Examples of Recent Research Activities - Completed or In Progress
Analysis of Addictions Treatment Outcome (In progress)
A great deal remains to be known about the optimal length of treatment necessary to produce "recovery", the types of treatments and patient characteristics that lead to good therapeutic outcomes, or the factors that influence the likelihood of treatment failure or drop-out. This ongoing study examines the factors that predict relapse, drop-out, and treatment completion for substance abuse disorders. Information being collected at the beginning of treatment includes demographics, addiction severity, psychological status, psychiatric diagnoses, primary drug of abuse, drug use history and cognitive status, and treatment outcome is being determined using a multivariate index that includes length of stay in treatment, amount of drug use at follow-up as monitored by self-report and random urine screening, as well as attendance in group and individual therapy. Some results from this study have been published in the following papers:
- An abstinence-oriented program for substance use disorders: poorer outcome associated with opiate dependence. Canadian Journal of Psychiatry, December 2000
- Association between concurrent depression and anxiety and six-month outcome of addiction treatment.Psychiatric Services, August 2005
- Sexual abuse and the outcome of addictions treatment. The American Journal on Addictions, March 2007.
An Examination of Serotonin Synthesis in Chronic Alcoholics Using Positron Emission Tomography (PET) (completed)
Some research has suggested that alcoholics have a genetically transmitted or developmentally mediated biochemical abnormality that creates a deficiency of serotonin in the brain. However it has not been possible to determine whether alcoholism is distinct from depression in terms of state and/or trait-dependent effects on the serotonin system. Alcoholic subjects (as well as age and gender matched controls) were screened and recruited at the Addictions Unit, while brain scans were conducted at the Montreal Neurological Institute. Regional brain serotonin synthesis was measured using positron emission tomography (PET) and α-[11C]methyl-L-tryptophan as the tracer. Comparisons of alcoholics and controls found that there were significant differences in the rate of serotonin synthesis between groups. Serotonin synthesis was significantly lower among alcoholics in Brodmann Area (BA) 9, 10 and 32. However, serotonin synthesis among the alcoholics group was significantly higher than controls at BA19 in the occipital lobe and around the transverse temporal convolution in the left superior temporal gyrus (BA41). Current alcoholism is associated with serotonergic abnormalities in brain regions that are known to be involved in planning, judgment, self-control and emotional regulation. Follow-up studies are planned. Some results from this study have been published in the following paper:
- Alterations in brain serotonin synthesis in male alcoholics measured using positron emission tomography (PET). Alcoholism: Clinical Experimental Research, Februrary 2009.
Medication Trial – Do Anti-depressant medications improve outcomes in the treatment of Alcoholism (patient recruitment complete, data analysis in progress)
This study examined the effects of an anti-depressant medication Citalopram in depressed and non-depressed alcoholics entering addiction treatment. Following an extensive baseline assessment, including an evaluation of depression status, and collection of blood samples for the determination of serotonin (5HT) parameters (5HT transporter polymorphism), patients were randomly assigned to receive placebo or citalopram (40 mg) in conjunction with a 12-week course of standard addiction treatment. Outcome is being examined in relation to both clinical variables (e.g. family history) and biological variables (e.g. 5HT uptake, genotypes) at intake. Some early results from this study have been published in the following journals:
- Early recovery from alcohol dependence: Factors that promote or impede abstinence. Journal of Substance Abuse Treatment, January 2010 (Volume 38, pages 42-50).
- Personality disorders among alcoholic outpatients: Prevalence and course in treatment. Canadian Journal of Psychiatry, February 2010
The Efficacy of Buprenorphine in the Detoxification of Opiate-dependent Patients: Management of Withdrawal Symptomatology and Retention in Treatment. (In progress)
Buprenorphine is a partial mu-opioid receptor agonist with mixed agonist-antagonist properties. It has been shown to be effective in alleviating many of the withdrawal symptoms of opiate dependence and some research has suggested that it is easier to taper than some of the more commonly used opiate substitutes such as methadone and LAAM. The present study was designed to further examine the efficacy of buprenorphine in the detoxification of opiate dependent individuals. A number of questions remain concerning the optimal starting dose of buprenorphine and rate of detoxification that will ensure compliance and retention in treatment. In addition, procedures need to be developed to transfer patients onto adequate blocking doses of naltrexone immediately following opiate detoxification. A gradual detoxification protocol over a 12 week period, beginning at 8 or 12 mg per day is being used in order to determine efficacy with regards to controlling withdrawal symptomatology and enhancing compliance and treatment retention.
