Addiction lies at the root of many serious problems in Canada. I’ve previously written about failed policies for addressing homelessness and how housing “non-profits” are often funded with little followup or accountability. It’s common to conclude that what individuals suffering from addiction really need is better access to mental health support programs.
So this time round, I’d like to explore the state and scope of the residential addiction treatment industry. Specifically, I want to understand who’s providing addiction recovery services, who’s paying the bills, and what measurable success rates they’re seeing.
Spoiler alert:
Residential treatment services are often (although not always) delivered in the complete absence of regulatory standards or even published methodologies.
Most programs are funded by provincial governments.
It seems no one can say for sure whether those programs actually help. And, as far as I can tell, there doesn’t seem to be anyone systematically tracking long-term outcomes.1
When it comes to large endeavors involving thousands of participants, the trick is getting the incentives right. That’s simple enough for businesses selling microwave ovens or car batteries. If your product works most of the time and your prices are competitive, you’ll likely do well.
But if your “product” is treatment services, and your paying customer is a provincial Ministry of Health, then things get more complicated. Your primary business incentive is to maximize payments by consistently filling available residential program beds. The Province’s incentive is to check the boxes on internal audits indicating that the process is happening.2 And even patients are often focused on complying with court orders or escaping hellish living conditions.
But it turns out that no one is held directly accountable for treatment success. In fact, in this particular field, there isn’t really any reliable way to measure treatment success - at least at the population level.
The 2023 Accountability for Safe, Quality Care in Bed-Based Addiction Treatment report from The Canadian Centre on Substance Use and Addiction (CCSA) is a good place to begin. The report observed how there is generally some level of financial accountability expected of for-profit and non-profit providers. But depending on your province, there may be no actual requirements to comply with any standard of care. Patients often have no assurance that the care they receive will meet any specific clinical standards or even be safe.
Among the report’s observations, was the astonishingly obvious recommendation that government should:
“Publish a common definition of bed-based addiction treatment services to support provincial and territorial legislation and standards development. A common definition will help to define the requirements to be met in an accountability approach.”
That no one had done that before 2023 - or since - is amazing. But we can only be grateful to CCSA for at least doing their part.
CCSA itself was created by an act of Parliament created CCSA in 1988 with a mandate to “improve the lives of people in Canada who use substances while ensuring safer communities for all”. $10.4 million of their $12.8 million budget in 2026 came directly from Health Canada. $8.3 million of that was spend on salaries and employee benefits. I reached out to CCSA asking about program outcome data they could share with me but there was no response.
There’s a lot of public money flowing into the system. Federally, 2025-2026 main spending estimates included $161.3 million for the substance abuse and addictions program as a transfer from the Department of Health. But most of the spending happens at the provincial level:
Ontario’s 2026 budget includes nearly $550 million to support the expansion of HART hubs, the Homelessness and Addiction Recovery Treatment hubs.
Ontario’s 2025 budget set aside $303 million over three years to stabilize community-based mental health and addictions services.
An earlier Ontario Ministry of Health package included $128.3 million over four years to expand withdrawal management services and community and residential addictions treatment.
Addiction support and treatment is a very big industry. According to Statistics Canada, 19.9 percent of all registered charities and 6.5 percent of “other non-profit organizations” directed at least some of their resources to people with addictions in 2023. In addition, 20 percent of residential facilities for victims of abuse similarly provided professional services related to addictions or substance use.
Besides the fact that the quality of patient care in residential programs is a black box, just finding an available bed and then figuring out what might happen to you once you’re there is often impossible. A 2023 study called “An environmental scan of residential treatment service provision in Ontario” found:
“A total of 102 residential addiction treatment programs and 36 residential supportive recovery programs in Ontario were identified. The scan noted substantial regional variations in program availability and wait times… [There were] notable gaps in program types, offerings, and availability among residential treatment programs in the province, including a lack of standardization on OAT policies across programs. Efforts should be made to ensure access to treatment-specific program information relevant to potential service users and to enhance coordinated access to residential treatment services in the province.”
The researchers also found that:
68.6 percent of residential programs and 91.7 percent of supportive-recovery programs are primarily dependent on provincial funding.
Residential treatment prices ranged from $550 to $14,250 per month for private, fee-based and semi-private options.
The bottom line is that, nation-wide, we’re probably spending billions of dollars annually on addiction treatment. That’s fine. The problem is that no one is in a position to confirm that all that spending is effective.
And, as a recent Free Press investigation into programs in Ohio found, it’s about much more than just wasted money. There’s no reason to assume that there isn’t also serious abuse and fraud happening.
Although the Canadian Institute for Health Information does track 30-day readmission rates.
I’ve previously written about the problem of assessing government work by measuring process outcomes.