Elemental

The Official Mental Health Magazine of the

University of Toronto

FAL L 201 9

SPOTLIGHTS SUBSTANCE ABUSE

CANNABIS USE, ALCOHOL ABUSE, HOW RECOVERY FROM
AND CONCURRENT DISORDERS DRUG ADDICTION IS POSSIBLE
SUBSTANCE USE THROUGH A PERSPECTIVE ON THE FUTURE
A PUBLIC HEALTH LENS OF INDIGENOUS HEALTH
elementalmag.ca
BEACON: A DIGITAL PLATFORM
MAKING TREATMENT HOW AUTISM MAY AFFECT 28 October 2019

MORE ACCESSIBLE SUBSTANCE ABUSE RISK Fall 2019, Issue No. 4

 FALL 2019
ISSUE 4
[1] SPOTLIGHT PAGE

INTERVIEWS Looking At Substance Use Through A Public 6-7

Health Lens / Dr. Hayley Hamilton

Concurrent Disorders: A Vicious Cycle of 8-9

Substance Abuse and Mental Illness /
Dr. Tony George

BEACON Digital Therapy: Making 10-11

Evidence-Based Treatment More Accessible/
Dr. Peter Farvolden

Shedding Light on Alcohol Use Disorders/ 12-13

Dr. Christian Hendershot

The Highs and Lows of Cannabis / 14-16

Dr. Jose Trigo & Dr. Julianne Vandervoort
 [2] TOPIC PAGE

ORIGINAL Possibility of Full Recovery From A 17

Drug Addiction
ARTICLES
Pressure of Socialization is Partly 18-19
Responsible for Increased Risk
of Drug and Alcohol Abuse on the
Autism Spectrum

Indigenous Health: 20-21

Looking Into the Future

Kindly Present 22-23

The Real Reason Why 24

We Procrastinate
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L E TT E R F R O M T H E E D I TO RS
W e are excited to introduce the
fourth issue of Elemental,
the University of Toronto’s official
Substance use and addiction are
thought to exist on a spectrum,
with a multitude of biological,
marijuana consumption in the last
30 days, respectively. Within a 30-day
period, 12% of students had operated
tri-campus mental health magazine. psychological, and social contributing a vehicle after consuming alcohol.
The theme of the current issue is factors at play. One important factor Moreover, within the last 12 months,
substance use and addiction. People to consider is how mental health approximately 15% of college students
can engage in substance use for a and addictions impact one another. had consumed prescription drugs
multitude of reasons—wanting to Research indicates that more than 50% that were not prescribed to them [3].
experiment, fit in, have fun, or cope of people with substance use disorders Providing opportunities to discuss and
with stressors. While the degree of use have also experienced mental health educate students on substance use and
varies by individual, casual substance challenges at some point in their life addiction is critical to reducing the
consumption can sometimes, [2]. In a University context, students stigma, preventing problematic use,
although not always, escalate into are susceptible to high levels of stress and highlighting available supports
addiction. Addictions can be either and may engage in substance use as a and positive coping strategies. With
substance-related (drug consumption, means of coping or temporary escape. the recent legalization of cannabis
for example) or process-related According to the 2016 Canadian use in Canada, these discussions are
(such as social media use) [1]. Both National College Health Assessment, not only timely but informative.
forms of addiction can significantly which surveyed 41 institutions and
impede an individual’s quality of over 43,000 students, approximately In this issue, we delve deeper into the
life, if not recognized and treated. 67% and 19% of Ontario college area of substance use and addiction.
students had engaged in alcohol and Dr. Tony George, Professor and
 SE CT I ON [ 01]

Clinician Scientist at the Centre Engineering, and Medicine – we

for Addiction and Mental Health are immensely appreciative of the
(CAMH), discusses the link between support provided since this initiative’s
mental illness and addiction. inception. Lastly, a special thank you
Dr. Jose Trigo, Neuroscientist at to our readers, without whom this
CAMH, discusses some of the risk endeavor would not be a success.
factors associated with cannabis use This magazine continues to serve as
and debunks some of the biggest a forum for constructive discussion
myths surrounding substance use on mental health and wellness at the
disorders. Dr. Christian Hendershot, University and beyond, and we thank
Professor and Head of Psychology in you for engaging in the conversation!
the Addictions Division at CAMH,
sheds light on alcohol use disorders, Sincerely,
while Dr. Julianne Vandevoort,
psychologist at CAMH, discusses Rachel Dragas and Kate Rzadki
available psychotherapy treatments Editors-in-Chief, Elemental
for cannabis use disorder and some
of the challenges associated with
treatment. We also explore the impact References:
of social pressures on substance use
in individuals with autism spectrum 1. Canadian Centre on Substance
disorder, as well as substance use Abuse (2010). Substance Abuse in
in Indigenous communities and Canada: Concurrent Disorders.
the need for culturally sensitive 5
treatment approaches. Dr. Peter 2. European Monitoring Centre
Farvoldhen, Professor and Founder for Drugs and Drug Addiction.
of CBT Associates, talks about (2013). Models of Addiction.
making evidence-based treatment
more accessible through digital 3. National College Health Assessment.
cognitive behavioural therapy (Spring 2016). Ontario Canada
platforms. We also discuss the mental Reference Group: Executive Summary.
health benefits of mindfulness and
self-compassion, and explore why
individuals engage in procrastination,
and what strategies can be employed
to circumvent this behaviour
and the stress associated with it.

We would like to extend our deepest

gratitude to the Elemental editorial
team as well as Grad Minds, for
their hard work and dedication in
contributing to this initiative and
mental health education at the
University of Toronto. We would
also like to recognize the faculty,
students, staff, and community
mental health advocates who have
shared their knowledge, research,
and insight with us. To our sponsors
at the Faculties of Arts and Science,

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survey. Furthermore, I am involved

in research focused on substance use
prevention and the mental health
service needs of vulnerable youth.

What are some current trends based

on the latest OSDUHS and are these
trends similar for older populations?

Over the past 20 years, there has

been a gradual decline in cannabis
use amongst grades 7-12 students
(currently 19% report past-year usage).
In contrast, use has almost doubled
amongst adults. This increase was
particularly evident amongst 18-29 year
olds with 39% indicating past-year use
in our 2017 survey. Cannabis use also
increased amongst adults over 50 years
of age. Prior to the recent legalization,
there were more conversations about
cannabis and its availability rapidly
increased with the proliferation of
6 dispensaries. In the past few years,
no significant declines in cannabis
LO O K I N G AT S U B STA N C E U S E use have been reported in our student
survey, but we are very interested in
T H R O U G H A P U B L I C H E A LT H L E N S seeing the data after its legalization.

What are some of the “motivations”

ASHLEY BO ZHANG, FARINAZ GHODRATI behind drug use, especially amongst the
student population?
AN INTERVIEW WITH DR. HAYLEY HAMILTON
People tend to use drugs for multiple
reasons. There is a social aspect, which

D r. Hayley Hamilton obtained

her PhD in sociology, studying
population health and the life course,
Can you provide a brief overview of
your current research projects?
refers to drug use in a social setting
when spending time with friends and
so on. Another motivation is peer
which led to her involvement in the We are currently in the data collection pressure, which points to the pressure
field of mental health and addictions. phase of the 2019 Ontario Student to ‘fit in’. Drug use could also be a
Dr. Hamilton has a quantitative Drug Use and Health Survey coping mechanism to combat stress,
background in data analysis, and (OSDUHS), which is a cross-sectional or personal/work issues for instance.
currently serves as Co-Lead on the survey of students in grades 7-12 that Boredom is another potential
Ontario Student Drug Use and Health has been repeated every 2 years since motivator. It should be noted that
Survey and the CAMH Monitor, 1977. When the survey began over 40 we have not explored the motivations
both of which look at substance use years ago, it was initially focused on and reasons for cannabis use in our
behaviour and general wellbeing in substance use, but has since evolved to surveys.
the Ontario population. We sat down include mental health, physical health,
with Dr. Hamilton to discuss her and general wellbeing. A report Which populations are most affected
involvement in substance use research outlining findings from our 2017 adult by substance use and why do you think
and her perspectives about the field. survey was recently released and now that is?
we are collecting data for our 2019
 SE CT I ON [ 01]

