Mental Health and Addictions Service

Addiction Services

St. Michael’s Hospital is a provincial addiction treatment leader

At St. Michael’s Hospital we pride ourselves on having created an interdisciplinary addictions model which integrates evidence-based addiction medicine and addiction psychiatry principles in a way that is unique in North America.

Our day-to-day clinical team consists of addiction experts from family medicine, psychiatry, internal medicine and emergency medicine. In addition, patients are seen by and cases discussed with our case managers, nurse practitioners and, perhaps most importantly, peer support workers with lived addiction experience.

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We treat all addiction types, often called in to see patients with whom engagement is difficult or who are at high risk of death or leaving hospital against medical advice. 

For people who use opiates we offer a wide spectrum of services from harm reduction (safe injecting practices, naloxone kits etc) to psychosocial and medical treatments. Not only are all of our treatments trauma informed, we also provide both first stage trauma treatment (through Seeking Safety and DBT) for individuals at the beginning of their recovery journey but also addictions-informed trauma therapy for those prepared for the later stages of trauma recovery. We have made a concerted effort to address the paucity of services available to men with traumatic experiences in their history.

Physicians in the Emergency Department are trained in the use of opiate replacement therapy but frequently call on our inpatient consultation team to see patients. Once admitted, patients are followed closely by this inpatient team who work to reduce risk of overdose and loss of drug tolerance for high risk users, keep people in hospital and initiate medication assisted treatments. Simultaneously, patients are integrated into robust and evidence-based group therapies working to engage patients and eventually into first stage trauma therapy or more intensive therapy to overturn underlying conditions driving drug use. In some cases when appropriate family therapy is offered.

Once discharged, patients are retained in our groups but also offered outpatient follow-up within 24 to 48 hours in our Rapid Access Clinics which have been operating successfully for five years where again medication assisted treatment but also psychosocial interventions are available. We also work to manage pain cases in consultation for which opioid dosing has become high risk.

For patients with addiction and pregnancy comprehensive and innovative antenatal and addiction care is offered by members of the Family Health Team. Many physicians in the Family Health Team have been trained in addiction and offer addiction treatment in conjunction with primary care.

More than 50 medical trainees from all discipline lines rotate through our service yearly and are jointly supervised by the interdisciplinary medical team. However, education extends beyond medical students and residents: we frequently give hospital rounds on harm reduction, motivational interviewing, addiction principles and opioid prescribing social workers and case managers from other organizations are trained in group psychotherapy and more than 200 practicing physicians have received training in medication assisted treatments such as buprenorphine.

Scholarship is important to our department as we search to build robust evidence for innovation in addictions. We are working to write up case series on our innovative treatments including more comfortable initiation of buprenorphine and greater integration of harm reduction in hospital. We are working on designing a number of clinical trials as well.

Together, we believe St. Michael's can serve as an example for comprehensive and interdisciplinary addiction care in Canada and internationally. 

The Addictions Team is an interdisciplinary team comprised of an addictions nurse practitioner, case manager, discharge planner, certified addiction medicine specialists from Medicine, Family and Community Medicine and Psychiatry providing consultation, treatment and care to complex patients with primary and comorbid addictions.

Addictions team

The Addictions Team provides specialized addictions assessment, treatment and connection to community resources for patients experiencing difficulties or problems with alcohol and/or drug use  in St. Michael’s Emergency Department and inpatient units.

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Addictions team Services offered

The addictions team consists of an addictions medical physician, addictions psychiatrists, nurse practitioner and addictions community worker.
                       
The Addictions Team will:

  • Connect you to withdrawal management services
  • Connect you to a short term additions community worker
  • Determine if an opioid (narcotic) replacement program is right for you
  • Start the process to get you suitable residential or outpatient treatment to meet your needs
  • Provide information regarding medical withdrawal and/or the role of medication in addictions treatment
  • Assess your suitability for participation in a concurrent disorders group

Eligibility criteria

Patients currently admitted into hospital (including Crisis Stabilization Unit).

How to access the service

For further information please page 416-864-5120.

Coordinated Access to Addictions Services

Coordinated Access to Addictions Services is a central number that individuals, family members and community agencies can call for guidance and referrals to substance abuse support services within the City of Toronto.

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Services offered

Coordinated Access professionals assist in determining a caller’s next step on their path to recovery. We match individual needs with one of more than 30 partnering agencies available in the city of Toronto. Services include:

  • Day and community withdrawal services.
  • Residential and community treatment options.
  • Services for people with concurrent mental health and substance use problems
  • Services to minimize the harm caused by an addiction (e.g. needle exchange programs)
  • Information on clinics specializing in Addiction Medicine. 
  • Community case workers
  • Family programs

Eligibility criteria

  • Any person dealing with a substance abuse issue (including family, friends or professionals seeking guidance or information).
  • 16+ years of age
  • Located in the City of Toronto

How to access the service

Through 1-855-505-5045 clients can speak to an addictions counselor who will assist them in finding the appropriate level of care for their needs.
Hours: 9 a.m. to 4:30 p.m., Monday to Friday                                                        

*Voicemail messages left after hours will be returned the next business day.

Download Coordinated Access to Addictions Services document (58 kb pdf file)

Mens Residential Withdrawal Management Service

Residential withdrawal management center for support through the withdrawal process staffed by sensitive, respectful, well trained professionals.

