Moving Toward a Systematic Understanding of Addiction Care

In 2016, the Canadian Centre on Substance Use and Addiction (CCSA) partnered with the National Recovery Advisory Committee to conduct the first Canadian survey of people in recovery from addiction to drugs and alcohol. Modeled after Life in Recovery (LIR) surveys previously conducted in Australia, the United States and the United Kingdom, CCSA’s LIR study engaged 855 individuals recovering from addiction, and asked them about stigma, barriers to care, the recovery journey, and life in recovery.

CCSA’s Technical Report, released in May 2017, details the results of the Life in Recovery survey. General findings revealed that:

  • Recovery leads to positive citizenship and life outcomes, such as improvements in work, finances, family life and overall health
  • Individuals use a variety of recovery resources, including informal supports (e.g., family and friends, religion and spirituality) and formal recovery programs (e.g., 12-Step support, detoxification programs, residential treatment), and
  • Individuals experience a range of challenges – including financial barriers, stigma, treatment delays, lack of services, and lack of service quality – when seeking treatment.

This survey sheds light on the cost of addiction and the complexity of recovery. Importantly, CCSA notes that recovery from addiction is achievable when people have access to quality, evidence-informed services and supports.

That’s where HRI comes in.

We work to integrate emerging data from studies such as CCSA’s, and from our own research projects, into clinical practice. But we also extend research into the post-discharge phase of treatment, picking up where other studies leave off, to build the data-driven care that benefits individuals struggling with addiction.

HRI’s Post-Discharge Outcomes Monitoring System is unique in Canada and generates data to evaluate the long-term impacts of treatment interventions. This data system will also allow for the development and testing of innovations to improve the treatment experience of patients, generate better outcomes, and offer better value for money – which, according to CCSA’s study – is exactly what Canada needs to advance addiction treatment.

The Life in Recovery survey is an important step toward a systematic understanding of addiction care in Canada. Emerging data gives hope to individuals in recovery and highlights the importance of applied mental health and addictions research in Canada, which is what we do every day at HRI.

Here are a few ways you can get involved and help us move mental health and addiction care forward in Canada:

Does Patient Experience Affect Addiction Treatment Outcomes?

In any industry, product and service improvements are most impactful when based upon reliable feedback from those who use and benefit from those products and services.

This perspective has driven the development of data collection tools that measure patient experiences in healthcare systems. To date, research in the general healthcare sector has shown that patient experience is positively associated with self-rated and objectively measured health outcomes, such as adherence to recommended treatments, use of preventive care services, and patient safety outcomes.1

Over the past two years, HRI helped to take this research into the field of addiction treatment. Using the Ontario Perception of Care – Mental Health and Addictions (OPOC-MHA) tool – an evidence-based tool that standardizes how mental health and addiction agencies obtain feedback about client perceptions of care – HRI, in partnership with Homewood Health Centre, has collected data to shed light on the relationship between perceptions of care and post-discharge outcomes in residential care. This work was part of a larger initiative led by Dr. Brian Rush, who co-developed the OPOC-MHA tool, to test it in a variety of treatment settings; Homewood was the only site to test the OPOC-MHA tool in a residential care facility.

How did we do this?

As part of HRI’s Post-Discharge Outcomes Monitoring System, which measures recovery-oriented outcomes up to one year post-discharge, the 38-item OPOC-MHA survey tool was administered to patients of Homewood Health Centre’s residential addiction program. 215 participants completed the baseline, discharge and one-month post-discharge questionnaires.

The OPOC-MHA tool measures seven domains, including access and entry to services, services provided, participation and rights, environment, discharge, and the overall experience (including service quality).

The focus of HRI’s analyses was OPOC-MHA item 31, which rates service quality and can be considered a proxy measure for overall patient satisfaction.

What did we find?

Participants who rated service quality more highly at discharge were, at one month post-discharge, significantly more likely to report:

  • Adherence to their treatment recommendations
  • High motivation to continue engaging in recovery
  • Better self-perceived mental and physical health, and
  • Better quality of life

In other words, delivering quality services matters. Perception of care may be an important indicator for addiction services providers to monitor regularly, since it relates to patient recovery outcomes.

