Category: Psychotherapy

Mentoring in Addiction Health Services Research: Transitions are not always smooth

What makes a good mentor? What are the criteria for a mentor/mentee working relationship? Is it the number or similarity of their publications on their CVs? Is it the academic profile at the institution homepage?  The answers probably vary depending on time, place, personalities and expertise. Read more about my most recent mentoring experience below.

October 15th, the AddictionHealth Services Research conference launched a new AHSR Mentor/Mentee Program.  This program provided early career investigators an informal opportunity to connect with senior researchers/faculty/administrators.  Through this program, the early career researchers had an opportunity to establish connections, gather feedback on their research goals, or ask questions pertinent to their work.  All AHSR presenters and registered attendees were welcome to participate.

All of the mentors had substantial expertise. Some have been working on integrating addiction treatment with primary care and medical care since the mid-1990s.  Others worked with large data sets and traditional claims and utilization analysis.  Others analyzed the quality and quantity of addiction treatment services for veterans.  There were experts on person centered care, the criminal justice system and treatment for incarcerated individuals, and on organizational change.
The goals of the program were to connect senior researchers with new/young researchers to improve dialogue in the field, foster open relationships (with the potential for future work projects), and share knowledge. The program participants:
  • read the circulated list of Mentors (with links to additional information on their research).
  • nominated their top three Mentor selections to ensure a reasonable number of requests across Mentors.
  • received a reply with the Mentor contact information to setup a meeting time.

A Mentor/Mentee Meeting Room at the conference was available throughout the event.  No booking was required.
The program gave me valuable time with an expert, a research leader, who would otherwise be unavailable to talk and advice. During this time, we came up with a mission statement and a plan for the transition to my new fellowship at the University of British Columbia in Canada. The plan is to use the mission statement for contacts with people whose work I admire, or would like to work with. Informational interviews with these people will help me orientate in the new environment and move my career forward.

I’m a psychologist who’s trained in science and is interested in improving addiction health services through practical implementation research. I’m a scientist interested in communicating with the public, arts and blending the scientist-artist career. In this Canadian fellowship, I’m studying ways of how to integrate addiction medicine education into the training for medical doctors.

The Addiction Health Services Research Conference (AHSR) is an annual meeting which embraces the challenge, celebrates success, and leads the way toward more effective implementation science. Text taken from:

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).

What has the doctor done well? A different type of Masterclass on youth mental health for family doctors in Ireland

A typical master class involves a Master and a Class. Unlike other masters, the organisers of this master-class chose a problem-based learning approach and encouraged all attendees to bring cases relating to youth mental health or addiction issues for the class discussion. My classmates were doctors and other health or community care professionals from the Mid-West of Ireland. From 2.00pm-4.30pm, on 1st April 2014, The Graduate Entry Medical Schoolof the University of Limerick, in association with the Youth Mental Health in Primary Care research team, hosted a master-class on interacting with young people around areas of mental health and addiction. 

Following welcomes and introductions by the organisers (shown in Figure 1), three small groups discussed patient scenarios. In the scenario about cough, they recognised that the cough can be only a symptom of a bigger issue that brought the patient to see the doctor. The focus of such consultation should be on making the patient come back, because the bigger issue can’t be resolved in just one consultation. Our need to gather information can be a barrier for reaching this objective. The main issue in the disordered eating scenario was how to ask a parent to leave the surgery so that the adolescent can talk with the doctor alone.
Figure 1. Dr Andrew O’Regan (L) and Prof Walter Cullen (R).
Dr Liz Schaffalitzky (not pictured) co-organized the session.
The 36 participants learned how to conduct a youth-friendly session with a young person, and how to use a brief intervention to address youth mental health and substance use in consultations. The importance and cost-effectiveness of early intervention in youth mental health and addiction and the role of general practice in early intervention were also discussed.

The class concluded by an extended Q & A session with youth mental health experts Dr Declan Aherne (Director of Oakwood Psychological Services), Dr Rachel Davis (Consultant Child and Adolescent Psychiatrist), Mr Rory Keane (Regional Drug Coordinator), Mr David McPhillips, (Community Substance Misuse Team), and Dr Patrick Ryan (Clinical Psychologist).

Retention versus continuity of care?

