What is the future of addiction medicine? What is the future addiction specialist going to look like? Nobody knows what the future is going to look like, but the delegates of the 25th CSAM annual conference imagined answers to these questions in Banff, Alberta at the Banff Centre on Tunnel Mountain. As a first comer to the conference, I had a lot to learn and a lot to write down. Read more below.
Seven high-profile experts explored trends at home and abroad and the scientific topics impacting the future of addiction treatment delivery in their keynote plenaries.
1. Prescription Abuse (Dr. Roger Weiss)
Dr Weiss updated he delegates on the progress of the Prescription Opioid Addiction Treatment Study (POATS). The outcomes of the first phase of the trial were disastrously low, in contrast with the buprenorphine that was 7 times more effective after 4 weeks. Who did well? If you’d ever been in a treatment, or used not-as-prescribed prescription opioids, or the OxyContin was your most frequently used opioid – that was a bad sign. Older people did better. Interestingly, depression was also a good sign. What initiates the addiction is not necessarily what maintains the addiction.
2. Marihuana and Anxiety (Dr. Matthew Hill)
Dr Hill introduced the insights from the basic science field. Why people use cannabis? 84% say it helps them relax; to help reduce feelings of stress, tension and anxiety. The endocanabinoids tends to keep the amygdala quiet when it should be quiet. They act as natural regulators of the amygdala. Anxiety may be related to impairment in the endocannabinoid signalling. Dr Hill’s 2014 talk on the same topic has been recorded and posted online.
3. State of the Science for Technology-Based Approaches to Substance Use: Directions for the future (Dr. Sarah E. Lord)
Internet Electronic Therapy was the focus of the first afternoon plenary. Dr Lord described some of the tools that are out there, gave examples of them and validation data. Brief intervention and CBT-4-CBT were among them. The space of phone applications industry is far ahead of the science.
4. Integrative Addiction Medicine (Dr. G. Bunt)
The weather conditions worsened in Banff so much that Dr Bunt slipped and fell down on the way to the lecture hall (see Figure 1).
5. Brain Plasticity and Addiction (Dr. Bryan Kolb)
Dr Kolb kicked off the Saturday conference programme. Brain changes constantly. Anything you learn is going to occur because the brain changes. Play and stress too modify pre-frontal cortex. Interaction of brain and psychoactive drugs keeps fascinating scientists.
6. Clinical considerations for behavioural addictionsin the settings of DSM-5 and ICD-11 (Dr. Marc Potenza). During the first part of this millennium the perspectives on addiction changed, especially the behavioural addictions. How are they different or similar to substance use disorders? Many are strongly associated with behavioural addictions, e.g., heavy alcohol use and gambling. In addition to the high rates of co-occurrence, there are similar clinical courses, similar clinical characteristics, similar biologies and similar treatments for behavioural addictions.
7. The Alberta Addiction & Mental Health Review: Current challenges & lessons learned (Dr. David Swann).
Investment into addiction treatment is only a fraction of the Alberta’s budget – 0.1%. The current government of Alberta isn’t doing evidence-based policy but policing evidence. Racism is alive and well in Alberta. Lack of understanding led to the fiasco of the primary care reform in Alberta. It has an ambiguous direction on harm reduction. Dr Swann concluded his talk with 30 questions for the audience.
|Figure 1. Banff centre snow