Mental health and addictions
Story by Connie Bryson/Illustrations by Mark Gervais
Diseases that threaten our physical health tend to be the ones that make the headlines. Yet most of us recognize intuitively that our mental health is just as important to our well-being.
An estimated one in three Canadians experiences a mental-health problem at some point in life. Mental illness is estimated to cost the Canadian economy more than $33 billion annually. Worldwide, tobacco and alcohol are among the leading causes of disease and disability. In addition, the physical illnesses associated with addiction to tobacco, alcohol, and illicit drugs cost Canadians about $40 billion annually. Long-term tobacco use, for example, is a risk factor in 6 of the 8 leading causes of death.
"Despite the heavy burden of addictions and mental illness on our society we have a shockingly low level of research, policy, intervention, and programming devoted to these issues," says AHFMR Health Scholar Dr. Cameron Wild, director of the Addiction and Mental Health Research Laboratory at the University of Alberta. "Addictions and mental illness have slipped under most people's radar because of the perception that other health issues are more pressing. And there is still a tremendous amount of social stigma around addictions and mental illness. These factors have contributed to their generally low profile in public opinion and in healthcare systems. But this is changing, albeit slowly. Advocacy groups are putting these issues in the spotlight-and governments, social agencies, and research-funders are responding."
As its name suggests, the Addiction and Mental Health Research Laboratory (AMHRL) is founded on the principle that addictions and mental health should be studied together. Dr. Wild refers to addictions as "a crossroads of familiar diseases and social and economic problems." For example, tobacco use is a primary risk factor for cancers and cardiovascular diseases. Long-term heavy consumption of alcohol is associated with cirrhosis of the liver; short-term binge drinking creates social disruption in such forms as drunk driving and violence. Injection-drug use is linked to transmission of infectious disease. Emerging evidence shows that there may be considerable overlap in the brain systems that underlie addictions and other mental-health disorders.
Another of the lab's principles is that individual, clinical, and population perspectives should be linked. "It's essential to approach addictions and mental-health issues not only from the point of view of the next client who comes through the clinic door, or the next person who might run into problems in school or on the job," says Dr. Wild. "There are important cultural, social, and economic influences on these conditions, and we need to look at these too. To do justice to the complexity of addictions and mental health, you have to use both perspectives-individual and population-and integrate them with other health issues."
Research at the AMHRL shows that simple, low-cost interventions can have a big impact on addictive behaviour. One study demonstrated that mailing information on alcohol self-help and assessment to drinkers who expressed interest in looking at such materials can reduce rates of binge drinking by 10%.
Another example is a program the lab developed five years ago in collaboration with Dr. Barry Finegan at the University of Alberta to stop smoking on hospital grounds. Prior to the province-wide ban on smoking in public places, hospitals in Alberta instituted their own smoking bans. Supported by Capital Health, the AMHRL worked with Dr. Finegan and Edmonton-area hospitals to provide information on stopping smoking and offer nicotine patches to smokers affected by the ban.
"The thinking is that if we ban smoking, that's surely going to help people's health," says Dr. Wild. "While this is true at one level, the reality is that 25% or more of people going into hospital for surgery are smokers. They are forced to quit for the time they're in hospital, and some are required to quit for a certain length of time after surgery. What support does the healthcare system provide for them?"
Dr. Wild and his team saw an opportunity to complement the ban with a service. Now, five years later, nurses in pre-surgery clinics in Edmonton deliver self-help materials and "the patch", if requested, to patients who are smokers. To date, this "Reduce My Risk" program has reached thousands of hospitalized smokers who would never have received any support to stop smoking otherwise.
"Policy is one thing; effective implementation is another. It means taking into account the realities of people's lives," explains Dr. Wild. "In this case, there are large numbers of smokers in hospital, and they need some assistance in dealing with smoking restrictions. This kind of easily accessible, straightforward intervention is the key to reaching large numbers of people."
Dr. Wild thinks that Alberta-wide research efforts could do even more to develop and deliver effective interventions for a variety of addictive behaviours. "In Alberta, we have a handful of outstanding researchers looking at these issues. But there's no network. I would like to see our lab as part of a regional centre of excellence for addictions and mental-health research, so that we are doing things on a province-wide scale, not just within our own region. The need is there."
What is an intervention?
An intervention is a set of materials, a program, a treatment, or a policy that is designed to have a positive impact on health outcomes.