It's very similar to what we've heard elsewhere, where there isn't adequate capacity with regard to accessing detox.
Keep in mind that detox is not treatment; detox is simply the first step. Locally, people have to keep phoning until there's a detox bed available, so they need access to a telephone, and they need to have the persistence and the perseverance to keep on calling until a bed becomes available. For somebody who's struggling with a substance use disorder, if they're craving or they're in withdrawal, they're only going to be doing that for a certain period of time before they go back out and self-medicate, if you will. They'll continue to use to avoid withdrawal.
I think that we set people up by not having a system of care that's evidence based and has continuity from outreach and engagement through various harm reduction strategies when they're prepared, when they want to move on to detox and have a transition there. The gap between detox and different treatment models is variable. In some instances, if people have stable housing, they might be able to go to a day program, and they don't have to go into residential treatment. But by and large with the folks we're talking about today, the psychosocial instability is such that residential treatment is usually preferred. Until their minds are more settled, it's very hard for them to engage in counselling, in the psycho-educational groups, and the intensity of just being present, not to mention some challenges with perhaps literacy skills and the pedagogy of how these things are taught within treatment centres, the ideology.
A host of things may not speak to a person. If the treatment centre is modelled on alcohol, that's not going to resonate with people who are smoking or injecting. They don't see the commonality to it. We need to be very mindful of this and be culturally appropriate, gender appropriate and so on. That sometimes is where supportive housing between detox and treatment can be helpful to help them to further stabilize so that they can engage when they go to a treatment centre. Following treatment, what's a 28-day period for brain rehab? Nowhere near long enough, and some treatment centres will go three months or six months.
I think it has to be client specific, particularly if there's a concurrent mental health problem, trauma or just layers of other issues that need to be addressed until people can get stable enough to get back out into the community and function on a day-by-day basis. This takes time, and that's not how we have provided services. As I mentioned, it's episodic acute care, nowhere near what we need.
In the DSM-5, the psychiatric manual, three months of non-use is early remission. Twelve months of non-use is sustained remission. We don't stop cancer treatment before they even get into early remission, and yet that's all we offer people with addiction. We're not offering them enough, long enough, appropriately client-centred treatment in order to achieve the success we could achieve if we did, and we blame these individuals because they're not able to get better. We don't provide them with a coherent, evidence-based system of care.