CDAP: Overview of MUSC’s Center for Drug and Alcohol Programs
Guest: Dr. Ray Anton – Psychiatry & Behavioral Sciences, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: Dr. Ray Anton is Professor of Psychiatry and Director of the MUSC Center for Drug and Alcohol Programs. Dr. Anton, give us an overview of the guiding mission and philosophy behind CDAP.
Dr. Ray Anton: First of all, thank you, Dr. Austin. It’s a pleasure to be here and talk with you about this, and to try to educate the MUSC community, and beyond, as to who we are and what we do. CDAP started about 15 years ago with the general thinking that there needed to be great improvement in the understanding and treatment of alcoholism and other addictions, and substance abuse. And we thought the best way to do that was to join basic scientists with clinical scientists and clinicians so that the clinical presentations and phenomena that we observe could be translated into very basic science questions, so we can understand, at a very molecular level, what addiction is and what it means to people. So, from the beginning, we put basic scientists and clinical scientists together, to mingle their offices and their laboratories, and space, in order to have a holistic approach to better understanding and prevention of alcoholism and other addictions.
People don’t start out, necessarily, wanting to become an alcoholic, or addicted, but after time and exposure, the brain changes such that there’s a biological and neurological, or neurochemical, underpinning of most addictions. So, our general aim and philosophy is to try to understand that biological underpinning of addictions, which then could lead to new and improved treatments, such medications, for these disorders.
Dr. Linda Austin: What are some of the most interesting areas of research going on currently at CDAP?
Dr. Ray Anton: Well, like most neuroscience in the country right now, the big, exciting thing that’s happening, particularly in human research, is the use of brain imaging technology to understand what’s different about an addicts brain versus someone that isn’t; or a social drinker versus an alcoholic. How do they react differently to alcohol and environmental stimuli that are similar to alcohol; like pictures of alcohol, and things like that? So, we’re using very sophisticated brain scanning techniques, which we call functional neural imaging, to understand the differences between alcoholics and non-alcoholics, or cocaine abusers and non-cocaine abusers, for instance.
Another big area that we’re quite excited about is genetics. We’re starting to understand the differences that people have in genetic structure, that they’ve inherited from their families, or beyond. Each of us has a slightly different genetic structure. Even though we’re mostly the same, there’s quite a bit of difference, some of which is not subtle. That may lead to a different response, or reaction, to abusable substances like alcohol, cocaine, heroin, or nicotine. So, we’re trying to understand at a more genetic level how people may respond differently, particularly to alcohol, and how this might predict response to certain medications; a field called pharmacogenomics. So, we take people’s blood. We analyze it in a laboratory. We understand some subtle differences between them. We have a lot to learn, although we have some exciting early findings as well.
Dr. Linda Austin: Here’s a question, and it may be too complex to answer simply in this medium. But, let’s take a person with alcohol addiction versus one who does not. The one who doesn’t have the addiction might go to a party and know themselves well enough to know that one or, maybe, two glasses of wine is plenty, and beyond that, they don’t drive; they get too sleepy or out of control. The person who has the alcohol addiction might know the same thing. But once they’ve had their first drink, it becomes easy to have a second drink. And once they’ve had a second drink, they really want that third drink. And once they’ve had a third drink, they want a fourth. What is the difference in the brains of those two people?
Dr. Ray Anton: Well, if I knew that, exactly, I’d probably win the Nobel Prize, but we have some hints of that. One hint is it appears that people that drink more heavily seem to have less sedation from it and more stimulation. So, where you or I might have several drinks and feel tired and want to go to sleep early, for people that are heavy alcohol consumers, they may actually get stimulated and feel more awake and more alive, and more energetic, and then would want three or four more of those to sort of keep that feeling up. So, it’s partly that.
There are other people that, because of stress or anxiety, or mood, may feel a little anxious or on edge a bit of the time. And, for them, actually, it’s a little different. They actually enjoy the sedative effect of alcohol. It calms them down. It allows them to get to sleep a little bit easier, and to be less irritable around their family, at least initially, with lower-level drinking. So, there are differences in people that cause them to drink differently.
Another area which we’re getting more excited about is the whole area of impulsivity. People are probably born with an underlying difference in neurochemistry which causes them to react more quickly for pleasure and reward, and stimulating circumstances; like the impulsive shopper, the impulsive gambler, people that do things without putting much thought into it. They do it because it feels good or seems like the right thing to do. We think that impulsive people tend to drink more easily, and drink more, and have, perhaps, less of a brake mechanism in their brain that sort of tells them this may not be good for them the next day. They react more to the immediacy of the moment. And all these are different subtypes which we’re trying to understand a little bit more, both from the presentation symptom point of and view and the genetic point of view.
Dr. Linda Austin: Dr. Anton, thanks so much for talking with us today.
Dr. Ray Anton: Thank you.