Current Research

Raising awareness and assessing treatment programs for addiction

The goal of Project Engage is to disseminate and evaluate evidence-based addiction treatments to addiction programs. The first demonstration project concerns the introduction of contingency management (CM). CM is an effective intervention for increasing treatment attendance among substance users as well as promoting abstinence. 

In the first phase of the project, our research team met with representatives of several programs. These meetings included education about CM and surveying those in attendance about their beliefs about evidence-based treatments and readiness to change. The meetings also involved a discussion about the logistics of implementing CM into their existing treatment programs. 

In the second phase of the project, study staff have been collaborating with interested organizations to establish a CM protocol specifically tailored to fit their services. The second aim of phase two relates to clients’ perceptions of CM. Clients who were exposed to CM are being surveyed on their beliefs about this treatment. 

The study of current treatment programs for those with opioid use disorder

The TOPP project is is a study surveying various psychosocial treatment programs nationwide to evaluate the breadth of current approaches to opioid use disorder. Examples of model programs with safe and effective methods of treatment will be identified. Results from the survey and identified model programs will provide a framework for developing and improving treatment programs for individuals with opioid use disorder. 

Reward-Related Decision Making, Impulsivity, and Cognitive Distortions in Problematic Gambling

Maladaptive reward-related decision making, impulsivity, and cognitive distortions are thought to be core features of problematic gambling. Some researchers have proposed that an aberrant decision-making style (including impulsive personality traits) may increase the acceptance of cognitive distortions, which may promote continued gambling. However, the interplay of these various factors is poorly understood. 

To date, studies have typically only examined the relationship in individuals with diagnosed gambling disorder and those seeking gambling treatment. Additionally, most studies have not explicitly considered the multidimensionality of decision-making and impulsivity. Amongst people who gamble, these processes may lead to greater risk-taking. 

This study aims to investigate the relationship between cognitive distortions and various mental processes that comprise reward-related decision making among individuals who gamble frequently. This project will develop and test a model of the relationship between reward-related decision-making, cognitive distortions, and gambling severity using structural equation modelling. 

The creation of a treatment for impulse control and addiction disorders

Over the past decade, psychological treatments have become increasingly sophisticated. One example is the creation of interventions that target common psychological processes underlying a group of similar disorders. These interventions are known as trans-diagnostic treatments and have immense advantages over traditional treatments. For example, they are more efficient and have been shown to treat secondary psychiatric co-morbidities in addition to the target disorder. 

As part of a collaboration with the University of São Paulo in Brazil, we are currently conducting research to identify common psychological dysfunctions that cut across addictive and impulse control disorders, including behavioural addictions. The goal is to develop a single treatment that addresses underlying factors common to most addictive and impulse control disorders. 

Expanding our current understanding of addictive disorders

Our current understanding of the signs and symptoms of addictive disorders (including behavioural addictions) is driven by experts’ ideas of what constitutes the symptoms of an addictive disorder. 

A lay epidemiological perspective (i.e., understanding of signs and symptoms of those with lived experiences) counterbalances traditional, expert-driven notions and seeks to understand a construct from a ‘bottom-up’ perspective. To this end, we collected data from a large sample of Alberta residents (3000+) to examine peoples' understanding of the earliest and most important warning signs of a variety of addictive disorders (e.g., alcohol, gambling, shopping, sex, video gaming). The data were collected from those with lived experiences, those with second-hand experience (e.g., family members) and those without any experience of an addictive disorder. 

The knowledge gained from a study such as this will not only help in developing an understanding of the commonalities and differences of various addictive disorders, but may also assist in refining diagnostic criteria for established disorders and help establish diagnostic criteria for lesser-known addictive disorders (e.g., sex). 

Proactive and Reactive Control in Gambling Disorder

Maryam's Master's project aimed to elucidate the different mechanisms of response inhibition in disordered gamblers. A variant of the traditional stop-signal task was used to investigate (1) how disordered gamblers reactively inhibited motor responses and (2) how they proactively anticipated and prepared to stop a response. Another goal of this study was to add to the research literature on reactive control, as well as uncover the anticipatory/proactive processes required for stopping a behaviour. The practical relevance of this study was potential treatment development and implementation. Given the strong link between high relapse rates and impaired response inhibition in disordered gamblers, identifying the mechanisms underlying this poor control could lead to more targeted treatments in this difficult-to-treat population. 

