Profile - Substance Abuse Treatment and Rehabilitation in Canada

Current treatment systems

It might be said that Canadian substance abuse treatment systems entered a fifth phase in the early 1990s, fueled by dramatic changes in the structure of health services across the country. Within a general environment of reduced expenditures for health services, most government substance abuse services have been integrated into community health and social services delivery systems. Only three provinces now have specialized alcohol and drug abuse foundations or commissions. In Ontario, the Addiction Research Foundation amalgamated with two mental health agencies and one other addictions agency to become the Centre for Addiction and Mental Health.

This integration of services for various health problems has been supported by adoption of a Population Health model by the provinces, territories and the federal government. This approach repositions the role played by health care services in determining the health of a population, giving greater priority to broad socio-economic factors. Accompanying this model has been an increased awareness of the need to better integrate alcohol and drug services, not only into the general health system, but into larger social welfare policy and social support systems as well.

Concurrent with this trend toward service integration has been a general devolving of responsibility and decision making to regional or district health boards that deliver a range of health services, including substance abuse services. The province of Quebec led this process, initiating a decentralized approach in the early 1970s. Quebec has recently passed still more responsibility to regional services, emphasizing integration of the various service areas, including substance abuse.

The majority of funds for alcohol and drug treatment and rehabilitation in Canada are provided by the provinces and territories through local taxes, provincial health insurance funds and federal transfer funds under the Canada Health Act and other federal programs. The estimate of the total costs of specialized substance abuse treatment was more than $290 million in 1992 (Single et al., 1996). The capacity of the systems across the country can be reflected in the number of substance abuse treatment programs, estimated to be 1200, and counselling staff, estimated to be 7200 in 1997. The 72% of programs responding to the program survey conducted for this report represents 1544 detoxification beds, 1775 short-term residential beds and 3010 long-term residential beds (see Table 1).

* Please refer to the Glossary in Section 10 for definitions of terms used in this table.

Persons experiencing alcohol problems generally predominate in treatment services' case loads. To illustrate, the Canadian Community Epidemiology Network on Drug Use (CCENDU), which examined data from six major cities, reports the following: "About 69% of persons entering treatment in Vancouver in 1993/94 identified alcohol as their drug of choice. In Calgary, 64% of people entering community-based and 58% of those entering hospital-based treatment identified alcohol as their most frequently used and major problem substance respectively. Alcohol was a presenting problem for 87% of clients entering treatment in Winnipeg in 1995. In 1995, 28% of women and 36% of men in treatment in Montreal reported using alcohol. In Halifax, 82% of all those in treatment during 1995 reported using alcohol" (Poulin, 1997). Toronto did not report data on this issue.

What is less known is the extent to which existing services in Canada fulfil treatment needs. Although research suggests that only a small proportion of alcohol or drug dependent persons seek and receive treatment, the actual proportion of those needing treatment who receive treatment in Canada is not known.

Table 2: Substance abuse treatment services offered across Canada*

Newfoundland
Outpatient	13
Day/even. treatrement	2
Short-Term Residential	5
Long-Term Residential	0
Outreach	2
Walk-in/crisis	7
Total	29

 

Nova Scotia
Outpatient	9
Day/even. treatrement	7
Short-Term Residential	7
Long-Term Residential	6
Outreach	9
Walk-in/crisis	4
Total	42

 

Prince Edward Island
Outpatient	2
Day/even. treatrement	1
Short-Term Residential	1
Long-Term Residential	1
Outreach	1
Walk-in/crisis	2
Total	8

 

New Brunswick
Outpatient	5
Day/even. treatrement	3
Short-Term Residential	3
Long-Term Residential	2
Outreach	3
Walk-in/crisis	5
Total	21

 

Quebec
Outpatient	72
Day/even. treatrement	52
Short-Term Residential	59
Long-Term Residential	43
Outreach	48
Walk-in/crisis	44
Total	318

 

Ontario
Outpatient	110
Day/even. treatrement	55
Short-Term Residential	43
Long-Term Residential	51
Outreach	61
Walk-in/crisis	64
Total	384

 

Manitoba
Outpatient	12
Day/even. treatrement	5
Short-Term Residential	8
Long-Term Residential	10
Outreach	8
Walk-in/crisis	10
Total	53

 

Saskatchewan
Outpatient	24
Day/even. treatrement	9
Short-Term Residential	10
Long-Term Residential	5
Outreach	14
Walk-in/crisis	14
Total	76

 

Alberta
Outpatient	41
Day/even. treatrement	22
Short-Term Residential	22
Long-Term Residential	13
Outreach	14
Walk-in/crisis	27
Total	139

 

British Columbia
Outpatient	128
Day/even. treatrement	43
Short-Term Residential	39
Long-Term Residential	28
Outreach	70
Walk-in/crisis	77
Total	385

 

Northwest Territories
Outpatient	7
Day/even. treatrement	5
Short-Term Residential	3
Long-Term Residential	2
Outreach	7
Walk-in/crisis	7
Total	31

 

Yukon
Outpatient	2
Day/even. treatrement	1
Short-Term Residential	2
Long-Term Residential	0
Outreach	0
Walk-in/crisis	2
Total	7

 

TOTAL
Outpatient	425
Day/even. treatrement	205
Short-Term Residential	202
Long-Term Residential	161
Outreach	237
Walk-in/crisis	263
Total	1493

*Please refer to the Glossary in Section 10 for definitions of terms used in this table.