A study conducted by SECOR on behalf of Portage, a non profit organisation dedicated to the rehabilitation and reintegration of people suffering from substance abuse back into the community, concluded that government investments in the fight against drug addiction have significant long term effects. www.portage.ca

1. The importance and the need for drug
addiction treatment in Québec
Final Report

2. Description of Portage and its Service Offering
.1.

3. Portage: Close to forty years of experience in drug
addiction rehabilitation in Québec
■ Founded in Prévost, Québec, nearly forty years ago, Portage is a non-profit organisation devoted to the social
reintegration of drug addicts, based primarily on a therapeutic community approach.
■ Portage currently provides services in five regions of Québec: the Greater Montréal Area, Québec City, Saint-
Malachie, Beaconsfield, and Prévost
Services provided Portage’s mission Accreditation
■ Assessment/orientation Portage fosters the strengths and skills of Portage is accredited by Accreditation
■ Non-residential drug addiction substance-dependent persons to enable Canada, which recognises the continuous
rehabilitation them, through comprehensive and cost- improvement of the quality of services at
effective interventions based on the Portage, the skills of its employees, and
■ Residential drug addiction rehabilitation
therapeutic community approach, to live the expertise of the organisation.
■ Gambling addiction rehabilitation lives of sobriety, filled with dignity, self-
■ Replacement therapy respect and accomplishment.
■ Social reintegration
■ Community help and support
1973 1975 1983 1986 1989 1991 1995 1996 1999 2001 2002 2007 2009
 Launch of the Mother and
 Opening of the  Opening of a  Implementation of a Child residential  Inauguration of the
head office in Day Centre in residential rehabilitation rehabilitation program, a first Movement for Integration
Montréal and Day Québec City program for adolescents of its kind in Canada, at the and Retention in
Centre with substance abuse centre in Prévost, near lac Employment (MIRE)
issues at the centre in Écho program in Montréal
Prévost, near lac Écho
 Inauguration of the
 Opening of a Portage Employment  Opening of a residential
residential Reintegration Centre rehabilitation centre for
 Inauguration of a
rehabilitation in Québec City adolescents in Saint-Damien-de-  Relocation of the
centre for adults Buckland new Portage
 Implementation of the adolescent facility
in Prévost, near centre in Montréal
 Launch of a day treatment program for  Implementation of a for the MICA and
in Saint-Damien-
lac Écho treatment and family de-Buckland to
Mentally Ill Chemical Abusers residential rehabilitation Mother and Child
services centre in (MICA) at the centre in program for English-speaking Saint-Malachie
programs
Montréal Prévost, near lac Écho adolescents in Beaconsfield,
Source: Portage
.2.

4. A distinctive therapeutic approach
■ The rehabilitation process at Portage is based on the therapeutic community, positive psychology, and
individual case management. The goal of Portage’s treatment approach is to help clients build on their
strengths and acquire the skills they need for rehabilitation.
■ The rehabilitation process at Portage is personalised in terms of both duration and content, which makes it
unique in Québec. The program’s duration is established based on each client’s needs, motivation, and
willingness to be treated.
Part 1 of treatment Part 2 of treatment
Focus on the development of interpersonal Focus on the development of community
relations, self-understanding, trust, and dignity. responsibilities to prepare clients for reintegration
Clients work on: into society. Clients are given responsibilities such
■ their personal path as:
■ assimilating skills associated with therapy ■ a mentoring role with new residents
■ Understanding the reasons that led to their substance ■ the organisation of travel and safety
abuse ■ the coordination of community activities
Post-treatment process
Portage’s unique post-treatment services aim to minimise the chance of relapse:
■ Ongoing treatment for all clients for up to two years following release from the rehabilitation program, at day centres and the
MIRE program
■ Supervised apartments for clients at the Mother and Child program for up to two years after completing the residential program
Source: Portage
.3.

