Long-term Residential Treatment for Substance Use Disorder

The capacity of Manitoba’s long-term residential treatment programming for substance use disorder/addiction got a much-needed boost with the opening of the 50-bed Bruce Oake Recovery Centre in 2021. The program has had significant success, with 145 alumni so far, 92% of whom remain connected to the centre for support, and return on Wednesdays for continuing care and community.

Key to this success is having a goal-oriented program that addresses all dimensions of an individual. Treatment encompasses physical, psychological, social, spiritual, and cultural aspects of recovery. There is a strong focus on social determinants of health and wellness, including relationships to others; work and/or meaningful contribution to society; education; housing; finances; and justice involvement or legal issues.

Individuals work with a dedicated counsellor to assess where they are in each domain and what needs to be done to ensure stabilization in these areas to sustain wellness and recovery. “That’s the advantage of a four-month program,” says Greg Kyllo, Executive Director of the non-profit facility. “We can do foundational work with individuals while they are here.”

“We don’t replicate services that are in the community,” adds Kyllo. “We get you connected to those supports while you’re here so that when you transition out of the program you already have them in place and you are already using them.”

BY CHRISTINE HANLON

lished by the AFM in 2019 indicated an average wait time of 52 days for men and 206 days for women!

At Bruce Oake – a facility for male identified and non-binary clients only – there are more than 300 people on the waiting list. Time from initial intake to admission varies, as the centre uses an equity-based approach and prioritizes participants based on their level of vulnerability and other factors. Anyone seeking to explore the possibility of long-term residential treatment for SUD can call the Centre 24/7 at 431-996-6253 or 1-866-612-6253 (www.bruceoakerecovery.ca.)

One goal is to have everyone leave Bruce Oake with a family doctor and already having had their first appointment. From weeks 12 to 16, participants start working with an outreach coordinator in addition to their dedicated counsellor. The Outreach team continue to support Alumni intensively, through one-on-one weekly meetings and Alumni Association events over their first year.

“Even though our program is longer than most residential programs, 16 weeks is usually not long enough for you to go on living your life without support,” says Kyllo.

The bulk of residential treatment programs – run by the Addictions Foundation of Manitoba (AFM) for the Manitoba Government are only 21 to 28 days long.

“We know that when focusing on core social determinants of health, you need longer than a month to build that sustainability,” says Kyllo. “The cost to society of only investing in 21-28-day treatment is huge. Well over $90,000 a year is saved by someone being in recovery and in a place of wellness rather than using social, justice, and emergency room services. The social return on investment in long-term treatment is incredible. Investing in treatment with better health outcomes just makes good business sense.”

Costs to society are exacerbated by long waits for access to residential services, during which an individual’s condition related to substance use disorder (SUD) can deteriorate. Data pub-

“If you’re ready, we can start the intake process right there on the phone,” says Kyllo, adding that the intake number is also a ‘warm’ or support line that can provide information, brief intervention support, and resources, as needed. “We don’t assume Bruce Oake is necessarily going to be the solution for everyone at any given time.”

The intake call meets people where they are at, through a brief clinical assessment of an individual’s current condition and what support they may be looking for at that point in time. Staff encourage individuals to maintain daily contact with the Centre if they are able, and actively refer them for immediate support from other agencies while they are waiting to be admitted. Support is self-determined and will vary depending on individual needs.

Bruce Oake believes that personcentred care requires agencies and service providers to reduce barriers by working better together in our communities. This includes ensuring mental health and substance use health care provide integrated support to meet individuals and families where they are at. The Centre partners with the Canadian Mental Health Association (CMHA), and frequently refers callers to the CMHA service navigation hub (mbwpg.cmha.ca/ programs-services/snh).

“At Bruce Oake, we individualize everything,” adds Kyllo, noting there is no pre-determined discharge date for participants. “We will not discharge someone until they have a safe place to go.”

Unfortunately, there is a shortage of transitional or stage two housing (integrating ongoing supports) in Manitoba, and limited resources for individuals to access it. But then it should come as no surprise that resources are an issue in all parts of the treatment continuum for SUD. Bruce Oake receives no operational funding from the provincial government, although there is hope it will in the future.

Although attendance at Bruce Oake’s residential treatment program is not covered by Manitoba Health, no one is turned away for inability to pay. “Accessing care is not based on socio-economic status,” Kyllo emphasizes. The Centre works with every individual to recoup costs of treatment and remove any financial barriers. This can involve helping individuals apply for government funding programs, including Employment and Income Assistance (EIA). Currently the majority of treatment costs are covered through fundraising and generous donations by the Winnipeg Community.

