Profile - Substance Abuse Treatment and Rehabilitation in Canada

The development of alcohol and other drug treatment in Canada

Treatment for alcohol and other drug problems in Canada defies simple characterization. For the most part, substance abuse treatment is the responsibility of the provinces and territories, and arrangements for treatment vary between and within these jurisdictions. Local social, economic and political conditions contribute to uneven patterns of substance use and differing treatment responses across the country. Any profile of treatment in Canada must acknowledge the evolving role of the federal government in overseeing the country's health system and in delivering treatment to particular populations.

Rush and Ogborne (1992) identified four phases in the development of treatment for alcohol problems in Canada and to a large extent these four phases are also reflected in the development of treatment for drug problems. The first phase, ending in the late 1940s, was dominated by moralistic attitudes and a general lack of attention to treatment. Some treatment for alcoholics and drug addicts was available in private asylums and some counselling services for narcotic addicts were established in prisons. However, most people with alcohol or other drug problems had little access to treatment services and the dominant view was that these problems resulted from a lack of "will power" or from personality defects.

The second phase, ending in the mid-1960s, was characterized by a change in attitudes to alcoholism and, to a lesser extent, changes in attitudes to problems involving other drugs. A major influence during this period was the growth of Alcoholics Anonymous (AA). AA promoted the view that alcoholism, although incurable, could be arrested if treatment was provided for withdrawal and the alcoholic followed a 12-step recovery program. With the support of some community leaders, AA members lobbied successfully for government-sponsored treatment and education programs. Efforts to secure government support for alcoholism services were also spurred by the view of alcoholism as a preventable and treatable "disease" rather than a symptom of moral weakness. Dr. Gordon Bell's pioneering work in alcoholism treatment throughout this period led to greater medical attention to alcoholism and to a model of treatment drawn upon by programs across the country.

By the end of the 1950s, most provinces had established departments, commissions or foundations to provide or coordinate addiction treatment services, with many new services established. Initially, these agencies were principally concerned with alcohol-related problems but later, as problems with other drugs began to increase, their mandates were expanded to encompass problems involving other drugs. However, it is important to note that treatment for people who used illegal drugs took place in the context of a strong punitive approach to dealing with drug abuse (Ogborne, Smart and Rush, 1998).

The third phase identified by Rush and Ogborne (1992) began in the mid-1960s and was characterized by a rapid expansion of services for addictions. The most rapid growth occurred between 1970 and 1976. Of approximately 340 specialized agencies operating in 1976, two-thirds were established after 1970, and expenditures on treatment services increased from $14 million to $70 million during the same period. A range of services was established during this period and included detoxification centres, outpatient programs, short- and long-term residential facilities and aftercare services. Some services for people with problems involving drugs other than alcohol were provided by programs established to serve those with alcohol problems, but some specialized "drug" treatment services were also established during this period, including a number of therapeutic communities (Smart, 1983). Throughout this period, individuals in treatment were increasingly found to be abusing other drugs in addition to alcohol.

This period also witnessed the first broad program of compulsory substance abuse treatment implemented in Canadian history. In 1978, the Government of British Columbia passed Bill 18, the "Heroin Treatment Act", arguing that compulsory treatment for heroin abusers was justified on economic grounds. As Boyd, Millard and Webster (1985) indicate, this legislation immediately ran into a number of problems, not the least of which were: public perceptions that the act contributed to "the continued irresponsibility of drug users" and, a court challenge to the constitutionality of the bill by a methadone-dependent individual who argued that her civil rights would be in jeopardy because the police would have the power to remove her from her children and husband. In October 1979, the Supreme Court of British Columbia ruled the Act unconstitutional, ending that experiment in compulsory substance abuse treatment for heroin dependence.

The fourth phase identified by Rush and Ogborne (1992) began during the 1980s, and featured the relative autonomy of the provincial foundations and commissions within their respective health and social service systems. In many cases, addiction research, education and treatment occurred in systems that paralleled and did not fully integrate with the general community health and social services systems. Despite this, there was a growing appreciation for the role of non-specialized health and social services in identifying and supporting specialized substance abuse treatment services.

This phase can also be characterized by the diversification and specialization of alcohol and drug treatment services, with growth in special services for women, youth and Aboriginal people occurring particularly. This trend was driven by research indicating that people respond differently to various types of treatment and by a growing belief that treatment should be adjusted for different populations and types of drug problems. While various modifications of the medical model of treatment were prevalent across the country, a number of other treatments based on cognitive, behavioral and social theories and research emerged during this period. Canada's Drug Strategy, conceived as a multisectoral partnership, was launched in 1987, and served to stimulate a range of activity, including the support of innovative treatment and rehabilitation services across the country.