In the past, there were greater ability to track trends within Ontario. makes our estimates conservative.
differences between males and females We need to continue tracking these This also pertains to our adult survey
when it came to drug use. These trends after cannabis legalization and on substance use – accessing the whole
differences have been reduced, but monitor the prevalence of cannabis adult population would be difficult. A
there still remain a few. For instance, use and related problems over time specific focus on individuals that are
men tend to have a higher prevalence of – which is something we plan to do. actively engaged in problematic use
using harder drugs and binge-drinking. One of the important components of requires more targeted studies.
Additional factors influencing drug assessing legalization is to evaluate
and alcohol use include socioeconomic what is happening over time and Another challenge is keeping up
status and related factors. However, to respond to the trends as needed. with emerging drugs - we ask about
we must keep in mind that it is hard to Moving forward, it is crucial to both common and emerging drugs,
generalize to a certain degree. continue monitoring cannabis use, not but there are constant reports about
just with respect to general use, but novel substances and risky behaviours
In your professional opinion, what do also hospital visits, impaired driving, involving students. Keeping track of
you think students can do to alleviate usage amongst teens, co-use with what is important to include in our
the stig ma surrounding substance use other substances, etc. This will allow student survey can be challenging.
disorder without undermining the appropriate responses to be developed
health concerns? - whether through targeted prevention While there are countless challenges,
efforts, public education campaigns, improvements in public knowledge
Part of the stigma surrounding or other means. about substances and advances in
substance use disorder comes from the technology with regard to how data
misconception that these individuals What would you say is the biggest are collected will likely improve this
are “choosing” to continue their drug misrepresentations in the general type of research in the future.
use, which is not the case for those population regarding substance use 7
suffering from dependence. Therefore, disorder? Do you have any tips for the student
there is a need to recognize that population specifically when it comes to
substance use disorder is an illness and One of the misrepresentations that substance use disorder prevention and
people require help and support to exists in the young adult population treatment?
combat their substance use problems. regarding substance use, particularly
Diverse forms of supports and services for alcohol and cannabis, is the sense Although it may seem obvious, I do
are available to those affected by that “everybody” is partaking in want to emphasize the dangers of
substance use problems. In terms use. Also, as previously mentioned, sharing medications and urge readers
of reducing substance use generally, the misconception that continues to abstain from doing so. Moreover,
it is important to consider, for to persist regarding substance use be informed and aware with respect to
example, improved coping skills and disorders – that it is entirely within the potential consequences and harms
educational conversations about the a person’s control to stop using the associated with substance use. Think
harms associated with substance use, substance. about your own substance use and
including the negative consequences the extent to which it may be having
of dependence. What are some of the challenges facing a negative impact on other aspects of
researchers in the field of substance use your life. You might also recognize
What are your thoughts on cannabis problems and what do you think is the that others around you may be
legalization and its public health future of research in your field? having problems with substance use.
consequences, particularly for Students can seek out assistance and
university students? Our student survey focuses on students services in the university and/or larger
in publicly funded schools, while the community. There are various groups
I think the consequences are still population that may be facing a higher and organizations that are there to
undetermined. One of the most prevalence of substance use disorders assist.
important advantages of our two may not be in school due to dropping
population surveys is that they have out, etc. Therefore, there is about
been ongoing for a considerable 8-9% of the adolescent population that
number of years, which gives us the we do not have access to, which likely

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C O N C U R R E N T D I S O R D E RS : A V I C I O U S C YC L E
O F S U B STA N C E A B U S E A N D M E N TA L I L L N E S S
JEFFREY LYNHAM

AN INTERVIEW WITH
DR. TONY GEORGE

D r. Tony George is a Clinician

Scientist in the Campbell Family
Mental Health Research Institute,
and the Head of the Biobehavioural
Addictions and Concurrent Disorders
Research Laboratory at the Centre
for Addiction and Mental Health
(CAMH). He is also a Professor
in the Department of Psychiatry
at the University of Toronto. He
8 received his M.D. at Dalhousie
University, and he did his medical
internship and residency in general
psychiatry at Yale University School
of Medicine. Dr. George’s research
interests include understanding and
treating concurrent disorders, with
a focus on tobacco and cannabis use
in schizophrenia. I sat down with Dr.
and to relapses. Back then, everyone and all was done, there were very
George to learn about some of his
in the hospital was smoking tobacco. upset patients, and a staff member
latest research.
The inpatient units were filled with with a broken arm. I said to myself,
smoke and I remember the senior “Wow! This whole tobacco thing is
Your primary research interest is in
doctor who was supervising me said, really important to patients and we
understanding concurrent disorders.
“We need to get this problem under don't even understand why.”
What initially drew you to this area
control.”
of research?
Why do you think there is a strong link
We ordered a meeting of all the between mental illness and addictions?
As a senior medical student, I realized
patients and staff and the senior
that the brain was the most important
doctor said, “Anyone who is caught I would say—and this is maybe
organ that we needed knowledge on. I
smoking is going to lose their oversimplifying things—is that if you
decided early on that I wanted a career
privileges to go outside. And if this look at the biology and pathways of
studying psychosis and schizophrenia.
happens repeatedly, we may have to the brain—whether it be dopamine
When I did my first rotation, I noticed
discharge you.” or glutamate signaling—the areas
something interesting—just about
that are dysfunctional in psychiatric
all these people with schizophrenia
disorders overlap almost perfectly
had addiction problems, and it really One of the patients became very upset with the areas that mediate substance
impacted their illnesses in terrible and threw a chair at the senior doctor. abuse. If you have dysregulation of
ways. It led to worsened symptoms By the time the local police arrived, one, it may also have an effect on the
 SE CT I ON [ 01]

other. What we find, when we look With these studies, it’s important to addiction to schizophrenia. People
epidemiologically, is that during the get beyond the withdrawal syndrome. with schizophrenia have very poor
onset of mental illness, if someone is Withdrawal symptoms from drugs cognitive control, and we found that
also vulnerable to substance abuse, depend on how long the drug sticks transcranial magnetic stimulation of
the substance abuse usually comes on around, and cannabis is one of the the frontal lobe can improve their
board at about the same time. They're drugs that sticks around the longest. cognitive function and reduce craving.
probably developmentally driven in It takes a month to wash cannabis out
that sense, and it all emanates from and withdrawal sort of comes and goes What advice would you g ive to your
the same common biology. within a week. It's more protracted, students who are starting out in this
and that is often why people have field?
Could you tell me about some of your trouble quitting.
current research looking into tobacco Pick a really interesting question. Pick a
or cannabis use in schizophrenia? Those who quit see dramatic question that fascinates and consumes
improvements in their symptoms. you, and then find a supervisor or
The majority of my work has Not so much improvements with mentor who you trust, and then talk
historically been on tobacco, but now it psychotic symptoms like what you see to people. Go to conferences and
has shifted to understanding cannabis in schizophrenia—like delusions or meet lots of different people. If you're
effects in schizophrenia and in people hallucinations—but improvements in going to be an innovator, you've got
with mood disorders like depression cognition, and improvements in mood to constantly fuel yourself with new
and bipolar disorder. What we've done and anxiety. Many people will say that ideas, and the only way to do that is to
in the last five to seven years is we've they’re using cannabis to treat their have collaborators. I think those that
said if people with schizophrenia or depression, anxiety, or post-traumatic do well are those who take risks, get
mood disorders are more prone to stress disorder, but these findings are out there, and challenge themselves.
taking up and getting hooked on and inconsistent with this notion of self- 9
continuing cannabis use, then why is medication. What does the future have in store for
that? Most importantly, if you look at research and treatments of concurrent
their symptoms and their functional How are concurrent disorders treated? disorders?
outcomes—memory, attention, and Separately or simultaneously?
judgment—what would happen if we The future is collaboration and
got people to stop using them in the There’s a lot of controversy about getting investigators together
short term? whether you should treat them who have common interests to ask
concurrently, and practically very similar questions. I think the
We wanted to know what happened if speaking, you kind of have to treat challenge for us is recruiting patients
we got people to stop using cannabis them concurrently because you're in sufficient numbers. The only way
for at least thirty days. We used a typically not going to have a treatment to do that is to band together with
neat little trick to get people to quit. for one disorder that will also treat other scientists who have similar
We offered an alternative reinforcer the other disorder. In mental illness interests. We need to come up with
to the drugs, and very simply, that and addiction, part of the problem protocols that can recruit a large
alternative reinforcer is money. We is that one begets the other because number of subjects so that we can do
say that if you can prove to us that the biology is related to the substance things like brain imaging, genetics
you can quit for thirty days (using abuse. Then it becomes a vicious and genomics, which will allow us
biochemical test of urine for a THC cycle. Recovery must be a dual kind to look at mechanisms and follow
metabolite), we will give you a big of thing, and there have been no real people over time. I’ve spent most
reward. The protocols are approved breakthroughs in this area. of my career doing our pilot studies
by the CAMH research ethics board. understanding the mechanisms, and
We find that about 50 percent or more One of the things we've been trying to we’re now at a pivotal point for larger,
are able to respond to the alternative do is using neurobiologically informed more definitive studies to be done.
reinforcer. At this point, we can say, approaches to target comorbidity. In
“Now that we've got past withdrawal, our most recent case with cannabis
what was the substance really doing to and schizophrenia, we've been looking
these patients?” at the frontal lobe and how it links

