The importance and the need for drug addiction treatment in Québec

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A study conducted by SECOR on behalf of Portage, a non profit organisation dedicated to the rehabilitation and reintegration of people suffering from substance abuse back into the community, concluded that government investments in the fight against drug addiction have significant long term effects. www.portage.ca

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The importance and the need for drug addiction treatment in Québec

  1. 1. The importance and the need for drugaddiction treatment in QuébecFinal Report
  2. 2. Description of Portage and its Service Offering .1.
  3. 3. Portage: Close to forty years of experience in drug addiction rehabilitation in Québec ■ Founded in Prévost, Québec, nearly forty years ago, Portage is a non-profit organisation devoted to the social reintegration of drug addicts, based primarily on a therapeutic community approach. ■ Portage currently provides services in five regions of Québec: the Greater Montréal Area, Québec City, Saint- Malachie, Beaconsfield, and Prévost Services provided Portage’s mission Accreditation ■ Assessment/orientation Portage fosters the strengths and skills of Portage is accredited by Accreditation ■ Non-residential drug addiction substance-dependent persons to enable Canada, which recognises the continuous rehabilitation them, through comprehensive and cost- improvement of the quality of services at effective interventions based on the Portage, the skills of its employees, and ■ Residential drug addiction rehabilitation therapeutic community approach, to live the expertise of the organisation. ■ Gambling addiction rehabilitation lives of sobriety, filled with dignity, self- ■ Replacement therapy respect and accomplishment. ■ Social reintegration ■ Community help and support1973 1975 1983 1986 1989 1991 1995 1996 1999 2001 2002 2007 2009  Launch of the Mother and  Opening of the  Opening of a  Implementation of a Child residential  Inauguration of the head office in Day Centre in residential rehabilitation rehabilitation program, a first Movement for Integration Montréal and Day Québec City program for adolescents of its kind in Canada, at the and Retention in Centre with substance abuse centre in Prévost, near lac Employment (MIRE) issues at the centre in Écho program in Montréal Prévost, near lac Écho  Inauguration of the  Opening of a Portage Employment  Opening of a residential residential Reintegration Centre rehabilitation centre for  Inauguration of a rehabilitation in Québec City adolescents in Saint-Damien-de-  Relocation of the centre for adults Buckland new Portage  Implementation of the adolescent facility in Prévost, near centre in Montréal  Launch of a day treatment program for  Implementation of a for the MICA and in Saint-Damien- lac Écho treatment and family de-Buckland to Mentally Ill Chemical Abusers residential rehabilitation Mother and Child services centre in (MICA) at the centre in program for English-speaking Saint-Malachie programs Montréal Prévost, near lac Écho adolescents in Beaconsfield,Source: Portage .2.
  4. 4. A distinctive therapeutic approach ■ The rehabilitation process at Portage is based on the therapeutic community, positive psychology, and individual case management. The goal of Portage’s treatment approach is to help clients build on their strengths and acquire the skills they need for rehabilitation. ■ The rehabilitation process at Portage is personalised in terms of both duration and content, which makes it unique in Québec. The program’s duration is established based on each client’s needs, motivation, and willingness to be treated. Part 1 of treatment Part 2 of treatment Focus on the development of interpersonal Focus on the development of community relations, self-understanding, trust, and dignity. responsibilities to prepare clients for reintegration Clients work on: into society. Clients are given responsibilities such ■ their personal path as: ■ assimilating skills associated with therapy ■ a mentoring role with new residents ■ Understanding the reasons that led to their substance ■ the organisation of travel and safety abuse ■ the coordination of community activities Post-treatment process Portage’s unique post-treatment services aim to minimise the chance of relapse: ■ Ongoing treatment for all clients for up to two years following release from the rehabilitation program, at day centres and the MIRE program ■ Supervised apartments for clients at the Mother and Child program for up to two years after completing the residential programSource: Portage .3.
