Dr. Glen Hanson Interview Excerpts
Dr. Glen Hanson has doctorates in dentistry from UCLA and pharmacology from the University of Utah. He is currently a professor in the Department of Pharmacology and Toxicology at the University of Utah with a long history of NIH-funded research. He currently is an NIH Senior Scientist and the Principle Investigator on NIDA grants dealing with the neurochemical effects of the psychostimulants. Dr. Hanson has written over 200 scientific research papers on drugs of abuse and their effects on brain chemistry and function and is the author of a widely used college text on drug abuse entitled “Drugs and Society”. He also is the Director of the Utah Addiction Center. He recently returned from a 3-year sabbatical in Washington D.C. at the National Institutes of Health (NIH) where he served as the director of the Division of Neuroscience and Behavioral Research and the acting director of the National Institute on Drug Abuse (NIDA). Dr. Hanson has addressed professional and lay audiences all over the world as well as testified many times before members of congress on drug abuse issues.
Glen: Play around with the molecule. You can add a little piece or take a piece away from the basic molecule. It can change fairly dramatically. What it is the drug does or doesn’t do. That same principle applies to the pharmacology of addiction, how these drugs of addiction are used. These people that make these drugs have figured this out. They know that they can modify some of these molecules in subtle ways and come up with a drug that has some very unique properties. An example of that is methamphetamine. We all know about methamphetamine. It has been out there since the late 1800’s. It’s originally developed as a decongestant. It was available over the counter. Now it is a serious substance abuse problem and it is relatively easy to make or to synthesis. You can go on the internet and you can find recipes on how to make this. You make it out of cold medication. You don’t have to be a sophisticated chemist to do it. You can make it in your kitchen or in your garage or whatever. So the chemistry is fairly straight forward. Well people have found that they can take that chemistry. They can modify it and get another drug that is called ecstacy. Ecstacy is also known as MDMA, which is an acronym for methylene dioxy methamphetamine. Because the core molecule is methamphetamine. But its properties are quite different. Now there is some overlapping components, Like methamphetamine is a very potent stimulant, very active on this dopamine reward pathway. Ecstacy also can be a fairly potent stimulant, active on that same dopamine reward system, but what it does in addition is it also has a very powerful affect on another brain system called serotonin. Serotonin turns out to be important for things such as mood, memory, sensory interpretation, and many of our hallucinogens or psychedelic drugs have very profound effects on serotonin systems. So ecstacy has picked up a piece of the psychedelics or the hallucinogens, has combined it with its methamphetamine core, which is the psycho stimulant on the dopamine, and it has got this combination. That is one of the reasons it is so appealing, especially to young kids. Is it kind of looks like a weak LSD or masculine, which is another hallucinogen or psychedelic, put it has the euphoric properties that come along with the stimulants like methamphetamine. So it is a combination and they go to raves or environments where there is a lot of sensory stimuli because of the hallucinogenic part. They get all kinds of wild interpretations. You know the brain is flooded with all this sensory stuff, doesn’t know how to sort it out, and as a result you end up with this experience that is out of this world because it is totally unreal. But on top of that you’ve got the energy that drives you to dance, to go all night, or to go two or three nights in a row, and that is the methamphetamine component. So it is the two things together. And of course like, with all the drugs of abuse, its got its serious downside. It pushes the systems to extreme. These kids often times crash for two and three days, difficulty sleeping, problems with memory, depressed, and in extreme cases, ecstacy or MDMA can also be toxic. It can also damage the serotonin brain system much like methamphetamine damages the dopamine of brain system. There we don’t know how long this lasts. We just haven’t had that much experience with it, whether it is going to be permanent, whether it’s only going to last months, it’s going to last years, and we don’t know the long-term effects on brain function down the road when these kids grow up, when they are 30, 40, 50 years old. Will there still be residual effects from the damage the drugs did when they were 13, 14, 19, 21.
Interviewer: Young kids as early as third grade get into huffing markers at school and other kinds of inhalants. I mean, this does some serious brain damage, doesn’t it?
