Rushing out the door: An Interview With Dr. Brian Rush

By Angela Yip

In brief

Dr. Brian Rush

Interviewing Dr. Brian Rush, Group Head of the Health Systems and Health Equity Research (HSHER) group at the Centre for Addiction and Mental Health (CAMH), doesn’t take place in a regular office setting. But then Brian isn’t a regular guy. For decades, he’s been working to develop more effective and efficient services and systems for people with addiction and mental health problems.

Listing his academic accomplishments would eat up this webpage—but I can tell you that he’s a full Professor in the Departments of Psychiatry and Public Health Sciences, University of Toronto, a member of the editorial board of the Journal of Substance Abuse Treatment (JSAT), and one of the top addiction services researchers in the world. Recently, he’s been a leader in research and development for the national and provincial Drug Treatment Funding Program (DTFP) and a collaborating architect of Systems Improvement through Service Collaboratives (SISC).

Last year, EENet had the pleasure of providing knowledge exchange support to Brian’s four Ontario DTFP Systems Projects, which were part of a larger suite.

So when Brian recently decided to retire after decades of work, I couldn’t resist recruiting him and a couple of other HSHER staff for a ‘focus group’ at a local restaurant. After ordering some snacks and beverages, we began our interview, reflecting on Brian’s amazing career, future retirement aspirations, the challenge of making Persian rice, and his recent horsing around (involving an actual horse)…..

Read Angela’s interview with Dr. Rush below.

Angela: How did you get into the field of Addictions?

Brian: During graduate school, as I was just about to finish a Master’s program, my supervisor came in one day with a job ad. He said, “Brian, I don’t think you’re really cut out to have a PhD and be a researcher. I think you might be interested in this job.” That was pretty hard on my self-esteem, but it was really a favour looking back on it. When I looked at the job ad, which was about alcohol and drugs, I thought, “Oh, I know about that! I can do that job!” I applied and Roberta Ferrance (who is still with CAMH), at the Addiction Research Foundation (ARF) in London, received my letter, a well-structured and well-written letter, and she really liked it. So Roberta hired me and that’s how I got started.

Dr. Rush with Rob Moore, Executive
Director, Provincial System Support
Program, CAMH

Angela: What has been your greatest success or contribution to the field?

Brian: That’s easy. The people I’ve helped to support. We’ve had a lot of really great projects, and yeah, I’ve got things like DATIS, Connex, the tiered-model, the needs-based planning and outcome monitoring – a lot of great things. But the greatest accomplishment is the people – some of whom are at this table – that I’ve had the opportunity to support. And they will continue, and they will support other people. They’ve learned how to support others, so that’s my greatest success.

Angela: What are some of the challenges you’ve encountered?

Brian: Well, I’ve had a really good track record with hiring people, I’d say I have a pretty good instinct, but it’s not perfect. I would say, it’s the people part – when one member of the team is not quite on the same page as everyone else, then that’s really hard.

Angela: What are some key things you’ve learned?

Brian: I think of two things. One is that researchers can really work with the community, and listen and learn – and really listen, creating a collaborative relationship. So I think it’s a lesson for researchers that you gotta get out there. You have to really be in the system, work for the system, as much as you work for yourself, the science, and the organization.

The other thing that I’ve learned quite recently is the challenges with the integration of mental health and addictions. In many, many ways it’s better, but I’m seeing now that maybe we pushed the pendulum too far in the integration of mental health and addictions. We focused on structural integration, functional integration, clinical teams, sharing information, but all of that needs people from mental health, addictions, and other areas to kind of be on the same page – to have the same world views, the same understanding of etiology, and how to manage things – and that’s where the work needs to be done in the mental health and addictions portfolio.

Having people in mental health really understand and respect the perspective the people from addictions bring, and also for the people on the addictions side, to understand and respect medication management, diagnosis, and so on – those kinds of more medical, mental health things. There’s a lot more work to be done, it may mean swinging the pendulum back a little bit, being more clear on when we need an integration process and when we don’t – or when we can manage with more or less of an integration – it’s not an ‘all-or-nothing’ thing.

Angela: Is there anything you would change about your career?

Brian: It’s been a good one. There were times when I thought I should’ve learned to say no a little bit more – just for my own health. And thank god my children survived! They’re all good, but that takes a lot of effort when you do what I do, and travel a lot, the hours I put in and so on. So I’m happy to say my kids survived me in this work life! And it’s just too much sometimes – there were times when I probably should’ve said no, but everything’s interesting, and it’s all in the common good.

So going back, no, I don’t think I can change that – that’s who I am. I hope to be different going forward, be more selective, be more aware and focused on self-care. I’ve only had one job, but it’s been all project-based, so it’s always changing, the people are always changing. Somebody would say, how can you do just one job? But it hasn’t really been one job, it’s been two different organizations, always different teams, new people coming and going. I guess I kind of do addictions and mental health, but I’m an addictions researcher and addictions touches everything: biology, medicine, health, mental health, economics, government policy, geography. It touches on every discipline that we have – almost! It’s just incredibly interesting and there’s always something to learn.

Angela: What key piece of advice would you give to a scientist starting out in the field?

