Proceedings of the Special Committee on
Illegal Drugs

Issue 12 - Evidence 

The Special Senate Committee on Illegal Drugs met this day at 8:07 a.m. to reassess Canada's anti-drug legislation and policies.

Senator Pierre Claude Nolin (Chairman) is in the Chair.

[Translation]

The Chairman: We are resuming the public hearings of the Special Senate Committee on Illegal Drugs. It is a pleasure to welcome you today, colleagues. I would like to take this opportunity to welcome those who travel to be present at this hearing, as well as those listening to us on radio, television or on the committee's Internet site.

The committee is made up of five senators. I would like to introduce those who are with us today. On my left are the Honourable Colin Kenny, from Ontario, who is the committee vice-chair, and the Honourable Tommy Banks, from Alberta; on my right is the Honourable Shirley Maheu from Quebec. I am senator Pierre-Claude Nolin and I too represent Quebec in the Senate of Canada. Senator Terrence Stratton, from Manitoba, is also a member of the committee, but he is not with us this morning. Beside me is the Committee's Clerk, Mr. Daniel Charbonneau.

[English]

The Senate Special Committee on Illegal Drugs has received a mandate to study and to report on the Canadian policies concerning cannabis and its context, to study the efficiency and approach of those policies, and the means and the controls used to implement them.

In addition to its initial mandate, the committee must examine the official policies adopted by other countries. The Canadian international responsibilities with regard to the conventions on illegal drugs, to which Canada is a signatory, will be also examined.

The committee will also study the social and health effects of the Canadian drug policies on cannabis and the potential effects of alternative policies.

[Translation]

The committee is supposed to table its final report at the end of August, 2002. In order to carry out a mandate properly, the committee has adopted an action plan based on three major thrusts.

The first is knowledge. In order to meet this challenge, we will hear from many Canadian and foreign experts representing the academic, police, legal, medical, social and government communities. These hearings will be held mainly in Ottawa, and occasionally, if necessary, elsewhere in the country.

The second thrust is the sharing of the knowledge. This is definitely our most noble objective. The committee wants all Canadians to become informed and share the information we collect. Our challenge will be to plan and organize a system to ensure that the knowledge is accessible.

We would also like to hear what people think about this knowledge. In order to do this, in the spring of 2002, we will be holding public hearings in various parts of Canada.

Finally, the third focus of the committee is to review very carefully the principles upon which Canada's public policy on drugs should be based.

[English]

Before I introduce you to the distinguished experts of today's hearing, I wish to inform you that the committee maintains an up-to-date Web site. The site is accessible through the parliamentary web site that can be reached at www.parl.gc.ca. All the committee's proceedings are posted there. The site includes the briefs and the appropriate support documentation of our expert witnesses. There are also more than 150 links to other related sites.

[Translation]

Let me say a few words about the committee room in which we are meeting today. This room, known as the "Aboriginal peoples room" was built in 1996 by the Senate to pay tribute to the first inhabitants of North America, who are still actively involved in the development of Canada. Four of our Senate colleagues are proud and worthy representatives of the aboriginal peoples.

Today, we will be looking at the relationship between drugs and crime. We will also be talking about addiction treatment. To help us in our work, we will first hear from Dr. Céline Mercier, an associate professor in the department of psychiatry at McGill University. Next we will hear from Dr. Serge Brochu, the Director of the International Centre for Comparative Criminology at the University of Montreal. Finally, we will hear from Dr. Michel Landry, the director of professional services and research at the Dollard-Cormier Centre.

Dr. Mercier is associate professor and research associate at the Psychosocial Research Unit at the Douglas Hospital. Dr. Mercier received her PhD in psychology from the University of Strasbourg. Her current research interests are an evaluation of services for the severely mentally ill, including the homeless, and second, an evaluation of services for alcohol and drug abuse. The third area is the quality of life as a criterion for evaluating services.

Welcome to the committee. Thank you for accepting our invitation. We are very interested in your work. Following your presentation, there will be a question period. If we are short of time, I will write to you, if I may, to get further information on some of the subjects discussed during your testimony. The floor is yours.

Dr. Céline Mercier, Associate Professor, Department of Psychiatry, McGill University: I have tried to prepare a summary of the knowledge we have on addiction trajectories. I based my paper on a well-established body of knowledge. I also wanted to pay particular attention to the differences between men and women.

My presentation will be organized around five themes. First, I will talk about the notion of trajectory. I will comment very briefly on the methods used for this purpose. Next, I will come to the main part of my paper, which deals with dependency trajectories.

There is still some questions outstanding about the relationship between time and trajectories, as well as the outlook. These issues could be studied in future research.

The concept of trajectory is based first of all on the basic principle whereby individuals will go through a number of stages or successive phases.

It is true that the concept of trajectory is somewhat incorrect. A trajectory is somewhat of a metaphor for the trajectory of the planets and the stars, that is something very focused and in continuous motion. The word "journey" ("trajet") would be more accurate. A journey includes detours, round trips, et cetera.

So we must bear in mind that this concept of trajectory is not necessarily linear, but that there will be different situations and different paths. The word "journey" is a more accurate way of describing the relationship an individual will have with psychotropic substances during his or her life.

There is another important concept as well. In addition to trajectories, phases and stages, there are also transitions and passages, when individuals move from one stage to another. If we look as well at the themes that recur in the literature, we find the term "addiction career". There is also a reference to the cycles of dependency or the natural history of dependencies.

This slide is really the most important one, and I think I could do my entire presentation based on this diagram. We see first in this figure that we have always studied one of the possible trajectories, the one with the following five phases: initiation to drugs, gradual start of abuse and dependency; period of dependency; treatment, and finally reintegration into society. This is the classic pattern that has been developed at length in the literature.

However, there is not enough emphasis on the fact that at each of these stages, there are deviations from the dependency trajectory. That is why I prefer to talk about trajectories for drug and alcohol use.

When we look at the diagram, we see that the first stage is the initiation, which is followed by a gradual start of abuse, generally characterized by a trend toward daily use. Following the initiation, there are two other possibilities. First of all, there is the cessation of all drug use. These are cases where people try a drug and fairly quickly stop using it, or use it moderately. This is similar to the drinking pattern followed by most Canadians.

What we do not see are the ultimate consequences of alcohol and drug use, such as disease, trauma and death, particularly because now, there is a risk of HIV infection with injected drugs. In addition, there is an ever-growing awareness about intoxication. The most damaging consequences of alcohol and drug use are well documented, for example brain and skull traumas.

We should always remember that at each of these stages, spontaneous cessation is possible, drug and alcohol use may stabilize at very moderate levels with no social consequence. However, serious consequences can occur at all stages of the process.

This chart also shows the various type of interventions that may occur along this addiction trajectory. During initiation, the most common interventions are primary prevention procedures designed to prevent problem behaviour among high-risk groups. The same thing happens at the next stage, the start of dependency. There are some secondary prevention programs focused very much on screening and early prevention.

The next phase is the period of dependency. Here again, the most frequently studied path is the passage from dependency to treatment, but there are significant number of cases of spontaneous remission. In the past 15 years a number of harm reduction programs have been developed. Finally, following the treatment phase, there is the reintegration process, which was studied very little until recently. So I am going to look at each of the stages in this general outline. Three strategies are used to develop knowledge about addiction trajectory.

The first strategy is prospective research, which involves following a number of individuals for several years. In this approach, we measure a number of children or teenagers or people in the same age group or in the similar situation, and we measure these same groups regularly for a long period of time. This is the strongest methodology, but with it we do not know ahead of time how these individuals will be at the end, because we track them from year to year and see how they develop.

The method more frequently used is a retrospective approach in which we study a group of individuals who have become dependent, who are in treatment or are rehabilitated, and, after the fact, try to reconstruct the stages of their addiction trajectory.

Finally, there is the transversal approach, in which we compare a group of different individuals who are at different stages. We compare the various groups. The major difference in this approach, which is doubtless the most accessible, is that individuals in the same group are not compared with each other, but rather with individuals in other groups.

Most of the studies are quantitative. They borrow a great deal from epidemiological methods. However, we also learn a tremendous amount about the nature of the processes through qualitative investigations, which are based more on life histories or interviews with key participants. I will now describe the various stages of the trajectory.

First of all, there is the initiation. Initiation to drugs is undertaken in most cases by a man who is a drug user or former drug user himself. This is not surprising, since there are more men who use drugs than women. There is therefore an obvious group effect. However, in the case of prescription drugs, which are often the first contact drug for women, the initiation is done by women. In the case of men, the initiator is most often a friend or a acquaintance. In the case of women, the initiator is most often the spouse or someone with whom they have a special relationship. Peer influence is a recognized phenomenon, particularly among young people. Women say more often that the reason they first try drugs was out of curiosity or the need for some relief during a crisis. Men most often refer to the "kick" as the reason they used drug for the first time. It is more common for women to receive drug as gifts, while men have to buy them.

What causes people to continue to use drugs once they have started? When we compared people who had stopped taking drugs when they were teenagers with those who had continued taking drugs over a longer period, we saw that those who took drugs on a more regular basis and over a longer period continued to take drugs. We saw that those who took drugs for the facts of the drug rather than because of social pressures were less likely to continue with their habit.

We were struck by the fact that those individuals who gave up drugs were mainly either married or had children.

When an individual begins to take drugs on a daily basis, you can say they are an addict. It is daily drug use that is the indicator, which determines the fact that the individual is becoming a substance abuser. This happens much more quickly among women than among men, often because of the influence of a partner who is a daily drug user. The influence of friends on men is greater. However, for both men and women, consistent substance abuse means that they are taking drugs for the effects, and no longer for curiosity or simply for social reasons.

There are two other approaches that can be used to look at the regular substance abuse phenomenon. Firstly, there is what we call the psychopathological approach. Based on follow-up studies, and studies of many children at a very young age, we found that some children have distinguishing behaviour patterns, such as hyperactivity, aggressiveness or extreme shyness. These children are likely to become drug addicts. A large proportion of those young people who demonstrated, from a very young age, specific distinguishing behaviour traits, become drug users. The second approach is a genetics based one. Children, especially boys whose parents had a history of substance abuse or dependency problems in the past, are vulnerable.

When a person becomes a drug addict, taking drugs becomes the centre of their lives and these people are more greatly exposed to the repercussions of their habit. During this period, we found that men are more likely to take different types of drugs, whereas women will tend to stick to one main drug type. Both men and women sell drugs. However, this phenomenon is much more marked among men. Both men and women get into criminal activity, but commit different types of crimes. Women tend to be more involved in fraud, whereas men are more likely to commit assaults and burglary.

Lastly, while men have more run-ins with the legal system, women have more dealings with the mental health system. This is a phenomenon which has been studied in some detail and which, can perhaps be put down to the different ways that society has of dealing with men and women who are marginalized. In terms of women, physical health, respiratory, cardiovascular and digestive related problems develop more rapidly than for men. In addition, women are more exposed to violence. There are more cases of infection, unwanted pregnancies, underweight births and potential child abuse or negligence.

