Society For The Study Of Addiction

Addiction Lives: Wayne Hall

In this occasional series in conjunction with the SSA’s journal Addiction, we record the views and personal experiences of people who have especially contributed to the evolution of ideas in the journal’s field of interest. Wayne Hall is a Professor at the Centre for Youth Substance Abuse Research (CYSAR) at the University of Queensland. In 2010 Wayne was the Wellcome Lecturer at The Centre for Neuroethics, University of Oxford, and received the Lee Greenaway Award from the Alcohol and Drug Foundation, Queensland. He was appointed to the editorial board of Public Library of Science Medicine in 2012, and has advised the World Health Organization on the health effects of cannabis use, the effectiveness of drug substitution treatment, the contribution of illicit drug use to the global burden of disease, and the ethical implications of genetic and neuroscience research on addiction. In 2016 he was invited to deliver the Society Lecture at the SSA Annual Conference in York.

This interview took place on 11 November 2016 in York, UK (during the SSA conference).

ADDICTION (A): So tell me Wayne, first of all how did you become involved in the Addiction scene?

Wayne Hall (WH): Well I think like a lot of people, by accident. It was an opportunity that came along to get back into research when I was buried under a very heavy teaching load with undergraduate medical students. And it looked like an attractive opportunity, so I applied and was lucky enough to be offered a job as the Deputy Director of the then newly established National Drug and Alcohol Research Centre at the University of New South Wales.

A: So remind me when are we talking about?

WH: 1988 was the year.  At the very end of that year.  I applied in the middle of the year and I think the interviews were towards the end and I took up the appointment just before Christmas in that year.

A: And just so as we get a sense of the context, so career wise you’d, what stage were you at?

WH: I sort of guess in current jargon, I would be an early career researcher. I had finished my PhD eleven years before. I’d worked in Government in a sort of health service as a research capacity in the Department of Health and then taken a post-doctoral fellowship which had taken me to the US for a year and the UK for a year.  Then came back and continued to do some work as a researcher mainly in psychiatry and mental health.  The money dried up for that, so I ended up taking a teaching position for I think it was three years at that point, which carried a lot of heavy teaching and not a lot of opportunity for research.  So when a research position came up that provided that opportunity to get back into research, I took it.

A: You move across into the addictions field, was this something that was going to be the rest of your career, or was it a brief period of time?

WH: Well I think it was something, I didn’t have long term career aspirations; in fact I was strongly discouraged from making the move by senior colleagues and mentors in the mental health field, because the addictions field was fairly non-existent as an academic entity in Australia.  There were clearly people involved in clinical treatment and dealing with addiction problems, but there wasn’t an academic field, per se.  And psychiatry on the whole didn’t see addiction as part of its business in Australia, and it largely still doesn’t.  So it was seen by some of my colleagues as sort of the end of my career and a really dumb thing to be doing. So I was strongly discouraged from doing it.

A: I think many of us are really pleased you did that dumb thing of moving into the field and this has got a lot of relevance to people at, you know at different stages in their career in different countries, so to what extent and in what ways did you then make that become so productive?

WH: Well it was really an opportunity, you know we had funding, we had interesting problems that were presented to us.  We had political interest in what we were doing and it was sort of like making hay while the sun shone.  It wasn’t a situation I had been in before with any sort of freedom to pursue my interest.  I started out doing what our funders and others wanted us to do and that was work around heroin and HIV AIDS was very much a topic at the time and then just sort of picked up whatever interesting topics came our way and cannabis was one of them.  We were just asked to write what was meant to be a very quick and dirty review of the adverse health effects of cannabis, which turned into a 100,000 word monograph and that’s a topic I keep being dragged back to.

A: We’ll come to the cannabis work in a short while, but let’s just stick with some of that early, mid-career development work, because I guess for a lot of researchers in the field, there is that challenge of whether you stay in the field or move back into what’s seen by others as more mainstream work. Tell us a bit about Australia and the research environment at that time.

