Professor C. Heather Ashton:
A Clinical Pharmacologist’s Influential Contribution to the Field of Psychology.
During the 1960’s, society witnessed an incredible rise in the use of many types of psychoactive substances. Timothy Leary’s influence with LSD experimentation encouraged people to “turn on, tune in, and drop out" (Timothy Leary, n.d) Society was also in the midst of rapid changes with the advent of the Vietnam War, the Feminist movement and the Civil Rights movement. Many followed Leary’s example as it seemed to have become the main theme of the sixties, perhaps as a means to either cope or escape from all that was occurring around them. It was during this period of time that Professor C. Heather Ashton began her career as a clinical pharmacologist. Her contributions are twofold. Firstly her career success as a woman working in a profession that was at one time reserved for men only and doing so during a great period of change for women. Her other major contribution involves her main body of work that has become instrumental in better understanding psychoactive substances and the affect to the human nervous system both physiological and psychological.
Professor Ashton graduated from the University of Oxford and obtained a First Class Honours Degree in Physiology in 1951. She qualified in Medicine in 1954 and gained a postgraduate Doctor of Medicine in 1956. She qualified as a Member of the Royal College of Physicians in London in 1958 and was elected Fellow of the Royal College of Physicians in London in 1975. She also became National Health Service Consultant in Clinical Psychopharmacology in 1975 and National Health Service Consultant in Psychiatry in 1994. She worked at the University of Newcastle upon Tyne as researcher, lecturer, professor and clinician from 1965 until her retirement, first in the Department of Pharmacology and later in the Department of Psychiatry. She is currently retired, but still busies herself in providing education and lectures on her momentous body of work (“Cirriculum Vitae”, n.d.).
The use of psychoactive substances is not new. Alcohol consumption goes back about 8000 years. The bible mentions Noah planting vineyards and later becoming intoxicated from drinking the wine (Ashton, 2005). The administration of psychoactive substances medically has also been widely used by physicians. Through the centuries, alcohol was used medicinally as a major analgesic (Hanson, 1995). Opium was used by Hippocrates, " the father of medicine", for its usefulness as a narcotic in treating certain diseases and epidemics. Later on, physicians lauded morphine as "God's own medicine" for its reliability, long-lasting effects and safety (“Opium Timeline”, n.d.).
Ashton’s work has centred around on the effects of psychotropic drugs such as nicotine, cannabis, antidepressants, benzodiazepines and others, on the brain and behaviour of humans. It is this particular aspect that links her work to psychology. Her main clinical work however, involved her experience and observation of addicted individuals to benzodiazepines while operating a benzodiazepine withdrawal clinic from 1982 to1994 (“Cirriculum Vitae”, n.d.).
Benzodiazepines were discovered, more or less by chance, by Sternbach in 1957 while working for Hoffman La Roche in New Jersey. The discovery occurred during a time when scientists were searching for a substance that would prove to be a safer alternative to barbiturates. Barbiturates, which were the most commonly used sedative, had huge problems with their dependence-producing properties and risk of death from overdose (Ashton, 2005).
In 1970, benzodiazepines replaced barbiturates. They quickly became known as “wonder drugs” because they calmed the mind, relaxed the muscles, controlled insomnia, helped people to tolerate the stresses of life, and were also useful anticonvulsants for people suffering from epilepsy (Ashton, 1989). Twenty years after their discovery, benzodiazepines became the most commonly prescribed of all drugs in the Western world (Ashton, 1989). Benzodiazepines are now classed as one of the most potent drugs earning them the reputation of a drug of dependence (Ashton, 2002). The dangers of this drug are evident, emphasized by the fact that the Government of Canada has listed benzodiazepines as a controlled substance as of June 1, 2000, under the Controlled Drugs and Substance Act. Details of the act with regards to benzodiazepines can be found at http://laws.justice.gc.ca/en/ShowFullDoc/cr/SOR-2000-217///en.
Yet despite Ashton’s warnings about the dangers of the drug on mental and physical health, manufacturing of benzodiazepines has been on a steady increase since their inception. According to Ashton, by 1983 there were 17 different types of benzodiazepines on the market worth nearly $3 billion worldwide. There are now 29 different types of benzodiazepines available in Europe and the USA (Ashton, 2005).
In order to fully understand the impact these drugs have on ones mental and physical health and well being, one may turn to Ashton’s research work on benzodiazepines. Ashton’s research shows that benzodiazepines are valuable in the short term. They can save lives of people suffering from repeated or continuous convulsions or seizures. They are routinely used as pre-medication before surgery and for minor operations in order to provide mild sedation as well as amnesia of the event. For severe anxiety, short term use may help ease a crisis and allow time to arrange longer-term treatment. And occasional use may also provide a night's sleep in times of temporary disturbance. Ashton notes the problem is when benzodiazepines are used in the long term which is defined as regular use for more than one to two weeks (Ashton, 1989).
