What’s going on inside Ontario’s private addiction rehab facilities?

By Iman Sheikh - Published on February 5, 2016
six people sitting in a circle sharing stories
Private addiction therapy lacks government regulation and has a murky accreditation process.

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The private addiction therapy industry in Canada has such little oversight that practically anyone can call themselves a specialist and charge thousands of dollars for unregulated treatment.

“Right now, if you were working as a librarian or a mechanic, you could open up a place and be an alcohol and drug counsellor,” says Tom Gabriel, former head of the Canadian Addiction Counsellors Certification Federation and a crisis and addiction counsellor for the Toronto Police Association.

Some enterprising Canadians have already seized this opportunity. Last summer, the OPP’s health fraud investigation unit  charged two individuals at an Addiction Canada treatment centre in Caledon with fraudulently calling themselves medical doctors. The employees, who were not licensed to practise medicine in the province, were charged with impersonation, fraud and for using the title of doctor.

Addiction Canada’s five facilities across Ontario and Alberta have also been subject to a number of negative allegations both in news reports and review sites in recent years.  Despite this, CEO and founder John Haines’ businesses are alive and well, and according to Addiction Canada director of operations Seth Fletcher, “the success rate is very good for people that come in. Recovery is only as good as the effort they put in.”

One Addiction Canada customer spent $20,000 on treatment for her son, who had a history of drug addiction and suicide attempts. She told CBC News last year that he was kicked out of the facility when staff suspected him of buying drugs, which led to him seeking refuge in a men’s shelter. The experience “added more frustration, more aggravation, more sadness,” she said at the time. Though he could not comment on this case, citing patient confidentiality, Fletcher says that the protocol when discharging someone is to inform as many family members as they can and give the family the opportunity to arrange some sort of transportation.

“Worst-case scenario, we will drive them to the nearest shelter,” he says. “Sometimes we’re caught between ‘We need to get this person off the property,’ but at the same time we never just kick somebody to the curb.”

A note posted to Addiction Canada’s website  describes the reviews the organization has received about its service and workplace as “illegal and slanderous postings.” It also says “being the largest treatment organization in Canada sometimes you become the target of many disgruntled and failed former clients.” Fletcher adds that a symptom of addiction is to “blame everything around you and not look at yourself.”

Receiving publicly funded treatment in Ontario typically involves time on a waitlist, and depending on the treatment, an assessment and referral. The referral service at the Centre for Addiction and Mental Health (CAMH) for Toronto residents, for example, is a two-step process that at its shortest takes three weeks to complete, and up to six months, depending on the time of year and the type of treatment sought.

In an email to TVO.org, Mark Nesbitt, a communications advisor at the Ministry of Health, responded to inquiries about wait times, saying that additional funding has increased the number of patients receiving treatment.

“The Ministry of Health and Long-Term Care provides over $200 million annually to approximately 170 organizations to provide addictions treatment programs such as community-based addictions counselling,” he says. “As part of Phase 2, the ministry is providing an additional $138 million, over three years, to support mental health and addictions agencies in the community.” He says the province has seen a 37 per cent increase in the number of new clients receiving community addiction treatment services since the new funding.

Nesbitt also says the ministry has no imminent plans to regulate addictions counselling services as a separate regulated health profession. Const. Bev Mackey of the OPP’s health fraud investigation unit, who worked on the earlier charges, says this is a problem.

“There’s a lack of government oversight in private facilities such as addictions treatment centres which needs to be addressed fast,” she says. “I would urge anyone to report to this detachment when they believe there’s criminal wrongdoing in an independent health facility.”

The lack of government regulation is complicated further by a murky accreditation process. Emblems for treatment facility websites claiming accreditation are not hard to come by. An organization called the World Accreditation Addiction Treatment Mark of Excellence sells seals to display online for a few hundred dollars a year, the completion of a 90-minute online course, and the declaration that the applicant is not funded by a pharma company. World Accreditation’s website boasts the lack of on-site visits as an advantage to its service, in addition to no costly accreditation fees, heavy fines or up to one-year wait time for approval. It is also the seal currently displayed on Addiction Canada’s website.

Gabriel describes the cottage industry of addiction treatment accreditation as “diploma mail.” Proper accreditation, he says, “is a process that takes months. [The accreditors] come in, they interview clients and referral sources, have a look at your financial books, screen the credentials of everyone that works there and examine board of directors.” Such accreditation is often valid for two to three years and can be costly.

To become certified with the Canadian Addiction Counsellors Certification Federation, for example, the federation requires the submission of credentials such as 4,000 hours of specifically related work experience within the past five years, and 270 documented hours of formal education at the college/university level in related knowledge and skill areas. Another body, the Canadian Council of Professional Certification, has a number of core requirements in addition to the equivalent of 4,000 hours of work experience providing direct, supervised counselling services, and at least 200 hours of education towards Certified Addiction Counsellor II, a designation program offered by the organization.

While waitlists for private facilities are much shorter, their financial costs can quickly outstrip affordability for those without access to funds. Former Toronto mayor Rob Ford  famously told reporters that his months-long stint in rehab at Muskoka’s Greenstone, a facility not yet accredited, could cost as much as $100,000.  

At Addiction Canada centres, Fletcher says some of the organization’s counsellors do have designation from the Canadian Council of Professional Certification, although it is not a requirement. “There’s no regulation that a counsellor needs to be certified,” he says. “What Addiction Canada is trying to do is set the precedent for certification and regulation. We’re currently in the process of getting our entire program accredited from Accreditation Canada, because we recognize that being a new industry there is very little regulation.”

Gabriel recommends a few guidelines for people seeking treatment. First, ministry-funded programs are subject to rigorous standards, so those are always a good choice. People can connect with these services by calling Ontario’s Drug and Alcohol Helpline, now known as Connex. They may refer over to the Metro Addiction Assessment Referral Service at CAMH for an evaluation. CAMH will then suggest an appropriate treatment facility if needed.

If the wait time for treatment is longer than the person seeking help wants and they can afford private treatment, Gabriel suggests taking a close look at the credentials of the staff in the facility before going ahead with the first few results that come up on a Google search. The staff should be a multidisciplinary team, including physicians, social workers and drug and alcohol counsellors.

“There are people who just decide one day that they want to be a counsellor and they don’t even have a Grade 12 education,” Gabriel says. “In private places, there’s no regulatory authority other than getting a business licence and insurance and opening up a place that’s zoned under the bylaws of the municipalities there. The public is uneducated and they’re at risk.”

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