WH: The large driver was the heroin epidemic which begun in the early, mid-eighties and was continuing into the late eighties that’s what led the Commonwealth Government, the Prime Minister, to fund research in the area, to establish the research centres.  They recruited Nick Heather whose interest was in alcohol and he was developing a major programme on particularly brief intervention and screening for alcohol in primary care.  But the political interest and demand was for advice around how to respond to heroin use.  So we did quite a bit of work initially on treatment of heroin dependence. We did literature reviews on the effectiveness of methadone maintenance treatment, which had been expanded to respond to heroin problems and to reduce HIV AIDS.  And from that we ended up writing a book by inadvertence under Jeff Ward led and we later developed an interest in heroin overdose deaths and the drivers of that and ways to prevent it and we found a ready audience for that work in Government, both federal and state and it made it a lot easier to get funding. There was also a separate funding scheme that allowed us to apply for, to do work on particular topics.  So it was a fairly exciting time to be in the field and anything we did was more or less new because there was very little work that had been done in Australia before. I mean we were obviously influenced very much by work that had been done here in the UK and particularly in the US, but it was a major novelty for us to be doing the sort of work we were doing.

A: So you are saying that we produced a book which Jeff Ward led on and the purpose behind that book both in Australia and internationally was what?

WH: Oh largely I suppose it was a defence of methadone maintenance treatment which was a controversial approach to treatment.  Its rationale was not well understood. So it was a matter of summarising the rationale for the treatment approach, summarising the evidence for its effectiveness and trying to come up with some specifications on how to do it properly, because it was fairly clear that a lot of the methadone that was being delivered, well methadone treatment being delivered in Australia was not optimal. It was low dose, it was fairly punitive, people didn’t stay in treatment long enough to benefit from it. So I think they were one of the key roles that we played in helping Government. It was actually one of the State Governments that requested and commissioned the work, but it obviously had national relevance as well.

A: And so that it’s documented, it also had international relevance. You brought that book out at a time when in the UK we were going through one of those phases where politicians were wondering about the legitimacy of methadone maintenance. What you produced was a publicly accessible synthesis of what the evidence showed. I actually remember you very kindly arranged for a batch of those books to come, so that the committee under the Reverend Polkinghorne, each person received a copy of that book and it was very helpful to them.  It was accessible.  So it had international effect as well, You mentioned that then the cannabis topic emerged from the idea of a small bit of work which ended up as 100,000 words. Tell us how that came about and how it evolved?

WH: Well that was again a piece of commission work from the Commonwealth Government, in this case it was the Federal Minister for Justice, who wanted some clear advice on what the national response should be to cannabis.  As he pointed out at that point rates of cannabis use were very, very high. They have since dropped very substantially, but at that point they were quite high amongst young people, rates of arrest were quite high and he asked the question was this a responsible response to cannabis, should we think of better approaches to dealing with the drug and its high prevalence of use amongst young people rather than relying on the criminal justice system?  So he created a task force that commissioned a series of reviews, one of which was a review, an updated review of the adverse health effects of cannabis and what we were meant to do was a review of reviews and of course with what we discovered when we went looking was there hadn’t been much done by way of review since 1983, which was then ten years before we were asked to do the review. So we ended up going off and doing reviews of what had been published since and what started out you know for something of the order of 10, or 15,000 words, ended up as I said growing and nobody complained. I mean it was, it delayed the report of the task force and they didn’t seem to mind and it was very well received the report when it was finally produced, for the same sorts of reasons I think that we aimed to write a report that was accessible to a broad audience, not just researchers and clinicians, but also policymakers and the general public.

A: What you are describing there is a good quality application of scientific method, but then also looking at how you bring that to the policymaking process .There is a consistent theme there isn’t there?

WH: Yes and I guess that had always been my approach that I had always written for a broader audience than my peers and I think if people can’t understand what you’re writing outside the field, a reasonably intelligent reader without any special knowledge, it might be a bit of a reach for them, they might have to work at understanding it, but it should be reasonably comprehensible without enormous amounts of study and going off and boning up on the literature.

A: I see that consistently through your product over the years that there continues to be a very high standard of scientific rigour, but also then what must be a lot of effort and time about making that into a form that is accessible, quite demanding of that political or general audience, but is actually accessible if they immerse themselves in it.