What happens next?

HRI, in collaboration with Dr. Rush, has prepared an abstract to be presented at the 2017 Issues of Substance Conference in November 2017, in Calgary, Alberta. HRI is also preparing a manuscript for publication, detailing our research findings related to the importance of perception of care and its implications for improved patient outcomes.

The HRI–Homewood study and other projects led by Dr. Rush have established the value of the OPOC tool. Based on this research, it is now being used at Homewood and across Ontario.

To learn more about the Ontario Perception of Care – Mental Health and Addictions tool, click here. For continued updates on HRI’s research around perceptions of care, subscribe to our newsletter, HRI Connects, or visit

1. Doyle, C., Lennox, L., Bell, D. (2013) A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMH Open Access, 3:e001570.

Examining the Role of Therapeutic Alliance in Patient Recovery

The quality of the relationship between patient and therapist is known as therapeutic alliance. Therapeutic alliance describes the level of trust and engagement between a patient and members of his or her treatment team. Research on therapeutic alliance examines the bond between patient and therapist, the level of agreement between both parties on treatment goals and therapeutic tasks, and how these factors influence treatment success.

Therapeutic alliance is specifically important to the recovery process among those seeking treatment for addiction and mental illness. Research has shown that the development of a strong therapeutic relationship predicts better treatment outcomes.

As part of HRI’s outcome monitoring system, our research team has been measuring therapeutic alliance in patients of the Addiction Medicine Service at Homewood Health Centre for more than two years.

Prior to discharge, participants are asked to rate six statements relating to mutual respect and mutual agreement on goals and therapeutic tasks. Overall, ratings of therapeutic alliance were strong among participants. When contacted 30 days after discharge, those who rated their therapeutic alliance the strongest were significantly more likely to report high levels of confidence (also referred to as “self-efficacy”) in their ability to work on their recovery. In addition, those who reported higher ratings of therapeutic alliance also reported higher levels of self-perceived mental health and physical health at one month post-discharge.

What does this mean?

Strong therapeutic alliance is linked to higher levels of self-efficacy, and research has shown that self-efficacy is an important factor in achieving enduring behaviour change, such as reduced substance use. So these early findings suggest that a strong therapeutic alliance helps to set people up for success.

Where will this research go?

In November 2017, HRI will share detailed findings of our research on therapeutic alliance at the Issues of Substance Conference, hosted by the Canadian Centre on Substance Use and Addiction, in Calgary, Alberta.
In future analyses, HRI will investigate whether participants’ ratings of therapeutic alliance at discharge are related to ongoing recovery at later time points after discharge. We also plan to monitor therapeutic alliance during treatment so that steps can be taken to ensure that this alliance is as strong as possible, as a way to improve care and outcomes.

HRI Senior Scientist is Lead Editor of Influential Guide to Addiction Treatment

The volume and complexity of addiction research can be challenging for healthcare providers to navigate when determining best treatment practices for individuals with addictive disorders.

A new book, co-edited by HRI Senior Scientist and Peter Boris Chair in Addiction Research at McMaster University, James MacKillop, will help treatment professionals arrive at solutions more quickly.

Book cover - Integrating Psychological and Pharmacological Treatments for Addictive Disorders

The book covers a comprehensive range of addictive disorders, including alcohol, tobacco, opioid, stimulant and cannabis addiction, as well as gambling disorder, dual diagnosis, and co-morbid psychopathology.

Preliminary reviews from the medical community have praised the book as an invaluable resource for a range of professionals, from early-career practitioners to seasoned experts. Medical experts anticipate that Integrating Psychological and Pharmacological Treatments for Addictive Disorders will advance addiction treatment and empower primary care physicians to better support patients suffering from alcohol and drug addiction.

Dr. MacKillop is the lead editor of the volume, which features chapters authored by leading experts from McMaster, Harvard Medical School, Stanford University, Brown University, University of Cambridge, University of Chicago, University of Toronto and UCLA, among others.

Integrating Psychological and Pharmacological Treatments for Addictive Disorders will be available July 4th and can be pre-ordered online from Routledge, Taylor & Francis Group.

