Evidence-based planning of alcohol and other drug treatment services in BC: A collaborative effort between CARBC and the Ministry of Health

A map of BC's Health Service Delivery areas

As researchers, our ultimate goal is to provide evidence-based information that will go on to inform policy and practice. Recently, we were lucky enough to have the opportunity to do just that.

For 18 months, the Centre for Addictions Research of BC (CARBC) has been collaborating on a project with the BC Ministry of Health. The Ministry’s initiative was to create 500 substance-use treatment spaces throughout the province; however, they wanted to know where these spaces would be best utilized. Would it be in the more Northern communities where substance-use treatment is scarcer? Or would it be in more busy urban areas where demand for these services is higher? These were some questions that a small team here at CARBC, alongside some key individuals within the Ministry, sought to answer.

From a health service delivery perspective, British Columbia is divided geographically into health authorities (HAs), health service delivery areas (HSDAs), and local health areas (LHAs). This is a nested structure where the 89 LHAs nest within the 16 HSDAs, which in turn nest within the five larger HAs.

We set forth to replicate a needs-based planning model developed by Brian Rush and colleagues (2014). This model applies a number of different parameter estimates based on substance-use issues reported by population survey data. The estimates were derived from an extensive literature review as well as input from a national review of experts. For example, in tier 4 (i.e., specialized care functions targeted to people assessed/diagnosed as in need of more intensive or specialized care), Rush’s model estimates that 60% of the help-seeking population will require withdrawal management services.

Further subdividing withdrawal services into three specialized types the model estimates that 36.8% of those people will require home-based/mobile treatment, 52.6% will require community/residential treatment, and 10.5% will require complexity-enhanced/hospital-based treatment. We created population estimates from aggregated 2009/2010 results of the Canadian Alcohol and Drug Use Survey (CADUMS), a national telephone-based survey that has been ongoing since 2008,  for each of the five tiers or levels of substance issue needs, stratified by problem severity. The parameter estimates were applied and the number of individuals 15 and older in each Health Authority (i.e., Interior, Fraser, Northern, Vancouver Coastal, and Vancouver Island) requiring specialized services and supports (e.g., withdrawal management services, community services and supports or residential services and supports) was calculated.

The aforementioned collaborative project resulted in a report for the health authority representatives. The estimated number of in-need services was then compared to current capacity to create a gap analysis. This gap analysis is being used to explore opportunities to re-allocate resources to better match need-based planning.

This collaborative project between CARBC and the Ministry of Health provided evidence-based research to inform British Columbia’s future substance use treatment planning. This project also helped foster a long-term working relationship with Ministry of Health and Health Authority staff that will continue to build on the experiences and lessons learned from this successful collaboration.


Chantele Joordens #3a Scot Macdonald

Chantele Joordens and Scott Macdonald, Centre for Addictions Research of BC

Joanne MacMillan, Ministry of Health

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Drinking, Disease and Distance: Access and use of primary health care services for treatment of alcohol-attributed diseases in rural BC

Since the turn of the century, there has been a sharp decrease in the proportion of the population that resides in rural and remote British Columbia (BC) communities. In 2011, 86% of British Columbians (3,790,694) lived in urban areas, whereas only 14% of the population, or 609,363 persons, resided in rural communities. Although a much smaller proportion of the population lives in rural areas, these communities have disproportionately higher rates of alcohol consumption and alcohol-related hospitalizations than urban areas of BC, such as Vancouver and Richmond. These higher rates of alcohol-related harms, when combined with poor access to health care, can result in greater disease severity and increased rates of alcohol-related deaths. Although these challenges have existed for many decades, we still have an incomplete understanding of the barriers to obtaining addictions treatment services, which is important information that could be used to inform health care policy and resource allocation decisions throughout the province.

For the past two years, I have worked with my former PhD Supervisor, Dr. Scott Macdonald, to address this lack of knowledge by examining access and use of primary health care services by persons with alcohol-attributed diseases in rural BC. I focused on primary health care physicians because they are the most accessible type of health care provider available in rural and remote communities that often do not have hospital-based substance use treatment services. Family doctors are ‘gatekeepers’ to specialist services, and have a significant role to play in the identification and treatment of alcohol-attributed diseases early in their development.

For these projects, I studied both geographic (spatial) variations in primary health care use, as well as place-based physician experiences treating persons in rural communities. In the first project, I used physician-billing data to model use of general practitioner services by persons with alcohol-attributed diseases from 2001-2011 with administrative health data provided by Population Data BC. We were surprised to learn that from 2001-2011, cases of alcohol-attributed diseases in primary health care practices grew significantly (53.3%), from 14,882 cases in 2001 to 22,823 cases in 2011.1 We also found geographic inequities in alcohol-attributed disease cases among primary health care populations by Health Service Delivery Area (HSDA). Rural areas generally had much higher rates of alcohol-attributed disease cases than highly populated areas of the province. For example, in the Northwest HSDA (which includes Smithers, Prince Rupert, and Kitimat) cases rose 77.2% from 57.1 per 10,000 in 2001 to 101.3 per 10,000 in 2011. The 2011 rate of alcohol-attributed disease cases per 10,000 in the Northwest HSDA was the highest in the province – almost double the provincial average of 48.2 cases per 10,000. In comparison, several urban areas such as Vancouver, Richmond, and Fraser North had no significant increases in alcohol-attributed disease cases during this same period.

In the second study, I distributed a mail and online survey to general practitioners in rural areas that were defined using the Rural Coordination Centre of BC’s system for defining rural communities. We received responses from 22% of participants (for a total of 67 completed surveys) who overwhelming reported that they experienced significant challenges in referring their patients to treatment in urban areas. Physicians cited long waitlists and a lack of residential treatment facilities and inpatient services as the main challenges to referring patients. In many of the surveys, physicians wrote about personal experiences working in their community, and the challenges associated with delivering appropriate health care in isolated communities. They also stated that travel costs, distance to treatment facilities, and responsibilities in their hometowns prevented patients from obtaining required services only available in other communities. Even when services were acquired outside of the community, many physicians reported difficulties upon returning home and; as one physician summarized: “relapse on return [to community] from treatment is the rule rather than exception. We want local treatment [Family Physician, #038].”2

The outcomes of our research suggest that an increasing number of British Columbians are presenting with alcohol-attributed diseases to general practitioners, and there are large geographic inequities in the incidence of alcohol-attributed diseases in primary health care patients. We also found that rural family doctors frequently experience significant challenges when referring patients to treatment. Addressing these challenges requires that we work with residents and health professionals in rural places to develop innovative – and cost effective – methods for enhancing the continuum of services provided to rural residents. In this study, several physicians suggested having a centralized referral phone number for substance use treatment services in urban Vancouver, Victoria, and Nanaimo, which would not require a large public sector investment. Additional participatory research, and accompanying policy development processes, is required to articulate and implement these suggestions for service improvement in rural areas where populations disproportionately experience alcohol-related harms and related diseases.


1 Slaunwhite, AK., Macdonald, S. (2015). Primary health care utilization for alcohol-attributed diseases in British Columbia, Canada 2001-2011. BMC Family Practice. (in press).

2 Slaunwhite, AK., Macdonald, S. (2015). Alcohol, Isolation, and Access to Treatment: Family Physician Experiences of Alcohol Consumption and Access to Health Care in Rural British Columbia. Journal of Rural Health. (in press).

A photo of Amanda Slaunwhite

Author: Amanda K Slaunwhite, Collaborating Scientist, Centre for Addictions Research of BC; Post-Doctoral Fellow,  University of New Brunswick.

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC