Profile - Substance Abuse Treatment and Rehabilitation in Canada

Acknowledgments

Health Canada is grateful to the Alberta Alcohol and Drug Abuse Commission (AADAC), the Addictions Foundation of Manitoba (AFM) and the Addiction Research Foundation (ARF) Division of the Centre for Addiction and Mental Health, for their support of this project, and to Lorraine Adam (AFM), Roberta Coulter (AFM), Bob Hunter (AADAC) and Alan Ogborne (ARF) for their significant efforts as members of the project working committee. Thanks are extended to Donna Kerr, Kerr Creative Consulting, for conducting the key informant survey, to Dr. Cam Wild (ARF) for information pertaining to mandatory treatment and to Gillian Leigh, Marconi Campus, Nova Scotia Community College, for preparing the annotated bibliography. Appreciation is expressed to the many individuals who supported this project by completing program surveys, by serving as key informants or by assisting as external reviewers of this report. Finally, thanks are due Susan Rosidi and Jill Austin of the Canadian Centre on Substance Abuse (CCSA) for overseeing the survey of treatment programs and Gary Roberts of the Centre for coordinating the project.

Introduction and Methodology

Substance abuse remains a major health, legal and social issue in Canada. The economic cost associated with alcohol in Canada in 1992 was estimated conservatively at about $7.52 billion, with 6,701 deaths attributed to its abuse. Illicit drug abuse accounted for 732 deaths and $1.37 billion in costs in that same year. Within these costs were an estimated $290 million spent on specialized substance abuse treatment (Single et al., 1996). In the context of the very significant human and financial costs associated with the abuse of alcohol and other drugs, it is timely to investigate treatment and rehabilitation activity to clarify what is being done and to determine how we might be more effective.

This report is one of two initiated by Health Canada in collaboration with the provinces and territories to provide current baseline information concerning substance abuse treatment and rehabilitation. The purpose of this report is to provide current information on the scope and nature of substance abuse services at the federal, provincial and territorial levels. To complement this profile of "where we are now", the other report, Best Practices -Substance Abuse Treatment and Rehabilitation, provides advice on "where we need to go" in substance abuse treatment and rehabilitation in Canada. These reports together will help guide Health Canada and the provinces and territories in the area of alcohol and other drug treatment and rehabilitation in this country.

Rush and Ogborne (1992) and Ogborne, Smart and Rush (1998) have respectively described the historical development of Canada's treatment of people with alcohol and other drug problems and this report benefits from these two articles. As well, this profile draws on a national survey of substance abuse treatment programs conducted for this project. Information on 870 programs was collected (estimated to comprise over 70% of the programs in Canada) which is now available as the Treatment Database in the Canadian Centre on Substance Abuse Internet site (http://www.ccsa.ca). Also contributing to this report is a series of key informant interviews, involving at least one person from each province, the Northwest Territories and Yukon. Those interviewed were identified by the person in charge of substance abuse treatment in each jurisdiction as very knowledgeable about treatment and rehabilitation.

Both the key informant and program surveys present data on the nature and scope of treatment in Canada, including who provides treatment in the provinces and territories, and the role of the federal government. We present information on a wide range of issues which have an impact on treatment effectiveness, such as government standards, program evaluations, professional development, treatment philosophies, practices, and special services across the country. The report concludes with a discussion on gaps, challenges and emerging issues largely drawn from the key informant survey.

This profile and the program and key informant surveys investigate both systems and program issues. A substance abuse treatment system is broadly defined as the set of programs and services in a region that are in some way coordinated and available to clients experiencing substance abuse problems. This typically includes those services that deal specifically with alcohol and other drug problems (often referred to as the "specialized sector"), as well as general health and social services that also routinely encounter individuals with these problems (the non-specialized sector). This project focuses on the specialized sector.

We regard tobacco use cessation within and outside substance abuse treatment as extremely important; however, we did not review cessation services in depth because a separate review of tobacco cessation programs in Canada was developed concurrent to this profile (and can be found at the Health Canada Web site - http://www.hc-sc.gc.ca/health-promotion-sante as the Guide to Tobacco Use Cessation Programs in Canada).

It should also be noted that drinking-driver remediation treatment services are largely excluded from consideration in this report. However, a description of the current status of these services can be found in Stoduto et al. (1997).

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 Information, a general solicitation undertaken during the survey of treatment programs, and discussions with a number of government officials. At the end of this report is an annotated list of these reports that should be viewed as an illustrative rather than exhaustive inventory of Canadian articles, studies and reports produced across the country in the past several years.