Accessing intensive support for substance abuse can be challenging, specifically for young people, as it presents additional barriers. In my experience working with clients seeking help with substance abuse, stigma and shame play a prominent role in one's readiness to access support. Social and cultural norms will often discourage an individual from reaching out to connect with community resources. Even once an individual gets past the shame or guilt they feel around substance use, not having the financial means to choose a program that is an appropriate fit for the client is easily one of the most common barriers. Private treatment options, while often having better amenities and more comprehensive medical and mental health support, typically cost several thousand dollars depending on the type of treatment.
While there are government-funded programs available that are more affordable, they are often limited to a specific health authority allowing only residents within a limited radius to be eligible to access those programs. Additionally, the different health authorities are not equally resourced. In fact, the largest health boundaries in BC are the most under-resourced resulting in increased wait times and a need to seek treatment outside of one's community. For programs with a larger catchment, clients may experience alternative barriers, such as fees for transportation being a financial strain to the client or caregiver.
Another common barrier to accessing treatment is the need for variety in the types of support available in each area. Communities often have abundant outpatient or outreach support but need more detox or treatment options or vice versa. I have witnessed this occur on several occasions where clients seek out resources, but what they receive is ultimately more harmful than helpful. Access to different kinds of support results in a more comprehensive approach to addressing substance abuse and helping people access the appropriate variety of support for them at that moment.
A similar issue is prevalent within the services available for addressing mental health and substance use. This is extremely common for young people as they are often not taken seriously and require additional support from adults and professionals to advocate for them to gain access to appropriate services. Many facilities will need a professional to provide referrals for the young person. Accessing a mental health or substance abuse counsellor will often require a referral or application. Suppose the client cannot establish and maintain a relationship with a professional. In that case, it can make it increasingly difficult to get the support they need. Even once one gains access to a program that provides intensive support, the challenges only continue within the colonial structures of the programs available.
A CBC News Article highlights additional barriers to accessing adequate support in treatment, such as fluctuation in wait times and lack of guidance for those who don't know what options are available or appropriate for themselves or their loved ones. Some programs are even resistant to progressive, evidence-based approaches, including "drug-free" facilities that go so far as to prohibit the use of mental health medications such as antidepressants.
Another issue is the tendency for programs or resources to treat addiction and mental health separately as they generally co-exist, with one affecting the other. Most programs cannot provide the level of individualized care required to address specific mental health needs. Instead, they offer a one-size-fits-all approach based on their available resources. The lack of resources allocated to substance abuse programs often results in staff being underqualified, inexperienced, and unable to provide complex mental health support, resulting in clients receiving inadequate services. The inability to address substance use due to challenges presented by mental health concerns can result in additional barriers to evoking cognitive or behavioural change.
For example, one client struggled immensely with trauma flashbacks in the middle of the night. With only a night attendant on duty overnight, this client could not receive the support to ground themselves, resulting in them running away from the facility on multiple occasions. Another client with complex trauma and concurrent disorders often struggled to participate in programming during the evening as they would often dissociate and cry uncontrollably for hours. This client sought support during the night but was met with a night attendant who was not equipped to handle the situation.
In my experience, community-based non-profit programs often must resort to hiring young inexperienced staff due to budgets allocated for staffing positions, making it challenging to ensure experienced clinicians are on-site at all times, despite this being what our clients deserve. A CBC News poll reveals the reality of the substance abuse programs available in BC and how common it is for substance abuse programs to not have trained medical staff on-site. In addition, most of these programs do not support Opioid Agonist Therapy (OAT) which has been proven to be an effective harm approach in helping clients with managing cravings and withdrawal symptoms along with acting as a protective factor from overdosing if a client is to relapse after a period of sobriety.
Another client struggled with disordered eating and was discharged from the program because they could not meet the program's expectation of eating consistent meals. They were basically given a choice to either work on their disordered eating or substance use. With this client not being ready to address their eating practices, they ultimately returned home and did not get support with either. I have heard accounts from other clients who have had similar experiences where an attempt was made to access support for their mental health. Many have been deferred to a substance abuse program to address their substance abuse before the program would support them with their mental health. Then when they attempted to address their substance abuse, they were told they must resolve their mental health before dealing with their substance abuse.
Clients should not have to pick between their mental health and addiction, as they are often concurrent. Again, this is a failure on a systemic level as most facilities often only have the means to specialize in a specific area of concern as staff are not equipped with the skill set to effectively support clients with complex needs. This issue extends to those with varying cognitive, emotional, and social abilities.