Brian: I would advise they be aware of the two-edged sword. To be successful, you have to work a lot of hours. It’s not 9-5. You’re a scientist. It’s always with you. Not only thinking, processing stuff, but just the time required to publish, to do grants. It’s so far beyond anything like a normal work week, so you better be prepared for that. The flip side of that? Protect your time with your partners, children, and make sure they’re the top of your list! You have to figure out how to make that work for you. It might mean getting up at 4am and they get up at 8am. It might mean organizing your life to make sure there’s time for the other important people in your life, but you will not survive unless you are prepared to work a lot of extra hours and really devote your life to this. You have to create that balance for yourself.

Angela: What direction would you like to see the field move towards?

Brian: I guess in a way, where my biases are. That’s where progress is going to be made. So narrowing it down to addictions, I would say we’re going to make progress on the genetic, biological side of things, but I really don’t think we’re going to find a magic bullet, a medication or a brain scan that’s going to be so diagnostic – or it’s going to be a long, long time before that happens. I’m not saying that I don’t value that research personally, but I think there’s a tendency to neglect the social side of things, the importance of the environment, the world in which we live, the social determinants of health, and their impact, not only on prevention, but in making treatment successful.

So where will we be? I would hope that we maintain at least some balance between the different kinds of research needed and not go so far down the epigenetics and the biological side, that we continue to invest in social research, cause if we don’t, I think that would be a big mistake.

Angela: What will you be doing during retirement?

Brian: I have this answer practiced, because that’s the first question people ask! I think because of CAMH policy and back to the old ARF days, we really believe in harm reduction. In fact, there was huge controversy years ago around controlled drinking, whether you could support somebody to reduce their drinking and they would still be able to function. So I’m implementing a program called ‘controlled retirement’! [laughs] I can’t go all out, there will be periods of relapse where I will be working and people will look at me and say, what’s really different, and I’ll say: Don’t worry, it’s just a relapse, and relapse is allowed! It’s a chronic care model! [Brian’s research staff sitting around the table, quickly quipped that they will implement a follow up, return-to-treatment protocol.]

So I can’t just drop everything, I’m not ready. But I’m enjoying the idea of writing without stress and really operationalizing that. To get up in the morning and work on a paper all day, or for two days, three days – I don’t know if that’s going to happen, but it’s more likely now! Less meetings, less emails, less letting the day get out of control. That’s my fantasy! I’m just going to enjoy having a bit more time. And I’m going to finish training Watonga. I hope by next summer, I’ll be riding my horse. I hope to enjoy all my children, my international family, and all my friends. It will be different. I will be working, but in a more controlled way (I hope!). It’s my goal to manage that….and PEACE OUT!

Dr. Rush with his horse

Angela: Wait, tell us about your horse, Watonga!

Brian: When people say, what are you going to do in your retirement, what’s your plan – as if you’re supposed to have a ‘plan’! I don’t really have too much of a plan, so I use Watonga as an excuse. I say, well, I bought a horse, and then people say, “Oh great, good going! That sounds like a good retirement plan!” It actually had nothing to do with retirement, but he makes a good excuse.

Watonga basically approached me and found me in the desert at a rescue ranch. We made some kind of connection that people have described to me as not uncommon sometimes between a horse and a person. I was open to that and he seemed open to that and so now he’s here. I’ve learned a lot about horses and now I’m learning how to talk “horse.” There’s actually a language that you use with your eyes, hands and your projection of energy – and he responds. So it’s actually learning another language, which is very cool. I’m going to put it on my CV! [laughs] Portuguese, Spanish, French, and Horse – intermediate level, because I’m still learning. He’s amazing and I’m going to spend more time with him.

I’d say a year from now, my goal is to drive up and pick him up in a trailer and take him to Algonquin Park and do a long trail ride. Right now it’s work. I’m learning and he’s learning, and he’s gentling, you still can’t really touch him too much on his back, or get on him, or even put a blanket on him. It’s a process of working with someone who’s been traumatized, who’s prey, and I’ve learned a lot about trauma-informed therapy and how to work with an entity, a person who’s been traumatized. The need to give space and how to reinforce – it all translates. I’ve also volunteered my time to the rescue ranch to help them evaluate their client therapy programs. They’re using horses for the treatment of US veterans from Iraq and Afghanistan for trauma, so I’m offering that in return to them. So Watonga’s a big thing. I’ve found him and he’s found me.

Angela: Final question: What do you cook better than anyone else?

Brian: Oh….not bulgogi, and not Persian rice! [Brian smiles at two of the research staff at the table who are the experts] I’d say I’ve learned from the best, my Brazilian friends, how to do a really good barbeque. I know for Karen [Urbanoski, Brian’s successor, the new Group Head of HSHER] and others, it’s still kind of gross to think about 50lbs of meat being consumed by four people! But I would say that’s probably it. And condiments! It’s a big joke in my house that that’s all there is available in the fridge – most of it which I’ve made myself. And it drives everyone crazy because there’s no room for actual food! So I plan this summer to do more pickling at the cottage. And I will conquer Persian rice, but not bulgogi, because Il-Ho [Kim, a project scientist, HSHER] is my neighbour!

Dr. Brian Rush will continue to work as a consultant numerous projects, including the Drug Treatment Funding Program. To contact Brian, please leave a comment below or contact EENet.

ANGELA YIP is a knowledge broker with a background in neuroscience. She has worked for a number of years in KE and research analysis. As a devout snowboarder, Angela is one of the only team members who welcomes the winter. When there isn’t snow on the ground, you’ll find her golfing and dreaming about eclectic cuisine.

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