A novel approach to treating addiction

Chronic substance abuse and mental illness are of critical concern. It’s not that one causes the other -- although that’s possible in some cases. It’s that, when they occur in tandem, they pose a heightened challenge to caregivers. They must assess both the illness and the level of addiction, and then design treatment specific to the individual. This is Dr. Michael Krausz‘s area of expertise. He’s the recently-appointed Providence Health Care BC Leadership Chair in Addiction Research at The University of British Columbia’s Department of Psychiatry and St. Paul’s Hospital in Vancouver.

Dr. Krausz received his medical degree at the University of Hamburg, Germany, in 1984. During his studies he worked part time as a psychiatric nurse, seeing firsthand the devastation that addiction, often combined with a mental illness, can cause. Later, having obtained a Ph.D. focused on addiction and schizophrenia, he thrust himself into a vigorous program of research and direct patient care. He soon achieved an international reputation for ground-breaking work treating addicts in several German and Swiss cities.

For instance, he worked in Zurich, where the so-called “Four Pillars” strategy originated. “At the beginning of the 1990’s, there was an ‘open drug scene’ in Zurich, much as there is today in Vancouver’s Downtown Eastside,” he says. “We broadened the scope of our work to include residential, abstinence-oriented and heroin-assisted treatment. The underlying concept was that different people need different kinds of treatment.”

Meanwhile Dr. Krausz took on a senior faculty position at the University Hospital in Hamburg, becoming Director of the university’s Centre for Interdisciplinary Addiction. In that capacity he published over 100 research papers, and founded and served as Editor-in-Chief for European Addiction Research and Addiction Therapy.

He arrived here in 2007 to take up his new post at UBC and St. Paul’s. It didn’t take him long to assess the situation. “I’m afraid the Downtown Eastside is a model for problems that other cities in North America and the world may experience in the future. It’s different from what I’m accustomed to, because here the clinical addiction research area is not well-developed yet. On the other hand, basic neuroscience and HIV/AIDS research here is excellent.

“I want to help build the capacity in BC for new forms of intervention and randomized clinical trials.” The latter involves testing a new treatment against the standard treatment, with subjects selected at random from particular population groups.

Dr Krausz draws on his experience in the Zurich clinical trials. “There was good coordination between law enforcement agencies and health care authorities in Switzerland. They encouraged municipalities around Zurich to establish their own systems of care and they sent all the heroin users who weren’t from Zurich back to their home towns for appropriate treatment.”

Could this work here? “You’d need to convince cities and towns around Vancouver, elsewhere in BC and beyond to accept the fact that Vancouver’s substance abuse and mental illness problems are their problems as well.”

Working with colleagues at UBC, St. Paul’s and various other institutes and agencies, Dr. Krausz wants to create a centre of excellence in severe addiction and concurrent psychiatric disorders. He’s already agreed to co-chair a new City of Vancouver program called Collaboration for Change, in which community and government representatives will try to improve mental health services in the Downtown Eastside.

“Research should always be connected to change,” he argues, “and should address real community problems and societal needs. Two areas in the Downtown Eastside need change. One is the way we deal with different populations there and their specific needs for treatment. The other is the high rate of addiction, physical and mental illness among First Nations people, which is associated with lifestyle, diet and poor living conditions.”

The Providence Health Care BC Leadership Chair in Addiction Research is supported by $2.25 million from the province’s Leading Edge Endowment Fund and a matching investment from the St. Paul’s Hospital Foundation. In 2001, the need for an addictions Chair to complement the work of St. Paul’s in HIV/AIDS and urban health was identified by BC Centre for Excellence in HIV/AIDS leaders Drs. Michael O’Shaughnessy and Julio Montaner. So, through the Foundation, the Centre contributed to the new Chair, along with an anonymous Vancouver family.

For further information, visit the Centre for Health Evaluation and Outcome Sciences (CHEOS), www.cheos.ubc.ca