Chapter 17 - Treatment practices

Forms of treatment 

The 1992 study by Single on the cost of alcohol and drug abuse estimated the cost of specialized treatment for dependency at approximately $290 million. But it would be misleading not to specify that the largest share of treatment dollars is for alcohol: in the case of residential treatment, $180 million was for alcohol and $21 for illicit drugs and in the case of  non residential treatment, $82 for alcohol and $8 for drugs.[1][18]

Most of this money is provided by the provinces and territories. The federal government directly funds rehabilitation for members of the First Nations living on reserves, members of the RCMP and the Armed Forces, inmates in federal institutions and those who have not lived long enough in a province to qualify for the provincial health insurance plan.

This said, the limited resources devoted to treatment of dependency and the growing pressures in terms of the number and diversity of clients, mean that the availability of treatment is limited.

 

Many agencies have received significant cutbacks in recent years. Possibly exacerbating the situation, substance abuse organizations are increasingly being asked to address problem gambling. … Similarly, Bill C-41, which permits court-ordered substance abuse discretion, has an impact on substance abuse treatment at a judge’s assessment and treatment resources. [2][19]

 

It is probably not an exaggeration to say that the area of addiction treatment is totally fragmented among the individual practices used by therapists, support and assistance groups, such as addicts anonymous, and therapeutic communities; and among pharmacological, cognitivist and behavioural approaches, psychoanalytic, humanist and systemic approaches; among the proponents of freedom of choice for the user and those who promote enforced treatment. Virtually every possible approach to and form of treatment is available.

Recent reports produced for Health Canada bear witness to this. The Profile of Substance Abuse Treatment programs indicates that in 1998 there were at least 1,200 different treatment programs and approximately 7,200 professional counsellors across the country.[3][20] Included in these figures are outpatient, day or evening treatment, short-term and long-term reisdential, outreach and crisis treatment programs. The breakdown by province and territory may indicate where priorities are set.

 

Substance abuse treatment services offered across Canada[4][21]

	Outpatient	Day/Even. Treatment	Short-term residential	Long-term residential	Outreach	Crisis	Total
Nfld	13	2	5	0	2	7	29
NS	9	7	7	6	9	4	42
PEI	2	1	1	1	1	2	8
NB	5	3	3	2	3	5	21
Qc	72	52	59	43	48	44	318
Ont	110	55	43	51	61	64	384
Man	12	5	8	10	8	10	53
Sask	24	9	10	5	14	14	76
Alta	41	22	22	13	14	27	139
BC	128	43	39	28	70	77	385
NWT	7	5	3	2	7	7	31
Yukon	2	1	2	0	0	2	7
TOTAL	425	205	202	161	237	263	1493

 

The primary affiliation of these programs also gives an indication of their orientation. Fully 43% of existing treatment programs are community-based. One of the implications of this fact is that funding is never secure. Overall, the programs may be broken down as follows:[5][22]

 

 

 

 

 

 

 

 

In terms of the therapeutic approaches used, 31% make use of confrontation and 40% of psychotherapy, but there are very broad differences between individual provinces and territories and even within a given province.[6][23]