The area which has been studied in the greatest detail is addiction treatment. There is the phenomenon called spontaneous remission. Many people, when they get into their thirties either stop using drugs altogether or tone down their habit. There is an obvious phenomenon of maturity in terms of drug use.

Among long-term users, we also see the retirement phenomenon, that is these individuals become fed up of their drug-using lifestyle. These individuals lose interest in the ongoing quest for drugs and for the pleasure that these drugs can provide them. In fact, it can be equated with a type of cost benefit analysis, whereby as the individual gets older, he/she decides that the habit is no longer worth it. The individual considers that the negative impact of his/her habit is no longer worth it. The individual, therefore, decides to break his/her dependency.

It has in fact been observed in groups undergoing treatment - and this is a theory - that there are two groups of people trying to stop using. First, there are people who have mainly used opiates on a regular basis for six or more years. Second, there is the group of users who have been using for two years or less and no longer want to deal with the secondary effects of drugs.

It has also been observed that there are two "exits" from addiction. The first "exit" is through spontaneous remission, where people rely much more on their natural network or self-help groups. They mainly want a change of lifestyle and environment. The other "exit" involves people who seek treatment and want to work mainly on the phenomenon of addiction.

As for treatment, it has been observed that female participants are fewer and treated for shorter periods of time owing to significant barriers to treatment. For example, women with children fear losing them while undergoing treatment. In general, they are stigmatized. Society's perception of women in treatment is still quite negative. It is also a field dominated by men. The demands of child care, in terms of the time investment, are also an obstacle.

On the other hand, women who seek treatment have more serious problems. It is a known fact that the availability of support at home and in the community is very important, both for men and women. However, it is also well-known that women have less support from friends and family than do men.

To date, the rehabilitation process has not been studied extensively. Nevertheless, very clear phases have been identified. The first phase is the "awareness" phase; that is when a person experience a critical event and decides to "kick the habit." This awareness is thus caused by both a critical event and fatigue.

In this case, a decision is made but not necessarily followed by a formal or informal request for help. With some individuals, this may happen very quickly, or it may take a number of years before a person takes steps to stop using.

Prior treatment experiences thus take on a different meaning, because they serve as experiments. People who have experienced different approaches with different workers know exactly where these steps will take them; to them, these steps are very meaningful.

Following treatment, the stabilization process is thought to involve two overlapping phases. Initially, the goal is to "kick the habit," to break free from both addiction and the environment, and then to rebuild a life and get rehabilitated. There are currently some very interesting studies being done with people whose use has levelled off or stopped completely for a number of years. The results are quite interesting.

First of all, very few of these people are happy. In fact, at the end of the report, which is supposed to be very scientific and serious, and this finding may come as a surprise, it can be seen that those who manage to rebuild a social life have a very hard time finding meaningful relationships, such a love life, which is an important part of life.

At the same time, these people experience ongoing withdrawal symptoms and remain in a constant state of mourning. In addition, a number of individuals remain involved in marginal and criminal activities because they become first-rate dealers; they know the ropes, both in terms of where to go and how to communicate.

What is quite clear, despite what one might think, is that once the substance abuse or even use stops, all the other areas of life do not necessarily improve. Legal or employment problems persist. Psychological distress levels are higher than average. Do not think that putting an end to drug use will affect the other areas. It appears, in fact, that each area is independent.

I would like to conclude my comments on this table by saying that the trajectories are not linear. This is not something that is settled once and for all. This table is actually a prospective study. It followed 300 young people who had checked into an opiate treatment centre. Eleven years later, researchers looked into what had become of them.

This study is interesting because out of 300 young people, only 32 could not be located 11 years later. So the researchers lost track of very few of them. Of these young people, it can be seen that 24 per cent improve. That is a kind of constant. It is believed that approximately 3 per cent per year of former opiate users will improve. If you look at those with the best results, as well as those with the next-to-best results, it amounts to 36 per cent over 11 years; so 3 per cent per year comes to roughly the same thing. In addition, 2 per cent of them will die. We see here that 26 per cent of them died.

In the category of those whose condition worsened, we also see that some of them "substituted," in other words, when they stopped using opiates, they switched to alcohol and tranquillizers. Eleven percent of the group remained junkies.

It is also interesting to note that a study was done of the 31 people who died between 1980 and 1984. What was their status four years earlier? Which category did they belong to in 1980, the last time they were assessed? What is disturbing is that among those who died, three had been in the best-results category. Seven were in the second category. So one third of the group was doing well, according to the results criteria, and yet they died in the following four years.

We also see that of the 85 people who were in the top category in 1984, only 53 remain four years later. That means that in a way, there are no guarantees, and that even after 11 years, these individuals are still at risk.

We speak of trajectories, but the timelines and the idea of reaching the end of a trajectory are still up for debate. Perhaps there has been too much emphasis on treatment and not enough on post-treatment support and especially on awareness of the process. In fact, society provides very little support, and there are very few positive images - this was the finding of a sociologist - of former users who have reintegrated into society.

The Chairman: Thank you, Dr. Mercier. As I said at the beginning of the presentation, the committee is focusing, in the first major phase, on cannabis in its context. Based on your work, what recommendations would you make specifically with respect to cannabis?

Dr. Mercier: I think I will make a recommendation based on what is known about the trajectory. We know that cannabis is a significant issue in groups of people who have stopped using or whose use has become quite controlled and moderate following adolescence.

It also appears that the issue of cannabis has a lot to do with trends; epidemiological use studies show that there are times when young people consume more alcohol and other times when there is greater cannabis use. These phenomena are somewhat tied up with socialization, socializing and partying among young people and teenagers.

The Chairman: With respect to the other phases of the trajectory, there are no cannabis users. We cannot disregard this fact. Other witnesses have shown us that there is at least some cannabis addiction, chronic use or problems. That is where my question was coming from. Do the analytical criteria from your presentation also apply to problematic users, even if most users disappear during the first phase of the trajectory?

Dr. Mercier: The analytical criteria I presented do apply to the overall cannabis use pattern. For each phase, there are "exits." Cannabis use does not normally have fatal consequences. A decision to seek treatment or spontaneous remission may occur at any point.

[English]

Senator Banks: We have often heard in this committee conflicting testimony on the question of whether cannabis, which is the particular focus of our study at the moment, is a stepping stone or a gateway leading directly, almost causally, to the use of what are generally characterized as more harmful drugs. Could you relate for us that concept on the one hand and the trajectory on the other?

Would you please comment on the relationship that you see between cannabis use and heroin or cocaine use? It would be equally provable that every one of those heroin and cocaine users drank water and we cannot conclude from that that drinking water leads to cocaine use.

Is there a causal relationship between the softer drugs and the harder ones?

Dr. Mercier: Absolutely not. Not at this time. I can document this from a literary review. Some of my research is with street kids. Consumption patterns have drastically changed in the last five years.

We have all heard that you start with alcohol, then you smoke a bit, then you try LSD, and after that you go on coke, and the last step is heroin. However, that is absolutely not the case. That is because all the drugs are available on the market and the prices are not so different. The availability is there.

The kids are at home in the basement on Friday night and they decide to go downtown for kicks. They will have heroin that night. I do not know if it is documented in terms of biology or things like that, but on the real scene now it is not the case. You do not have this escalation we used to hear about.

For instance, many people will smoke and after that they will have coke, pills or whatever is there.

Senator Banks: You talked about signs of moving from one phase to the next. Parents, and maybe friends and spouses, would be very interested in hearing whether there are characteristics that users clearly exhibit with regard to daily behaviour that would indicate that they are about to enter the next phase.

Dr. Mercier: There are some experts who will tell you that there are absolutely clear signs. They say that kids in kindergarten or daycare who are very shy or very active are at risk for drugs. This is a way to see things, but such an approach can be as harmful as it can be beneficial for the kids.

Senator Banks: How?

Dr. Mercier: If you say that a six- or seven-year-old kid is at risk of becoming a young offender or becoming a drug abuser, then you will see him in this perspective. You will start acting differently with him. You will refer him or her to special services instead of saying, "This kid is so shy, I really have to go with him and just try to take him with the group." Your reflex will be to take him out of the group and send him to a specialist. This issue is very controversial and it is happening more and more in the schools.

Senator Banks: Yes, it certainly is. In your research, do you normally use a sample size of 300 as in the example in the chart before us? That is a very substantial sample.

Dr. Mercier: My current studies are of people who have moved out of drug dependencies. I am working more with the qualitative, working with interviews and things like that. I am also really interested in young kids, those who come to the street, those who get out as well as those who stay there. The difference is that those who stay on the streets have been involved in drugs. This is not an issue for those kids who come downtown just for kicks. For many of them, it is a matter of one summer. They may have some problems going back to the mainstream, but they go back.

Senator Banks: When you are following that sample group in the prospective study, you are not isolating out any one particular drug from any other in terms of being able to focus on, for example, the cannabis use among those kids in particular? Do you separate that out?

Dr. Mercier: No. First, Dr. Richard Tremblay, who you might have heard of, has done this prospective study in Quebec and he has done some of the best prospective studies in Canada and even in the world. He is the one who, from his studies, can tell you at three, five or six years of age, when kids have particular characteristics you can predict that they will have problems with drug use 10 years later. He has documented that very closely. I have not done this type of study.

I am doing a field study in the streets in Montreal. Everything is mixed in this study. The subjects use cannabis, cocaine, as well as take pills and drink a lot of alcohol. It is the same at parties where there is use of marijuana and alcohol, so it is difficult to think of something like a passage from alcohol to marijuana and to PCB.

Senator Banks: It seems almost casual rather than causal.

Dr. Mercier: I agree.

[Translation]

Senator Maheu: I have listened to your comments with keen interest. I was trying to remain within the spirit of the discussion on cannabis. However, in listening to you, I had more and more questions about Ecstasy, the new drug our young people are using. With respect to your study, which is, after all, 20 years old, how would Ecstasy change your data or the approach you took in your study?

Dr. Mercier: I will give you a hypothetical answer because I really have not studied this drug, Ecstasy, and can only answer based on my first hand experience. I think Ecstasy is part of a separate culture. I believe it is closely associated with techno culture. I would say it is almost a self-contained world. I really cannot comment or answer your question in detail because it seems to me that when it comes to the whole Ecstasy phenomenon, it might be a mistake to think of it as just another drug. In order to understand what Ecstasy is, you have to understand that it is actually the drug that stands for the joy of partying and that there is a whole context surrounding it. It must not be treated the same way as a drug that is used according to other drug patterns. I think the pattern of use and the culture surrounding Ecstasy have to be considered separately.

As for the harmfulness of Ecstasy, I really cannot say. I read articles about it, but I do not know enough about it.

Senator Maheu: When you say a separate culture, how can you use those terms when we are talking about the drug of today's youth? It is not a separate culture, it is the young people of today.

Dr. Mercier: I used the term "culture" in the anthropological sense, meaning, in fact, that it is a culture, a world, a sub-group. We can speak of punk culture, in the sense that these are people with a set of values, discernable physical features, and social and other activities of their own. That is what I meant when I said there was a culture. Drugs and alcohol have their place in punk culture. In the techno and "rave" culture, Ecstasy plays a major role. That is why I feel it has to be approached from that perspective.