WH: Well and often you’ll write more than one version.  I mean I think you have to start off with a technical version that will satisfy sceptical peers that you’ve done a serious job. But it shouldn’t end there.  We would write for a lot of those reports, executive summaries which would be ordinary language accounts that we’d try to translate the scientific findings into language that might have implications for policy and often would write popular accounts for a broader audience, including the popular media, on this sort of stuff.  But it was always a choice that you didn’t do the latter first, that you did the serious review first and then did the more popular accounts later.

A: There you are as an increasingly respected researcher and you do this body of work around the health implications of cannabis use and it’s well received and you could have then said oh that’s good, now what’s the next topic.  But the story evolves doesn’t it in terms of your own involvement?

WH: The WHO at that point was about to update their review because they hadn’t done one for ten years.  They discovered that we were just finishing one off.  We got the members of a World Health Organisation Committee to peer review our document. I was invited to join them and we were involved in producing the WHO report in 1997.  That led to a lot of other commission work for WHO on other topics, on opiate substitution treatment, the oversight of the Swiss heroin trials, which were a very controversial issue throughout the 1990’s and a variety of other work for international agencies that meant that our work started to attract, the work of the Centre more broadly started to attract a lot of international interest.

A: Bringing that up to today you’re a very astute observer and commentator about the changes occurring in different parts of the world around drugs policy and cannabis policy and several of us have heard your recent talks on that.

WH: I think one of the more surprising things is that cannabis as a topic has largely attracted very little interest from the US and there was not much interest in our work in the USA for most of that period. But obviously the changes that have occurred there since the mid-nineties with citizen initiated referenda have created a lot of interest in my work and I just over the last several years have found myself invited to write commentaries on, to review papers and to write commentaries on papers for major American journals in the sort of general medical domain and specialist ones in the addiction and mental health field as well.  Inevitably that means expressing views on what’s happening there and what’s likely to happen.  One of the problems with these sorts of debates is that most of the people in them tend to be highly partisan, pro or con.  So trying to weave a way though, acknowledge the legitimacy of concerns on the part of people on both sides of the debate and to pull it into some sort of context and also point out what sort of evidence we would need to have to be able to make a judgement about whether on the whole this was a good or a bad thing. I think that’s been a major contribution. As you say that’s a bit of a theme that’s come through in my work and I’m attempted to continue to do that.

A: Moving on from the cannabis area to some of the other substance areas, I think it’s fair to say that you came to be regarded as somebody who brought that rigour to the field, so you would then be asked to help steer the analysis of other areas.  You mentioned the WHO wanting to look at the area around the heroin prescribing that was occurring in Switzerland. So how did that come about and how did you approach that task?  These were the early stages of any data emerging weren’t they?

WH: Yes. Well WHO got involved in that topic very reluctantly because they knew it was a hot potato and on a hiding to nothing as we say in Australia.  It was funded as I understand it by the Swiss Government because they’d come under considerable criticism from other European countries and also other members of the UN community in the drug policy area.  So they wanted an independent appraisal of it and they’d been criticised with people saying this wasn’t a scientific trial, this was just giving heroin to heroin users. So we were invited to look at what was going on in Switzerland, to visit the trial sites, to look at the protocols and to interview patients and staff and come up with some reports on what we thought was going on.  That was probably one of the most difficult tasks I’ve faced, because I think the Swiss researchers were struggling in a very difficult political environment.  They had been under enormous pressure to implement this approach to treatment. The trial, the original trial design had fallen over because the patients allocated to the control group just abandoned the study and disappeared, so that they couldn’t carry out the trial as originally envisaged, which meant that the sorts of results that they were able to report on had severe limitations. We wanted to acknowledge that without sort of saying that the whole thing had been a terrible mistake and a disaster and that this was an experiment that should be looked at more closely and that you know future research in that area could be improved in ways that would inform policy towards the treatment of heroin dependence.  So we didn’t make ourselves popular with anyone.   In the report that we finally delivered we weren’t sufficiently critical from the point of view of those who were opposed to the trial and some of the Swiss researchers I think were a bit affronted with what they saw as lack of full support for what they were attempting to do.

A: At this stage there are a number of different areas that you are beginning to apply that approach to. I’m also aware you were looking at cohorts and mortality.  Now outside North America it was very rare for this to be done, I think it would be fair to say.

