Profile - Substance Abuse Treatment and Rehabilitation in Canada

Who provides treatment and rehabilitation in the provinces and territories?

Typically, addiction services fall within the responsibility of the provincial/territorial ministry of health. In Alberta, the Ministry of Community Development is responsible for funding treatment services through the Alberta Alcohol and Drug Abuse Commission (AADAC), and in British Columbia, the Ministry for Children and Families has responsibility. In Ontario, other ministries besides the Ministry of Health (i.e., Community and Social Services and provincial Corrections) also fund addiction treatment services.

The proportion of services provided by various agencies varies considerably across the country. In the Yukon, 95% of services are reportedly provided directly by the government, but in no other jurisdiction except British Columbia is the government directly involved in service provision. In British Columbia, 30% of services are reportedly run directly by the government.

In the Atlantic Provinces, regional health boards are the dominant players in the direct delivery of services, providing 85% to 100% of all services in these provinces. Regional health boards also provide 60% of services in Saskatchewan and similar boards are expected to be prominent in Ontario, once an ongoing rationalization project is completed. In Manitoba and currently in Ontario, a high proportion of services is provided by provincially funded private, non-profit agencies. In Alberta, British Columbia and Northwest Territories, provincially funded private, non-profit agencies provide from 60% to more than 80% of services.

The primary affiliation of a treatment program provides some indication of the nature and orientation of its services (Figure 1). For the country as a whole, 43% of treatment programs can be described as community-based services, while 13% are affiliated with hospitals and 27% are associated with a provincial/territorial government. Eleven percent of the country's treatment programs are affiliated with Native services, while correctional treatment services account for the remainder of programs across the country (6%).

Figure 1

The workplace remains an important setting for substance abuse intervention. Employee assistance programs (EAPs) continue to be seen by substance abuse services as having an important role in identifying and assisting employees with these problems. For example, particular effort is being made in British Columbia to increase the number of EAP coordinators that can function as effective substance abuse treatment case managers. Also, respondents in some regions note that the 225 private EAP providers in the country (CCSA, 1996) are increasingly providing brief substance abuse counselling (in addition to assessment and referral).

Government-funded programs in Alberta and British Columbia charge fees to cover room and board in residential programs. Fee schedules in these provinces are reportedly geared to income and are often paid by employee assistance programs or other third parties. Continued restructuring of systems may result in further consolidations and more fee-for-service arrangements. Just over half of the treatment programs in the country accept out-of-province referrals, with most (84%) not requiring an extra fee.