Wayne Skinner
University of Toronto, Psychiatry, Faculty Member
- Psychiatry, Health Sciences, Addiction, Mental Health, Problem gambling, Mutual aid societies, and 16 moreFamily studies, Systems Theory, Substance Abuse, Addiction and Recovery, Dual Diagnosis, Biopsychosocial Perspective, Addictive Behaviours, Mental Health and Addictions, 12 Step Treatment for Addiction, Concurrent Disorders, Addiction Theory, Addiction and Mental Health, Gamblers Anonymous, Philosophy, Michel Foucault, and Continental Philosophyedit
The authors aim to incorporate educational reflection techniques in an addiction psychiatry postgraduate core rotation in order to increase critical self-awareness of attitudes, values, and beliefs related to working with people with... more
The authors aim to incorporate educational reflection techniques in an addiction psychiatry postgraduate core rotation in order to increase critical self-awareness of attitudes, values, and beliefs related to working with people with substance use and other addictive disorders. Reflection discussion times, reflection journaling, and mandatory end-of-rotation reflection papers were embedded into a core addiction psychiatry postgraduate training block. Qualitative analysis of 28 reflection papers was performed to determine key factors and constructs that impacted on the development of attitudes and professionalism. A number of constructs emerged that demonstrated the attitudes, beliefs, stereotypes, and stigmas students have regarding addictive disorders. Some constructs also highlighted that students felt much more comfortable dealing with addictive disorders after the training and would treat individuals with these conditions in a more effective manner. Reflection techniques were endorsed as extremely valuable by students, especially in the development of professional attitudes that will help clinicians effectively engage and provide appropriate care for individuals suffering from addictive disorders. The authors suggest that reflective practices be used more extensively in psychiatric training in order to build and establish reflexive self-awareness as a core professional competence essential to work effectively in clinical practice, especially in the most demanding contexts.
Research Interests: Psychology, Psychiatry, Addiction, Focus Groups, Reading, and 15 moreWriting, Medicine, Teaching, Curriculum, Thinking, Medical Students, Humans, Medical Journalism, Awareness, Academic Psychiatry, Professional Practice, Curriculum and Pedagogy, Clinical Competence, Core Competency, and internship and residency
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Abstract Gamblers Anonymous (GA) seems to have undergone noteworthy changes over the last ten to twenty years in both Canada and the US. A recent qualitative, ethnographic study involving interviews (15 male, 8 female) with GA members and... more
Abstract Gamblers Anonymous (GA) seems to have undergone noteworthy changes over the last ten to twenty years in both Canada and the US. A recent qualitative, ethnographic study involving interviews (15 male, 8 female) with GA members and observations of 42 ...
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Very little is known about gender differences in psychoactive substance use among gamblers. In this study, 200 individuals seeking treatment for problem gambling were assessed with respect to lifetime and current use and abuse of licit... more
Very little is known about gender differences in psychoactive substance use among gamblers. In this study, 200 individuals seeking treatment for problem gambling were assessed with respect to lifetime and current use and abuse of licit and illicit substances. As a group, they were found to have experience with psychoactive substances exceeding that reported for the general population. There were no gender differences in patterns of illicit drugs; however, the women gamblers reported greater experience with psychiatric medications over the lifetime and during the treatment and follow-up periods.
