Prof Jonathan Chick – Castle Craig's Medical Director

Professor Chick is the Medical Director at Castle Craig Hospital in Scotland. He is currently chief editor of ‘Alcohol and Alcoholism’, which is the official journal of the Medical Council on Alcohol.

He is an elected member of the scientific council of the Société Française d’Alcoologie (SFA) and is a member of the board of trustees of the General Services Office of Alcoholics Anonymous in the UK.

Professor Chick is also the author of Understanding ‘Alcohol and Drinking Problems’, in association with the British Medical Association.

Career

Professor Chick’s career began at Dingleton Hospital in the Scottish Borders. The hospital had become famous for its therapeutic community back in the 1950s and 1960s. Jonathan’s stint at Dingleton directed him to visit a project in Paris, where a local Parisian Council (13th Arrondissement) and the sector psychiatrist decided to close down St Anne’s Asylum and use the funds to build a very small new hospital in the suburbs which would provide outpatient and hostel facilities for their psychiatric population.

At the time this was very innovative and attracted the attention of Hugh Freeman, who was then editor of the British Journal of Psychiatry. Jonathan’s research on the 13th Arrondissement Project became his first ever publication. His experience was formative in that he saw the benefits and pitfalls in trying to manage serious mental illness in the community.

Jonathan’s 13th Arrondissement research also strongly influenced his psychiatric career. His first post was as a senior officer to Dr. Bruce Ritson, whose work in Boston mirrored that of Chick’s in Paris. And later, the consultant post taken by Professor Chick at the Royal Edinburgh Hospital brought services much more into the community using local resources.

Edinburgh Medical School

While at Edinburgh University Medical School, psychiatry was always on the horizon, but not alcoholism or addiction. Jonathan’s alcohol interest came from Norman Kreitman, a very clear-thinking psychiatric epidemiologist, who was directing a Medical Research Council (MRC) unit.

Chick’s most memorable alcohol-related moment happened during these years. Jonathan had been an avid reader of The Divded Self by R.D. Laing and suggested that he be invited to speak at the Annual British Medical Association Medical Students Lecture. Things didn’t go as smoothly as planned. Jonathan helped a very drunk Laing off the train from London and helped him to the lecture theatre, where some of the great minds of Edinburgh University had gathered. Laing had reservations about institutional medicine, and this quickly became obvious from his slurred speech; soon enough several senior members of the psychiatric establishment began exiting in disapproval.

Professor Chick went from the epidemiological unit to the position of consultant psychiatrist at Royal Edinburgh Hospital, a position he held for 31 years. Initially the consultant post was created to develop out-patient and community services; hence Chick was almost full-time in alcohol related work.

Drug abuse was much less frequent at the time and it had more stigma than alcoholism, psychiatrists were galvanised to do something in Edinburgh about drug problems following Dr. Roy Robertson’s research. Dr. Robertson announced to the Edinburgh population that 50% of injecting users were HIV-positive. This really struck a chord among the middle-classes and a drug treatment service was swiftly established. Jonathan helped with this enterprise while running a separate alcohol service clinic.

Professor Chick had considerable influence on two major streams of work that guided the Scottish Health Service. One was the SIGN Guideline on the management of alcohol misuse and dependence in primary care. Strict clinical guidelines began being formulated since the early 1990s, but by 2002 internationally recognised guidelines were absent for alcohol related treatment.

This delay was largely precipitated by the view that self-reported statistics was all that the literature on alcohol had to go by, and hard-headed statisticians naturally took issue with this. Jonathan and his team brought along reports on treatment outcomes and studies that had been conducted to present the evidence which prescribed methods to address alcohol problems in primary care.

The second major stream was the Health Technology Assessment for alcohol dependence, and this would now include health economic evaluation. The SIGN guidelines never went into health economics and relative costs of what the guidance was, but the Health Technology Group was specifically interested in cost-effectiveness. Jonathan and others realised that while alcohol treatment could cost thousands, it could cost the Health Service tens of thousands later on if adequate treatment was not provided.

For a full profile of Jonathan Chick, see the following link for an in-depth interview, published in the journal Addiction. http://onlinelibrary.wiley.com/doi/10.1111/add.12603/pdf