Alcohol Causes Enormous Harm in Canada. Doctors Say Too Few People Are Getting Proven Treatment

Lucas Tremblay

9/28/20267 min read

At 54, Jordan Kawchuk never imagined he would be living with more than a dozen roommates.

But for nearly six months at the beginning of 2026, that was his reality at the Vancouver Island Therapeutic Community in Nanaimo, B.C., a residential treatment centre for men dealing with substance-use problems.

For Kawchuk, a writer and former television producer, it was not his first experience with treatment. It was his second stay at the Nanaimo facility and the fifth in-patient program he had entered during a decades-long struggle with alcohol-use disorder.

Alcohol, he says, has cost him jobs, money and trust.

The most painful losses, however, were his marriage and the opportunity to live full-time with his daughters while they were growing up.

Kawchuk’s experience is deeply personal, but the health problem behind it is widespread.

Alcohol use costs Canadian society an estimated $20 billion a year through health-care expenses, lost productivity and criminal justice costs.

And while overall alcohol consumption in Canada has declined slightly, research suggests people who continue to drink are, in some cases, consuming more.

A national study led by researchers from the Centre for Addiction and Mental Health found earlier this year that alcohol causes more overall harm in Canada than any other drug, exceeding the harms associated with non-prescription opioids and tobacco when researchers considered a range of health and social consequences.

Yet despite the scale of that harm, physicians and addiction specialists say alcohol-use disorder remains underdiagnosed and undertreated.

Hundreds Hospitalized Every Day

The numbers illustrate the scale of the problem.

The Canadian Institute for Health Information says approximately nine people die in Canadian hospitals every day from conditions caused by alcohol.

Around 280 people are hospitalized daily for alcohol-related harm, compared with roughly 84 daily hospitalizations associated with opioids.

Nearly 18 per cent of Canadians aged 15 and older are expected to meet the clinical criteria for alcohol-use disorder at some point in their lives.

But specialists say a comparatively small number receive treatment that reflects current medical evidence.

For Dr. Evan Ailon, who operates what he describes as Vancouver Island’s only dedicated medical practice for alcohol-use disorder, one of the greatest challenges is not persuading patients to seek help.

It is getting the health-care system to treat the condition like other chronic illnesses.

“The challenges that I have are with colleagues whose lack of information, lack of knowledge about this really gets in the way of the treatment of these patients,” Ailon said.

Doctors Often Miss the Problem

Ailon says many patients tell him their alcohol use was overlooked by primary-care providers, or that they were simply told to drink less.

Others were advised to attend Alcoholics Anonymous without being offered medical treatment.

Support groups can be extremely valuable for some people, Ailon said, but they should not be treated as the only available intervention.

Alcohol-use disorder can be treated with medications, counselling, behavioural support and other approaches tailored to the individual.

Yet medication remains strikingly underused.

“Some of the most effective medications that have ever been invented in medicine, full-stop, are for alcohol-use disorder,” Ailon said. “But that is just something that’s not known by most providers and certainly not known by the average person.”

Medications Exist, But Few Receive Them

One of the most widely used medications is naltrexone.

Approved by Health Canada in 1997, naltrexone affects the brain’s opioid reward system and can reduce alcohol cravings and consumption. For people trying to remain abstinent, it can also reduce the risk of relapse.

Another medication, acamprosate, was approved in Canada in 2007.

It is used to help people maintain abstinence by stabilizing neurotransmitter systems disrupted by chronic alcohol consumption.

These medications are not appropriate for every patient, and treatment plans can vary depending on individual circumstances. But addiction specialists say they remain vastly underprescribed.

CAMH estimates that fewer than two per cent of people with alcohol-use disorder receive appropriate medications.

Ailon says the consequences of that treatment gap are visible in hospitals.

He regularly sees patients admitted with advanced liver disease who have had multiple previous hospitalizations related to alcohol.

When he looks through their charts, he says, he often sees repeated warnings about drinking — but little evidence that anyone offered treatment for the underlying alcohol-use disorder.

Ailon Compares Gap to Untreated Diabetes

For Ailon, the difference between the way alcohol-use disorder and other chronic illnesses are treated is difficult to justify.

He compares it to a patient repeatedly arriving at hospital with complications from uncontrolled diabetes.

If doctors simply told that person to stop eating sugar but never prescribed any of the medications available to treat diabetes, he said, that would be considered unacceptable.

Yet when it comes to substance-use disorders, he argues, that type of response is often normalized.

The result is that people with a potentially treatable condition can move through hospitals and clinics repeatedly without receiving targeted medical care for the disease driving their health problems.