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●● The diagnosis of pathological gambling first appeared in the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual in 1980, and appears again in DSM-IV (APA, 1994). Although the DSM-IV categorizes... more
●● The diagnosis of pathological gambling first appeared in the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual in 1980, and appears again in DSM-IV (APA, 1994). Although the DSM-IV categorizes pathological gambling as an impulse-control disorder not elsewhere categorized, the criteria specified for diagnosing this disorder are somewhat similar to those for alcohol and substance dependence
Research Interests: Genetics, Psychology, Clinical Psychology, Addiction, Personality Disorders, and 15 morePsychopathology, Electroencephalography, Serotonin, Brain, Humans, Impulse Control Disorders, Gambling, Pathological Gambling, American Psychiatric Association, Literature Search, Gambling Disorder, Endorphins, Pathological, Functional Laterality, and Diagnostic and Statistical Manual
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Most texts that discuss ways to identify, assess and treat concurrent disorders concen-trate on methods, techniques, tools and instruments. The interpersonal dimensions of working in this area are given, at best, a passing nod. This is... more
Most texts that discuss ways to identify, assess and treat concurrent disorders concen-trate on methods, techniques, tools and instruments. The interpersonal dimensions of working in this area are given, at best, a passing nod. This is understandable: co-occurring substance use and mental health problems are complex and diverse, with patterns of illness and recovery that are dynamic and elusive. To be as helpful as possi-ble, the counsellor needs many resources to understand the client’s problems. When clients present with complex problems and histories, the clinician’s first consideration tends to be, “What tools will help me screen for substance use and mental health problems and, then, assess comprehensively?” However, if one is preoccupied with technique, it is easy to forget that the funda-mental task for the counsellor is to work with the client and the other people who can play an important role in producing healthy outcomes. This chapter addresses the role of the client–coun...
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Substance use - and abuse - has existed in virtually all cultures throughout human history. Canada is no exception to this. But what may come as a surprise are the rates and the substances themselves that are most liable to abuse in this... more
Substance use - and abuse - has existed in virtually all cultures throughout human history. Canada is no exception to this. But what may come as a surprise are the rates and the substances themselves that are most liable to abuse in this country. A recent study estimates that the cost of substance abuse is equivalent to $1,267 for every man, woman, and child in Canada in terms of lost productivity, health care, and law enforcement. And this does not include the personal cost. It is an issue worth considering. In an accessible and engaging style, this short book presents the latest research, survey, and interview data on substance abuse, taking into account Canada's regional differences and demography. It describes the models used by experts to explain substance abuse and addiction, and evaluates the various social policy, psychological, and medical solutions. Students and interested general readers alike will learn a great deal about how experts have come to understand the compl...
Whereas the proportion of older adults who experience gambling problems appears relatively small, factors such as cognitive changes with age, social isolation and maintaining fixed incomes can make older adults particularly susceptible to... more
Whereas the proportion of older adults who experience gambling problems appears relatively small, factors such as cognitive changes with age, social isolation and maintaining fixed incomes can make older adults particularly susceptible to gambling problems, increasing the severity of the consequences they may experience. Relatively few resources are available that are directed specifically to older adults with gambling problems. This report identifies, based on the knowledge and evidence currently available, Best Practices for treating gambling problems among older adults intended for practitioners, patients, families, policy makers and others concerned with this population. A team of gambling researchers and experienced clinicians first identified overarching conceptual frameworks to guide the work. The researchers then shaped a set of Best Practices that was reviewed by a working group developing Best Practices for preventing gambling problems among older adults. Based on their fe...
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Research Interests: Communication, Social Work, Social Problems, Housing, Qualitative Research, and 12 moreCommunity Based Participatory Research, Empathy, Library and Information Studies, Humans, Gambling, Male, Ontario, Aged, Middle Aged, Public health systems and services research, Homeless Persons, and Interviews as topic
ABSTRACT This study reports the findings of a general population telephone survey (N =2500) conducted in Ontario, which was designed to examine behaviour, knowledge and attitudes related to responsible and problem gambling using a... more
ABSTRACT This study reports the findings of a general population telephone survey (N =2500) conducted in Ontario, which was designed to examine behaviour, knowledge and attitudes related to responsible and problem gambling using a combination of closed- and open-ended questions. When asked to identify ‘signs and symptoms of problem gambling’ or to define responsible gambling, most respondents focused on financial issues suggesting that the general population has a very narrow view of the issue of problem gambling. The majority (65.8%) are not aware of any initiatives to reduce problem gambling; however, we found that people who participate in slots and instant lotteries were more likely to report being aware of initiatives to reduce problem gambling. These findings suggest that people do notice the presence of the help-line number on tickets and slot machines. The survey also examined responsible gambling behaviour and biases in beliefs about gambling.
