Addiction services largely unregulated
Addiction counselling is an unregulated field where anyone — even those with criminal convictions or who have been found guilty of unethical behaviour — can put up a shingle and start selling their services, says an Ottawa counsellor who is lobbying government for tighter rules.
“You could go hang up a sign on Bank Street and the next day you could probably see 10 people a day at $200 a pop,” said Crystal Smalldon, executive director of the Canadian Addiction Counsellor Certification Federation. “All you have to say is, ‘I’m an addictions counsellor’ and people believe you.
“We regulate taxi drivers. We regulate hairdressers. We don’t regulate addiction counsellors. It makes no sense.”
The CACCF does offer a stringent certification process, but it’s voluntary and there is no regulation in any province that requires addiction counsellors to be certified. Smalldon has lobbied every provincial and territorial health minister, including Ontario Minister of Health Dr. Eric Hoskins, but has got nowhere.
The issue is especially important now as a wave of fentanyl overdoses, including at least two teenagers’ deaths, has swept over the city, blamed on an influx of counterfeit prescription pills containing the powerful opioid fentanyl.
“If you have $25,000, you could get treatment right now. But the problem is, you don’t know who’s doing the treating,” Smalldon said. “You can pay the money and send your daughter to any facility that has a bed for a teenager right now, but if you walk in you just trust they know what they’re doing.”
About 4,500 addiction counsellors in Canada are certified by the CACCF, including about 1,500 in Ontario. But the federation estimates there are 12,000 to 15,000 counsellors without certification. The CACCF certification program requires 270 hours of direct education in the 12 “core functions” put forward by the Canadian Centre on Substance Abuse and two years of full-time, supervised work in an addictions setting. The counsellors must do at least 40 hours of continuing education and sign and abide by a “canon of ethics.” The certification costs $285 and must be renewed every second year.
Smalldon concedes there is a place in treatment programs for peer-to-peer counselling — former addicts who help out in Alcoholics Anonymous or Narcotics Anonymous, for example — but said treating addictions is complex and requires special skills and knowledge.
“You don’t know who is going to come through your door. Everyone’s journey is different. Every person in recovery was addicted for a different reason and every person who has found success in recovery has followed a different path. Having that learned experience is vital, however, you can’t use your journey to recovery as a pathway for other people to get to theirs.”
Last spring, Ontario Provincial Police charged the operator of a private clinic in Caledon, Ont., with two counts of fraud, one count each of money laundering, benefiting from the proceeds of crime, and trafficking in a controlled substance. Two staff members were also charged with practising medicine without a licence.
Smalldon said her federation’s disciplinary panel recently received a complaint about a counsellor, conducted an investigation and found him guilty of sexual misconduct with a female client. They stripped him of his certification, but without the teeth of regulations, he was back at work the next day, she said.
“He’s committed very dangerous acts and there’s not a single thing anyone can do. That blows my mind.”
In practice, most major hospitals or social service agencies would only employ counsellors with degrees or diplomas or who are registered with the Ontario College of Social Workers and Social Services Workers. An addiction counsellor certification “might be a bit redundant,” conceded one human resources director with a prominent Ottawa social service agency.
Smalldon, herself a licensed social service worker, says the two jobs can’t be compared.
“We’re told, ‘Why don’t you just call yourself social workers?’ We’re not social workers. ‘Why don’t you call yourself psychotherapists?’ We’re not psychotherapists. It’s like making your car mechanic a cardiologist. It’s not going to go well. We are trained to be addiction counsellors.”
In an email, a spokesman for Hoskins said the health ministry “has no plans to regulate addictions counselling services as a separate regulated health profession at this time.”
In a letter he sent to Renfrew-Nipissing-Pembroke MPP John Yakabuski last October, Hoskins said the field was outside the government’s responsibility.
“I recognize that there are a number of private addiction treatment facilities in the province, and that they might employ unregulated staff. As these facilities are not regulated or funded by the ministry, they operate beyond the ministry’s jurisdiction,” Hoskins wrote.
That response frustrates Smalldon.
“If it’s not his responsibility, then whose is it?” bcrawford@postmedia.com Twitter.com/getBAC