Most programming is designed for neurotypical individuals and does not have inclusive or flexible programming to accommodate neurodivergent clients. Clients are generally expected to share and contribute to discussions if they are comfortable. While this can be beneficial, assuming every youth (ages 13-18) that comes into our facility is generally on the same level of reading and writing comprehension and emotional intellect. Over the past year, I've encountered many clients who struggle with the expectation of sitting for an hour, looking up at a whiteboard, receiving verbal and visual information, and writing notes while the staff facilitate a group.
One particular client I worked with struggled with literacy due to dropping out of school at a young age. Staff noticed that their comprehension skills were lower than their peers, and there were thoughts that perhaps they often pretended to know what everyone was talking about when that wasn't the case. Another client struggled to understand emotions; he struggled to understand that there are many levels of emotions and that there are other emotions than just "sad" and "happy." When kids are in group settings where they can catch on that they are not on the same level as their peers, their self-esteem is impacted. Not having flexible approaches to facilitate effective intervention and rehabilitation can make clients feel disconnected and misunderstood, making them less likely to express that they need extra support.
According to The Organization for Economic Co-operation and Development, 13.8% of Canadian Grade 10 students do not have the baseline reading skills needed to navigate themselves in western society. We know that people with addiction come from all walks of life. Still, it is worth mentioning that a disproportionate amount of people with addiction are marginalized. According to Frontier College, children in low socioeconomic communities are almost twice as likely to be behind in early development skills as high-socioeconomic status peers. Statistics Canada reports that "literacy skill level and household income are positively related." Failing to account for neurodivergent individuals by having preconceived expectations of the neurotypical brain function reinforces unrealistic expectations for people with varying cognitive abilities and complex behavioural struggles.
Another unrealistic expectation I often see at the live-in treatment facility is group living. Going through recovery is hard enough without learning how to live peacefully with multiple peers going through their own struggles. It is said that 1 in every 66 youth (ages 5 to 17) has Autism Spectrum Disorder. You don't have to have a disorder or developmental disability to imagine how difficult it could be living in a limited space with strangers but imagine a client with ASD having to adjust to a new living space when they have challenges with social skills, repetitive behaviours, speech, and nonverbal communication. This leads me to believe that to be able to maximize support for these types of clients, staff need to be trained in behavioural intervention. We cannot continue this mentality of "one-size-fits-all."
The implications of colonial values and perspectives are also significant in the ideas of what treatment is and failing to recognize different perspectives on healing and recovery. Most programs are founded on colonial perspectives that neglect to consider how their structures may affect those directly impacted by colonialism. For example, the 12-Step program was created out of Christian inspirations with the slogan "If you work it, it works," implying the indoctrinated idea that people who struggle with addiction are not trying hard enough if they are unable to abstain from using. While this model can be effective for many, it is not always a good fit and those searching for support in reclaiming their life from addiction.
Indigenous peoples are highly overrepresented in addiction treatment programs in Canada. However, there is still a lack of cultural intervention. Most Indigenous peoples spiritually heal and strengthen when immersed in their culture. So it is crucial to create space and resources for spiritual and cultural practices. Due to a lack of Indigenous representation within professional roles, Non-indigenous people attempt to facilitate cultural practices. This often leads to the overgeneralization and inaccuracy of Indigenous cultural practices. Religious-based programs indoctrinate colonial perspectives with a rigid approach to their definition of "wellness ."
This can erode the client's cultural identity, specifically when considering Indigenous peoples impacted disproportionately by colonialism's effects. Elder Jim Dumont of the National Native Addictions Partnership Foundation said, "Culture is the facilitator of spiritual expression. One's spirit desires to live life to the fullest. A connection to spirit is essential and primary to well-being. Cultural interventions are therefore essential to wellness."
A previous client of mine came all the way from a secluded Indigenous reservation to a city so that they could receive support for their recovery. This young person had expressed multiple times how difficult it was to adjust to the air quality, the food, and the constant noisiness. This youth also felt uncomfortable being surrounded and supervised by white staff. The program makes efforts to be culturally sensitive, though more could be consistently implemented. When this youth could smudge, drum, and do land-based activities, they expressed that it was spiritually healing. It can be extremely beneficial for these youth and clients of all ages to connect with Elders, medicine people, and liaisons to stay connected to or learn about their culture.
Noticing the gaps and barriers to service delivery has been both disheartening and inspiring as many clients overcome the significant obstacles that make accessing treatment difficult. It is important to reiterate that many issues related to accessing treatment come down to financial means for those attending and delivering addiction treatment programs. Much of the public believes substantial government funds are allocated to addiction services. In reality, programs and resources are actively being downsized and closing down as funders will deem them unnecessary, despite clients accessing their services up until the day these facilities close. The issues discussed in the blog are not exclusive to addiction treatment services. They are also relevant to accessing mental health care, medical care, and housing/shelter resources.
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