“It got progressively worse. Last summer I spent a great
deal of time doing work on myself and doing some soul searching and trying to
figure out where I am in my life right now and what’s of real value and where
do I want to go at this stage in my life.”
James’ journey brought him to a new CAMH program that brings
together a team of clinicians from different disciplines that work together to
deliver a structured program, or “pathway”, for clients.
>> See larger version of the infographic
It’s called the Integrated Care Pathway (ICP) for Major
Depression and Alcohol Dependence. It’s a 16-week outpatient program that
combines psychotherapy and medications along with care and support. Currently,
it’s common practice to treat depression and alcoholism as separate conditions.
This new approach treats them concurrently, with evidence-based interventions
that are personalized, optimized and sequenced to achieve the best outcome
possible for the individual patient.
Dr. Andriy Samokhvalov and pharmacist Anne Kalvik
Dr. Andriy Samokhvalov is a psychiatrist and clinician
scientist with CAMH’s Addiction Medicine Service and part of James' treatment
team. He explained why CAMH created this particular pathway.
“People self medicate with alcohol, and at the same time
when people are consuming alcohol they tend to have some sort of emotional
disregulation and when they withdraw they might be more depressed and anxious.”
Anne Kalvik is a pharmacist with the Addiction Medicine
Service who is one of the clinicians involved.
“People require support. For both conditions, the
medications don’t make the client feel instantly better. Medication for alcohol
dependence works subtly, but you have to take them in order to get benefit from
Dr. Julie Irving is a psychologist working in Addiction
Medicine Service and part of James’ team. She helped create the cognitive
behavioural therapy aspect of the pathway and has seen how that pathway
teamwork has really helped clients.
we’re hitting the ground running with patients. If they’re getting ongoing
medications from their pharmacist and having the psychiatrist who can alleviate
some of those really severe symptoms early on…to me it seems like, anecdotally,
it helps people get a jump on things faster which can help with motivation”.
James has found the psychotherapy helpful in working through
his thought processes to prevent getting into depressive states. He’s on
medication for depression. For a while he was also on anti-craving medication,
and now says he doesn’t have physical cravings.
“I definitely think the best part of that was I got the
ability to catch my thoughts. I now walk on a daily basis for at least an hour
and a half every morning, so I find that very helpful.”
Dr. Samokhvalov has been pleasantly surprised by how engaged
clients have been with the program so far, which has a 90 percent retention
"A lot of resources are dedicated to handle a single client.
Even if they don’t respond well in terms of treatment, they still stay in
James is the first graduate of the ICP for Major Depression
and Alcohol Dependence and has now been sober for over seven months.
“Ultimately what I got out of it is that I need to utilize
all the support that’s available to me, but it’s up to me to do that. So now I
feel that I have control of my self-care and that I’m able to make the right
decisions. I’m just so very, very grateful for all the nice people that
encouraged me and supported me and my life is so much better now than it used
to be because of the wonderful people at CAMH.”