International study explores how AA contributes to recovery

Treatment of alcohol use disorder is multi-faceted and often includes participation in mutual-support groups, the oldest and largest of which is Alcoholics Anonymous (AA).

Although frequent AA meeting attendance is associated with greater abstinence from alcohol, there is little understanding of the specific mechanisms by which AA benefits people. In other words, we know that AA works, but we aren’t sure how.

Recent studies suggest that AA may prompt important behavioural changes by positively impacting impulsivity and social networks. New research from the Peter Boris Centre for Addictions Research will take a deeper dive into this theory. The study will be led by Dr. James MacKillop, Peter Boris Chair in Addictions and HRI Senior Scientist, and Dr. John Kelly, Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine at Harvard Medical School. Their team will examine impulsivity and social networks to see how these mechanisms drive recovery success in AA attendees.

The process

Researchers will follow people seeking treatment for alcohol use disorder in both inpatient and outpatient settings. The study will involve participants from multiple treatment programs based in Guelph and Hamilton, Ontario, and Boston, Massachusetts.

Participants will be assessed when they enter treatment, at 4-6 weeks into treatment, and at four more time points over a one-year period. Assessments will ask about alcohol use, personality traits, family and peer behaviour, and general personal and health information. Novel approaches will be employed to measure impulsive behaviour and analyze social networks, allowing researchers to determine how these mechanisms relate to abstinence and other markers of recovery.

Generating new knowledge to help recovery

This study will shed light on the psychological and social mechanisms of recovery and how AA activates these mechanisms. Researchers also hope to discover factors that could predict positive or negative experiences with AA. Clinicians and scientists may also use findings to identify therapeutic targets for people receiving treatment in an effort to boost recovery success.

Funding and collaboration

This study, entitled Investigating Impulsivity and Social Network Changes as Novel Mechanisms of Behavioural Change for Alcoholics Anonymous’ (AA) Positive Effects, is funded by the US National Institute of Alcohol Abuse and Alcoholism (NIAAA).

Collaborators on this project include:

  • John Kelly (Massachusetts General Hospital, Harvard Medical School)
  • Robert Stout (PIRE Decision Sciences Institute, Providence, RI USA)
  • Allan Clifton (Vassar College, New York, USA)

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Evidence 101: Q&A with an expert

Dr. David Streiner has attempted to retire three times, but this biostatistics expert is in high demand.

Dr. David Streiner headshot

Dr. David Streiner

Having trained as a clinical psychologist more than 50 years ago, Dr. Streiner is now Professor Emeritus in both the Department of Psychiatry and Behavioural Neurosciences and the Department of Clinical Epidemiology and Biostatistics at McMaster University, and a Professor in the Department of Psychiatry at the University of Toronto.

His research expertise is sought by scientists, faculty, residents, and students alike. A star behind the scenes, Dr. Streiner frequently consults with HRI scientists and trainees on everything from study design to research analysis.

In this question-and-answer feature, Dr. Streiner provides clarity about some of the most common questions we receive at HRI about evidence.

What does “evidence” mean in the context of healthcare?

Evidence is the available body of facts that healthcare providers can draw from to best treat patients. The most common method of obtaining healthcare evidence today is through research studies. Prior to the rise of scientific healthcare research, evidence was based primarily on clinical expertise and opinion.

What is “evidence-based practice” in healthcare?

The term “evidence-based practice” originated from Dr. David Sackett, an American-Canadian physician who defined the term as “…the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of patients.”

So when using an evidence-based approach, one would base healthcare decisions solely on evidence from scientific research.

How is “evidence-informed practice” different from “evidence-based practice”?

Early critics of evidence-based practice argued that its definition limited medicine to a “cookbook approach” that fails to consider each patient’s unique values and preferences, and downplays the clinician’s experience and knowledge of the patient. A new term began to circulate, which encompassed a more person-centred approach:  evidence-informed practice.

