Understanding

			Gaining insight into the problems associated with mental illness and addiction, and translating that knowledge into solutions and resources, is fundamental to the Centre's work. The Centre and its many partners work on both aspects to improve the quality of life for people who have addiction and mental illness. Anxiety Disorders Unit Thinking outside the box Dr. Neil Rector Everyone has disturbing thoughts. For most people, they're fleeting. Not so for people with obsessive compulsive disorder (OCD). "They think that simply because they have a negative thought about a potential negative outcome, they are now responsible for preventing the outcome," says psychologist Dr. Neil Rector, head of the Centre's Anxiety Disorders Clinic. They're boxed in, endlessly rethinking thoughts, castigating themselves and previewing catastrophes. Many compulsively perform rituals to relieve their anxiety. New application for cognitive therapy In 1999, the clinic broke new ground by adding cognitive therapy to the standard behavioural and medical treatments for OCD. "Cognitive therapy works by helping clients view their experiences from alternative perspectives. They are helped to identify and test their catastrophic thoughts regarding their obsessions and to learn about the actual risks of having obsessive thoughts," says Rector. Cognitive-behavioural therapy (CBT) has been "the treatment of first choice for other anxiety disorders. However, the cognitive component has lagged behind for OCD," says Rector. Only three small studies to test its effectiveness for OCD have been done, all in Europe. The Centre is embarking on a study developed at Boston University that will rigorously test a new treatment manual that includes cognitive modules. "We're studying whether the cognitive piece offers something new," adds Rector. The Centre is also actively training experienced clinicians in CBT techniques. "These particular intervention skills are in short supply in the community," says Rector. Cognitive therapy requires 12 to 14 sessions for results. For OCD clients, as Rector points out, this could mean a significant reduction in symptoms, in "only three months of hard work -- after decades of suffering."		En Français | Help | Search | Events | CAMH Library | Guide to CAMH | Donate Now   On this page Anxiety Disorders Unit Neuroscience/Molecular Neurobiology In the Lab Developing More Effective Treatments Ontario Student Drug Use Survey Understanding Addictive Behaviours Youth and Family: Better Understanding Supporting Cultural Adaptation Methadone Maintenance: A Pharmacist's Guide to Treatment Training and Education Raising Awareness, Furthering Understanding     For further information Related Pages PDF Version of the 1999/2000 Annual Report Message from the Chair and President Understanding Prevention Care Statistics Salary Disclosure Act Board of Trustees Senior Management Group Vision, Mission, and Values Financial Statements (PDF Version only) How to Reach Us

			Neuroscience/ Molecular Neurobiology Dr. Fang Liu and Dr. Hyman Niznik New key to unlocking brain's mysteries A groundbreaking study conducted by the Centre, the University of Toronto and Hospital for Sick Children may, in time, lead to improved treatments for schizophrenia and addiction. The study, published in the January 20, 2000 issue of Nature, discovered a previously unknown method of communication between a dopamine receptor (D5) and a GABA receptor, according to the late Dr. Hyman Niznik*, head of the study team and section head, Laboratory and Molecular Neurobiology at the Centre. Dopamine and GABA are chemicals in the brain called neurotransmitters. Many of the symptoms associated with schizophrenia and addiction are caused by either too much or too little dopamine and GABA. New model for understanding brain cell activity The study found that the two receptors, or brain proteins, communicate directly with each other. This overturns the conventional understanding of how these proteins work. Niznik explained, "Neurotransmitters and receptors work like a key and lock system. The neurotransmitter is the key; its receptor, or protein, is the lock." The keys open the locks, exciting brain cell activity. The new discovery has, in essence, discovered one lock opening another. Potential significance It is too soon to say whether this discovery will definitely have an impact on treatment. However, according to Niznik, our new understanding "may have therapeutic potential for certain symptoms, including the ones we have no treatment for today." He explained that current antipsychotic drugs help manage only certain types of symptoms of schizophrenia such as hallucinations, delusions and paranoia. To date, there are no real treatments for other types of symptoms, such as disconnected thought processes and lack of emotional range. The last two symptoms may sound less dramatic, but they seriously interfere with people communicating and socializing. "People who suffer from schizophrenia may skip from topic to topic for no reason and with no reference to what is being said to them. They may have emotional responses that are utterly inappropriate to the circumstances. The upshot is that even people who have the delusions and hallucinations under control still have trouble reintegrating into society because of those other unmanaged symptoms," said Niznik. The Centre's discovery may give researchers a means of attacking these symptoms along with the others. Now that researchers know how the two brain proteins communicate, the next step for the Centre is to determine whether and how the communication is malfunctioning in the brain of someone with schizophrenia. As Niznik put it, "Are the proteins talking too much or too little?" The answers "might, in time, allow us to help restore normal function."		Dr. Hyman Niznik passed away on March 31, 3000. An internationally renowned scientists as well as a beloved colleague, he will be greatly missed.

