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“Because of the increasing rates of obesity, unhealthy eating habits, and physical inactivity, we may see the first generation that will have a shorter life expectancy than their parents.”

U.S. Surgeon General,
Richard Carmona,
March 2004

Presenters


Mark Gold, MD

Dizney Eminent Scholar and Distinguished Professor at the University of Florida, College of Medicine’s Brain Institute and Chairman of the Department of Psychiatry.

BIOGRAPHY:
Mark S. Gold, M.D. is a Dizney Eminent Scholar and Distinguished Professor at the University of Florida, College of Medicine’s Brain Institute, Departments of Psychiatry, Neuroscience, Anesthesiology, Community Health & Family Medicine. Dr. Gold is the Chairman of the Department of Psychiatry. He is a Distinguished Fellow of the American Psychiatric Association (2003), University of Florida College of Medicine 2003 Exemplary Teacher , Underrepresented Minority Mentor (2004), UpToDate’s Addiction Medicine Section Editor, American Academy of Addiction Psychiatry (2005; Founder’s Award), 24th Annual Nelson J Bradley Career Life Time Achievement Award (2006), DARE’s Public Service Award (2007), Teacher of the Year, researcher, and inventor who has worked for over 35 years to develop models for understanding the effects of tobacco and other drugs on the brain and behavior. Dr. Gold has developed animal models which have led to new treatments for addicts and also conceptualized hypotheses which were more-than novel but also yielded new approaches to treat patients.

Gold’s major research focus has been on developing animal or laboratory models and bringing them from concept to therapy. Dr. Gold’s work on the brain systems underlying the effects of opiate drugs led to a dramatic change in the way opiate action was understood. Gold’s work on cocaine let to a complete change in thinking about cocaine’s addiction liability, acute and chronic actions. Current NIDA Director, Nora Volkow, M.D. has cited this work and Gold for changing the focus of addiction treatment from withdrawal to drive for the drug. In addition to theory, Dr. Gold’s research has led to changes in the treatment of opiate and cocaine addictions and also obesity. Over the past decade, Dr. Gold has pioneered the hypothesis of hedonic overeating or pathological attachment to food as an addiction. Gold’s group first proposed overeating, binge eating and obesity as hedonic, drug-abuse like events in the 1990s and has reported research for the past decade in this important area of public health and treatment development. This work led to new approaches to treat the obese as well as to prevent overeating in recent post-addicts. Drs Brownell and Gold recently (7/07) brought many of the nation’s experts in obesity, drug abuse and addictions together at a think tank held and hosted by Yale University.

Since beginning his career in research at the University of Florida in 1970, he has been the author of over 900 medical articles, chapters, and abstracts in journals for health professionals on a wide variety of psychiatric research subjects and authoring twelve professional books including practice guidelines, ASAM core competencies, UpToDate, and CMEs.

For a complete biography on Mark S. Gold M.D.: http://www.psychiatry.ufl.edu/faculty/gold-mainshort.shtml

PERSONAL STATEMENT:

As a researcher who has studied drugs of abuse and addictions since 1972, I was amazed at the similarities between overeating and obesity and drug use. Up to that point the World Health Organization had defined opiates as drugs that reversed opiate withdrawal. I remember our group’s excitement when we discovered that clonidine was safe and effective at reversing opiate withdrawal signs and symptoms and was not itself opiate drug. Sadly, though clonidine worked for detoxification, it did not change the outcome or course of the disease of addiction leading me to conclude that withdrawal was a distraction. Addictive disease is a process that changes priorities, decision making, reinforcers and drives.

I remember studying human cocaine abuse in the late 70s and early 80s when cocaine was not considered addicting by organized psychiatry. The study of cocaine dependence liberated us from the notion that a drug dependency was automatically associated with a severe or even demonstrable abstinence syndrome. It naturally followed that experts would go on to show that gambling could be addictive followed by sex and sexual addictions. Food, not just food but great food or highly palatable and reinforcing foods, was next.

Fifteen years ago, I chaired ASAM symposium entitled “Is Overeating an Addiction” which turned into more of a debate. I presented descriptive evidence supporting this hypothesis. Tobacco, amphetamine or cocaine cessation was always accompanied with long lasting overeating. In fact, rebound hyperphagia, overeating, and obesity were such common problems in drug treatment settings, that many had developed prophylactic diet and exercise programs.

All of this clinical wisdom suggested that drugs and food competed in the brain for the same reinforcement sites. Other support for this notion came from the neurobiolgical facts. If drugs of abuse are powerful hijackers of the brain and motivation, they must do this by specific interactions with existing pathways that are species survival –specific. Later, I organized a Journal of Addictive Diseases special issue on this subject which were some of the first to present animal and human data and to seriously consider the possibility and salience of the addiction model.

Last year, I had the chance to help organize and Co-Chair, a “think tank” of national experts on Obesity and Addictions held at Yale University. I also chaired another ASAM Symposium on Overeating and Pathological Attachment to Food as Addictions in Toronto. The talks showed how far the field had come and how much evidence existed for hedonic overeating and the addiction model. Basic neurobiological studies now support the common pathways between food and drug reinforcement.

Obesity is a major, often ignored, world-wide public health problem. Continued compulsive overeating and loss of control over food can cause shame, guilt and depression like those seen in other addictions. Like cigarette smokers know that smoking can cause heart disease and cancer, obese patients know that their continued overeating will likely cause them to have a shortened life with numerous medical illnesses. They, however, are powerless to cut down on their overeating and lose weight despite realizing that their eating is a major problem. Obesity is so all-consuming and compelling that the most effective current evidenced based treatment is not pharmacological or psychosocial but surgical. New treatments are probably a decade away. addiction and addiction treatment models can work, offer hope and decrease shame, guilt and stigma. Early identification, interventions, diet and exercise are treatments of choice.

PUBLICATIONS:

Body Mass Index and Alcohol Use

Weight Gain after Adolescent Drug Addiction Treatment and Supervised Abstinence

Adolescent Drug Addiction Treatment and Weight Gain

Interaction of Satiety and Reward Response to Food Stimulation

Overeating, Binge Eating and Eating Disorders as Addictions

Eating Disorders, Overeating and Pathological Attachment to Food