The use of inhalants, an inhalant is a compound and sometimes not even a drug in the sense that it is something you normally would put inside your body in order to accomplish, whether it is therapeutic or some kind of an effect. These things are usually solvents. Often times they are gasoline or petroleum product, and they are around the house so you don’t even have to go out and buy them in the street. They are not illegal. They are readily accessible and as a result then most of the family members, even young kids, are exposed to them. What you do, what these kids do is they inhale those fumes. So that is why we call these things inhalants because they are not taking them orally, they are not injecting them, but they are introducing them through the nose. It goes into the lungs, and the chemicals in this never were made for consumption. They were made to run your car or they were made to remove things on your type page like whiteout, or they are a glue made to glue things together. So you are introducing chemicals into your body that were never meant to be there and these are poisons. The attraction is that they also foul up brain chemistry. They cause all sorts of weird experiences because of what it does to that chemistry. Here you are with these young kids that are trying to find new experiences and this definitely would be a new experience. But it is a new experience in a very toxic way. It’s like I want a new experience so I hold my breath for five minutes until I pass out. For most of us this isn’t very appealing. For a young kid that is not doing a lot of really good decision making may do it just because the friends are doing it or they want to see what it is like. They just want to see what it is like. Unfortunately this little experiment, self experiment can cause some severe damage to the heart, severe damage to the brain, to the kidneys. These drugs really can be very potent toxins. They can kill or they can cause permanent damage that the individual never does recover from. Part of that comes from the hypoxy, meaning that if you’ve got these fumes this liquid toxin on a rag and you are putting it in a bag and you are just sitting there and inhaling the fumes, you are not getting oxygen. And so if the brain doesn’t have oxygen, especially if you pass out while you got this thing taped around your head inhaling, then you may have damage to the brain just as if you had drowned and you couldn’t breath for extended periods of time. So this is very, very scary stuff. Rarely do we see kids continue to use inhalants after they get out of grade school or junior high. They grow up, they think, “Boy this is really stupid. I don’t want anything to do with this.” Some of it is culture because it is the little kids that do this. But they grow up and say this is a bad idea and they move on. But there are occasionally that child that do it, and they can’t move on because they have damaged themselves in the process.
Finally, could you make a plea to the viewers that … that drug addiction is not glamorous but it is something that we need to face as a society because it effects not just the person but our whole society is suffering the affects.
Addiction and drug abuse takes many, many different forms. We can’t stereo-type this. We can’t nice and cleanly identify. This is addiction. This is a person that gets addicted and we understand all that there is to understand about it. Because addiction can be expressed in the use of illegal drugs, such as the cocaines and the methamphetamines, the heroins, the PCP’s and the marijuanas. It can be legal drugs that aren’t perceived as drugs by many people. Some folks they interpret or they define legal as, or drug as whether it’s legal or it’s not legal. So those would be like the alcohols and the tobaccos and the nicotine. And even in some context like the alcohols for example, some cultures that is part of growing up. That is part of the society. You know you drink a glass of wine or you take or drink a can of beer and it is sort of expected and that is just part of your life style. So addiction certainly can be expressed in that context. It can be expressed in inhalants, by chemicals that were meant to be consumed and can cause serious damage. Addiction can occur in prescription drugs where you start off being treated for a condition and the treatment goes wrong for some reason and you become addicted. So it has many, many faces and many, many people from all walks of life can get involved and get sucked into the process of addiction. It does start from bad decision making. Sometimes it is bad decision making that you didn’t even know you were making a bad decision because you didn’t have all of the information. Or in a prescription drug setting you start using it for a legitimate reason and then the thing just gets out of hand because you don’t really quite know what’s going on and you find yourself becoming dependent on it and then becoming severely addicted. So it is bad decisions but as I said a lot of times you don’t even know you’re making the bad decision. However it is a disease process and many diseases are that very same way. They start because you make bad lifestyle decisions. A lot of our cancers are preventable because we make bad decisions in what we eat, in our environment, how we live our lives, cardiovascular diseases the same way. Diabetes, type 11 diabetes for many people is the same way. And so bad decisions lead us into the pathology and takes us into the disease. Very similar to the addiction model. Bad decisions lead us into a process that takes us into a disease. We should deal with these individuals in the same way we deal with other diseases. Meaning that we should have compassion. We should have some appreciation for what takes place. Even though it is decision making we should understand that all decision making isn’t good and evil, sometimes it is just ignorance or it is not being realistic or it is over estimating your capabilities. So let’s get rid of some of this morality issue that hampers the way that we can deal with these people in a productive way. In it’s extreme it requires professional care. You’d never say to a cancer patient, “Well you go home, you become a better person, and that cancer will disappear.” We say, “Well you go and change your lifestyle. You start taking better care of yourself, but you see a professional that can help you.” Either give you medication or give you radiation therapy or whatever is necessary in order to deal with what’s in place. The same thing applies to addiction. Yes they need to take responsibility and this is their issue. This is their disease and if they are not engaged, if they are not accountable, you are not going to be very productive or very successful in treating it. But having said that, they often times need help. They need professional care. They need a clinician that understands. Sometimes they need medication. And as important as anything else and in some ways even more important, they need understanding from their families, from their community, their neighborhood, their support systems. They need people to show them that they care, they are willing to work with them just as you would care for a person that has other diseases in order for them to be successful and have a productive and positive outcome to the treatment of the disorder of addiction.