During Ashton’s lecture, Benzodiazepine Dependence and Withdrawal Methods which was held in Vancouver, BC, on April 4, 2006, she recalls how her involvement with the benzodiazepine withdrawal clinic “happened quite by accident”. She mentions that in 1981 a young woman came hobbling into the research clinic on crutches. This woman was a registered nurse with no previous psychiatric history. She had been injured in a traffic accident with two broken limbs and was plagued by further complications. She had been given a prescription for lorazepam, commonly known as Ativan, for muscle relaxation. After a few months on the drug, this individual began to notice some unusual symptoms that concerned her. She found her way to Ashton lamenting, “…I think I’m addicted, can you help me”. Ashton recalls she naively agreed to help even though she had no experience with drug addiction. Most physicians at the time believed benzodiazepines were not addictive. This individual underwent a withdrawal process noted by Ashtonduring her lecture that “…contributed to numerous withdrawal symptoms such as anxiety, tremor, hallucinations, insomnia, muscle cramps, and many other numerous physiological and psychological symptoms which are now recognized as typical benzodiazepine withdrawal symptoms”. Upon the full recovery of her patient, Ashton noticed that all of her patient’s physiological and psychological symptoms had also disappeared. This lady became Ashton’s first patient with benzodiazepine dependence. Shortly afterwards, a flood of others wanting to get off of benzodiazepines began to appear. This lead to the formal opening of the clinic in 1982 in which Professor Ashton recalls she ran “single handedly” for 12 years until forced to retire. Ashton stated that, “…strangely, none of my medical colleagues, either clinical pharmacologists or psychiatrists wished to take over the clinic in 1994…” Ashton commented on how she feels the current medical training is not equipping doctors with the necessary skills and tools to deal with such an addiction. (“Benzodiazepine Dependence and Withdrawal Methods”, 2006).
It wasn’t until Ashton opened the benzodiazepine withdrawal clinic that her warnings about the dangers of benzodiazepines began to manifest itself into a more urgent and serious way. Ashton has published approximately 250 papers in professional journals in which 50 were concerning benzodiazepines (“Cirriculum Vitae”, n.d.). Yet it seems her warnings about these drugs continue to go unnoticed. According to the Therapeutics Newsletter dated November 2004, benzodiazepine use in British Columbia increased by 11% between 1996 and 2001 (“Use of Benzodiazepines in BC: Is It Consistent With Recommendations”, 2004). This complacent attitude towards addressing her warnings may be contributed to current attitudes or trends of society which at times seem driven by the motto, ‘a pill for every ill’. It may also be an indirect reflection of Ashton’s gender in a once male-dominated profession along with the fact that women are still prescribed benzodiazepines more than men (“Use of Benzodiazepines in BC: Is It Consistent With Recommendations”, 2004). Aston’s body of work is not only testimony to her dedication and commitment but also reflective of her humanity.
During the 12 years the clinic was in operation, over 300 patients passed through its doors and over 90% successfully withdrew from their addictions (Ashton, 2005). When she started the clinic, Ashton noted that there were no proper methods or protocols for withdrawal from benzodiazepines because of the erroneous belief that such drugs were not addictive. Her involvement in the clinic provided her with a tremendous amount of information which was gathered, recorded and analyzed. From this information, Ashton developed methods for withdrawal from benzodiazepines that she found the most successful. She published the results in a manual called, Benzodiazepines: How They Work and How to Withdraw otherwise referred to as The Ashton Manual. It was initially written in 1999 and then revised in 2002. This manual is considered a world renowned medically approved document that provides detail information of the dangers of a drug once touted as non-addictive. It also includes detailed schedules for withdrawal from benzodiazepines. Many medical and mental health professional bodies have approved of its use. The College of Physicians and Surgeons of BC classed the manual as a guide for physicians to educate and help patients properly get off benzodiazepines. The manual can be located from the main web page of the College of Physicians and Surgeons of BC in the Library section of Recommended Online Resources, Consumer and Patient Education (https://www.cpsbc.ca/cps/college_library/online/type/e-Books ).
Ashton’s body of work from the clinic has stimulated more research into how benzodiazepines work in the body and their affects on behaviour. This in turn has shed new light on the workings of the brain and on the neurophysiology of anxiety (Ashton, 1984). Ashton noted that tolerance and withdrawal symptoms of benzodiazepines can mimic other types of psychiatric and psychological disorders resulting in diagnostic errors. Some of the withdrawal symptoms she mentions includes; perceptual distortion, hallucinations, delusions, paranoid thoughts, unreality, depersonalization, agoraphobia, depression, and suicidal ideation to mention a few (Ashton, 1984). From a cognitive psychological aspect, Ashton noted the effects these drugs have on cognitive processing particularly memory in individuals who had experienced prolonged usage of benzodiazepines. She discovered that episodic memory was more impaired than somatic and immediate memory and retrieval of memory from long-term stores. Specific defects in visuospatial ability and sustained attention have also been described in long-term therapeutic dose benzodiazepine users. These symptoms gradually improve about one year after withdrawal of benzodiazepines but can take longer (Ashton, 2004).
