In this occasional series we record the views and personal experience of people who have specially contributed to the evolution of ideas in the Journal's field of interest. Nick Heather is a British psychologist who has made notable and innovative contributions to this field. He has, over a distinguished career, developed and directed three research centres but has still found time to play the piano.
Addiction (A): You were born in 1938. What are your earliest memories?
Nick Heather (NH): I was in London during the blitz and my earliest memories are of blackout curtains, air-raid sirens and going down into our Anderson shelter (a kind of primitive bomb shelter people had in their back gardens).
A: Did you stay in London throughout the war?
NH: No. Towards the end, my family went up to North Wales where we had relatives. We moved because of the V2 rocket scare. It was quite a change moving from London to this little village called Rhuddlan, near Rhyl. But my first clear memories are from there, such as going to school for the first time.
A: What was your family background?
NH: My father was manager of a busy off-licence in Wood Green, north London. I think he probably fitted Jellinek's description of the ‘delta-type’ alcoholic.
A: For the benefits of readers like me, what type is that?
NH: That is the one who does not lose control, but drinks heavily every day, such as what we think of as the continental or French kind of alcohol dependence. My father managed to do his work very efficiently, but most nights would be drinking extremely heavily with his friends. There was obviously a high occupational risk factor there.
A: So do you think your father's drinking affected the focus of your later career choice?
NH: I have often thought about whether this was why I developed an interest in alcohol problems. I simply do not know. It might simply have been something I just stumbled into. But I was very deeply affected by his drinking at the time; I was ashamed of the fact that virtually every night he would be drunk. His mates would often come round at closing time at 10–11.00 p.m. and they would continue drinking into the early hours of the morning. He was very generous and warm, and certainly a very intelligent man, although he did not use his abilities as much as he could have done.
A: Your mother?
NH: My mother was simply a housekeeper but a wonderfully kind and sensitive person. Some people regarded her as little short of a saint because of her kindness to other people. She gave me a lot of love and a good upbringing.
A: Did you have any brothers or sisters?
NH: I had two brothers who were much older, and one sister who died just before the war and whom I never knew. My parents were quite old when I was born and I was probably an unexpected child.
A: Was your family religious?
NH: Not particularly. And I certainly am not. I would probably call myself agnostic, for want of a better word. I am also quite impressed with the more positive kind of atheism espoused by Richard Dawkins, which is critical of the effects of organized religion in the world. Having said that, many of my friends are deeply religious and I do not hold that against them!
A: Could Alcoholics Anonymous (AA) function the way that it does without a religious underpinning?
NH: I do not think we completely understand the way it works and why it achieves the success that it does, but I think that it is possible the spiritual component is an essential part of it. I am not sure why. I have found itdifficult to reconcile a rational, scientific approach with 12-Step ideology. I am interested in whether mutual-aid groups that eschew the 12 Steps but retain all the other advantages of group affiliation can be as successful as AA.
A: This is a trivial issue, but reading through your CV I see that your name is actually Brian, so why Nick?
NH: When my mother came back from hospital with me I had a lot of black hair and was very ugly, apparently, so my father said I looked like ‘Old Nick’. Nobody has ever called me anything else, including the close family, but I still have Brian on my birth certificate and passport, which often causes problems.
MOVING TOWARDS AN ACADEMIC LIFE
A: You came into academic life rather late; can you tell us how that happened?
NH: Having passed the 11+, I went to a school called Latymer in Edmonton, north London, which was an ordinary grammar school at the time but is now one of the most prestigious selective grammar schools in London, if not the whole United Kingdom. I did quite well, but left at 16 after gaining good ‘O’-levels. The main reason for leaving was because my parents came from a background where becoming a white-collar worker was something of an achievement, and nobody expected me to go to university or imagined that this could be possible. Going to university was simply something other, better-off people did. Also, I was a little wild and got into one or two scrapes, so the school did not exactly encourage me to stay on. I found jobs in the City of London doing clerical work, which was very tedious, and I stuck them out until National Service.
A: National Service was compulsory at that time, wasn't it?
NH: Yes, I caught the end of it in 1957. I believe the last batch was in 1959. I did most of my time in Germany as a signals operator in the Royal Air Force. It added to my experience of life, but the only concrete thing I gained from it was the ability to touch-type.
A: And then?
NH: Afterwards, I returned to the same type of work for a while: trainee sales representative for a paper manufacturer, which meant that I just answered the phone. After a year of that, I thought there must be more to life than this and the year was then magically 1960. I had read a little of Jack Kerouac (On the Road) and something was in the air, so I dropped out, as they say. I cashed in my small superannuation and went down to Eastbourne for the summer and worked at washing-up in hotels, labouring jobs and being a deck-chair attendant, where I met some university undergraduates. One chap persuaded me that I might have the ability to go to university. So I went back home and studied ‘A’-levels by correspondence course. I was helped by knowing somebody who had a similar working-class background, had left school at 16 and had then decided to do the same thing as me. His name was Michael Mulkay. We both obtained good grades and he applied to the London School of Economics and was accepted to study sociology. He finished up as Professor of Sociology at the University of York and, I believe, made an important contribution to the sociology of knowledge during his career. I chose to study psychology and obtained a place at University College London.
