Examples of Recent Research Activities - Completed or In Progress
Canadian Research Initiative in Substance Misuse (CRISM) (In Progress, Initiated March 2014)
McGill Québec/Atlantic Regional CRISM Network - Treatment of Mental Illness and Addiction
CRISM was developed by the Canadian Institutes of Health Research (CIHR) in collaboration with the Canada Drug Strategy. The purpose of CRISM is to fund provincial networks of clinicians, clinician/scientists, health administrators, patients and family/caregivers to develop and implement efficacious interventions for substance misuse that are cost effective, patient-centred, and feasible to implement within community-based clinical settings.
The McGill-based network will design and implement treatment programs that improve care for patients with concurrent disorders such as psychosis, mood, anxiety and personality disorders. The onset of mental illnesses and substance dependence - termed comorbidity, concurrent disorders or dual diagnosis - often begins in adolescence or early adulthood, preventing individuals from completing their education, maintaining employment, and forming positive, enduring relationships with family and friends. In patients with comorbidity, the course and outcome of both disorders are more severe, and they are at elevated risk for poor medication compliance, psychological distress, poor quality of life, family stress, early mortality, and poor outcomes. The McGill network will focus on early interventions, methods to improve access to care, building treatment capacity, peer counseling as well as family support and treatment. Patients and family/caregivers will be given an opportunity to participate in many aspects of the network development.
The McGill network is comprised of mental health practitioners from the Addictions Unit, McGill University Health Centre, frontline primary care clinics (CSSS de la Montagne, CSSS Cavendish) as well as secondary/tertiary care clinics (Allan Memorial Institute, Douglas Hospital). In addition, there are members from McGill University, University Laval, and Dalhousie University.
Illicit and prescription opiate abuse: Improving treatment outcomes. (In progress)
Dependence on opiates is a major health issue in Canada. Among intravenous users, concomitant risks include the transmission of the human immunodeficiency (HIV), hepatitis B and C viruses, and tuberculosis, as well as a high incidence of death due to overdose. The incidence of non-medical use of prescription opioids is rising throughout North America, reaching near-epidemic proportions. Given the high social, health and economic costs associated with opiate dependence, research into effective treatment is a critical clinical and research issue.
The current program of research will provide a novel approach to improving outcomes for opiate dependent patients. There is accumulating evidence that chronic opiate use is associated with the development of hyperalgesia, a state of nociceptive sensitization characterized by increased sensitivity and enhanced pain responses to noxious stimulation. Paradoxically, opioid use aimed at relieving pain may make individuals more pain sensitive over the course of chronic abuse. Hyperalgesic, highly sensitive opiate-dependent patients may experience a great deal of difficulty tolerating opiate withdrawal including the somatic symptoms (fever, chills, pain, muscle cramps), as well as the emotional distress (agitation, anxiety, sleep disturbance) and mood symptoms (dysphoria, irritability) inherent in the detoxification process. The research program will explore the relationships between psychiatric comorbidity, pre-existing pain syndromes and the development of hyperalgesic responses during detoxification, and the role of these factors in treatment outcome. Both short-term outcomes (e.g. drop-out, completion of detoxification) and longer term treatment outcomes (slips, relapses and abstinence) are being examined.
Prior to treatment patients that consent to the study are being assessed in terms of type of opiate abused (illicit street vs. prescription opioids), patterns and amount of substance use, addiction severity, psychiatric problems, impulsivity, psychological distress, general sensory and pain sensitivity via clinical interviews, self-report questionnaires, and objective measures. Subsequently, all patients will be prospectively monitored throughout the detoxification process in terms of craving, mood, objective and subjective withdrawal symptoms, vital signs, subjective experiences of pain, and objective measures of hyperalgesia and allodynia. The study will compare both opiate (illicit vs. prescription opioids) and sedative-hypnotic dependent patients at treatment entry, during detoxification, at the end of detoxification, as well as at 3- and 6-months of follow-up. The study is in progress.
- Mauger S, Fraser R, Gill KJ (2014) Utilizing buprenorphine-naloxone to treat illicit and prescription opioid dependence, Neuropsychiatric Disease and Treatment. 10: 587-598. DOI: http://dx.doi.org/10.2147/NDT.S39692
CIHR Team in Substance Abuse Treatment - Treating Substance Dependence and Mental Illness: Tools for the Front Line Practitioner (Phase 1: data collection complete, data analysis and manuscript preparation in progress; Phase 2: 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 into three primary care clinics in Montreal, administered by a Health and Social Services Centre (Centre de Santé et de Services Sociaux; CSSS), 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. Patient outcomes 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. Phase 1 of the project had been completed and involved a needs assessment to inform the development of training materials, methods and delivery, clinician training via the implementation of an addictions program coordinator, establishing a portrait of clinical practice and exploring current organizational readiness to change.
Phase 2 is a qualitative expansion of phase 1, exploring the implementation process and development of frontline services for substance abuse at multiple CSSS throughout Quebec. This research project was concurrent with policies from the Quebec Ministry of Health and Social Services (MSSS) mandating CSSS to provide screening and early intervention for substance abuse (and gambling). Organically the project expanded to examining the facilitators and barriers of these policies. Each of the 94 CSSS in Quebec was invited to participate in phase 2, followed by a purposive sampling of 21 CSSS. To date, 45 participants have been interviewed including clinicians, management and directors involved in the development and implementation of services for substance abuse.
- Research partner CSSS de la Montagne: http://www.sherpa-recherche.com/
- CIHR Team in Substance Abuse Treatment - Treating Substance Dependence and Mental Illness: Tools for the Front Line Practitioner (Presentations PDF)
Analysis of Addictions Treatment Outcome
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.
- 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 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.”
- Research project in collaboration with Network for Aboriginal Mental Health Research (NAMHR): http://www.namhr.ca/
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.
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.
The Lives of Aboriginal Women (Subtitle: Mental Health and Substance Abuse Problems Among Urban Aboriginal and Non-aboriginal women)
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
Last updated June 17 2014