Projects

This pilot study will test the feasibility and efficacy of a novel computerized intervention. The intervention will be an add-on to the current ‘treatment as usual at the Burnaby Centre for Mental Health & Addiction (BCMHA) in Burnaby, BC, Canada. The study will be randomized and double-blinded by design. The intervention is an adaptation of the recently developed “retraining of automatic approach” intervention, which has been shown to reduce relapses in alcohol-dependent persons (Wiers 2013) and seems to be currently successfully tested in smokers (Woud 2016). It is a simple targeted computer-based training for “avoidance of substances”. As opposed to the more regularly used explicit or declarative learning, an implicit non-declarative procedural learning approach is used. This approach is less dependent on an individual’s ability to understand their own situation-dependent behaviours but is more of a procedural type of training such as learning to ride a bike. Participants respond to stimulant cues by initiating a distancing activity (pushing a joystick away). Positive activities in contrast, are pulled in. This differential activity trains participants to alter initial responses and “cognitive biases” (Wiers 2013).

Tüscher and colleagues recently developed a paradigm called the “Hybrid Response Inhibition Task” HRIT. They demonstrated that this task reliably captures three subcomponents of response inhibition including interference inhibition (Simon task), action withholding (go-nogo), and action cancellation (stop task). Subcomponents like the early interference inhibition seem to engage more strongly with frontoparietal–pre-motor circuits whereas the later action cancellation subcomponent relies more heavily on the (indirect) prefrontal–striatal pathway (Sebastion 2013).

We intend to assess differences between stimulant-dependent individuals, pathological gamblers, and controls as a first step towards understanding the mechanism underlying addiction-associated alterations in inhibition. The study will allow us to differentiate between subcomponents of altered response inhibition among the three groups of subjects.

The purpose of this study is to assess individuals on measures of impulsivity, irritability and anxiety upon admittance to the Burnaby Centre for Mental Health and Addiction and again following three months of treatment.  This will provide a definitive measure of any changes in these three measures as a result of treatment. Results will be compared to healthy controls

Study procedures:  Two 1-hour sessions–once shortly after arrival to the Centre, and again three months later.  During these sessions, participants will be asked to fill out questionnaires and perform computerized tasks. Assessments will focus on several components of impulsivity. We are interested in seeing if we can assess changes in impulsivity over time and want to know if measurements for different components change individually or as a group.

This cross-sectional study examined the impacts of cannabis use in patients receiving treatment for severe concurrent disorders, a population that is understudied and often excluded from research. A publication reporting findings from this study can be found here.

This study aims to examine how early-life adverse experiences such as sexual or physical abuse influence the genetic profile of multi-drug abusers relative to healthy controls. Specifically, we intend to investigate the relationship between traumatic childhood events and the degree of DNA modification exhibited by these patients.
Study procedures: Subjects will be recruited from the Burnaby Centre for Mental Health and Addiction (BCMHA), a specialized rehabilitation centre for substance use disorders. They will be asked to fill out questionnaires, and we will collect samples of their blood immediately upon admission to BCMHA and again following three months of abstinence.

While tobacco smoking rates are decreasing, smoking remains the number one cause of preventable deaths in Canada. Rates are substantially higher among individuals who suffer from either a mental or substance use disorder (or both), and attempts at quitting are difficult. Current interventions primarily involve medication, education, and cognitive behavioural approaches. Recently, a research group developed a novel method to treat tobacco dependence that relies on simple mechanic training. The intervention requires participants to make avoidance movements by pushing a joystick in response to images of smoking. This may improve tobacco dependence and self-control in individuals by encouraging the implicit avoidance of smoking. Specifically, this unique approach attempts to alter the subconscious cognitive biases of smokers without requiring active learning. This makes it helpful for people who have failed when using medications, education, and cognitive interventions.

The present study will evaluate the effectiveness of this intervention as an add-on to treatments currently available at the Burnaby Centre for Mental Health & Addiction (BCMHA). In the session, participants will be asked to use a joystick to “push” or “pull” pictures of tobacco-related cues and non-tobacco-related cues on the computer screen. We will provide subjects with a training session before the study begins, and during the course of the study, we will ask them to voluntarily stop smoking cigarettes for as long as they are able to for the remainder of the study.

CEASAR is a randomized controlled study, piloting a novel intervention to improve outcomes in individuals suffering from cocaine or methamphetamine use disorder. Currently available treatments for stimulant use disorders yield only modest effects. The goal of the CEASAR study is to determine the feasibility and efficacy of a cognitive bias retraining intervention at the Burnaby Centre for Mental Health and Addiction, a tertiary treatment centre for concurrent disorders. This intervention (adapted from Woud 2016) involves patients completing the push-pull task to strengthen avoidance responses to stimulant cues. We will assess craving, rate of relapse, and the automatic association between activities and stimulant use.