A: How did you hear about psychology, as at that stage it probably was not on the radar of most people thinking of university?
NH: I do not think that is true. It was certainly on my radar. One thing to note is that, in a sense, leaving school at 16 was a blessing in disguise. I was good at languages and if I had stayed on I probably would have read for a degree in French or German. That little extra time gave me the opportunity to think about what I really wanted to do, what I was really interested in, and that was psychology. I had read a couple of popular books by Hans Eysenck and had a general idea of how a scientific approach to psychology worked. Interestingly, on going for an interview at UCL, I discovered while waiting to be seen that I was sitting next to Mike Eysenck—Hans' son who is now, of course, a renowned psychologist in his own right. You can imagine how impressed I was, and my feeling of ‘What on earth am I doing here?’.
A: Did you enjoy your studies?
NH: UCL was supposed to be one of the best places to study psychology at the time and it probably still is. But I only really decided to go there because I was a Londoner. The course gave me a very good grounding in the experimental and scientific approach to psychology. Actually a small group of us were the first to do statistics as a subsidiary, and the statistics department developed a course especially for us. This, of course, was in the academic department where the discipline of statistics was virtually invented. I enjoyed my undergraduate days enormously and it really changed my life. I did not work very hard—remember it was London in the 1960s and a great deal was going on outside the lecture room—but I managed to get a 2/1.
FINDING MEANINGFUL DIRECTIONS
A: When you graduated, what happened next?
NH: I started a PhD at UCL under Bob Audley on ‘random walk’ models of decision-making processes and inparticular on perception as a decision-making process. I did 2 years of this and gave it up. I have always felt rather guilty about this, as Bob Audley was extremely kind to me. Why did I give it up? Well, it was the middle of the 1960s and this particular research seemed to be utterly meaningless to me at the time. I sometimes regret having given it up but, again, as far as my later interests are concerned, it may have been a blessing in disguise.
A: You did not finish your PhD but you continued in higher education.
NH: Yes, I obtained a job lecturing at West Ham College of Advanced Technology (now the University of East London) but I became fed up with that, too. I remember going in one morning for an early lecture and hearing a subject in a memory experiment verbalizing nonsense syllables and thinking, yes, this really is nonsense! So I dropped out again and went to Morocco. It was when I came back from there that I decided to study clinical psychology. I thought that with clinical psychology I would be doing something more tangible, more about human life. So I applied to and was accepted at the MSc course in clinical psychology at the University of Leeds.
A: There is a touch of irony here in that you had been studying random walk models, and in a sense the concept of randomness might be something that could be applied to your early career path.
NH: I do not think it was random. I think I was looking for something relating to psychology, but in a way that made it meaningful for me. This is reflected in my first book, which was called Radical Perspectives in Psychology, a kind of distillation of objections to academic psychology and psychiatry around in the 1960s. It was not a particularly original book; some of it was simply a condensation of some of the better ideas of R. D. Laing, for example, but I do think one thing it did offer was a critique of academic psychology as dehumanizing. It was part of a series of 36 short textbooks in the ‘Essential Psychology’ series, edited by Peter Herriot, who was at City University. I was actually given the title of Radical Psychology, but there had already been a book called that, so I changed it to Radical Perspectives, which was accurate because it was representing various radical perspectives that had been around in the 1960s. These included objections to the artificiality of the psychology experiment and how it has very little resonance with real life. People still come up to me occasionally at conferences and say, ‘I read your book on radical perspectives in psychology and it changed my life’, because they had never seen these ideas presented in print before. I suppose that is a tribute to the inclusive policy of the series. From my point of view, it gave me the confidence that I could write books and perhaps contribute to ideas.
‘. . . my first book, which was called Radical Perspectives in Psychology, a kind of distillation of objections to academic psychology and psychiatry around in the 1960s.’
A: With the benefits of the many years since then, how far do you feel that these criticisms remain valid?
NH: Well, I think many of them have been answered, to some extent, because this was before the cognitive revolution in psychology and we were in the 1960s, still talking about rat psychology. In fact, one of the radical magazines around at the time was called Red Rat.
A: Was this movement political?
NH: Not in the active sense—if you like, Marxian rather than Marxist: and the Marxian view is that mainstream psychology and psychiatry is ideological in the sense that it supports the status quo and existing power arrangements and prevents people from asking questions about social injustices, etc. Not such an outlandish idea, if you ask me now. Other criticisms in the book have now been made redundant by the progress of the Women's Movement, gay rights, progress in civil rights, etc. Still others were very much of their time and now seem nonsense. But some issues, such as purported racial differences in IQ, are still very much alive.