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B E AC O N D I G I TA L T H E RA PY : M A K I N G E V I D E N C E -
10
B A S E D T R E AT M E N T M O R E AC C E S S I B L E
JEFFREY LYNHAM
AN INTERVIEW WITH Waterloo and Ryerson University. I had What steps are involved in accessing
DR. PETER FARVOLDEN a conversation with Dr. Farvolden to online therapy through BEACON?
learn more about BEACON and iCBT.
People start by completing a thorough

A lmost one half of Canadians

(49%) suffering from depression
or anxiety will not seek help [1].
Could you explain what iCBT is and
how it was developed?
online assessment, which is the first step
in a stepped-care model. The assessment
is then interpreted by a therapist,
Common barriers to treatment include
The way we describe it is therapist- and then, if appropriate, they’re
long waitlists, geographic distance,
assisted internet-delivered CBT “onboarded” to BEACON therapy.
insufficient number of healthcare
(TAiCBT). There's about forty years Currently, if they have depression,
providers, and perceived stigma.
of research on the effectiveness of CBT generalized anxiety, panic disorder,
However, with the exponential advances
for mood and anxiety. There’s also been social anxiety, or post-traumatic stress
in technology over the last few decades,
a long history of research on figuring disorder, we can onboard them to a
internet-based interventions have been
out what minimal intervention is— protocol driven treatment. If iCBT
proposed as one solution to help bridge
how to take the effective components is not appropriate, they’re directed
the treatment gap.
of CBT and deliver them in the most toward other resources.
efficient way. With iCBT, there’s about
Dr. Peter Farvolden is a Founding
twenty years of research with over a After registration, they will receive
Clinical Director of CBT Associates,
hundred randomly controlled trials their first message from the BEACON
a leading Toronto-based psychology
in depression and anxiety. With all therapist that reviewed their initial
practice, and the Clinical Lead of
this data, we have been able to draw assessment. After which they will
BEACON, a digital therapy platform
conclusions about who it would work receive new material on roughly a
that delivers internet-based cognitive
for, how long treatment should last for, weekly basis. The therapy introduces
behavioral therapy (iCBT). He also
and what components of CBT would clients to ideas and techniques that are
holds faculty appointments at the
be most effective for mood and anxiety part of CBT. The client works through
University of Toronto, University of
disorders. the activities with the guidance of a
 SE CT I ON [ 01]

dedicated therapist who will give them would prefer face-to-face therapy. They having an interaction, you're unable to
feedback on their progress. On average, would prefer to have that interaction. pause time and consider what you're
effective treatment occurs in about At first, people might say that iCBT going to say next. With this platform,
eight weeks, but if needed, we can keep would not work for them, but when we you have time to consider what you're
them onboard BEACON therapy for up start to tell them to look at the research going to say next. Not only that, they
to twelve weeks. that says that it’s just as effective as have time to consult with colleagues to
face-to-face treatment, their openness get their input on how to treat a client.
In our model, all of the therapy occurs to iCBT increases.
through messaging. There are no A disadvantage is that you can't see
scheduled phone or video sessions. What advantages and disadvantages the person's face and their emotions,
You message your therapist whenever does BEACON provide for the therapist? because normally we get information
you wish, and your therapist responds from people from the tone of their
within 1-2 business days. For therapists it provides several voice and all the non-verbal cues. If
advantages. One of them is that the you're messaging, you don't have access
What advantages and disadvantages educational part of CBT can be done to that information. However, there is a
does BEACON provide for the client? by the platform. For example, if I’m science developing of how to do therapy
meeting with a client who has panic through messaging in the most effective
BEACON helps to overcome barriers disorder, one of the things I have to do way. Researchers are looking at message
to accessing effective evidence-based is explain how the panic cycle works. histories to find out what makes for
treatment. One barrier is stigma. I have had clients over the last several effective psychotherapy when using this
Although people have done great years who asked, “Why don’t you have modality.
work over the last ten years to reduce a video on this? Why am I paying you
stigma, it’s still a significant barrier for to do a lesson on panic disorder?” A What does the future have in store for
some people to access treatment. In my platform can probably do a better job BEACON? 11
experience, people will access therapy giving out information, and in this
this way who would otherwise never way, the therapist doesn't have to be I think the future is building out our
darken the door of a psychologist. They repeating information. This frees up library of protocols. Today we are
just wouldn’t do it. It still takes quite a more time to do therapy with the client. treating mild-to-moderate depression,
bit of courage to show up to the office anxiety and PTSD; we are in process of
of a psychologist. Additionally, the idea of weekly one- developing more protocols to provide
hour sessions is a convention based care for other conditions that are
There’s also geography; for example, a on how traditional psychotherapy is treatable through CBT. The future also
lot of people can’t take an afternoon done. For a lot of people, it might involves including relapse prevention.
off work every week to see their be more useful to have three or four Typically, in psychotherapy, we treat
psychologist. It may take an hour to get briefer interactions with your therapist somebody until they're well enough,
to the office, and then an hour for the every week. For example, if a client is but then we stop treatment and
appointment, and then another hour to given a CBT assignment, they might don’t follow up. I think in terms of
get back home. It becomes a three-hour forget what they were supposed to do. maintaining wellness, the future is that
thing that no one really has time for. With the conventional once-a-week somebody can come on the platform
psychotherapy format, the client would and be treated, and then we'll continue
Another advantage is that they can do have to wait until the next week to to follow them in order to help them
it when, where, and however they want. say to their therapist that they forgot stay well.
They can do a lot of it intensely over what to do for their assignment. With
a short period of time, or they can do the BEACON format, if you don't References:
it more stretched out over the twelve understand something, you can get
weeks. We certainly tell people that feedback faster. 1. Canadian Mental Health Association.
the more they engage with us, and the (2019). Fast Facts about Mental Illness.
more effort they put into it, the better The other huge advantage for therapists Retrieved from: https://cmha.ca/about-
the chances are that this is going to be is that they have time to think. In cmha/fast-facts-about-mental-illness
helpful. traditional psychotherapy, if you're
The disadvantage is that some people sitting in a room with somebody and

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SHEDDING
LIGHT ON
A LC O H O L U S E
D I S O R D E RS
JEFFREY LYNHAM