WH: Yes. Well it was the North American work that we attempted to replicate within Australia. It wasn’t ideas that we’d sort of come up with, plucked out of the air, or then came up on our own. So certainly a lot of the work that had been done in the US in the late sixties and early seventies, by people like Jerry Jaffe and the groups at Chicago, seemed to me to be well worth attempting to replicate and so a lot of what we did built on that. I think the birth cohort stuff was really inspired by reading work on birth cohort trends in lung cancer mortality and realising that we could make lots of inferences about when heroin use started and how it evolved by looking at changes in, over those deaths in different birth cohorts.

A: Here again is probably an important lesson for us all to learn within our field. We don’t need to invent everything de novo. Colleagues working in other areas of research will have developed methods, applied them and it may not be exactly the same.  And it does seem to me that you have brought that to the field in quite a number of ways.

WH: I’ve always looked out for what’s going on in neighbouring fields and methods that might have interesting applications, because you know none of us has a monopoly on wisdom and choice of methods. Sometimes I go along to talks and hear about interesting approaches and think well that could be applied in an interesting way and look around and find that nobody had done it so attempt to do that.

A: You become director of NDARC and there’s a hugely productive period and you have around you a very impressive group of, very young researchers. Is there anything that you think is a lesson for other people about how to create that and how to maintain it?

WH: Well I think the things that made it possible were really not entirely within our control.  It was the continued political support for the Centre and continued funding of it, which came from senior civil servants in the Commonwealth Department of Health who appreciated the value of what we were doing. I certainly made an effort to understand the policy issues that were of concern to them and attempted to address them.  I would often make suggestions on the sort of research that we could do that might be relevant, the time frame within which it could be done, if it required additional resources and what they might be.  But I think it was a fair amount of what I’ve described as strategic opportunism.  There was political interest and concern, particularly about heroin use, a lot of, that drove our work and that provided opportunities to do further work.  The cannabis work we continued, we found it a lot easier once we’d done reviews and done publications to get peer review grants in that area and so we were able to pick up on particular issues around the treatment of cannabis dependence, its prevalence and fortunate to team up with old colleagues, including those who had told me I should stay away from addiction.  I persuaded the Commonwealth Government to fund a national survey of mental health and wellbeing and to insist that that ought to include drug and alcohol dependency in it, because there was certainly a senior official from the Department of Mental Health who said what’s that got to do with mental health, thus I remember it being very early days.  The results of that survey, not unexpectedly confirmed that there were high rates of prevalence of comorbidity between common mental disorders and alcohol and other drug problems and that had a big impact on the agenda of Government in attempting to address comorbidity in a more effective way.

A: There is a mixture of identifying topics of relevance where science ought to have something to be able to contribute, but also some medium and longer term planning. Setting in motion surveys probably has only a very modest early yield, but the value presumably increases as time passes.

WH: Well the survey was a good example because the Commonwealth funded the data collection, but not the data analysis. So, one of the best and most astute decisions I made was to teach a course to undergraduate advanced psychology students wherein I gave a description of the survey and what was planned and from that class we recruited three students who ended up doing PhDs on the survey, one of whom was Louisa Degenhardt.  So that meant we were then able to mine that data and to get a lot of very good quality publications out of it subsequently.  That survey has since been repeated ten years later, so there’s a tradition now of doing surveys of that sort.

A: Another distinctive feature is the outstanding people that you’ve had working with you.

WH: I think it’s a lot of luck. I think it helps when you’ve got a topic that’s hot that young people are concerned about and interested in.  If you are prepared to support people and the Centre did have a reputation by this stage as being a very supportive environment and place that people wanted to work in, so it was a lot easier to attract.  Certainly it hadn’t been easy in the early days.  We often had very few applicants for positions and they weren’t always the best applicants. They were often filling in for positions. They weren’t committed to staying in the field or developing, doing degrees of anything of that sort. So the early days that certainly wasn’t true, but I think by the time as you say we had a critical mass and I think we also had a fairly good media profile which meant that there was lots of commentary in the popular media, which meant that people knew about us and it was a lot easier to recruit and retain good staff.

A: So a hugely successful centre, developing, you’re leading it and then you decide to move.

WH: Yes.

A: So what’s behind that and what was it that attracted you to moving and how did that unfold?