A: Your very first paper in a refereed journal was entitled ‘Changes in psychometric test results following cosmetic nasal operations’. A fascinating title!
NH: After gaining my MSc in clinical psychology my first job was at the University Hospital of South Manchester, which had a brand-spanking-new department of psychiatry but was waiting for the arrival of a top-grade clinical psychologist. In the meantime I was employed as a kind of stop-gap. I was the only full-time psychologist serving this huge psychiatric hospital. I was extremely busy and like to think I paid my clinical psychology dues there, conducting psychometric testing and behaviour therapy of all kinds. While I was there a psychiatrist, George Hay, invited me to do the statistics for a follow-up study of ‘nose-jobs’. It was elementary statistics, and a few of my early publications were like that.
A: Would it be reading too much into your early output to say that there were hints of quite a big interest in psychometrics and methodology which you retain?
NH: It was not an obvious interest I had at the time, but looking back one can see a concern with methodological issues. I think that the remark somebody made, ‘That which exists must exist in quantity’, is something I very much believe in. Actually, the big influence on me at the time was personal construct theory and I came under the spell of Don Bannister, who was absolutely brilliant. His approach appealed to me enormously because he was wonderful at taking the mickey out of academic pomposity and what he described as the ‘science club’, and through him I found George Kelly, which gave me something which is still relevant now—that is, a method of scientific analysis which does some kind of justice to the complexity and richness of human life. My MSc project in Leeds was an attempt to use repertory grids to show that schizophrenics were more thought-disordered when they were thinking about people than when they were thinking about inanimate objects. I had a chance to continue repertory grid research in Manchester, when Brian Hore asked me to take part in a project which was trying to understand the psychological changes taking place during group therapy for alcoholism. That was also my introduction to alcohol studies. It was not a particularly good study and I was not especially proud of it, but it was published in the Journal of Studies on Alcohol.
A: Do you feel that there is still a place for methods such as repertory grids?
NH: Yes, I think so. I think it is a way of trying to discover people's views of the world, the way they see themselves, their place in the world and their deeply held values. Sometimes it is possible to capture those world-views in ways that the subjects themselves are unable to articulate but will recognize. There is an obvious relevance here to addiction and to why people find addiction hard to break, because it has something to do with their treasured view of themselves, their identity if you like, and their view of the world as well.
A: You did not stay at Manchester very long.
NH: After 2 years at Manchester, Reg Beech came in to head the psychology department and he wanted to bring in his own people, so to gain promotion I had to move on. I met Frank McPherson at a conference and he told me about a job in his clinical psychology department in Dundee, so I went up there. That job was half-time working in prisons and young offender institutions and half-time in regular adult clinical psychology.
A: And you then took up working towards a PhD again?
NH: That was when I started to work for a PhD again. I continued using repertory grids techniques, trying to test various theories of delinquent values. I had always been interested in sociology and for a while had been a member of something called the National Deviancy Conference, quite famous in the history of sociology in the United Kingdom, I believe, and very much concerned with labelling theory and generally how culturally and subculturally transmitted values determine individual behaviour. My thesis was essentially a test of the ideas of David Matza who proposed that, rather than delinquent and non-delinquent youth having distinct values, they shared both conventional, respectable values and what he called ‘subterranean’ values originating essentially from leisure activity rather than work. My studies confirmed this idea and showed that what seemed to determine whether or not someone became delinquent was the relative strength of those two sets of values.
MOVING TOWARDS ADDICTIONS
A: Did this work have any relevance to addiction?
NH: I think it was relevant to addiction. I started to conduct some work on the acute effects of alcohol on people's world-views using repertory grid techniques. I thought that an acute effect would be to alter the world-view to one that placed greater emphasis on excitement and ‘kicking the traces’ and less to conventional values of work and respectability. Part of the attraction of drinking could be that it enables an outlet for these kind of subterranean values. However, I was not allowed to give the subjects enough alcohol to show it. I never had time to follow this up, unfortunately, and then I became caught up with the controlled drinking issue. Also, when I began working in prisons I asked myself what I could possibly do that would be of any use at all. The answer, of course, was to work in the field of addictions, and in particular at that time in Scotland, alcohol addiction. Half the guys in prison would probably not have been there if they had not had a severe alcohol problem. So that is when I became really immersed in alcohol studies. I also worked with young offenders. I carried out a survey of young offenders' use of alcohol and the relationship as they saw it between their drinking and offending behaviour.
A: You mentioned your interest in the controlled drinking controversy. How did that start?