  5. 5. Multiple targeted programs to serve clients with diverse needs Portage provides rehabilitation services to adolescents, adults, pregnant women and mothers with young children, the aboriginal community, mentally ill substance abusers, and individuals referred by the justice system from all regions of Canada. Portage helps clients identify the causes of their problems, determine the general skills they need to face these problems, and develop strategies to resolve them. Portage Program Duration based on the needs of the individual, 6 months on average AdultProgram (Prévost) Adolescent Program (Montréal, Prévost, Saint-Malachie) ■ Program offered since 1973 ■ For adolescents, 14 years of age or older ■ For adults, 18 years of age or older ■ Residents live in a supportive, enriched, and structured setting ■ Residents have access to Portage Academy, which enables them to get ■ They take part in sporting and recreational activities and in daily group their high school diploma while in therapy sessions Capacity: 70 clients ■ They have access to Portage Academy Capacity: 104 clients Mother and Child Program Mentally Ill Chemical Abusers (MICA) Program (for men) ■ Portage is one of very few facilities in Canada to offer a rehabilitation ■ This program, which treats substance abusers who have mental health program for pregnant women and mothers with young children (0 to 6 problems (primarily schizophrenia), is in high demand, as shown by the years of age) waiting list ■ Portage provides day care services with specialised educators, where the ■ Portage would like to further develop this program in the next few years, children receive treatment as well. The children also have access to a in particular by opening a similar program for women nearby elementary school. Capacity: 20 clients Capacity: 25 mothers, 25 children Portage Québec City Day Centre MIRE ■ The Portage-Québec centre offers a Day Centre Program and an ■ The MIRE Program helps adults who have had trouble integrating or aftercare follow-up program reintegrating into the job market to find suitable employment. There is a particular focus on single parents and individuals of more than 35 years of age. Capacity: 225 people divided into nine groupsSource: Portage .4.
  6. 6. Governance Structure and Funding Portage has a Board of Governors (made up of 200 volunteers) who sit on the various committees which support clinical programs and the organisation’s administration ■ Every year, the Board of Governors must elect a Board of Directors composed of 25 members In 2010, the organisation’s funding was primarily ensured through public funds (74%) and contributions from its Foundation (15%). The Chagnon Foundation has contributed approximately $8 M in 10 years to the Mother and Child Program/ Funding for Portage 2010; in $K and in % Other foundations and Total budget of $11.2 M in 2010 Portage Foundation other revenues The organisation has a foundation, which holds Portage’s assets in trust. The Portage 1,325 (11%) Foundation is managed by a separate Board of Portage Foundation 1,638 Directors. (15%) Since its inception in 1973, the Portage Foundation has raised over 25 million dollars to fund Portage’s various programs 8,264 ■ Funding activities: Fundraising (74%) campaigns, recognition galas, golf Government tournaments, unsolicited donations programs: (online, by telephone, In Memoriam, The ministère de la Santé et des spontaneous donations, donations of Services sociaux (78%), the ministère de la Sécurité publique goods and services) and the Direction régionale des services correctionnelsSource: Portage .5.
  7. 7. High success rate for long-term treatment Portrait of Portage’s clientele Portage achieves high abstinence rates in adolescents and adults in %, January 2003 to October 2008 after long-term treatment 40 to 64 0 to 12* ■ 66% of adolescents who complete 181 days or more of treatment remain abstinent after 14.5 months 9% 6% ■ 70% of adults who complete 211 days or more of treatment reamin after 25 to 39 16 months 23% Most of Portage’s clients are under 25 years of age (68%) 41% 13 to 17 21% 18 to 24 (*) The 0-6 population corresponds to the children taking part in the Mother and Child Proportion of clients who abstain from using drugs after residential treatment at the Portage centre in Prévost, Program and to whom support and specific services are provided near lac Écho in %, January 2003 to October 2008, various durations of treatment ADOLESCENTS ADULTS Average age: 16 Average age: 30 80% 76% 69% 70% 66% In 2009, close to 58% 2,000 drug addicts 55% 58% 55% 50% 53% 45% used Portage’s 37% services 32% (approximately 50% at a residential facility and 50% at external programs) 15–60 days 61–180 days 181+ days 1–30 days 31–120 days 121–210 days 211+ days 7.5 months after treatment 14.5 months after treatment 8.5 months after treatment 16 months after treatmentSource: Portage .6.