WH: It came as a huge shock to a lot of people I work with, including most of the staff, I mean nobody saw it coming.   There was speculation that I was off to the US at one point because they thought there might be interest in me working there.  I guess I got to the magic age of 50, I was turning 50, I recognised that more and more of my time was spent doing those aspects of the role that I found least enjoyable-wearing a collar and tie and sitting through interminable meetings, advising Government and having to bite your tongue on Government policy if you’re part of the policy processes like Cabinet Government that even if you disagree with what Government is doing you have to toe the line. I wasn’t enjoying that aspect of it and I’d always had an interest in issues around ethics and public policy and at the time, this was around 2000, there was enormous excitement about the completion of the first draft of the Human Genome.  A position was advertised at the University of Queensland to look at the public policy and ethical implications of the Human Genome project and its application to medicine and health. So I wrote an email to the head of the centre saying I don’t have any track record in this field, but I think I could do the job and here’s why.  He contacted me and said when can you come and I went up and gave a talk and I was offered the job.  It was a bit difficult to keep that secret because Queensland is not that far from Sydney, the University of Queensland, so I had to move fairly quickly and make a decision on whether to accept it or not and relocate the family and all that went with it and I did, much to the consternation of my staff, for all the reasons you thought.  They just saw me as being there for the next ten years and I felt I needed a new challenge and something new to interest me.

A: And how did that unfold, because it was clearly a brave decision?

WH: Yes , brave and …

A: Or brave or foolish or whatever.

WH: Yes it’s brave in the ‘Yes Minister’ sense and that was certainly what a lot of my friends and colleagues thought. It was a risky manoeuvre and it wasn’t wholly successful from the point of view that it was difficult to get funding to do work in a field that I had no track record in. I did have funding for three years that was extended to four, so I did manage to produce some interesting stuff in that particular time. The irony was I found it much easier to get funding to do work on the ethical implications of the genetics and neuroscience of addiction, because I had a track record in that field. So I ended up being pushed back to, into the sort of addiction mental health area, where I started looking at the ethical implications and public policy around cigarette smoking, alcohol, illicit drugs and pharmaceuticals. I was doing quite a lot of work for the pharmaceutical regulatory process in Australia and I ended up chairing one of the committees that was involved in the Australian equivalent of NICE and devising guidelines for the treatment of various conditions and deciding what drugs would be publicly subsidised. So I wandered around a range of interesting topics where my past expertise was relevant and then I got funded for five years to work explicitly on what I called the addiction neuroethics, the sort of ethical implications of addiction neuroscience and genetics.

A: You were very much exploring a new area.  You’d gone out from a safe territory into unknown territory.

WH: It was hard work. The first two or three years there was more than one occasion where I thought maybe I’ve made a real mistake here and this is going to be a struggle to get on top of it. But again I had some really good luck in attracting very bright young people to work with me who are very knowledgeable and finding collaborators who knew a lot more about the topic than I did who were interested in working with me. So that made it a lot easier.  Again, WHO were interested in that as a topic area, so I was fortunate that they commissioned me to do work for them. I did similar work for the European Monitoring Centre on Drugs and Drug Addiction. So it wasn’t hard to continue, to actually build work in that area and build a track record in much the same way as I had done in cannabis in the past and of course once you have a track record, it’s much easier to get funding.

A: Let me pick up on the point you made about becoming involved in the policy process and then the extent to which you have to put on the suit and the tie and become part of the system, or you’re outside it. I’d be interested to hear how you think scientists should manage that in their contribution.

WH: I think it is a tricky one. You know it can be inside the tent or outside the tent and there are pros and cons of doing both. If you want to have a policy impact you often have to be inside the tent and that’s not always a comfortable place to be because politics is the art of the possible and compromises are inevitable. I think it’s important to have had some experience of that and to realise the predicament that politicians and policymakers grapple with, because it’s easy to be a researcher and  say the whole policy process is irrational because they’re not following evidence based policy or practice. Evidence is obviously important and it’s important to be arguing for it, but it can’t be the sole arbiter of what policies get implemented.  As I’ve gotten older and I think one of the things about age is that you become less concerned about how people think about you and you’ve got a lot less to lose, so it’s a lot easier to be outspoken and to cause offence, which is what I’ve been probably been doing a bit more of in the last five, ten years, than I did in the past.