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Given the preponderance of Gamblers Anonymous (GA), there has been relatively little effort to explore the existing evidence base on its effectiveness as a recovery approach for problem gambling. To remedy this gap in the literature we... more
Given the preponderance of Gamblers Anonymous (GA), there has been relatively little effort to explore the existing evidence base on its effectiveness as a recovery approach for problem gambling. To remedy this gap in the literature we conducted a scoping review of the literature on mutual aid for individuals experiencing problem gambling published between 2002 and 2015. We searched 13 databases and reviewed reference lists and websites of relevant organizations. We reviewed records for eligibility and extracted relevant data from eligible articles. Three reviewers independently assessed the methodological quality of the included studies using the Mixed Methods Appraisal Tool. We identified 17 studies in 25 publications that were eligible for inclusion. Most studies were conducted in the United States, were cross-sectional in design, and involved both male and female adult participants. Results indicate that the evidence for the effectiveness of GA either as a control condition or i...
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Brief treatment (BT) is an evidence-based approach to a wide range of issues that can affect performance and health of people in the workplace. Employee assistance programs are ideally positioned to offer this service. This chapter... more
Brief treatment (BT) is an evidence-based approach to a wide range of issues that can affect performance and health of people in the workplace. Employee assistance programs are ideally positioned to offer this service. This chapter reviews key research supporting BT, and outlines a six part process on which effective BT interventions can be built: engagement, assessment, planning, taking action, reviewing progress, and ending. It highlights the roles of both counsellor and client in effective BT.
Previously entitled Alcohol & Drug Problems, this new edition has been renamed Fundamentals of Addiction to reflect advances in the field extending beyond psychoactive drug use to include behavioural or “process” addictions. Most chapters... more
Previously entitled Alcohol & Drug Problems, this new edition has been renamed Fundamentals of Addiction to reflect advances in the field extending beyond psychoactive drug use to include behavioural or “process” addictions. Most chapters have been wholly revised and updated, while new topics have been added to reflect changes in the field. In order to be even more useful for students as a course text and for counsellors as a practical guide, this new edition includes practice tips and print and online resources at the end of each chapter. Helping people affected by addictions requires—like all good clinical practice—an ability to listen to clients with compassion and empathy, to foster their trust and a positive therapeutic alliance, and to show respect for the person’s autonomy. But it also requires a sophisticated understanding of the increasingly complex issues with which many struggle, insight into how addictions affect specific populations, and information about the latest evi...
A quick-reference, multi-media guide to using Motivational Interviewing (MI) to treat co-occurring disorders. Addiction—whether to alcohol and drugs, sex, gambling, or Internet use—and mental health problems often go hand-in-hand. This... more
A quick-reference, multi-media guide to using Motivational Interviewing (MI) to treat co-occurring disorders. Addiction—whether to alcohol and drugs, sex, gambling, or Internet use—and mental health problems often go hand-in-hand. This concise book summarizes the key principles of a particular therapeutic approach to concurrent disorders, Motivational Interviewing (MI), which guides clients in eliciting and strengthening their desire for change. Laying out a four-stage treatment model—engagement, preparation, active treatment, and continuing care—the book walks readers through key facets of the therapeutic rapport at the heart of MI: working collaboratively on goals; connecting to the patient by understanding his or her strengths, needs, and concerns; and using the core MI skills of open questions, affirmations, reflections, and summaries (“OARS”). Readers are immersed in the spirit of MI through explanations and illustrations, preparing them for the practical challenges of therapeu...
