The
Centre for Addiction and Mental Health (CAMH) does not support mandatory
drug testing and treatment for people on welfare. Research has shown that
drug testing has limited utility in confirming substance use problems
and treatment needs. Such an approach would also serve to perpetuate the
stigma associated with poverty and addiction and may lead to detrimental
individual and social consequences. CAMH is also concerned about the ethical
and legal implications of that infringement on the human rights of its
patients and clients who are on welfare.
Limitations of Drug Testing
Drug
testing has limited utility in determining an individual's need for treatment.
Positive test results may indicate the presence of certain substances
in a person's system at the time of testing, but cannot confirm the existence
of an addiction or dependency. The resources required to implement drug
testing could be more usefully applied toward enhancing access to motivational
screening and clinical assessments within the addiction treatment system
in order to appropriately identify and meet individual treatment needs.
CAMH
is concerned that denying welfare benefits to individuals who do not comply
with an abstinence-based treatment program would fail to take into account
current knowledge about the cyclical nature of addictions management,
where 70% of individuals experience at least one relapse after the first
year of their progress toward recovery.
CAMH
recommends that addictions treatment should be based on a system of client-centred
care, in which treatment is managed in the context of a trusting client-therapist
relationship which provides access to a range of treatment approaches.
Stigma
Research
shows that substance use is no more prevalent among people on welfare
than it is among the working population, and is not a reliable indicator
of an individual's ability to secure employment. 70% of people who use
drugs are, in fact, employed.
CAMH
believes that the threat of removal of income support from individuals
for whom social assistance is a last resort unfairly targets the disadvantaged.
Research from the US indicates that denying benefits to those who fail
to comply with treatment may result in increased poverty, crime, homelessness
and higher health care and social costs. Such an approach would also further
entrench the stigma which erroneously links drug addiction with economic
need, and fail to address the complex but more relevant needs of those
requiring assistance.
CAMH
recommends that people on welfare have access to those supports that more
reliably predict who will be able to find and keep a job, including appropriate
housing and childcare, social supports, and literacy and skills training.
Ethics and Law
Mandatory
treatment is common for those who have broken the law, or whose impaired
functioning may affect public safety. CAMH believes that subjecting people
on welfare to mandatory drug testing and treatment solely on the basis
of their economic need has no justification and would constitute an infringement
on their right to privacy and self-determination. The Ontario Human Rights
Code recognizes addiction as a disability. Denial of welfare benefits
on the basis of an addiction would thus contravene the Human Rights Code,
a conclusion that has been upheld in a recent Court of Appeal decision.
Conclusion
The
Centre recommends that the government shift from its proposed direction
of requiring the mandatory drug testing and treatment of people on welfare
suspected of having a substance use problem, to instead providing them
with the necessary supports to help them in their efforts to leave the
welfare system. These supports include access to:
-- existing case workers in the welfare system trained to appropriately
screen, identify and refer people with addictions and mental health
problems;
-- existing case managers in the welfare system trained in motivational
strategies to more effectively engage people with substance abuse problems
in the assessment and treatment system; and
-- adequate housing, child care and vocational supports for those who
require further assistance.
In
addition, the government should direct the resources designated for mandatory
drug testing and treatment toward expanding the capacity of the current
treatment system. This will allow for the provision of the more appropriate
and effective clinical assessments and treatment for people with substance
use problems regardless of their circumstances.
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