Psychologist Alan I. Leshner served as director of the National Institute on Drug Abuse for seven years, during which time he put NIDA and drug abuse research on the map, increased our understanding of the scientific underpinnings of addiction, and placed science squarely in the center of the nation’s policies on drugs. He also expanded the depth and breadth of NIDA’s behavioral science research and training portfolio, and made great strides in linking basic and clinical research for the development of behavioral treatments for drug abuse. APS Executive Director Alan Kraut sat down with Leshner, an APS Fellow and Charter Member, on the eve of Leshner’s departure from the Institute, to take a look back at Leshner’s career, to talk about the advancement of psychological science, and speculate on Leshner’s next challenge as executive director of the American Association for the Advancement of Science.
KRAUT: You’ve had a long and distinguished career in public service for 22 years, including stints at the National Science Foundation, and the National Institute of Mental Health. For the last seven years, you’ve been director of the National Institute on Drug Abuse, one of the National Institutes of Health. You’re the highest ranking psychologist in federal government. Now you’re going to the private sector, to become executive director of American Association for the Advancement of Science (AAAS), the publisher of Science magazine, arguably the most important scientific association in the world and the most influential scientific journal.
I appreciate your willingness to talk with me about your career and reflect on what you’ve accomplished along the way.
THE PRE-NEUROSCIENCE DAYS
LESHNER: No, ‘neuroscience’ was not a word when I was a graduate student. Everyone who later became a neuroscientist was either an anatomist, a physiologist, or a physiological psychologist.
KRAUT: What was your first academic position?
LESHNER: I started out at Bucknell University, where I was one of the first physiologically-oriented members of the psychology faculty. Because I was interested in the physiology of abnormal behavior in addition to the basic science that I was doing, I was viewed as an anathema. The view at the time was ‘How could you believe there was such a heavy physiological component to psychopathology?’
KRAUT: You were at Bucknell for how long?
LESHNER: I was on the faculty of Bucknell for 12 years although I was only there continuously for seven. I took a series of sabbaticals: Went to the Wisconsin Primate Center, did a sabbatical at the Weizmann Institute of Science in Israel as a Fulbright scholar, then spent my last two years on leave at the National Science Foundation.
THE ACCIDENTAL DEPUTY
KRAUT: In 1988, you came to the National Institute of Mental Health. How exactly did you get there?
LESHNER: Basically by coincidence. I was having lunch with Jim McGaugh at a COGDOP [Council of Graduate Departments of Psychology] meeting. During a presentation, the new NIMH director Lew Judd said he was looking for a deputy. Jim asked me if I wanted to be deputy, and I said “not at all.” And six months later I became the deputy.
KRAUT: Let me point out the APS connection here. That was Lew Judd’s first official presentation as the brand new NIMH director. In fact, he came to COGDOP at the request of APS. I was working with the then-COGDOP Board to arrange for him to be speaker, and Jim McGaugh, who was APS president at the time, was making a presentation to COGDOP on behalf of the Society.
LESHNER: That’s right. And Jim and I were friends and colleagues because we shared an interest in neurobiology.
KRAUT: So six months later …
LESHNER: Six months later I went to NIMH. I had been an NIMH grantee so I knew the institute supported basic science. But I discovered it had all these other programs. For example, Lew asked me to get involved in strengthening some of the demonstration programs. I had to ask him “what’s a demonstration?”
Lew and I together built neuroscience as a core of what NIMH did, and also strengthened the behavioral science portfolio. NIMH had always been a strong supporter of behavioral science but we broadened that portfolio significantly.
KRAUT: Then when Lew Judd left, you became the acting director. You know what was interesting. I’ve seen lots of comings and goings at NIH and NSF. It’s unusual to make the kind of impact you made as the acting director of an institute. Usually, acting directors are caretakers – they keep the place going until a new director is selected.
LESHNER: Well, nobody told me the acting director is supposed to be just a caretaker. Perhaps foolishly, I thought the acting director was supposed to act like the director. So I proceeded to build on the initiatives that Lew and I had already begun, and to start my own initiatives, like expanding treatment research in mental health. I don’t believe we have a separate mind and separate body, so I thought it was important to look at ways in which pharmacological and behavioral treatments could complement each other. But at the time, NIMH didn’t have a treatment branch. One of the things I did was to develop the treatment focus and try to expand both behavioral and pharmacological treatment.
KRAUT: There were many other programs you developed at NIMH, most of which are still there, and all of which had an impact on direction of research on mental health and mental illness, on basic science, neuroscience and behavioral science.