AN INTERVIEW WITH
DR. Christian
Hendershot

A lcohol is one of the most

commonly used drugs in Canada.
As with many drugs, alcohol can become
addictive, it can be abused, and it can
12 cause people to become dependent
on it. But why do some people who
start drinking alcohol eventually
become alcoholics while others seem
more resilient? In order to develop
more personalized therapeutics and
interventions for alcohol use disorder Your primary research interest is in Generally speaking, what effect does
(AUD), researchers are investigating understanding alcohol use disorders alcohol have on our mental health, and
AUD in specific populations. (AUDs). What drew you to this area why does it become addictive?
of research?
Dr. Christian Hendershot is a Senior Alcohol has a complex pharmacological
Scientist at the Centre for Addiction Studying addictive behaviours allows profile, meaning that it activates a
and Mental Health where he serves as for some unique opportunities number of neurotransmitter systems—
the Head of Psychology, Addictions to integrate psychological and there’s no single mechanism of action.
Division. He completed his PhD in pharmacological perspectives in One of the more popular views is that
Clinical Psychology and his Clinical studying a common behaviour with there are distinct neurodevelopmental
Residency in the Department of large-scale health implications. One stages leading up to addiction. For
Psychiatry and Behaviour at the of the things that got me interested example, early stages are characterized
University of Washington in Seattle. in AUDs was working on a study that by reward-based drinking, while later
He also completed postdoctoral examined genetic variation in alcohol stages largely involve relief-based
fellowships at the Mind Research metabolism in people of East Asian drinking. Over time, drinking to feel
Network and the Center on Alcoholism, heritage. That led me to do some good turns into drinking to avoid
Substance Abuse and Addictions at research looking at how genetic factors feeling bad. These stages are thought
the University of New Mexico. Dr. involved in alcohol metabolism might to involve a developmental shift in
Hendershot shared some of his insight relate to cognitive and behavioural risk the brain mechanisms that influence
and current research looking into the factors for alcohol use. decision-making while addiction
etiology and treatment of addictive progresses.
behaviours.
 SE CT I ON [ 01]

Could you comment on some of the risk What would you say is your most non-abstinence treatment outcomes—
factors for developing an AUD? To what significant research accomplishment to basically meaning reductions in heavy
extent is it based on environment, and date? drinking or grams of alcohol per
to what extent is it based on genetics? day—are associated with long-term
A while back we published the first clinical and health benefits, even
The evidence is clear that study that showed, on a large scale, the when total abstinence isn’t achieved.
environmental and genetic factors are extent to which alcohol consumption These findings are challenging the
both important. At the population is related to non-adherence to conventional focus on abstinence as the
level, genes and environment appear antiretroviral medications in patients only acceptable treatment goal, and as a
to contribute roughly equally. We with HIV/AIDS. That study stands result, there will be a push for the Food
also know that the relative strength out because it had clear clinical and Drug Administration to approve
of genetic and environmental applications, and it got some attention non-abstinence outcomes as a basis
influences changes from adolescence in areas of the world that have suffered for approving new medications. These
to adulthood, and that genes and the most from the impact of the HIV findings are particularly important
environment interact to affect risk, epidemic. More recently, I’ve also been because abstinence-based treatments—
so it’s a complex picture. Some risk fortunate to receive a couple of early while important for many people—can
factors are more consistent than career recognition awards from CIHR. also deter many people from entering
others. For example, personality traits treatment. There’s good evidence to
related to impulsivity or disinhibition, What are the most rewarding experiences suggest that simply accessing treatment
early life stress, and having a family you have while doing your job? has a much larger impact on drinking
history of alcohol problems—which is reductions, as compared to the specific
both a genetic and an environmental One of the most rewarding experiences type of treatment that’s offered.
risk factor. But no one risk factor in has been seeing my students and post-
itself is a determinant, and there’s no doctoral fellows begin to transition to 13
single gene or set of genes responsible independent academic careers—mainly
for developing alcohol problems. because it reflects the end product Everyone responds to alcohol
of a lot of hard work on their parts. differently—not everyone who drinks
Could you tell me about any of your I also enjoy being able to interact alcohol becomes addicted. It’s clear
current research on AUDs? with researchers in other parts of that many factors influence the rate
the world, and I enjoy collaborating at which we can slide into addiction
At any given time, we have a number with colleagues at other institutes on including environment, culture,
of projects going on—ranging from common projects. genetics, and even personality traits.
clinically oriented treatment studies A better understanding of what makes
to laboratory studies that use drug What does the future have in store for certain people more susceptible to
administration methods. Some of our AUD research and treatment? addiction is warranted in order to
recent projects have used intravenous develop more personalized therapies
alcohol administration procedures as Some of the hot topics right now are for AUD.
a way to study behavioural and brain similar to those that you’re seeing
markers of responses to acute alcohol, in other areas of health research, for
because we now know that individual example, lots of interest in mobile- and
differences in alcohol response biosensor-based assessment methods,
are linked to future risk for heavy as well as “big data” projects. Soon
drinking. Soon, we’ll be starting a we’ll be seeing results from some large,
couple of laboratory-based medication longitudinal imaging studies with
trials, which involve using drug self- adolescents that aim to characterize
administration procedures as a way to the effects of alcohol and other drugs
test potential treatments for AUD and on the developing brain.
smoking cessation.
In terms of treatment, we’ve recently
seen some very convincing evidence
from large-scale clinical trials that

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ON THE HIGHS
A N D LOW S O F
CANNABIS
FARINAZ GHODRATI,
ASHLEY BO ZHANG
an interview with
Dr. Jose Trigo &
Dr. Julianne Vandervoort

W e had the pleasure of sitting

down with Dr. Jose Trigo,
a neuroscientist at the Centre for
Addiction and Mental Health (CAMH) Dr. Jose Trigo is a Neuroscientist at the Centre for Addiction and Mental Health (CAMH)
studying substance use disorders as a of a drug decreases, the use will cannabis preparations. In fact during
part of Dr. Bernard Le Foll’s team at increase (5). Our research is aimed at the ‘60s-70s, the amount of THC
the Translational Addiction Research finding pharmacotherapy treatments in cannabis products was only 4%
Laboratory in the Campbell Family for cannabis use disorder as the while now, it is easy to find cannabis
Mental Health Research Institute. current standard of care for patients products with a 28% THC content,
14
His current research focuses on solely includes psychotherapy with with some concentrates having an even
translational studies of clinical and no approved pharmacotherapy. higher amount up to 90% of THC (8).
preclinical research on cannabis and Ultimately, there is a problem coming, The THC dosage is significant as it is
opioid use disorders. and it might not be here yet, but the psychoactive ingredient in cannabis
inevitably, there will be a need for and higher amounts can lead to
Your primary research interest is the
pharmacotherapeutic interventions of negative health effects such as anxiety
field of cannabis use disorder. What
cannabis use disorder in the future as and cannabis-induced psychosis (9).
drew you to this area of research?
the use of cannabis escalates.
In your professional opinion, do the
Cannabis use has been consistently
What are the most important risk viewpoints of students on different
increasing and research shows that
factors/predictors for substance use substances such as nicotine, alcohol and
approximately 8% of people that ever
disorder, especially for university cannabis affect their pattern of use/
use cannabis may develop cannabis
student population? abuse?
dependence (1,2). According to the
United States National Institute of There is clear data showing that the
Health, prevalence of daily use of Cannabis use during adolescence is
perception of risk for using cannabis is
cannabis (5.8 %) is at least equal to definitely riskier than when your
decreasing while its usage is increasing
the combined use of cigarettes (3.6%) brain is fully developed, so it is not
(10). Contrarily, due to public
and alcohol (1.2%) in 12 th graders recommended to use cannabis in the
awareness of the risks of tobacco, the
(3). Even before the legalization developmental stages during which
perception of risk of cigarette smoking
of marijuana, the use of cannabis neuronal connections are shaping.
has been increasing and its usage has
had been increasing in Canada (4), Epidemiological studies have shown
been on the decline. It is evident that
which poses as a huge problem. The that use during this period translates to
substance use is associated with the
perceived lower risk associated with an increased probability of developing
perception of risk (10), which is why
cannabis use is problematic as it is future cannabis dependence
we need to educate the youth and
leading to an increased usage of the (6,7). In addition to age, another
provide them with all the facts so they
drug. There are many studies showing important risk factor is the amount
can make informed decisions.
that as the subjective perceived risk of tetrahydrocannabinol (THC) in
 SE CT I ON [ 01]

