Reprinted from "Concurrent Disorders" issue of Visions Journal, 2004, 2 (1), p. 12
Programs and services must adjust to reflect changing client demographics, public policy, emerging research, and fiscal realities. My ex perience in the public service is that all program areas can undergo subtle or significant change at any given time. Alcohol and Drug Services (A&D) is one of those programs that stands out as having undergone significant organizational and service delivery transformation since its inception.
In the 1950s, science and academic knowledge of addictions was rudimentary. The then-fledgling Addiction Foundation of BC opened an outpatient treatment centre in Vancouver and shortly after, the Narcotics Addiction Foundation was incorporated. Alcoholism and drug addiction were viewed as two separate streams of concern requiring two separate approaches. The methodology of treatment was primarily based on the self-help model most familiarly associated with Alcoholics Anonymous.
As research demonstrated a need to establish one system to provide all substance abuse services, in 1973 the government of the day proclaimed the Alcohol and Drug Commission Act to establish a commission that was to assume responsibility for all services. While pro background viding addiction services to the general population, the criminal impact and influence of addiction was a dominant focus of the commission’s energies. One mainstay of the commission was its implementation of the methadone program and compulsory treatment for heroin users under the Heroin Treatment Act. The act enabled the detention of users in the province’s heroin treatment cent.
Following a repeal of the Heroin Treatment Act in 1982 the government realigned addiction services to broaden its health focus. The Alcohol and Drug Commission was disbanded, and the services were relocated under the Ministry of Health within a new division called Alcohol and Drug Programs (ADP). The following years were a period of limited growth but resulted in the development of significant program expertise and knowledge.
In 1987, the province received the Jansen Report on liquor policies for British Columbia and the Ryan Report on alcohol and drug abuse in the workplace. Both recommended significant increases in funding for addiction services. Also in 1987, the Sullivan Commission on Education recommended the inclusion of a comprehensive school health program to include alcohol and drug use information within the curriculum. That year’s budget speech verified the need for additional funding and stressed the need for better coordination of all the programs related to substance abuse.
As a result, the coordination of services and policy development was designated to the Ministry of Labour, as opposed to having it spread through a number of different ministries. Sixty million dollars in new funding was added for new program areas and for the first time in BC, prevention services. Funds were distributed to the Ministry of Education for school-based programs and the Ministry of Health to strengthen parenting programs. ADP was moved from the Ministry of Health to the Ministry of Labor and Consumer Services. The funding and restructuring was presented in the form of a three-year, province-wide T.R.Y. (The Responsibility is Yours) campaign.
In 1991, the Royal Commission on Health Care (the Seaton Report) made recommendations on sweeping changes to the delivery of health care in BC. While the report suggested establishing an independent commission to govern addictions services, the government determined that the services needed to be realigned and better integrated with health services and therefore moved them to the Ministry of Health in 1992. A great 2. A greater focus on facilitating linkages between the community-based prevention services was made.
In November 1995, the report on the Gove Inquiry into Child Protection was presented to government. The author’s recommendations were primarily intended to address child protection issues arising out of the tragic death of Matthew Vaudreuil; however, many of the recommendations were designed to make fundamental change to improve the quality of life of children in British Columbia, not simply from a child protection viewpoint. One of the suggested changes was to integrate all community services that were seen to be fractured. Alcohol and Drug Services was seen as an integral part of the community service delivery systems and was moved with 35 other program areas from across five separate ministries into a newly-formed Ministry of Children and Families (now known as the Ministry for Children and Family Development). Judge Gove reasoned that “professionals working together on a daily basis to meet the needs of their clients would not owe allegiance to a variety of authorities that may or may not share common values and priorities.
In the later part of 1990s, the Vancouver Downtown Eastside drug use problems, the interest in a four-pillar approach (prevention, harm reduction, treatment and enforcement), and the complexities in the successful treatment of the dually-diagnosed or concurrent disorders client caused a review of the alignment of addictions services. In 2002, Alcohol and Drug Services was moved to the Ministry of Health Services and Health Planning, where the policy responsibilities for treatment were integrated with Mental Health into a Mental Health and Addictions Division. Policy direction for prevention was aligned with the Population Health Division. As health services are delivered on behalf of the Ministry of Health by five regional health authorities, alcohol and drug prevention and treatment program delivery was transferred under their responsibility. All of the health authorities have developed close linkages between their mental health and alcohol and drug services. Many have developed a fully-integrated model of service delivery.
Managing the A&D portfolio is complex and never easy. There are many passionate viewpoints as to the causal factors of addiction, how it can be treated or prevented, the adequacy of resources, where the resources should be allocated and who should or should not manage the service delivery system. It is a subject area where almost everyone has experienced some impact in their lives and where everyone has an opinion. It is because of this that alcohol and drug services will always encounter tensions or a ‘push-pull’ in its service delivery focus and its organizational structure. What is clear in my experience is that where a service is valued and relevant to the community it serves, it will sustain organizational change.
About the Author
Ron is Director of Special Projects for Health Protection Planning in the Ministry of Health Services