			In the Lab Responsive Receptors Serotonin reuptake inhibitor treatment is the most common treatment in the world for depression. We are conducting a first study, using brain imaging to measure the effect of such treatments in the human brain, to try to uncover how they work. Bipolar Depression Treatments In the treatment of bipolar depression, antidepressants can have an exaggerated effect and produce mania or increase the frequency of mood swings. While mood-stabilizing drugs are effective in stabilizing both manic and depressive swings, they are often associated with significant side-effects, including weight gain. The Bipolar Clinic is comparing the effects of a new mood stabilizer drug associated with weight loss during treatment with an antidepressant that has some preferable effect on bipolar depression. Sad Events in the Brain PET (positron emission tomography) scans provide a profile of the activity of brain circuits during emotional challenges. There are some similarities between "sad brains" and patients with depressive illness. In a new study, patients with bipolar disorder show an exaggerated brain response when asked to recall a personal sad event even when they were not in a depressed phase. Misregulation of Brain Receptors Both in mental illness and drug addiction, there is considerable evidence that brain receptors are not regulated properly. The Centre's research looks at the cellular mechanisms that are responsible for achieving receptor regulation and how these mechanisms are changed with receptor disregulation. This knowledge may lead to new biological treatments for depression.		CAMH Publications

			Developing More Effective Treatments Functional Bowel Disorder in Women Functional bowel disorder (FBD) is a chronic and debilitating syndrome frequently associated with anxiety, depression and impaired daily functioning. By bringing together investigators from a spectrum of relevant disciplines and by taking a holistic view of this disorder, this study is assessing both the biological and psychosocial aspects of FBD to improve understanding of the syndrome and determine the most effective treatments. Depression in the Workplace Rising rates of disability due to depression are of concern to multiple stakeholders including the Ontario Roundtable on Appropriate Prescribing. Three Canadian companies, representing 80,000 workers, were selected as participants in a project with workers on short-term disability that examines the efficacy of different antidepressants and their relationship with return to work. Recurrence of Clinical Depression People who have recovered from an episode of clinical depression have an increased risk of becoming depressed again, especially if they show signs of negative thinking. This study tries to identify, in advance, the patients most likely to become depressed again on the basis of changes in conscious reaction to emotionally laden stimuli. The goal is to customize treatment strategies to reduce the rate of relapse or recurrence in vulnerable individuals. Post-Menopausal Depressed Women Women are twice as likely as men to develop major depression and are especially vulnerable during times of change in reproductive hormone activity. Antidepressants may also be less effective during these periods. The Depression Clinic is studying the effect of adding a selective estrogen receptor modulator to standard antidepressant therapy in post-menopausal depressed women.

			Ontario Student Drug Use Survey Training a spotlight on adolescent health Dr. Edward Adlaf How old are students when they first experiment with alcohol and tobacco? Who are the heaviest marijuana users? The heaviest drinkers? In Ontario, since 1977, the answers to questions like these have been provided by the Centre's Ontario Student Drug Use Survey (OSDUS), the longest-running study of adolescent drug use in Canada. And the answers have been used to help inform the development and evolution of policy, education and care. Timely public health response Indeed, monitoring alcohol and drug use and impaired mental health "is critical to providing a timely and appropriate public health response," says Dr. Edward Adlaf, lead scientist of OSDUS. He cites a trend confirmed in the 1999 OSDUS. "We're seeing a continuum of use -- not clusters of students restricting themselves to one drug," says Adlaf. This has implications for programming, such as the Centre's Virtual Party Web site (see page 15), which educates teens on the effects of alcohol and drug use. Similarly, the study's finding, that students who use drugs frequently also have other mental health problems, has treatment implications. As Adlaf points out, "Treating someone for substance abuse alone when he or she also has depression or an anxiety disorder might not solve the problem." First in Canada OSDUS has always been relevant to communities. "The original request for a study came from the Toronto School Board," Adlaf notes. "And the boards are still our main partners, inviting us into the schools to conduct the survey." Since its inception, the scope and reach of OSDUS has grown. Unlike previous surveys, which sampled students in Grades 7, 9, 11 and 13, the 1999 OSDUS surveyed students from Grades 7 to 13 inclusive. OSDUS data has been widely used in the past by Public Health Units across the province to develop prevention programs by helping to identify the most problematic drugs and potential target groups. In 1998-99, the Centre's Dr. Louis Gliksman directed Canada's first national drug survey of undergraduates, an expansion of work the Centre had begun in Ontario universities several years ago. The findings, which were released this year, provide a useful comparison with the OSDUS data. Adlaf reflects that while OSDUS is critical for its data, its profile and respect in the community also play an important role. "The study itself helps keep the issue of alcohol, drug use and adolescent health on the public agenda."		1999 Findings: Student drug use on the rise Since 1993: * Alcohol use rose to 66 per cent from 56 per cent and more students reported weekly drinking and more episodes of heavy drinking. * 29 per cent of students report using cannabis, up from 13 per cent. * 28 per cent report smoking, up from 24 per cent. Three contributing factors: * weakening perception of risk of harm * weakening perception of moral disapproval * increased perceived availability One positive finding is that fewer students are using alcohol, tobacco or cannabis at an early age.