LESHNER: One of the issues at NIMH that always interested me was the AIDS prevention being done there. There still is no vaccine for AIDS, but at that time no vaccine was even in the offing, which meant there was no way to prevent the spread of the disease other than through behavioral treatments. Working with people like Ellen Stover and at the time, Steve Koslow, we tried to strengthen the scientific underpinnings of behavioral prevention programs. It was at a time when NIMH first built its AIDS research centers at the University of California, San Francisco, and Columbia University; these were run by people with strong behavioral science backgrounds who brought tremendous rigor to the programs.
KRAUT: At the time NIMH was spending probably at that time $70 or $80 million a year, but before you came, the people in charge weren’t talking about it as one of their premiere programs. Then you came and said ‘it’s a public health problem, as behavioral scientists we have something to say about it, and let’s put our knowledge to work.’
LESHNER: (laughing) Yes, you can say I said that.
NOT JUST DRUGS OF ABUSE
KRAUT: Next you became the first psychologist to head a national institute of health: You were selected as the director of the National Institute on Drug Abuse. Your background had some psychopharmacology….
LESHNER: No. I wrote two papers in psychopharmacology in my life. I knew fundamental behavioral endocrinology, hormones and behavior. I didn’t know about drug abuse. But I came to NIDA at a time when it was probably useful to have someone take a fresh look at the way in which we were approaching the science of drug abuse and addiction.
Recognizing the complexity of the problem, and the need to bring the full power of science to bear, I wanted to expand NIDA’s research portfolio and basically every aspect of the system. For example, we knew relatively little about the role of cognitive function, the role of learning and memory in drug abuse and addiction. Now as I give talks and I hear from people in the field, it’s almost a truism how central learning and memory are. But almost nobody was studying those aspects at the time. I forced the Institute to expand its portfolio to include other aspects of behavioral science.
KRAUT: I also remember it had been an unwritten requirement that virtually every research project funded by NIDA needed a drug of abuse in its protocol. You also changed that policy.
LESHNER: It was surprising to discover that you could only apply for a NIDA grant if you literally employed a drug of abuse, since so much basic behavioral science and basic neurobiology is directly relevant to drug abuse. I decided early on we needed to expand the range of researchers and the range of research approaches. So we started an initiative called “Not Just Drugs of Abuse” and expanded the portfolio into neurobiology and into fundamental cognitive science. That’s turned out to be extremely useful.
We also had too much of a focus on one small area in the base of the brain called the “reward system.” Although there’s no question that circuitry is tremendously important in drug abuse, you have to look beyond it. For example, we expanded the neuroscience focus into what is now another truism – the importance of the frontal cortex of the brain, and the behavioral functions involved in drug abuse and addiction that are controlled through the frontal cortex. These all seem obvious now, but at the time the portfolio was much narrower.
ALIGNMENT OF THE STARS
KRAUT: At about the same time, working with General Barry McCaffrey as drug czar in the White House, you and NIDA became the scientific base of national drug policy. How did that come about?
LESHNER: One of the best aspects of my tenure as the NIDA director has been what I called the “alignment of the stars.” At the same time that I was interested in expanding NIDA’s role and contributions to national practice and national policy, we had Harold Varmus [then-director of NIH], who was very supportive of NIDA. We had Donna Shalala [then-Secretary of Health and Human Services], who understood this as a public health issue. We had Barry McCaffrey who decided science could serve national needs and wanted to base policy on science as much as he could. And ironically, attorney general Janet Reno was a tremendously important player in moving national understanding and leading national policy. She and the people she appointed in the Department of Justice understood the importance of our science to what they did. That alignment of stars was responsible for increasing the science base of policy and encouraging a greater understanding of drug abuse and addiction as a health issue rather than just as a social issue.
The Justice Department became one of the biggest advocates for increasing drug treatment, particularly for criminal offenders. Janet Reno very early on got it – that addiction is a brain disease. In fact, the Department used to have me come there and give talks about addiction as a bio-behavioral disorder to judges, to correctional officials, to probation officers, to people in the criminal justice system, and that the logical follow up to understanding it as an illness is to understand that you have to treat people while they’re under criminal justice control.
There’s no question that science has been centrally responsible for the change in the way the public generally sees drug abuse and addiction. This year, for the first time in American history, a study by the Robert Wood Johnson Foundation showed that the majority of the American public think addiction is a health issue, think it’s an illness. That’s a tremendous change, and reflects what science tells us about addiction.