The Chairman: Dr. Mercier, you referred to Dr. Tremblay. We heard from Dr. Zoccollilo. Are you referring to the same team?

Dr. Mercier: Yes.

The Chairman: We already have that data, but it has to do with teenagers. You referred to younger children.

Dr. Mercier: Dr. Tremblay's first longitudinal study was of children aged five or six.

The Chairman: We do not have that. Are you familiar with the Toronto Drug Court, with that use of the court system?

Dr. Mercier: No.

The Chairman: It is an Ontario experiment. Perhaps your colleagues would like to talk about that later. Based on the data from studies by Tremblay, Zoccollilo and others, what can you tell us about the current situation of the young people you are in contact with? Does the treatment approach need to be changed? First of all, is the treatment objective - abstinence - the right one? Abstinence from what?

Dr. Mercier: I think all groups will use research data to show that they are right. However, I think what has fundamentally changed in treatment models is that they are really much more pragmatic.

There was the harm reduction model, but one of the consequences of this model is that the actual goal of treatment is not only to stop controlling the negative consequences, but also to produce results. It is abundantly clear that abstinence for young people in their early twenties is not an objective that is going to motivate them. Nor is it necessarily a realistic objective, given the world we live in.

It may not even be a desirable objective because - and we see this increasingly - abstinence may also have quite significant social and psychological secondary effects. So current models increasingly advocate an attempt to better balance the individual's and the treatment's objectives. At this point, the most important change is greater attention to the person in treatment; what are the individual's objectives, and why does he or she wish to end, bring under control or change his or her involvement with drugs.

From this perspective, the feeling is that there are greater chances of achieving results, which are not the results expected by the therapist - complete abstinence eventually - but rather results that will have an influence on the individual's life, physical health, social health and psychological well-being.

The Chairman: Precisely, if the therapist's objective is abstinence, with everything you have said about "exits" or breaking free, which is very much a part of your current research, what happens to quality of life, self-esteem and social reintegration? Are we not in fact finding that total abstinence is not the solution or that it has to be adjusted to the individual?

Dr. Mercier: That is precisely what I am trying to demonstrate. I think there are two compelling arguments. The first one is that total abstinence is not the whole story. In fact, the best dealers are former users, who are actually no longer at risk, are still under control and perfectly familiar with the environment.

The Chairman: They are part of the 24 per cent?

Dr. Mercier: That is right. In fact, they do not use, so they are absolutely perfect. My second argument is that when you set your sights too high, you are in for a series of failures. In order to reach a goal, more attention must be paid to individual dynamics and potential. Set one goal at a time. For example, going back to cocaine inhalation rather than injection makes it easier to succeed. Injection related risks are thus avoided. The objectives are adjustable.

The Chairman: There are four cornerstones to Canadian policy. Prevention is the one that interests me this morning. Have you seen any improvement nationally in prevention measures? If so, should we continue, and if not, what do you suggest?

Dr. Mercier: To assess prevention campaigns, the consumption curves for the various substances are the best indicators.

The Chairman: I am referring to problem use.

Dr. Mercier: There still has not been very much change in the consumption of illegal drugs. As far as alcohol is concerned, the trend is downward. There are no serious studies that demonstrate that prevention campaigns have an effect on use. Secondary prevention campaigns are the most useful and effective, because they are targeted at very specific things. The campaigns to prevent people from driving while under the influence, such as Alcochoix or Operation Red Nose, are excellent examples. These campaigns have shown that prevention really can change things.

As for primary prevention, there are two major schools of thought that are quite contradictory. Of course, we have the approach advocated by Richard Tremblay's team, which focuses primarily on targeting children at risk. The other approach, particularly for children and youth, is to work more on the environment, thus, at the level of the family. This second approach is at the level of family policy. For example, the 1, 2, 3, Go! project in Montreal provides a comprehensive preventative approach. We begin by ensuring that there is enough food in the house. Children who are well nourished and parents who are supported within a good social network contribute to long-term prevention.

The Chairman: You are talking about a perfect society.

Dr. Mercier: Perhaps people see it that way. The community kitchens in the schools enrich the child's environment, thus encouraging him to stay in school. Preparing meals in a group allows the mother to expand her social network. The children will be well nourished. This is a very practical approach. It is a matter of creating a well-organized network with experts who can help problem children.

I tend to favour the comprehensive approach. We should be working on the child's environment: his family, his apartment building, then his neighbourhood.

The Chairman: Thank you very much for appearing before us.

We will now be hearing from Dr. Serge Brochu. Dr. Brochu received his doctorate in psychology from the Université de Montréal in 1981. Since 1997 he has been a full professor with that university's Criminology Department. He is the author of the book Drogue et criminalité: une relation complexe.

Describing his research over the past 10 years on this topic, he has also worked with L. Guyon, Mr. Michel Landry and Mr. Bergeron on publication of the book L'évaluation des clientèles alcooliques et toxicomanes.

Mr. Brochu, thank you for accepting our invitation. We are inspired by the interest that you take in our work. As I was telling the previous witness, you will have an opportunity to make your presentation, and then we will ask you some questions. And since our research staff is very efficient, I certainly will have some questions to send you in writing, and I will patiently await your response.

The letters that I send our witnesses as well as the replies are posted on our Internet site. So please do not hesitate to give me all the documentation that you think is relevant.

Dr. Serge Brochu, Director, International Centre for Comparative Criminology, Université de Montréal: It is an honour to appear before your committee, which I believe is doing very important work, because in the area of drugs, we must take nothing for granted.

With regard to Canada's anti-drug policy, it is important to talk about the kind of control that we want to exert. I believe that all Canadians agree that drugs must be controlled in some way, and we must determine whether the criminal system is the best way of exerting control in this area.

Today, I would like to say a few words about the link between drugs and crime in terms of psycho-active substances, since we cannot remove alcohol from the equation and the possible link with criminal activities.

Psycho-active substances are those that have an effect on the central nervous system, such as alcohol and illegal drugs. Many studies in this area have been carried out over the past ten years. Just in my office at the Université de Montréal, I have2,973 studies that attempt to show a link between psycho-active substances and crime. Most of these studies come from the United States or from English-speaking countries, which tends to colour their perspective somewhat, since we know that our neighbours to the south have very clearly opted for a punitive approach to illegal drugs.

What comes out of all these studies is that the link between drugs and crime is very complex. One might think that the substance taken is important, of course, but we must remember that the substance is being taken by a person who may have a history of delinquent behaviour or a criminal background, or the person might have anti-social tendencies, and all of this may be within a context that favours criminal activity.

We are going to have another look at the relationship between drugs and crime at the end in order to better understand the various kinds of relationships between these two factors. The first thing to look at is the actual intoxication. Consuming a substance can lead some people to display criminal behaviours. So, these criminal activities can be associated with what we call the psycho-pharmacological effect. Both the properties of the substance and our expectations of the substance can have an effect, and this is the case for any substance.

We must also consider the high cost of drugs. When someone on the street has to pay $80 a gram for cocaine - and sometimes the price is even higher on the street in Montreal - this requires some money. And if you take three grams a day or three grams a week, that really eats into your budget. For people who are addicted, the high cost of the substance can lead some people to move towards crime.

A third consideration is the legal world of drugs. It is a parallel system, and so, if you feel that you have been wronged, you cannot go to the police, and so you then take matters into your own hands. This is what we call systematic criminality, which is linked to the legal supply and distribution system.

These are the three main relationships that we see within the literature. I will try to provide illustrations of these relationships by making reference to Canadian studies. The Canadian data have to do with the first two kinds of relationships. As for the third, we will have to rely to a greater extent on the social context of our neighbours to the south.

Regarding the first kind of link, intoxication, we have obtained data from 8,593 inmates throughout Canada's penitentiaries. These penitentiaries hold people who are serving sentences of more than two years, which are relatively long compared to the sentences served in prisons.

We first tries to determine the alcohol and drug consumption rate amongst these people. On the screen, you can see the alcohol consumption rate. We see that 95 per cent of federal inmates declare that they have consumed alcohol in the past. This is slightly higher than the general population in terms of consumption. We also see that 63 per cent declared that they had used alcohol regularly during the past year. I should point out that some of these people were incarcerated during that time, which limited their alcohol consumption. Twenty-one percent said that they had taken alcohol only on the day of the offence. In a few moments we will see that some took both alcohol and drugs on the day that they committed the offence.

Now, with regard to drugs, 80 per cent of the inmates declare that they had taken illegal drugs in the past, and this figure is much higher than for the general population, because for this age category, approximately one third of all Canadians admit to having taken illegal drugs. In this case, the self-reported rate of consumption is much higher.

Sixteen percent of the people said that they had only drunk alcohol on the day of the offence, whereas 13 per cent said that they had drunk alcohol and taken drugs on the day of the offence. So, about half the people took illegal drugs or drank alcohol on the day they committed the offence, because in addition to the 21 per cent and the 16 per cent, we must add the 13 per cent who drank alcohol and took drugs.

This first graph shows that illegal drug use is much higher among the Canadian prison population than among Canadians as a whole. Some will say that it was drug use that led these people to commit crimes. Others will say that drug use led these people to be caught. That is a different way of looking at the issue.

Let us look at the substances behind violent crimes. In terms of homicides, 31 per cent of Canadian prison inmates said that they had consumed alcohol on the day of the crime. Eight percent of them said that they had only taken drugs and 19 per cent alleged that they had consumed an alcohol drug mix. Of those who committed homicide, 50 per cent had consumed alcohol on the day of the crime.

In terms of assault, 38 per cent of inmates stated that they had only consumed alcohol. Of the 8 593 inmates, 9 per cent said they had only taken drugs and a further 22 per cent said that they had taken both. As a result, the profile for homicides and assault is very similar.

These Canadian statistics are very similar to scientific data available in North America. Consequently, we can conclude that alcohol remains the most prevalent psychoactive substance in violent crime.

We can compare this situation with money-related crimes, whereby the individual is attempting to obtain money to buy alcohol and drugs.

As for armed robbery - a violent crime - with the objective of obtaining money, a different profile emerges. In crimes of this type, illicit drugs dominate. Twenty-five percent of offenders consumed illicit drugs on the day of the crime. In addition, a further 17 per cent of offenders consumed both alcohol and drugs. This is a totally different profile from the preceding one.

In terms of break and enter, the same profile predominates, where offenders consumed only drugs. In the case of theft, we see the same drug dominant profile. As for fraud, there is no difference between alcohol and drug consumption and drug-related crime.

There are two very different profiles. Firstly, alcohol-related violent crime. Secondly, illicit drug-related money crimes. We are now looking at intoxication, and therefore we will look at the economic aspect later.

The Chairman: This is an important issue, because the authorities in Toronto based their decision to set up a special drug-related court on these findings.

Dr. Brochu: In terms of the psychophysiological aspects, there are various explanations which allow us to understand the situation. I would just like to add that some of the explanations are not based on scientific evidence. It is thought that alcohol may induce aggressiveness. We are well aware of that most Canadians who have in the past or who continue to consume alcohol have not necessarily become violent afterwards. Quite the opposite sometimes, they often become much softer.