To address the gaps between need and access, and between treatment guidelines and their implementation for mental illness, through capacity building of front-line health workers. Following a learning needs assessment, work-based... more
To address the gaps between need and access, and between treatment guidelines and their implementation for mental illness, through capacity building of front-line health workers. Following a learning needs assessment, work-based continuing education courses in evidence-supported psychotherapies were developed for front-line workers in underserviced community settings. The 5-hour courses on the fundamentals of cognitive-behavioural therapy, interpersonal psychotherapy, motivational interviewing, and dialectical behaviour therapy each included videotaped captioned simulations, interactive lesson plans, and clinical practice behaviour reminders. Two courses, sequentially offered in 7 underserviced settings, were subjected to a mixed methods evaluation. Ninety-three nonmedical front-line workers enrolled in the program. Repeated measures analysis of variance was used to assess pre- and postintervention changes in knowledge and self-efficacy. Qualitative data from 5 semistructured focus ...
Research Interests: Anxiety Disorders, Evidence Based Practice, Capacity Building, Comorbidity, Curriculum, and 15 moreHumans, Female, Cognitive Therapy, Male, Depressive Disorder, Mental Disorders, Ontario, Middle Aged, Adult, Community Based Mental Health Services, Education Continuing, Health Personnel, Psychology and Cognitive Sciences, Inservice training, and Medical and Health Sciences
Gamblers Anonymous (GA) has earned a reputation in the literature as a fellowship with very few women and as host to a recovery culture that marginalizes women's needs and concerns. A notable example would be the preponderance of... more
Gamblers Anonymous (GA) has earned a reputation in the literature as a fellowship with very few women and as host to a recovery culture that marginalizes women's needs and concerns. A notable example would be the preponderance of war storiesrecovery ...
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Problem gambling, substance use disorders, and their cooccurrence are serious public health concerns. We conducted a comprehensive review of the literature to understand the present state of the evidence on these coaddictions. Our main... more
Problem gambling, substance use disorders, and their cooccurrence are serious public health concerns. We conducted a comprehensive review of the literature to understand the present state of the evidence on these coaddictions. Our main focus was illicit drug use rather than misuse of legal substances. The review covers issues related to gambling as a hidden problem in the illicit drug use community; prevalence, problem gambling, and substance use disorders as kindred afflictions; problem gambling as an addiction similar to illicit drug use; risk factors and problems associated with comorbidity, and gender issues. We end with some suggestions for future research.
We conducted a study offering peer support and education to members of families affected by concurrent disorders (CD). This article is an analysis of the qualitative data from a mixed methods study. Using constructivist grounded theory,... more
We conducted a study offering peer support and education to members of families affected by concurrent disorders (CD). This article is an analysis of the qualitative data from a mixed methods study. Using constructivist grounded theory, we analyzed semistructured interviews with participants, with half attending a 12-week support group and reading weekly workbook assignments, and the others receiving the workbook only and being interviewed 3 months later. We developed a model that describes family journeys into, through, and beyond CD, involving three phases connected by two transitional constructs. Preoccupation with the unresolved CD of an ill family member characterized the journey into and through illness, the first two phases, whereas renewal characterized the passage from illness to journeying on toward recovery. Participants had strong comments about health care providers and the service system, and spoke of the need for self-care, empowerment, support, and inclusion.
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About 1000 persons seeking treatment for alcohol or drug dependence were asked, relative to cigarettes, about the difficulty of quitting the use of the substance for which they were seeking treatment, the strength of their strongest urges... more
About 1000 persons seeking treatment for alcohol or drug dependence were asked, relative to cigarettes, about the difficulty of quitting the use of the substance for which they were seeking treatment, the strength of their strongest urges to use, and the pleasure they derived from use. Fifty-seven percent said that cigarettes would be harder to quit using than their problem substance. These ratings were related to the level of cigarette dependence and the perceived difficulty of quitting the use of the problem substance. The alcohol-dependent persons were about four times more likely than the drug-dependent persons to say that their strongest urges for cigarettes were at least as great as their strongest urges for their problem substance. Cigarettes were generally rated as less pleasurable than alcohol or other drugs. Thus, experiential experts on dependence judge cigarette dependence as at least as "addictive" as other drug use, but not as pleasurable, indicating important similarities and differences between cigarette dependence and other forms of dependence on psychoactive substances.