NH: David Davies, who was running the Alcohol Education Centre at the time, convened a meeting on ‘Resumed Normal Drinking’ at the Crichton Royal Hospital in Dumfries in 1976. David had, of course, begun the whole controversy with his 1962 paper. I was asked to provide a summary of an early review of the controlled drinking issue by Lloyd & Salzberg —an article which is rarely cited these days but was influential at the time. I found the whole topic really interesting. I suppose it was the radical quality of the claims about the controlled drinking goal that attracted me. So I then applied to the Medical Research Council (MRC) to carry out a randomized controlled trial of a cognitive–behavioural treatment for people suitable for the controlled drinking goal and was delighted to get it—my first grant ever. I was lucky enough to be able to employ Ian Robertson as research assistant and main therapist on the project. Ian had just finished an MSc in clinical psychology at the Maudsley and wanted to move back to Scotland. This was a very lucky break as far as I was concerned, because my collaboration with Ian was to prove very important to my career.
‘I suppose it was the radical quality of the claims about the controlled drinking goal that attracted me.’
A: You became involved in the New Directors Group around this time?
NH: The Crichton Royal meeting became an annual event at various locations and quickly turned into the New Directions in the Study of Alcohol Group (NDSAG). I was appointed Secretary of the group and drew up the constitution and so forth. The first Chair was a chap called George Gawlinski, who had been on the committee for the so-called Kessel Report which instigated the demise of in-patient units and the move to community-based services. But George found he was too busy to do it justice and resigned after a year, so I became Chair, a position I held until I left for Australia and was succeeded by Gillian Tober. I was later made Honorary President of the group, a position I still hold and am very proud of. The focus on controlled drinking soon expanded to become a more general critique of the disease concept of alcoholism—something I regarded at the time as a very dumb idea and still do. I am sure it has held us back from a proper understanding of alcohol problems and how they may be resolved in all kinds of ways. I am depressed by the resurgence of the notion of there is something called ‘alcoholism’ which is a brain disease. Anyway, NDSAG provided a venue for all those who were uncomfortable with the disease view and abstinence-only goal and, more widely, provided a chance for hard-pressed people trying to help those with alcohol problems to meet others in the same situation in a relaxed, informal and non-pompous setting and where they could give their ideas a full airing. The group is still going strong and I am able to keep up with people whom I first met in the early days 30 years ago—Doug Cameron, Ron McKechnie, Rose Kent, Robin Davidson, John Davies and a whole bunch of others—whose friendship I value very highly. I believe that NDSAG was extremely important in the development of the response to alcohol problems in the United Kingdom. This was not reflected so much in the scientific literature as in a more informal way of spreading ideas, although we did produce a book written by NDSAG members which I still regard as an excellent volume .
INTO THE STUDY OF INTERVENTIONS
A: When did you start working in the area of brief interventions?
NH: When I received the MRC grant to conduct the trial of cognitive–behavioural treatment with a controlled drinking goal I thought I had received a promise from a local psychiatrist, who had better remain nameless, that he would refer suitable problem drinkers to the trial; in the event he referred just one and we had to seek out our own clients by contacting general practitioners (GPs) directly and other sources of referral; so we had far fewer clients in the trial than we wanted. We did actually show an effect of treatment over minimal advice and a self-help manual, a finding which surprised us, and I think was due largely to the above-average quality of the treatment given by Ian Robertson and later Maurice Winton. Anyway, the slowness of referrals left us with spare time and I suggested to Ian that we write a book on the whole controlled drinking issue; this became the book called Controlled Drinking. I should point out here that most of the work for this was undertaken in our own time, not the time MRC was paying for. Perhaps the main conclusion of the book was that, although the controlled drinking goal did have a place in the specialist treatment of those with relatively serious problems, its most important application was in community-based services offered by generalists and mainly as a form of early intervention.
A: How did you take the community intervention idea forward?
NH: We began looking around for ways in which these community-based interventions could be developed. One idea was the model of the ‘alcohol education course’ for young offenders with alcohol problems, not education in the merely information-giving sense but really a form of condensed cognitive–behavioural treatment and relapse prevention. I received a grant from the Alcohol Education and Research Council to employ Steve Baldwin to follow this up and evaluate its impact in a PhD thesis. Much later, Steve was tragically killed in the Selby rail disaster in 2001.
A: Other approaches?
NH: Another application was self-help manuals sent through the post to people responding to newspaper advertisements. We collaborated with the Scottish Health Education Group (SHEG) in Edinburgh—at that time, a brilliant group of people with truly innovative ideas. They spent a great deal of money developing a self-help manual we wrote, called So You Want to Cut Down Your Drinking?, with great production values, colourful and interesting layout and illustrated with cartoons by some of the United Kingdom's leading cartoonists. I received another grant from the Scottish Home and Health Department to evaluate the effects of this self-help manual on people who had responded to a newspaper advertisement but had no formal contact with services for problem drinkers, with positive results. All these kinds of development were later included under the rubric of ‘broadening the base’ of treatment for alcohol problems.