While participation in AFM’s five 21 to 28-day residential treatment programs is covered by Manitoba Health, no long-term treatment program in the province receives such coverage (www.gov.mb.ca/mh/addictions/ agencies.html), including Tamarack Recovery Centre and the Behavioural Health Foundation (BHF). Both have long wait lists and face challenges related to funding a participant’s treatment.

Access to long-term residential treatment programs continues to be a challenge for those ready to seek help despite the $62 million the provincial government has invested in close to 50 initiatives to improve mental health and addictions services throughout Manitoba since October 2019. These include six Rapid Access to Addictions Medicine (RAAM) clinics, medical and community-based withdrawal management services, mobile withdrawal management services, opiate agonist treatment, short-term and long-term residential addictions treatment, after-care programming, supportive recovery housing and outreach.

Despite this investment, services still fall short of filling the need. Long waits between detox and residential treatment can place people with an SUD at greater risk of relapse, with potentially deadly consequences. Lower tolerance after a substance-free period translates into a higher suscep- tibility to overdose. Craving-blocking Opioid Agonist Treatment (OAT) can be a useful tool in these circumstances, but resource constraints can pose obstacles to those who want to access it.

During a recent visit to the RAAM clinic, Mary (not her real name) and her mother were turned away after waiting in line for 45 minutes outside in the cold. Of eight in line, only five were admitted and Mary was told some days it was only one or two.

Imagine how hard it is for someone with a SUD to will themselves to seek help in the first place. How many people don’t come back?

The RAAM clinic website makes this situation clear: “Services are provided on a first come, first served basis, with some prioritization based on urgency. The walk-in clinics fill up quickly, it is advised you arrive at registration time. If the clinic is full, you may be referred to other services in your community.” In Winnipeg, the clinic is open from 1-3 pm on Tuesdays, Wednesdays, and Fridays.

Yet RAAM clinics are keys points of access, providing a doctor specializing in addictions, a safe consumption space, education, brief counselling, OAT medications, and connections to intensive withdrawal addiction services and residential treatment, including programs in other jurisdictions. It’s a little-known fact that the Government of Manitoba will cover costs of long-term treatment out-ofprovince to facilities such as Guelph, Ontario’s Homewood Health Centre.

Bruce Oake’s treatment program utilizes the same person-centred approach as Homewood and other leaders in the field. Underlying this approach is the program’s commitment to supporting participants in the development of hope, belonging, purpose, and meaning – core principles from the First Nations Mental Wellness Continuum Framework (thunderbirdpf.org/fnmwc/). Treatment at Bruce Oake combines the western medical model with an Indigenous traditional approach. Programming can be individualized to incorporate Indigenous cultural practices, including ceremonies in the sweat lodge onsite.

Cultural reclamation can be an important aspect of healing and building a sense of purpose and belonging that helps heal the trauma and shame experienced by so many struggling with SUD.

Not surprisingly, research identifies unconditional positive regard, empathy, and genuineness as key factors in a therapeutic relationship with someone experiencing a SUD.

At Bruce Oake, culturally diverse staff have a combination of training, credentials, accreditation, and lived experience. “Several members of our team are hired based on their thriving in their own recovery,” explains Kyllo, a registered social worker in long-term recovery for over 16 years. “If you can model the ability to live on a day-today basis with a SUD, you have the unique ability to support others on that same journey. There’s a level of empathy there that you can’t have if you haven’t experienced those same emotions. You ‘get it’ and that translates when you’re helping someone.”

Much of the program is groupbased, encouraging members to become part of a community. “We know that connection to peers and working in a group environment helps gets us out of isolation,” says Kyllo, pointing to peer support as an evidence-based practice. “We know that connection is part of the solution of treating SUD and addiction.” Social learning is key and connecting to peers with shared lived experience can begin to build trust and support for one another. Alumni of the Bruce Oake Recovery Centre meet on a weekly basis and are encouraged to build a peer support community.

“It’s working,” says Kyllo. “There are different paths for everyone. We’re not going to be the right path for 100% of people, but I’d say that for 80% of those who are struggling with an SUD/addiction, we can be a helpful part of their journey.”

However, the help Bruce Oake provides is only available to 50% of the population, one reason why the Centre works with and financially supports Tamarack Recovery, which has some gender-specific programming for women. “Recovery outcomes in residential settings are proven to be better in gender-specific programs,” acknowledges Kyllo. For now, opening a separate version of the Bruce Oake Recovery Centre for female-identifying participants is still only an aspirational goal.

In Manitoba, there continues to be a striking disparity between SUD services, including long-term treatment, for women compared to men. For the sake of our daughters, sisters, nieces, and mothers, we must hold the government accountable for moving forward on this issue, not tomorrow, but now!