By Greg Basky for SHRF
Addiction is a growing problem in many parts of Canada and around the world. On the prairies, stress, boredom, and poorer mental health caused by the COVID pandemic have been linked to increased drinking among the roughly 29 per cent of residents with a history of alcohol use. Here in Saskatchewan, StatsCan figures show that up to 18.5 per cent of people 12 and older engage in heavy drinking at least once a month, which is higher than the Canadian average of 16.6%. And while best practice management of chronic pain is shifting away from long-term use of opioids, many people suffering from this debilitating condition continue to misuse these and other substances.
To help researchers in this province develop innovative approaches for addressing substance misuse at all points along the continuum from prevention and screening through to treatment and rehabilitation, the Saskatchewan Health Research Foundation has dedicated the current round of its Solutions funding to addictions. (Last year, SHRF’s Solutions support focused on projects advancing the delivery of virtual care.)
This year, SHRF is providing $900,000 in funding to 10 projects that will all closely involve persons with lived and living experience with addictions to help ensure that the strategies are effective and provide people with support they need. Partnership with the Saskatchewan Centre for Patient-Oriented Research (SCPOR) provides support to patient partners and researchers and advances patient-oriented research in Saskatchewan.
Joe Vidal, chair of SHRF’s Board of Directors, says the organization’s ability to be responsive, by aligning its research support with the changing needs of the province, is a great strength. “Substance use and addictions is a growing health problem in Saskatchewan,” said Vidal. “This funding will help support health care providers and those living with addictions by providing innovative and impactful solutions to these urgent issues.”
Read on to learn more about two projects that are being supported by Solutions funding. Heather Hadjistavropoulos, a psychology professor at the University of Regina, is project lead on work to fine-tune an online therapy program for Saskatchewan residents who have problems with alcohol. Susan Tupper, Strategy Consultant on Pain, Quality improvement, and Research with the Saskatchewan Health Authority, is leading a team that’s exploring whether educational comics can help reduce the stigma people with chronic pain experience when they seek care.
See the list of funded projects related to Addictions here
Online therapy a “new doorway to care” for people who misuse alcohol
Research suggests that up to 80 per cent of people who misuse alcohol never seek treatment, for reasons that include stigma and challenges accessing support services in rural and remote areas. Since late 2019 more than 650 people who have reported having problems with alcohol – the majority, residents of this province – have completed a made-in-Saskatchewan, online therapy program on their own time, from the comfort and privacy of their own home. People can access the program through self referral or be referred by a healthcare provider.
Grounded in a therapeutic approach called cognitive behavioural therapy (CBT), the course – which comprises online learning modules, narratives/vignettes, and worksheets – already boasts impressive results, with around 50% of participants reporting they had reduced their alcohol consumption to within Canada’s low risk guideline, felt more in control, and experienced fewer cravings. Other participants have reported they quit drinking entirely.
Analysis shows the program has helped people at either end of spectrum, from the “sober curious” who don’t necessarily have a drinking problem but suspect alcohol use could be standing in the way of the life they want, all the way to people consuming more than 90 drinks a week.
Now Heather Hadjistavropoulos and colleagues at the Online Therapy Unit (University of Regina) are fine tuning their program to make it even more effective and engaging for Saskatchewan people.
Vignettes are a key component of the online program. Based on feedback from people who have completed the program, Hadjistavropoulos and her team are developing a more diverse set of narratives that are more representative of the full spectrum of people who misuse alcohol.
“People don’t feel alone,” says Hadjistavropoulos. “They see that other people have gone through the same struggles and they get ideas. It’s stronger than if I, as a therapist, say ‘do this’.” Graduates of the program reported that having more – and more varied – narratives would have been helpful, because the stories helped them come up with strategies they could apply in their own lives.
As part of the revamp, Hadjistavropoulos and her team – which includes people who have lived experience with alcohol misuse – are also creating standalone modules to support people who are wrestling with other problems such as cannabis use, anger, and depression and anxiety. The first version of the program only briefly touched on these issues. “People told us ‘This is really great. It’s helping reduce my alcohol use. But I could really use help with some other problems I’m having right now.’’’ says Hadjistavropoulos.
With the help of the SHRF grant, Hadjistavropoulos and her team hope to see even better outcomes and engagement with the program. “We’re really trying to give people strategies they can apply in their own life, to make the changes they are seeking.”
Can graphic medicine improve health care interactions for people with chronic pain?
Globally, about one in five people live with chronic pain. While the majority are able to manage this misunderstood condition, around five per cent are debilitated by their pain – which translates to about 50,000 people in Saskatchewan. People living with pain often use prescription medications such as opioids to cope; others also use substances such as alcohol, cannabis, or illegal opioids.
When people seek help in the healthcare system, the encounters can be highly charged and turn confrontational. In previous research, Susan Tupper found people living with pain feel misunderstood or discriminated against by health care providers. At the same time, providers report that they feel pressured to prescribe opioids, and worry they don’t know enough about other treatment alternatives, or how to build a supportive relationship with patients.
Tupper, project co-lead Erin Beckwell, and their team, will do in-depth interviews with 10 people living with chronic pain, and five health care providers, to hear their stories about the difficult interactions they’ve experienced. Then the team will work with a graphic artist to turn the information they gathered into four comic-style stories featuring fictional, composite characters based on the interviews.
While there’s solid evidence demonstrating the effectiveness of educational comics – also known as graphic medicine – in increasing providers’ empathy toward patients with other chronic conditions, Tupper says this will be the first time the novel tool is applied to chronic pain in adults. “We’re going to use educational comics to try to challenge the stigma, biases, and beliefs that people might have,” says Tupper. “We also want to highlight the fact that some of this is structural stigma, and we need to change how we as society think about pain.”
Comics have a couple of unique features that can make them more effective than traditional print materials. Thought bubbles and side panels are often used to share peoples’ unspoken thoughts or beliefs. “There are hidden narratives that we’re hoping to reveal with these that we hope will improve both the understanding and empathy on the part of healthcare providers, but also awareness in patients about how they might be able to communicate what they need more effectively. That’s why we’ve called it ‘solutions-focused storytelling’”
Tupper and Beckwell will get feedback on the comics from the people they interviewed, to confirm the stories accurately describe or illustrate their experiences. Then they’ll test them with a focus group of potential end users – patients and health care providers – to get ideas on how to use the tool. They will seek additional funding to help roll out the resource.
Beckwell, Field Education Coordinator and Clinical Instructor with the University of Regina’s Faculty of Social Work, says that while the health system turns out lots of patient education material, most of it is pretty dry. “Being able to present something that’s thought provoking and even a bit challenging in a way that feels youthful and lighthearted – rather than a stern talking-to about how you’re doing things wrong – hopefully this gets folks engaging,” she says.
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For more information on the funding program and future opportunities, please contact:
Chelsea Cunningham, SHRF Programs Manager
ccunningham@shrf.ca