Towards a Canadian Health Research Institute on Addictions

Executive summary

Whether measured statistically or in terms of public concern, addiction is a major health issue for Canadians. More than one in five deaths in Canada and hundreds of thousands of hospitalizations result from the use and misuse of tobacco, alcohol and illicit drugs every year. The cost to the economy is at least $18 billion a year, including more than $4 billion in direct health care costs. The problems associated with addiction to gambling are closely related to those arising from other addictive behaviours, and the expansion of legalized gambling has been linked to pathological gambling, family problems and suicide. Socially and economically disadvantaged groups, including Native Canadians and street youth, are particularly vulnerable to the effects of addiction.

Canada’s efforts to reduce the harm associated with addiction have been hampered by the absence of a coordinated research approach. Funding for addictions research has become increasingly sporadic and piecemeal in recent years, and the sharing of knowledge among the many disciplines and jurisdictions working in this area has suffered as a result. A national addictions research institute would be an invaluable means of connecting research across the country, linking our knowledge of addictions with research on other determinants of population health, and pointing the way toward more effective interventions.

A significant amount of addictions research has been conducted in Canada since the late 1940s, much of it involving collaborations of two or more academic disciplines. Most addiction research is carried out in provincial addictions agencies, or by academics funded by provincial governments, US research institutes and, to a lesser extent, the federal government. At the provincial level, research is strongly connected to decisions about service delivery and policy. Internationally, Canadians take part in major collaborative research projects conducted by the World Health Organisation, the United Nations, and the International Labour Office, among others. Agencies in the US, Europe and Australia have enthusiastically endorsed the proposed institute on addictions and have indicated that they would welcome collaborative ties.

Despite its strengths, addiction research in Canada suffers from major weaknesses. In the same year (1992-93) that the Canadian government invested $0.12 per capita for research on alcohol and other drugs, the Australian government spent CDN$0.27 per capita, and the US government spent CDN$3.33. Since then, the gap has widened. In 1998-99, the US government awarded six times as much money to support addictions research being conducted in Canada as did the Canadian government. Of the six Canadian winners of the prestigious Jellinek award for alcohol research, four are retired and two recently left Canada to work elsewhere. More importantly, the lack of institutional support has driven many promising young scientists to work in other countries or other fields.

Only a dedicated CIHR addictions institute encompassing all types of psychoactive substances and addictive behavior can stop the “brain drain”, address the process of addiction in all its aspects and improve the quality and scope of research. It would address the specialized needs of treatment providers, prevention programmers and policy makers looking for guidance on emerging issues such as marijuana policy, drug courts, heroin maintenance and the proliferation of video lottery terminals. Such an institute will improve the health and well being of Canadians, and will begin to rebuild the international reputation Canada enjoyed in this field in the 1970s. The impact of addictions on Canadians cannot be captured by focusing on specific diseases or populations, on mental health or on public health in general.

The Institute will engage in a set of interrelated activities aimed at developing and disseminating knowledge on addictions, and promoting its application in cost-effective interventions. It will establish priorities, fund, monitor and coordinate research on the nature, extent and consequences of substance abuse and gambling, track emerging trends, and carry out basic research on the etiology of addiction and studies on the effectiveness of treatment, prevention and other interventions. Institute research and other activities will be considered to be in the public domain and will be made widely accessible.

The proposed institute will be “an institute without walls.” That is, its activities will be mainly carried out by researchers and others working in various universities, addictions agencies and private organizations throughout the country. There will be a small central office, consisting of a few staff whose major function will be to assist in co-ordination and strategic planning. The staff will work with the institute’s network of researchers and organizations to help establish national research priorities and related activities.

Rather than organizing addictions research along traditional lines (tobacco, alcohol, illicit drug or gambling), the research program will follow the four sectors or themes of CIHR research. An additional category will encompass research on multiple aspects of addictions to provide synergy across the four other research domains. Thus, for example, a project which includes basic biological research, applies the results in a clinical setting, explores the implications to health care systems, and estimates health impacts at the population level would involve all four domains. To ensure continuity of research quality over time, the new institute will develop programs to build human resource capacity. The Institute will develop and encourage young researchers in the field by developing both pre- and post-doctoral fellowships and faculty development grants.

Among the various governance and management options considered, it was decided that the responsibility for the general direction and governance of the proposed institute should be shared between the CIHR and a governing board for the institute. While budget allocation and the responsibility for overall governance of its member institutes will be in the hands of the CIHR, the major program decisions regarding the institute’s activities will be made by its governing board.

Management of the institute will be the responsibility of the Scientific Director, assisted by Associate Directors for each area of research and a small staff of 7 to 10 persons. The institute will have an advisory committee for each of the major research domains to help develop research programs and protocols, review progress and make recommendations for future directions and research priorities. A planning cycle will be used to ensure effective strategic planning with the involvement of the CIHR, academic institutions, government, community groups and other key stakeholders, and to provide mechanisms to ensure accountability in meeting goals.

To inform funding decisions and ensure high quality, all research will be subject to peer review. The advantages of various options were considered. A centralized review process promotes more comprehensive and multidisciplinary research, while institute-based review is better able to ensure that specialized expertise is involved in the process. The consensus was that the best system would combine the strengths of both approaches, using a centralized review process for investigator-initiated basic research, and review by member CIHR institutes for special programs of research to address specific needs such as neglected areas of research or rapidly emerging issues. The institute will establish a pool of experts for the central CIHR office to draw on when reviewing proposals in the addictions field, and the CIHR would nominate members of the institute’s review committees for special competitions to ensure that no peer review process becomes the captive of any particular discipline or viewpoint. In addition to scientific merit, proposed research projects will be judged on the basis of their transformative and innovative potential. Special programs for multidisciplinary research involving more than one CIHR institute could be managed jointly by the institutes involved.

In sum, the proposed CIHR institute on addictions would fully embody the vision of the CIHR regarding the development of health research in Canada. It represents an opportunity to revitalize addictions research and reposition Canada as a leading nation in an important arena of health research. The proposed institute will be a highly visible national response to a clearly identified need.

It will:

  • produce multidisciplinary research of high quality–including clinical, biomedical, health care systems and socio-cultural studies–that will support efforts to improve and maintain the health of Canadians;
  • combine all aspects of addictions and transform addictions research in Canada, promoting synergistic research among various disciplines and aspects of addictions, and promoting the application of research findings in policy and program development;
  • be characterized by extensive networking and the timely dissemination of knowledge focused on informing policy and program decisions;
  • stimulate the recruitment and development of new and highly qualified researchers who would make Canadian addiction research competitive at the international level;
  • provide strong linkages between the CIHR and research in other countries; and
  • be inclusive, with joint ownership across jurisdictions and sectors, offering the opportunity for involvement and funding contributions to CIHR research by the private sector.