Mental Health Community Comes Together for PTSD Research

On May 1, HRI kicked off Mental Health Week 2017 with an evening of music, comedy and community spirit at our first fundraising event in beautiful downtown Guelph.

Sharron Matthews performs

Sharron Matthews performs GIRL CRUSH

Guests enjoyed a one-of-a-kind concert experience by musical comedienne, Sharron Matthews, whose award-winning cabaret, GIRL CRUSH, celebrates diversity, self-acceptance and the importance of supporting one another – a fitting theme for such an event. A pre-show Penny Social featured a variety of incredible prizes, and an auction held after the performance saw two lucky guests go home with travel adventures, generously donated by VIA Rail Canada and WestJet.

We are thrilled to announce that we exceeded our fundraising goal. As a direct result of this support from our community, sponsors and donors, HRI is now able to recruit a Doctoral or Post-Doctoral Fellow, who will be dedicated specifically to trauma research.

HRI has initiated the development of several research projects related to Post-Traumatic Stress Disorder (PTSD), and we look forward to sharing the details of these projects with you in a future newsletter.

We extend our sincere thanks to our Presenting Sponsor, Homewood Health Centre, and to KPMG, Wes and Christine Gee, Mathews, Dinsdale & Clark LLP, CIBC and Linamar, whose sponsorship made this event possible. We are also grateful to the Guelph Chamber of Commerce and Guelph Today, who provided media sponsorship for this event.

And finally, thanks to our community, our supporters and our followers. Because of you, HRI is leading an effort to advance care in mental health.

Sharron Matthews

Sharron Matthews had guests in stitches with her musical comedy, GIRL CRUSH

Guelph Honour Guard at fundraising event

Members of the Guelph Police Service Honour Guard were in attendance

Andy MacDonald

Andy MacDonald, General Manager of Emergency Services for the City of Guelph, discusses the impact of PTSD on first responders and their families

Dr. Roy Cameron

HRI Executive Director, Dr. Roy Cameron, discusses HRI’s unique approach to mental health and addiction research

We’re Making a Scene for Mental Health: An Evening with Shelley Marshall

Click image to visit www.supporthri.caTo celebrate Mental Health Week 2017, Homewood Health Centre proudly presents a special event to raise funds for the vital research that the Homewood Research Institute (HRI) is conducting to address the mounting crisis of mental illness related to Post-Traumatic Stress Disorder (PTSD).

On May 1, please join us for an unforgettable one-night-only showing of Hold Mommy’s Cigarette, a hilarious, heartbreaking and ultimately uplifting one-woman play by acclaimed actor and comedienne, Shelley Marshall. Shelley takes audiences on a raucous adventure through her real-life experience growing up in a dysfunctional environment fraught with depression, trauma and suicide, and her remarkable journey toward a life of purpose and fulfillment. An unrelenting mental health advocate, Shelley gives hope to audiences and inspires positive change everywhere she goes.

This performance takes place at Guelph’s beautiful downtown venue, River Run Centre, and will raise funds for the Shelley Marshall Scholarship, a fund named in Shelley’s honour that will support applied research aimed at improving the lives of people living with PTSD.

Tickets are available now through the River Run Centre Box Office.

For further information, including show time, and details about a pre-show fundraiser, HRI’s PTSD research team, sponsorship opportunities, and a profile of our Honorary Chair, Andy MacDonald, General Manager of Emergency Services at the City of Guelph, please visit the event website,

We hope you will join us for this enlightening evening in downtown Guelph, as we work toward improvements in mental health practice and to improve care for all Canadians.

This performance contains adult content.

Presenting Sponsor:
Homewood Health Centre logo




Click for a full list of our generous sponsors

HRI Releases Early Findings from Post-Discharge Outcome Evaluation

Does mental health and addiction treatment really work?

This is one of the most common questions that clinicians, patients and families have when considering admission to a treatment facility. And this is why HRI, in collaboration with Homewood Health Centre, has developed an outcome monitoring system – the first of its kind in Canada — to measure the outcomes of patients who receive treatment at the Health Centre. Through our research and evaluation studies, we aim to answer this question and – more importantly – to inform continuous improvement efforts in mental health and addiction treatment.