  8. 8. Admission rates to main programs in decline ■ Since 2007-2008, admission rates have been in decline for the two programs with the highest capacity, i.e., the Adolescent (-1% per year) and Adult (-3% per year) Programs  In 2010-2011, the Adolescent Program is only being used at three-quarter’s of its capacity. Before the implementation of the Access Mechanism system, this program continually ran at full capacity ■ The admission rates at the Mentally Ill Chemical Abusers (MICA ) Program and the Mother and Child Program are better, with an annual growth of 2% and 1%, respectively  For the current year, the MICA Program is running at full capacity, while the Mother and Child Program is at 90% capacity Evolution of Admission Rates for each Portage Program 07-08 to 10-11; in % of capacity per program CAGR* -3% CAGR* +2% CAGR* 114% 117% 112% +1% CAGR* 105% -1% 100% 102% 100% 95% 91% 89% 86% 76% 74% 73% 75% 69% Capacity: 104 Capacity: 70 Capacity: 20 Capacity: 50 Adolescent Program Adult Program Mentally Ill Chemical Mother and Child Abusers Program Program 07-08 08-09 09-10 10-11** *CAGR: Compound annual growth rateSource: Portage **Year to date .7.
  9. 9. The Evolution of Drug Addictionand Description of Needs .8.
  10. 10. Illegal drug use in decline in Québec, yet one of the highest rates in Canada Generally speaking, illegal drug use is in slight decline in Québec and in Canada ■ Between 2004 and 2009, illegal drug and cannabis use in Québec has fallen by 8% ■ In Canada, the decrease illegal drug use is even greater, but less pronounced when including cannabis Nevertheless, Québec has one of the highest rates of drug use in Canada, ranking 2nd/10 for illegal drug use and 3rd when including cannabis Lifetime Drug Use 2004 and 2009; in % of the sample; Canada (n=13,082) and Quebec (n=1,009) Canada -11% Québec ranks 2nd/10 Use of one of the five following provinces in terms of illegal drugs: crack/cocaine, proportion of the population speed, ecstasy, hallucinogens having used one of the five and heroin Quebec -8% illegal drugs listed, behind British Columbia 2004 2009 Québec ranks 3rd/10 Canada -5% provinces in terms of Use of one of the six following proportion of the population soft or illegal drugs: cannabis, having used one of the six cocaine, speed, ecstasy, illegal drugs listed, behind hallucinogens and heroin Quebec -8% Alberta and British ColumbiaSource: Health Canada, Canadian Alcohol and Drug Use Monitoring Survey .9.
  11. 11. Many illegal drugs are used more in Québec than in the rest of Canada ■ Crack/cocaine and amphetamines are used more in Québec than they are in the rest of Canada ■ The greatest differences between Canada, as a whole, and Québec are in the use of amphetamines (+86%) and crack/cocaine (+20%) Lifetime Drug Use 2009; in % of the sample; Canada (n=13,082) and Quebec (n=1,009) +2% +1% Canada Quebec +1% +20% +86% 0% +11% -6% Cannabis Crack/ Amphe- Metham- Halluci- Ecstasy Salvia All cocaine tamines phetamines nogens drugsSource: Health Canada, Canadian Alcohol and Drug Use Monitoring Survey . 10 .
  12. 12. A noteworthy phenomenon: Steady rise in the use of legal drugs In North America, there is a marked increase in the use of legal drugs (542% increase between 1992 and 2005 in Consumption rates for Vicodin and Oxycontin for non-medical purposes number of American teenagers using prescription drugs to in high schools 2010; United States, used at least once during the year almost 10% in 2005). In 2009, 16 million Americans aged 12 and older had used Grade Vicodin Oxycontin an analgesic, tranquiliser, stimulant, or sedative for non- medical purposes at least once in the year leading up to 8th grade 2.7% 2.1% the survey 10th grade 7.7% 4.6% ■ A study conducted by Monitoring the Future showed high 12th grade 8.0% 5.1% consumption rates for Vicodin and Oxycontin (powerful analgesic drugs) for non-medical purposes In 2009, 23% of Ontario high school students had tried these drugs in the past 12 months. The province recently adopted legislation to better monitor the use of legal drugs: the Narcotics Safety and Awareness Act. According to researchers, Ontario generally falls within the Canadian average. The use of legal drugs is accordingly also seeing a significant increase in Canada and Québec: ■ Cases are often more serious ■ The resulting addictions are not addressed as well by current programs ■ These drugs are becoming a major problem The slight decline in illegal drugs in Québec is largely offset by the increase in legal drug use. These trends generate new addictions and new treatment needs.Source: National Survey on Drug Use and Health; Monitoring the Future, Ontario Student Drug Use andHealth Survey (2009), studies by the Centre de recherche sur la communication et la santé (UQAM) . 11 .
