Category: Motivation

Doctors sweat to discover traditions of the first nations

Many doctors see addiction as a disease of body only. If overdone, this view can lead to medicalization of addiction. Some may argue that the latest research proves addiction as a chronic brain disease. This view is supported by brain scans of people who used drugs compared to people who didn’t. The scans show a loss of dopamine neurons after heavy methamphetamine use. Although brain’s plasticity allows it to recover, we don’t know how much of this loss is permanent.

While brain researchers may not mean to reduce addiction to a purely medical condition, its psychological, social and spiritual facets get sometimes overlooked. Not only medical students do not get enough education on addiction, what they get is often focused on the biological aspect.

To bridge this gap, in June 2014, a group of eight medical doctors (five doctors in training and three staff) from Canada went on a three day journey to a remote First Nations (i.e. American Indian) community to hear stories of recovery and participate in traditional healing techniques. After the trip, the Director of their addiction training programme (, analysed the group’s experiences using qualitative research techniques and presented* the narratives at conference of the Association for Medical Education and Research in Substance Abuse.

People from the First Nations reservation shared their experience with the power of spiritual recovery tools – sweat lodges (see Figure 1), community round ups, connection to heritage, family support, and elder-guided self-reflection: “…learning came through creating bonds of friendship with people at Alkali Lake. It was through these bonds that the human face…emerge[d] and the real learning started to happen.”

Figure 1. Sweat lodge (photocredit: fellowship archive)

First Nations communities are over-represented among people with substance use disorders in Canada. Having little sense of cultural competency, clinicians can become discouraged when faced with the suffering and despair of those with substance use disorders: “…the most valuable lesson [of the field trip] was in deepening the understanding that the most effective way of being an addiction physician is by humbling ourselves, relinquishing our titles as doctors and getting to know the person behind the addiction.”

The Director encouraged programmes to “find a local community that has tackled the programme and go out to do a field trip and learn from the community members.”


*Text first published at a registration-restricted website:

Story based on a poster presented at the AMERSA conference November 5th, 2014: Lighting the ember of hope: Integrating field experience and narrative techniques into Addiction Medicine Fellowship training. By Launette Rieb (a,b), MD, MSc, CCFP, FCFP, dip. ABAM; Nitasha Puria (b), MD, CCFP; Marcia Thomson (a), MSc; and Evan Wood (a,c) MD, PhD, ABIM, FRCPC, dip. ABAM


Author affiliations:
a)St. Paul’s Hospital Goldcorp Addiction Medicine Fellowship, Vancouver, B.C., Canada. b)Department of Family Practice, and c)Division of HIV/AIDS, Faculty of Medicine, University of British Columbia, Canada

Association’s for Medical Education and Research in Substance Abuse mission is to improve health and well-being through interdisciplinary leadership in substance use education, research, clinical care and policy. Text taken from
Clinical addiction medicine training is a multidisciplinary addiction medicine fellowship that strives for excellence in clinical training, scholarship, research and advocacy and involves medical education to trainees from Psychiatry, Internal Medicine, Family Medicine and Nursing. For more details, click here.

Alcohol and opioid agonist treatment: A community response

September 9th, 2014 – From research to practice: The Community Response organisation in Dublin is pleased to announce a new stabilization programme for people who are in Opioid Agonist Treatment and also who have alcohol problems. The programme aims to assist service users either reduce the amount that they drink, the frequency, or both. It shows that discoveries made by UCD’s researchers have real impact.

I welcome this new programme with great joy, because family doctors in our PINTA feasibility study complained about a high prevalence of alcohol problems in agonist patients and a lack of specialist services where they could get more help. At a 3-way meeting between Coolmine, Community Response and PINTA team yesterday, Nicholas – one of the facilitators – said “the group will aim to reduce drinking as opposed to complete abstinence.”

In 2009, our research group picked a random group of patients receiving agonist treatment in family practice. Three out of every 10 of these patients had drink problems. Recent developments in the addiction research brought effective tools to doctors who treat such patients – they are called the brief interventions. Brief alcohol interventions are for people who drink in excess of the recommended limits, but who don’t have addiction. Ever since our national prevalence study, we struggled with specialist treatments for patients with alcohol addiction, whom family doctors couldn’t help. First, we looked into the medical literature – no success. We asked the patients, interviewed their doctors and even consulted the experts in a national guideline development process, including Nicola Perry from Community Response. The result of the process was a clinical guideline for family doctors and a new study piloting the guideline in 13 family practices (check my previous post about this research). Despite all of these efforts, many services refused to treat problem drug users with concurrent alcohol addiction. This new course is a godsend for the patients and for our work.