			Understanding Addictive Behaviours Problem Drinkers Using a variety of clinical approaches, a research project has been evaluating the effectiveness of self-help initiatives in clients in the general population. These initiatives are subtle and provide help without the use of formal treatment programs. Female Gamblers Very little is known about the special treatment needs of female gamblers. The Ontario Substance Abuse Bureau is funding a clinical research project led by the Centre to explore the differences between male and female gamblers with the goal of developing more customized treatment responses that will help women with gambling problems. Problem Gambling This research project compares female and male pathological gamblers and examines the relationship between pathological gambling and other psychiatric disorders. It also tries to identify those factors that promote recovery from gambling addiction with formal treatment (which is the most common way gamblers stop gambling) and to specify other variables that may predict treatment success. Youth and Family: Better Understanding Youth, Drugs and Violence A cross-national comparison of youth in Toronto and Philadelphia examines how various personal, social and neighbourhood factors affect the relationship between drugs and violence among those aged 14 to 17. This study will provide guidance for treatment directed at the prevention and reduction of drug-related violence among youth. Alcohol and Aggression Aggression is common in and around bars frequented by young people. Research using observations in bars and interviews with young people has helped to increase an understanding of how and why aggression occurs. This research has played a key role in the development of a program designed to make bars safer. This program will be evaluated and further research conducted with the aid of a grant from the US National Institutes of Health. Mood Disorders "Help us," said some families struggling to manage the needs of relatives with major depression and bipolar disorder. From that request came a psychoeducational series that offers caregivers up-to-date information on the disorders, practical coping strategies and a safe environment in which to share their experiences and receive support from other caregivers. Supporting Cultural Adaptation Immigration, Resettlement and Mental Health The primary objectives of this study are to gather immigrants' accounts of positive and negative impacts of moving to Canada and to identify the most salient themes and issues of immigration and resettlement. Korean and Vietnamese Youth This study investigates the mental health of youth from Korean immigrant families and compares the results with data obtained from the children of Southeast Asian refugees and a matched control sample of non-Asian Canadian youth. Results will contribute to the development of culturally appropriate preventive and remedial action for immigrant and refugee youth.

			Methadone Maintenance: A Pharmacist's Guide to Treatment Striking down the barriers to treatment "The situation was pretty grim," says Dr. David Marsh. "Some people committed suicide while they were waiting." What they were waiting so desperately for was methadone maintenance treatment, the most effective treatment available for opiate addiction. Before 1996, Ontario and Canada "had one of the lowest per capita rates of methadone availability in the developed world," says Marsh, clinical director of the Centre's Addiction Medicine Program. Regulatory changes empowered the Centre (through the former Addiction Research Foundation), to collaborate with the Ontario College of Physicians and Surgeons and Ontario College of Pharmacists to make methadone a priority -- through the development of guidelines that regulate the use of methadone in this province. Reaching communities, physicians, pharmacists Once the regulatory framework was in place, the Centre worked to develop the training and education resources required to equip physicians, pharmacists and counsellors to be able to dispense methadone in communities across Ontario. "We developed a three-day course and physician's guide, which is a highly structured one-day training course and two-day clinical placement," says Marsh. Today, more than 120 physicians in Ontario have been trained to provide methadone treatment to 5,000 patients, compared with 500 patients only five years ago. In 1996, the Centre launched the Methadone Dissemination Program. It identified six high-need Ontario communities: Sudbury, Thunder Bay, Hamilton, Ottawa, Windsor and the Niagara Region. Some of them had no doctors authorized to prescribe methadone. At most, they had two. Local Centre staff organized stakeholder committees with physicians, pharmacists, addiction counsellors, clients and police. Today, the committees recruit local doctors and co-ordinate the caregivers. World's first pharmacist's guide Unlike physicians, pharmacists don't require special authorization to dispense methadone, but "there are many nuances that don't apply to other areas of their practice," says Marsh. One example: for several months, patients have to take their doses under a pharmacist's supervision. In 1997, the Centre's training for providing methadone treatment was expanded to include pharmacists. And this year the Centre released Methadone Maintenance: A Pharmacist's Guide to Treatment. The guide comprehensively covers clinical, pharmaceutical and patient-related issues. "To the best of my knowledge this is the first publication of its kind anywhere in the world," says Marsh. "It will be valuable not just to educate and recruit pharmacists in Ontario, but across North America and other jurisdictions, as more and more move to community-based opiate agonist therapy.*" Also in 1999-2000, Marsh adds, "We helped the provincial correctional system develop a new methadone policy for inmates." The Centre is currently at work on a counsellor's guide and a client's manual.		Client receiving methadone treatment * a drug that activates opiate receptors, thereby producing effects similar to morphine.

