Alberta’s drug policy is increasingly framed around recovery. In principle, that is hard to oppose. People who use drugs deserve more than survival. They deserve safety, housing, treatment, dignity and a future.
But recovery cannot be the price of admission to care.
I learned that before medical school, working in a group home with young people whose lives were shaped by substance use, trauma, poverty, Child and Family Services involvement and unstable housing.
A young person could yell at us, use drugs, miss curfew, refuse school, skip appointments, disappear for a night or say they wanted nothing to do with us.
The next morning, we were still there.
That steadiness was not permissiveness. Boundaries still existed. Risk was taken seriously. There were hard conversations, safety plans, crisis calls and natural consequences. But the relationship did not disappear when a young person behaved like someone in crisis. No one had to become calm, compliant or easy to help before we decided our responsibility to care came first.
Over time, that mattered. It did not fix everything. But it made trust possible; sometimes it kept people alive.
It also taught me that engagement is often quieter and less linear than systems want it to be. If engagement meant perfectly following the program, many of the youth I supported were not “engaged” at all. Some would not go to school. Some would not come out of their rooms. Some refused to speak to us for days, then appeared in the kitchen at midnight because they were hungry, scared or finally ready to talk.
Those moments were the reward for tolerating the harder parts of the work: the lashing out, the fear, the volatility, the times it would have been easier to decide a person was not ready and step back.
Over time, I saw what steadiness made possible. A midnight conversation after a trashed bedroom or a slammed door was not the kind of engagement that looked good on a form, but it often was the first sign that trust still existed, and it was where change happened. The job was to keep the relationship intact enough that even imperfect engagement had somewhere to land.
That is the lesson Alberta risks forgetting.
The province describes its approach as a recovery-oriented system of care, with major investment in treatment spaces and recovery communities. It also has passed the Compassionate Intervention Act, which allows family members, guardians, health-care professionals, police or peace officers to request treatment orders for people whose substance use or addiction has made them a danger to themselves or others. For youth, the province describes a lower threshold intended to allow intervention before imminent, life-threatening harm.
At the same time, Alberta closed supervised consumption services in Calgary and Lethbridge as of June 30.
The issue is not whether recovery matters. It is whether people can still reach care before they are ready for recovery, and before they are in enough crisis to have treatment imposed on them. A system that narrows low-barrier voluntary care while expanding involuntary pathways risks confusing the destination with the doorway.
This is where the lesson from youth care becomes a medical one.
Much of medicine happens before someone is ready for a complete life change. A patient may not be ready to stop using substances. They may not trust treatment. They may not attend consistently. But they may still come in for contraception, wound care, STI testing, naloxone, mental health support, housing forms or simply because someone at the front desk remembers their name.
Those contacts can look small from the outside. They are not. They are the kinds of voluntary, low-barrier contact Alberta should be protecting before treatment is accepted, before recovery is realistic and before crisis makes intervention unavoidable.
That is harm reduction.
Harm reduction is often caricatured as giving up on recovery. In practice, it is the opposite. It keeps people connected to care long enough for safety, trust and readiness to become possible. Alberta Health Services itself describes supervised consumption services as evidence-based services that reduce harm, provide monitored hygienic spaces for drug use and connect clients to medical care, substance-use treatment and social supports.
These services do not claim to solve addiction alone. They keep people alive, visible and connected while the conditions for recovery are still being built.
That visibility matters. Someone who uses a supervised consumption site, sees a nurse for wound care, accepts naloxone or returns to a youth clinic after missing three appointments is not outside the system. That person is still within reach.
The danger of compassionate intervention is not only that it may fail. It is that it may teach people to see care as something that arrives through force, after every earlier opportunity for voluntary contact has been weakened or ignored. For people whose lives have already been shaped by Child Services, policing, trauma, institutional harm or adults making decisions about their bodies, that distinction matters.
Treatment may temporarily separate someone from substances. It may create a window of safety. But it does not automatically create trust, housing, follow-up, income, medication access or a relationship with care.
I saw this time and again in group care when youth were involuntarily admitted to PChAD, Alberta’s Protection of Children Abusing Drugs program. In theory, it offered a pause: a short period of safety, detoxification, stabilization and assessment. In practice, many youth returned angry, guarded and no more connected to voluntary care than before. The brief separation from substances did not repair the conditions they were going back to.
This is not just a philosophical concern. The evidence for compulsory addiction treatment remains limited and contested. In its 2025 evidence brief, The Canadian Centre on Substance Use and Addiction found that most studies do not show significant reductions in substance use or reoffending, while some associate involuntary treatment with increased overdose or death after release. The Alberta Medical Association has warned that current evidence does not show the benefits of involuntary treatment outweigh the risks and costs, including the risk of re-traumatizing people who use substances.
That does not mean families are wrong to be desperate. It does not mean clinicians should ignore danger. It means the system should be most careful at the exact moment it is most tempted to use force.
Youth care taught me that the hardest part of helping someone is often staying useful before they are ready to change. Not passive. Not permissive. Useful.
That looks different in medicine than it did in a group home. It looks like flexible rebooking, walk-in capacity, outreach after missed visits, peer support, transportation help, trauma-informed reception staff, supervised consumption services, accessible primary care and documentation that asks, “What got in the way?” rather than “Why did you fail?”
It means seeing missed appointments, relapse, intoxication, anger and ambivalence not as proof that someone does not want help, but as evidence that help must be built differently.
We understand this in other parts of medicine. A patient with uncontrolled diabetes is not told to come back only once their blood sugar is controlled. A patient with hypertension is not denied care because they are inconsistently taking medication. Someone who misses physiotherapy after an injury is not assumed to want a poorer recovery.
But with addiction, the same behaviours are moralized. And that moral judgment can be deadly.
Alberta does not have to choose between recovery and harm reduction. A serious recovery-oriented system would protect both. It would invest in treatment beds and recovery communities, but also in the low-barrier services that keep people alive long enough to use them.
Recovery should remain a goal. But recovery cannot be the doorway into care.
Alberta should learn from the best of youth care: engagement is not built through punishment, shame or abandonment. It is built by keeping the door open long enough for trust to survive instability.
That does not fix everything.
But it makes care possible.