5. Multiple targeted programs to serve clients with diverse needs
Portage provides rehabilitation services to adolescents, adults, pregnant women and mothers with young children, the
aboriginal community, mentally ill substance abusers, and individuals referred by the justice system from all regions of
Canada. Portage helps clients identify the causes of their problems, determine the general skills they need to face these
problems, and develop strategies to resolve them.
Portage Program
Duration based on the needs of the individual, 6 months on average
AdultProgram (Prévost) Adolescent Program (Montréal, Prévost, Saint-Malachie)
■ Program offered since 1973 ■ For adolescents, 14 years of age or older
■ For adults, 18 years of age or older ■ Residents live in a supportive, enriched, and structured setting
■ Residents have access to Portage Academy, which enables them to get ■ They take part in sporting and recreational activities and in daily group
their high school diploma while in therapy sessions
Capacity: 70 clients ■ They have access to Portage Academy
Capacity: 104 clients
Mother and Child Program Mentally Ill Chemical Abusers (MICA) Program (for men)
■ Portage is one of very few facilities in Canada to offer a rehabilitation ■ This program, which treats substance abusers who have mental health
program for pregnant women and mothers with young children (0 to 6 problems (primarily schizophrenia), is in high demand, as shown by the
years of age) waiting list
■ Portage provides day care services with specialised educators, where the ■ Portage would like to further develop this program in the next few years,
children receive treatment as well. The children also have access to a in particular by opening a similar program for women
nearby elementary school. Capacity: 20 clients
Capacity: 25 mothers, 25 children
Portage Québec City Day Centre MIRE
■ The Portage-Québec centre offers a Day Centre Program and an ■ The MIRE Program helps adults who have had trouble integrating or
aftercare follow-up program reintegrating into the job market to find suitable employment. There is a
particular focus on single parents and individuals of more than 35 years of
age.
Capacity: 225 people divided into nine groups
Source: Portage
.4.

6. Governance Structure and Funding
Portage has a Board of Governors (made up of 200 volunteers) who sit on the various committees which support clinical
programs and the organisation’s administration
■ Every year, the Board of Governors must elect a Board of Directors composed of 25 members
In 2010, the organisation’s funding was primarily ensured through public funds (74%) and contributions from its Foundation
(15%). The Chagnon Foundation has contributed approximately $8 M in 10 years to the Mother and Child Program/
Funding for Portage
2010; in $K and in %
Other foundations and Total budget of $11.2 M in 2010 Portage Foundation
other revenues The organisation has a foundation, which holds
Portage’s assets in trust. The Portage
1,325
(11%) Foundation is managed by a separate Board of
Portage Foundation 1,638 Directors.
(15%) Since its inception in 1973, the Portage
Foundation has raised over 25 million dollars to
fund Portage’s various programs
8,264 ■ Funding activities: Fundraising
(74%) campaigns, recognition galas, golf
Government tournaments, unsolicited donations
programs:
(online, by telephone, In Memoriam,
The ministère de la Santé et des spontaneous donations, donations of
Services sociaux (78%), the
ministère de la Sécurité publique goods and services)
and the Direction régionale des
services correctionnels
Source: Portage
.5.

7. High success rate for long-term treatment
Portrait of Portage’s clientele
Portage achieves high abstinence rates in adolescents and adults in %, January 2003 to October 2008
after long-term treatment
40 to 64 0 to 12*
■ 66% of adolescents who complete 181 days or more of treatment
remain abstinent after 14.5 months 9% 6%
■ 70% of adults who complete 211 days or more of treatment reamin after
25 to 39
16 months 23%
Most of Portage’s clients are under 25 years of age (68%) 41% 13 to 17
21%
18 to 24
(*) The 0-6 population
corresponds to the children taking
part in the Mother and Child
Proportion of clients who abstain from using drugs after residential treatment at the Portage centre in Prévost, Program and to whom support
and specific services are provided
near lac Écho
in %, January 2003 to October 2008, various durations of treatment
ADOLESCENTS ADULTS
Average age: 16 Average age: 30
80% 76%
69% 70%
66% In 2009, close to
58% 2,000 drug addicts 55% 58% 55%
50% 53%
45% used Portage’s
37% services
32%
(approximately 50%
at a residential
facility and 50% at
external programs)
15–60 days 61–180 days 181+ days 1–30 days 31–120 days 121–210 days 211+ days
7.5 months after treatment 14.5 months after treatment 8.5 months after treatment 16 months after treatment
Source: Portage
.6.