A: That presumably touches on another aspect of your work where you then have become involved with committees with the United Nations, which was a new development. Does that fit in as a continuity?

WH: No. There were positions which became vacant on the International Narcotics Control Board and former colleagues in WHO asked if I was prepared to be nominated as a WHO nominee for membership of the board.  I thought nomination meant a fairly slim chance of success and I was mistaken. I was a bit shocked to discover that I had been elected by the Economic and Social Committee and it was an interesting experience. I found that again it was like being back in the tent, in this case within the international drug control treaty system and attempting to make the system work in a more effective way or that was responsive to some of the criticisms of it.  I found that the time requirement was fairly demanding and that was why I ended up resigning after a couple of years because the travel and the time spent attending meetings in Vienna, in addition to a new role that I had just taken on at the time made it very difficult to do justice to do both. So I decided to step down.

A: I think you’re describing how important it’s been to be inside the tent, but to be uncomfortable about being there and not to lose connection with the outside of the tent perspective?

WH: I think you’ve got to be prepared to walk if you really feel that you’re principles are then compromised then you don’t have anything other to do than to resign .  I’ve certainly done that, not  an on principle resignation where I’ve made a great deal of fuss about it, but I’ve decided that on the whole I’d rather, not be involved in the process and when my term’s been up, or in the case of the INCB, I stepped down earlier.  But I’ve done that on a number of occasions with various committees.

A: From your personal point of view, what do you see as having been the most rewarding achievements and what do you see as the biggest frustrations?

WH: That’s a hard question to answer.  I guess the cannabis work, sort of becoming an expert by inadvertence in the cannabis area was certainly not something I set out to do. At times I’ve thought this is the last time I’ll give a lecture on this, or the last time I’ll write on this topic and I find myself continuing to being drawn back to it. I suppose the fact that people continue to be interested on what I have to say on that topic suggests that that’s been a major contribution.  That is probably the major one. I guess the frustration has really been the difficulty in securing funding for continuation of the sort of work that I did. I think the people I’ve trained, the students have become postdoctoral fellows and are now mid-career researchers, have secured funding and they’ve been very successful.   I mentioned Louise Degenhardt earlier as certainly one of the stand outs, but there have been others, Adrian Carter who worked with me on the addiction Euro ethics to my great pleasure was just recently given another five year funding on a fellowship to work on that topic area and he’s part of a very large group in Melbourne that are working in that area. So I think they will continue, but it might continue in the location where, as opposed to the University of Queensland, which I guess is a minor disappointment, but that’s just, that’s the way things work out.

A: It’s extraordinary what a powerhouse of research and policy relevant research Australia has become.  That has been an amazing achievement which has persisted, hasn’t it?

WH: It has. We attracted very good people who were all of a similar like mind and similar approach. It wasn’t as though I had a great deal of difficulty selling this idea to peers and colleagues and the people we’ve recruited who wanted to come and work at the centre for precisely the reason that’s the sort of work they do. So I think it’s research that’s seen as making a difference, I think it’s attractive to a lot of people who want to get involved in research. So I think once you get that sort of reputation as a setting and as a group, it’s a lot easier to continue, particularly if you’ve got continued funding and support from Government as we had done for the better part of 25 nearly 30 years.

A: I think it’s a distinctive feature of the addictions field, that there are remarkable opportunities to bring science to the policymaking process, more so than in most other fields which are research driven.

WH: I think it is. Certainly the field I came out of, mental health, one of the things that really pleased me much later in life was the fact that former colleagues said what the mental health field needed was a centre like NDARC.  I think we were successful, I think there was a lot of luck involved in that inevitably, but there are peers and colleagues working in adjacent fields particularly in criminology, you know Don Weatherburn is someone who’s work I’ve admired. He does a lot of very similar work, so we are not alone in having done that. But I think we probably have been more successful than some other fields in Australia in that way.

A: Wayne, you have been a major influence on a lot of people in the field, there will be have been influences on you, so who were major influences and in what way did they influence you?