Clinical Utility of a Brief Self-directed Intervention for Cannabis Misuse

Maggie's PhD research project is aimed at developing and testingthe clinical utility of a self-directed intervention for individuals experiencing cannabis misuse and who wish to recover with minimal support. Given high rates of cannabis misuse, its associated harms, and low rates of treatment-seeking, an intervention that can attract individuals who wish to recover with minimal professional support could fill an important need for minimal cost interventions with high impact. To date, no self-directed treatment for cannabis use disorder (CUD) currently exists. Therefore, two research objectives are proposed: 1) To develop an intervention package that helps people become motivated to address their cannabis misuse with a self-help workbook with combined telephone support; and 2) To pilot the proposed intervention in a sample of individuals with CUD.

Putting Contingency Management Research into Practice

A Randomized Clinical Trial of Contingency Management for Methamphetamine 

Methamphetamine misuse has become a growing concern in Alberta. Moreover, individuals who use methamphetamine in Alberta are exhibiting significant difficulty remaining in treatment, with a retention rate nearly six times lower than what has been documented in other studies with this population. 

Contingency management (CM) is an extensively studied evidence-based treatment (EBT) that provides incentives to encourage positive behavioral change. There is considerable literature demonstrating the effectiveness of CM in the treatment of addictive disorders, including methamphetamine use disorder. Despite a paucity of research regarding methamphetamine use, current findings from the United States (US) are largely congruent with the broader substance use (SU) literature which demonstrates that CM improves various treatment outcomes in this hard-to-reach population, including increased retention. However, despite the promising literature on CM, the uptake of this EBT in Canada is slow. In fact, CM is seldom used in clinical settings. Given the lack of published literature on CM in Canada, it proves difficult to understand whether this EBT is equally efficacious in improving SU outcomes as compared to the US. 

Megan’s dissertation is focused on implementing and formally evaluating CM in outpatient addiction treatment in Alberta with individuals who use methamphetamine. The findings from this study will provide evidence for the utility of CM in the treatment of methamphetamine use disorder in Canada. Specifically in Alberta, it is hoped that the integration of CM will increase retention, and thereby translate into better outcomes in this population. Overall, it is hoped that positive outcomes from this study will further facilitate the integration of this EBT into clinical practice. 

Attitudes Toward Evidence-Based Practices and Their Influence on Beliefs about CM

A Survey of Addiction Treatment Providers Across Canada 

Megan’s Master’s research examined how attitudes toward evidence-based practices impacted beliefs about contingency management (CM), which is an evidence-based treatment (EBT) for addictive disorders that is often underused in clinical settings.  

We found that attitudes toward CM were relatively neutral. Providers appeared interested in learning about CM but felt that there were tangible barriers preventing them from integrating this evidence-based treatment into their current clinical practice. Overall, the findings suggested that future implementation efforts should take a collaborative approach to ensure a clinically relevant and empirically-based implementation process that supports and encourages the use of CM as an EBT in the Canadian context.  

Transdiagnostic Addiction Treatment with ...

Technology-Mediated Ecological Interventions

Addictions in Canada are exacerbating and incredibly costly at individual and societal levels. Technology-mediated ecological interventions are promising and cost-effective yet poorly understood. Efforts to develop such interventions are gaining traction but transdiagnostic approaches have been neglected despite their justification. This research program aims to synthesize extant literature in this domain and propose a concept map along with recommendations for intervention development. A transdiagnostic EMI for addictions will be developed and subjected to preliminary testing, with an emphasis on personalization to enhance user engagement. Knowledge translation is embedded throughout this process by incorporating various stakeholders’ perspectives. Subsequent studies may investigate which components of the intervention are most impactful on engagement and treatment outcomes. Future iterations of this intervention will likely benefit from capitalizing on emerging technological innovations (e.g., machine learning).