Some theories state that alcohol induces a loss of inhibition. This is the theory which is most often bandied about. It is thought that we all have inhibitions which impede our aggressive or warm hearted impulses and, it is said that a couple of glasses of an alcoholic drink suppress these inhibitions, therefore, giving free rein to our impulses. However, for this to happen, a person must have impulses. We think that people with antisocial personalities are more likely to commit violent crime. In other words, these are the individuals aggressive proclivities.

However, anthropological studies have clearly shown that there are specific circumstances and physical settings which induce violence. For example, in bars, which are normally overheated, places where the air conditioning has broken down, venues where people are crowded together, where a lot of alcohol is being consumed and in specific districts. There is more violent behaviour in these types of places than in a hotel lobby where there is soft music playing and seating which is well spaced out. Even the physical environment has an impact on violence.

We live in a society where people sometimes have expectations in term of alcohol consumption. While in our society, we equate alcohol consumption with aggressiveness or a certain permissiveness, we allow intoxicated people to behave in ways that would not otherwise be tolerated. We have expectations and we can consume alcohol so that we can behave in a particular way. We should not brush aside this so-called psycho-pharmacological aspect of the phenomenon. It is not only the properties of the substance which are important, but also the expectations that are created by the use for this substance. Taking the particular substance may be a handy excuse to justify socially unacceptable behaviour. It will always be possible to state, after the fact, that we simply had to much to drink. That is sometimes socially acceptable.

The Chairman: The courts no longer accept this argument.

Dr. Brochu: No. Society should no longer accept this either. However, it does. Sometimes women who have been beaten will say that their husband was drunk and if he had not been drunk he would not have beaten them up. This is an argument that is used on a social level. Feminist organizations are really against the use of this argument and they make great use of the part of the theory to argue that this is only an excuse and that we should not tolerate this type of behaviour, and with reason.

Let's look at the economic aspect of the phenomenon and the second type of drug-crime relationship. Early we saw the figures on this important aspect in terms of illicit drug use on the day of the crime for 8,593 inmates that we questioned. We saw that it was quite different from the issue of intoxication. Things become clearer, when you understand that most of the offenders had taken cocaine - the drug of choice - on the day of the crime. Cocaine is expensive and many of these offenders were addicted to cocaine. There remains the issue of whether a person is psychologically or physiologically addicted to drug, but the fact remains that these people had a drug habit and they had some difficulty in going without their fix.

A series of studies was conducted in Canada, including one on federal penitentiary inmates, that I mentioned earlier. I want to show you the proportion of inmates who stated that they had consumed drugs, and committed their crime to obtain psychoactive substances.

We also questioned 248 Ontario penitentiary inmates, 221 federal penitentiary inmates in Quebec, 100 women at the provincial penitentiary in Tanguay, and 94 men at the Provincial Detention Centre in Montreal.

Fourteen per cent of inmates stated that they committed their crimes with this specific goal of obtaining illicit drug. Seven per cent of them said that they intended to acquire drugs or alcohol, while 2 per cent stated that they intended to obtain alcohol. It is understandable that a few crimes were committed for alcohol because very low cost alcohol products are available. We might wonder way, but the percentage is low. The cross-Canada study on 8,000 inmates paints this picture.

It is very interesting to note that when we conducted our study, the results were the same for Ontario inmates, nearly identical for federal penitentiary inmates in Quebec, the same for female inmates and similar for male inmates at the Montreal Detention Centre. Consequently, there is a constant here. We can say that between 17 and 24 per cent of inmates stated that they committed their crimes with the specific goal of acquiring illicit drugs. When I say between 17 and 24 per cent, I am adding the drugs only, pink column and the drugs and alcohol, purple column. These results were born out by drug tests. These inmates were addicted to drugs and in a majority of cases, cocaine.

Illicit drug use promotes crime - frequently violent crime -because some drug users get into debt with their suppliers. People want to be paid, and those higher up the flag pole, when they lend drugs for sale, also have to be paid. These disputes also have to be addressed. They take the form of threats, violence and altercations between sellers and customers. Of course, drug peddlers attempt to make as big a profit as possible by mixing substitutes into the drugs they are selling. Customers, for their part, attempt to acquire a quality drug that is as pure as possible and sometimes, either the customer or the peddler feels that they have been had.

Turf wars and violence occur mainly when a new product emerges because the particular area in question has not yet been claimed by one particular group. When a new drug emerges, there is sometimes more violence in the battle for this area.

Managing reluctant workers is an area where poor choices are often made. These workers are chosen for their force of character and their muscles. This can often backfire against those people at the top of the network.

Most of the available studies were conducted in the United States. This is a country with a much greater level of systemic violence. Studies conducted by Pat Erickson in Ontario show that systemic violence is on a much greater scale in Canada than in the United States. Their are more threats in the drug-related community but far fewer violent acts or settlement of scores than in the United States.

I would like to go back to the triangle we looked at at the beginning to show you the relationship between drugs and crime. We have talked about the substance, the type of products consumed, frequency, intensity, the method of consumption, anti-social persons, people with violent proclivities and the environment.

Let's now turn to what we know about the relationship between drugs and violence. One substance stands out. The dominant substance here is alcohol. Not all people who drink alcohol have problems of violence. We find that those who consume more than five glasses of an alcoholic beverage sometimes manifest violent behaviour. This takes place in the permissive environment where access to the drug in question is relatively easy. This is unlike the situation of illicit drugs where it is the repressive environment which promotes violence. This violence is systemic.

In this case, the substances are illicit drugs sold on the black market. Who is involved in this drug-violence relationship? Well, people attempting to take advantage of the illegal drugs market, a bit like the situation in terms of alcohol during prohibition in the United States. Al Capone took advantage of a market in a repressive environment. This enabled him to make major profits. A study conducted in Chicago showed that petty street traffickers were earning up to $40 an hour, tax free. That is a lot of money. These people from disadvantaged backgrounds could not earn as much money legally. The repressive background enables these people to make money without addressing any of the squabbles within this market, because it is, of course, illicit.

A third type of relationship between money or lucrative crime and substances is based on illicit toxicomanogenic substances. The more a substance is toxicomanogenic, the more it is addictive and the more it is likely to be linked to crime if it's expensive. This is an important aspect. We refer to this as the economic-compulsive aspect. If I can go without a particular product, then I don't need to commit a crime to obtain the product. If the particular product in question is inexpensive, I don't need to commit a crime to obtain it either. You must remember that some people do indeed consume and are addicted to these expensive products without becoming criminals. These people have an easy access to a particular product, often because of where they live. In Switzerland, heroin is being prescribed on an experimental basis. In that country, we are seeing a clear drop in crime. Studies have clearly shown that people no longer need to turn to crime. Some of these same people were previously criminals.

We find that those people who get into criminal activity and who were not criminals before they became addicted will commit minor crimes, such as shoplifting, petty trafficking, or in the case of women, prostitution. Prostitution is less and less common among women however. They now prefer fraud or peddling. Those people who are already involved in criminal activity will tend to turn to armed robbery and more serious crimes.

This relationship between money-oriented crime and drugs often occurs against the backdrop of difficult access to drugs. If an individual is unable to get access to a drug of choice or to alternatives or if he/she does not want to make do with these alternatives, they are likely to get pushed into criminal activity. If access to treatment is difficult, a person may also tend to opt for crime. This is a complex relationship.

Imprisonment does not necessarily address the problem. A study that we conducted recently in Canadian penitentiaries in Quebec showed that inmates are taking drugs there too. We asked inmates to tell us about their drug use habits over the past three months of imprisonment. All the inmates were men. Sixteen per cent of them told us that they had consumed alcohol, whereas 29 per cent said that they had taken illicit drugs. In the majority of cases, these inmates were taking cannabis, whereas on the outside, the same inmates used to take cocaine. This is a significant change. Why were these people consuming cannabis, which is more readily detectable by its smell and by the traces it leaves in urine? Cannabis is detectable for 15 days after it was consumed, whereas cocaine can only be detected for 48 hours afterwards. Inmates want to escape. Cocaine is a stimulant which brings the inmate back to reality and this is not the desired effect. These people want to escape. Tranquillizing substances are the favourite. Sometimes they take benzodiazepine. However, they are easily able to get their hands on cannabis.

In terms of heroin, few inmates had a heroin habit before they were locked up. Consequently, few of them continue to consume inside because this drug is much more expensive. Drug prices in a penitentiary are much higher than they are on the outside. However, European studies show that in those countries where heroin is much more popular than in Canada, inmates continue to take this drug in prison. Thirty-three percent of inmates stated that they had consumed alcohol and drugs while in the penitentiary.

In a penitentiary, most of the alcohol consumed is homemade and is manufactured in the penitentiary. This type of alcohol is associated with drunken revels. Consequently, whenever there is a party with visitors or a show in the penitentiary, most of the alcohol consumed is moonshine.

As a lead into the following presentation by Michel Landry on the impact of treatment in terms of those individuals caught up in the judicial system, I want to mention some studies on this issue. Dr. Landry is going to talk about Quebec studies. The impact of treatment on these people is that they unfortunately tend to drop out of the treatment program quite quickly, even before the therapy has taken effect. At this time, there is no particular way of keeping them in the treatment program. Dropping out of treatment leads these people to go back to their old ways. In the United States, there is legal pressure to keep these people in treatment programs. When these people remain in treatment programs, the success rate is identical to the rate for the population as a whole. We should point out that some people who go into the detoxification treatment don't do it voluntarily. Some enter these programs because they are under pressure from their family, some come because of legal or employer-related pressures.

Legal pressure is quite different from pressure from friends, an employer or a family. The fact remains, however, that if addicts see their treatment program out, their success rate is fairly similar to that of other drug addicts, who are not caught up in the legal system.

Treatment works best when it is conducted in a community rather than in a detention-like setting. In terms of investing in treatment, this investment should not only be made in treatment in a detention setting but also in treatment in a community environment. It is however, preferable to begin the treatment process in the penitentiary. When an offender is sentenced to prison, he or she should not in fact be sent to a penitentiary. Imprisonment often leads to an individual becoming hardened. The environment surrounding the individual means that the inmate will not open up to other people. The therapy used in the treatment process attempts to break down the shell that the inmate has withdrawn into when he or she was imprisoned.

American studies show that short and long-term costs are much lower when treatment is conducted in a community setting rather than in detention.

The Chairman: Thank you, Dr. Brochu. I would like to come back to the issue of the special court. You said that this type of court represents a positive approach.

Dr. Brochu: Several studies have been conducted on drug treatment courts. A study in Ontario has just got underway and it is not yet possible to have clear results. In the United States, several studies have been carried out on the effects of this type of court. It seems, that in the short term, these types of courts have a positive impact. However, treatment does not necessarily have to be carried out through a drug court. Treatment can be conducted following parole or it may even be a condition of parole. There are different ways of referring a person to treatment without necessarily going through the drug court. If you look specifically at the impact of drug courts, american studies show a positive result in the short term. The problem is that there are few places for people referred to treatment by the justice system. The same problem exists in the United Kingdom where drug courts have also been set up. The system does just not have the capacity to take in all those referred.

