1. The importance and the need for drugaddiction treatment in QubecFinal Report

2. Description of Portage and its Service Offering.1. 3. Portage: Close to forty years of experience in drug addiction rehabilitation in Qubec Founded in Prvost, Qubec, 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 Qubec: the Greater Montral Area, Qubec City, Saint- Malachie, Beaconsfield, and PrvostServices provided Portages mission Accreditation Assessment/orientationPortage fosters the strengths and skills of Portage is accredited by Accreditation Non-residential drug addictionsubstance-dependent persons to enable Canada, which recognises the continuousrehabilitationthem, through comprehensive and cost- improvement of the quality of services ateffective interventions based on thePortage, the skills of its employees, and Residential drug addiction rehabilitationtherapeutic 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 support19731975 1983 198619891991199519961999 20012002 20072009 Launch of the Mother and Opening of the Opening of a Implementation of a Child residential Inauguration of the head office in Day Centre inresidential rehabilitationrehabilitation program, a firstMovement for Integration Montral and Day Qubec Cityprogram for adolescents of its kind in Canada, at theand Retention in Centrewith substance abusecentre in Prvost, near lacEmployment (MIRE) issues at the centre in cho program in Montral Prvost, near lac cho Inauguration of the Opening of a Portage Employment Opening of a residentialresidentialReintegration Centre rehabilitation centre for Inauguration of arehabilitation in Qubec City adolescents in Saint-Damien-de- Relocation of thecentre for adults Buckland new Portage Implementation of theadolescent facilityin Prvost, near centre in Montral Launch of a day treatment program for Implementation of a for the MICA and in Saint-Damien-lac chotreatment and family de-Buckland toMentally Ill Chemical Abusersresidential rehabilitationMother and Childservices centre in(MICA) at the centre inprogram for English-speakingSaint-Malachie programsMontralPrvost, near lac cho adolescents in Beaconsfield,Source: Portage .2. 4. A distinctive therapeutic approach The rehabilitation process at Portage is based on the therapeutic community, positive psychology, andindividual case management. The goal of Portages treatment approach is to help clients build on theirstrengths and acquire the skills they need for rehabilitation. The rehabilitation process at Portage is personalised in terms of both duration and content, which makes itunique in Qubec. The programs duration is established based on each clients needs, motivation, andwillingness to be treated.Part 1 of treatment Part 2 of treatmentFocus on the development of interpersonal Focus on the development of communityrelations, self-understanding, trust, and dignity.responsibilities to prepare clients for reintegrationClients 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 safetyabuse the coordination of community activitiesPost-treatment processPortages 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 theMIRE program Supervised apartments for clients at the Mother and Child program for up to two years after completing the residential programSource: Portage.3. 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 ProgramDuration based on the needs of the individual, 6 months on averageAdultProgram (Prvost)Adolescent Program (Montral, Prvost, Saint-Malachie)Program offered since 1973 For adolescents, 14 years of age or olderFor adults, 18 years of age or older Residents live in a supportive, enriched, and structured settingResidents 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 therapysessionsCapacity: 70 clients They have access to Portage AcademyCapacity: 104 clientsMother and Child ProgramMentally 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 6problems (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 ain particular by opening a similar program for women nearby elementary school.Capacity: 20 clientsCapacity: 25 mothers, 25 childrenPortage Qubec City Day CentreMIRE The Portage-Qubec 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. 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 organisations administration Every year, the Board of Governors must elect a Board of Directors composed of 25 members In 2010, the organisations 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 Foundationother revenuesThe organisation has a foundation, which holdsPortages 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 PortageFoundation has raised over 25 million dollars tofund Portages various programs 8,264 Funding activities: Fundraising (74%) campaigns, recognition galas, golf Governmenttournaments, unsolicited donations programs: (online, by telephone, In Memoriam, The ministre de la Sant et desspontaneous donations, donations ofServices sociaux (78%), the ministre de la Scurit publique goods and services)and the Direction rgionale des services correctionnelsSource: Portage .5. 