  13. 13. Are drug problems in Québec more frequent today than they were ten years ago? ■ A strong majority of people (92%) believe that substance abuse problems have either held steady or worsened in the past ten years ■ Access to illegal substances seems easier today—95% of people believe that it is easy for young people to obtain drugs Frequency of Substance Abuse Problems Access to Illegal Substances past ten years, in %, n=1,000 in %, n=1,000 58% 54% 38% 37% 5% 3% 3% 1% 1% More As Less DNK* Very easy Easy Difficult Very difficult DNK* frequent frequent frequentSource: Léger Marketing *DNK = do not know . 12 .
  14. 14. Eight out of ten Quebecers feel that drug and alcohol addiction are serious problems According to a survey done by Léger Marketing, Quebecers feel that drug and alcohol addiction problems are important public health concerns: ■ 82% of Quebecers consider drug addiction problematic and 81% consider alcohol addiction problematic Assessment of the importance attributed to addiction issues by Quebecers 2010, drugs and alcohol, n=1,000 DRUGS ALCOHOL 3% 4% 15% 15% 36% 39% 43% 45% Very important Not very important Somewhat important Not importantSource: Léger Marketing . 13 .
  15. 15. A large number of high school students need help Regular and prolonged or excessive drug use can have serious repercussions on an individual. Cannabis, the illegal drug most commonly used by young people, can cause physical problems such as pulmonary and cardiovascular issues, as well as cognitive (memory, attention, information management) and mental health (depression, psychosis and schizophrenia) problems. The DEP-ADO scale (Dubé et al., 2007) shows an alarming trend of addiction cases becoming more serious in young people, with 79% of youth who use amphetamines, and over 83% who use cocaine, requiring a treatment intervention Proportion of high school students with a “yellow light” or “red light” in %, by substance used, 2007 Green light DEP-ADO code: Yellow light The DEP-ADO code ranks the level Excessive 16% 16% 68% 100% Red light of addiction of high school students alcohol according to three degrees of seriousness: green, yellow, and red. Excessive- repetitive 34% 27% 39% 100% A person deemed to be in the green alcohol light category has no consumption problem (in the sense that no Cannabis 22% 22% 56% 100% specific intervention or treatment is required). However, it is recommended that Amphetamines 52% 27% 21% 100% people in the yellow and particularly the red light categories seek treatment Cocaine 65% 18% 17% 100% This approach does not take addiction to multiple substances into accountSource: Institut de la statistique du Québec, 2007 . 14 .
  16. 16. Cases processed per Access Mechanism, Montréal The Access Mechanism in Montréal opened 503 case files, of which 350 were processed in the past year, of which only 82 were assigned to rehabilitation centres Structure of the Access Mechanism for Drug Addiction in Montréal 2009, for Francophones under 18 years of age Case files opened Nb. of internal referrals No. No. Partners Centres opened referred Youth centre 135 Grand Chemin 18 Friends and family 59 Pavillon du Nouveau Point de Vue 36 Self-referral 35 Portage 20 Educational institution 51 CDC-IUD Réadaptation interne Jeunesse 8 Access Mechanism partners 11 CSSSs 27 Hospital centre 12 Community organisation 12 Other establishments (police, RDC, etc.) 8 Total case files opened 350 Total internal referrals 82According to the ACRDQ, 0.8% of the population 15 years of age and older is addicted to illegal drugs, representing some 30,000 people in the Montréal metropolitan area. Accordingly, the number of case files opened represents only 1% of the people suffering from addiction, and the number of internal references, slightly less than 0.3%.Source: [MATJM] . 15 .
  17. 17. Economic and Social Impactof Drug Addiction in Québec . 16 .
