On the Mic with Mike #6: Dr. Patricia Conrod on the developing adolescent brain

Dr. Mike Strong: Welcome to this episode of On the Mic with Mike. Today, we're here at the University of Montreal, and we're going to have a conversation with Dr. Patricia Conrod. She’s a psychologist who's doing some absolutely fascinating work, particularly with adolescents and the developing brain, and thinking about how the issues of drug use can have impacts on the brain. This will be excellent, and I'm looking forward to having this conversation. Why don't you join me as we head on in?

So, Patricia, welcome to this edition of On the Mic with Mike. We're really looking forward to having a conversation with you. You've got a fascinating research group going on. We want to explore a bit of that and then we'll go past that a bit as well. So why don’t you just tell us what it is that you do in your research?

Dr. Patricia Conrod: Sure. I'm a clinical psychologist by training and professor of psychiatry at University of Montreal. And I study neuro biological risk factors for mental health concerns and addiction. But I also translate what we learn about risk into novel early intervention prevention strategies.

Dr. Strong: OK - so as a psychologist, how do you do that translation? How does that work for you?

Dr. Conrod: Sometimes what we come to understand about risk can be addressed using intervention treatment strategies that already exist, but are delivered in a more targeted or selective way.

Other times, it involves really experimenting, and developing a novel intervention. In other words, something very new that's based on neuropsychology or, you know, a different form of psychosocial intervention. It could also be a neuro modulation, for example. So really developing something new and then testing that from beginning right up until the present.

Dr. Strong: So if I understand correctly, from what I've read about your work, you're really interested in sort of the developing brains of adolescence going through to early adulthood?

Dr. Conrod: Yes.

Dr. Strong: So the background to all of this is that the brain is not fully set and ready to go into your mid 20s - right? So how do you work with something that is like a brain?

Dr. Conrod: Evolving.

Dr. Strong: That's right. It isn't quite ready.

Dr. Conrod: The thing is, it involves different research designs. So, for example, in a treatment study, you would just observe whether the problem goes away or reduces in some way. When you're looking at the effect of a preventative intervention, you have to use a very different design. You have to follow people for longer periods of time. Usually your child's brain ends up being much bigger. You always need a control condition in order to know whetherthat something, didn't happen that was supposed to happen. So sometimes the methodology is different. The other thing you have to do is make sure your design captures what's developing over time. So it's sensitive to developmental changes, for example.

Dr. Strong: A lot of discussion in my circle sort of centers around a male-female difference, in terms of development as adolescents go through teenage years. That's not just simply their social or economic environment. There is truly an underlying difference.

Dr. Conrod: Right. It could be qualitatively different -, but it could also be differences in pace or the course of changes. It could be that one gender or sex goes through a process earlier or later than the other - or they just don't go through that process at all. So there are a number of important differences.

Dr. Strong: So that contributes to the size of the study you need, because that's a variable as well.

Dr. Conrod: Yes, it absolutely would contribute to the size. I think what really contributes to the size is the fact that I study conditions that are considered common psychiatric conditions have a certain common prevalence. At least one in three Canadians will experience some kind of mental health concern in their lifetime, if not more. But when you’re trying to prevent more rare occurrences, like certain forms of drug misuse or suicide, you need much larger studies in order to demonstrate that you can prevent a very rare occurrence. Particularly if they're difficult to protect.

Dr. Strong: So we have a new variable that's been introduced into the behavior of our teenagers and going forward. That would be the cannabis story.

Dr. Conrod: And vaping.

Dr. Strong: Yes, vaping, we’ll get to that in a second. On the cannabis side of the equation, we know that at least in the studies that I've seen, that Canadians have the youngest median age of onset of first use. We have some of the purest product that's out there. We have availability now. And so all of it, that's a whole new variable that is at least declared. How is that affecting your work?