7. High success rate for long-term treatment Portrait of Portages clientele Portage achieves high abstinence rates in adolescents and adultsin %, 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 treatmentremain abstinent after 14.5 months9% 6% 70% of adults who complete 211 days or more of treatment reamin after25 to 3916 months23% Most of Portages 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 Prvost,Program and to whom support and specific services are provided near lac cho in %, January 2003 to October 2008, various durations of treatmentADOLESCENTS ADULTS Average age: 16 Average age: 3080%76%69% 70% 66%In 2009, close to58% 2,000 drug addicts55% 58% 55% 50% 53% 45% used Portages37% services 32%(approximately 50% at a residential facility and 50% at external programs) 1560 days 61180 days 181+ days130 days31120 days 121210 days 211+ days 7.5 months after treatment14.5 months after treatment8.5 months after treatment 16 months after treatmentSource: Portage.6. 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) ProgramsIn 2010-2011, the Adolescent Program is only being used at three-quarters 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%, respectivelyFor the current year, the MICA Program is running at full capacity, while the Mother and Child Program is at 90% capacityEvolution of Admission Rates for each Portage Program07-08 to 10-11; in % of capacity per programCAGR* -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 ProgramMentally Ill ChemicalMother and ChildAbusers ProgramProgram 07-08 08-09 09-1010-11***CAGR: Compound annual growth rateSource: Portage **Year to date.7. 9. The Evolution of Drug Addictionand Description of Needs.8. 10. Illegal drug use in decline in Qubec, yet one of thehighest rates in Canada Generally speaking, illegal drug use is in slight decline in Qubec and in Canada Between 2004 and 2009, illegal drug and cannabis use in Qubec has fallen by 8% In Canada, the decrease illegal drug use is even greater, but less pronounced when including cannabis Nevertheless, Qubec 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% Qubec ranks 2nd/10Use of one of the five followingprovinces in terms of illegal drugs: crack/cocaine,proportion of the population speed, ecstasy, hallucinogenshaving used one of the five and heroin Quebec-8%illegal drugs listed, behind British Columbia 20042009 Qubec ranks 3rd/10Canada-5%provinces in terms ofUse of one of the six followingproportion of the populationsoft 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. Many illegal drugs are used more in Qubec than inthe rest of Canada Crack/cocaine and amphetamines are used more in Qubec than they are in the rest of Canada The greatest differences between Canada, as a whole, and Qubec are in the use ofamphetamines (+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%CannabisCrack/Amphe-Metham- Halluci- Ecstasy SalviaAll cocainetaminesphetamines nogensdrugsSource: Health Canada, Canadian Alcohol and Drug Use Monitoring Survey. 10 . 12. A noteworthy phenomenon: Steady rise in the use oflegal drugs In North America, there is a marked increase in the use of legal drugs (542% increase between 1992 and 2005 inConsumption rates for Vicodin and Oxycontin for non-medical purposes number of American teenagers using prescription drugs to in high schools2010; United States, used at least once during the year almost 10% in 2005). In 2009, 16 million Americans aged 12 and older had used GradeVicodin Oxycontin an analgesic, tranquiliser, stimulant, or sedative for non- medical purposes at least once in the year leading up to8th grade2.7%2.1% the survey10th 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 (powerfulanalgesic 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 Qubec: 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 Qubec 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 sant (UQAM). 11 . 13. Are drug problems in Qubec more frequent todaythan they were ten years ago? A strong majority of people (92%) believe that substance abuse problems have either held steady orworsened in the past ten years Access to illegal substances seems easier today95% of people believe that it is easy for young peopleto 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%MoreAsLess DNK*Very easy EasyDifficult Very difficultDNK*frequent frequent frequentSource: Lger Marketing *DNK = do not know . 12 . 