Alcohol Problems Often Go Unrecognized

Jürgen Rehm, a senior scientist at CAMH and professor at the University of Toronto’s Dalla Lana School of Public Health, says another major issue is that alcohol-use disorder frequently goes undetected.

Rehm co-chaired a committee that developed new Canadian guidelines for treating high-risk drinking in 2023.

He says the problem often begins with basic communication.

Doctors may not ask enough questions about alcohol use, while patients may not volunteer information about how much they drink or how drinking is affecting their lives.

The result, Rehm said, is that high-risk drinking and alcohol-use disorders are often identified too late.

By the time someone receives treatment, they may already be dealing with serious medical, psychological, financial or family consequences.

Stigma Remains a Barrier

Kawchuk says stigma has followed him throughout his attempts to seek help.

He recalls visiting emergency departments and hearing health-care workers make dismissive comments about people with addiction.

On some occasions, he said, he was made to feel that his need for a hospital bed was less legitimate than that of other patients.

He has also encountered people who appear sceptical when alcohol-use disorder is described as a disease.

“I’ve seen people roll their eyes,” Kawchuk said.

Those experiences can make it harder for people to seek help, especially when they already feel shame about their alcohol use.

Ailon says that stigma remains embedded in parts of the health-care system, despite advances in understanding addiction as a medical condition.

Peazzi asked the Canadian Medical Association and the College of Family Physicians of Canada to comment on the state of alcohol treatment in Canada. Both declined.

Questions About Residential Treatment

Ailon also believes some patients are directed too quickly toward expensive residential programs.

Private in-patient treatment can cost tens of thousands of dollars, and he questions whether that level of spending is always justified when some patients could achieve comparable results through outpatient treatment.

“When I see people who are dropping $40,000 on something that is no better than what they can do as an out-patient, it obviously makes me a little bit hesitant,” he said.

He stressed, however, that residential treatment can help some people.

The broader issue, he said, is whether treatment addresses the underlying circumstances that contribute to a person’s drinking.

Removing someone from their usual environment for several months can create stability, but if they return afterward to the same pressures, relationships, trauma or living conditions that contributed to the problem, relapse may remain likely.

Community as Treatment

At the Vancouver Island Therapeutic Community, the philosophy is built around structure, accountability and relationships.

The program is operated by Connective, a non-profit organization.

Chris Kinch, a vice-president at Connective, says residential treatment is not appropriate for everyone, but it can be valuable for people who benefit from living in a highly structured environment.

Residents attend meetings, work with counsellors, participate in group therapy and support one another throughout the day.

“Community is the method of treatment that’s used,” Kinch said.

The program also emphasizes social skills, responsibility and helping residents prepare to participate in their communities after they leave.

For Kawchuk, that environment gave him something he had struggled to find elsewhere: enough distance from his daily life to rest, recover and work on himself.

Returning Home With Different Priorities

After nearly six months at VITC, Kawchuk decided he was ready to leave in June.

His first trip was to see his daughters in the Okanagan.

Years earlier, alcohol had cost him the chance to spend as much time with them as he wanted while they were growing up.

Now, rebuilding those relationships has become more important to him than professional success or financial status.

“I don’t care about the careers or getting back to making television or getting rich or owning a home,” he said. “That’s the only thing I want.”

“Now it’s time to get to know them as adults.”

Kawchuk says he continues to take medication, attend Alcoholics Anonymous meetings and write a book about his experience with alcohol-use disorder.

For him, recovery now involves several different forms of support rather than a single solution.

A Large Problem With a Small Treatment Response

Canada’s experience with alcohol presents an unusual contradiction.

Alcohol is legal, widely available and deeply embedded in social life. It is also responsible for enormous health and economic costs.

Yet people who develop alcohol-use disorder can still struggle to receive the same kind of routine, evidence-based medical treatment expected for other chronic diseases.

Medications exist.

Clinical guidelines exist.

Behavioural therapies and peer-support programs exist.

Residential programs can help some patients, while outpatient treatment may work for others.

But specialists say the system often fails at the first step: recognizing alcohol-use disorder and presenting patients with the full range of treatment options.

The result is a condition affecting millions of Canadians over their lifetimes while only a small fraction receive medications specifically designed to treat it.

For Kawchuk, the stakes are no longer abstract.

After decades of treatment attempts and losses, he says maintaining his recovery requires constant attention.

“I just have to be diligent,” he said. “I have to know that it is life and death because the disease is out to kill me.”

For doctors pushing for reform, his experience illustrates the broader challenge.

Canada already has many of the tools needed to treat alcohol-use disorder.

The question is whether the health-care system will start using them consistently.

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