepare for, find and maintain employment. Examples of interventions include counselling and assessment, skills development, vocational crisis interventions and self-employment.