A: And then?
NH: Probably the most important application of the controlled drinking goal at the time was brief intervention given opportunistically by GPs and other primary health care staff. We collaborated again with SHEG to produce a screening and intervention pack for GPs called DRAMS (Drinking Responsibly and Moderately with Self-control), which we then proceeded to disseminate in the Scottish highlands. I obtained a grant from the Scottish Home and Health Department to evaluate this pack in a randomized controlled trial . George Fenton, who was then Professor of Psychiatry at Dundee University, insisted quite reasonably that we involve the newly formed Department of General Practice too. They were responsible for persuading GPs to take part and recruiting enough patients for the trial, but at the end of the planned intervention period we had only about 30 participants in each of three groups—not enough power to detect a probably small effect of brief intervention and thus an inconclusive result. This seems to be a perennial problem with research in this field, at least for me—recruiting enough participants for adequate statistical power, especially when you have to rely on other people for recruitment who may not share your enthusiasm for the research. We did approach the Scottish Office for more funding to increase the sample size but they declined, presumably because they were unaware of the importance of the brief intervention idea. This was one of the most disappointing and frustrating episodes in my career—having what I thought was a great idea but not gaining the resources to study it properly. In the end, it did not matter much because Paul Wallace and his colleagues, in a study funded adequately by the MRC and using the MRC GP research network, were able to demonstrate the effectiveness of GP brief intervention. This was followed by Peter Anderson's study in Oxford, and then much more research from around the world, confirming the effectiveness of opportunistic brief intervention in primary health care.
A: What were the influences on the development of brief interventions?
NH: I suppose the background had been laid down by the Maudsley Alcohol Pilot Project in the 1970s, which had recommended a community-based response to alcohol problems. As far as the notion of brief intervention goes, Jim Orford and Griffith Edwards had shown that 3 hours of ‘advice’ produced equally good outcomes as conventional treatment and Bill Miller's work had shown that a controlled drinking self-help manual was as good as a programme of cognitive–behavioural therapy. But all these studies were still being conducted in the specialist clinic and we wanted to move out of the clinic into the community. We were aware, too, that Jonathan Chick in Edinburgh was studying the effects of 1 hour's counselling by a nurse on excessive drinkers identified in hospital wards. But the most direct influence was Mike Russell and colleagues' classic study of GPs' brief advice to smokers published in the British Medical Journal in 1979 , showing for the first time that such advice was an effective and highly cost-effective way of increasing cessation rates. So we said: ‘Why can’t the same thing be done with low-dependence problem drinkers?'.
A: Did you have any job security at this time?
NH: In 1979, I had moved over to the university from the National Health Service (NHS) on soft money. My salary was paid originally for work on delinquency but I became increasingly interested in alcohol problems. I began to attract funding from various sources and to employ a small group of people as researchers. Steve Rollnick was one of the first to arrive and we did some interesting work together on applying Bandura's concepts to the treatment of alcohol problems, among other things. I managed to get the group dignified in the university by the title of Addictive Behaviour Research Group. We looked at a whole range of issues concerning drinking and drinking problems, plus some work in other areas such as preventing HIV risk-taking behaviour among intravenous drug users. There had been an explosion of HIV among drug users in Dundee and Edinburgh in the mid-1980s and we were responding to that. But although head of this research group, I was always on soft money. I went away on a summer holiday a couple of times without knowing I had a job to come back to. It was not very comfortable, especially with a young family to support. So eventually I became fed up with this and put in a proposal for a programme grant on brief interventions to the Scottish Office, which would at least give me 5 years' job security. This was for a programme of research on the development and evaluation of brief interventions for a range of substance disorders in a range of settings and proposed to answer questions about brief interventions and their effects that still need answering today. Unfortunately the Scottish Office, in their infinite wisdom, rejected the proposal without giving any reasons. Maybe they were given some bad advice.
THE MOVE TO AUSTRALIA
A: Then came your move to Australia.
NH: As it happened, in 1986 I think it was, David Hawks was touring the United Kingdom looking for people to apply to be directors of two new research centres that were being set up in Australia. I applied for the post of Director of the National Drug and Alcohol Research Centre (NDARC) at the University of New South Wales, went to Sydney for an interview and was offered the job. It was a big decision for my wife and me, remembering that I was already 49 and at a time in my life when it would be a big change to move to the other side of the world, for all kinds of family and personal reasons. But we decided we had nothing to lose and took the plunge. It was a decision neither of us has ever regretted.
‘I applied for the post of Director of the National Drug and Alcohol Research Centre (NDARC) at the University of New South Wales, went to Sydney for an interview and was offered the job.’
A: I think that setting up this research establishment arguably has contributed to Australia being such a major force in the field of addictions.
