James* has been through periods of depression on and off for many years. He’d sought help through a number of agencies, including CAMH. In addition, James struggles with alcohol use as well as opiate substances. He was willing and ready to try anything that might help him. “It got progressively worse. Last summer I spent a great deal of time doing work on myself and doing some soul searching and trying to figure out where I am in my life right now and what’s of real value and where do I want to go at this stage in my life.”
James’ journey brought him to a new CAMH program that brings together a team of clinicians from different disciplines that work together to deliver a structured program, or “pathway”, for clients. It’s called the Integrated Care Pathway (ICP) for Major Depression and Alcohol Dependence. It’s a structured, 16-week outpatient program that combines psychotherapy and medications along with care and support.
Currently, it’s common practice to treat depression and alcoholism as separate conditions. This new approach treats them concurrently, with evidence-based interventions that are personalized, optimized and sequenced to achieve the best outcome possible for the individual patient.
Dr. Andriy Samokhvalov is a psychiatrist and clinician scientist with CAMH’s Addiction Medicine Service and part of James’ treatment team. He explained why CAMH created this particular pathway.“What we noticed in our program is 60 per cent of our patients have quite high depression scores, higher than moderate severity. People self medicate with alcohol, and at the same time when people are consuming alcohol they tend to have some sort of emotional disregulation and when they withdraw they might be more depressed and anxious.”
Anne Kalvik is a pharmacist with the Addiction Medicine Service who is one of the clinicians involved. “People require support. For both conditions, the medications don’t make the client feel instantly better. Medication for alcohol dependence works subtly, but you have to take them in order to get benefit from them.”
So how does this translate to a client who needs help? Here’s what James had to say about it. “I found that I had immediately clicked with my psychotherapist. With the entire team, including the nurse and pharmacist and Dr. Samokhvalov, I like them as people, not just as clinicians.”
Dr. Julie Irving is a psychotherapist working in Addiction Medicine Service and part of James’ team. She helped create the cognitive behavioural therapy aspect of the pathway. “I was really struck by how nice it is to be part of a team where there are ample opportunities to consult when issues arise. We have regular case conferences every week and we’re all in touch sometimes even several times a day if we need to and an issue is coming up”.
Dr. Irving has seen how that pathway teamwork has really helped clients. “It’s like we’re hitting the ground running with patients. If they’re getting ongoing medications from their pharmacist and having the psychiatrist who can alleviate some of those really severe symptoms early on…to me it seems like, anecdotally, it helps people get a jump on things faster which can help with motivation.
James has found the psychotherapy helpful in working through his thought processes to prevent getting into depressive states. He’s on medication for depression. For a while he was also on anti-craving medication, and now says he doesn’t have physical cravings. “I definitely think the best part of that was I got the ability to catch my thoughts. I now walk on a daily basis for at least an hour and a half every morning, so I find that very helpful.”
Dr. Samokhvalov has been pleasantly surprised by how engaged clients have been with the program so far, which has a 90 per cent retention rate. “A lot of resources are dedicated to handle a single client. Even if they don’t respond well in terms of treatment, they still stay in treatment.”
James is the first graduate of the ICP for Major Depression and Alcohol Dependence and has now been sober for over seven months. “Ultimately what I got out of it is that I need to utilize all the support that’s available to me, but it’s up to me to do that. So now I feel that I have control of my self-care and that I’m able to make the right decisions.”
He says the pathway has given him a lot of personal insight as well as the resources and capability to be his own best caregiver. “I’m just so very, very grateful for all the nice people that encouraged me and supported me and my life is so much better now than it used to be because of the wonderful people at CAMH. “It’s very heartwarming to know there are people who actually have nothing but loving kindess and compassion for people such as myself that suffer from depression and addiction issues.”
*Not the patient’s real name.