2022 Edition

Residential Treatment Services (CA-RTX) 15: Substance Use Services

The organization provides coordinated substance use prevention, treatment, and recovery services based on the residents’ assessed needs and goals.
NA The organization does not provide substance use services.




Residential Treatment Services provide individualized therapeutic interventions and a range of services, including education for residents to increase productive and pro-social behaviour, improve functioning and well-being, and return to a stable living arrangement in the community.
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for communication/collaboration among team members
  • Criteria for determining the level of care
  • Procedures for providing withdrawal management services
  • Educational materials or other documentation of information provided to persons served upon discharge from withdrawal management services
  • MOU(s) with MAT providers, when applicable
  • Interviews may include:
    1. Clinical/Medical director
    2. Relevant personnel
    3. Residents
  • Review case records

Fundamental Practice

CA-RTX 15.01

A qualified team of health professionals, with experience, training, and competence in engaging, diagnosing, and treating persons with substance use disorders provide services, including:
  1. administering or reviewing diagnostic, toxicological, and other health related examinations;
  2. determining the optimal level and intensity of care, including clinical and community support services;
  3. evaluation for psychotropic medications and medication-assisted treatment;
  4. prescribing and managing medication, including appropriate management of pharmacotherapy for individuals with co-occurring conditions;
  5. review of complicated cases where co-occurring substance use, health, and mental health conditions intersect; and
  6. coordinating care with other service providers, including primary care and mental health providers, when appropriate and with the consent of the service recipient.


Element (c) does not apply to withdrawal management programs.


CA-RTX 15.02

The organization directly provides a comprehensive range of prevention and treatment services, including:
  1. individual and group therapy;
  2. illness management and psychoeducation interventions;
  3. medication education;
  4. clinical monitoring and drug screening;
  5. coping skills training;
  6. relapse prevention;
  7. acute care; and
  8. support groups and self-help referrals.
Examples: Other prevention and treatment services may include withdrawal management, inpatient care, intensive outpatient care, medical care, psychiatric rehabilitation, and targeted case management services.


CA-RTX 15.03

Therapeutic services help residents develop the knowledge, skills, and supports necessary to:
  1. manage mental health and/or substance use disorders;
  2. develop and practice prosocial behaviours;
  3. cultivate and sustain positive, meaningful relationships with peers, family members, and the community;
  4. develop self-efficacy; and
  5. promote recovery, resilience, and whole-person wellness.


Recovery is a holistic process of change where individuals learn to overcome or manage their diagnosed symptoms and conditions in order to improve overall well-being and achieve optimal health.


CA-RTX 15.04

Residents and their families, when possible, are connected with peer support services appropriate to their request or need for service.
Examples: Peer support services can help to promote resiliency and recovery and are provided by individuals who have shared, lived experience. They can include peer recovery groups, peer-to-peer counselling, peer mentoring or coaching, family and youth peer support, or other consumer-run services.


CA-RTX 15.05

Qualified personnel determine the need for and appropriate level of withdrawal management for the person using diagnostic criteria according to clinical decision support tools and clinical practice guidelines.
NA The organization does not provide withdrawal management.
Examples: Residential Withdrawal Management programs reviewed can include programs that are:
  1. Clinically-Managed: Clinically-managed residential programs, also referred to as non-medical or social detox, emphasize peer and social support. Services are primarily provided by appropriately trained, non-medical personnel.
  2. Medically-Monitored: In medically-monitored residential/inpatient programs, 24-hour medically-supervised withdrawal management services are provided by an interdisciplinary staff under the direction of a licensed physician.
Note: COA does not accredit medically-managed intensive inpatient withdrawal management programs. Medically-managed programs involve 24-hour medically-directed evaluation and withdrawal management and require an appropriately trained and licensed physician to provide and manage all diagnostic and treatment services. Programs are provided in acute inpatient care settings, such as hospitals, and are specifically designed for individuals with symptoms that require primary medical and nursing care services.

Fundamental Practice

CA-RTX 15.06

Residents receive withdrawal management services provided by a qualified team of appropriately trained and licensed professionals, including:
  1. assessment and evaluation;
  2. monitoring and stabilization; and
  3. engagement with substance use treatment to assist with relapse prevention following the discontinuation of substance use.
NA The organization does not provide withdrawal management.
Examples: Staffing may vary depending on the intensity of the services offered. For example, organizations providing medically-monitored withdrawal management will typically employ an interdisciplinary staff of nurses, counsellors, social workers, addiction specialists and/or other health and technical personnel, whom all work under the supervision of a licensed physician.


CA-RTX 15.07

Prior to discharge from withdrawal management services, all individuals receive:
  1. education about relapse, overdose, and mortality risk and prevention; and
  2. information on relevant harm reduction activities.
NA The organization does not provide withdrawal management.

Fundamental Practice

CA-RTX 15.08

Organizations providing withdrawal management to individuals withdrawing from opioids:
  1. counsel individuals on the importance of medication-assisted treatment (MAT) and the risks of relapse, overdose, and death following detoxification without transitioning to maintenance medication;
  2. offer MAT following withdrawal management either directly or through linkages with MAT providers;
  3. clearly document when clients refuse MAT; and
  4. provide a naloxone kit or prescription for any individual who refuses MAT.


Organizations that do not offer medication-assisted treatment should have MOUs with MAT providers to ensure timely initiation of treatment. Studies have shown the risk of relapse increases dramatically following withdrawal without ongoing treatment, with 25% of readmissions occurring within the first 7 days post discharge.
NA The organization does not provide withdrawal management.