8. Admission rates to main programs in decline
■ Since 2007-2008, admission rates have been in decline for the two programs with the highest capacity, i.e., the Adolescent
(-1% per year) and Adult (-3% per year) Programs
 In 2010-2011, the Adolescent Program is only being used at three-quarter’s of its capacity. Before the implementation of the Access
Mechanism system, this program continually ran at full capacity
■ The admission rates at the Mentally Ill Chemical Abusers (MICA ) Program and the Mother and Child Program are better,
with an annual growth of 2% and 1%, respectively
 For the current year, the MICA Program is running at full capacity, while the Mother and Child Program is at 90% capacity
Evolution of Admission Rates for each Portage Program
07-08 to 10-11; in % of capacity per program
CAGR*
-3%
CAGR*
+2% CAGR*
114% 117% 112% +1%
CAGR* 105%
-1% 100% 102% 100%
95%
91% 89%
86%
76% 74% 73% 75%
69%
Capacity: 104
Capacity: 70
Capacity: 20
Capacity: 50
Adolescent Program Adult Program Mentally Ill Chemical Mother and Child
Abusers Program Program
07-08 08-09 09-10 10-11**
*CAGR: Compound annual growth rate
Source: Portage **Year to date
.7.

9. The Evolution of Drug Addiction
and Description of Needs
.8.

10. Illegal drug use in decline in Québec, yet one of the
highest rates in Canada
Generally speaking, illegal drug use is in slight decline in Québec and in Canada
■ Between 2004 and 2009, illegal drug and cannabis use in Québec has fallen by 8%
■ In Canada, the decrease illegal drug use is even greater, but less pronounced when including cannabis
Nevertheless, Québec has one of the highest rates of drug use in Canada, ranking 2nd/10 for illegal drug use
and 3rd when including cannabis
Lifetime Drug Use
2004 and 2009; in % of the sample; Canada (n=13,082) and Quebec (n=1,009)
Canada -11%
Québec ranks 2nd/10
Use of one of the five following provinces in terms of
illegal drugs: crack/cocaine, proportion of the population
speed, ecstasy, hallucinogens having used one of the five
and heroin Quebec -8% illegal drugs listed, behind
British Columbia
2004 2009
Québec ranks 3rd/10
Canada -5%
provinces in terms of
Use of one of the six following
proportion of the population
soft or illegal drugs: cannabis,
having used one of the six
cocaine, speed, ecstasy, illegal drugs listed, behind
hallucinogens and heroin Quebec -8% Alberta and British
Columbia
Source: Health Canada, Canadian Alcohol and Drug Use Monitoring Survey
.9.

11. Many illegal drugs are used more in Québec than in
the rest of Canada
■ Crack/cocaine and amphetamines are used more in Québec than they are in the rest of Canada
■ The greatest differences between Canada, as a whole, and Québec are in the use of
amphetamines (+86%) and crack/cocaine (+20%)
Lifetime Drug Use
2009; in % of the sample; Canada (n=13,082) and Quebec (n=1,009)
+2%
+1%
Canada Quebec
+1%
+20%
+86%
0%
+11% -6%
Cannabis Crack/ Amphe- Metham- Halluci- Ecstasy Salvia All
cocaine tamines phetamines nogens drugs
Source: Health Canada, Canadian Alcohol and Drug Use Monitoring Survey
. 10 .

12. A noteworthy phenomenon: Steady rise in the use of
legal drugs
In North America, there is a marked increase in the use of
legal drugs (542% increase between 1992 and 2005 in Consumption rates for Vicodin and Oxycontin for non-medical purposes
number of American teenagers using prescription drugs to in high schools
2010; United States, used at least once during the year
almost 10% in 2005).
In 2009, 16 million Americans aged 12 and older had used
Grade Vicodin Oxycontin
an analgesic, tranquiliser, stimulant, or sedative for non-
medical purposes at least once in the year leading up to 8th grade 2.7% 2.1%
the survey 10th grade 7.7% 4.6%
■ A study conducted by Monitoring the Future showed high 12th grade 8.0% 5.1%
consumption rates for Vicodin and Oxycontin (powerful
analgesic drugs) for non-medical purposes
In 2009, 23% of Ontario high school students had tried these drugs in the past 12 months. The province recently adopted
legislation to better monitor the use of legal drugs: the Narcotics Safety and Awareness Act.
According to researchers, Ontario generally falls within the Canadian average. The use of legal drugs is accordingly also
seeing a significant increase in Canada and Québec:
■ Cases are often more serious
■ The resulting addictions are not addressed as well by current programs
■ These drugs are becoming a major problem
The slight decline in illegal drugs in Québec is largely offset by the increase in legal drug use.
These trends generate new addictions and new treatment needs.
Source: National Survey on Drug Use and Health; Monitoring the Future, Ontario Student Drug Use and
Health Survey (2009), studies by the Centre de recherche sur la communication et la santé (UQAM)
. 11 .

