Last month, while more than five people were dying every day in B.C. because of toxic street drugs, the provincial government announced new funding for 100 addiction treatment and recovery beds across the province.
The beds are distributed among 14 organizations chosen for "their demonstrated ability to provide high-quality, evidence-informed, bed-based treatment and recovery services," according to a spokesperson for the Ministry of Mental Health and Addictions.
But some advocates are concerned that many of the newly funded spaces are in facilities that compel patients to participate in 12-step program, a treatment option that many in the recovery world swear by, but that is also facing growing skepticism from researchers and those who object to its religious overtones.
At least 29 of the 100 beds that received funding in February are in facilities that mandate a 12-step program similar to Alcoholics Anonymous, CBC News has learned, after contacting the organizations and reviewing their websites. That includes the service group that received the largest chunk of funding, Salvation Army Harbour Light, home to at least 15 of the beds.
Those numbers are deeply disappointing to Leslie McBain, co-founder of the advocacy group Moms Stop the Harm, who points out that many of the newly funded beds also require complete abstinence.
"The 12 steps don't work for everyone," she told CBC News. "If that's what a person wants and needs and it's helpful for them, that's great. But there's lots and lots of people out there for whom it doesn't resonate."
McBain wants to see provincial regulation governing all addiction treatment and recovery facilities in B.C. to ensure the care is evidence based, but she says the most important thing is giving patients choice rather than one prescribed path.
"We have evidence that shows the efficacy of different pathways to recovery, and it's always best when the person gets a choice and are comfortable in their situation," she said.
"I think it's just cruel to not let people have that choice."
Move away from 12 step programs
McBain's comments reflect a slow move away from treating the 12 steps as the default program for addiction.
Since the 12 steps concept was created more than 80 years ago, mutual support groups like Alcoholics Anonymous and Narcotics Anonymous have been instrumental in the recovery of untold numbers of people around the world.
These programs have long been at the centre of most recovery programs in B.C. When CBC News called every drug addiction rehab facility in the province in 2016, the majority adhered strictly to 12-step regimens.
But addictions researchers have long questioned the overall effectiveness of AA and many patients object to its tinges of Christianity. At the same time, recent decades have seen the development of numerous pharmaceutical treatments for addiction, along with secular alternatives to the 12-steps.
Some of the organizations included in February's announcement are among the many B.C. treatment facilities slowly moving away from the mandatory 12-step programs.
Edgewood Treatment Centre in Nanaimo, which received funding for five beds, is one of those. Until recently, all clients were required to participate in the 12-step approach, but they can now opt out, according to Dr. Mel Vincent, Edgewood's director of psychiatric services.
"If they come in and they're atheist or they have no interest in God or they object to the 12 steps for the content, then they definitely have the option," he said.
Vincent attributes the change to a number of factors, including shifting perceptions of addiction in the medical community, more specialized professional training and the urgent need for a dynamic approach when thousands of people are dying every year from drug poisoning.
But he still thinks 12-step programs like AA have an important role to play in treatment.
"It's important because it's one of the most universally accessible outpatient after-care programs available," Vincent said.
'There's fellowship, there's a camaraderie'
That's a view shared by Jerome Abraham, executive director of the Penticton Recovery Resource Society, which received funding for three beds in February. Men who stay at the organization's Discovery House are required to attend in-house 12-step groups for their first 90 days.
Abraham describes himself as "the biggest beneficiary of Discovery ever" — he began his time there as a resident seeking treatment for a 17-year drug addiction — and he says the 12 steps have been crucial for him.
"There's fellowship, there's a camaraderie. There's people that are working together toward a common goal and they're there to help each other," he said.
The sheer ubiquity of AA and NA meetings is an advantage. Abraham describes it as a worldwide community — even during a trip to Chile, he was able to find a group to drop in on.
But Discovery House is evolving, too.
Approaches like cognitive behavioural therapy have been worked into the program and after the first three months, clients can choose alternative, secular group therapies like Smart Recovery or LifeRing.
"We rely heavily on 12-step facilitation for some of our groups, but we've also grown and learned a lot, and I don't think that that's the only approach to recovery," Abraham said.
If there's one thing that everyone interviewed for this story agrees on, it's that much, much more addiction treatment of all kinds is needed to address B.C.'s unrelenting overdose crisis, and it needs to be folded into a comprehensive plan that includes things like harm reduction, housing options and mental health care.
In February alone, 155 people died after using toxic street drugs, and another 165 died in January.
As McBain points out, fewer than half of the 100 beds funded last month are actually new — 54 have simply been converted from private pay to publicly funded.
She says she receives emails almost every day from parents who are desperate to get help for their children.
"When they need it, they can't find the beds. They can't find the facilities that will take them. They can't find the facilities they can afford. And so, 100 beds compared to probably hundreds and hundreds of people seeking treatment right now is just not enough," McBain said.