Addictions Research Section: Research Annual Report 2003

Section Head: Dr. Tony Toneatto

The Addiction Section conducts clinical research, experimental and applied, in all aspects of addiction. Drs. Bruna Brands, Beth Sproule and Tony Toneatto are the Section's scientists. Our research activities focus on four areas: gambling, psychopharmacology, treatment outcomes and clinical services.

Gambling Research

In our gambling research (Dr. Tony Toneatto), we aim to develop effective treatments for pathological gambling. Within the past year, we have completed two studies, one on the effectiveness of naltrexone for people with concurrent alcohol and gambling problems, and a second comparing several brief cognitive-behavioural treatments. We are now in the follow-up stages with both studies.

During the next year, we will conduct two treatment studies. The first will evaluate manual-assisted tele-counselling for gambling problems. The second, in collaboration with Dr. Nigel Turner and Mr. Warren Spence, will evaluate the effectiveness of acupuncture as a treatment for problem gambling.

Dr. Toneatto is also studying thinking processes in people who have gambling problems; results show a high correlation between irrational beliefs (such as thinking that efforts to regain gambling losses are justified) and the development of problem gambling.

Psychopharmacology Research

Our psychopharmacology research (Drs. Bruna Brands, Beth Sproule, Peter Selby, David Marsh) focuses on the care of opioid addiction.

Drs. Brands and Marsh have co-authored Best Practices in the Design and Delivery of Methadone Maintenance Treatment Programs. This publication offers information that can help opioid-treatment programs become more effective and encourage the establishment of new programs.

Dr. Brands (with Drs. Joan Blake, Beth Sproule, Douglas Gourlay and Usoa Busto) is studying the expansion of methadone maintenance treatment (MMT) availability to patients with dependence on opioids other than heroin, to increase access to treatment that previously would have been unobtainable.

Dr. Brands is also studying the effectiveness of treatment programs specifically designed for adolescents who are dependent on heroin, among whom multiple drug use is common. We found that, among adolescents who use heroin, the mean age of first use was 15 years. In this population we also saw an association between heroin use and significant comorbidity, including mental health issues and physical health risks.

Dr. Sproule is developing a novel approach to statistical analysis, using "fuzzy logic" to evaluate the relationships between patient characteristics and medication outcomes. We are conducting an ongoing and extensive evaluation of this approach, including comparisons to other methodologies.

In another study, Dr. Sproule has compared the attitudes and professional interactions of community pharmacists toward patients taking mental health-related medications and those taking cardiovascular medications. Despite the generally positive attitudes expressed by community pharmacists, we found that pharmacists interacted less with, and offered fewer professional activities to, patients using mental health medications. This pattern needs to be improved; more interaction could optimize the prevention, detection and management of drug-related problems in these patients.

In collaboration with colleagues in the Clinical Neuroscience Section, Dr. Sproule is also evaluating the effects of hypnotic medications in older adults.

Treatment Outcome Research

Treatment outcome research consists of three clinics, headed by psychologists who are developing empirically based treatments for addictive disorders.

Dr. Shelley McMain, head of the Dialectical Behaviour Therapy Unit, is conducting a five-year, CIHR-funded study evaluating the clinical and cost effectiveness of dialectical behaviour therapy (DBT) for people who have borderline personality disorder, including many who have concurrent substance use problems.

The Anger and Addiction Clinic, headed by Dr. Lorne Korman, is evaluating an integrated treatment for people who have concurrent anger, substance use and gambling problems. The researchers are testing a DBT-based treatment that targets emotion dysregulation, thought to underlie both anger and addiction problems.

The Eating Disorders and Addiction Clinic, headed by Dr. Christine Courbasson, has developed (with Lauren Dixon) a manualized treatment, rooted in DBT, that targets the emotion regulation problems that are common to both eating disorders and problem substance use. This treatment is the first to tailor DBT to treat concurrent eating and substance use problems simultaneously.

Clinical Service Research

Our clinical services research area conducts effectiveness and process research in collaboration with CAMH addiction programs and services.

We are about to complete a study evaluating the outcome and process of brief treatment for addictions. This study will identify the key treatment interventions that produce therapeutic benefit.

Other projects in progress include studies evaluating the delivery of treatments for problem gambling, addiction in youth and addiction in women.

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