NH: I think you are right. I do not know if you know the history of the origins of the centre. It was part of a National Campaign Against Drug Abuse (NCADA) which was started by Bob Hawke, the Australian Prime Minister at the time. He was being interviewed on TV about his daughter's heroin problem, broke down in tears and pledged to launch a national campaign against this evil scourge, etc. That, at any rate, is the popular story of how it began. If true, isn't it astonishing how often developments in our field happen because the personal lives of politicians are affected? Fortunately, wise heads at the Australian health department persuaded the Prime Minister that alcohol was the country's main drug problem and that alcohol should at least be included in the campaign. A relatively minor part of the campaign in financial terms was the setting-up of two research centres, one on treatment research in Sydney, of which I was appointed director, and one on prevention research in Perth, of which David Hawks himself became the first director.
A: This was an exciting time for you?
NH: Setting up the centre was a very exciting time for me, probably the most exciting period of my career. A small skeleton staff had been appointed before I arrived, including Janet Greeley and Nadia Solowij, both very able researchers; but apart from that, it was carte blanche. There was enough core funding to appoint five academic researchers, each with his or her own research assistant, and ample support staff—IT expert, librarian and secretaries. On top of that, we were able to apply for project grants which were relatively plentiful under the NCADA. Given my experience of scraping by in Dundee, this was heaven! So I was able to attract some very talented people into the alcohol and drug field, Richard Mattick and Shane Darke being two examples, both of whom have gone on to make very significant contributions to our field of interest. At the beginning we had some trouble in identifying a suitable Deputy Director; the powers-that-be became rather impatient and I had to resist considerable pressure to appoint people I did not think were good enough. In the end this tactic paid off, because I was able eventually to persuade Wayne Hall to take the job. As I expected, he turned out to be someone of extraordinary gifts in research and scholarship, especially the ability to assimilate and make clear sense of large bodies of evidence. And, as is well known, he went on to make a very large contribution to our field. Wayne took over as Director when I left but has now unfortunately moved out of the addictions field, although I hope he will retain an interest.
A: Anyone in particular who helped you at this time?
NH: In developing the centre, I was helped greatly by people who had been instrumental in bringing NDARC to the University of New South Wales, notably Ian Webster, Alex Wodak and Syd Lovibond, and later by the Chair of the NDARC Management Board, Kevin Rozzoli who was then Speaker of the NSW Legislative Assembly. But my excitement at working in Australia was not confined to the centre itself. Shortly after I arrived, Tim Stockwell took up the post of Deputy Director of the prevention research centre in Perth and later became the Director of what became known as the National Drug Research Institute. Tim is someone with whom I have always got on very well, so that was a big plus. Added to that, there were other people I knew well from the United Kingdom already working in Australia—notably Bill Saunders and Steve Allsop. As a result of the NCADA, there was so much happening all over the country in the drug and alcohol field. I seemed to spend half my time on planes travelling from one city to the next, bearing in mind that Australia is about the size of the whole of Europe. They really were heady days. Australian friends have told me that the quality and quantity of research in the addictions field in Australia improved enormously as a result of the injection of funding by the NCADA. I hope that the output of NDARC contributed something to that; in fact, I know it has. Traditionally, Australians sometimes feel that most things of importance are happening in Europe and the United States, not where they are. They call this the ‘cultural cringe’. I hope this feeling is disappearing now because there is no basis for it. Australia has some really first-class universities and some very bright people, especially in the addictions field.
A: How did being the Director of a large research centre affect your own work?
NH: Obviously, my administrative duties running the centre hindered my own research to some extent. With some exceptions, I decided to concentrate on alcohol studies, leaving illicit and prescribed drugs to Wayne, Shane and others. Richard Mattick took some interest in alcohol and worked with me on developing the Impaired Control Scale. I carried out some interesting work, too, with Janet Greeley on alcohol cue exposure. Also, when I arrived, Robyn Richmond had already conducted a great deal of work on brief interventions against smoking. I managed to arrange it so that her unit became part of NDARC, thus adding nicotine addiction to the range of problems we were interested in, and we extended the research on brief interventions to cover alcohol. I had a very fruitful research collaboration with Robyn, as I did with Alex Wodak, who is a very stimulating guy. With Alex I obtained a grant to develop a measure of the effects of treatment for opioid dependence, including methadone maintenance, the Opiate Treatment Index. This work was carried forward mainly by Shane Darke. Another important collaboration was with Amanda Baker, who did a PhD under my supervision on types of brief intervention against HIV risk-taking among injecting drug users (IDUs). They did not work! I am not one of those people who insist on their names being on papers to which they have made no contribution but, despite this, my list of publications increased considerably while I was in Sydney. In 1990 I persuaded Bill Miller to come and spend a sabbatical year with us. At the same time, I found some money to bring Steve Rollnick over for a year to work on a brief intervention study in general hospitals and on developing the Readiness to Change Questionnaire. As I said before, I first employed Steve in the late 1970s and we have been close friends ever since; so Bill and Steve met each other for the first time and got on like a house on fire. The result was the first edition of the book, Motivational Interviewing and, of course, an enormously fruitful collaboration between them that is still going on. I am rather proud to have been a kind of midwife to the birth of this partnership.