HOW PSYCHOLOGY HAS CHANGED
KRAUT: What changes have you seen in psychology since you’ve been in public service?
LESHNER: When I came to the federal government, I always hesitated before I told my colleagues that I was a psychologist. One of the things that has changed dramatically – and I think this is largely a result of APS’s influence – is that people now assume behavioral science to be a core part of the scientific community. Virtually every NIH institute now claims to support a larger layer of behavioral science, whereas twenty years ago, you whispered that you had a behavioral science portfolio because that wasn’t “real science.” We’ve stopped talking about hard science and soft science. It’s been a dramatic change.
KRAUT: Another change is that now you can find psychologists doing research and teaching in schools of communication, business, computer science, certain schools of law, schools of public health, even in schools of medicine outside the department of psychiatry.
LESHNER: People recognize that psychologists bring a unique perspective, a unique ability to look at behavior in a rigorous way and that it’s relevant to a variety of areas. Whether it’s an internal medicine department in a hospital or whether it’s a department of obstetrics and gynecology, there’s a need to bring a psychological perspective.
KRAUT: What about the next generation of psychologists? Both at NIMH and at NIDA, you’ve had a large impact through your research training for psychology students.
LESHNER: We systematically have gone after a broader array of psychologists and behavioral scientists, both in our portfolio and in our training programs, in order to create a broader behavioral science of drug abuse and addiction. A much larger array of behavioral scientists are now supported by NIDA compared to seven years ago.
LINKING BASIC AND CLINICAL RESEARCH
KRAUT: Do you think those new psychologists represent new subdisciplines that wouldn’t have been here without NIDA?
LESHNER: As we expanded the breadth of our research, we’ve tried to recruit more behavioral scientists, cognitive scientists, into studying basic phenomena we think might be relevant to drug abuse and addiction. Those people are bringing new behavioral science perspectives to the study of craving, memory processes, and cognitive processes. There were few people doing that 10 years ago.
Another area where we’ve expanded tremendously is in behavioral treatment development, particularly the relevance basic behavioral science. A lot of that has happened because of one individual there, Lisa Onken, who rigorously and intensively developed a behavioral treatment program at NIDA that’s grounded in core basic behavioral science principles. It’s unusual for an institute to have such a clear focus on basic science as the precursor to behavioral treatment.
KRAUT: You say it’s unusual, but it may even be unique, particularly the Clinical Trials Network sponsored by NIDA – this huge nationwide snowflake-like set of centers where substance abuse clinical trials are being conducted, and right now those are primarily clinical trials on behavioral treatment.
LESHNER: The Clinical Trials Network has succeeded far beyond my wildest hopes. It began with the notion of “how do you bring science-based treatment into clinical practice?” We learned that it occurs through a blending of the work of practitioners and scientists. With Congress’ budget largess, we succeeded in establishing 13 nodes around the country tied to over a hundred community-based treatment organizations. They’re all doing treatment research.
In deciding what protocols to run at these sites, we looked at the science base and saw that a large number of the best treatments, the most appropriate treatments to be tested in this network, were in fact behavioral treatments. So, of the first 18 protocols that will be run over the course of the next year to 18 months, the vast majority are behavioral treatments based on fundamental principles of behavior and behavior change.
SCIENCE POLICY: FACTS AND VALUES
KRAUT: On the one hand, you were a scientist leading a scientific institute, on the other hand, you had to be a politician making sure that the importance of the NIDA agenda was seen by the NIH Director, the Department of Health and Human Services, the White House, the Justice Department. How did you manage this balancing act?
LESHNER: In this kind of position, it’s important to understand the role science can play in national policy. One of the things I learned very early was that scientists should not be doing politics with a capital ‘P’ but they have to do small ‘p’ politics. Scientists don’t make policy; scientists inform policy. In order to be credible and in order to have a role, you have to accept that policy is made both out of fact and values. We’re the fact guys, we are not the value guys. And you have to be prepared to lose gracefully when values override fact in the equation. There are areas where people want to us to mix science and values, and they get very frustrated because we have been unwilling to bend the scientific facts in order to make their points.
My favorite example is medical marijuana, which has been an extremely difficult issue. It’s important to separate whether a substance is an abusable dangerous substance and whether it’s a medicine. Of course marijuana is abusable. Whether it’s a medicine is, from my point of view, an open and empirical question. It ought be studied and it is being studied, but we shouldn’t decide it before we study it. People on both sides of the issue have been very unhappy with the straight line that I keep walking. People want me to say, no, no, no, it can’t possibly be medicine. And of course, that’s not true. Lots of abused substances are also medicines. But on the other hand, other than anecdote, there’s not evidence; therefore, I can’t say because 100 people claim that it helped their glaucoma, that makes it a good medicine for glaucoma. That’s an example where values get mixed with science and the task of the NIH institute director is to walk that line very rigidly and never deviate.
