addiction services exist in quebec. why don’t more front-line workers know about them?

when françois decided to enter drug addiction treatment when he was living on the street in montreal five years ago, the biggest obstacle wasn’t the over one-hour trek by métro and two buses to reach the rehab centre he had chosen north of the island, he says.the hardest part to access treatment was finding out about the rehab centre in the first place. “it was word of mouth on the street,” françois, who asked that his last name not be used to protect his privacy, said of the vilavi centre in terrebonne. he ended up completing a six-month program there at no cost to him. he remains clean, he says, and has a permanent roof again.despite speaking to clsc workers about wanting to get into treatment, françois said it was another unhoused person who recommended vilavi for its single rooms and non-confrontational approach.“when you’re in shelters, you meet a lot of people who’ve tried therapy in different places,” françois said. it was the other unhoused person who also informed him that inpatient rehab is free for welfare recipients.the directors of rehab centres say that françois’s trajectory is a familiar story. word of mouth and internet searches are the most common ways that montrealers gain access to treatment for substance abuse, they say, and it's time to educate workers in the health, social services and education fields.“professionals don’t know what services are available and if they’re free of charge,” said geneviève lefebvre, president and ceo of portage, a bilingual inpatient and outpatient treatment centre that is fully funded by the province and free to participants.occasionally, a doctor with personal knowledge of a treatment option will pass information along, she said. but often it’s the individual or a family member who will discover a residential treatment centre through a web search, lefebvre said. she has worked for different organizations in the addiction field for 33 years.“how is a loved one now coordinating services for someone with a substance abuse problem when we have so many professionals in the system?” she asked. vilavi executive director bruno ferrari concurs, saying that many individuals are left alone to research rehab centres, figure out which one might suit them and apply directly for admission. “they search, and if they don’t find, they give up,” he said. in june, portage submitted a brief to the quebec government that pleads for the province to institute mandatory training for front-line workers in the health, social service and education networks — including clscs, the 811 info-santé phone line, schools and hospitals — on what addiction services are available to people of different ages and in different situations, and how to access them.the brief also pleads for mandatory training for front-line workers to use validated screening tools that are available across quebec to detect substance abuse problems. they're basically a list of questions.“we believe that if the whole quebec system — all the professionals in quebec — had at least 10 or 15 hours of training on that, that could help with early intervention and help people be assessed quicker and referred quicker without their situation deteriorating,” lefebvre said.as examples, hospital emergency department staff and 811 nurses could systematically use the short version of the screening test to detect whether a person seeking medical help may have an underlying substance use problem, she said. the portage brief was presented to a government public consultation as quebec prepares to update its action plans for mental health, homelessness and addiction. portage, which has operated for 53 years, conducted focus groups with clients to develop the recommendations in its brief, lefebvre said. “they were all saying the same thing: front-line workers don’t know about the services,” she said.some people were even directed to treatment places where they would have had to pay thousands of dollars when free treatment was available, lefebvre said. the workers didn't know the criteria to access free service.one adolescent in the focus group said her school's professionals met with her about her behavioural problems, but no one addressed her addiction, lefebvre said. “she said, ‘they knew i was using, but they never asked the question.’”one man said he was in a hospital for his third overdose and was never asked about his drug use, what he was using or how often, lefebvre said. he was only handed a sheet listing addiction treatment centres when he was discharged, she said.portage offers services to youth, adults, mothers with children — who are offered subsidized daycare — pregnant women and people with a substance use disorder and concurrent mental health disorder.“when they come to us, it’s like one minute to midnight," lefebvre said of clients, who have lost family, homes, jobs and friends before finding portage. joël tremblay, a psychologist and one of the researchers who helped develop and then update quebec's addiction screening tools over the last 25 years, contends the impediment to wider screening and referral is a lack of public funding for addiction, which in turn is likely due to stigma about the disease. "people never forget about cancer or heart disease, but addiction is always at risk of being forgotten," tremblay, a member of recherche et intervention sur les substances psychoactives québec (risq), the research team that developed the addiction screening tests in french and in english and for adolescents and adults. he was director until this past april."the tools are there," he said."but of course there is a huge rotation of professionals and we always have to ... release the information about the tools again and again."while one administrative health region of quebec may actively use the screening tools, others use them infrequently, tremblay, a professor in the department of psychoeducation and social work at université du québec à trois-rivières, said. "and sometimes in the same region, you have a few years where there are very active clinicians referring people to services. and then they have a new director, a high rotation of people, a crisis, and suddenly they forget about addiction."it's estimated that one in 25 quebecers has an addiction problem, but addiction receives about half a per cent of the provincial health-care budget, he said."the budget is so thin and the problem is so big," tremblay said."if we start to systematically screen people, we will not be able to offer them all services."but, he added, "that's like not screening for cancer because we wouldn't have the resources to help people."lgyulai@postmedia.com