A: How long were you in Australia for?
NH: Six-and-a-half years. I left in January 1994 at a time when Sydney was completely encircled by bush fires. Since I left NDARC has gone on from strength to strength, especially in the area of research on illicit drugs. I would say it is now one of the leading research centres in our field in the world and I am very pleased to have played a part in this achievement.
BACK TO THE UK
A: Then you came back to a post in Newcastle.
NH: There were many things that influenced my coming back, both personal and professional. I was very tempted to stay on in Sydney but if I had done so it would have become increasingly difficult to remove my young second family and I might have been there for the rest of my life. I realized, and my wife agreed with me, that this is something we did not really want to happen. Our youngest son was born in Sydney, we all became Australian citizens, it is a very beautiful country, and the life-style is great. But despite all this I never got over a feeling of some home-sickness and I realised how British I really am, despite all my grumbles about the United Kingdom and its politics. I also missed my two older sons from my first marriage. So, we had another very difficult to decision to make but we are now sure it was the right one. I landed a very good job in Newcastle, which was a permanent job paid by the NHS but conducting research and with affiliations to local universities. Job security at last! Newcastle was ideal because one of my older sons already lived there and it was near to my wife's family home in Fife. In that post I think I became one of the few people in a position to try to plug the gap between university research in addictions, which is often not clinically relevant, and NHS research by practitioners which seems to be fast disappearing entirely, in the United Kingdom at least.
A: So what have you been doing since you came back?
NH: I then set up the third research group of my career, called the Centre for Alcohol and Drug Studies. This produced a whole range of research, again mainly on alcohol problems but also including, for example, a study of GP brief intervention against benzodiazepine dependence. The alcohol work included a trial of a new kind of treatment for problem drinking aimed at a moderation goal and called moderation-oriented cue exposure. This appeared to be based on sound theoretical underpinnings but unfortunately we found it did not improve on the existing way of aiming at the moderation goal, behavioural self-control training. Also, with colleagues I have undertaken more development of the Impaired Control Scale and a treatment version of the Readiness to Change Questionnaire. I also worked with Tim Stockwell and Timothy Peters to edit a large handbook on alcohol and its problems, which took an enormous amount of time and energy but which thankfully seems to have been well received .
‘I then set up the third research group of my career, called the Centre for Alcohol and Drug Studies.’
A: And you became involved in a major multi-site treatment trial?
NH: There have been two major projects since I came back to the United Kingdom. One is the UK Alcohol Treatment Trial. Shortly after I returned from Australia in 1994, MRC convened a meeting, chaired by Griffith Edwards, on what was needed in research on treatment for alcohol problems in the United Kingdom. One of the main conclusions was the need for a multi-centre trial; so a group of us got together and submitted an application which, after a pilot project and some adjustments to the proposal, was eventually accepted. This was the largest clinical trial of treatment for alcohol problems ever carried out in the United Kingdom and, just for once, adequately funded, at least by UK standards. It was a great chance to work over an extended period with friends and colleagues I have known for many years—Christine Godfrey, Ray Hodgson, Jim Orford, Duncan Raistrick and Gillian Tober—and to make some new friends in Alex Copello and Ian Russell. It has been hard work but I am sure it will turn out to be very rewarding. The first, main findings were published in the British Medical Journal in 2005 [11,12] and a few other findings have been published. But there is much more to come from this enormous database and, from what one can tell, some very interesting incidental findings. This will keep me busy for a couple of years.
A: And your other large project since returning home?
NH: The other large project was working with the World Health Organization (WHO) to try to implement brief interventions in routine primary health care across Europe and Australia. When I got back to the United Kingdom, Peter Anderson, who was then at the WHO Regional Office for Europe in Copenhagen, invited me to join Phase III of a WHO collaborative project on managing alcohol problems in primary health care that had been going on since the early 1980s. At about the same time, Brian McAvoy returned to the United Kingdom from New Zealand to take up a post as Professor of Primary Health Care at the University of Newcastle and he had a strong interest in managing alcohol problems at the primary care level, so this was an ideal basis for a collaboration. We were able to appoint a very talented researcher, Eileen Kaner, to the research team, and she has now gone on to establish her own reputation as a leading researcher in this area. Eventually Phase III turned into Phase IV and I was appointed ‘Technical Focal Point’, which is WHO-speak for the person running the project. The idea was to form a strategy for routinely implementing screening and brief interventions for hazardous and harmful drinking that was suited to the particular health care systems of each of the 12 countries taking part. This has been a really wonderful project to work on, regularly meeting people from different countries at different venues all over Europe and making some very good working and personal relationships. The Phase IV project has finally ended and a report edited by myself has been published on the WHO website (at http://www.who.int/substance_abuse/publications/identification_management_alcoholproblems_phaseiv.pdf).