What are your thoughts on marijuana options for cannabis use disorder
legalization and its health effects and are lacking. Given the uprise in the
consequences especially on university use of cannabis, we are in need of
students? pharmacotherapy intervention for
this disorder and it is imperative that
Marijuana or their isolated components
we keep investigating in order to be
do have medicinal applications and
prepared. Moreover, historically,
some beneficial applications may
studies on the effects of cannabis
have yet to be discovered. However,
have been conducted with lower
as a recreational substance, the public
doses of THC than the ones currently
needs to be educated on all the facts,
available (e.g. up to 90% THC), so
including the associated risks because
we are largely ignoring the long-term
as with any other drug, cannabis also
effects of the exposure to these high
has side effects. Cannabis is the most
concentrates of THC in humans. It
common illicit drug worldwide (11),
would be particularly interesting to
and its use has been increasing even
have longitudinal studies assessing the
before legalization. I want to once
risk of various higher doses of THC,
again emphasize the importance of
so in general a lot remains unknown in Dr. Julianne Vandervoort is a Psychologist
education when it comes to cannabis
this field of research. in the Concurrent Outpatient Medical
use, particularly amongst the teen and and Psychosocial Addiction Support
young adult population. Service (COMPASS) at CAMH
Do you have any final tips for our
student readers specifically when
What would you say is the biggest myth which have empirical evidence, include
it comes to substance use disorder
in the general population regarding cognitive behavioural therapy (CBT),
prevention and treatment?
substance use disorders? motivation enhancement therapy 15
Ensure you have all the information (MET), and contingency management.
There are a variety of myths, which At COMPASS we offer a 12-week,
from reliable sources in order to make
essentially come from the lack of manualized treatment encompassing
informed decisions. Furthermore,
knowledge and education. One of the both CBT and MET. Other
familiarize yourself with the official
most common misconceptions that I community-based treatments available
guidelines including Canada’s Lower-
have encountered regarding cannabis include Marijuana Anonymous and
Risk Cannabis Use Guidelines,
comes from the fact that it has Self Management And Recovery
available online on the CAMH website.
medicinal properties, which promotes Training (SMART) recovery.
the erroneous thinking that if a drug Our discussion continued with Dr.
has medicinal properties then it cannot In your professional opinion, what are
Julianne Vandervoort, a psychologist
be detrimental for your health. What the major challenges when it comes to
in the Concurrent Outpatient Medical
is lacking from the reasoning here is treatment?
and Psychosocial Addiction Support
the fact that all medication, even over Service (COMPASS) at CAMH,
the counter drugs, if used improperly Historically, one of the challenges has
working alongside Dr. Le Foll. Dr.
can lead to health problems, and the been that treatment for substance use
Vandervoort provides assessment in
same goes for cannabis. For instance, disorders was not substance specific.
addition to both individual and group
it is intuitive that you would not take Patients have shared that when seeking
psychotherapy to individuals with
a pill for your headache or to decrease treatment for their cannabis use and
substance use disorders (primarily
cholesterol levels when you do not finding themselves in a group amongst
cannabis and alcohol) and other
actually have such problems. people working on goals related to other
concurrent mental health disorders.
substances, they have sometimes felt
What do you think is the future of
invalidated. Common misconceptions,
research in your field? Currently, what are the available
for example, that cannabis is not
psychotherapy treatments for cannabis
As I mentioned before, while approved really a harmful substance, may lead
use disorder?
pharmacotherapy exists for other people who are suffering from their
substance use disorders such as cannabis use to feel misunderstood
The three main behavioural treatments
nicotine and alcohol, the treatment or even discounted by others. It has
available for cannabis use disorder,

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therefore been very important to the patient’s main coping strategy, we 6. Anthony JC. The epidemiology
create a platform for people to unite need to build other coping strategies of cannabis dependence.
to specifically talk about cannabis. to address these concurrent problems Cannabis Depend Its nature,
Unfortunately, treatment specifically in order for treatments to be effective. consequences Treat. 2006;58–
aimed at cannabis use can be hard to 105.
References:
find in Ontario and Canada. It is my
hope that with increased awareness 1. Lev Ran S, Le Strat Y, Imtiaz 7. van der Pol P, Liebregts N,
about warning signs for cannabis use S, Rehm J, Le Foll B. Gender de Graaf R, Korf DJ, van
disorder and increased open discussion differences in prevalence of den Brink W, van Laar M.
about cannabis treatment, there will be substance use disorders among Predicting the transition
a push for more hospitals and clinics individuals with lifetime from frequent cannabis use
to offer cannabis-specific treatment, exposure to substances: results to cannabis dependence: a
whether in the form of individual from a large representative three-year prospective study.
or group-based psychotherapy. With sample. Am J Addict. Drug Alcohol Depend.
the important research conducted by 2013;22(1):7–13. 2013;133(2):352–9.
Dr. Le Foll, Dr. Trigo, and others,
ideally it will be possible to combine 2. Wagner FA, Anthony JC. 8. Colizzi M, Murray R.
psychotherapy and pharmacotherapy From first drug use to drug Cannabis and psychosis:
for promising outcomes. dependence: developmental what do we know and what
periods of risk for should we do? Br J Psychiatry.
dependence upon marijuana, 2018;212(4):195–6.
The second major challenge relating cocaine, and alcohol.
to cannabis use treatment is the fact Neuropsychopharmacology. 9. Di Forti M, Morgan C, Dazzan
that patients’ cannabis use did not 2002;26(4):479–88. P, Pariante C, Mondelli V,
16 appear problematic for several years
before they detected the significant Marques TR, et al. High-
3. Johnston LD, Miech RA, potency cannabis and the risk
negative impacts on their mental and O’Malley PM, Bachman of psychosis. Br J Psychiatry.
physical health. Most people seeking JG, Schulenberg JE, Patrick 2009;195(6):488–91.
treatment for cannabis use have been ME. Monitoring the Future
using cannabis daily for several years national results on drug use: 10. Johnston LD, O’Malley PM,
by the time they present for treatment. 1975-2018: Overview, Key Miech RA, Bachman JG,
I hope that with increased awareness Findings on Adolescent Drug Schulenberg JE. Monitoring
and understanding of cannabis use Use. 2019. the Future national results on
disorder, people will recognize early
warning signs and seek support or drug use: 1975-2013: Overview,
4. Health Canada. Canadian Key Findings on Adolescent
treatment earlier on. Tobacco, Alcohol and Drugs Drug Use. 2014.
Survey (CTADS): Summary
The third major challenge relates to of Results for 2013. 2013;(July 11. United Nations Office on
the fact that most people presenting 2):1–24. Available from: Drugs and Crime. World Drug
for treatment for cannabis use disorder http://healthycanadians.gc.ca/ Report 2018.
also have other concurrent psychiatric science-research-sciences-
disorders. Cannabis has been used recherches/data-donnees/
for “self-medication” of anxiety and ctads-ectad/index-eng.php
depression or to numb symptoms
of post-traumatic stress disorder. 5. Terry-McElrath Y M, O’Malley
Conversely, cannabis use may have PM, Patrick ME, Miech RA.
exacerbated other mental health Risk is still relevant: Time-
issues. If we do not address these varying associations between
comorbid disorders in treatment, then perceived risk and marijuana
it is unrealistic to expect significant, use among US 12th grade
lasting changes in cannabis use. In students from 1991 to 2016.
other words, if cannabis use has been Addict Behav. 2017;74:13–9.
 SE CT I ON [ 02 ]

