Mark Gold: "It’s unlikely for it to be one disease, and to have one cure for everyone"

The hits keep coming on “10 Words or Less,” the feature in which I ask brief questions of interesting people and request brief answers in return. Today’s participant is one of the foremost living experts on addiction. He is a Distinguished Alumni Professor and the Donald Dizney chair of the Department of Psychiatry in the University of Florida College of Medicine. Before we proceed, here’s the usual “10 Words” disclaimer: "Ten words" is an ethic, not a limit, so please, no counting. Besides, if you think it’s easy, let’s see you do it.
Name Mark Gold, MD
Residence Gainesville, Fla.
Born when, where New York City, May 1949
A formative experience "Listening to my mother, a Julliard-trained pianist, play the piano, and watching her give piano lessons."

What did you want to be when you grew up? "I really didn’t know. At one point, I wanted to be a history professor. At another point, I wanted to be an English professor. Then a psychology professor. And then I found neuroscience while at Washington University in St Louis."
Family circumstance "Married 42-plus years, 4 children, 3 grandchildren."
A favorite pastime outside of work “Thinking."
Some wisdom you’ve gained from that “I have a list of patents and inventions. My mind experiments are important to me and some of them have been relevant to my career, But all the time I’ve spent thinking about problems has at least helped me formulate approaches and solutions. So I spend a lot of time thinking, rather than doing."
Something you like to do outdoors “Run."
What’s your best time? "I’ve never been in a race."
Someone outside your family who influenced you "A recently deceased uncle, Louis Stoll. He was a scientist and generally great thinker. Early in my life, grade school and so forth, he was my science mentor and helped me think about physics and chemistry and understand the literature."
Do you have close nonprofessional experience with addiction? “No."
Is it a malady of the mind or the body? “If you think about it in 1971, they didn’t even think that tobacco smoking was addicting. So addiction in '71 was the presence of a physical withdrawal syndrome. Experts now consider withdrawal to be a sideshow. They would say addiction is a disease of the brain."
Are drugs the best way to arrest addiction? "That’s more of an experimental question. People in the field know that addiction develops over time, and also now appreciate that it develops more quickly in some than others. The process is highly variable, [including when the age at which exposure begins, trauma experience, and prenatal conditions] It’s unlikely for it to be one disease, and to have one cure for everyone.
     “I think a lot about this. I once went to Ireland on a UN trip, or maybe it was World Health Organization consulting. The question was whether the gene for alcoholism was present in Irish people. and whether that explained why there were so many families with generations of alcoholism. My approach was to see about the prenatal diet and advice that mothers were given when they were pregnant. Many of the women were encouraged to drink beer for its iron content and nutrient value! There were ad campaigns encouraging women to drink beer during their pregnancy. It was clear to me that instead of over-ascribing to the genetic basis to the number of alcoholics, we could say part was genetics and part was epigenetics and exposure."
Is one substance particularly worse than others? "Tobacco. Even to this day, the most common addictions on the planet are tobacco-related. In the US, the No. 1 cause of addiction-related death is smoking and second-hand smoke. Second hand smoke should never be underestimated."
Does food addiction exist? "Definitely. It’s not really a question to me. The basic scientific evidence is very strong, at least for constituents of food having reinforcing effects that appear like drugs of abuse, causing binging, loss of control, and drug-like neurochemical changes in the brain."
Is all obesity explained by food addiction? "No no no no no. Not at all.”
Care to estimate how much of it is? “It's difficult to determine, but I think we’ll figure that out over the short period of time. I don’t think that’s going to be debated forever."
Can we say a substance is addictive, since it might be to some and not others? “We can say that in animal experiments of non-human primates living in the wild, it’s pretty clear that animals that have different preferences. … I think it’s better to say there’s wide variation and diversity. It’s likely that some people conserve a lot of energy from every meal, and some people are born with different metabolisms, and maybe there are lessons in those extremes that will help us develop new treatments."
A way in which public perceptions have changed “Addiction is recognized as a disease now and the need for treatment is recognized as not simply the addicts' fault. First use is voluntary but addiction is a disease of the brain. … However much scientific progress has been recognized and some things have changed, shame, stigma, and discrimination are still common for addicts."
A way in which obesity research should change? “Many researchers are working on diabetes or nephrology or orthopedics. They’re in the consequences instead of the disease itself. I think attempts to focus on causes and prevention strategies and early intervention and treatment will bring everyone back to the food-brain interactions and how to think about the hijacking of the brain."
Is sustainability a global issue or a personal one? “It's a global issue, but every person has a role to play."
Something that sustains you "I’m an optimistic person and I enjoy my work and really enjoy helping other people. I think that giving is sustaining."



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