The therapeutic injunction system has been in place in France since 1970. A study by a colleague at the Institut national de santé et de recherche médicale, in France, showed that many people fell through the cracks because of the therapeutic injunction forcing them to follow a treatment program. These people were never treated, because there were not enough places or follow-up. If we want to set up drug courts in Canada, we shall have to plan effectively and organize consultation mechanisms with the treatment systems to ensure that the required treatment services are available. If we fail to do this, setting up drug courts will be nothing more than a sham, if the people requiring treatment fall through the cracks of the system.

The Chairman: Could we, using the statistics tabled on the screen, compare the alcohol and drug consumption of those individuals who have committed crime?

Dr. Brochu: In terms of consumption throughout an individual's life, over the past 12 months or over one day, the figures are very different from those for Canadians of the same age in general. Reports have shown that approximately a third have consumed alcohol or drugs during their lives, but here, the figures are much higher.

The Chairman: In a penitentiary setting, the federal aspect becomes much more important, both because the legislation prohibiting substance use is federal and because the imprisonment- related legislation is also federal. That raises two problems. If we look at your figures, we can see that imprisonment is a deterrent. The money-related aspect offsets this deterrent somewhat. In other words, the more money one has, the easier it is to consume a substance. Are the monitoring initiatives in the prison system efficient?

Dr. Brochu: It is difficult to maintain this balance. Paradoxically, the objective of detention is the release of the inmate. In order to release the inmate, he needs to be able to have access to social life, he needs therefore to have visits and to go out. Of course, drugs enter the walls of the prison during these visits. When an inmate has permission to leave the prison, he can bring drugs back in. We can search everybody. We can subject everybody to urinalysis. At the same time, we have to consider the Charter of Rights and Freedoms. If we were to search every visitor who would come into contact with inmates, we would be breaching the Charter of Rights and Freedoms. In my opinion, it is impossible for the prison to be a drug-free location as long as we continue to have dealers and users under the same roof. We have the perfect setting for passing drugs. Iron detectors, urinalysis and searches make such transactions difficult. Nevertheless, drugs are used. Drugs are also being used in European penitentiaries.

The Chairman: The study you published two years ago raised eyebrows amongst the government representatives responsible for the correctional system.

Dr. Brochu: In Canada, the Correctional Service does random urinalysis testing. These tests detect cannabis in the urine 15 days after consumption and, for other products, 48 hours after consumption. Consumption rates are still quite significant. The finding show that the conclusions of these reports are not very different from the random urinalysis testing.

[English]

Senator Banks: Can you tell us about methodology and the results that you extrapolate from the methodology? For example, you have just been talking about drug use and alcohol use in particular being high among people who are in prison for violent offences. Do we derive from that that drug use, including alcohol use, outside the penitentiary is more likely to land you in the penitentiary, or do we derive from that that going to penitentiary is more likely to lead you to drug use, or both?

Dr. Brochu: This is a very interesting question. It is very difficult.

[Translation]

We did a study showing the relationship between drugs and crime amongst inmates at the Montreal Penitentiary.

We observed that, for most men, minor crimes occurred before or at around the same time as alcohol consumption. This was followed by cannabis consumption and, much later on, the use of cocaine and heroin. On average, the individuals began using cocaine at the age of 18 whereas the crimes were perpetrated much earlier on.

It can be concluded that, for most people incarcerated at the Montreal penitentiary, the crimes began occurring at the same time as alcohol consumption. At one point, the individual became more involved in drug consumption, but beforehand, he was more involved in deviant behaviour. This is also a lifestyle where consumption, pleasure, drugs and racy behaviour go and in hand. This is very attractive for a young person who is looking for the rush that comes with alcohol, drugs and small crimes. In chronological order, often, for the people who are in the Montreal penitentiary - several studies have corroborated this - small crime occurs well before the consumption of costly drugs and well before drug dependency.

It is a bit different for woman. We conducted the same study with female inmates at the Tanguay prison. We observed that drug consumption occurred before small crime, which was perpetrated in order to get the money to pay for the drugs. At the beginning, the drugs were often offered as a gift to women, and this was done in different ways. Once the women is no longer receiving these gifts and has quite a costly drug habit, she may very well commit lucrative crimes in order to be able to buy drugs. Your question is quite relevant. As far as the men are concerned, most of them were already exhibiting delinquent behaviour before their drug addiction occurred. They used whatever lucrative means they knew of in order to meet the requirements of their drug habit.

We are in the process of completing two studies on very regular cocaine users. At the beginning, we noted that cocaine consumption occurred on a very irregular basis, and this lasted quite some time. It was initiated for pleasure. At one point, consumption, particularly for women, becomes associated with luxury and considerable pleasure. We followed two cases. For the women, this becomes associated with a lifestyle of excess and crime, in this case, is perpetrated so that this luxury can be bought. However, at this point there is not necessarily any dependency. When dependency occurs, things fall apart. At the beginning, these women used the money they obtained from the crime to purchase drugs but they also bought luxury items: beautiful clothing, jewelry, restaurant dinners, evenings in bars, et cetera. When they became dependent on the drug, they could no longer afford these luxuries and all of the money was used to purchase drugs. However, not everybody reaches this stage.

[English]

Senator Banks: You are saying that is it is not the case that drugs have led to crime, but that crime has led to drugs. That is the opposite of much of what we have heard. It is a new idea for me.

Professor Mercier also talked about something that I would like you to address. She said it was difficult for women, because of social impediments, to obtain rehabilitative treatment. I assume that the same thing would be true in prison.

Professor Mercier talked about the pressures of leaving children to other care and just general social pressures that seemed to make it less likely that women would enter treatment programs, even in prison. What can we do to fix that?

[Translation]

Dr. Brochu: This is a very difficult problem, particularly for women. Child custody is an issue that pertains to a small number of women that are incarcerated in Canada. At Joliette, in Quebec, there are very few women, and out of this number, not all are drug addicts. It is difficult to provide specific programming for them.

At one point, we did provide separate programming for the women because some of them had been physically and sexually assaulted by men. It is not always easy to talk about these assaults in front of men. We tried to have specific groups for the women but we went back to mixed groups. Dr. Landry could provide you with a better answer.

Let us go back to the case of the children who sometimes prevent the woman from obtaining treatment. For women, children often motivate them to stop using drugs. That is very interesting. During our study, we asked these women: Why did you stop using? They were afraid that they would lose custody of their children or that they were pregnant. These were regular cocaine users. They were using a lot. When they discovered that they were pregnant, many stopped or reduced consumption. Being pregnant or wanting to keep one's children makes many users reduce or stop cocaine consumption. They tended to use other products. This may be a factor that we could use to help these women change directions permanently.

The Chairman: Dr. Brochu, scientific research is being conducted, but we do not have enough information about consumption - all of the witnesses have told us this. By investing money, we may find some solutions. Do you think that enough research has been done and that it is time to take action? In other words, if we are to keep things rolling, has the government put enough effort into research?

Dr. Brochu: Considerable efforts have been made by both the federal and provincial governments over the past few years to have more studies on drug addiction. We now have a very interesting research base, but as you say, sometimes it is not well-known. We have problems linking this data to other research. The Europeans chose to establish a monitoring centre.

The Chairman: Are you suggesting that we recommend the establishment of an independent monitoring centre?

Dr. Brochu: Yes. In my opinion, this would be a step in the right direction. We have a lot of research that is not well known. I think that the monitoring centre would enable us to bring this research together and to sponsor some research in areas that are not well-known. We could also have recurrent information. The last study on Canadian drug use is already a few years old. In my opinion, we need a mechanism that can coordinate all of the information from the various departments and ensure that we have up-to-date and recurrent information that we can pass on.

Some monitoring centres buy drugs in order to analyze purity so as to inform users who can in turn prevent overdoses. This information is important.

Legislators must maintain the programs that are currently in place. It appears that the Alliance de recherche université-communauté [University Community Research Alliance] programs, established by the Social Sciences and Humanities Research Council of Canada, will not be maintained and yet this very interesting program put academics, first-line workers and decision-makers in contact with each other. This type of research is not easy to do. The vocabulary is different. Time frames vary from one group to the next: researchers need time to do the research whereas decision-makers want an immediate answer. It took us several years to get to understand each other, but we had gone beyond that point. The partnership with front-line workers - we had learned how to make the research known and to use it to modify treatment so that we would have greater impact - has come to an end due to a lack of money.

The Chairman: Let us talk about the alternative to the current enforcement system. You demonstrated, with supporting data, that the criminal consequences of alcohol consumption are much more obvious than the criminal consequences of illicit drug use. In your text, you concluded that we should examine the consequences and focus our efforts, in terms of law enforcement, on alcohol rather than on illicit drugs. You went so far as to recommend that we control the illegal drug market, which few witnesses had dared to do. Should we follow your recommendation for all psychoactive substances? If not, what would your criteria be?

Dr. Brochu: Easier access to a product increases consumption. It is, therefore, very important that we determine for which type of drug we will facilitate access for consumption. Let us take the example of wine consumption in Quebec. There was a time when the Société des alcools du Québec controlled the sale of wine. Based on this observation whereby the greater the access to a product the greater the consumption which all research has demonstrated, we had foreseen that there would be a per capita increase in alcohol consumption amongst Quebecers. Wine consumption did in fact increase; however, the consumption of other types of alcohol decreased.

Alcohol consumption amongst Quebecers has remained more or less the same. Instead of drinking liquor without food, Quebecers turned to a gentler type of alcohol, less harmful to health and usually accompanied by food.

The access to the products should be based on this model. We would be giving access to a mild product as opposed to hard product. As regards cannabis, we would be regulating the THC content and taking cannabis with an increasingly high THC content off the market.

During prohibition, in the United States, bootleg alcohol with a very high alcohol content was sold. Chartreuse, which is 60 per cent alcohol, is probably the strongest liquor on the market right now. People buy wine containing alcohol levels of 12 per cent or 13 per cent. Very few people consume such strong alcohol. We need to put a soft drug on the market and control it so as to reduce the use of hard drugs.

That will not resolve the problem of heroin addicts. You cannot buy heroin over the counter at the local drug store. Heroin could be sold in pharmacies, but under medical control. The heroin addict, for example, as a result of treatment or easier access to drugs, will reduce criminal activity significantly. A certain percentage of those already involved in crime will continue with this lifestyle, but they will not need to increase lucrative crime in order to pay for their drug habit.

Swiss studies show that crime drops when people have access to heroin prescription program. Since the 1980s, studies conducted by Merck, Ball and Scheffer, in the United States, show that when a heroin addict receives effective treatment, the crime rate also drops dramatically. It is important that we provide the necessary treatment and, as far as legalization is concerned, that we give access to hard drugs, under medical supervision, to individuals who are drug-dependent.

The Chairman: This is the Swiss model. Let us go back to the controlled market. RCMP representatives have cautioned us about the competing markets. On the one hand, the illicit market will drop its prices and, on the other hand, the legal market will sell a product which, given all of the controls involved, will cost a lot more than the illicit product.