POLITICS WITHIN SCIENCE
KRAUT: Let’s talk about politics small ‘p,’ the politics within science. You have scientists thinking their way is the right way, that they’re going to find the magic bullet in terms of a gene or a neurotransmitter or a behavioral intervention, and they tell you to spend the money on their research. What’s the role of the institute here?
LESHNER: Every field of science has its own internal religions, its own paradigms that drive how it traditionally thinks. If you’re going to be a national leader, a part of the task is to make large advances, not just incremental advances, in order to accelerate progress. That’s one of the things I’ve enjoyed doing for the past 22 years, whether it was at NSF or NIMH or NIDA. I take whatever religion it is, it doesn’t matter, and ask “So, how do you know that’s it?”
One of my favorite examples is the dopamine reuptake transporter as the seat of cocaine addiction. I kept saying, ‘Gee, a cocaine experience is far more diverse than could be explained simply by its binding to that single receptor system.’ Of course, I was told that I was naive, that due to my background in psychology I didn’t understand the pharmacology. Now, we have people studying opiate mechanisms, cannabinoid mechanisms, all kinds of ways in which neurotransmitter systems can interact. The same holds true in behavioral science. If you didn’t say reward and reinforcement, you couldn’t get a NIDA grant. Now we have people studying learning and memory processes, and studying craving.
The moral of this is the same moral in any field of science: whatever you think is the truth of the moment is probably wrong. Therefore you need to be as open to diverse approaches as you can possibly tolerate.
KRAUT: Another mark of your leadership has been to include the academic community in decisionmaking.
LESHNER: One of the mistakes many science leaders make is they think they have to own all the ideas, whereas I have two traits that have made me successful: I have very good taste in people and I have very good taste in their ideas. I have no need to own the ideas – I just have a need to implement other people’s good ideas. I tried to bring in large numbers of advisors to NIDA both from within the field and from peripheral fields. Because having a fresh look from someone who knows nothing about the subject often is tremendously important. We’ve done that in areas like craving, we’ve done that in any number of areas, and it’s been very useful.
KRAUT: Plus, there are issues that require more than the individual investigator.
LESHNER: The most interesting problems in American science are too much for one individual or even too much for one discipline. We’ve moved to a kind of collaborative multidisciplinary science, recognizing that to get an understanding of a phenomenon you need to bring to bear not only different levels of analysis but also different types of analysis.
LOOKING BACK, LOOKING FORWARD
KRAUT: You’ve talked about your philosophy as a director of NIDA; what about your philosophy as an ex-director? You’re leaving NIDA at a time of unprecedented budget gain and things are good financially. Is there any frustration at knowing there are going to be some things that are going to be left undone?
LESHNER: Nobody ever gets to accomplish everything. My view of leadership is that the task is to push the elephant up the hill, over the edge and onto the ledge. Once it’s on the ledge, you can turn your attention elsewhere. I’ve been very fortunate in that I’ve been able to push a bunch of elephants because of the budget largess we’ve enjoyed. We’ve been able to expand and improve the quality of neuroscience, expand behavioral science enormously, improve and expand treatment research, build the Clinical Trials Network. The area I’d recently begun to work on is prevention. I think that’s an area that needs greater leadership and I’m hoping that my successor decides that’s a major opportunity.
KRAUT: Looking ahead, what do you anticipate at AAAS?
LESHNER: My friend and mentor Rich Nicholson [former executive director of AAAS] has done an outstanding job leading AAAS and making it a strong organization. My job is to build on that strength and expand AAAS’s national leadership. I intend to expand the way in which science is perceived and the way in which science is involved in American life. I believe the task of AAAS is not only to advance science for the benefit of scientists but to advance science for the benefit of all people.
KRAUT: Will we see AAAS involved with national policy issues?
LESHNER: I suspect you’ll see AAAS voicing views on policy issues. AAAS already has a wide array of programs that bear on policy issues. I would like to see us serve more of an advisory function than an analytical function, and provide recommendations that are science-based and useful. Another one of my jobs will be to expand the visibility of AAAS programs on science education – that’s something that people don’t know about nearly enough.