Members

• Trainee: Laura Schmid
• Research Assistants: Ria Nair, Dave Vass, Achint Lail, Noor Ramadhan, Alex Romanchuk
• Research Supervisors: Thomas Chao, Christian Schütz
• Coordinator: Laura Schmid
• PI: Christian Schütz

In psychiatry, insight often refers to an individual’s ability to understand the severity and causes of their disease or disorder. Within addiction, having impaired insight may lead to the individual not getting the help that they need. This study uses a picture task followed by a series of insight-provoking questions to identify insight in individuals with stimulant-specific concurrent disorders. Conducted out of three hospitals, we will assess patients throughout their treatment course to determine changes in insight and its relation to treatment success to provide a greater understanding of the impacts of insight on recovery. 

Members

• Research Assistants: Priya Johal (Lead), Keenan Klassen, Anisha Lehal
• Research Supervisors: Myriam Juda, Christian Schütz
• Coordinator: Laura Schmid
• PI: Christian Schütz

The opioid crisis and its effects on the health of women and their children has brought attention to mothers with substance use disorders (SUD). The stigma experienced by mothers because of seeking help for SUD in combination with the expectation for mothers to hold the primary caregiver role creates additional barriers for mothers when seeking treatment, as limited options exist that recognize and compensate for these maternal-specific pressures. Furthermore, mothers with SUD report a unique set of treatment barriers, recovery facilitators and motivators, and recovery challenges. A lack of adequate childcare has been identified as a primary barrier for mothers when seeking and taking part in treatment; therefore, this study seeks to gain insight into the needs of mothers who are currently in treatment for SUD as well as provide an evidence-based model in support of a family-based substance use treatment model. Through semi structured interviews, the current study is building upon prior literature investigating the childcare needs of mothers with SUD. 

Eugen Bleuler first introduced the concept of double bookkeeping in schizophrenia. He used this term to describe the tendency for people who experience delusions to simultaneously be convinced of the delusional content and yet to act as if the delusion(s) was untrue/irrelevant or be unbothered by discrepancies that emerge. The two realities seem to coexist in a single person without mutual interference. While this concept has primarily been explored in schizophrenia, double bookkeeping may hold promise in elucidating insight deficits in individuals suffering from substance use disorders. We explore the existence of an analogous double awareness/reality in individuals with addiction. Individuals with addiction can experience the negative consequences from substance use or be aware of the deleterious effects, while simultaneously live in a reality as if these issues were absent. Our analysis aims to better understand why addiction can be so recalcitrant and treatment-resistant. We will elaborate the conceptual implications and provide novel perspectives for treatment optimization and intervention development.

Childhood trauma poses a significant barrier to treatment for substance use disorders and mental disorders, though its impact on treatment for concurrent disorders is unknown. Priya Johal's honours thesis will investigate the relationship between childhood trauma and treatment outcomes in patients with severe concurrent disorders. Specifically, the study will examine whether childhood trauma—both trauma count and trauma severity—predicts relapses, AWOLs, treatment completion, and psychological functioning. The study will also examine whether particular types of childhood trauma (i.e., physical, emotional, and sexual abuse, and physical and emotional neglect) are stronger predictors of treatment outcomes. Results from this study aim to help clinicians better understand treatment barriers for this population and inform the development of future treatment plans. 

Craving has been highly discussed in addiction research but what is not known is the pattern of incubated craving over an extended period of abstinence. Our study utilizes electroencephalography to identify neural markers that may indicate cue-induced incubated craving through a computerized probabilistic picture task. This study takes place in three treatment hospitals in which craving will be assessed over the course of treatment in patients undergoing concurrent disorder. Identifying the pattern of cue-induced craving over a longitudinal period of abstinence will contribute to our understanding of risk factors that contribute to relapse and overdose.

Members

• Research Assistants: Priya Johal (Lead), Harman Ranote, Aksheen Chahal, Chaehyeon Lee, Achint Lail, Noor Ramadhan, Suzanne Paddinge
• Research Supervisors: Myriam Juda, Christian Schütz
• Coordinator: Laura Schmid
• PI: Christian Schütz

People with serious mental illness (SMI) have higher rates of comorbid physical disease, more preventable hospitalizations, and higher mortality rates. This is largely from medical causes, and may, therefore, require more primary care services than the general population. This study looks to understand how primary care providers can better care for the physical health of people living with SMI. This research will be conducted in Ontario and British Columbia and will include both quantitative analyses of administrative data and in-depth qualitative interviews with patients and primary care providers. The B.R.A.I.N. Lab will be involved in the patient interviews of the broader project.

Members

• Brandy Holownia, Caitlin Courchesne
• Coordinator: Laura Schmid
• PIs: Agnes Grudniewicz, Allie Peckham, Christian Schütz