CRISM Atlantic: Building upon the strong reputation of Atlantic addictions research as CRISM's newest node
For addiction researchers watching Canada's toxic drug crisis ripple across the country, it's like watching a massive storm brew over the horizon. As the wind blows in, it carries with it whispers of the destruction to come.
"We know that drug trends tend to start west and head east. For us it can be like an early warning system, alerting us of what may come," says Dr. Sherry Stewart, clinical psychologist, Canada Research Chair in Addictions and Mental Health, and professor in the Departments of Psychiatry and Psychology & Neuroscience at Dalhousie University.
"The good news is, being in the Atlantic provinces and part of a pan-Canadian network, we can see what people in other provinces from BC to Québec are doing to address the toxic drug crisis. Through research, we can see what's working and what's not. It can help us be better prepared."
Growth in numbers
Dr. Stewart is the Nominated Principal Investigator of the Atlantic Node of the Canadian Research Initiative in Substance Matters (CRISM), a Canadian Institutes of Health Research (CIHR)-funded research network organized into five regional nodes. In the early days when CRISM was launched in 2015, CIHR faced the question about how the Atlantic region should be represented in the network: Should it be independent or integrated with Québec?
"At the time, in part due to our smaller population base in the Atlantic provinces, we really didn't have researchers who had substantial expertise in addictions intervention research or randomized controlled trials in the addictions area. Québec had a wealth of knowledge and experience in these areas. It made collaboration essential," reflects Dr. Stewart.
A strategic partnership was formed with Québec to help the Atlantic provinces grow in capacity for addiction clinical trials research. In CRISM's first national trial – OPTIMA, comparing the effectiveness of two different models of care for the treatment of opioid use disorders – the Atlantic provinces played a supportive role through participation and leadership in ancillary studies to gain experience in participating in a national trial. In 2022, an independent Atlantic Node was established, and Dr. Stewart says they now have the capacity to run trials of their own and participate with Atlantic-based sites in cross-national trials.
"For example, we now have an Atlantic Canadian trial site for the ASCME clinical trial – studying the best evidence-based intervention for methamphetamine use disorder – with the capacity to quickly establish a second site if needed. That is huge growth for us."
The Atlantic node framework for research priorities
The Atlantic research team is using a matrix model to develop three focus areas of research: rural access and telehealth, youth and substance use, and the comorbidity of mental and physical health conditions with addiction. Those three focus areas, Dr. Stewart explains, will all be approached from three important perspectives.
"We have cross-cutting advisory councils to ensure all the research we do considers sex and gender, perspectives of people with lived or living experience of substance use, and Indigenous perspectives. Thus, it's a three-by-three matrix underlying the work we do as a Node."
As part of the node's commitment to incorporating these perspectives, they recently hosted the Research is Healing Mawio'mi (gathering). Indigenous community members, service providers, researchers and people with lived experience in substance use convened for a discussion around substance use research needs in their rural and urban-based communities, data sovereignty, historical research-related harms, and combining Indigenous ways of knowing with Western methods to guide research.
Regarding their youth priority, CRISM Atlantic researchers are investigating lung function in youth who vape nicotine. They're also contributing to the nationwide Canadian Underage Substance Use Prevention (CUSP) randomized trial exploring personality-targeted interventions for reducing substance use in youth in Canadian high schools.
Finally, as part of the node's focus area in comorbidity, Dr. Stewart is co-leading a multi-site study evaluating the targeting of personality factors to improve mental health and reduce substance harms in clients with opioid use disorder.
"I've always been fascinated by individual differences in personalities and motivations behind people's substance use choices and their mental health risks," she explains. "If we can get a better understanding of how personality factors – like anxiety sensitivity and impulsivity -- are related to disorders like panic or attention deficits and to preferences for certain types of substance use like sedatives or stimulants, then we can use personality-targeted approaches to simultaneously help people with their mental health and substance use. That is an exciting and novel way of doing things."
Collaboration is the key to future success
Dr. Stewart believes the Atlantic Node of CRISM will help to further build the strong reputation of Atlantic Canada in addictions research.
"I really hope that we can build more expertise in randomized controlled trials and other intervention research approaches for addictions. In 10 years, I would like to see Atlantic Canada conducting more of this type of research and translating findings into improved services for Atlantic Canadians struggling with problematic substance use."
The way to accomplish that, she says, is to build research capacity through collaboration with scientists across the country and within the Atlantic provinces, and to involve service providers and people with lived and living experience in the development, conduct, and translation of the work.
"Because addiction services are provincially organized, until now, there hasn't always been a mechanism for sharing between provinces like PEI and Nova Scotia or Newfoundland and New Brunswick, yet we're often facing similar substance use challenges," explains Dr. Stewart. "CRISM allows us to learn from each other, increase research collaborations within Atlantic Canada, and to participate nationally in truly translational substance use research."
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