Dr. Conrod: So how is it affecting my work? It's definitely put my work into the spotlight. And many people are interested in the research I do. By the way, the research I do is in the context of brain and neuropsychological development and social development. What is the impact of early onset cannabis use, alcohol use, and tobacco use on the developing brain? That's what I study.

The approach that I take is that we compare the effects of different drugs as well. We put them through the same test. What we're finding - it's actually quite surprising - is that cannabis is quite important in terms of how it affects brain development and neuropsychological development and mental health.

Dr. Strong: Positively or negatively?

Dr. Conrod: Negatively. It's a little surprising because the public health profile or harm profile of alcohol versus cannabis is very different. Alcohol is a very harmful drug for society, as it is related to accidents and a number of health concerns.

But for the adolescent developing brain, if you just focus on that aspect, some of our recent studies are suggesting that cannabis is actually more harmful. So obviously, it depends on how you look at it. It depends on what outcomes you're looking at. But from the perspective of the developing brain, cannabis has a profile that really requires a lot more research.

Dr. Strong:  Right - I have colleagues working on it. I work in neurobiology and neurodegenerative diseases side of the equation. I look at it more from the side of dementia so much later on, of course. But there's a lot of work.

Dr. Conrod: Alcohol has a significant role.

Dr. Strong:  And, you know, if you take a population study of animals – and you’re looking at rats, for instance - and you give them cannabinoids, over a period of time you do end up with behavioral changes. You get anxiety and depression that can be measured. And for many of us, we often sort of look and say it’s truly one out of three figure as you were describing it as a mental health event of some sort in their lifetime, if not more than all of that. Yet is it more disproportionate now in the younger age population? I look at that particularly as late teenagers getting into their 20s. Are we looking at a train wreck and saying: “Yeah - that's the cause?”. Is there concern?

Dr. Conrod: It's very difficult because of the changes in drug use patterns that have happened over the course of 10 to 15 years in North America. So attributing those changes to mental health outcomes is a difficult thing. What is clear is that in North America, anxiety and depression rates are going up in young people. But it’s difficult to do that.

Dr. Strong: Cause and effect are hard to figure out.

Dr. Conrod: We are doing studies right now where we are trying to estimate causal relationships between substance use and mental health outcomes and neural developmental outcomes. By using very large cohort studies with multiple repeated assessments, you can actually pick up a potential effect of the onset of the substance use throughout the course of development.

Dr. Strong: So if you kind of place yourself five years from now, maybe ten years from now, where do you want to see it having an impact? How does this translate for you?

Dr. Conrod: I want to see my research having an impact on the interventions and the policies that are available to the population that will protect them from substances of abuse. So, you know, it's become clear to me, and I think to most Canadians, that criminalizing policies are not helpful as a way to regulate substance use and substance related harms. But that's not to say that we don't need regulatory policies. In fact, I believe my understanding of the literature is that the more the population or a society puts limits on how accessible substances abuse are, the more they're protected. Somewhere between decriminalizing and fully unregulated legalization, we need a whole bunch of evidence-based policies and we need to understand them.

But we also need intervention programs that are going to protect people who might be vulnerable to misused substances or experienced harm from substances through genetic processes, familial processes, individual personal processes, or cultural factors.

Dr. Strong: So how did you get into all of this? It's a fascinating area.

Dr. Conrod: It’s a fascinating area.

Dr. Strong: But it's got to be all consuming to be thinking about it, so how did you come down this pathway?

Dr. Conrod: I think I remember taking my first psychology course as a junior college, which you call Cégep in Québec. I was a pretty good student. But once I was exposed to research on the brain, I just became absolutely fascinated, and much more motivated and focused.

Dr. Strong: Because, as you know, from a psychology training there’s a breakpoint at which you decide you're going to be purely a clinical psychologist or you’re also going to take on a major research bent. That's an active decision.