Retention in treatment has been traditionally regarded as a key outcome measure of addiction treatment. Thinking about this indicator brings us to fundamental questions of what a success in treatment is and how it can be measured.
The longer drug users stay in treatment, the higher their chances of success. Their health improves; they commit less crime and have more stable daily routine. Early identification and treatment of drug problems is also associated with better outcomes. NIATx, for instance, is an easy to use model of process improvement designed specifically for behavioral health. It helps substance abuse and mental health treatment organizations improve user access to and retention in treatment, defined as “attendance at the second, third, or fourth outpatient treatment sessions”. Others regard 12-month retention in care as success.
Rowdy Yates said, at the INEF conference in Dublin, 2011 that drug users seeking treatment want to give up drugs and what they get from us? Methadone [a replacement opioid]. This statement reflects the inability of many treatment systems to offer a menu of options and tailor them to individual needs of drug users. Medicating drug problem is one of the solutions that work for a large population of treatment seekers. Other options should be offered too.
Dr Okruhlica, in Slovakia, agrees with the diagnosis of addiction by the International Classification of Disorders (ICD) or Diagnostic and Statistical Manual DSM. This definition lists several symptoms of addiction. If somebody has certain number of these symptoms, they receive the diagnosis. If the person doesn’t have symptoms for a year, they cannot be regarded as ill any longer. Harm reduction experts believe that while the medical diagnosis of addiction could be helpful in understanding the problem, even the most dependent users have control over their drug use and choice plays an important role in their life. Dr Zinbergwas a pioneer of this approach with his monograph The Basis for Controlled Intoxicant Use. Studies on uncontrolled drug use followed. These views are regarded as extreme by many. Their believability is further undermined by the fact that non-problem drug users live in anonymity. For example, very few scientific studies manage to engage with non-problematic heroin users.
On the other hand, the recovery-oriented movements, especially AA, maintain that once a person “gets” addiction, they will become ill forever. This opinion can be very helpful for people in treatment, but can actually harm people out of treatment. Ex-users seeking re-integration into job markets are viewed as irresponsible and incapable of holding jobs for long time – result of a society stigmatization.
Because retention in treatment, as a robust outcome indicator, is highly esteemed in the drug addiction field, most professionals working in the addiction are able to place them somewhere on the continuum delineated by the two extremes – illness for life vs. uncontrolled drug use. See figure 1 below.
Figure 1 Continuum of opinions
Alongside the controversy around medicalization of drug use runs another debate about language. For many, language doesn’t matter too much and is a matter of political correctness. Opposite to them, I would like to hope, stand the language-believers. For them, the words we use shape and influence the world we live in. If we call drug users “junkies” they will become “junkies” – whatever that word represents to those who use it. Similarly, the term retention could be too close to detention; people are not kept in treatment to help them regain life, but to help sustain the treatment centre. Just like in the prison, where the inmates have little control over their length of stay, the people detained or retained in treatment have little control over length of their treatment. Opponents of the word retention propose continuity of care as an alternative, more humane, term to describe this golden-standard treatment outcome indicator. For them, it incorporates also the individual willingness to receivecare. But, are patients aware of it? I ask.

Language shapes and influences the drug treatment systems that we study or work for. It is important to recognize that even though retention and continuity of care could be the same thing – looked at from different angles – we have to choose the words we use in treatment carefully and make sure people who use our services are aware of it.

A decade in the addictions field

book, envelope, window

Edited March 4, 2020 by janklimas

… or women, men and non-binary folk who mentored me.

Career in addiction health services research can be daunting. There are moments when people in this career path struggle at work. Have you ever been in that situation yourself? Here’s my story.

Needle exchange movie at 16

The internet was still a toddler and I watched the TV rarely. But when I turned on the box on one of such occasions, a summer afternoon, I was brought into the streets of the Slovakian capital, Bratislava, which was a world far far away for me. Young social work students backpacked those streets with bags full with clean needles and distributed them to drug users and sex workers; they talked about what this exciting and controversial pastime meant for them. They worked for a needle exchange project – Odyseus – and I wanted to do it too. I was excited to help drug users in the same way these women did, but I had to wait a couple of years until I grew up.

At that time, they still called it ‘Street work’ which later became ‘Terrain Social Work’. In the following years, I learned from my future boss that the Slovakian public TV screened the film quite often, but mainly as a filler in the downtime hours.

Unanswered phone call at 20

After acceptance at the psychology degree, my world changed and the range of my interests expanded. Nevertheless, I never forgot about that documentary. It was in the second year when I saw a poster at our university board, at advertised Needle Exchange as a part time job for students. I picked up a public phone and dialled a number from the poster – following my teenage dream. Nobody picked it up, so I left a message which too remained unanswered, forever. The number on the advert wasn’t for the Needle Exchange which the documentary talked about, but I didn’t know it at that time. By chance, I ended up working for the agency from the documentary movie because they had an email address posted on the internet and were more responsive than the project which advertised on our student board.