Over time, the concept of evidence-based practice has evolved to include not only scientific research but also clinical expertise and the patient perspective brought to light by proponents of evidence-informed practice. Today, we see both terms used interchangeably.

How do we create evidence in healthcare?

First of all, we need research. Without research, we have no evidence. But to do research, we also need participants. We know that research plays a central role in designing and evaluating new treatments, but we often forget that patients and families play a central role in the research itself.

When answering research questions, we use a variety of methodologies. For example, if we want to know about the prevalence of a medical condition in a population, a cross-sectional study would be appropriate. On the other hand, if we want to find out whether a proposed treatment would help people with a specific condition, a randomized controlled trial would be used. At the end of the day, the research methodology depends on the question being asked.

The following infographic outlines some of the most common research approaches used at HRI:

Infographic explaining several types of research studies



New findings released from study examining long-term recovery outcomes

HRI has released an infographic featuring recent findings from a study that aims to shed light on the process of recovery from mental illness and addiction.

The Recovery Journey Project is a multi-year, longitudinal study conducted and led by researchers at HRI. As an independent research organization, HRI works with treatment providers to collect data from former patients and clients for up to one year after treatment to better understand the progress patients make and challenges they face during recovery.

The primary goal of the project is to provide evidence that can guide and continually improve treatment approaches to help people achieve long-term recovery.

Since 2015, HRI has conducted research with patients who receive residential treatment for addictions at Homewood Health Centre, in Guelph, Ontario. Recent findings were published in an infographic and accompanying background report. The infographic shows changes in various indicators of recovery for patients who were admitted to the Addiction Medicine Service between April 2016 and March 2017 and whose progress was followed from admission to 12 months after completing treatment.

View the infographic

View the background report

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Investigating the experience of female military members and veterans exposed to inappropriate sexual behaviour

With support from the Government of Canada’s Defence Engagement Program, HRI has launched a collaborative effort to better understand the unique experience of servicewomen. Specifically, the project aims to explore the relationship between exposure to inappropriate sexual behaviour during military service and the onset of moral injury among female military members and veterans.

Moral injury refers to the psychological distress that individuals may experience when their personal moral beliefs have been betrayed – either by themselves or by someone else (e.g., an authority figure.)

“Inappropriate sexual behaviour has been linked to moral injury in other armed forces settings,” says Dr. Margaret McKinnon, Homewood Research Chair in Mental Health and Trauma, and lead investigator on the study.

“Unfortunately, the majority of studies to date have been conducted in U.S. settings, so the impact of this behaviour is unknown in the Canadian context.”

Experiences that lead to moral injury are strongly associated with the development of post-traumatic stress disorder, major depressive disorder, anxiety, and suicidal ideation. With a better understanding of how moral injury may factor into the experiences of servicewomen affected by inappropriate sexual behaviour, treatment providers can intervene more quickly and effectively.

“Another major goal of this initiative is to mobilize scholars, clinicians and policy makers who can work with us to address concerns related to moral injury within these populations,” says McKinnon.

Key collaborators on this project include:

Focus groups are now underway with female military members and veterans to discuss their experiences and the events that may trigger potential feelings associated with moral injury, such as shame and guilt.

Workshops are also being held with researchers, clinicians, and scientists to examine the psychological consequences of exposure to inappropriate sexual behaviour and the potential steps that can be taken to address these concerns in partnership with the military.

On October 23, 2019, the research team hosted an interactive workshop at the annual Canadian Institute for Military and Veteran Research (CIMVHR) Forum. Thought leaders from the government, academia, industry, health and philanthropic sectors were present to share ideas and insights on how to move research, prevention and intervention strategies forward.

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HRI Scientists honoured for research contributions

Dr. James Mackillop elected to Royal Society of Canada

In September 2019, HRI Senior Scientist, Dr. James MacKillop, was elected to the Royal Society of Canada’s College of New Scholars, Artists and Scientists.

The College recognizes emerging scholars, artists, and scientists and brings its members together to develop interdisciplinary approaches to urgent matters that concern all Canadians, from environmental sustainability to advances in health science.