Research Interests: Humans, Alcoholism, Female, Male, Adult, and 3 moreJAMA, Tobacco use disorder, and Medical and Health Sciences
This study reports the findings of a general population telephone survey (N= 2500) conducted in Ontario, which was designed to examine behaviour, knowledge and attitudes related to responsible and problem gambling using a combination of... more
This study reports the findings of a general population telephone survey (N= 2500) conducted in Ontario, which was designed to examine behaviour, knowledge and attitudes related to responsible and problem gambling using a combination of closed-and open-...
Research Interests:
The authors aim to incorporate educational reflection techniques in an addiction psychiatry postgraduate core rotation in order to increase critical self-awareness of attitudes, values, and beliefs related to working with people with... more
The authors aim to incorporate educational reflection techniques in an addiction psychiatry postgraduate core rotation in order to increase critical self-awareness of attitudes, values, and beliefs related to working with people with substance use and other addictive disorders. Reflection discussion times, reflection journaling, and mandatory end-of-rotation reflection papers were embedded into a core addiction psychiatry postgraduate training block. Qualitative analysis of 28 reflection papers was performed to determine key factors and constructs that impacted on the development of attitudes and professionalism. A number of constructs emerged that demonstrated the attitudes, beliefs, stereotypes, and stigmas students have regarding addictive disorders. Some constructs also highlighted that students felt much more comfortable dealing with addictive disorders after the training and would treat individuals with these conditions in a more effective manner. Reflection techniques were endorsed as extremely valuable by students, especially in the development of professional attitudes that will help clinicians effectively engage and provide appropriate care for individuals suffering from addictive disorders. The authors suggest that reflective practices be used more extensively in psychiatric training in order to build and establish reflexive self-awareness as a core professional competence essential to work effectively in clinical practice, especially in the most demanding contexts.
Research Interests:
Alcohol and drug using clients of the Addiction Research Foundation were asked about their interest in receiving treatment for cigarette smoking. Forty-six percent said that they were "moderately" to "very... more
Alcohol and drug using clients of the Addiction Research Foundation were asked about their interest in receiving treatment for cigarette smoking. Forty-six percent said that they were "moderately" to "very much" interested in attending a treatment program if it were available. Despite a consistent preference for receiving smoking treatment after their alcohol or drug problem was treated, there was moderate interest in receiving smoking treatment during the alcohol or drug treatment among those who were very interested in receiving smoking treatment in general. Seventy-one percent reported that it would be "as difficult" or "more difficult" to give up cigarettes than the drug or alcohol which brought them to the hospital for treatment. The importance of treating smoking in alcohol and drug using clients is discussed.
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Research Interests:
Given the preponderance of Gamblers Anonymous (GA), there has been relatively little effort to explore the existing evidence base on its effectiveness as a recovery approach for problem gambling. To remedy this gap in the literature we... more
Given the preponderance of Gamblers Anonymous (GA), there has been relatively little effort to explore the existing evidence base on its effectiveness as a recovery approach for problem gambling. To remedy this gap in the literature we conducted a scoping review of the literature on mutual aid for individuals experiencing problem gambling published between 2002 and 2015. We searched 13 databases and reviewed reference lists and websites of relevant organizations. We reviewed records for eligibility and extracted relevant data from eligible articles. Three reviewers independently assessed the methodological quality of the included studies using the Mixed Methods Appraisal Tool. We identified 17 studies in 25 publications that were eligible for inclusion. Most studies were conducted in the United States, were cross-sectional in design, and involved both male and female adult participants. Results indicate that the evidence for the effectiveness of GA either as a control condition or i...