Research Profile - Untangling the knot
Dr. Brian Rush
A CIHR-funded researcher is championing a new protocol to identify and treat mental health problems in people with addictions
Addiction and mental illness are sometimes like the twisted strands of a tangled knot, says the University of Toronto's Dr. Brian Rush.
"Alcohol and drugs and mental health can be tied up tightly together," says Dr. Rush, who is also a Senior Scientist at the Centre for Addiction and Mental Health.
Unfortunately, addiction agencies and mental health clinics traditionally have worked independently at trying to untangle the knot.
At a Glance
Who – Dr. Brian Rush, Senior Scientist at the Centre for Addiction and Mental Health, University of Toronto professor, Associate Professor at the Dalla Lana School of Public Health.
Issue – Clients’ mental health problems sometimes go undetected at addiction centres, which tend to focus on treating the abuse problem alone.
Approach – After completing a validation study of potential tools to screen for mental health problems, Dr. Rush and his team are pilot- testing a new clinical protocol at four Ontario addiction treatment centres.
Impact – If successful, the clinical protocol will be offered to other treatment centres to create a “community of practice” across Canada.
"For the client it's a nightmare," says Dr. Rush.
"You can imagine a person with an alcohol or drug problem who is also taking medication for depression. They go to the addiction program and get told, 'You can't come here if you're taking that because we don't accept any medication in our program.' It still happens – very rarely – but there is a long history in some addiction programs of not allowing any anti-depressants because they feel people need to take control and clean out."
Dr. Rush is leading a Canadian Institutes of Health Research (CIHR) funded initiative to provide addiction agencies with effective tools to screen their clients for mental health conditions. Proper assessment, he says, is crucial to providing appropriate treatment.
"I know of a case of someone who had been in drug treatment programs more than 10 times. No one ever asked him about his mood swings. It turned out he had bipolar disorder, but no one had ever asked the simple kinds of questions that would have brought that to light."
Dr. Rush has already conducted a review of screening tools – essentially, simple questionnaires that addiction counsellors can use to identify clients with mental health problems such as depression, anxiety disorders, phobias and schizophrenia. Now that his team has evaluated the tools, they are pilot-testing a new screening protocol at four addiction treatment agencies in Ontario.
For Dr. Rush, the project is the culmination of 10 years of research work, much of it done hand-in-hand with addiction treatment centres and mental health clinics. If the tests go well, he has plans to build a nationwide "community of practice" for the protocol.
"To me, it's where research needs to go," says Dr. Rush. "You can't just write a research paper or develop a clinical protocol, publish it and put it on the web. You have to draft it, talk to the agencies, implement it, evaluate it, revise it and work with it."
The protocol will be adjusted and refined based on the experiences of the four test sites, then disseminated to other treatment centres across the country through Web-based and print materials.
Directly engaged in the development of the protocol, the addiction agencies participating in the study say they have already benefited.
"We were involved in the validation of the screening tools and it was a really nice integration of research and practice," says Paul McGary, Director of the Mental Health and Pinewood Centre Program of Lakeridge Health in Oshawa. "We were receiving immediate feedback about client responses and that was directly translated into treatment planning and clinical practice. When you can inform clinical practice that quickly, that's where it really becomes valuable."
The Study
The goal is to improve the identification and treatment of people who are seeking help from addiction agencies while experiencing "co-occurring mental and substance use disorders."
Ontario addiction treatment centres in Toronto, Oshawa, Peterborough and Red Lake are testing the clinical protocol for a staged approach to screening for mental health problems.
"We chose tools that were in the field already but had not been researched sufficiently with people with alcohol and drug use problems," says Dr. Rush.
The treatment centres will be using what Dr. Rush calls "a short screener" questionnaire designed to indicate whether mental health problems exist. It can be followed up with a longer-form screening tool that yields more detailed information about the specific mental health issues involved.
"The mental health system grew up separately from the addiction treatment system. And a lot of philosophical differences have been keeping them apart. It was two different worlds, but this is bringing them together."
-- Dr. Brian Rush