For 10 Tuesdays, ten participants of the new course will come to Community Response for a 1.5 hours (10-11.30am) group sessions to learn about:

  1. The Process of Addiction
  2. Progression of Alcohol Use
  3. Stages of alcohol use- Early, Middle, Late
  4. Alcohol Problems in life
  5. Justification verses Reasoning   
  6. Withdrawals, Triggers, Cravings
  7. Learning from relapse
  8. Wheel of Change
  9. Interaction of Methadone and Alcohol
  10. Coping with cravings – “Urge Surfing” technique

Two experienced facilitators will lead the meetings. They will see participants individually too. Community Response’s Peer Support and Life Ring will provide aftercare. Treacy and David, who run a similar group in the Coolmine, focus their group on complete abstinence from alcohol, but they allow “certain percentage of slips. Slips are an opportunity to talk about what they [participants] can do if they relapse.”

How to get on the programme?

Go to www.communityresponse.ieand download a referral form. Complete it and E-mail it to [email protected], or post to 14 Carmans Court, Carmans Hall, Dublin 8. You will then be contacted to make an appointment for an assessment. The 20-minute assessments are every Friday between 9.00 am – 1.00pm, until Friday, 5th September, 2014. For more info, call 01 4549772 and ask for Nicholas, or e-mail [email protected].

Community Response Ltd, established in 1990, based in the Liberties in the South Inner City of Dublin, provides a comprehensive programme for primary alcohol and Hepatitis C services.

To stay updated on the alcohol stabilisation and other courses, follow @CommResponseon Twitter or Facebook

Work of the Primary Mental Healthcare Research Group cited in this article:
  • Klimas, J., Lally, K., Murphy, L., Crowley, L., Anderson, R., Meagher, D., . . . Cullen, W. (2014). Development and process evaluation of an educational intervention to support primary care of problem alcohol among drug users. Drugs and Alcohol Today, 14(2), 76-86.
  • Klimas, J., Cullen, W., Field, C. A., & the PADU-GDG (2014). Problem alcohol use among problem drug users: development and content of clinical guidelines for general practice. Irish Journal of Medical Science, 183(1), 89-101. doi: 10.1007/s11845-013-0982-2
  • Klimas, J., Anderson, R., Bourke, M., Bury, G., Dunne, C., Field, C. A., . . . Cullen, W. (2013). Psychosocial interventions for problem alcohol use among problem drug users (PINTA): protocol for a feasibility study in primary care. Research Protocols, 2(2), e26. doi: 10.2196/resprot.2678
  • Field, C. A., Klimas, J., Barry, J., Bury, G., Keenan, E., Smyth, B., & Cullen, W. (2013). Problem alcohol use among problem drug users in primary care: a qualitative study of what patients think about screening and treatment. BMC Family Practice, 14(1), 98.
  • Klimas, J., Field, C. A., Cullen, W., O’Gorman, C. S. M., Glynn, L. G., Keenan, E., . . . Dunne, C. (2012). Psychosocial interventions for problem alcohol use in concurrent illicit drug users. Cochrane Database of Systematic Reviews, (11). doi:10.1002/14651858.CD009269
  • Ryder, N., Cullen, W., Barry, J., Bury, G., Keenan, E. and Smyth, B. P. (2009). Prevalence of problem alcohol use among patients attending primary care for methadone treatment. BMC Family Practice, 10, (42).

No Fixed Abode: Movie Screening on Wednesday – 20th August at 10am in Filmbase, Dublin

August 20th, 2014 – South West Inner City Network in Dublin is pleased to invite all to the premiere of No Fixed Abode, a short movie exploring the experience of homeless people in Dublin. Result of a six months course for clients in a community addiction programme, the movie tells a real-life story of female homelessness-to-recovery journey.
Johanka Macekova, the course coordinator from SWICN, says: “The course gave the participants an opportunity to experience the creative process. They had a chance to do something different and to learn how to use a semi-professional computer programme for movie-making.”
There were 14 ex-users in the course. The programme was participant led, which means that the movie was created and produced by the participants themselves – from the script, through acting and directing.
As the movie production progressed, the group struggled with the motivation and perseverance with the task. The upcoming screening marks not only a successful completion of a media course, but also celebrates another step forward on the journey of personal development.
“They learned how to work as a team, how to resolve conflicts and manage expectations in the group”, adds Johanka Macekova,
“hope to see you there – Wednesday – 20th August at 10am in Filmbase, Temple Bar, Dublin.” The screening is FREE and open to all:
To stay updated on the movie and media courses, follow @SWICNdublinon Twitter, Facebookor join the event page:
South West Inner City Network (SWICN) is a community organization, providing a wide range of services for adults and young people living in Dublin 8, Ireland.
Community Addiction Programme (CAP) provides a range of services to help problem drug users come off drugs and alcohol, and to restart their lives.
Digital film making course for adults is for people interested in getting an insight into digital film making. It’s an introductory course into digital film making that gives the participants opportunity to learn about script-writing, storyboarding, directing, acting, using camera and sound equipment, editing.