  18. 18. Drug Addiction: Significant costs for the province ■ In 2002, the costs of illegal substance abuse represented over $1.6 billion for the province, representing 0.6% of the GDP ■ This impact is calculated based on five elements: health care, law enforcement, prevention/research, loss of productivity, and other direct costs Direct health care • Morbidity costs: total • Hospitalisation for short-term care Total Cost of Illegal Drug Use • Hospitalisation for psychiatric care 2002, in $M, top four Canadian provinces • Specialised residential treatment • Specialised non-residential treatment • Outpatient care: medical fees • Visits to family physician • Prescription drugs Direct law • Police services enforcement costs • Courts • Correctional service (including probation) Direct prevention and • Research research costs • Prevention programs • Salaries and operating funds Other direct costs • Damages caused by fire • Damages caused by road accidents • Work place costs • EAP and health promotion programs • Drug screening in the work place • Administrative costs of transfer payments • Welfare and other programs • Workers’ compensation Indirect costs: loss of • Long-term disability productivity • Short-term disability (days of bed rest) Ontario Quebec British Alberta • Short-term disability (days of reduced activity) Columbia • Early deathSource: Canadian Centre on Substance Abuse . 17 .
  19. 19. Significant costs associated with loss of productivity, law enforcement, and health care ■ Most of these costs are associated with the loss of productivity (57%) and law enforcement (28%), while prevention and research costs represent just 1% of the total ■ In terms of health care costs (13.8%), the principle issues are morbidity following a short-term hospitalisation (37.6%) and specialised residential treatment (31%) Breakdown of the Costs of Addiction Associated with Illegal Drugs Direct Health Care Costs Associated with Illegal Drugs 2002, in %, Canada 2002, in %, Canada Prescription drugs Morbidity—hospitalisation Direct costs: for short-term care law enforcement 28.3% Visits to family physician 4.3% Outpatient care: medical fees 2.0% Indirect costs: loss of productivity Specialised non-residential treatment 1.0% Direct costs: 1.0% 0.2% health care Specialised residential treatment 31.0% Morbidity—hospitalisation for psychiatric care Direct costs: Other direct costs prevention and research Estimated health care costs Total costs of illegal drugs in associated with illegal drugs in Québec: Québec: $1.627 M $225 MSource: Canadian Centre on Substance Abuse . 18 .
  20. 20. Portage’s contribution to Québec’seconomic and social welfare . 19 .
  21. 21. Understanding the social, human, and economic impacts of Portage’s services ■ In 2009, approximately 2,000 people used Portage’s services in Québec ■ The success rate is around 70% on average for the programs as a whole ■ In 2009, Portage’s activities therefore contributed to the rehabilitation and reintegration of around 1,400 drug addicts in Québec ■ This represents a gain of $45.5 M on total costs and $6.3 M on direct health care costs Impact of the Funding Shortfall for Portage’s Services If Portage could not continue to operate due to a lack of sufficient funding, a large portion of the individuals treated could not receive treatment from another centre:  Portage offers specific programs unique to its facilities and under-developed in other existing centres (for example, the Mother and Child Program, the MICA Program, and the Adolescent Program,)  Portage’s specific approach corresponds to specific needs that no other centre can meet  The accommodation capacity and resources of other centres are limited ■ It is estimated that 75% of the 2,000 treated annually, so 1,500 people, would not be able to receive treatment another centre. With a 70% success rate at Portage, this corresponds to 1,050 fewer people reintegrated in society every year without Portage’s services ■ This drop in the number of people reintegrated into society would have a $34 M impact in terms of additional costs for the province every year, and additional direct costs of $4.7 M in health care Ten-year forecast: Cumulative additional costs for the province are estimated at $1.9 B and direct health costs at $260 M.According to the ACRDQ,* 0,8% of the population 15 years of age and older was addicted to illegal drugs, i.e., around 50,000 people in Quebec in 2010*** Source: Service offer of CRPATs [rehabilitation centres for alcoholics and drug addicts], Fédération québécoise des centres de réadaptation pour personnes alcooliques et autrestoxicomanes, 2004.** SECOR estimate: based on 6.2 M individuals in 2004, 6.7 M in 2010 and an 8% drop in consumption. . 20 .

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