Alberta Chooses Religion over Lives in Drug Treatment

On March 12, fierce drug policy author and journalist Maia Szalavitz published a stinging indictment of the Christian domination of addiction treatment across the United States. Her New York Times piece describes the 12-Step addiction recovery model, which she asserts helped her become abstinent in the early ’90s.

She then asks why this Christianized approach consumes such a large slice of the funding pie.

I was recently provided a list of every detox, short-term and long-term residential facility across Alberta that details each facility’s approach and offerings, maintained by senior staff at Alberta Health Services’ mental health and addictions department, to help clinicians make informed referrals for people seeking help.

From this document, I calculated the proportions of various treatment modalities, including abstinence requirements, Christian approaches and the use of 12-Step programs.

With four people in Alberta dead each day from unregulated drugs that abstinence strategies do little to address, the data are shocking.

It's important to note that I am not against any voluntary coping strategy, even if it lacks evidence: people should be allowed any approach they feel will do something positive, whether it’s a shopping habit or crystal meth (the latter of which, in oral form, is both available and an evidence-based option for treating ADHD).

Szalivitz offered the same approach on Twitter. “If you are going to comment on my article, please read it carefully. I am not saying that some people don't benefit from AA; I'm not saying AA is bad; I'm not saying atheists can't benefit. I'm saying it shouldn't be paid for via rehab or mandated as the only way to recover.”

What should be publicly funded is a different story entirely. Public dollars should be limited to evidence-based treatments and pilot testing. In the press release explaining our protest of the Alberta Recovery Conference in February, we pulled definitions of recovery and treatment from the master’s thesis of Kat Hedges, the strategic communications co-ordinator of the Alberta Alliance Who Educate and Advocate Responsibly, or AAWEAR, a group created “by and for people who use drugs in Alberta.”

“‘Recovery’ is a non-linear, socially constructed practice, and success is contingent on an individual’s goals related to drug use. ‘Treatment’ is an evidence-based medical practice that insists on verifiable, objective medical outcomes, evaluation, accountability and voluntary consent,” Hedges wrote.

Unfortunately, 12-Step abstinence-based approaches do not make the grade for treatment, particularly as the extremely high rate of drug use resumption following current treatment modalities spells death for countless people.

And we still don’t have basic evaluation data for Alberta’s “recovery-oriented” system of care, as detailed in Albertans for Ethical Substance Use Policy’s June 2022 open letter, so it’s impossible to say what is even working.

Formats of care

The Alberta Health Services document categorizes facilities into five groups for substance use care:

• Withdrawal management/detox
• Intensive adult concurrent disorders treatment
• Intensive adult substance use treatment
• Indigenous/National Native Alcohol and Drug Abuse Program substance use treatment
• Supported/transitional recovery

We’ll focus on supported/transitional recovery, which represents both the clearest delineation of government ideology and the area of greatest provincial investment. Among these facilities are the “therapeutic communities,” including the Red Deer Dream Centre that accepted its first clients in November.

Spaces and beds

The AHS document counts the beds at each of the 25 facilities across Alberta. These range from four at Grandmother Turtle House to 163 at Oxford House. No bed count is provided for Calgary Dream Centre. The total is 571, with a quarter operated by the non-profit Oxford House. Its executive director, Earl Thiessen, is a vocal supporter of the United Conservative Party abstinence-only policy measures.

Typically, we’d be more interested in spaces. How many people can use a bed over a given year based on average length of stay? Since length of stay varies from a few months to indefinite with supported/transitional recovery, we get a better look at the overall picture by focusing on beds.

The Alberta Model is a Christian abstinence model

In her New York Times piece, Szalavitz outlines the 12 Steps:

Delving into the content of the steps is required to understand how religious they are. The first three include admitting “powerlessness” over substance use and turning “our will and our lives” over to the care of a higher power to “restore us to sanity.” While some members argue that this power can be anything other than oneself — even a doorknob — it’s hard to see this as anything other than a stand-in for a loving God.

The rest of the steps include taking “moral inventory,” uncovering “defects of character” that are thought to underlie addiction and praying for God to “remove” them. Many meetings close with the Lord’s Prayer. Such clearly religious practices would not be accepted as medical or psychological treatment for any other condition.

To put it bluntly: 12-Step programs are Christian. They are also explicitly abstinence-based.

According to the AHS document, at least 47 per cent of the beds are in facilities describing themselves as Christian or “faith-based.”

Meanwhile, the 12 Steps are used in facilities representing 77 per cent of the total beds, and abstinence is the focus of facilities representing 94 per cent of beds. So much for harm reduction in Alberta.

This is problematic. As Szalavitz puts it: “To make real progress in fighting overdose and addiction, we need to separate medical care and religion in treatment, as we do for every other health disorder.”

And given that 12-Step groups are freely available and ubiquitous, why are we funding this modality with public dollars?

Meanwhile, several facilities occupying nearly 20 per cent of the total beds employ the Genesis Process, which reads like religious indoctrination. Why are taxpayers funding facilities to educate people on a “biblical understanding of what causes their self-destruction”?

A suspicious mind might wonder if our institutions are working to drive people into Christianity at their most vulnerable.

Breaking loose

I recently broke down several recent UCP overtures toward forced abstinence. We are entering a precipitous moment and it seems our institutions are fine to go along for the ride. It could take several forms, but many workers are already forced into abstinence by unwitting or uncaring workplaces. (A free evidence-based workplace substance use policy is available here.)

Szalavitz explains an American legal precedent setting out the unconstitutionality of forcing workers into 12-Step programs for addiction because of their inherent religiosity.

I am aware of only one sector in one Canadian province that has been forced down this road, after Byron Wood and maverick labour lawyer Jonathan Chapnick won their case against Vancouver Coastal Health over being forced into a 12-Step program.

I know people who are happy and healthy after participating in 12-Step abstinence. For the most part, they shed the less useful stuff and hold onto what worked for them — as Szalavitz puts it, the active ingredient in their success is peer support, not the steps themselves, because secular groups seem to be similarly useful.

But for every story like that, how many are dead? We have no idea, because we have no data.