Photo credit: Dr. Mark Crowther

Dr. MacKillop is the inaugural holder of the Peter Boris Chair in Addictions Research, the Director of the Peter Boris Centre for Addictions Research, Co-director of the Michael G. DeGroote Centre for Medicinal Cannabis Research, and a Professor of Psychiatry and Behavioural Neurosciences at McMaster University. His research leverages multidisciplinary perspectives to generate novel insights into addiction. To date, this work has generated more than 120 peer-reviewed publications and other works.

Dr. Ruth Lanius wins Banting Award for Military Health Research

HRI Associate Clinical Scientist, Dr. Ruth Lanius, was the recipient of the 2019 Banting Award for Military Health Research, an honour presented at the Canadian Institute for Military and Veteran Health Research (CIMVHR) Forum, which took place in Ottawa, Ontario from October 21-23.

Named after Sir Frederick Banting, a researcher, physician and Nobel laureate who discovered insulin, the Banting Award is presented annually to a Canadian researcher making important advances in military health research.

Dr. Lanius received the award for her work using advanced brain imaging to better understand post-traumatic stress disorder (PTSD). Her team uses technology to test adjunct treatments for PTSD, such as providing real-time feedback to patients about their brain waves and teaching them to re-regulate brain activity.

As the recipient of the Banting Award, Dr. Lanius has also been invited to be keynote speaker at next year’s Forum.

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Dr. John Kelton joins HRI Board of Directors

HRI is pleased to welcome Dr. John Kelton to our Board of Directors.

Dr. Kelton is a Distinguished University Professor and Executive Director of the Michael G. DeGroote Initiative for Innovation in Healthcare at McMaster University in Hamilton. He assumed his current role in 2016, after completing a 15-year term as McMaster’s Dean of the Faculty of Health Sciences and Vice-President for Health Sciences. He also served concurrently as Dean of McMaster’s Michael G. DeGroote School of Medicine.

During Dr. Kelton’s tenure, McMaster earned recognition as one of the top 40 universities in the world in medicine and health sciences.

Dr. Kelton is a practicing hematologist at Hamilton Health Sciences. He leads an internationally recognized research program exploring platelet and bleeding disorders. He has also earned global attention for his research on bleeding disorders of pregnant women and heparin-induced thrombocytopenia.

In 2015, Dr. Kelton was named a member of the Order of Canada. He has been awarded an honourary Doctorate of Science from the University of Waterloo, an honourary Doctorate of Law from the University of Windsor, and an honourary Doctorate of Science from Western University. He is also the recipient of a Prix Galien Research Award.

Dr. Kelton brings a wealth of experience to the HRI Board of Directors. His expertise in clinical research and innovation will be an asset as HRI continues to accelerate Canadian progress in clinical treatment and outcomes for mental illness and addiction.

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2018-2019 Annual Report now available

HRI’s latest Annual Report highlights some of the milestones that our donors and supporters helped us achieve in 2018-19. We are pleased to share these stories with you – stories that demonstrate the difference we are making together to help people experiencing mental illness and addiction.

Thank you for following and supporting our work. Thank you for giving us so many reasons to celebrate.

Read the Annual Report now

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HRI launches videos shedding light on mental health and addiction research

HRI recently launched Vimeo and YouTube channels and released a series of videos highlighting the importance of mental health and addiction research in Canada.

Six videos offer a glimpse into how we are working to transform treatment to help people living with mental illness and addiction. Some of the highlights include:

  • An overview of the Recovery Journey Project, a study examining the long-term outcomes of inpatient addiction treatment in Canada
  • Research underway that is changing our understanding of PTSD
  • The life-changing benefits of participating in research at HRI
  • How collaboration significantly reduces the time it takes for research discoveries to be put into practice
  • The benefits of using living research environments to test novel treatments among the people who need them the most

Click to visit HRI’s Vimeo and YouTube channels and follow/subscribe for future updates.


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