14. Eight out of ten Quebecers feel that drug andalcohol addiction are serious problems According to a survey done by Lger 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 problematicAssessment of the importance attributed to addiction issues by Quebecers2010, drugs and alcohol, n=1,000DRUGSALCOHOL 3%4%15% 15% 36% 39%43% 45% Very important Not very important Somewhat important Not importantSource: Lger Marketing . 13 . 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 (Dub 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 lightThe DEP-ADO code ranks the levelExcessive 16% 16% 68%100% Red lightof addiction of high school students alcoholaccording to three degrees ofseriousness: green, yellow, and red.Excessive- repetitive 34%27% 39%100%A person deemed to be in the greenalcohol light category has no consumptionproblem (in the sense that noCannabis 22% 22% 56%100%specific intervention or treatment is required).However, it is recommended that Amphetamines52% 27%21% 100%people in the yellow and particularly the red light categories seektreatment Cocaine 65%18% 17% 100% This approach does not take addiction to multiple substances into accountSource: Institut de la statistique du Qubec, 2007 . 14 . 16. Cases processed per Access Mechanism, MontralThe Access Mechanism in Montral opened 503 case files, of which 350 were processed in thepast year, of which only 82 were assigned to rehabilitation centres Structure of the Access Mechanism for Drug Addiction in Montral 2009, for Francophones under 18 years of age Case files opened Nb. of internal referralsNo. No.PartnersCentresopenedreferredYouth centre135 Grand Chemin18Friends and family59Pavillon du Nouveau Point de Vue36Self-referral 35Portage 20Educational institution 51CDC-IUD Radaptation interne Jeunesse8Access Mechanism partners 11CSSSs 27Hospital centre 12Community organisation12Other establishments (police, RDC, etc.) 8Total case files opened 350Total 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 Montral 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. Economic and Social Impactof Drug Addiction in Qubec. 16 . 18. Drug Addiction: Significant costs for the province In 2002, the costs of illegal substance abuse represented over $1.6 billion for the province, representing0.6% of the GDP This impact is calculated based on five elements: health care, law enforcement, prevention/research, lossof productivity, and other direct costsDirect health care Morbiditycosts: 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 drugsDirect law Police servicesenforcement costs Courts Correctional service (including probation)Direct prevention and Researchresearch costs Prevention programs Salaries and operating fundsOther 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 compensationIndirect costs: loss of Long-term disabilityproductivity Short-term disability (days of bed rest)Ontario QuebecBritish Alberta Short-term disability (days of reduced activity) Columbia Early deathSource: Canadian Centre on Substance Abuse . 17 . 19. Significant costs associated with loss ofproductivity, 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 %, Canada2002, in %, CanadaPrescription drugs Morbidityhospitalisation Direct costs: for short-term care law enforcement 28.3%Visits tofamily physician4.3% Outpatient care:medical fees 2.0%Indirect costs:loss of productivity Specialised non-residential treatment1.0% Direct costs: 1.0%0.2% health careSpecialised residential treatment31.0% Morbidityhospitalisationfor psychiatric care Direct costs:Other direct costs prevention and research Estimated health care costsTotal costs of illegal drugs inassociated with illegal drugs inQubec:Qubec:$1.627 M$225 MSource: Canadian Centre on Substance Abuse . 18 . 20. Portages contribution to Qubecseconomic and social welfare . 19 . 21. Understanding the social, human, and economic impacts of Portages services In 2009, approximately 2,000 people used Portages services in Qubec The success rate is around 70% on average for the programs as a whole In 2009, Portages activities therefore contributed to the rehabilitation and reintegration of around 1,400 drug addicts in Qubec 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 Portages 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,) Portages 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 toreceive treatment another centre. With a 70% success rate at Portage, this corresponds to 1,050fewer people reintegrated in society every year without Portages services This drop in the number of people reintegrated into society would have a $34 M impact interms of additional costs for the province every year, and additional direct costs of $4.7 Min health careTen-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], Fdration qubcoise des centres de radaptation 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 .