Psychiatry Of Meth Addiction

Where did you receive your schooling and training?

I finished high school at Punahou, and then went to Princeton for an undergraduate degree in philosophy and pre-medical preparation. I was in the first graduating class of John A. Burns School of Medicine here in Hawaii. My graduate training was in the Navy.

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Dr. William Haning

What interested you in psychiatry and addiction medicine?

I spent 15 years in emergency medicine and occupational health, and a disproportionate percentage of my patients in emergency medicine ― whether at Straub, Pearl Harbor and Schofield, or as medical director at OCCC ― had alcohol and drug use disorders. As the medical director of the alcoholism treatment facility at Tripler Army Medical Center, I became aware of how much more my patients needed from me than I was able to give. I went back in my 40s and took a psychiatric residency, and then joined Tripler’s Department of Psychiatry, and we set up an addiction psychiatry training program. I now work almost exclusively with addictive disorders.

Can you talk about your work with methamphetamine use disorders?

As principal investigator and co-director of Pacific Addiction Research Center, I specialize in studying methamphetamine use disorders. We have done multiple clinical trials, that is, studies involving types of treatment for methamphetamine dependence. My department was chosen by National Institute of Drug Abuse to participate in these clinical trials based on the staggeringly large presence of methamphetamine in Hawaii.

Methamphetamine use crosses over generations. In many households, its use may be seen among grandparents, parents and children. It has become an enormous driver of the economic engine associated with crime here in Hawaii. It is the most difficult addiction to treat, beyond alcoholism, and has arguably most severely injured the people who are worst able to deal with it: adolescents, Native Hawaiians and Pacific Islanders, and laborers, such as restaurant and construction workers, and hotel service employees.

Methamphetamine use inflicts severe injury on adolescents during the process of growing up, in a time that their young brains and hearts are still maturing. Native Hawaiians and Pacific Islanders are populations with the least exposure over the centuries to alcohol and intoxicants, other than perhaps kava, and may thus be more susceptible. And for laborers, there’s an economic impact, as far as damage to health and risk for injury.

Can you talk about the process of addiction?

When methamphetamine is first used, it is perceived as a performance drug. It seems to enhance alertness, extend endurance and take the edge off boredom that may be associated with strenuous, tedious employment. Customarily, someone looking for methamphetamine may most easily find it in restaurant kitchens, at construction sites, in factories where repetitious piece work is required. Folks begin to use this to get through the day and, at first, it appears to help. But as it is progressively used, the need for more frequent doses increases. There comes a time when the habitual user is taking the drug not so much for its exciting or beneficial effects, but simply to get through the day. Long-term use is associated with depression, as well as loss of impulse control, and psychosis. More simply, you become sad, stupid and really sick. Crazy sick.

Can you talk about the process of quitting meth?

It is very difficult for folks who have been using for years, sometimes even only for months, to stay stopped. They lack energy and motivation. Their sleep is disturbed. They are depressed. They cannot organize their thinking, and concentration ranges from difficult to impossible. Some of the psychotic symptoms, such as illusory visions and voices ― hallucinations ― persist. When this has been going on for weeks, it’s discouraging. When it goes on for months, it is completely demoralizing. At some point, it is not about having the will to stop using the drug, it is about not having the will to do anything, to care about anything, to maintain relationships or hold jobs or just plain show up. The key to recovery is persistence.

There is a set point when the biologic damage done to the brain by methamphetamine use has healed enough that people begin to feel normal again. This seems to be in the vicinity of one year after halting the drug use. The evidence for this is striking, and includes sophisticated imaging as well as behavioral testing. It is why long-term treatment programs tend to have a better record in managing this problem.

Anything else you’d like to mention?

Ask: Who is the most susceptible population, the most damaged population and the population for whom the greatest amount of immediate good could be done in treatment of all forms of addictions?

Answer: Inmates. And everyone else embroiled in the criminal justice system.

Fortunately, there are remarkable people in Hawaii working hard for this population. Judge Steven Alm has done more good for the development of addiction management than any number of medical specialists in this field. He has devised a variation on drug courts called HOPE (Hawaii’s Opportunity Probation with Enforcement). And he has done so through the simple recognition of how we relearn good behaviors and unlearn bad ones.

Additionally, the present medical director of the state prison system, Dr. Lori Karan, a professor on our faculty, is a national expert in addiction medicine. She came to Hawaii and her present job expressly with the intent of improving the quality of care of prison inmates, focusing on substance use disorders. Her interest reflects the enormous public health problem posed by incarceration of people with addictions. If they do not get the care that they need, then they continue to cycle and recycle through the system, creating havoc for themselves, their families and the people around them — and unwillingly. Nobody sets out with the objective of becoming an addict and becoming disliked. This is an illness state that commonly has bad behavior associated with it, as well as impaired judgment.

For those in recovery, there is a unique experience ― they are returned the life that they had once been given, with an opportunity to do it over. It is one of the few illness states, at least among chronic and progressive illnesses, where it is actually possible not merely to halt the progress of the illness, but also to evolve and improve the life and health of the patient. People don’t just

stop getting worse in this class of illnesses. They actually get better.

Dr. Haning’s psychiatric work earned him Hawaii Medical Association’s designation as 2014 Physician of the Year. For more information on substance abuse education or assistance, email haning@hawaii.edu.