FEATURE — Spring 2007

Professor Mark Gold

Explaining the Disease of Addiction

Over the last four decades, alumnus Mark Gold has dedicated his distinguished medical career to the study of the brain and addiction, from tobacco and opiates to food, revealing many new understandings and treatments for addicts.

By Diane Duke Williams

As distinguished professor and chief of addiction medicine at the McKnight Brain Institute at the University of Florida College of Medicine (UFCM), Mark S. Gold has seen the terrible price of succumbing to addictions.

“More than 50 percent of the preventable causes of death are from tobacco, secondhand smoke, alcohol, and other causes of addiction,” says Gold, A.B. ’71, also recently the recipient of the Donald R. Dizney Eminent Scholar Chair. “Addiction is a disease, and physicians need to do more to get patients the help that they need.”

Gold has worked for more than 35 years to uncover the effects of tobacco and other drugs on the brain, which has led to new treatments for addicts. As a result of his research, cocaine was reclassified as an addictive drug in the 1980s. He also has proven how opiates, such as heroin, alter brain function, and he was awarded a patent for the discovery of clonidine, which remains widely used for opiate withdrawal and pain management.

In addition, Gold has determined that proximity can be a factor in addiction. Children who are exposed to secondhand smoke can become physically addicted to cigarettes just from living with parents who smoke. And he discovered that operating room personnel are exposed to drugs from patients who exhale traces of painkillers during surgery, a factor that might contribute to the high addiction rate among anesthesiologists.

Now, he is studying how overeating and obesity relate to addiction.

Gold’s father worked for his family’s leather business in New York City, and his mother was a Juilliard-trained pianist. During a visit to St. Louis, where his business had a Central West End showroom to sell alligator and leather to companies such as Brown Shoe Co., Gold’s father visited Washington University. He convinced his son that the University was the perfect fit for him—it was the only school to which Gold applied.

Gold was an outstanding student, although he describes himself as “impractical,” changing his major several times. One common passion, though, was his interest in brain function, which led him to volunteer with then-Professors John Feighner and Samuel Guze in the psychiatry research program at the School of Medicine.

During his undergraduate years, he based course selection on a professor’s charisma and popularity, and his favorites were former Professors Herb Metz, Peter Riesenberg, Graham Allen, and Rita Levi-Montalcini, an international nerve growth expert and Nobel laureate who taught neuroanatomy.

“Levi-Montalcini was inspiring, daring, decades ahead of her time, and an amazing teacher,” Gold says. “I have visited her on two occasions in Italy and have been very lucky to have had this woman as an inspiration and long-distance mentor! To say she is a genius does not do her heroism and other attributes justice.”

While vacationing with his family in Miami the summer before his freshman year of college, Gold met Janice Finn. Despite the long distance between St. Louis and Miami, their love affair flourished, and they became engaged the summer before his junior year.

Gold graduated Phi Beta Kappa in psychology from the University in 1971 and was accepted at the School of Medicine as well as at Duke University School of Medicine. But his heart lay with Finn, still a junior in college in the Sunshine State, and he chose to attend the University of Florida medical school.

Professor Mark Gold joined the University of Florida faculty in the Department of Psychiatry in 1990 and started an addiction medicine division. Today, the division boasts more than 10 faculty members.

Early in his UF medical school career, Gold taught general neuroanatomy and had principal responsibility for the section on neuropharmacology. And while conducting research in a memory lab, he made a breakthrough discovery: If someone uses amphetamines while studying, he or she will need to take them again to effectively recall the information.

Scientists now refer to this as “state-dependent memory,” which describes how something learned in one situation or “state” is generally better remembered while in a similar situation. In rat studies supported by medical student research grants and fellowships, he linked this discovery to a region of the brain—a tiny area in the stem called the locus ceruleus.

This discovery earned Gold the American Medical Association’s national student research award in neuroscience, and he placed second overall for all research done by medical students in the United States in 1974.

“So I got into this from the research side,” he says. “It’s a complicated area that combines my knowledge of anatomy and my interest in the brain and even philosophy.”

Gold completed a residency in psychiatry at Yale University School of Medicine, during which he and his colleagues determined that the locus ceruleus was the neuroanatomical center for addicts trying to wean themselves from narcotic drugs.

After serving on the Yale faculty for a few years, he wrote popular books and worked doing research in the private sector. He also worked as a consultant to Major League Baseball, the NBA Players Association, the White House, the U.S. Drug Enforcement Administration, and a number of major U.S. corporations.

“More than 50 percent of the preventable causes of death are from tobacco, secondhand smoke, alcohol, and other causes of addiction. Addiction is a disease, and physicians need to do more to get patients the help that they need.”

In 1984, Gold turned the mechanism of cocaine addiction upside down by proposing the so-called “dopamine hypothesis,” a theory about how repeated cocaine use causes a relative dopamine depletion and why that would interfere with motor function and cause anhedonia. This hypothesis has been confirmed by PET and other imaging studies and may lead to new treatments that increase dopamine—a chemical that helps brain cells communicate.

He joined the University of Florida faculty in the Department of Psychiatry in 1990 and started an addiction medicine division. Today, the division boasts more than
10 faculty members.

And Gold, the mentor to many of the nation’s top leaders in drug education and research, has been instrumental in establishing the only mandatory addiction medicine clerkship at a U.S. medical school. “We don’t train physicians to identify and treat drug abusers and dependent people in the same way that we train medical students to deliver babies, respond to a heart attack, or treat high blood pressure. We’re better at treating the cancer that results from tobacco smoking or replacing the liver that results from alcoholism than we are at intervening and then treating the primary cause,” he says.

Gold also serves on the State of Florida’s committee that supervises doctors who have drug problems and helps the committee conduct research on which physicians are at the greatest risk and how best to help physicians who become drug addicts.

Although Gold has received many honors, including a Distinguished Alumni Award from Washington University in 1989 (of which he is extremely proud), one recent award he found particularly gratifying was the Nelson J. Bradley Life Time Achievement Award from the National Association of Addiction Treatment Providers.

“This award was so poignant to me because John Schwartzlose, the director of the Betty Ford Center, said that my career in research has done the most to help explain and destigmatize the disease of addiction to patients and their families,” he says.

Gold and his wife have four children: Their youngest son, Kyle, is a senior at Washington University; Steve is a graduate of Yale University and the University of Florida colleges of law and public health and is interested in public health and policy law; Kimberly, after graduating from Columbia University and doing a post-bac at Harvard University, is a medical student at Yale; and Jessica is a sophomore at the University of Pennsylvania.

Gold says that learning from disparate experts at the University and seeing how they used the scientific method greatly benefited him as a scientist. “I also learned at Washington University that there is no shortcut and that while novel ideas are fantastic, hard work and discipline are essential,” he says.

Diane Duke Williams is a St. Louis writer who contributes to School of Medicine publications and to the Washington University in St. Louis Magazine.