Dr. Brochu: Initially, this competition will exist. The government needs to refrain from being too greedy and overtaxing the products.

The Chairman: We need to wipe out the competition.

Dr. Brochu: Indeed. However, all things considered, if I had the choice, I would prefer to buy my wine at the Liquor Control Board, where the quality is controlled, and where I do not risk being incarcerated or getting a criminal record rather than buying contraband products. If the cannabis market were regulated, a lot of people would no longer go to the local dealer, because there are many risks associated with the trafficking of cannabis. The dealer may sell the product for less, but the content is not controlled. I would prefer to go to a place where there is quality control providing that the prices are not unduly high.

We can use tobacco sales as an example. When the sales tax on tobacco is very high, many people began buying their cigarettes on the black market, tax-free. When we remedied this problem, people stopped purchasing from the illicit market because the current legal system was satisfactory

The Chairman: You will certainly hear people say, further to your testimony, that tobacco is allowed and that we are having a dreadful time curtailing smoking amongst young people, that alcohol is also allowed, and that these two aspects are adequate in themselves, that we should not be adding other allowable substances and that we should continue outlawing cannabis. What would you say to these people? Many Canadians think like that.

Dr. Brochu: You have to look at the perverse effect of criminalizing cannabis. A young person who wants to smoke a marijuana joint, as a result of peer pressure or for all kinds of reasons, may wind up with a criminal record. This is a very significant handicap in the life of a young person. Is it not better to control the use of cannabis than potentially handicapping this young person? In my opinion, the measure is not proportional to the problem of consumption.

We must be careful about the way that the drug is marketed. We are not going to say that it is now legal to consume and promote consumption. It has to be a crown corporation that tries to control and not promote consumption. That is different. The most significant probable risk associated with legalization is that there will be promotion rather than control of consumption. We need to legalize cannabis so that we can control it better. We are not going to promote, that is very different.

The Chairman: What do you do with somebody who decides to grow a hundred plants in his or her garden?

Dr. Brochu: We should treat it the same way as we do alcohol.

The Chairman: Making wine in your basement is all right. If it is not dangerous, it should be tolerated.

Dr. Brochu: That is right. You always have to look at the problem. When we design policies pertaining to crime, we think that we are inflicting a problem on somebody. We need to determine whether or not the solution is not creating more problems than the behaviour we are trying to avoid.

Senator Maheu: Recently, at a conference in Ottawa, a representative from Interpol, who is also a member of the FBI in the United States, talked about those individuals who are worried about the drug phenomenon. He said that we needed to open our eyes and stop worrying about heroin, cocaine or cannabis and that we needed to keep a watch over Ecstasy use in our young people. This will be the drug of the future. This pill costs three cents and does not require very sophisticated equipment to make it. If, today, we are thinking about legalizing or controlling the drugs that we are familiar with differently, what would you say about Ecstasy? What could we do in future to control this substance?

Dr. Brochu: It is difficult for me to talk with any certainty about Ecstasy because there have been no studies done on the relationship between Ecstasy and crime. Europe has a much bigger Ecstasy problem than we do in Canada. It is possible that the problem could come here.

Right now, we know that Ecstasy appears to be used primarily during raves, and hence in very particular situations. There is very little consumption between raves. People use Ecstasy heavily during these raves and then they stop. Most consumers will take this drug again when in the same type of situation.

Senator Maheu: In schools as well?

Dr. Brochu: Once again, very few studies have been done. We are currently analyzing the results of a drug-use survey pertaining to young people living in the northern part of Montreal. We have observed that cannabis is being used but that there is very little use of the other drugs. The survey pertains to young people in secondary school. Ecstasy may be used to greater extent by CEGEP students. I do not know. The survey did not indicate that Ecstasy was being used by this population of young people. We always have to be careful with self-reporting investigations. It is sometimes easier to acknowledge cannabis consumption than cocaine or Ecstasy consumption.

The Chairman: Thank you very much Dr. Brochu for your testimony and for your frank recommendations. I will send you in writing the questions that have been suggested to me by the research staff and we will publish your answers.

Dr. Michel Landry received his doctorate from the Université de Montréal in 1976. Since 1999, he has been an associate professor in that university's Psychology Department. He is also Director of Professional and Research Services of the Centre Dollard-Cormier, co-director of RISQ, [Quebec Research and Intervention with respect to Psychoactive Substances] and of the intervention and research collective on socio-health aspects of drug addiction. Dr. Landry, the floor is yours and I would like to thank you for the interest that you have shown in us. We are honoured by your interest.

Mr. Michel Landry, Director, Professional Services and Research, Centre Dollard-Cormier: It is a privilege to appear before this committee. I am a researcher and for a very long time I have been involved in treating drug addicts. It is therefore for that reason that my research interests are at the heart of this issue.

I will present you with a summary of some of the research conducted by our research team on the impact of certain types of treatment given in Quebec.

The objective of my presentation is to compare data from four evaluative studies conducted at two Quebec public addiction rehabilitation centres. There were four studies carried out with different cohorts. We wondered whether or not we would be able to identify any similarities between them. We tried to improve our understanding of the process and results of our intervention in Quebec.

I will describe these studies very briefly. These are four studies involving five groups. In fact, several of these studies were carried out at the Centre Domrémy-Montréal and one of them included a cohort from a centre in Trois-Rivières.

As you can see, some of the studies involved the general population of drug addicts being treated. There were all kinds of problems. Some of the studies pertained to groups that had particular problems, including two that pertained to clients involved in the legal system. That means that these people had been under some court pressure or had quite a significant criminal history.

We also carried out a study involving people with mental health problems, serious problems, as well as drug addiction and who were being treated in a centre offering specialized programming for them. We therefore conducted studies using populations that, although all drug addicts, were relatively different. We wanted to see whether or not there was any convergence between these studies.

The studies were carried out between 1991 and 1998. The method used to conduct these studies was quite similar, namely, we took measurements at the beginning of the treatment and then at different intervals, varying from five to eight months. We then determined whether or not any change had occurred and if it was being maintained.

We also evaluated seven life areas. Earlier, Dr. Céline Mercier said that just because consumption decreases does not mean that the other life areas will improve. It is important that we have an comprehensive portrait of the improvement. Obviously, alcohol and drug consumption must be included in the portrait, but we must also take a look at physical and psychological health. Does the employment situation of these people improve? Do they have the same legal problems? We were, therefore, measuring all of these things in these people. In order to do this, we used an instrument that is very popular in the United States, the addiction severity index. In Quebec, we translated this expression as the indice de gravité d'une toxicomanie. We used this instrument to measure change.

These are naturalistic studies without control groups. Dr. Mercier referred to certain studies with two groups, one that received treatment and one that did not. We want the group receiving treatment to improve more than the group that does not. Improvement can occur even without treatment in people who have drug addiction problems.

In this case, we did not undertake this type of study, primarily for ethical reasons. In order to conduct this type of study, some of the people should not be receiving treatment and they should be selected randomly. We did not want to do this for ethical reasons and, furthermore, this would have required a more complicated procedure.

We wanted to assess the exposure to treatment. A lot of research establishes a link between the quantity of the treatment received and success. Dr. Serge Brochu was saying that amongst a criminal population, the people who drop out of treatment very quickly are more likely to be unsuccessful than those who remain in treatment for a significant amount of time. Many studies have confirmed this.

Not all studies, however, show that this is the case. Other studies have shown that results, changes, can be achieved even with very brief treatment. There is no unanimity on this issue in the studies, but when dealing with a population that is particularly difficult, such as people with significant legal problems or mental health problems, we think that a certain length of treatment is required in order to have any effect. At least we based ourselves on this premise.

We said that, given that we do not have a control group, if we were able to compare people who had less treatment to those who had more, we would expect that those with lengthier treatment to have shown considerably more improvement. We measured this based on the number of days in treatment and also on the number of hours of treatment received. Someone could be receiving treatment for six months and be seen only a few times, whereas, during the same six-month period, somebody else may have received more intense treatment. We felt that the number of hours in treatment was very important.

I will quickly describe this table which gives a brief description of the clients. You can see that these people are, on average,35 years old. These are adults. Generally speaking, there were more men than women because that reflects the situation in our treatment centres, not only in Quebec but everywhere else.

The usual distribution is 70 per cent men and 30 per cent women. With the inmate clientele, the proportion of men increased significantly, reaching 80 per cent. In the case of people with mental health problems, the proportion of women increased and reached 40 per cent. These people had high school education or more. Approximately 50 per cent of these people had at least a secondary school diploma, meaning that 50 per cent had not completed their secondary school education.

This population is not very educated. I would add that the people admitted to our centres use all kinds of substances, including alcohol, cocaine and any other kind of drug. The primary substance used by nearly one-third of our clients is alcohol, another third consume alcohol and other drugs, and another third comprises the users of particular substances such as cocaine, heroin or cannabis.

The studies on exposure to treatment show that the people remain for quite a long time in treatment, on average about 150 to 180 days. This is viewed as an acceptable threshold that enables the treatment to have some effect.

Moreover, the number of hours of treatment is not very high; namely, 12 to 18 hours in general. These thresholds are very short, with the exception of one cooperative that provided lengthier treatment in terms of hours of treatment provided. Nevertheless, these thresholds are quite weak. The people who participated in the research for a longer period of time - that we managed to reach once the study was over - had received more hours of treatment than those that we lost during the research. We usually lose some people along the way and these people had fewer hours of treatment than the others.

The ratio of time spent in treatment to the number of hours of exposure is low. People in treatment generally have one interview or one treatment activity every two or three weeks, depending on the group, which is not very much. More is offered, but people do not necessarily always show up for their appointments. They may not come. They may leave treatment for some time and then come back. That is the reality we have to work with. The whole issue of people quitting treatment or not really participating in it is an ongoing concern. Those admitted for residential program intervention had a higher intensity of treatment.

I will move quickly through the statistics in the document to get to how the subjects progressed. What happens to people who stay an average of six months in treatment and who receive between 15 and 20 hours of treatment during that period?

I will first present four scales: the alcohol and drug scale; the psychological scale, the family and social scale. The figures on the left in the tables simply indicate how serious the alcohol abuse problem is. The score varies between zero and one, and the higher the score is, the worse the problem. As you can see, people score high on the alcohol scale in time one and the score decreases in time two. Between five and eight months after treatment begins, these people had improved with respect to alcohol consumption. Six months later, this improvement has been maintained. For groups that were followed for a longer period, the scores indicate that this improvement had been maintained even 18 months later. Where alcohol is concerned, we see that the situation for people improves and that the improvement has been maintained 12 to 18 months later.

In the drug scale, the results are approximately the same. Most of the groups decrease their consumption and maintain their improvement. The exception is people with mental health problems, where the curve rises again. This group has not maintained its improvement.

On the psychological scale, all the groups show the same pattern, that is, an improvement, which is more dramatic in some cases, such as the red line, and more gradual in other cases, but the indication is that people are improving. The same is true for the family and social scale, where the curve shows that people's scores have declined and then remained fairly steady. On these four scales, that is, alcohol, drugs, psychological and family, we see improvement which is then maintained.