The Social and Psychological Impact of Gambling in the Cree Communities of Northern Québec (Subtitle – The In Search of Peace of Mind Project) (Data collection complete, data analysis in progress)
In small isolated communities of the Cree territory, gambling traditionally brought people together in a social activity that redistributed wealth within a closed system. In the past ten to twenty years gaming and gambling activities have increased as the population has grown in size, social complexity, and wealth. The “In Search of Peach of Mind” project was developed at the request of the Cree Board of Health Social Services of James Bay (CBHSSJB), and represents a partnership between academics (K. Gill, J. Derevensky) and representatives of the CBHSSJB (J.Torrie). A detailed survey of gambling, addiction and mental health was conducted using semi-structured and structured instruments in randomly selected respondents (n=510) from 4 Cree communities. Analyses of the data found that 65.2% of the total sample took part in a gambling/gaming activity over the past year. Approximately 8.6% of the individuals who had participated in any gambling or gaming activities over the past year were categorized in the high risk problem gambling category, using the Canadian Problem Gambling Index. Problem gamblers showed significantly higher levels of psychological problems, including depression and anxiety, compared to low risk gamblers. In addition, problem gambling was associated with higher rates of cigarette smoking and current substance abuse. Approximately 42% of the problem gamblers were found to have a concurrent substance abuse problem. The high rates of lifetime comorbidity between problem gambling, nicotine dependence, substance abuse and other psychological problems suggest that for some Cree adults, gambling is part of a pattern of high-risk behaviour that carry significant negative long-term health consequences. These results suggest that interventions for gambling disorders should not focus on gambling alone, but rather the constellation of dysfunctional behaviours that pose a risk to “Peace of Mind.”
The Lives of Aboriginal Women (Subtitle: Mental Health and Substance Abuse Problems Among Urban Aboriginal and Non-aboriginal women) (Data collection complete, data analysis and manuscript preparation in progress)
This study identified a population of Montreal Aboriginal and non-Aboriginal women seeking shelter and mental health services in Montreal. In the course of the study a number of inter-related issues were explored including substance dependence, physical/sexual abuse, family functioning, and mental health in relation to need for treatment, access to services, utilization of and satisfaction with services and outcome. The barriers to treatment access for recent migrants to the inner-city, the difficulties inherent in the urbanization process (including socioeconomic factors as well as cultural adaptation), as well as the specific cultural factors which confer risk and protection for substance abuse and other mental health problems were examined. Some results from this study have been published in the following papers:
- Substance Abuse in an urban Aboriginal population: Social, legal and psychological consequences. Journal of Ethnicity in Substance Abuse, 2002
- Substance abuse among urban Aboriginals: Association with a history of physical/sexual abuse. Journal of Ethnicity in Substance Abuse, 2002
CIHR Team in Substance Abuse Treatment - Treating Substance Dependence and Mental Illness: Tools for the Front Line Practitioner (In progress)
The objective of this program of research is to accelerate the translation of treatment strategies created by science into effective practices. The research will examine the process of implementation of an evidence-based program of treatment for substance dependence, including brief interventions (BI) into three primary care clinics in Montreal, administered by the Centre de Santé et de Services Sociaux (CSSS) de la Montagne, and directly measure program effectiveness as determined by changes in health care service delivery, sustainability and outcomes for patients. During the process of program implementation, the Team will utilize an integrated knowledge translation (iKT) strategy to build collaborative mechanisms for knowledge exchange between researchers, addiction specialists and frontline practitioners (guided by the principles of participatory-action research), and directly examine the process of knowledge uptake and barriers to transfer using both qualitative and quantitative methodologies. Evaluation will involve multiple measures, time points and domains, taken from the perspective of multiple stakeholders. Outcomes for patients treated with the BI will be determined by a multivariate index that includes retention in treatment, changes in the amount and frequency of drug/alcohol consumption, reduction in the severity of addiction, duration of continuous abstinence, reductions in psychological distress (depression, anxiety), number of visits to emergency services, number of hospitalizations, as well as improvements in psychosocial functioning and quality of life.