From a neuropsychological perspective, Ashton noted that here is evidence that long-term or high dose benzodiazepine use may actually cause structural brain damage (Ashton, 2004). Some of the CT studies that were conducted on several individuals yielded the following results; signs of cerebral atrophy in high dose benzodiazepine usage and cerebral ventricular enlargement in 17 long-term, high dose benzodiazepine users who had never abused alcohol. However, Ashton suggested that further research needed to show whether or not benzodiazepines can cause permanent neurological damage (Ashton, 2004).
During her lecture, Benzodiazepine Dependence and Withdrawal Methods Ashton commented about the current state of benzodiazepine usage. She said, “…change is slow”. Although her work has made great contributions benzodiazepines are still prescribed in large numbers. To date, there continues to be no formal treatment centres or clinics to help deal with this unique addiction. Ashton’s work has been successful in the creation of many private support groups that continue today. These groups utilize her method of treatment for benzodiazepine addiction by use of the Ashton Manual as the support tool. In her conclusion Ashton mentioned, “…much more is needed to be done…(“Benzodiazepine Dependence and Withdrawal Methods”, 2006)”.
Even though Professor Ashton is technically retired from clinical practice, she maintains a busy schedule as lecturer and educator where she continues to give advice on benzodiazepine problems. Her current involvements include the North East Council for Addictions as well as her work as a patron of the Bristol & District Tranquilliser Project in Britain. She was a generic expert in the UK benzodiazepine litigation in the 1980s along with involvement with the UK organization, Victims of Tranquillizers. She has submitted evidence about benzodiazepines to the House of Commons Health Select Committee in Britain as well as evidence to other various Government committees on tobacco smoking, cannabis and benzodiazepines in the UK, Australia, Sweden, Switzerland and other countries. She continues to be an outspoken advocate of education about the dangers of such psychoactive drugs and their effects on the brain and behaviour.
Ashton, Heather, C. (2005) “History of Benzodiazepines: What the Textbooks May Not Tell You”. Third Annual Benzodiazepine Conference, Bangor, Maine. 12 October 2005. Retrieved February 7, 2007 from Web Site http://www.psychmedaware.org/History%20of%20Benzodiazepines.html
Ashton, Heather, C. (2004) Protracted Withdrawal Symptoms From Benzodiazepines. Comprehensive Handbook of Drug & Alcohol Addiction. Retrieved March 28, 2007 from Web Site http://www.benzo.org.uk/pws04.htm
Ashton, Heather, C. Benzodiazepines: How They Work and How to Withdraw; aka The Ashton Manual. (Newcastle upon Tyne: School of Neurosciences, Division of Psychiatry, 2002) [Electronic Version] Retrieved February 7, 2007 from Web Site http://www.benzo.org.uk/manual/index.htm
Ashton, Heather, C. (1994) Guideline for the Rational Use of Benzodiazepines: When and What to Use. Review Article from: Drugs 48, 25-40. Accessed March 27, 2007 from Web Site http://www.benzo.org.uk/asgr.htm
Ashton, Heather, C. (1989) Anything for a Quiet Life. New Scientist. [Republished online with revisions by the author]. Accessed March 28, 2007 from Web Site http://www.benzo.org.uk/afaql2.htm
Ashton, Heather, C. (1987) Dangers and medico-legal aspects of benzodiazepines, J. Med Defence Union, 6-8. [Electronic Abstract] Accessed March 27, 2007 from Web Site http://www.benzo.org.uk/uaq1.htm
Ashton, Heather, C. (1986) Adverse Affects of Prolonged Benzodiazepine Use. Adverse Drug Reaction Bulletin. 118. Accessed March 28, 2007 from Web Site http://www.benzo.org.uk/adv.htm
Ashton, Heather, C. (1984) Benzodiazepine Withdrawal: An Unfinished Story. British. Medical Journal 288. Accessed March 28, 2007 from Web Site http://www.benzo.org.uk/ashunfi.htm
Benzodiazepine Dependence and Withdrawal Methods. Lecture by Professor C. Heather Ashton, Vancouver, BC. Psychiatric Medication Awareness Group & Focus Consultants, 2006.
Curriculum Vitae, (n.d.). Ashton, Heather, C. Retrieved February 7, 2007 from Web Site http://www.benzo.org.uk/ashcv.htm
Hanson, David J., (1995) Preventing Alcohol Abuse: Alcohol, Culture and Control Wesport, CT: Praeger. Accessed March 24, 2007 from website http://www2.potsdam.edu/hansondj/Controversies/1114796842.html
Opium: A History (n.d.).Booth, M. Simon & Schuster, Ltd., 1996. Accessed March 25, 2007 from Web site http://opioids.com/timeline/index.html
Timothy Leary (n.d.) Erowid Character Vaults. Accessed March 24, 2007
Use of Benzodiazepines in BC: Is It Consistent With Recommendations (2004) Therapeutics Newsletter. Department of Pharmacology & Therapeutics, University of BC. 54, 1-2. Accessed March 30, 2007 from Web site www.ti.ubc.ca .