The Canadian Journal of Psychiatry

To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study).

We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample (n = 679) was collected in 2002.

Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine–crack or benzodiazepines). Large proportions of illicit opioid users have physical and (or) mental health comorbidities, including infectious disease and (or) depression, and therefore require integrated interventions. Finally, morbidity risks among illicit opioid users are often predicted by social marginalization factors, for example, housing status or involvement in crime.

Given the epidemiologic profile and high disease burden associated with contemporary forms of illicit opioid use, more effective treatment approaches are urgently needed in Canada and elsewhere. Specifically, treatment must adjust to the extensive polysubstance use realities, yet it must also more effectively address the complex physical and (or) mental health comorbidities presented by this high-risk population.

To provide an overview of treatment options for opioid-dependent patients.

We screened all published studies on the treatment of opioid dependence, with a special focus on systematic literature reviews, formal metaanalyses, and recent trials.

Both clinical experience and neurobiological evidence indicate that opioid dependence is a chronic relapsing disorder. Treatment objectives depend on the pursued goals: crisis intervention, abstinence-oriented treatment (detoxification and relapse prevention), or agonist maintenance treatment. The high quality of solid evidence in the literature demonstrates that there are numerous effective interventions available for the treatment of opioid dependence. Crisis intervention, frequently necessary owing to the high overdose rate, can be effectively handled with naloxone. Abstinence-oriented interventions are effective for only a few motivated patients with stable living conditions and adequate social support. Agonist maintenance treatment is considered the first line of treatment for opioid dependence. Numerous studies have shown efficacy for methadone and buprenorphine treatment, while maintenance with other agonists is also becoming available to a greater extent. Maintenance treatment with diamorphine should be made available for the small group of treatment-resistant, severely dependent addicts. Other harm-reduction measures can serve to engage individuals with opioid addiction who are not in treatment.

Opioid dependence is a chronic relapsing disease that is difficult to cure, but effective treatments are available to stabilize patients and reduce harm, thereby increasing life expectancy and quality of life.

To evaluate the impact on high school students of a video-based antistigma program portraying real life experiences of individuals with schizophrenia and lesson plans to guide classroom discussions and active learning.

We used a pre- and posttest design to measure the short-term impact of the program on student's knowledge of schizophrenia and its treatment as well as students' self-reported socially distancing behaviours. Participants (571 students) were from 8 high schools across Canada.

Following the Reaching Out antistigma program, high school students were significantly more knowledgeable and less socially distancing. Impact also varied by age group and sex.

Video-based antistigma programs are comparable to programs that deliver educational messages through direct contact with individuals with mental illnesses. Video-based programs are more easily disseminated on a broad scale.

Research into risk and protective factors for psychiatric disorders may help reduce the burden of these conditions. Spirituality and religion are 2 such factors, but research remains limited. Using a representative national sample of respondents, this study examines the relation between worship frequency and the importance of spiritual values and DSM-IV psychiatric and substance use disorders.

In 2002, the Canadian Community Health Survey obtained data from about 37 000 individuals aged 15 years or older. While controlling for demographic characteristics, we determined odds ratios for lifetime, 1-year, and past psychiatric disorders, with worship frequency and spiritual values as predictors.

Higher worship frequency was associated with lower odds of psychiatric disorders. In contrast, those who considered higher spiritual values important (in a search for meaning, in giving strength, and in understanding life's difficulties) had higher odds of most psychiatric disorders.

This study confirms an association between higher worship frequency and lower odds of depression and it expands that finding to other psychiatric disorders. The association between spiritual values and mood, anxiety, and addictive disorders is complex and may reflect the use of spirituality to reframe life difficulties, including mental disorders.

Publicly funded cognitive-behavioural therapy (CBT) for mental disorders is scarce in Canada, despite proven efficacy and guidelines recommending its use. This paper reviews published data on the economic impact of CBT to inform recommendations for current Canadian mental health care funding policy.

We searched the literature for economic analyses of CBT in the treatment of mental disorders.

We identified 22 health economic studies involving CBT for mood, anxiety, psychotic, and somatoform disorders. Across health care settings and patient populations, CBT alone or in combination with pharmacotherapy represented acceptable value for health dollars spent, with CBT costs offset by reduced health care use.

International evidence suggests CBT is cost-effective. Greater access to CBT would likely improve outcomes and result in cost savings. Future research is warranted to evaluate the economic impact of CBT in Canada.

La thérapie cognitivo-comportementale (TCC) financée par l'État pour les troubles mentaux est rare au Canada, malgré son efficacité prouvée et les lignes directrices qui la recommandent. Cet article examine les données publiées sur l'effet économique de la TCC afin d'éclairer les recommandations en vue des politiques canadiennes actuelles de financement des soins de santé mentale.

Dans la documentation, nous avons recherché des analyses économiques de la TCC dans le traitement des troubles mentaux.

Nous avons repéré 22 études économiques de la santé faisant appel à la TCC des troubles de l'humeur, anxieux, psychotiques et somatoformes. Dans les établissements de santé et parmi les populations de patients, la TCC seule ou combinée avec la pharmacothérapie représentait une valeur acceptable pour les fonds de santé dépensés, car les coûts de la TCC sont compensés par une utilisation réduite des soins de santé.

Les données probantes internationales suggèrent que la TCC est rentable. Un meilleur accès à la TCC améliorerait probablement les résultats et se traduirait par des épargnes. Il faut plus de recherche pour évaluer l'effet économique de la TCC au Canada.

To examine differences between single and married mothers in the 12-month prevalence of psychiatric disorders.

The analysis uses data from the National Comorbidity Survey, collected in 1992–1993, and focuses on women aged 15 to 55 years with children (n = 1346). Psychiatric disorders are assessed with the University of Michigan Composite International Diagnostic Interview, a survey instrument based on DSM-III-R criteria.

Compared with married mothers, previously married mothers have elevated rates of disorders. Prevalences among single mothers who were never married are similar to those among married mothers, but they are generally lower than prevalences among mothers who experience a marital disruption.

These results indicate that marital separation and divorce may be markers for elevated risk for psychiatric disorder among women with children. It is important to consider the impact of marital history on the relation between family structure and psychiatric outcomes.