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Dr. Remi Quirion talks about addiction and mental illness

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Dr. Quirion: Canadian scientists are recognized as world leaders in the understanding of addictive behaviours. However, the genetic of addiction is very complex and genes only predispose an individual toward the development of a certain type of addiction.

Social and environmental factors are often key triggers in the development of addictive behaviours, especially in maturing brains such as during adolescence. In a given family, each sibling is unique..one may 'receive' a group of genes that may predispose him to heart disease while the other will get a few more that are related to addiction. Moreover, many genes play important roles in a variety of diseases hence the occurrence of a great deal of co-morbid conditions.

We hope that progress in genomic science will allow us to better predict who may be at risk of developing hypertension, diabetes or some form of addiction ('personalized medicine'). If health research is successful in that regard (and I am most confident that we will), we hence could advise a given individual not to eat too much fatty fatty food, carbohydrates or to place itself under very stressful conditions..each of these elements contributing to the more rapid development of a given pathological condition.

c. f. from unspec. Canada writes: The question I have is how do we do justice to caring for the mentally ill when most of the interest and new funding dollars are for addictions (eg. the name CAMH), and addictions is the 'sexy' area of mental health to focus on. How do we separate them and do justice to both, or keep them combined and get equal funding for both?

My second question is - most child/adolescent psychiatric programs won't take children with concurrent disorders of addiction and psych. yet the incidence is very high just as it is in adults. What are we supposed to do with the psychotic, addicted teenager?

Dr. Quirion: Well here I have to challenge you. Addiction is still the very poor cousin in regard to monies invested for research, care and treatment. And addiction is not more sexy than mental illness..it is part of it. Nobody will win by opposing mental health and addiction. What is very clear is that current investments are totally insufficient. This was well shown by the series in The Globe & Mail, and by multiple studies including recent ones under the leadership of Senators Michael Kirby & Wilbert Keon and others funded by the Canadian Institutes of Health (CIHR).

As to your second question, indeed addiction is frequent in children and more specifically in teens. We must find a way to provide to them and their families much better access to care and treatment making sure that all health care professionals are well trained to recognize different forms of addictions in our youth.

C. M. from Ontario Canada writes: What is Dr. Quirion's position on the Benzodiazepines (eg Diazepam), in particular the short life ones (Lorazepam, Ativan) and the way they are being heavily prescribed by doctors ? How knowledgeable does he think Doctors in general and Psychiatrists in particular are on Benzo addiction?

Dr. Quirion: Addiction to various substances varies greatly with some being very addictive (crack, heroin, etc). Prescription drugs such as the benzodiazepines are much less addictive and again individual differences and genetic predisposition play a role in the development of these addictions. It is thus important for all health care professionals to be well aware about addictive's potential and treat accordingly. More research is also needed on processes of addiction associated with various groups of prescription drugs. CIHR with partners most recently issued a call to support innovative research on abuse of prescription drugs.

Fela Grunwald from Toronto Canada writes: The article on Addiction and the graphics were very helpful. I would have loved to see an illustration of the brain of a schizophrenic on and off medication and on drugs. My brother is a paranoid schizophrenic and a crack addict. It is my understanding that the brains of schizophrenics have extra dopamine receptors and that the medication he is on (intramuscular Modecade) suppresses dopamine release to make him less 'manic/psychotic'.

He complains of the sluggishness he feels, particularly the few days after an injection. It is clearer now that the crack increases the dopamine high that the medication inhibits. What happens when he then uses crack and his dopamine receptors shrink even more over time, as stated in the article? It would seem that the medication might be contributing to his cravings for crack and adding depression to the mix. Can you elaborate a bit on this and is there research being done anywhere? Thank you

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