WH: There were lots of mentors in the mental health field, like Gavin Andrews had been the one I’d worked closely with.  He was also a major mentor of Richard Mattick who came into the centre subsequently.  In the addiction field, we really had to look overseas because well certainly Nick Heather was local, but his expertise and interest was more in alcohol policy, whereas we were more interested in illicit drugs and heroin in particular.  We very much looked to the UK and I think Griffith Edwards was obviously an influential figure and someone who took me seriously very early on before I’d published many papers.  I think on the first visit to the National Addiction Centre in 1991 he put himself out to spend time with me and to give lots of encouragement as I know he’s done to a lot of other younger people. And I think it was the welcome I got from him and from the group, yourself included, at the National Addiction Centre that was very important. We were certainly much less influenced by what was going on in the US. I think there were also major important differences in healthcare systems and the criminal justice emphasis on drug policy there. We certainly looked to American research because there was important work done as I mentioned earlier, but we got much more out of initially working in the UK and then through the WHO with the Europeans, the Swiss and Germans and other researchers there.

A: Griffith Edwards will have been an influence on both of us in major ways. How did he have an influence and how did Griff operate?

WH: It was encouragement that the work you’re doing is interesting, it’s important. He liked the approach I took. We discussed earlier that I wrote in an accessible style and I mean his writing and his approach was something we set out to emulate as I thought he was very successful in doing that.  It was just more general encouragement and then of course invitations to write commentaries for Addiction and invitations to review articles, introductions to people like onto the Addiction editorial board which brought me to the UK annually and certainly I got to meet a lot of senior researchers here in the UK.  So it was an entree into an important field .Griffith also had lots of international connections, so meeting people like Jerry Jaffe and John Ball and others. So it was a very important sort of introduction to addiction research networks as well as the personal encouragement.  And it was just always enormously stimulating, whenever I came to London we’d spend time together just shooting the breeze as it were, talking about topics of mutual interest and it was just a great pleasure to speak to him.

A: I found them very influential and the comfort and encouragement would also be mixed with …

WH: Criticism.

A: With criticism and that actually was an essential ingredient wasn’t it, it wasn’t just support.

WH: Oh no, no.  It wasn’t sort of unconditional love and regard.  I mean he’d let you know when he thought you’d said something stupid or disagreed and certainly there were occasions when we had differences of opinion.  But you know that was, I think that was important as well. I don’t think it’s good for your intellectual health to be given unconditional support regardless of what you have to say and I think criticism and disagreements are an important part of it and Griffith was never shy about disagreeing. There were always serious criticisms and you had to make an effort to answer them if you felt you could answer them, then it strengthened your case and improved the quality of your argument.

A: Before we conclude, are there areas that you still think that we’re failing to cover that we should be looking at and are there questions that need to be asked that aren’t yet being asked?

WH: I think Griffith had a comment in his interview on the lack of wisdom in people at the end of their careers laying down the law about what needed to be done.  I don’t really have any clear views on that. I’ve always looked for interesting new ideas and the one that most excites me at the moment is the area of waste water epidemiology. I’ve been working with a group of environmental toxicologists now for almost ten years looking at the capacity to monitor drug use in populations from waste water and I think there’s really interesting opportunities there, not just for the addictions field, but for public health more generally, because we are looking at monitoring alcohol and tobacco as well as illicit drugs in waste water and also monitoring population health by looking at bio markers in waste water. Just being open to new ideas and bringing them into the field is important and not becoming a ghetto where we only talk to one another and are preoccupied with continuing to do more or less the same old stuff.

A: There is a restlessness about wanting some new question or new challenge and that is Wayne Hall isn’t it.

WH: It is, yes. I have a short attention span, (laughs)  If you recruit bright young people into a field and a topic, you can often say well there’s someone who is going to take care of that as an area and I can leave that and move onto something else. That’s what I’ve largely done, the people I’ve trained have picked up some of the topic areas and gone a lot further with them than I have That’s what you should be attempting to do, seeding new talent and new research.

A: Are there any questions that you’re thinking why hasn’t he asked me about or any areas we ought to cover?

WH: No I think we’ve covered practically everything. There’s interests outside the addictions field but that is probably another subject from this conversation.

A: Wayne Hall, thank you very much indeed.

Wayne Hall was in conversation with John Strang

This interview is licensed under CC BY-NC-ND.

The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.