P O S S I B I L I T Y O F F U L L R E C OV E RY
FROM A DRUG ADDICTION
ALIREZA (ALLAN) JAMSHIDI

R ecovery from substance addiction

requires more than medicating
patients. Even a combination of medical
missing component in the treatment of
drug addiction.
Moreover, finding new friends,
developing new healthy habits, and
building a healthy social life is not easy
therapy and psychotherapy would not Stress is a contributing factor for for many people. Further compounding
necessarily result in a full recovery from people to take drugs and even develop the issue is that finding a job or reuniting
drug addiction. What is missing in the a chronic dependence on them. Feeling with family may be challenging for
recovery process? of depression, detachment, shame, and people during and after recovery. Lost
guilt are also common among people connections, loneliness, detachment,
Drug addiction can affect the during the recovery phase of addiction guilt, shame, and financial problems
physical, mental, and social health of [1]. Unlike chemical imbalances caused are all undeniable sources of stress and
people suffering with this disorder. by drugs abuse that have a more discomfort that might increase chances
Neuroscience research has made large straightforward solution, social aspects of relapse and failing the recovery
strides in understanding the biological of addiction are not as easily treatable. process [2]. All these issues highlight
effects of drug abuse, particularly as it Therapists might be able to provide some the importance of developing thorough
relates to the central nervous system. psychological support for people who recovery strategies and treatment plans
Through these discoveries, psychiatrists are trying to give up drugs by reminding that address the relationship between
and psycho-pharmacologists have been them of their efforts, enhancing their social and psychological challenges 17
involved in creating medications to self-esteem and self-confidence, and related to drug use and recovery from
balance the unbalanced biochemistry shifting their perceptions on areas of drug addiction.
of drug users to aid in their recovery their personal life connected to their
process. Achievements in these areas drug use; however, an individual’s Unfortunately, social programs are not
are significant and progressive. On social life exists beyond therapy sessions as widespread as necessary partly due to
the other hand, psychologists have yet addressing social factors is remains the requirement for more sophisticated
studied behavioral patterns of people a challenge during treatment. For recovery plans that are tailored for the
with substance addiction and created example, chronic involvement with specific person with drug addiction
several efficient therapies. Despite drugs may isolate individuals from and their uniquely personal social
the advancements in psychology and healthy social interactions with non- situation. Providing social support on
psychiatry, many people with addiction drug users creating an environment top of biological and psychological
never fully recover and relapse rates that may be less conductive to recovery based treatment needs to be included in
remain high. Treating the social from substance abuse. Alternatively, recovery programs for people with drug
aspects of recovery remains a challenge if someone decides to abandon addiction to allow for the development
in existing treatment paradigms. friends or social connections that are of social behaviours and environments
Providing social support for patients connected with their drug use, feelings that promote a life of sobriety.
as they resume their normal life after of social disconnection, loneliness, and
a period of drug abuse might be the depression may become heightened. References

[1] O'Connor, L. E., Berry, J. W., Inaba, D.,

Weiss, J., & Morrison, A. (1994). Shame,
guilt, and depression in men and women in
recovery from addiction. Journal of substance
abuse treatment, 11(6), 503-510.

[2] Sinha, R. (2001). How does stress

increase risk of drug abuse and relapse?.
Psychopharmacology, 158(4), 343-359.

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PRESSURE OF SOCIALIZATION IS AT LEAST

PARTLY RESPONSIBLE FOR INCREASED RISK OF DRUG
AND ALCOHOL ABUSE ON THE AUTISM SPECTRUM
PAULINA SCHECK

I always used alcohol and drugs to

deal with social demands, but I did
not start regarding it as self-medication
All respondents identified drug and
alcohol use as a primary support for
socializing. Social drinking and drug use
Drug and alcohol use were described as
“unavoidable” and “necessary” in the
process of habitual socialization and
until much later, as a so-called “late-in- began during teenage years, ages 13 to learning to make friends. Although
life” diagnosed autistic. As an adult, a 18, with only one respondent indicating positive outcomes were identified,
successful bar night involves drinking a late start, at age 21. The types of respondents also indicated that they
just enough to deal with sensory issues substances used included alcohol, would not recommend using drugs and
but not enough to get drunk or feel prescription opiates, amphetamines, alcohol as a socializing strategy. For
hungover the next day. It wasn’t always cocaine and marijuana, with alcohol example, one respondent said “I have a lot
like this. As a teenager, I went through a being the primary substance resorted of sensory issues and only drinking gives
binge drinking phase, and experimented to due to ease of access. Reasons for the me a sense of stillness that allows me to
with any drugs I could get a hold of, all use of substances to socialize included: focus on others. I find it easier to notice
to make it easier for myself to interact shyness, loneliness and isolation, lack social cues and respond appropriately
with others. Later, in my 20s, someone of confidence, the need to fit in or and even perform the social gestures
gave me a Dexedrine pill at a party. I was feel included, the need to deal with required of me – fake eye-contact,
planning to get drunk that night, but inhibition, self-doubt, the need to facing people, arms relaxed, open etc.,
18
suddenly I did not need to. That was appear more “fun”, selective mutism, the sorts of things that communicate
when I realized there was an underlying and sensory issues, with sensitivities to good intentions. I just can’t do it as
issue to my need to have a drink as soon sound and touch reported as the greatest well or as often sober”. When asked
as I entered a loud and crowded space. obstacles to socializing. Respondents whether they condone this strategy or
also reported that drug or alcohol use would recommend it to others, the same
A recent study found that autistic allow them to engage in physical contact, respondent said “I definitely would not.
people, and especially those with a with some respondents indicating that Some of the things I got desensitized to
shared diagnosis of Autism Spectrum they would need to use drugs or alcohol while drunk have stayed with me sober,
Disorder (ASD) and Attention Deficit to be able to have sex. and I am thankful for that, but I wish
Hyperactive Disorder (ADHD), are there were other ways to get to where I
at higher risk of addiction [1]. This am today.”
study suggested shared genetic and
environmental factors were liable for
increased drug and alcohol consumption
for those on the Autism Spectrum;
however, this interestingly contradicts
community-generated knowledge.
According to autistic social media,
autistic people themselves believe that
the pressure of socializing is at least
partly responsible for their increased
rates of drug and alcohol consumption.
To test this hypothesis, I created a short,
informal questionnaire and shared it
with five autistic individuals, both male
and female, between the ages of 22 and
55 years. Below, I discuss some of the
findings.
 SE CT I ON [ 02 ]

A common complaint with drinking that allow autistic people to manage There are many potential solutions
and drug use in social contexts was the their sensory issues as they interact, as emerging from the stories autistic
risk of becoming too uninhibited. For socialization supports, but that they are people share on social media and in
example, one respondent said, “alcohol worried about perception and potential support groups, some of which were also
tends to be a bit too much of a release stigma. All respondents indicated that mentioned by my respondents. A wider
from the social pressure, self-doubt and self-acceptance is one effective way to awareness and acceptance of autism
stress that I seem to constantly feel, it overcome the pressure of substance use; in public spaces would go a long way
has been problematic for me in the past as one respondent indicated, “easier said in making us feel comfortable asking
so now I choose to avoid it altogether”. than done, but I always say, ‘own your for accommodations or using sensory
Most respondents confessed they had awkwardness’.” The same respondent supports. Similarly, universal diagnosis
lost control of their drug and alcohol suggested that more widely accessible for anyone on the spectrum, not just for
use at some point in their lives and felt social groups for neurodivergent people those who experience severe challenges,
they were spiraling into addiction. A who struggle with the same issues would will lead to a better understanding
more distressing finding is that nearly all at least let them know they are not alone. of our own needs. People from older
female respondents confessed to losing generations, like my grandmother,
their ability to negotiate boundaries How to make sense of these findings? The passed away without ever knowing they
during physical contact while being difficulties that respondents identified were autistic, nonetheless, their struggles
intoxicated. seem to fall in a few general categories lasted throughout their lifetime. There
including: isolation, social anxiety, issues is increasing awareness that social and
Most respondents answered that they of self-worth, pressure to live up to environmental change are the most
were not receiving any other support, expectations, and sensory issues. Sensory effective way to deal with autism. This
such as therapy, when they resorted to hypersensitivities are a consequence of comes with a related understanding that
drug and alcohol use to socialize. One what has been previously described as it is less important to focus on a cure
respondent indicated a link between sensory processing disorder, which leads than to create inclusion for people on 19
the absence of a formal diagnosis and to poor sensory integration and the risk the spectrum.
drug and alcohol use for socialization: “I of becoming overwhelmed for people on
wasn’t diagnosed until age 52, so I had the spectrum. While this is not intended
been through a lifetime of just feeling to be an exhaustive investigation of the References:
different and not quite knowing why, topic, I believe it reinforces the insights
often blaming myself for my lack of coming from autistic social media and 1. Butwicka, A., Langstrom, N.,
friends, failure to fit in etc. Had I known community support-groups; issues Larsson, H., Lundstrom, S., Serlachius,
when I was younger, I might not have related to socialization are responsible E., Almqvist, C., Frisen, L. and P.
felt the need to drink, take drugs to fit for at least a subset of the kinds of Lichtenstein 2017 Increased Risk for
in with people, I might have accepted drug and alcohol use-related problems Substance Use-Related Problems
myself for who I was and not bothered that autistic people face. The story, in Autism Spectrum Disorders: A
to be like other people”. as it emerges from my experience and Population-Based Cohort Study. Journal
my respondents’ is very similar; faced of Autism and Developmental Disorders
When asked what would replace alcohol with an increasing pressure to perform 47(1): 80-89.
in the autistic socializing toolkit, most socially and a limited acceptance of our
respondents indicated that there is no difficulties, we all eventually discovered
replacement that works quite the same that drugs and alcohol allow us to do
way. However, some alternatives were what we need to do, mostly in our
discussed. As one respondent confessed, teens. As adults, we regretted excesses
“I find that, in social situations, if I and pondered over just how vulnerable
have any kind of drink in my hand we were. As some confessed, not being
(coffee or pop) I feel more comfortable. provided with the means to understand
I use it as a barrier between me and the “why we are this way”, as one respondent
world”. Another respondent answered put it, prevented us from being more
that they use their phone as a “blocker” effective in our self-management, and
and confessed that they would be sometimes it made us judge ourselves
interested in using stim toys, toys harshly and push ourselves too far.