Dr. Conrod: Yes. In Canada, though, I think we more than many other countries preserve the clinician scientist model in psychology. So most PhD clinical psychologists in Canada are still trained through a thesis-based PhD. I still believe that's extremely important because there's so much that we still need to understand and learn about the brain, and about the interventions that are offered through clinical psychology. I believe that anyone, any practitioner of psychology should still be reading literature, and evaluating the outcomes of the interventions that they're offering. I think you would agree that that should be the case for all health sciences.

Dr. Strong: I agree. But then to end up in this particular field, looking at addiction management, how did you end up there?

Dr. Conrod: It was through the honours program at McGill University. As an undergrad in the honours program, you had to do a research study in your second year. I went around to the different professors in the departments doing research. As you know, the psychology program at McGill is really strong, fascinating research. I sat down, heard, and studied a little bit about what Robert (Bob) Pihl was doing. He is an addiction researcher at McGill. I just found the work fascinating, started there, and then have just continued from that point. I just find that what's fascinating about addiction research is that you can study it at the cellular level, and you can study it at the molecular level. You can study it at a whole brain systems level, the individual level, and the societal level. It's never dull.

Dr. Strong: If you go back - a lot of people I talk to say “How did you get into all of this?” You can go back even further than that - when they were younger. Was there somebody in your life who was a mentor? Was that it?

Dr. Conrod: Was there a mentor? Well my mother is a psychologist. She's definitely had an impact on me. So when we were students she went back to school and just plugged away at it until the point where she got right through to completing her PhD. That definitely had an influence on me.

Dr. Strong: In the same area of psychology?

Dr. Conrod: Different area - but she was she trained as a clinical psychologist and is still practicing to this day. My father was an educator - and obviously had an influence on me probably going into academia.

Dr. Strong: One of the other things we kind of explore a little bit is that this is our life and we obviously love it. You clearly love what you're doing. But what do you do when you're not doing this - is there something else?

Dr. Conrod: I'm attending to my family, for the most part. I have two children. What else do I do? I focus on my physical health. I dance every chance I have.

Dr. Strong: Any particular type? Jazz or ballet?

Dr. Conrod: All of it. I just try to maintain a healthy life, and maintain a good support network.

Dr. Strong: Do you have two children?

Dr. Conrod: I do. At the moment they’re 11 and 14.

Dr. Strong: Are either of them starting to say: “Gee mom, I wouldn't mind doing what you do. What do you do? Can you explain it?” Are they starting to tweak to an interest?

Dr. Conrod: Absolutely. They're always intrigued. I think they vacillate between being interested in my husband's career choices and my career choices.

Dr. Strong: What does your husband do?

Dr. Conrod: Right now he runs a start-up in Montreal.

Dr. Strong: A whole different world.

Dr. Conrod: A very different world - but still a lot of overlap because we both deal with big data.

Dr. Strong: Right.

Dr. Conrod: Digital technology is pretty universal to science and business. We are also managing large teams, and staying on track with projects and timelines.

Dr. Strong: So you're kind of in a very similar sort of thread of ideas with this a concept of mentoring. But when you're talking to students - particularly young students coming through who are looking for advice or thinking about it - what do you advise to them?

Dr. Conrod:Yeah. I didn't mention that one very important mentor for me were a couple of graduate students who were in the same lab where I began studying, and who I continue to collaborate with today. That was very important. So what I would say to a student is really make use of and find a cohort of students who are at the same level of study. Make sure that you're interacting with your peers or using that network, but that you're also finding someone who's a couple of years ahead of you who can also kind of help guide you through some of the decision making, sharing information and so on. That's also something that I often try to create within my team. My research centre in our department is making sure you're focusing on the cohort effect because it's extremely important, right?

Dr. Strong: It's interesting that you say that because one of the things when either I’m teaching about mentorship or talking to students or other investigators about it is an almost inadvertent mentor. There are ones who are active mentors that you seek out, take an interest in you, and spend some time with you. But there's also this sort of inadvertent, incidental mentoring. Colleague and friends who are peers that you learn something from as you go along. Until you've been there, and actually had a chance to experience that, it can really be a ‘what are you talking about?’.