What observations can we make? There is a clear trend for the mental health group, where there is an increase in consumption on the drug scale. That said, the third point in the graph is significantly lower than the first point. So we can draw the conclusion that people who come to treatment in centres such as those in Quebec improve their situation on at least four of the scales. This is good news for those providing treatment.

Is this improvement due to the treatment? We compared the results between those who stayed longer in treatment and those who left after only a short time. In some cases, those who stay longer in treatment improve more than those who do not stay long. There is a correlation. This is not the case in all studies; in fact, it is true in only a minority of the studies.

Generally speaking, no connection is observed between the time spent in treatment and a person's improvement. That means that the subjects improve no matter how long they are in treatment. That raised other questions for us. This is good news, but at the same time the improvement is not necessarily due to our intervention. So we have questions on that. We have some hypotheses. We know that many people improve without treatment. So maybe there is a phenomenon of natural remission. Some people in treatment have improved even if they left treatment very quickly. They improved because of natural remission, which happens in many cases.

It could be the effect of the person's initial motivation to ask for help. When people decide to ask for help, they are making a decision. There are some people with problems who ask for help. Most people do not do so. The fact of asking for help could be a sign that the person is taking action toward change. For some people, that is enough to produce a change. It could be a natural assessment after the crisis, that is, that people ask for help when they are in a crisis, and with time, the crisis diminishes. Those are our hypotheses.

On the employment scale, you see that there is not a great deal of improvement. The change is much less dramatic. However, there is significant improvement. On the physical health scale, there is some deterioration at the beginning and then the situation returns to how it was at the beginning.

The legal status scale shows an interesting phenomenon. It shows two groups that undertook treatment because of legal problems. It is to be expected that their scores are high at the beginning, unlike the other two groups, which come for treatment without having legal problems. The latter two groups understandably start very low on this scale. Their situation with respect to legal status cannot improve. The groups represented by the red and blue lines on the scale improved significantly, while the other group made a rapid but not significant improvement. So two groups out of three improved their legal status among those that could improve.

We can conclude that there is not a great deal of improvement in the areas of physical health and employment/resources.

On the physical health scale, there is a temporary deterioration because when people are under the effect of drugs, they do not take care of their physical health. When the effects of the drugs wear off, they may become more aware of their physical health problems. It is not because these problems did not exist before, but because the people were not necessarily aware of them.

Where improvements in legal status are concerned, two groups improved, but the employment scale shows slight improvements only, for the mental health and adult groups.

What conclusion can be drawn from all this data? To begin with, the improvements are found mainly in the areas of drugs and alcohol use, psychological well-being and family relations. We are very pleased to see improvements regarding alcohol and drug use, since our mission is to help people deal with their substance abuse.

This is probably also linked to more targeted interventions. When people are asked their expectations regarding treatment and the improvements that they would like to make, the vast majority tell us that they want first and foremost to relieve their psychological distress. So there is a connection with people's expectations. In our bio-psychosocial approach, we emphasize the psychological aspect of treatment, and we feel that the improvement shown is probably related to people's expectations and our specific areas of intervention.

Improvement on the social scale are less impressive. This is an area in which we have less impact and to which we need to give more thought. Some things are more difficult than others to improve in the short term. For example, the employment status of those who have been on social assistance for a long time - and that is the case for many of our clients - cannot be expected to improve rapidly. When the studies were carried out, the economic situation was very difficult, and jobs were hard to find. For someone with a history of substance abuse, the situation was even more difficult, given all the assumptions about them.

We are, however, looking at what could be done to have an impact on this specific area. People improve their situation and it is not necessarily as a result of a treatment that they have been given, since other change factors are indicated, which we do not yet understand very well, and these may be responsible for people's improvement.

So qualitative studies may be needed in order to develop a better understanding. We would like to be able to say that some people improve or get worse with treatment and that others do so without treatment. We think that it is time to go to see people and talk to them.

There is a research method called "qualitative research," which we want to use to gain a better understanding of how these four groups of people fare later on. This method would no doubt help us better understand the results that we have obtained, and we are therefore going to develop it in the future.

Another strategy is to develop treatment methods suited to different types of clients. For example, people with legal problems had access to a specialized program in one of the two centres. In the other centre, the same group received general treatment, which was offered to all drug addicts. No difference in effectiveness has yet been observed, in that both groups improved to the same extent.

We therefore need to continue thinking about a matching strategy. From a clinical standpoint, it continues to make sense, but the research done in that area shows two different tendencies. Some research seems to support the matching hypothesis and other research does not. There is also the fact that matching is linked to variables that are so numerous and so complex that it is difficult to find a treatment that is most likely to work or the specialized treatment that is best suited to the particular type of person. This treatment is still being studied.

Motivation is something that needs to be worked on to a greater extent. As you see, many people drop out of treatment quickly and we think that better ways must be found of keeping people longer in treatment so that it can be effective. There has been a change over the past 20 years. People used to say that someone was not motivated, it was his or her problem and not ours. Now we say that the problem must not be looked at in that light. Motivation is something that can change, something that can be worked on.

A number of American authors have begun working on the subject of motivation, including Prochaska and Di Clemente, who have developed a model that explains how people change.

Those models are being used now to try to find more effective interventions that will help us keep people in treatment. A recent study showed that people's motivation changed over six weeks. If we have an impact on motivation, we can keep people in treatment and motivate them to change.

As researchers, we feel that there are ethical considerations and that we must not merely offer treatment on the basis of its impact on people or the changes that will result. There are also humanitarian reasons for offering treatment; in other words, these people need help and some of them are in such rough shape and are having so many problems that even stabilizing them is a great improvement.

There is also the fact that many people are not interested in receiving treatment and, from a perspective of harm reduction, it is important to reach these people to offer them some initial assistance that may open the door to more systematic treatment.

The progress of these people fluctuates. They do not make linear progress. They will come for treatment, drop out, disappear, but 10 years later, many of them are back for treatment.

It is our view that if we can help them to stabilize their situation, we have already made significant progress. So the effectiveness of treatment should not be judged only on the basis of a person's results. It is important that treatment show respect for the individual. That is why there are more and more ethics committees to ensure that human rights are not violated when research and treatment are carried out.

These ethical considerations are increasingly important, especially considering the approach that people will go for treatment if pressure is put on them. Yes, but at what cost? Will the person's rights be protected? Those are questions that must now be asked.

The Chairman: Thank you, Dr. Landry.

[English]

Senator Banks: Thank you, Dr. Landry. Can you take a step back in your life and view of the question of treatment before you had formed your present opinion? I believe your opinion is based on what you last said, which was that everyone who is an addict to anything is entitled to treatment as an illness.

A significant proportion of the Canadian public thinks otherwise. They think that a penal regime, a penal result and treatment, is more effective and appropriate because the abuse of drugs is wrong and it is something that one brings upon oneself. It is not like walking into a plane and getting a cold, or getting hit in a car accident, it is something over which an individual has control. It is hard to argue, in their view, that one could grow up entirely without a concept of right or wrong in that respect, and that one could get very far in terms of trying drugs without having someone say to them, "This is a very slippery slope, this is a dangerous thing to begin to experiment with." I do not know whether you ever had that opinion, but it is one that you have certainly heard.

What has convinced you that the treatment option is the only right, preferred, proper and most sensible one?

[Translation]

Dr. Landry: That is a very interesting question. It leads us to consider the extent to which people are responsible for the fact that they become addicted to drugs or alcohol. The medical model asserts that drug and alcohol addiction is an illness. It is something that is outside the responsibility of the addict. If we take the model even further, we can talk about biological determinism, which means that people have something in their make-up that causes them to become alcoholics. That view has been quite widespread with respect to treatment for alcoholism.

I do not for a moment deny that there may be certain vulnerability factors in the genes of certain people. However, I do not believe that alcoholism in general is necessarily determined by our genes and that there are various factors that cause a person to become an alcoholic or a drug addict. Some people may have the biological vulnerability but still not become alcoholics. There are many other social and psychological factors that lead to people becoming alcoholics or drug addicts. Certain deliberate acts may lead us to take more risks or develop a dependency.

In my opinion, people have some responsibility for having developed the problem, which is the case for other illnesses, by the way. The whole issue of what if any preventive action should be taken regarding activities that may be detrimental to our health - for example, smoking and seat belt use - is a broad social debate. We cannot eliminate the whole notion of people's responsibility for their actions and their responsibility as well for their problems with alcohol or drugs. On the far right, there is the purely moral model which places the responsibility totally on the individual and leaves it up to him or her to do what it takes to get out of the situation.

[English]

Senator Banks: In the same sense it would be true to say that if you developed emphysema it was your fault for having started smoking?

[Translation]

Dr. Landry: Is treatment in that case something that I would favour? Yes, for a philosophical reason, since it is better to help people resolve problems that they have developed than simply to punish them for having the problem, and for a pragmatic reason, since treatment can lead to changes. Many studies have shown this. Treatment needs to be offered because it is probably the most humane and least costly way of dealing with the problem. That does not mean that putting pressure on people who have a problem may not help to get into treatment. There may be a certain amount of pressure from the person's environment, not just from the courts. Pressure from a spouse or the workplace may lead someone to realize that there is a problem and that something has to be done to resolve it. So the pressure must be used constructively to motivate the person to resolve the problem.

Treatment must continue to be offered to people for all these reasons and also because I would be concerned, on a much broader perspective than alcohol and drug addiction, that as soon as people are assigned responsibility for having developed a given disease, our society might become very repressive and begin to say: "If you have a liver problem, it is because you are an alcoholic, if you have a heart problem, it is because you did not do enough exercise and did not eat right. We are going to stop your medical treatment or invest less time and money in your treatment." Since our society finds it much easier to criticize people who have developed alcohol and drug problems than those with other problems, it tends to take this approach more readily.

[English]

Senator Banks: It is not a far reach to go from that view to the one that says it would be logical that the softer drugs be decriminalized if not legalized. To take the moralist view that is held by many Canadians, the government is already into all of the great sins and operates them, excepting prostitution. We have already taken over gambling. We are already the bootleggers. Is there any reason that you can think of that the government ought not to oversee, tax and make available on a controlled basis drugs and all other mind-altering substances? We already do so, why stop here?

[Translation]

Dr. Landry: I imagine one could use a more cynical argument. There are moral and pragmatic considerations in deciding whether or not to decriminalize or even legalize cannabis. There are drawbacks to giving a criminal record to young people who have used cannabis. The cost involved in suppressing the use of soft drugs such as cannabis is something that must be taken into consideration. What are the dependencies or the drugs? To a certain extent, gambling can be considered a drug. Which ones will we include in our legislation? Which ones will it be prohibited? These are often pragmatic considerations. These are evils that we must live with and at a certain point in time, we have to decide which is the lesser of the two evils.

Moreover, with respect to these substances, we know that as a society we have been able to manage alcohol consumption. Things are more complicated when it comes to tobacco. Most people are capable of consuming alcohol in moderation without developing serious problems related to its consumption.

We might also wonder about cannabis. Would our society be able to learn how to manage such a substance which, according to the scientific data that we have, is no more dangerous than alcohol? This means that most of those who use it would be able to do so without developing any problems. Would it be preferable to maintain the illegal status of this substance or might there be a better way to manage it if it were included in a legal framework? This is one of the questions that we must ask.