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20

I N D I G E N O U S H E A LT H —
LO O K I N G I N TO T H E F U T U R E
MARIJA ZIVCEVSKA

A history of colonization, isolation,

loss of culture and subsequent
intergenerational trauma have left
Over the years, healthcare professionals
have begun to embrace more holistic,
multidisciplinary approaches in efforts
to each perspective individually [6].
This pedagogy emphasizes the need
for mutual respect and understanding,
Indigenous communities in Canada to blend Western biomedical practices encouraging collaboration across
particularly vulnerable to various with more traditional Indigenous Indigenous and non-Indigenous
health and social inequities [1]. It is views [4,5]. In essence, culturally systems of thought. So how can this
often easy to dismiss these issues as sensitive treatment emphasizes the approach be applied to treatment of
something of the past, yet historical need to recognize wellness from an substance use disorders?
injustice is embedded in the present, Indigenous lens, understood as the
notably in the modern landscape interplay between the mind, body A recent review by Rowan and
we live in today. Mental health and and spirit [4]. This intersect between colleagues, examined the efficacy
substance use are now recognized by Indigenous and Western methods is of integrating both Western and
Indigenous communities and their referred to as “Two Eye Seeing”, a culture-based interventions to treat
governing organizations as top health concept that describes the capacity substance use disorders in Indigenous
priorities [2], yet underutilization of to view the strength of Western populations across North America [7].
services and high treatment dropout practices with one eye while viewing A total of 19 studies were examined.
rates suggest systemic barriers exist the strengths of Indigenous practices Some of the cultural interventions
within our current Western approach with the other [6]. Binocularity, included were: prayer, talking circles,
that fail to address the needs of these then ultimately offers a larger, more sweat lodges, fasting, art creation,
populations [3]. comprehensive field of view, in relation singing, traditional teachings and
 SE CT I ON [ 02 ]

ceremonial practice. Interestingly, across Indigenous communities [2]. 4. Hill DM. Traditional medicine in
benefits were seen across all areas of As a first step towards development contemporary contexts: Protecting
wellness (physical, emotional, mental, of culturally relevant and applicable and respecting indigenous knowledge
and spiritual) with 74% of studies treatment models, efficacy of non- and medicine. Ottawa, ON: National
reporting eliminated or reduced alternative interventions require Aboriginal Health Organization; 2003
substance use problems [7]. Given the further investigation. Looking into Mar.
vast variety of interventions included, the future of Indigenous health, we
it is, however, difficult to compare must broaden our perspective beyond 5. Rojas M, Stubley T. Integrating
exact benefits across modalities. our mainstream norm and consider mainstream mental health approaches
Nevertheless, such reports offer an alternative ways of thought. and traditional healing practices. A
intriguing insight into the validity of literature review. Adv Soc Sci Res.
recognizing alternative approaches and 2014;1:22-43.
expanding our current Euro-centered References:
healthcare model. 6. Iwama M, Marshall M, Marshall A,
1. Reading CL, Wien F. Health Bartlett C. Two-eyed seeing and the
In exploring how traditional healing inequalities and the social determinants language of healing in community-
practices can be incorporated in of Aboriginal peoples' health. Prince based research. Canadian Journal of
treatment, it is important to recognize George, BC: National Collaborating Native Education. 2009 Jul 1;32(2):3.
that there is vast diversity across Centre for Aboriginal Health; 2009
Indigenous communities in Canada, Mar 26. 7. Rowan M, Poole N, Shea B, Gone
each with unique geographic and JP, Mykota D, Farag M, Hopkins C,
linguistic cultures, spiritual beliefs and 2. Firestone M, Smylie J, Maracle S, Hall L, Mushquash C, Dell C. Cultural
experiences. Subsequently, research McKnight C, Spiller M, O’Campo P. interventions to treat addictions in
and treatment should reflect such Mental health and substance use in Indigenous populations: findings 21
diversity, understanding the legacy an urban First Nations population in from a scoping study. Substance Abuse
of colonial policies that affect the Hamilton, Ontario. Canadian journal Treatment, Prevention, and Policy.
wellbeing of each particular group. of public health. 2015 Sep 1;106(6):e375- 2014 Dec;9(1):34.
81.
Ultimately, there is an urgent need to 8. Bartlett C, Marshall M, Marshall
supplement and expand community 3. Duran E. Transforming the soul A. Two-eyed seeing and other lessons
centered research, to involve Indigenous wound: A theoretical/clinical approach learned within a co-learning journey
perspectives across various levels, to American Indian psychology. of bringing together indigenous and
services and programs [2]. Substance Archana Publications; 1990. mainstream knowledges and ways of
use disorders are still predominantly knowing. J Envi Stu Sci. 2012;2(4):331–
seen and treated from an individual 40.
Western perspective, limiting
treatment efficacy and relevance

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recognizing that one’s mistakes and present, be that thoughts or sensations,

failures are not radically different the central point of self-compassion is
KINDLY PRESENT from the ones consuming others [6], the relationship with the self5.
and thus the individual can begin to
connect to friends or even strangers Both mindfulness and self-compassion
ANDREA DIAZ as opposed to suffer in isolation [7]. have been found, independently, to
Mindfulness in self-compassion refers be highly correlated with PWB. Baer,

A s the notion of mindfulness has

become more relevant in Western
culture, and ever more prevalent in
to the ability of remaining aware of
the painful experience rather than
using mechanisms such as avoidance or
Lykins, and Peters found that self-
compassion and mindfulness appear to
predict PWB with different strengths
popular media, psychologists have rumination [3,7]. [3]. Self-compassion was a significantly
begun to study its effects on the stronger predictor of eudaemonic
different facets of well-being. A Extensive research has been done on living than mindfulness when they
related concept, self-compassion, has the effects of mindfulness and self- looked at the constructs as a whole.
similarly been researched in the field of compassion on many aspects of the By contrast, examining the effects
positive psychology. Though similar, individual. Increased mindfulness of individual components of each
mindfulness and self-compassion are appears to be highly correlated with construct yielded equal predictions of
two different constructs that can both increased Psychological Well-Being wellbeing [3].
contribute to psychological well-being. (PWB) and decreased stress [4].
Moreover, studies have shown that the Similarly, higher self-compassion However, when the interconnections
two can work in harmony to bolster scores have been associated with less between mindfulness, self-compassion,
the positive effects of the other, as anxiety and depression [5] as well as and psychological well-being are
discussed below. higher PWB [4]. In this context, PWB examined, the literature consistently
22 is concerned with the components shows that self-compassion is a
The practice of mindfulness has that can lead an individual to lead robust mediator between mindfulness
origins in Buddhist philosophy, a self-actualizing life, namely a and PWB [6,7]. Maintaining a
which sees suffering as an inevitable sense of purpose, autonomy, warm present-oriented and nonjudgmental
universal phenomenon [1]. In the relationships, personal growth, self- awareness is associated with improved
field of psychology, mindfulness acceptance, and environmental mastery psychological health when the
has been adopted as the practice of [8]. High levels of mindfulness, in individual shows an attitude of self-
being nonjudgmental and accepting association with self-compassion, can kindness, considers one’s experiences
awareness of the present moment [2-4]. thus lead an individual to exhibit more as part of a common humanity, and
It is focused on distancing oneself from characteristics corresponding to PWB. is mindfully aware of his or her
the situation at hand to create enough Since mindfulness appears to be one suffering. The ability to notice human
space for open and honest reflection of the three fundamental aspects of experience with compassion in the
before responding [1]. Mindfulness is self-compassion, it is reasonable to present moment lends the individual
a dichotomous construct comprised propose that the two constructs might access to a deeper understanding with
of realizing that focused attention is be individually correlated in some way. clarity, thus allowing the capacity for
being paid to the present moment and However, despite some overlap, there judgement-free acceptance. Individuals
noticing what the individual’s outlook are some important differences between tend to make decisions that facilitate
is on said moment [2]. mindfulness and self-compassion that the characteristics of psychological
are worth mentioning. Mindfulness well-being when mindfulness levels
Self-compassion, by contrast, can focuses on the present moment; this are high—this is likely due, at least in
be divided into three components: may be positive, negative, or even part, to self-compassionate behaviours
self-kindness, common humanity, neutral—the goal is to be keenly [8]. The openness and acceptance
and mindfulness [3,5]. Self-kindness aware of what that present moment of mindful awareness gives space for
refers to adopting an attitude of entails. In contrast, self-compassion compassionate understanding of the
kindness towards oneself in times focuses mainly on the human aspect of self, placing individuals on a path
of hardship, as opposed to engaging suffering and how individuals relate to toward meaningful and fulfilling lives.
in self-criticism [6]. A shared, that suffering [3]. While mindfulness
common humanity is the notion of focuses on one’s experience with the Given the profound implications of
 SE CT I ON [ 02 ]