Student project at 21

Part of my comprehensive exam in the 3rd year of my undergrad was a research project. As most of my friends, I struggled with access to patients. Because of that, almost everyone did a literature review – without having a clue what we were doing. I chose the role of family and drugs as my topic, but it wasn’t an easy choice. At that time, my interest in drugs was drifting away and I felt like researching something else, for example depression or disabilities. I don’t remember how I ended up with drugs again, but my review led to working with Dr Timulak, and eventually, to my MSc and PhD projects.

Dr Peter Halama, PhD and Hungarian trams at 25

Dr Halama, PhD was this new face at the Trnava University, when I wrapped up my comprehensive exam. They were good friends with Dr Timulak and when I asked him about ideas for my MSc research, he said that Dr Halama was doing some interviews with drug users. Two years later, I found myself co-presenting our findings with Peter at a psychotherapeutic conference in Slovakia. Read more about that research here. From there, it was easy to continue in my research with Peter at a doctoral level. I enrolled as a part time student in Social Psychology, which did not convince him that I would finish it. When I announced – after two years of studies – that I’m moving to Hungary for a year, I think Peter had a hard time suppressing his doubts that I would finish my PhD from Hungary. My Hungarian adventure was, however, a real turning point. I had to commute between offices and spent long hours in trams. Being too bored of watching cars and people pass by, I started to read open access articles which I downloaded from internet the previous day. Some were more interesting, others less, but when I found something really relevant to my work, I felt like a gold miner who just dug his jewel out of piles of dirt. My passion grew stronger with every new paper.

Irish job hunt at 28

When we arrived to Ireland in early Autumn 2008, all I had was a small EU grant with a budget of 3000 euros and an unclear host organization. We managed to survive for almost a year with a great help of my wife’s EVS stipend and occasional p/t jobs. The work on my PhD and the EU grant took most of my time, leaving only a couple of hours for finding a more stable position. When I eventually ran out of money, it was late winter and the job market had dried up. I submitted my resume to many advertisements, including a research job on men’s sexual health. I must say that research was not on my list of Top 5 jobs, but when this position came up after 8 hopeless months of job hunt it was a true God-send. The pictured ad initially offered a PhD post in drugs research, but at the interview, my current boss – Prof Walter Cullen – told me about a p/t place on the same project. That’s how I came to research drinking among methadone patients in primary care at UCD.

Dr Dennis McCarty, PhD at 31

OK, I know I said that there were 5 key decisions earlier, but there has been a lot going on recently. In July 2011, I have been to a summer school on drugs in Amsterdam, Netherlands – no one could imagine a better place for this adventure. Dr McCarty, lectured for several days on different policy models and evidence based treatments. Two years later, I’m sitting in an office down the hall from Dr McCarty’s office, writing my final report about the INVEST fellowship. Visit this post to read more about how I got here. I did not think that the summer school would lead to a fellowship in Portland, OR and I’m most grateful that it did.

With Dennis, I have learned about things I thought did not exist. For example, about researchers who enjoy writing. Writing up research projects is a task that many new researchers fear the most. Dennis is a master writer and his craft is contagious; I’ve discovered a need in me, a strong urge to write a lot and in many different formats. I hope this ‘fire’ will keep on burning for at least another 10 years.

Engage in not for profit organizations.

Two organizations jump started my work in non-profits, the University Pastoral Centre and a youth club. I learned the power of community building through youth activism with John Lesondak and taught team building for non-profits with Ivan Humenik. With Ivan and friends, we also had a musical band, JK& band. These activities inspired me to get involved in the community projects for people who use drugs.

Access mentors in voluntary service programs.

Petra a Ivan Sedliacik connected us to the world through the European Voluntary Service, which is a training program of the European Union. My youth exchange training took part in Budapest, Hungary, and a small suburban town called Goddollo with Zsuzsa Szabo. I was trained as European volunteer, improving soft skills and contributing to the common good. Petra and Ivan continued to support me throughout my training and shared their own experiences from living abroad and being European volunteers.

Be a life-long learner.

A Leonardo Da Vinci Scholarship, which was European Union’s Lifelong Learning Program, took me to Cork city on the south of Ireland. Geoff Dickson mentored me in the city’s YMCA. A few miles away, in Ballincolig, Ivan McMahon overlooked my evaluation of youth programs for early school leavers and single moms. It was great to see the practical application of science in Ireland while doing my part time doctoral degree. I got to evaluate training programs, develop program databases and identify best practice approaches for real life problems by searching the literature.

Write outside your comfort zone.

While writing scholarly articles is difficult itself, one can easily fall asleep their comfort zone. I stepped out of this zone in 2013 when I enrolled in a prompt-based creative writing workshop in Portland, OR, housed by the state’s largest bookstore, the Powell’s books on Burnside street ( This is when I began to take my writing interests seriously thanks to our volunteer instructor, Matt Blair. His workshop re-invigorated my passion for writing and taught me the value of daily writing practice.