Normalizing relapse and supportive housing: B.C.’s drug recovery spectrum evolves

How to approach the toxic drug crisis is the matter of much debate – but most agree more help needs to be available for those who want it.

British Columbia is phasing out antiquated drug treatment and recovery concepts, and modernizing the response spectrum to include the acceptance relapse is all but certain and supportive housing is required for some patients.

It comes after the scientific and medical communities, along with those with lived experience, provided evidence that traditional ideas of “zero tolerance” after treatment were ineffective – and could actually do considerable harm.

Supportive housing in B.C. is often run by third-party non-profit organizations overseen and funded by the province to subsidize the rent of recovering residents, while providing programming on everything from group counselling to art programs to meals. Many applicants for those rooms were homeless when they went into treatment.

“Recovery does not end when you were discharged from a treatment program that is the most vulnerable place and time for many people,” explained Keir MacDonald, CEO of housing provider Coast Mental Health. “(Housing and wraparound services) really are such a vital step that really can help either set them off in a continued strong trajectory or unfortunately, reverse many of the progress.”

Emily Grant, the program manager for the organization’s Pacific Coast Apartments in downtown Vancouver, says while some require intense support, others cook their own meals in their kitchenette and keep to themselves while going back to school or finding work.

“We’re here really to help support our tenants with their day-to-day and their goals, and that could be anything from appointment reminders to someone’s goal to get back into the workforce,” she explained. “When you have your own place and a door that locks, you have that safety, you have that sense of belonging, and it really allows you to take that stable foundation and move forward.”

Relapse now expected

When CTV News asked MacDonald if there was a zero-tolerance policy for drug use by residents, he responded that there’s been an evolution in the understanding of addiction and that they now prefer to identify triggers and try to figure out why the resident returned to drugs.

“We have had to evolve and recognize that, you know, the substance use disorder is a chronically relapsing condition,” he said. “It shouldn’t mean a loss of your housing or a loss of your community. And I hope that’s a lesson many of us have learned.”

Typically, in-patient drug treatment programs can last from 30 to 90 days. The next phase can be fraught, even for those with resources and families to return to because they’re re-entering the same environment or lifestyle they were in during their drug use.

Vancouver Coastal Health’s executive director for Substance Use and Priority Populations explained that the public rehab system now recognizes that not only are relapses typical, they can be a deadly stumble in the face of the toxic and unpredictable illicit drug supply.

“We absolutely are building the system so that people are welcome to come back really as many times as it takes,” said Miranda Compton. “For folks who are encountering those twists and turns and setbacks on their wellness journey that it can be fatal.”

The complexities of recovery

Guy Felicella has recognizable face in British Columbia for his harm reduction advocacy and education efforts in the educational and corporate spaces. He uses his personal story of recovery from crime and street homelessness on the Downtown Eastside as a cautionary tale.

“The simplification of saying, ‘Hey, go to treatment, that’ll change everything,’ (is frustrating),” he said. “I got off drugs all the time, but what I couldn’t get over was how I viewed myself as a person and I needed some clinical counseling to get over that.”

Felicella’s doctor was renowned addiction physician Gabor Maté, who worked with him to be able to start living the life he wanted. He’s now married with three children and is urging business owners to offer jobs to recovering drug users, while encouraging Joe and Jane Public to be supportive of people when they stumble in their recovery.

“There’s a tremendous amount of shame that comes with that,” he said. “We don’t need to be beating up on people when they’re already beating up on themselves.”

This is the fifth installment in a five-part series exploring British Columbia’s response to addiction and toxic drugs, as well as factors contributing to the crisis.

Read part 1 here: How B.C.’s approach to toxic drugs and addiction is changing

Read part 2 here: Deaths of despair: Gabor Maté urges empathy during B.C.’s toxic drug crisis

Read part 3 here: From shame and secrecy to Suboxone: B.C. drug users credit harm reduction for recoveries

Read part 4 here: Detox wait times plummet after B.C. innovates drug treatment intake