New Trends in Addiction Treatment

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Today we can look back to a time when addiction, like mental illness, was considered more a lack of moral fibre than a health issue requiring help and understanding. In the past, little was understood of the special difficulties faced by those dealing with both mental illness and substance abuse. Substance abuse disorders are common for those dealing with chronic mental illness; however, few programs offer assistance for people struggling with both. With an eye to the future, Canada’s largest centre of its kind, the Centre for Addiction and Mental Health (CAMH) is taking the lead in the pursuit of new, individualised treatments for people with co-occurring mental health and addiction problems. New addiction treatment and training programs are also being developed to provide support for the diverse populations that CAMH serves.

In an effort to increase the safety of our city by reducing crime and drug use, the Toronto Drug Treatment Court (DTC) was started in December 1998 to help addicted non-violent offenders charged with possession of cocaine or heroin, or charged with prostitution to support this habit. In this voluntary program, the first of its kind in Canada, participants are provided with court-supervised treatment and given access to a number of services including housing, medical care and mental health care. Having reached this program’s goals of living free of drugs and in stable housing, plus either working or in a retraining program, clients who face jail time will instead receive a non-custodial sentence. DTC has been successful at significantly reducing drug use and criminal behaviour, and improving clients’ physical and psychological well-being. DTC is a joint venture involving federal and provincial ministries and agencies, the Toronto Police Service and community organisations. The results of DTC have been so promising that a second program has begun this year in Vancouver.

CAMH’s Rainbow Services has also created a new assessment tool to help therapists working with Lesbian, Gay, Bisexual or Transsexual (LGBT) clients. Often mental health and addiction workers do not know the most respectful and appropriate way to discuss gender or sexual orientation. This, unfortunately, has sometimes led to poor experiences for those seeking help. This new method, developed with the aid of clients, therapists and members of the community, encourages clients to open up about pertinent life experiences. The guide is now being used across the Addictions Programs at CAMH. “Staff have told us that it makes asking questions about sexual orientation and gender easier, and it helps them to better match clients with appropriate services,” says Farzana Doctor, Manager, Rainbow Services.

Among CAMH’s most vulnerable clients are senior citizens. CAMH is currently combining three programs to more effectively help this group: OPUS-55 (a program for older persons dealing with addiction), Geriatric Psychiatry, and Neuropsychiatry (two programs which have traditionally addressed how aging and disturbances of the nervous system give rise to mental disorders). “What ties these three programs together so effectively is our dedication to providing services to our clients – services imbued with respect, sensitivity to client needs, and responsiveness, regardless of the nature of problems,” says Gaby Golea, administrative director of Geriatric Psychiatry, Neuropsychiatry and Dual Diagnosis and Associate, Faculty of Nursing, University of Toronto. OPUS-55 realises that “total abstinence” from drugs or alcohol is not possible for every senior client. Instead, the program aims for a reduction in destructive practices, focusing on each client’s personal needs and abilities. With these three programs, offering both inpatient and outpatient services, clients have access to even more help.

Although studies clearly link anger, violence and substance abuse, until recently no treatment program existed to help people dealing with all three. “In the typical anger management course available in Ontario, clients dealing with substance abuse are often screened out, while programs to help addiction can face challenges in dealing with potentially angry and aggressive patients, particularly if they have limited resources,” says Dr. Lorne Korman, Clinic Head, Anger and Addiction Clinic and Assistant Professor, Department of Psychiatry at the University of Toronto.

This is where CAMH enters the picture, where, through its Concurrent Disorders Service, it offers the Anger and Addiction Clinic, an outpatient program to help clients build the skills necessary to manage their emotions, behaviours and their lives. Clients of the Clinic are provided with a minimum of six months of treatment using an adapted form of psychotherapy called Dialectical Behaviour Therapy, or DBT. DBT is a cognitive-behavioral approach initially designed to treat borderline personality, a disorder characterized by problems in regulating emotion. DBT has been shown to effectively reduce suicidal behaviour, anger and substance use.

CAMH’s goal is to work toward a more seamless integration of addiction and mental health programming. In keeping with this, CAMH’s largest clinical program, the Schizophrenia Program is collaborating with the Concurrent Disorders Service to help their clients who have substance abuse problems. Specialised training is given to health care workers in the Schizophrenia Program, providing them with increased knowledge regarding the issues of substance abuse. Several staff in the Schizophrenia Program are now running groups for clients with active addiction problems and mental illnesses that have a chronic and severe nature. The plan is to extend the learnings from this pilot project to all areas within the Schizophrenia Program and then to the other clinical areas within CAMH.

More information can be found about CAMH’s programs at www.camh.net.