Dr. Conrod: Yeah. There are ways as a supervisor or as a leader to help nurture that without being the direct mentor.

Dr. Strong: I may be entirely wrong with this observation. But I get a sense right now that particularly at the undergraduate level, there is more of an acuity to succeed and move forward to the next level. So that sense of community isn't quite there. I get the sense that it's not as strong, and I worry about it as we move into the graduate zone. For those of us who are training or teaching, do you have tricks or tools that you use to try and encourage that mentorship?

Dr. Conrod: Well I think that's where the research laboratory really does have a different culture. So maybe at the undergraduate level there is quite a bit of competitiveness and some anonymity in some of the larger universities. But once students get involved in a research lab, and that can happen as early as second year university, it's a very different experience. It's smaller, and it's supportive. They're all working towards a common goal.

Dr. Strong: Right.

Dr. Conrod: They're sharing resources. Social lives also emerge from it. I think that's another advantage and reason to encourage undergrads to get involved in research. It really changes your undergraduate experience.

Dr. Strong: I’m going to ask you a question that’s going make you flip forward a little bit, as we go along here. Part of the work that I've done has been to look at frontal lobe and frontal dysexecutive function.

Dr. Conrod: That's a lot of the work that I've done too.

Dr. Strong: OK - so you know when I started the theory of the mine wasn't even on the map. We had this idea that something was going on in the behavioral part of the frontal lobe of the brain. We really didn't understand the concepts of praxis. So, I’ve been around a little bit longer. In the time period that I've been doing this, I've seen a fascinating evolution of our ability to understand how the frontal lobes function and their contribution to the essence of an individual. I would never have predicted that, nor would I have predicted some of the imaging correlates as we start to think about neural networks and how they tie in together. So you're in a different plane right now, in the sense that that's all on your plate and you have all of the imaging capacity that we've got and the ability to interrogate these regions of the mind. But what would surprise you if we were going to go 5-10 years from now? Are there things that we don't know about how the brain functions that if you could just spend an infinite amount of time that’s where you would delve because it's going to tell us something we don't know? Do you ever think about that?

Dr. Conrod: Right – we don’t know what we don’t know

Well, I think that I think that one thing that's happening today is that we're redefining how we understand and measure psychiatric conditions. There are the psychiatric and traditional classification system and ways in which we refer to psychiatric conditions such as major depression and anxiety disorders or psychosis. More and more people are coming to agree that those might exist along a continuum. So it's not just that you have it or you don't. People can experience some of these symptoms without harm and without need for clinical intervention. But that's only after a certain point. We're also learning that there are other dimensions that impact all psychiatric conditions so that there is vulnerability to psychological problems, psychiatric conditions, and isn’t specific to one particular disorder. As you can imagine, this hierarchical way of understanding executive functions, cognitive processes, behaviour, psychiatric conditions, and psychopathology risk is just beginning to understanding will really change the way we think about things. It’s really forcing us to not think just in a linear way or to think about categories but to think about multiple interacting dimensions, processes that are also structured in a hierarchical way. With human beings - in order to understand how we can understand such complexity and how we can move forward - we're going to need systems. This includes ways of talking, ways of interacting, ways of being able to understand things that are so complex because it's the only way that we're going to be able to truly understand what's going on in here.

Dr. Strong: It doesn't sound like the excitement is done for you yet.

Dr. Conrod: No.

Dr. Strong: Listen, this has been a wonderful conversation. I really appreciate it.

Dr. Conrod: I do, too. Thank you for having me.

Dr. Strong: I probably could spend an hour or two having a conversation around this topic, but thank you very much. That's it for another episode of On the Mic with Mike. Thank you, Patricia, for joining me for this. And we'll see you again soon - take care.