Far more people come out of detox than there are beds at the next stage in the recovery process -the stabilization unit.
"They're bound to relapse," she says. "They aren't treated. All they are is detoxed."
Gaping holes in medical service delivery for addicts and alcoholics have been identified in repeated studies on addiction, including Victoria's 2007 Breaking the Cycle of Mental Illness, Addictions and Homelessness, and the 2009 B.C. Medical Association report Stepping Forward: Improving Addiction Care in British Columbia.
The BCMA recommended that 600 more treatment beds be opened by 2012, and service gaps eliminated.
"Whether in a detoxification centre, an emergency room or their own homes, individuals often make the choice to seek treatment only to be confronted with obstacles, a lack of space, a wait list with no certain date of entry, and even unanswered phone calls," the report said.
Those additional treatment beds have not materialized. Instead, with about 400,000 British Columbians suffering from addiction or substance abuse problems, there are fewer than 250 publicly funded adult residential treatment beds -and none on Vancouver Island.
Martin Spray was the executive director of the Victoria Life Enrichment Society, the last publicly funded treatment centre on the Island, until cuts in 2002 forced its closure. He says the government told the non-profit organization that research showed residential treatment to be no more effective than outpatient treatment.
That view fuels the debate between the groups working with addicts and alcoholics and the province, which is faced with ever-increasing health costs.
B.C. medical health officer Dr. Perry Kendall says the province tries to reserve treatment beds for the most desperate -people who have concurrent medical disorders or who need close medical supervision.
"Most people with addictions don't need a residential care, 28day bed course of management," he says, adding that it is critical to ensure the addict or alcoholic is connected with someone who can provide ongoing supports.
The Vancouver Island Health Authority spent $103.9 million in 2009/10 on addictions and mental health treatment. That money goes to everything from hospital psychiatric beds to the Assertive Community Treatment teams that provide outreach to street people with mental health and addiction problems.
People who work with drug addicts and alcoholics want the spending to increase -but they also say the lack of co-ordination and capacity are bigger problems.
It's what led Dave -who asked that his last name not be used -to relapse.
The 22-year-old was drinking so heavily a year ago, he landed in Royal Jubilee Hospital with a ruptured esophagus. Coughing up blood, Dave was on a cot in an emergency hallway for two days until staff realized he was going through withdrawal from alcohol and moved him to the detox unit.
While in detox, he was still vomiting blood and unable to eat or drink. After four or five days, he was transferred back to emergency to be rehydrated, then sent back to detox, then released. He says he didn't receive counselling and wasn't given a recommendation.
"I didn't have any support or any direction. Nobody told me what I should or shouldn't do and there were no resources that were made available to me ... a stabilization house or anything," he says. The experience kept him sober for a month before he relapsed.
The transfer from detox to stabilization to treatment should be seamless, says Gordon Harper, executive director of the Umbrella Society for Addictions and Mental Health, a non-profit peer support group that helps get people through the public system.
"If someone is detoxing at the hospital or at the detox, if they could be transferred seamlessly to [the 28-day stabilization unit in Victoria] they could achieve a little bit of short-term stability in their lives and start to look at a plan," he says.
Instead, Harper, himself sober for more than 20 years, wryly notes that someone hoping to access provincial addiction services had better be available on a Tuesday or Thursday at 1: 30 p.m. for a PowerPoint presentation.
Harper and his three staff have sat through the presentation more than once holding the hand of a shaky, drug-or alcoholaddled client trying to make sense of what programs may be available, what forms they have to fill out and which appointments they have to keep to get into them.
Rob DeClark, program director at the private Cedars centre in Cobble Hill, says a seamless service once existed in the public system -in fact, it saved his life.
DeClark is 33 and holds a masters' degree in social work from Carleton University. When he was 17, he was an intravenous heroin addict living on the streets in downtown Vancouver.
"The cops were after me. I was in a heap of trouble. I owed a bunch of drug dealers money and I wanted to get out of town," DeClark recalls.
He escaped by going to detox in Kamloops. "Then [after detox] I was given a choice. I could either head out and be on my own or there was good, publicly funded, six-month treatment centre across the road," DeClark says.
"So I went there. The treatment centre itself was six weeks and then I stayed for 4 1 /2 months in a recovery house -a halfway house," said DeClark.
That type of transition in the public sector today would be a dream, says Jody Paterson, former executive director of PEERS, a support agency for current and former workers in the sex trade. It has become more complicated with regional health authorities.
"For a while it was OK. You could get someone into Crossroads [treatment centre] in Kelowna. You could work it. But the regions started to do was say, 'I'm sorry. Our priority is people from this region.' So on the Island where there was no residential treatment whatsoever, there was literally nothing for people to go into."
Dr. Mel Vincent, a psychiatrist at the private Edgewood treatment facility in Nanaimo, says out-patient services work for some addicts and alcoholics, but not all.
"If you're looking at someone who is actually dependent, dayin, day-out, heavy users with lots of negative consequences and their whole life is disrupted, then in-patient residential treatment has a better outcome," Vincent says.
"We get people here who have gone to day programs. They go every day from nine to five but they're on their own in the evening. Most of them end up using when they are in that treatment. It's that they can't not use. It's the power of the disease."
Neal Berger, the founder and executive director of Cedars, says there is no question that residential treatment can work.
Berger cites the high success rates for executives, doctors and pilots with drug or alcohol problems. They are whisked off to abstinence-based residential treatment, and to keep their jobs they have to enter tightly monitored continuing care agreements.
They agree to random urine testing, continued counselling and full participation in a 12-step program.
Their recovery success rate is 95 per cent.
"The First Nations guy from Northern B.C.? He's going to see a counsellor on an outpatient basis who probably doesn't have any addictions training. And that's it," Berger says. "Somebody's going to say treatment doesn't work. I shouldn't think so. That treatment wouldn't work for the doctor either."
More than anything else, Harper says, people in the grips of addiction need a system that gives them hope.
"What would be really, really nice on a local level is if someone could walk into a place, without having to make an appointment and without having to be particularly concerned about what day it was or what time it was, and walk away with something that increased their hope that change was possible," Harper says