Current Projects
Insight Deficits in Substance Use Disorders Through the Lens of Double Bookkeeping
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.
Clairvoyant (24-Week, Multicenter, Randomised, Double-Blind, Placebo Controlled, Parallel-Group, Phase 2 Clinical Trial to Evaluate Efficacy and Safety of Psilocybin-Assisted Psychotherapy in Adults with Alcohol Use Disorder (AUD))
Alcohol Use Disorder (AUD) is a diverse, complicated, and chronic relapsing disorder including both intense binge drinking episodes as well as prolonged periods of heavy alcohol consumption. Based on published evidence, serotonergic psychedelics could possess clinical potential for inducing therapeutically beneficial behaviour changes for people with AUD. Clairvoyant is an international research study which investigates the effectiveness of psilocybin, a serotonergic psychedelic against a placebo with the support of psychotherapy for individuals who struggle with AUD. The information obtained from this research can inform us of the potential benefits of psychedelic treatments for psychiatric conditions.
CEASAR (Computerized Exercise to Alter Stimulant Approach Responses): Piloting a novel intervention to improve outcome in individuals suffering from cocaine or methamphetamine use disorder: A randomized controlled study
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.
ROAR CANADA (Reducing Overdose and Relapse: Concurrent Attention to Neuropsychiatric Ailments and Drug Addiction)
With a prospective sample size of 1500, ROAR CANADA is the largest study to date on individuals with severe concurrent disorders. Individuals with concurrent disorders (i.e., a diagnosis of both a mental disorder and a substance use disorder) often face barriers to participating in research studies, and thus their experiences are less well-understood. This study will focus on thoroughly characterizing individuals treated in concurrent disorder programs and analyze overdose and relapse rates when these individuals transition back into the community. The information collected in ROAR CANADA will be used to support the creation of similar integrated treatment programs throughout Canada.
The Red Fish Virtual/Digital Innovation Hub. The Wearables project – Strategic Investment Fund (SIF)
The Red Fish Digital Innovation Project (DIP) has been launched as a partnership between BC Mental Health and Substance Use Services (BCMHSUS), TELUS, and The University of British Columbia, to create the Red Fish Virtual/Digital Innovation Hub. The project is funded by the Strategic Investment Fund (SIF) and overseen by TELUS and the BC Ministry of Citizens’ Services Telecom Office (TO).
This project aims to pilot, assess, and evaluate pioneering technologies to enhance the quality of care for clients experiencing complex co-occurring mental health and substance use challenges across BCMHSUS clinical programs in the province. This project will be implemented at the Red Fish Healing Centre in Coquitlam, BC. This treatment center is a new state-of-the-art provincial 105-bed inpatient facility, providing quaternary care for participants with complex clinical pictures of co-occurring substance use disorders and severe mental health illness, particularly mood and psychotic disorders.
The DIP is built upon the development of three parallel technology pilots:
- The Sleep and Circadian Rest/Activity Rhythms Pilot (DIP – SCRAR) will examine continuous sleep patterns and circadian rhythms using wrist-accelerometers and subjective measures such as chronotype and sleep disorder symptomatology.
- The Drug Craving Biofeedback Pilot (DIP – DCB) will identify neural correlates of cue-induced craving using EEG, a computerized probabilistic picture card task, and subjective reporting of craving by individuals seeking treatment for complex concurrent disorders.
- The Objective Stress Detection Pilot (DIP – OSD) will track electrodermal activity to measure objective stress responses using wearable galvanic skin response (GSR) sensors and subjective.
For more information, please reach out to sarah.munozviolant@ubc.ca
Insight into Stimulant Use
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.
Childhood Trauma and concurrent disorders treatment outcomes
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 Associations to Relevant Electroencephalography Signals (CARES)
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.
Cannabis and Polysubstance Use: Response Inhibition and Stress Exposure (CAPU RISE)
We are assessing the short-term effects of cannabis oil on individuals who use cannabis recreationally and binge drink. The study employs a range of methods including biosampling, questionnaires, and magnetic resonance imaging (MRI).
HRI (Hybrid Response Inhibition): Addiction and Bipolar Disorder
Response inhibition, a cognitive control process, and form of impulsivity, refers to the ability to inhibit an action once initiated. Controlling impulsive behaviour can be difficult for individuals with addiction and other mental disorders such as Bipolar Disorder (BD), and treating the parts of the brain related to cognitive control can improve these symptoms. The current study will investigate differences in fMRI-assessed activations during Tüscher and colleagues’ “Hybrid Response Inhibition Task” (HRIT) in stimulant users, pathological gamblers, BD patients, and controls. Subsequently, Transcranial Magnetic Stimulation (TMS) will be used to target brain regions engaged during response inhibition to test the biological underpinnings of cognitive control in these four cohorts.
PriSMI
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.
Sexual Abuse and Sleep and Rest/Activity Rhythms project (SASRAR)
The Sexual Abuse and Sleep and Rest/Activity Rhythms project (SASRAR) investigates the role of sexual abuse in sleep and rest/activity rhythms disruption in individuals with concurrent disorders undergoing inpatient treatment at the Red Fish Healing Centre for Mental Health and Addiction. This project employs self-reported and psychodiagnostic measures to understand the experience of sexual abuse in childhood and adulthood and actigraphy data to measure sleep and rest/activity rhythms.
MED1
This Phase II, the multi-site pilot study examines the safety and feasibility of three open-label Experimental Sessions of therapy assisted by flexible doses of MDMA in reducing symptoms of eating disorders, specifically Anorexia Nervosa, Restricting-Type (AN-R) and Binge Eating Disorder (BED) based on a comparison of Eating Disorder Examination (EDE) and Readiness and Motivation Questionnaire (RMQ) results at Baseline to Visit 16 (Study Termination). Our site (Vancouver) will be exclusively recruiting participants with BED.
Mothers in Substance Use Treatment: What About Their Kids?
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.
The Relationship Between Psychedelic Use and Posttraumatic Stress Disorder Symptoms Among Adults with Childhood Trauma: A Naturalistic Online Study
This online survey-based study will investigate whether naturalistic psychedelic use influences the impact of and impairment from childhood trauma. Our hypothesis is that participants who have used psychedelics will report lower levels of impairment and impact severity related to their trauma compared to matched controls who have never used psychedelics.
Past Projects
Bipolar disorder (BD) is a mental health disorder characterized by unusual shifts in mood, energy and activity levels, interfering with patients’ daily activities. Studies have identified areas of the brain involved in this disorder, which play a central role in cognitive control. Cognitive control is the mind’s ability to actively make goals and direct behaviour, to act consciously instead of instinctively. An important function of cognitive control is to stop impulsive behaviour. Controlling impulsive behaviour can be difficult for people with BD, and treating the parts of the brain related to cognitive control can improve these symptoms.
In order to do this, it is important to differentiate categories of impulsivity. The current study investigates the three subcomponents of response inhibition, a specific form of impulsivity. First, participants go through a functional Magnetic Resonance Imaging (fMRI) scan while performing a task related to response inhibition. This can show which parts of the brain are engaged during response inhibition, which helps researchers know where to target treatment. Later, we will stimulate the identified areas using Transcranial Magnetic Stimulation (TMS). TMS is a non-invasive method that is being tested as a way to enhance or dampen specific parts of the brain, which could help treat issues with cognitive control. In this study, we want to compare activation patterns between BD patients and healthy individuals in order to better understand differences of impulsive responses. Our current goal is to study these patterns, not to actually treat BD as a part of this project. But we hope to go one step forward in creating a novel treatment option for patients with BD.
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 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.