Jonathan first met the health system on the floor of an emergency room.
He had drunk himself into a crisis, and the team did what they are trained to do: stabilize, monitor, and discharge. He got a lecture. He got a referral. He was given an AA meeting list. Then he got on with the long business of suffering.
For years, Jonathan bounced between moments of crisis and well-intentioned medical appointments that never touched the parts of his life that actually kept him sick. His body was treated; his days were not.
He stopped drinking more than once, but sobriety kept breaking against the same jagged realities, such as sleep that never settled, routines that never stuck, a home that pulled at old triggers, and expectations he simply could not meet.
Eventually, something different happened. He found help that worked on two fronts at once: the “why” (addressing an undiagnosed mental-health challenge he had been trying to numb) and the “how” (the practical skills and supports to make daily life manageable). Recovery finally had somewhere to live. It was the difference between crisis care and the supports that make recovery livable.
Jonathan’s name is not really Jonathan. It is Irving. That person is me.
I am sober. I have two adult children, postgraduate degrees, and the privilege of serving as CEO of a national professional health care association. And I will always believe my story did not need to take as long to unfold, or cost as much, in time, money, and pain, if the right supports had been in place.
The illusion of the crisis middle
Canada keeps funding the “crisis middle” of addiction and mental health, the overdose, the psychiatric emergency, the hospital bed, and the treatment center, and wonders why people return through the same revolving door. We debate involuntary treatment and other crisis-centric policies as if decisiveness alone can substitute for effectiveness.
Meanwhile, we underinvest where outcomes are actually won or lost: the wrap-around services and interventions aimed at prevention or post-crisis supports.
I needed help making a week, or even a day, that worked. I needed a home that did not sabotage me, a consistent way to get to school and work, a plan for triggers and cravings, a schedule that included sleep, meals, and meds, and the skills to navigate real-world friction without falling apart.
I also needed someone who could have spotted and addressed the mental-health issues that often drive substance use in the first place, early, not after years of damage.
As a patient in the system, I witnessed firsthand how fundamental systemic changes are needed to help Canadians with addictions. I now bring that lens to my professional life.
The missing link in addiction recovery
I have worked in Canada’s health system for more than 30 years alongside clinicians, leaders, and policymakers. A year ago, I became CEO of the Canadian Association of Occupational Therapists, where I see daily how well-entrenched system habits, not a lack of solutions, are standing in the way.
Occupational therapists (OTs) are often the missing link in addiction health and social services.
OTs are trained to focus on people in all their dimensions, and work with them to make daily life livable. OTs look at the fit between a person, their goals, and their environment, and they help change what needs changing in that environment so people can participate in the roles that matter to them: student, parent, worker, neighbor, and friend.
In addictions and mental health, that looks like prevention and early support for kids and families; practical, trigger-aware planning for the week after discharge; and hands-on help with housing, routines, transportation, work or school readiness, and parenting.
If that sounds like “soft” care next to emergency or addiction medicine, ask anyone who has relapsed because life outside the hospital or treatment center was impossible to manage. Ask the emergency doctors who keep seeing the same people for the same reasons.
Reimagining the continuum of care
Governments and health systems organize care around crises, yet recovery is decided by everyday life, and that is exactly where we fail to invest.
So why are OTs not part of the default playbook? Habit, mostly, and a lack of awareness of what OTs do and the critical role they play, or could play, in improving health outcomes and quality of life.
Governments and health systems reflexively build solutions around physicians and nurses in crisis settings. Hiring templates, referral forms, and program designs often omit OTs or relegate them to “rehab” after the drama is over. And because we measure wait times and bed days more than we measure whether people are keeping housing, staying in school, or maintaining work, we overlook the professionals who move those outcomes.
We can do better, without pretending we need to invent new solutions. We have already trained the workforce.
OTs need to be seen as essential across the whole continuum of care, with embedded roles in:
- primary care and community mental-health hubs
- youth and family services
- schools and housing programs
- recovery programs and justice transitions
Critically, the moment someone leaves the hospital after an overdose or psychiatric emergency, they should be automatically connected to an OT in the community.
Matching the problem to the skill set
This is not about choosing one profession over another. It is about matching the problem to the skill set.
Emergency teams save lives. Physicians diagnose and prescribe. Psychologists and social workers provide therapies and supports. Occupational therapists make the rest of life work so recovery can stick. We need all of the health professions. We also need to make the best use of each of them.
I sometimes think about the tally of my own crisis-only years: the emergency visits and admissions, the opportunities missed, the cost to my family and to the system. Multiply that by the thousands of Canadians cycling through the same door and the conclusion writes itself.
Funding prevention and post-medical supports, what OTs do every day, is not only compassionate. It is fiscally responsible.
We say we want fewer overdoses and fewer mental-health crises. Then we should stop pouring all our energy into the moment of collapse and start investing in the weeks, months, and years to make collapse less likely.
Put OTs on the field. We do not need to wait for another debate about involuntary treatment to do it.
Irving Gold is a health care executive.