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Services offered

  • Centre operates 24 hours a day/7 days per week.
  • Centre provides assessment and referral to various treatment programs. 
  • Staff refer to appropriate medical services when required. 
  • Counselling is provided in group and individually.
  • Medications will not be prescribed
  • Previously obtained prescription medications must be in their original containers and will be secured by staff and made available to the person as prescribed.

Eligibility criteria

Residential Withdrawal Management Services are for:

  • Residential program for men 16 years or older.
  • Persons who are intoxicated or in severe withdrawal from alcohol and/or other drugs
  • Persons whose usual place of residence or home environment is not conducive to recovery
  • Persons who are assessed to be suitable for non-medical withdrawal 
  • Persons who are in a crisis related to their ongoing recovery who require a brief supportive stay.

How to access the service

Withdrawal management (“detox”) services are available upon self or health provider referral. To access please call the central access number 1-866-366-9513.

Mens Community and Day Withdrawal Management Service

Community and Day withdrawal programs are structured day-time withdrawal management programming and support.  Day withdrawal is offered on-site as well as community locations.

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Services offered

  • Community and Day Withdrawal Programs run five days per week.
  • Education sessions provided focus on addictions, life skills, and relapse prevention in an effort to facilitate healthier lifestyle choices
  • Provide nonmedical assistance for withdrawal from alcohol and/or drugs. Referrals to appropriate addiction medicine physicians when required.
  • Individual/group/family/significant other counseling
  • Individualized care plans
  • Stress management and relaxation techniques
  • Assessment and referral services

Eligibility criteria

Residential Withdrawal Management Services are for:

  • Community and day programs for men 18 years or older
  • Persons who are withdrawing from alcohol and /or drugs who have passed the crisis stage, and are able to participate in a structured program
  • Persons with family, significant other, or social service worker support at their usual place of residence

How to access the service

To access  Men’s Community and Day Withdrawal Programs  please call the central access number 1-866-366-9513

Rapid Access Clinics

This is an urgent care, drop in service for people with addiction disorders who required emergency room or hospital in-patient care.

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The clinic operates Monday, Wednesday and Friday from 9 to 11 a.m. The RAC physicians and the nurse practitioner are available to immediately address semi-urgent (but non-emergent) addictions medicine care such as opiate replacement therapy, benzodiazepine stabilization and tapering, alcohol anti-craving medication and non-urgent alcohol withdrawal protocols. The community addiction worker provides follow-up care focused on community linkages and treatment matching.

Services offered

The RAC offers medications for withdrawal and alcohol craving (e.g. Naltrexone) or opiate agonist therapy (e.g. methadone or Suboxone). If you have already been started on methadone or Suboxone you will have to return to your original prescribing doctor.

The RAC will not be able to assist you if you are requesting narcotics, benzodiazepines or pain management.

Eligibility criteria

The RAC is accepting all clients. For more information please call 416-864-3082, or Coordinated Access at 1-855-505-5045.

Rapid Access Clinic FAQs

Direct the patient to come any (non-statutory holiday) Monday - Friday at 9 a.m. to 17th floor outpatient registration desk and let the receptionist know that they are here for Rapid Access Clinic.

Addictions groups

Our first stage engagement group is designed to help you identify any issues with your substance use and help you make changes, whether your goal is a harm reduction approach or abstinence.

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You may be referred to this program if you need help with any of the following:

  • Understanding the links between your mental health, physical health and substance use;
  • Helping you decide what changes, if any, you might make to improve your health;
  • Helping you recognize the values and strengths you have that can assist your recovery;
  • Planning ways to reach your mental health, physical health and substance use goals.

Services offered

Once you have established a goal, you will have the option to join our second stage group that uses practical approaches to continue to assist you with achieving your goal. The Addiction Team here at St. Michaels wants to engage with you even if you’re unsure of your goal or if a more comprehensive treatment plan is needed. Please feel free at any time to speak with one of our facilitators if you have any questions.

In general, we offer two main groups, one is called the  Engagement Group where we assist you in developing goals for your own recovery and the second Community Reinforcement Group is an early stage treatment group that will you look at both mental health and substance use problems.  If when we meet, we agree that you need more or different services, we will work to get you connected to other treatment options that can better meet your needs.

Eligibility criteria

Patient eligible if:               

  • Substance use disorder which is currently active, AND
  • concurrent mental health disorder, AND
  • use of hospital services (ER, inpatient stay) in the past three months, AND
  • A primary support (GP, psychiatrist, case manager, psychotherapist, or UCP) involved.

Please note groups are conducted in English.

How to access the service

FAX completed referral form to: 416‐864‐3091,

  • Outpatients: referral form will be reviewed by Addictions Team and patient will be (or patient’s team) contacted with first appointment
    Details.                                            
    OR
  • Discharges from the Emergency Department*, Psychiatric Emergency Service*, Crisis Stabilization Unit* after hours: please give the patient the Addictions Group Client Information Sheet, and direct the patient to come the next Tuesday or Thursday at 3 p.m. to the 7th floor (directions on information sheet).
    OR
  • Inpatients: DO NOT USE THIS FORM.Please page 416-692-7539 to have the patient seen by Addictions Team (Monday to Friday, 9 a.m. -5 p.m.) for full assessment.