Time for a Provincial Reset of Substance Abuse Programming

by Dr. Richard Thatcher

Like the old saying, when opportunity knocks, you are wise to answer the door—or something like that.

Clearly, the opportunity to upgrade preventive and remedial responses to substance abuse problems in Saskatchewan is knocking loudly, alerting us to the fact that the time is ripe for a service review.

The establishment of a ministry of mental health and drug abuse services last year must be applauded, as must the support given to the sixteen supervised safe injection sites in the province (although the failure to refund the Saskatoon site is surely a questionable one). Yet while the provincial government has gained ground in framing and planning a intelligent remedial response to cover the wide range of alcohol and drug mis-users in our province, a plan is just ink on paper until it is instituted—and there is much yet to institute. The appropriate distribution of resources along a full continuum of care appears to be seriously lacking. A fundamental reset in preventive and remedial programming is clearly needed at this time.

Consider the fact that in very recent years drug overdose deaths in this province have been accelerating at a frightening pace: 233 deaths in 2020 and 75 thus far in this calendar year. Let’s admit it, we have another epidemic on our hands. If I’m not mistaken, those drug fatality figures do not include all the deaths associated with alcohol intoxication, including assaultive encounters, accidents at work, and traffic fatalities.

A friend of mine whose son had a serious binge drinking problem recently said to me: “Like my older teenage boy’s secretive drink scares the daylights out of me. But it’s hard to get help. There are far more binge drinkers in the province than true alcoholics. But he can’t get treatment anywhere, unless he depicts himself as true drunk.”

Another consideration demanding a program review and service reset at this time is the current effort to simply move the Pine Lodge treatment centre program to another facility, without carefully examining its most effective location or the nature of its therapeutic orientation or curriculum. The program was in hiatus after a fire sacked the building in Indian Head in which it was housed.

Apparently the Pine Lodge program that the current board supports is primarily based on a very traditional 12-step model and there are other programs in the province centered on the same approach. The Pine Lodge program incorporated the 12-step approach into their core treatment model. Such an approach may be a useful referral resource, along with S.O.S., high quality counselors linking the client to supportive interveners, Smart Recovery, Last Door programming and Moderation Management counselling; however, it clearly should not be a direct recipient of public resources: it is not an inpatient treatment model, it is a voluntary, community-based, self-help program.

The very purpose of AA and other 12-step programs is undermined by its appropriation as a formal inpatient treatment model that can exclude those who are not willing to participate in the 12-step procedures. Surely examples of forced participation in a particular regimen of treatment are ill-advised, much as “conversion therapy” should be a thing of the past. Clever lawyers seeking class action clients or Charter challenges should surely take notice if clients are refused treatment in a public program because they do not accept the philosophy of the 12-step model.

Good reason demands that public programs centered on 12-step based treatment programs – or any other community-based, volunteer peer group program — must have their core therapeutic model replaced and have their client base greatly expanded to include more choices and clients with a wider range of problems. The current programs requiring client obeisance to a a one-size-fits-all treatment model is fundamentally flawed by its curious mixture of faith with rational skill development and its false labelling of clients as having a chronic disease from which they must forever try to recover (A heavy and unnecessary burden to carry until death do us part). Such a belief is falsely presumed by the idea that some people have innate predispositions to drinking (Note, the “alcoholic personality” research has come up dry, despite continued efforts, including the most recent ‘brain wave” research).

The 12-step model is not a good fit with minorities, the poor, women, those who have not ‘bottomed out” and those who do not believe in a higher power. If I’m not mistaken, that’s the majority of people in the province who are experiencing substance abuse problems. Surely they deserve more consideration in treatment program design.

The available evidence makes it clear that, for most mood-modifying substance mis-users, the psychic treadmill introduced by 12-step participation is an unnecessary and false prerequisite for overcoming chemical dependency—and, ultimately, whether in a peer support group or not, overcoming substance abuse is a personal achievement made much more likely by a little help from one’s family and friends.

It is worth noting that most people with substance abuse problems eventually overcome them on their own, without any form of professional treatment or formal peer group support.

While AA has demonstrated its effectiveness for some individuals, its volume of client inclusion is but a small fraction of the population in need.

The question must also be asked in any serious review: Would it not be more appropriate to house Pine Lodge or a replacement treatment centre in or very near to Regina or Moose Jaw where a wide range of potential service supports and human service personnel are available rather in a rural location far from a major centre. And I’ll bet there are many patches of real estate in either city where a treatment centre would be more than welcome. The building housing the previous St. Michael’s Retreat in Lumsden is an especially attractive prospect.

Surely there is a confluence of circumstances at this time which indicate that it is high time to review the scope, potential client coverage and best practices for substance abuse prevention and intervention currently in play in the province. Surely that would readily fit with the wider efforts going forward for which the Provincial Government can deservedly be proud.

Dr. Richard Thatcher– a semi-retired social-psychologist and freelance journalist who has worked as a researcher and policy advisor on substance abuse issues for several decades. He has designed several substance abuse programs and he is the author of 5 books on the subject.