Detox and addiction treatment is an important piece of the wrap around service that Boyle Street Community Services employ when working with a client struggling with substance use. Like many of our systems, however, gaining accessing to these programs can be extremely difficult; exponentially so if you are experiencing poverty or homelessness.
The Mobile Outreach Addictions Team (MOAT) is a dedicated and hard-working team made up of Paul, Ethyl and Nick.
One of six MOAT teams across the province, MOAT’s mandate is:
To assist and support clients who wish to access information about, and/or participation in addictions detox and treatment programs.
They also provide harm reduction informed addiction management strategies to clients. Each of the team members fulfills this mandate with compassion and collaborate support, drawing on their experiences and expertise.
Part of MOAT’s success with engaging individuals in the inner city is their mobile component.
By mobile component, we mean that workers can physically meet people where they are at, engaging with individuals in various locations around Edmonton, as well as other hard-to-reach areas such as the river valley and parkland.
Mobile component also refers to the team’s patience and flexibility in being there for people no matter where they are at in their journey with substance use. They accept and support their clients in the good days, and the challenging ones – this is where you really see MOAT live the Boyle Street value of “we never give up, even if the challenge is tough, seemingly impossible.”
“We never give up, even if the challenge is tough, seemingly impossible.”
Some of the specific supports MOAT helps clients to connect with are:
Detox: typically, a seven-day process where a person can safely experience substance withdrawal symptoms in a supervised environment.
Treatment: either out-patience or in-house programs lasting between 18 to 90 days, primarily working on a person’s psychological state and wellness.
Sober Living: whether this be in a sober living housing (a one-year lease), or on ones own, this stage of rehab is a person’s transition back into society.
If you have between $12,000 – $36,000 a month to spend, you can enjoy one of Canada’s seven Luxury Rehab centers to go through the whole process. However, a MOAT client who relies on government programs knows a radically different reality.
Once a client makes the decision that they want to go through treatment, Paul, Nick or Ethyl work with the client to support them in applying to a residential treatment program. The average wait time for a bed in treatment is 6-8 weeks.
Upon entering treatment, individuals must be sober for the 7 days prior. This means accessing detox for many folks before their treatment dates.
There are only 2 detox facilities in Edmonton – the George Spady Society and Alberta Health Service’s Alcohol and Drug Abuse Commission with roughly only 60 available beds between the two sites. 17 beds specifically set aside for men, and only 6 beds specifically reserved for women. Priority at both detox centers is given to clients who have an approved treatment start date.
But now, timing is crucial.
The best-case scenario is that the MOAT staff can orchestrate a seamless transition from detox directly to treatment. If this is not possible because of bed availability, the client is placed in a disadvantaged, even life-threatening situation.
If a client has gone through detox, but has to wait for their residential treatment intake date:
Many folks have no option but to return to the same environment they were in previous to detox. With our community, this often time means going back to living on the streets.
If they relapse while waiting, they no longer qualify for treatment. They then have to reapply, wait another 4 to 12 weeks, and try again.
A serious risk to some clients following detox is that since detox lowers a person’s tolerance to substances, if a person does relapses and consumes the same amount/strength of substance as they did before detox, they risk an overdose, and potentially death.
Sober living is the final and ongoing stage of the “rehab” process. Some clients opt for finding residence in a sober living facility. However, the limited number of sober living facilities and long wait times makes this difficult to secure when directly leaving treatment.
Without question, timing is vastly important for a client looking to address their substance-use.
Ethyl, one of the MOAT workers explains, “ When you want to quit, you have to do it right then when you are in that motivated mindset,” still another factor of why the average 6-8 week wait for treatment means most people don’t even make it to their treatment date.
A lot can change in a client’s situation in that time; a change in health, a change of location, a change of responsibility, a change of heart…whatever the case, once a detox intake is missed, you are reset to the back of the line, and must start the process from the beginning.
When formal treatment can not be realized, MOAT continues to work along side clients to make sure their basic needs are met, to educate about harm reduction strategies, and to continue building community support.
When Ethyl and Nick were asked, “What is the biggest barrier that prohibits clients from making it to detox and treatment?”, both quickly and matter-of-factly reply, “ Being homeless”.
The lack of stability in a person’s life when they are experiencing homelessness makes it incredibly difficult to be able to focus their attention on working through their addictions. When you are working on securing housing, figuring out where you will get your next meal, and doing the multitude of things a person struggling with homelessness must do, addressing your addictions tend not to take priority. In fact, it might be the only thing that helps you get through each day.
“Can you imagine having to stay sober and have nowhere to go?” – Ethyl
Homelessness also makes communication a big challenge. When a client does not have a permanent address and does not own a cell phone, it is extremely difficult to keep in contact.
Ethyl describes how she spends a large portion of her time trying to keep clients occupied as they wait for detox. Reflecting on how hard it is for clients to stay positive with such a difficult path ahead, she says being up-front and honest is the only policy.
“Sugar-coating does not help anything. I tell my clients that they don’t have to prove anything to me. They know that it will be hard, and that they have to put in the work, but I will be with them every step of the way, and I will never give up on them. Never. No matter what.”
In addition to their case load, MOAT facilitates biweekly harm reduction workshops at the George Spady Detox Centre. They also work at the the Boyle McCauley Health Centre’s needle exchange once a week, and staff the Streetwork’s Needle Exchange Outreach van on Tuesday evenings. Paul and Nick have also found themselves making semi-regular visits to Edmonton’s Remand Centre connecting with people who are about to be released on bail.
There is a common misconception that people struggling with substance use have the option, yet refuse to go through detox and treatment. The reality is that people are bravely asking for help, willing to put in the work, but deterred by the multitude of barriers, all preventing them from being successful in completing treatment.
In commenting that there is no shortage of people asking for help, Nick simply states, “I don’t have to sell anything.”
MOAT is a fascinating and uniquely dense approach to harm reduction, one that the team’s members handle with an extraordinary degree of commitment and passion.
Each member of the team brings a unique method of working that is exemplary in articulating the programs fluidity and measures of success. The diversity of each team member’s approach and life experience compliment and strengthen the work as a whole.
Becoming embedded in this program and seeing the genuine concern and care given by the MOAT staff was a reminder that Paul, Ethyl and Nick’s priority of a relationship-based approach to their work is the key in finding success with clients facing so many layers of complex challenges.
If you are interested in learning more about the Mobile Outreach Addictions Team and the positive impact that the program is having on their clients and the city, we invite you to our next Boyle Street Ambassador Impact Session on MOAT on Monday, November, 26th from 6:30 pm to 8:00 pm.