Dear neighbour

An open letter to my neighbour who crashed my bike parked in an underground parking lot.

Thank you for the opportunity to stay at home and to learn how to true a smashed wheel on my bike last night.
You smashed my rear wheel as you were parking on Thursday, between 5-7pm. I parked my bike in a way that part of my rear wheel was in your space. So, both of us played a role in this accident. I’ve learned to not park my bike behind the lines of my parking spot. So, I’ve gained a lot last night.
I did not appreciate though that you did not come to knock on my door and tell me about the wheel. It’s hard, I know. That’s why I’m writing this letter to you. I’ve parked my bike outside the usual bike room only for 2 hours. Normally, I park it in the storage, which is very hard to access. I was going to go to my writing group and could not go there because of the wobbled wheel.
 I’ve got some bike tools because I like bikes and cycling and fixing them. So, I tried to true the wheel for about an hour, but I gave up. The wobble was too bad and couldn’t be fixed without a proper trueing stand. I’ve learned about my limits last night.
Then, I went jogging before going to bed. I want you to know that it’s o.k. to come and talk. We’re neighbours, after all.



Answer to Ethan #38: how to write a science blog

Ethan Siegel posed challenging questions in his post about science blogging. They prompted me to think about my own blog. If you’d ever been thinking about your own blog too, my thoughts might help.
Figure 1 Ethan’s blog. Photo credit

1) What is it that you’d like to write about?
I started my blog without careful planning. Shortly after the start, I’ve read someone else’s blog and I realized that I could write about the research I’m doing and about our research group. Blogging was my way of publicising and highlighting my research work. There wasn’t much research to write about at that time. Or, perhaps, as a starting writer, I didn’t see the writing opportunities as I see them now. I started to write about many other topics, including my personal life, hobbies and interests. Sometimes midway my evolution as a blogger, I took stock and divided my topics into three main categories: science, academic and creative. The science and academic categories differed mainly by the language and style of writing. Creative group was everything else. For instance, travel, concerts, poetry, etc.
2) Who is your audience?
Figure 2 William Zinsser, photo credit:

The first time I have been asked this question was when I talked to Rachel Dresbeck, PhD. I didn’t like that question because I was reading William Zinsser and he said to forget about writing for somebody. “Write for yourself”, I’ve read in his book (On writing well). I told Rachel that I’m writing for academics and psychiatrists who get bored on conferences and who check social media for amusement. She laughed. I laughed too. But there’s a grain of truth in that answer. I write for everybody who likes my posts and who shares my passions. As I grow, my passions develop too. With them, my target audience changes too – from enthusiast researchers and potential researchers to free spirits, artists and life lovers.

3) what are the goals of your writing?
To write a lot.
Some writing leads to more writing. It’s an amazing discovery; one topic leads to another.
To enjoy writing and like its results.
Some topics are easier to write about – on some days, my thoughts flow better. I find it really surprising to read posts that were difficult to write and see that I like them.
To share my ideas and see whether they spark some discussion.
In agreement with my point #1, I don’t write for a particular person or group. Nevertheless, I still want, need, and urge to share my writing with someone. Maybe it’s just the residual momentum from my blogging youth, or a continuing need for highlighting my work/life. Regardless of the motivation, I continue to write a public blog and assume that the silence of commentators = agreement and that “the vast majority of them simplywon’t comment or engage you.

Figure 3 Portland, Oregon guide by Rachel Dresbeck
photo credit

4) what else is Ethan advising to science bloggers?
This is merely a summary of  Ethan’s useful tips, some of which I mentioned above:
  • write often
  • be self-critical and honest about your own writing
  • find your own style
  • share your work with the online community
  • be a real person
  • be prepared for the kind of negativity that only the internet can heap upon you