			Training and Education The Changing Face of AIDS Workers of community-based AIDS service organizations experiencing the changing face of AIDS can be challenged by the complexities presented by the drug-using population. The Centre's HIV Program has developed a national training-needs survey targeting AIDS service organizations in five regions of Canada, which will form the basis of a training needs report. Mental Disorders in Primary Care The World Health Organization has developed a package of materials designed to help primary care physicians in the diagnosis and treatment of patients with one of six mental health problems. A study conducted in New Brunswick and Ontario, with funding from the Ministry of Health, investigates the impact of this package on the attitudes and behaviour of family physicians. Mental Health Services A detailed analysis of mental health services delivered by fee-for-service physicians and the changes occurring over a five-year period provide new information on a sector which, after psychiatric hospitals, represents the second largest portion of the mental health care budget. This report on the evolving role of family physicians and psychiatrists will be of great interest in the field. Keeping Up-to-Date Education and Training Services has been identifying and developing alternative ways for community practitioners to keep up-to-date with the latest information and skills in addiction and mental health programming. To address the feasibility of Internet-based learning for medical and counselling professions, the Centre is analyzing survey data from professionals in addiction and mental health to get an idea of the barriers and opportunities in marketing and designing on-line courses for practitioners. Raising Awareness, Furthering Understanding Public Education The Centre plays a crucial role in furthering the public's understanding of mental health and addiction. This happens in part by removing the barriers that prohibit people from seeking the help they need and by fostering public acceptance. The Centre's informative supplement in the Globe and Mail's Ontario edition in October is one example. The Centre also helps to promote Mental Health Week, Mental Illness Awareness Week and Drug Awareness Week. Working like Crazy This documentary, produced by Sky Works and supported by the National Film Board, the Ontario Ministry of Health and the Centre for Addiction and Mental Health, chronicles the lives of a group of psychiatric survivors who strive to lead quiet lives of small victories over tremendous obstacles. By having real work, these people have broken their isolation and given themselves a safe space in a community of their peers, a place where they can earn income and begin to rebuild their lives. Resources for Health Professionals The Centre translates the knowledge gained from research into practical resources and tools for health professionals and the public. Some recent additions include: Methadone Maintenance: A Pharmacist's Guide to Treatment and Management of Alcohol, Tobacco and other Drug Problems: A Physician's Manual. The Centre's Journal of Addiction and Mental Health celebrated its first anniversary in 1999. Best Advice The Centre's "Best Advice" papers present the most up-to-date knowledge on emerging issues and are designed to be used by professionals in the mental health and addiction fields, policy makers and others who wish to understand the latest information on key issues. Our two most recent additions are: Community Treatment Orders: Overview and Recommendations and Alcohol and Drug Prevention Programs for Youth: What Works.

			For general information on addiction and mental health: Call the R. Samuel McLaughlin Addiction and Mental Health Information Centre Toll free in Ontario 1-800-463-6273 or local (416) 595-6111 www.camh.net/mclaughlin DISCLAIMER: The Centre is not able to provide diagnostic, treatment or referral services through the Internet. Individuals should contact their family doctors, or their local mental health or addiction agency for further information.		© Copyright Centre for Addiction and Mental Health 33 Russell Street, Toronto Ontario, Canada M5S 2S1. Telephone: (416) 535-8501 The Centre is fully affiliated with the University of Toronto. A Pan American Health Organization and World Health Organization Collaborating Centre For inquiries regarding the content of this page, contact Please direct technical questions or comments about this site to If you are a spammer or spam-harvesting robot, please send mail to imaspammer-on@lists.camh.net.
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