self-compassion on the mindfulness- 2. Bluth, K., & Blanton, P. (2014). 6. Shahar, B., Szsepsenwol, O., Zilcha‐
23
happiness relationship, researchers Mindfulness and self-compassion: Mano, S., Haim, N., Zamir, O., Levi‐
have used a plethora of interventions Exploring pathways to adolescent Yeshuvi, S., & Levit‐Binnun, N. (2015).
to harness mindfulness and self- emotional well-being. Journal of Child A Wait‐List Randomized Controlled
compassion in efforts to increase and Family Studies, 23(7), 1298-1309. Trial of Loving‐Kindness Meditation
PWB. These include meditation Programme for Self‐Criticism. Clinical
programs such as the Mindfulness- 3. Baer, R., Lykins, E., & Peters, J. (2012). Psychology & Psychotherapy, 22(4),
Based Stress Reduction (MBSR), Mindfulness and self-compassion as 346-356.
compassion meditation, and loving- predictors of psychological wellbeing
kindness meditation. Collectively, in long-term meditators and matched 7.Nedeljkovic, M., Wirtz, P., &
these strategies aim to increase either nonmeditators. The Journal of Positive Ausfeld-Hafter, B. (2012). Effects of
mindfulness, self-compassion, or Psychology, 7(3) 230-238. Taiji Practice on Mindfulness and Self-
both and have all found significant Compassion in Healthy Participants—
correlations between these constructs 4. Gard, T., Brach, N., Hölzel, B., A Randomized Controlled Trial.
and PWB [3,6,9]. More active Noggle, J., Conboy, L., & Lazar, Mindfulness, 3(3), 200-208.
interventions including mind-body S. (2012). Effects of a yoga-based
practices such as yoga [4] and Tai intervention for young adults on 8.Hollis-Walker, L, & Colosimo, K.
Chi [7] have been found to reinforce quality of life and perceived stress: (2011). Mindfulness, self-compassion,
mindfulness and self-compassion, The potential mediating roles of and happiness in non-meditators: A
further improving an individual’s mindfulness and self-compassion. The theoretical and empirical examination.
psychological well-being. Journal of Positive Psychology, 7(3), Personality and Individual Differences,
165-175. 50, 222-227.
References:
5. Bluth, K., & Blanton, P. W. (2015). 9. Lim, D., Condon, P., & DeSteno, D.
1. Rosenzweig, D. (2013). The Sisters The influence of self-compassion on (2015). Mindfulness and Compassion:
of Mindfulness. Journal of Clinical emotional well-being among early and An Examination of Mechanism and
Psychology, 69(8), 793-804. older adolescent males and females. Scalability. PLOS ONE, 10(2): e0118221.
The Journal of Positive Psychology,
10(3), 219-230.

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THE REAL REASON WHY WE PROCRASTINATE

JEFFREY LYNHAM

E veryone has goals, dreams, and

desires. Whether it’s going to the
gym regularly, learning a new language,
Procrastination is typically caused by
this “emotional reasoning.” You take
your emotions as evidence for the
To overcome procrastination, you
must learn how to separate how you
feel from how you act. In other words,
or moving to Africa to build a school, truth and assume that they reflect how you may not be able to control your
we all have an area of our lives we things really are. Your logic: “I feel feelings, but you can control your
would like to improve. But how come overwhelmed about starting this term actions. Next time you have the impulse
we procrastinate doing the things that paper; writing it will be unbearable.” to finally start working on that term
we know are important? Since your thoughts about the task paper you said you were going to do
that you have been procrastinating last week, you have only a few seconds
You might think that we procrastinate feel so negative, you conclude that before you will talk yourself out of
because we don’t know how to make the task will indeed be too difficult to doing it. But if you commit yourself to
changes. But now that we’re in the complete. acting immediately, you will disengage
digital age, we have all the information yourself from the repetitive loop of
we need readily available. You can Most procrastinators try to analyze why emotional reasoning. At first, you
find a mentor who has already done they procrastinate. They may wonder will probably feel anxious, or even
what you want to do and follow in why they are so unmotivated or what afraid, but you need to push past those
their footsteps. You could walk into happened in their childhood to cause feelings and act anyways.
a bookstore and find dozens of books them to be so lazy. Different mindsets
written by accredited experts that will contribute to procrastination, such as To help you get started on achieving
24 give you a step-by-step guide on how to hopelessness, feeling overwhelmed, your dreams and your goals, you can
accomplish what you want. You could perfectionism, undervaluing the break a complex task into a series of
even use Google to find hundreds of rewards, fear of failure, fear of success, small steps that you can complete in
articles with instructions on how to and fear of disapproval. However, a few minutes each. Focus on taking
get started on your goals. insight into why you procrastinate one step at a time, rather than trying
wouldn’t change your life. Even if you to do everything at once. For example,
Even if we know what to do and how find out that your parents placed too the first step for writing your term
to do it, we often don’t push ourselves much pressure on you as a kid, this will paper may be to just search for some
to actually do it because of one simple probably not motivate you to do things references online. Once you get started,
fact: We never feel like it. For example, that are challenging or uncomfortable. you may feel a sense of accomplishment
someone who has not exercised in that will motivate you to do even more
years will probably not wake up one You might be wondering, “So where than you had initially planned. As
morning and feel like going for a jog. does motivation come from?” Well, you progress, you will often find the
The mistake that procrastinators let me ask you another question: What task to be much easier than you had
make is that they wait for inspiration comes first, motivation or action? anticipated, and you will forget about
to strike. But if you wait until you’re Many procrastinators think that why you were procrastinating in the
“in the mood” to do an unpleasant motivation comes before action, but first place.
task, you might be waiting forever. it doesn’t. The most successful people
Logically, we know what we should be know that it’s the other way around.
doing, but our feelings often make our Once you actually do something, you
decision. Unfortunately, how we feel will often feel more motivated.
in the moment usually does not align
with our overall goals.
 SE CT I ON [ 02 ]

THE TEAM
EDITOR-IN-CHIEFS EXECUTIVE EDITORS MAGAZINE DESIGNER
Rachel Dragas Alexa Lopreiato Jeffrey Lynham
Kate Rzdaki Alexandara Uzelac

PHOTOGRAPHERS JOURNALISTS EDITORS

Samar Ahmad Farinaz Ghodrati Benjamin Bendosz
Chandra Erickson Andrea Diaz Natasha Cheong
Hussein Hamam Alireza (Allan) Jamshidi Celina Liu
Joanne Wong Jeffrey Lynham Rahul Rana
Ashley Bo Zhang Paulina Scheck Emily Vecchiarelli
Ashley Bo Zhang
Marija Zivcevka

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26

Elemental
The Official Mental Health Magazine
of the University of Toronto

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