13. Are drug problems in Québec more frequent today
than they were ten years ago?
■ A strong majority of people (92%) believe that substance abuse problems have either held steady or
worsened in the past ten years
■ Access to illegal substances seems easier today—95% of people believe that it is easy for young people
to obtain drugs
Frequency of Substance Abuse Problems Access to Illegal Substances
past ten years, in %, n=1,000 in %, n=1,000
58%
54%
38% 37%
5%
3% 3%
1% 1%
More As Less DNK* Very easy Easy Difficult Very difficult DNK*
frequent frequent frequent
Source: Léger Marketing *DNK = do not know
. 12 .

14. Eight out of ten Quebecers feel that drug and
alcohol addiction are serious problems
According to a survey done by Léger Marketing, Quebecers feel that drug and alcohol addiction
problems are important public health concerns:
■ 82% of Quebecers consider drug addiction problematic and 81% consider alcohol addiction problematic
Assessment of the importance attributed to addiction issues by Quebecers
2010, drugs and alcohol, n=1,000
DRUGS ALCOHOL
3% 4%
15% 15%
36%
39%
43%
45%
Very important Not very important
Somewhat important Not important
Source: Léger Marketing
. 13 .

15. A large number of high school students need help
Regular and prolonged or excessive drug use can have serious repercussions on an individual.
Cannabis, the illegal drug most commonly used by young people, can cause physical problems such as pulmonary and
cardiovascular issues, as well as cognitive (memory, attention, information management) and mental health (depression,
psychosis and schizophrenia) problems.
The DEP-ADO scale (Dubé et al., 2007) shows an alarming trend of addiction cases becoming more serious in young people,
with 79% of youth who use amphetamines, and over 83% who use cocaine, requiring a treatment intervention
Proportion of high school students with a “yellow light” or “red light”
in %, by substance used, 2007
Green light
DEP-ADO code:
Yellow light
The DEP-ADO code ranks the level Excessive
16% 16% 68% 100% Red light
of addiction of high school students alcohol
according to three degrees of
seriousness: green, yellow, and red. Excessive-
repetitive 34% 27% 39% 100%
A person deemed to be in the green
alcohol
light category has no consumption
problem (in the sense that no
Cannabis 22% 22% 56% 100%
specific intervention or treatment is
required).
However, it is recommended that
Amphetamines 52% 27% 21% 100%
people in the yellow and particularly
the red light categories seek
treatment
Cocaine 65% 18% 17% 100%
This approach does not take addiction to multiple substances into account
Source: Institut de la statistique du Québec, 2007
. 14 .

16. Cases processed per Access Mechanism, Montréal
The Access Mechanism in Montréal opened 503 case files, of which 350 were processed in the
past year, of which only 82 were assigned to rehabilitation centres
Structure of the Access Mechanism for Drug Addiction in Montréal
2009, for Francophones under 18 years of age
Case files opened Nb. of internal referrals
No. No.
Partners Centres
opened referred
Youth centre 135 Grand Chemin 18
Friends and family 59 Pavillon du Nouveau Point de Vue 36
Self-referral 35 Portage 20
Educational institution 51 CDC-IUD Réadaptation interne Jeunesse 8
Access Mechanism partners 11
CSSSs 27
Hospital centre 12
Community organisation 12
Other establishments (police, RDC, etc.) 8
Total case files opened 350 Total internal referrals 82
According to the ACRDQ, 0.8% of the population 15 years of age and older is addicted to illegal drugs, representing some 30,000
people in the Montréal metropolitan area. Accordingly, the number of case files opened represents only 1% of the people
suffering from addiction, and the number of internal references, slightly less than 0.3%.
Source: [MATJM]
. 15 .

