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Dr. Remi Quirion talks about addiction and mental illness

Globe and Mail Update

From the lab to the legislature, the push is on to recognize and treat addiction as a mental illness. A growing body of research finds addiction is not the result of bad behaviour or weak character, but the result of biochemical disruptions in the brain that genetically vulnerable people are, on their own, powerless to overcome. It distorts mood, clear thinking and compulsion control. People who suffer from it, scientists believe, can no more talk themselves out of their dependence any more than people can talk themselves out of depression.

The American Medical Association first recognized addiction as a disease in 1956. Still, there remain doctors who refuse to treat patients with addictions, patients too ashamed to seek treatment and pharmaceutical companies reluctant to develop drugs for addicts.

But Rémi Quirion, professor of psychiatry at McGill University and scientific director of the Institute of Neurosciences for the Canadian Institutes of Health Research, said, "More and more experts agree addictions are a brain disease. Addictions are themselves a mental illness."

As with any mental illness, addiction runs in families, impacted by genes, stress and lifestyle risk factors. The right combination can make a person dependent on a psychoactive substance from the first try.

Do you have questions about drug addiction and mental illness? We're pleased to have Dr. Quirion online Wednesday, July 2 at 3:30 p.m. ET for a live online discussion. Send your questions now and read his answers, which are posted below.

Dr. Rémi Quirion is a McGill University Full Professor and Scientific Director at the Douglas Hospital Research Centre (a McGill affiliated teaching hospital). Under his leadership, the Douglas Hospital Research Centre became a premier research facility in Canada in the fields of neurosciences and mental health.

Dr Quirion promoted the development of neurosciences and clinical research in Neurology and Psychiatry as well as social and evaluation aspects of research in mental health and addiction.

Dr. Quirion is one of the most highly cited neuroscientists in the world, in addition to being Fellow of the Royal Society of Canada and a "Chevalier" of the "Ordre national du Québec". He also received in 2003 the Médaille de l'Assemblée nationale du Québec" and the "2003 First Annual Award - National Mental Health Champion (Research)". In 2004 he received the "Wilder-Penfield Award, Prix du Québec", the highest distinction in Biomedical Research in Quebec, as well as a Heinz-Lehmann Award from the Douglas Hospital Foundation, and the Dr. Mary V. Seeman Award from the Canadian Psychiatric Research Foundation.

Carolyn Abraham, globeandmail.com writes: Thanks for joining us today Dr. Quirion. If science has now gathered evidence that addictions are a mental illness, how should the health system deal with a patient who has a substance dependence?

Dr. Quirion:Very good and important question. Patients suffering from an addiction should be offered the same access to care and treatment as ANY other types of patients..suffering from a cancer, a cardiovascular problem, hip surgery, etc. Canadians are most proud of our universal health care system. Accordingly, we must make sure that ALL have equal access to the best of care..including fellow Canadians suffering from a mental illness or an addiction. To settle for less should not be acceptable to anyone.

al goguen from Victoria Canada writes: I can't recall the name of the Dr. who was an alcoholic and gave a lecture on addiction. Why for instance, in the same family, one sibling is an alcoholic, and another one not. His explanation made a lot of sense. The Dr was convinced that he was an alcoholic because he had a different liver than a non-alcoholic. The cells of an alcoholic liver are smaller and therefore keep the alcohol longer than a liver of a non alcoholic whose liver cells were bigger, and therefore could get rid of the alcohol faster. At the time I thought it made a lot of sense: one liver kept alcohol longer and another one not. But now Dr. Quirion's explanation is even more convincing.

Mental illness is not easy to deal with, but with time I hope they will be able to find a proper treatment with this disease. All my life, I thought it was not fair that my older brother could not drink like I can. He could not stop drinking while I would fall asleep, wake up with a hangover and didn't feel like seeing another drink for a couple of days. While my brother was craving for the stuff even though he had been sicker than I did. The two different explanations still make a lot of sense, and hope they can help those who are addicted to alcohol or any other drugs. So many are suffering with addictions.