Glen: Addiction, despite the fact that it is so wide spread and the issues of drug abuse are so pervasive. I mean if you look at the numbers. The numbers say half a trillion dollars it costs our society every year. Half a trillion. That’s trillion with a T. That’s big dollars and that includes all the costs, includes the medical costs, includes the cost to our criminal justice system, and includes the cost to our personal lives. But it doesn’t take into account the emotional costs. Those you can’t put a number on those. So everybody says yes. It is incredibly important. It covers all aspects of public health and yet most folks are more than willing to sort of sweep it into the corner. It is not very glamorous. I mean it doesn’t have the appeal of a cancer or a diabetes. It’s hard on some of these people to really relate to them, to embrace them, especially some of the extreme cases, the ones who are abusing cocaine or methamphetamine. You see them out under the viaduct or they are being thrown in jail. It is hard for us to relate to them in our nice clean tidy world. They just don’t seem to have a place. So as a consequence we wall ourselves off. We say, “Well someone else should take care of that.” Let’s let the criminal justice system take care of it because we don’t really understand all the biology and the medical pieces to it. Or let’s let the medicare, the public dollars take care of it because that is not the really nice clean disease model that we are used to dealing with and our insurance companies are used to supporting. So it is a step child even though it is a very critical public health issue. It’s one we often times ignore, low priority, we’re less inclined to spend money, and if we do we have this mind set, “All right we’ll spend some money, we’ll get you treatment, you go in for a month or two months. Then you should be clean and you should be fine.” It’s not a disease that can be cured in a month or two months, just like other diseases. Again the diabetes you don’t cure that. That is something that goes on forever. You take insulin forever. You take medication. People that are suffering from addiction, this is probably something they are going to have to wrestle with for the rest of their lives, so a two month treatment approach isn’t going to work. It’s something that requires extensive involvement. But these are people just like us. They had the same desires, the same aspirations, the same goals before they got involved in the addiction as we did. Even now, they would give anything. I think many of them to have normal homes, have a normal job, a normal family that is supportive. Despite yes it was their bad decisions that got them there, but they want to be happy just like the rest of us do. So I don’t think that we should be categorizing them as some alien different species because they got caught up in this issue of addiction. There were issues there and often times they are issues that we have no appreciation for. It is hard for us to walk in the shoes of those people that suffer from addiction. So it is important that we not be judgmental and we appreciate their capacity, we understand their potential, and we work with them to try to develop that potential. Just like we would anyone else. We are understanding more and more about addiction. The science is becoming more sophisticated. We are able to do more things with a lot of our brain imaging strategies. Now we can start looking into brain areas and brain systems and understand. What is going on? Why does it happen? What’s the consequences? And we are having leads. We are developing leads I think that will improve our interventions, that will allow us to develop more effective medications for treating these people. But addiction is not addiction, is not addiction, is not addiction. It doesn’t all come in the same box. It’s almost as varied as the individuals who suffer it. Addiction is a disease of how the brain works. How an individual has a personality. How an individual makes decisions and we all do that differently. So the expression of the addiction disease is going to be highly varied according to who it is that it is effecting. Which means we can’t have cookie cutter type of treatments. These things have to be very individualized. They have to be identified for that person. You need to understand on an individual basis why are they doing this? How long have they been doing it? What type of drugs have they been using? Where are they in the process? What consequences have occurred up to now? And what sort of capacity has been left in terms of how the brain functions when we get them. All of these are critical factors if we are going to treat these people and have a good resolution to that treatment.