A: Getting the brief intervention idea really taken up?
NH: Of course, the task of getting screening and brief interventions incorporated routinely in primary health care is an ongoing one and is liable to take some time. Following the end of the Phase IV study, with the help of WHO personnel and other colleagues, I set up something called the International Network on Brief Interventions for Alcohol Problems (INEBRIA). This is intended to stimulate and encourage research and practical applications of screening and brief interventions all over the world, not just in primary care but in a range of suitable settings. The network's website is http://www.inebria.net. After setting it up, I thought I had better leave the running of it to younger hands and Peter Anderson took over as Chair of the network.
A: When did you formally retire?
NH: In 2003. I was given an Emeritus chair and a room at Northumbria University, with which I had had a formal link for some years before my retirement. I chose to join the Division of Psychology and it is great to be back in a university department of psychology after all these years.
A: I do not see any slowing down in your rate of output despite the fact that you officially retired.
NH: No, I am trying to slow down but it is difficult, partly because this just happens to be an interesting time for alcohol studies in the United Kingdom. For example, in connection with the Alcohol Harm Reduction Strategy for England, I was asked by the National Treatment Agency for Substance Misuse to review the evidence on effectiveness of treatment for people with alcohol problems, together with Duncan Raistrick and Christine Godfrey . This will feed into the Models of Care for Alcohol Misuse and hopefully make a difference. But I have got to wind down. I am trying to become involved in more theoretical issues. I am excited by the work of George Ainslie and other people who want to develop the microeconomic account of addiction or, in Ainslie's case, the ‘pico-economic’. I collaborated with Rudy Vuchinich to produce an edited book on this theoretical perspective, based on a conference in Birmingham, Alabama .
A: I believe you have a plan to write a book on addiction theory. With all this going on, I am not sure how you are going to have time to write this.
NH: I shall clear my desk—some time!
A: For readers who want to know a little more about Nick Heather the person, would you mind telling me who are your heroes?
NH: In the addictions field, I would have to say Bill Miller. There are many people whose work I have a deep admiration for but I would have to single out Bill because he has made seminal contributions to our field in so many ways, not just Motivational Interviewing, although that itself is one of the most important ideas to have emerged in the field. I first got to know Bill when I helped organize the Third International Conference on the Treatment of Addictive Behaviours in North Berwick, near Edinburgh, in 1984. This conference was based around Prochaska & DiClemente's transtheoretical model and may have been the first introduction of the ‘stages of change’ idea to the United Kingdom. The conference produced the first edition of what I think has been a very influential book . The stages of change have recently been subject to some stringent criticisms but I do not think all of them are justified, and I intend to become involved in that debate when I have time. The main point here, however, is that Bill Miller's work has continued to be an inspiration for me; I find that almost everything I write these days contains a long list of references to his work. He is probably the most productive individual I have come across in my career. Another hero, as I have already suggested, is George Ainslie, although I do not know him personally all that well.
Outside addictions, my choice of heroes, it would have to be a toss-up between Thelonious Monk and Jimmy Greaves.
‘Outside addictions, my choice of heroes, it would have to be a toss-up between Thelonious Monk and Jimmy Greaves.’
A: Why Jimmy Greaves?
NH: His calmness and composure in front of goal. He was the greatest goal-scorer I have seen and I have seen a few. As this suggests, I am crazy about sport. I played football as a young man at a reasonably good level and now watch it avidly, with two season tickets at St James' Park. I played cricket until I was nearly 50 and then became a qualified umpire. I now play golf—not very well, but I am still trying to get my handicap down.
A: You mention the jazz musician Thelonious Monk. You play jazz piano yourself, I believe.
NH: Yes, jazz is my other great passion in life and Thelonious is my main man. His music is so full of joy. When I was at University College I was the pianist in a rhythm and blues band, with some good musicians, and since we could not find a singer, I did that too. We did not keep it up, otherwise we would undoubtedly have become rich and famous. Now, I still play quite a bit, just for my own satisfaction. One of my regrets is that for a long time I have not played in a band with other people, which is such an enjoyable experience. It is something I encourage my younger sons to do all the time, because they both play the piano much better than I do.
A: There is quite a tradition of jazz and blues musicians within the addictions field, such as John Booth Davies.
NH: I would not put myself in the same league as John; he's a proper musician.
A: What do you find funny?
NH: I would include TV programmes such as Fawlty Towers and Yes Minister. I think I have a fairly typically British sense of humour.
A: How would you like to be regarded by people in the field?
NH: Well, I don't know; as somebody who has made a contribution to the understanding and treatment of addictions in general and alcohol problems in particular—simple as that.