A Call for Change

Although cannabis legalization and the opioid crisis dominate headlines, leading alcohol researchers stress the need for greater awareness and changes in attitudes and approaches to reduce alcohol-related harms.

Held on November 14, the 2017 CAMH Campbell Family Mental Health Research Symposium featured eight researchers presenting on “Alcohol, the Brain and Society: From Impact to Intervention.”

“We are hearing a lot about opioids and cannabis, but on the ground, the major problem is alcohol,” said CAMH’s Dr. Bernard Le Foll. CAMH’s Alcohol Research and Treatment Clinic treats more than 2,500 clients with alcohol problems each year. Yet, it’s estimated that fewer than 10 per cent of people with alcohol problems receive treatment.

A challenge is that people often don’t know that effective, evidence-based treatments to reduce drinking exist. “There is a huge need for more public education and for disseminating best practices in treatment among health-care providers,” said Dr. Le Foll.

Citing the need for greater public awareness of harms associated with alcohol, Dr. Deborah Hasin of Columbia University shared new findings that showed overall alcohol use, as well as high-risk drinking and cases of alcohol use disorder, all increased in the U.S. between 2001-2002 and 2012-13. “It’s an increasingly serious public health issue,” said Dr. Hasin.

These harms impact on public health and mortality, said CAMH’s Dr. Jürgen Rehm. After decades of consistently rising, life expectancy fell in the early 21st century among middle-aged, non-Hispanic white adults in the U.S. More recently, life expectancy for all Americans has been stagnating or decreasing over the last two years. The decrease is linked to causes that are heavily influenced by alcohol use, including poisonings, liver cirrhosis, suicide and several diseases not widely known for their link to alcohol use, such as Alzheimer’s disease, pneumonia and hypertension. “The availability and affordability of alcohol today are much higher than in the past, and we need to reduce both,” said Dr. Rehm, Scientific Chair of this year’s Campbell Symposium.

Keynote speaker Dr. Nick Heather of Northumbria University issued “a plea to abandon the term ‘alcoholism.’ The main problem is that it teaches the public that, if they’re not ‘alcoholics,’ there’s no problem with their drinking.” The term can also lead to defensiveness and resistance to change drinking behaviours. Instead, he proposed that dependence is part of a continuum of any alcohol use and defined as a person’s difficulty in changing their drinking behaviour, despite their motivation to change.

Dr. Heather received the prestigious Jellinek Award for alcohol research, presented during the symposium by CAMH’s Dr. Harold Kalant. The award honours Dr. E.M. Jellinek, whose 1960 book The Disease Concept of Alcoholism was “a major influence in convincing people that alcohol use disorders were not a moral failing and that re-education and treatment were needed for people with alcohol problems,” said Dr. Kalant. Debate about the disease concept continues today, hotly discussed among the symposium’s presenters and participants.

Exploring biological factors, CAMH’s Dr. Tony George said, “we know there’s clearly a genetic component and evidence for gene and environment interactions.” Dr. Marc Schuckit of the University of California San Diego identified that people with a low level of response to alcohol – who are less likely to feel effects from drinking – have a greater risk of problem drinking. He described 40 years of research that led to his current research to prevent alcohol problems using videos and education specifically based on response to alcohol.

Dr. Robin Room of the Centre for Alcohol Policy Research demonstrated how social and cultural factors influence drinking and what’s viewed as problem drinking. “No single sector of science will solve the problems,” concluded Dr. Room. “A complexity of factors must be considered.”

Speakers at the 2017 CAMH Campbell Symposium were:
• Dr. Tony George, Chief of the Addictions Division and Head of the Biobehavioural Addictions and Concurrent Disorders Research Laboratory in the Campbell Family Mental Health Research Institute at CAMH
• Dr. Deborah Hasin, Professor of Epidemiology (in Psychiatry) at the Columbia University Medical Center in the U.S.
• Dr. Nick Heather, Emeritus Professor of Alcohol and Other Drug Studies at Northumbria University in the U.K.
• Dr. Harold Kalant, Research Director Emeritus of Biobehaviour Studies at the Addiction Research Foundation/CAMH
• Dr. Bernard Le Foll, Head of the Alcohol Research and Treatment Clinic and Head of the Translational Addiction Research Laboratory in the Campbell Institute at CAMH
• Dr. Jürgen Rehm, Senior Director of the Institute for Mental Health Policy Research and Senior Scientist in the Campbell Institute at CAMH
• Dr. Robin Room, Director of the Centre for Alcohol Policy Research in Melbourne, Australia, and former Vice President for Research at CAMH (then called the Addiction Research Foundation)
• Dr. Marc Schuckit, Professor of Psychiatry at the University of California San Diego in the U.S.