Treatment success can be measured in a number of ways. For patients seeking treatment in the Addiction Medicine Service (AMS) at Homewood Health Centre, one method is to examine how alcohol consumption changes over a defined period of time.

To do this, HRI has implemented a comprehensive outcome monitoring system in the AMS at the Health Centre. We collect and analyze data from patients who have agreed to complete questionnaires at the time of admission, again at discharge and at one, three, six and 12 months post-discharge. Patients who choose to participate answer questions relating to many different life domains, including substance use; psychological, physical, social, and occupational wellness; daily life functioning; engagement in continuing care activities; and overall quality of life or life satisfaction.

To generate initial findings about changes in alcohol consumption, we examined the percentage of days that participants abstained (PDA) from alcohol, comparing pre-treatment to post-treatment data in order to explore how drinking behaviours change from before admission to post-discharge.

The figure below (Figure 1) presents PDA from alcohol in the 90 days prior to admission and PDA in the past 30 days at each follow-up time-point. Participants who did not consume alcohol in the 90 days prior to treatment or in the past 30 days at a follow-up time point were considered 100 percent days abstinent.PDO figure

Figure 1 shows that PDA from alcohol greatly increased from before treatment to one-month post-discharge (i.e., that participants reported consuming alcohol on significantly fewer days following treatment). PDA remained high at all subsequent follow-up time points.

These early findings represent data collected from AMS patients who participated in the outcome monitoring system in fiscal year 2016. Evaluations are ongoing and will be rolled out in other programs. A unique system in Canadian healthcare, HRI’s outcome evaluation project allows for continued, rigorous evaluation of the quality and effectiveness of mental health and addiction treatment at Homewood.

As HRI’s outcome monitoring evaluations advance, we will continue to share findings from other domains. If you would like to receive future research updates, please subscribe to our quarterly newsletter, HRI Connects.

Partnership Will Fund Research to Aid Military Members and Veterans

Individuals with post-traumatic stress disorder (PTSD) often experience difficulties in performing tasks that rely on cognitive ability, such as memory, attention, or learning. Such difficulties undermine treatment efforts and have also been associated with poor functional outcomes, including difficulty returning to work.

Trauma-related mental illness is of particular relevance to military, where urgent calls exist to address the mounting crisis of mental illness, and in particular PTSD, in these populations.


Left to right: Roy Cameron, Executive Director, Homewood Research Institute; Margaret McKinnon, Associate Co-Chair, Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University and Homewood Senior Scientist; Theresa Hacking, President, Military Casualty Support Foundation; Rob Schlegel, CFO Schlegel Health Care Inc.; Heather McLachlin, President, Cowan Insurance Group.

In 2016, representatives of The Cowan Foundation, Schlegel Health Care Incorporated, the Military Casualty Support Foundation and Homewood Research Institute identified a shared priority for research on interventions that could improve transitions from military to civilian employment. A partnership between the four organizations was established to fund a study proposed by Homewood Senior Scientist, Dr. Margaret McKinnon, which will examine the efficacy of a novel cognitive training program called Goal Management Training (GMT) in improving cognitive functioning among military members and veterans with PTSD.

GMT aims to help participants build skills in performing behaviours that rely on basic cognitive processes, such as planning, organization and achieving goals for everyday functioning. As part of this research study, a nine-week course of Goal Management Training will be offered free of charge to military members and veterans. Pre-and post-testing will examine the impact of GMT on cognitive functioning, psychological status and functional outcomes.

“This novel form of treatment extends beyond traditional approaches,” explains Dr. McKinnon.

“GMT focuses on memory, attention and other cognitive functions that typically go unaddressed following the onset of PTSD.”

Longer-term impacts of Dr. McKinnon’s research may include the application of similar clinical interventions to address PTSD in police and first responders. This study is helping to launch a national network lead by HRI, to further advance the development of novel treatment approaches for those with PTSD.

If you would like to receive future research updates, please subscribe to our quarterly newsletter, HRI Connects.