17. Economic and Social Impact
of Drug Addiction in Québec
. 16 .

18. Drug Addiction: Significant costs for the province
■ In 2002, the costs of illegal substance abuse represented over $1.6 billion for the province, representing
0.6% of the GDP
■ This impact is calculated based on five elements: health care, law enforcement, prevention/research, loss
of productivity, and other direct costs
Direct health care • Morbidity
costs: total • Hospitalisation for short-term care
Total Cost of Illegal Drug Use • Hospitalisation for psychiatric care
2002, in $M, top four Canadian provinces • Specialised residential treatment
• Specialised non-residential treatment
• Outpatient care: medical fees
• Visits to family physician
• Prescription drugs
Direct law • Police services
enforcement costs • Courts
• Correctional service (including probation)
Direct prevention and • Research
research costs • Prevention programs
• Salaries and operating funds
Other direct costs • Damages caused by fire
• Damages caused by road accidents
• Work place costs
• EAP and health promotion programs
• Drug screening in the work place
• Administrative costs of transfer payments
• Welfare and other programs
• Workers’ compensation
Indirect costs: loss of • Long-term disability
productivity • Short-term disability (days of bed rest)
Ontario Quebec British Alberta • Short-term disability (days of reduced activity)
Columbia • Early death
Source: Canadian Centre on Substance Abuse
. 17 .

19. Significant costs associated with loss of
productivity, law enforcement, and health care
■ Most of these costs are associated with the loss of productivity (57%) and law enforcement (28%), while
prevention and research costs represent just 1% of the total
■ In terms of health care costs (13.8%), the principle issues are morbidity following a short-term
hospitalisation (37.6%) and specialised residential treatment (31%)
Breakdown of the Costs of Addiction Associated with Illegal Drugs Direct Health Care Costs Associated with Illegal Drugs
2002, in %, Canada 2002, in %, Canada
Prescription
drugs Morbidity—hospitalisation
Direct costs: for short-term care
law enforcement
28.3%
Visits to
family physician
4.3%
Outpatient care:
medical fees 2.0%
Indirect costs:
loss of productivity Specialised
non-residential treatment
1.0% Direct costs: 1.0%
0.2% health care Specialised
residential treatment 31.0% Morbidity—hospitalisation
for psychiatric care
Direct costs:
Other direct costs
prevention and
research Estimated health care costs
Total costs of illegal drugs in associated with illegal drugs in
Québec: Québec:
$1.627 M $225 M
Source: Canadian Centre on Substance Abuse
. 18 .

20. Portage’s contribution to Québec’s
economic and social welfare
. 19 .

21. Understanding the social, human, and economic
impacts of Portage’s services
■ In 2009, approximately 2,000 people used Portage’s services in Québec
■ The success rate is around 70% on average for the programs as a whole
■ In 2009, Portage’s activities therefore contributed to the rehabilitation and reintegration of around 1,400
drug addicts in Québec
■ This represents a gain of $45.5 M on total costs and $6.3 M on direct health care costs
Impact of the Funding Shortfall for Portage’s Services
If Portage could not continue to operate due to a lack of sufficient funding, a large portion of the
individuals treated could not receive treatment from another centre:
 Portage offers specific programs unique to its facilities and under-developed in other existing centres (for example,
the Mother and Child Program, the MICA Program, and the Adolescent Program,)
 Portage’s specific approach corresponds to specific needs that no other centre can meet
 The accommodation capacity and resources of other centres are limited
■ It is estimated that 75% of the 2,000 treated annually, so 1,500 people, would not be able to
receive treatment another centre. With a 70% success rate at Portage, this corresponds to 1,050
fewer people reintegrated in society every year without Portage’s services
■ This drop in the number of people reintegrated into society would have a $34 M impact in
terms of additional costs for the province every year, and additional direct costs of $4.7 M
in health care
Ten-year forecast: Cumulative additional costs for the province are estimated at
$1.9 B and direct health costs at $260 M.
According to the ACRDQ,* 0,8% of the population 15 years of age and older was addicted to illegal drugs, i.e., around 50,000 people in Quebec in 2010**
* Source: Service offer of CRPATs [rehabilitation centres for alcoholics and drug addicts], Fédération québécoise des centres de réadaptation pour personnes alcooliques et autres
toxicomanes, 2004.
** SECOR estimate: based on 6.2 M individuals in 2004, 6.7 M in 2010 and an 8% drop in consumption.
. 20 .