We must determine whether it is preferable to keep this substance illegal or find some legal way to manage its use.

[English]

Senator Banks: Do you think it can be argued that the social harm that is done to themselves and to the community by those persons who abuse alcohol is greater than the harm that is done to themselves and to the community by those people who abuse, if that is the word, cannabis? If that is the case, what possible rationale could there be for the government being the purveyor of the more disagreeable and more dangerous substance?

[Translation]

Dr. Landry: Since I am responsible for professional services in a treatment centre, I must take care in answering your questions.

Firstly, we can say that we are more familiar with the damage caused by alcohol than that caused by cannabis, since alcohol is a legal substance that has been studied for some time. We must take care, however, to not play down the effects of cannabis with which we are less familiar and which have not been studied extensively. It may be possible that cannabis causes more or less severe damage, according to its concentration, for example in THC, and according to the form in which it is available. However, in view of what we know now, we can say that we are fairly certain that the use of cannabis is no more dangerous than the use of alcohol.

However, we must be aware of the context. Our civilization is quite familiar with the management of alcohol. We are aware of its effects, its evolution, and we have learned to live with the product. If cannabis were to be legalized tomorrow morning, the learning curve would be rife with problems.

We must also consider the North American context in which this decision would be made, that is to say that legalizing a drug such as cannabis, in a context where it is prohibited by our neighbours, would involve risks that are not necessarily related to the substance itself, but rather the social context in which this decision is made. This matter will have to be given serious consideration if ever we decide to legalize this substance.

[English]

Senator Banks: The question was theoretical because there are constraints on our freedom of action in that respect.

[Translation]

Senator Maheu: You made a very interesting presentation. For some time now I have felt as you do with respect to the way in which we should consider the treatment instead of the cost and the patience that must be used when treating patients.

Do you feel that governments spend enough on research and treatment for those who have drug dependency problems? I would say that the answer is no.

What would you recommend that might make us agree within your way of thinking with respect to the needs of patients who go for treatment to the two organizations that are related to your studies? Many doctors tell their patients that if they drink or if they smoke, then they, and not the Canadian taxpayer, will be responsible for any associated consequences or costs. That does not seem to be the way your operate. How will you manage to get the public and the governments on side?

Dr. Landry: To answer your question as to whether or not there are enough treatment options, I would say that no, there are not. Let us take Quebec as an example. At this time, .6 per cent of the total health budget goes for treating alcoholics and drug addicts. In any case, that was the situation three years ago. Things may have changed slightly since then, because the Quebec government has made some efforts to increase the availability of treatment. That is one way to see this issue.

We can say that we are beginning to recognize that problems related to alcohol and drugs have an impact on a host of other social and health problems. A large number of hospital admissions for any number of problems can be in some way related to alcoholism or drug addiction.

We are well aware of the impact of social problems on families, on the education of children and on separations. To my mind, it is not only a question of spending more money on direct treatment of alcoholics and drug addicts - this would of course be necessary. But we must also work together with stakeholders in other health and social services sectors who work with alcoholics and drug addicts. These sectors must first recognize that the problems relating to alcoholism and drug addiction do exist. For example, with respect to mental health, in psychiatric hospitals, between 30 and 50 per cent of the patients also have alcohol and drug-related problems. If that is not recognized and if nothing is done to take that into account, then the treatment will be much less effective.

We must sensitize those working in these fields and make them aware that when someone comes to see them in their office, the patient might also have problems related to heavy consumption of alcohol and drugs. They must be able to give them the appropriate support that they require.

In Quebec, there was an attempt to set in place a network which, with the appropriate tools, would allow for the detection of young people experiencing problems in school. If the problem is not too serious, something will be done at the school level. If not, then an evaluation by a specialized centre would be requested. There has to be an intervention strategy. This requires financial means, but also a greater willingness to accept these problems, to see them and to want to correct them.

More research could be done, even if a great deal has been accomplished over the past 10 years. Great strides have been made, and that must be recognized, but we must maintain the momentum so as to continue to learn more about people, to increase the effectiveness of the treatments and to bring people to recognize that the problem exists.

Senator Maheu: With respect to treatment, many people say that if an individual does not want to help himself, then he cannot be forced to do it.

Dr. Landry: We never give up that easily. We have to find ways to motivate people. It is true that if the person does not cooperate, we will never be able to implement any type of lasting change. We can try to reduce the damage related to consumption, which is already a positive step forward.

For that reason, even if people do not want to quit, we must have treatments that will, at the very least, help them to temper the damage caused by using.

In doing this, we establish a contact that could, eventually, motivate them to go even further. We have to be patient. We must be tolerant and persevere because people often return to our centres more than once. Not all of them do, but it is still quite common. According to our philosophy, we must always welcome them and try to find a more appropriate treatment for them.

The Chairman: One of your slides deals with the return to work and the quality of returning to work. Would this include returning to school?

Dr. Landry: We work with minors and we have a program for young people. We encourage young people to return to school and this might also apply to older people as well. There is no reason why it would not. In some cases, they must go back to school before being able to return to work.

The Chairman: Before dealing with government involvement, I would like to discuss your typical cannabis addict. What does he look like? How old is he? Is it a man or a woman? Where does the person come from? What led to the use of drugs?

Dr. Landry: The legal term is now users. If we take the proportion of users who use mainly cannabis, they are in a minority. We must be aware of that. This does not mean that they use cannabis to the exclusion of other products such as alcohol or cocaine.

The Chairman: Earlier, you divided the users into three groups. I am most interested in B and C, in the third group, particularly B where both a main drug and cannabis were used.

Dr. Landry: I cannot give you specific data, but I can give you a ratio. It would be about 5 per cent of people. This does not give you a picture of who they are.

The Chairman: We have heard testimony to that effect.

Dr. Landry: We know that there is probably no physical dependency with cannabis, even though some have discussed this. Those who have developed a psychological dependency on cannabis develop something called amotivation, that is, these people become disinterested in things, they are no longer absorbed by their work, by their lives. That is what the situation appears to be.

The Chairman: What is their average age? Would the ratio be about the same for all age groups?

Dr. Landry: I do not know. I will have to give you an answer in writing.

The Chairman: Would it be mainly men, or women?

Dr. Landry: There is no difference with respect to the ratio. It is about 70 per cent male, 30 per cent female in general. I do not think that a proportion stands out with respect to the use itself.

The Chairman: We understand that the use of this drug is a problem, that an addiction develops. If we follow Dr. Mercier's progression, with cannabis, it must have taken longer because the overconsumption does not begin at age 16, although it might be possible.

Dr. Landry: The progression related by Dr. Mercier can apply to cannabis just as well as to any other drug.

The Chairman: In that case, the user would be older?

Dr. Landry: Yes, and the same applies for alcohol. If we want to take two opposite examples, I would say that it takes more time to develop an addiction to alcohol than to cocaine. It takes a certain amount of time for cannabis, but I will have to look into that. A clinical practitioner could give me an idea, but it would not necessarily be supported by any specific research data.

The Chairman: Is abstinence your ultimate goal?

Dr. Landry: I will give you a qualified answer. Since 1997, the approach taken by the Centre Dollard-Cormier in its treatment program has been to reduce the damage. This would of course not exclude abstinence, but it is not compulsory. We realize that people who come to us for treatment can have varying objectives. Some are looking for abstinence and we will help them to do that. We will no doubt realize that for some of these people, abstinence is probably the only realistic goal. But even if that is the most realistic plan for their particular case, if they tell us that it is not what they are seeking, then we will work with them to help them choose something more realistic.

A recent survey of our users has shown that abstinence was the main goal for 45 per cent of them. The others had different objectives such as reducing the use or eliminating a given product or to stop using cocaine but to continue to use alcohol and cannabis. We help them meet their objectives, whatever they might be.

The Chairman: I assume that the means that you have adopted respect the ethical values of your organization.

Dr. Landry: From an ethical standpoint, we are comfortable with our position.

The Chairman: In our correspondence, I would like you to elaborate on the matter of ethics. An important part of our work will deal with the role of ethical issues in the drafting of public policy. We feel that the moral aspect of this issue relates to ethics. Not only morality for the sake of morality, but individual morals as well.

Dr. Landry: Problems with drug and alcohol addiction are often chronic, and cannot be solved in one fell swoop. They can be recurrent. That is the first consideration. Secondly, we must turn our attention to the harmful effects associated with the use of these substances. By insisting on abstinence, we are discouraging people from using the services that could be beneficial in other areas. That is also an ethical problem.

We must clearly establish abstinence among those who want it, but this must not be our sole objective if we can help someone in some other way. We also know that a certain number of people resume the use of these substances to a degree that is not harmful. Abstinence is therefore not the only road to recovery.

The Chairman: Earlier this morning, I asked a question about the possibility of Canada having an independent monitoring body that would collect hard data on all aspects related to the use and abuse of illegal substances, as they do in Europe.

Do you believe that you have been sufficiently consulted in the drafting or maintenance of government policies? That includes both levels of government. Are the disintoxication or treatment methods taken into account when these policies are drafted or maintained?

Dr. Landry: I cannot comment on what is done at the federal level, but I would say that provincially, yes, we are consulted. We do have a certain impact.

The Chairman: Treatment is also a large part of the federal policy, it is one of its main aspects. It is all very well to say, but if the federal government is not concerned about the treatment procedures or the effects of the treatment, then it will be hard to succeed. If I understand you correctly, only the provinces do that.

Dr. Landry: I am more familiar with what is done at the provincial level. Moreover, I have sat on some task forces organized by Health Canada relating to treatment for the duel problem of drug addiction and mental health. I was among the experts. I do not know what impact it had on federal policies, but we can say that a federal body is involved with this issue. We probably have a more direct impact on provincial policies.

The Chairman: What do you think of having the federal and provincial governments cooperate in setting up a monitoring body such as the ones that they have in Europe? Even with the federal structure, nothing would prevent us from setting up this type of monitoring organization.

Dr. Landry: I do not want to get into a discussion on policy. However, I think it would be a good idea to pool all of our knowledge here in Canada.

Something similar has already been done. There was a task force struck to bring together people in Canada to try to collate the epidemiological data that we now have. At this time, the information is quite piecemeal and scattered. We must be able to coordinate our research efforts. I think a pooling of this data would be a very good idea.

The Chairman: How important would it be to have an independent body?

Dr. Landry: Clearly, it must be independent.

The Chairman: Thank you, Dr. Landry. I will be in touch and I am looking forward to reading your answers.

Before we adjourn, I would like to remind all of those who are interested in the work of this committee that they can find more information on illegal drugs by consulting our Web site at the following address: www.parl.gc.ca.

There you will find the briefs submitted by all of our witnesses, as well as their biographical data and any supplementary documentation submitted by the witnesses. There are also more than 150 links related to illegal drugs. E-mail messages may also be sent to us through this Web site.

On behalf of the Special Committee on Illegal Drugs, I would like to thank you for the interest that you have shown in this important study.

The committee adjourned.