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

Dr. Quirion: Unfortunately, it is still not possible to visualize clear differences between such conditions in a given individual. A large group of individuals must be studied and an 'average' image generated. Individual differences are great as they are in term of genetic predisposition. However, it is rather clear that crack interacts with the brain dopaminergic system, hence altering the effectiveness of the medication.

bruce weaver from Canada writes: I have always thought if you can quit something how can it be an illness? I know people who were alcoholics who quit. I knew someone addicted to crack cocaine who quit. My uncle was a schizophrenic. He couldn't quit he was like that the rest of his life. Surely there is a difference between an addict and someone with a true mental illness?

Dr. Quirion: Good question. Schizophrenia is an extremely difficult disorder to manage. As to quitting, yes one can 'quit' the habit of smoking, drinking alcohol, etc..but often such a person is highly at risk and often only considered in remission having to refrain himself from social conditions associated with substance use potential.

Scary Fundamentalist from Vancouver, Canada writes: If people are really predisposed towards a particular addiction (believe it or not, I actually agree with this), would the addiction never happen if they were never exposed to the substance in question?

Dr. Quirion: Hmmmm, I like fundamentalists, especially if they are from beautiful Vancouver! Well hard to tell for sure but likely yes..but of course, rare that a given person is only predisposed to one addiction. Often, it is overall sensitivity to various forms of addiction that is increased, not to a single addiction making it much more difficult to avoid exposure.

lindapc foothills rocky mountains from Canada writes: This is not a shocker to the average parent that has watched their child spiral on a course of insanity while being addicted to alcohol, drugs, sex and or gambling. For a great many years, I have been hearing how addictions are a result of mental illness, now it comes out that that is the reality.

So, what can anyone do for the people that have genuine mental illness, documented, quantified by a physician; in regards to the addictions?

Will there be more facilities built to supply help to those individuals that may require more intense treatment in the area of mental health/addictions?

Dr. Quirion: This question relates to a lot of discussion and exchanges over the past week in the G&M. Canada must ensure better access to care for all suffering from mental illness, addiction, etc. Much work ahead of us all.

Sue City from Canada writes: Another excuse for people to not take control of their lives. I've dealt with an addiction and I worked hard to overcome it. If I could've leaned on the 'I am sick, therefore, I am helpless' idea, I might not have beaten it. Though, chronic and abusive addiction (ie. hard-core junkies, binge drinkers) may not have the required willpower as they are truly living inside the allegory.

But, are we only talking substance addiction here? What about sex addicts, pedophiles, rapists? Will they use this as a defense? 'I couldn't help myself. It's in my genes.'

Dr. Quirion:Well one can argue that this could apply to heart diseases, diabetes, and even cancer! We often do know what we need to do (exercise everyday, eat well, etc) but we do not do it..some are better than others at that and can beat it but certainly not all. A lot is in our genes but in most cases this is only part of the story.. environment being the real trigger leading to the disease. Again, I would argue that in most cases of addicted behaviours, one can manage it, but it not really cured, it is only in remission.

haron wickman from Winnipeg Canada writes: I am interested in Dr. Quirion's view on harm reduction and addiction.

Dr. Quirion: Harm reduction is not a magic bullet and through innovative research we hope to be able to find more effective means to treat various addictions in the future (vaccines, etc). However, harm reduction programs have often proven to be effective particularly to reduce risky behaviours associated with certain forms of addiction (needle exchanges spreading the risk of HIV transmission).

Christine Diemert, globeandmail.com: Should all addicts be treated as some with a mental illness, or are there exceptions?

Dr. Quirion: Good question and no easy answer..what we can say is that addictions are brain disorders. Some addictions are much stronger than others but apparently all act by stimulating what is known as the reward pathway of the brain. The reward pathway is critically important to promote normal food intake, sexual behaviors etc..but this pathway is apparently highjacked, in varying degress, by rewarding substances and behaviors from gambling to heroin!

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