Since 1985, Mark S. Goldman has worked as a research professor in the psychology department at the University of South Florida, where he later became director of the Alcohol and Substance Abuse Research Institute. Goldman’s major research interests are in alcohol expectancies, cognitive mediators of alcoholism risk, and the development of drinking in children, adolescents, and young adults.
Goldman was tapped in 1998 to co-chair the Task Force on College Drinking under the auspices of the National Institute on Alcohol Abuse and Alcoholism. The task force assessed the physical, psychological, and social consequences of drinking in college-aged youth, and called for research-based prevention programs across the nation.
In June 2003, Goldman was named associate director of NIAAA, where among other things his job is to integrate behavioral and biomedical research activities.
APS Executive Director Alan Kraut recently sat down with Goldman to talk about the latter’s experience in the public policy arena and the role of psychological science in addressing the nation’s problems of alcohol abuse and public health.
Developmental Perspectives in Alcoholism
KRAUT: Here you are, a senior researcher, a productive researcher, a funded researcher, deciding to take at least a couple of years out of your research career to come to NIAAA. What led to your decision?
GOLDMAN: Well, there were two factors. One is that, both in terms of where the field is going and in terms of where my research is going, it’s become clearer and clearer that the problems attended to in alcohol use and abuse in the United States are intrinsically multidisciplinary. What I mean by that is you’ve got to put together the behavioral level of attention to this problem with more of a molecular/biomedical focus on the problem. They’re all starting to come together.
At the same time, Ting-Kai Li last fall became the director of NIAAA. He is well known in the alcohol field, primarily for his work in genetics and areas having to do with metabolism and more biomedical kinds of issues. T. K. was recognizing the same thing I was – that there has to be a combination of these two approaches. So he asked me to come and serve with him to combine behavioral research with biomedical, to foster the transdisciplinary connections between the two.
That was very appealing – to initiate a new direction for the institute that’s funded me for most of my life. But, I also wanted to maintain a connection to the research world. Fortunately, the NIH has an arrangement called an Interagency Personnel Agreement by which I could keep one foot in my laboratory and still come and have some input in what’s being done at NIAAA.
There are advances both in the biomedical realm and the behavioral realm, but not enough is being done to bring them together, so that, in a sense, my being here is both a symbol of the connection and will actually help to manifest the connection. The longer goal is to create more permeability between the field and NIH.
KRAUT: You came here having been co-chair of a major policy initiative at NIAAA.
GOLDMAN: Yes, I was co-chair of NIAAA’s college drinking initiative.
KRAUT: Tell us a little bit about that and where that is now.
GOLDMAN: Let me put it in a larger context. When I began in the alcohol field 30 years ago, or more, the attention was on the so-called alcoholic. The profile for that was a man about 40 years of age who had been drinking for many years. He had already shown loss, perhaps of a spouse, family members had given up on him, loss of jobs. He ended up at a facility where it was very difficult to work with him, because he was already pretty far along the continuum of the disorder. Today, we know that most of the processes involved in getting to that point happen much earlier in life. In fact, we have new data that suggests that much of the risk has already been manifested by the time someone is 25 years old. The risk factors originate largely in adolescence but possibly even in childhood. By the time of young adulthood, the problems are already quite manifest.
KRAUT: Some current research indicates that you’re at much higher risk if you’ve had significant drinking experience by the time you’re 12 or 13 or 14 years old. How much of a role does this early exposure play in later alcoholism?
GOLDMAN: If you’ve had significant drinking experience by the time you’re 12 or 13, you’re at about four times the risk of developing alcohol dependence later in life. The question is whether that’s merely because you started early, or if it’s because people who are at risk tend to start early. It probably is closer to the latter, although there may be some risk that comes just from starting early and building up the habit.
We now know a lot more about what’s going on in adolescence, and adolescence seems a particular time of risk for a disorder such as alcoholism, because that’s a time of general risk taking. The manifestations of that risk are seen in college students and alcohol. Young people were dying from overuse of alcohol for many years, but it recently became more and more public. I was asked to co-chair this task force with Father Edward Malloy, president of the University of Notre Dame. As you can imagine, university and college presidents have a vested interest in this area. In fact, when you talk to them behind the scenes, most presidents will tell you it’s the most difficult problem they face, the nightmare they face, because most of them have gotten calls with terrible news involving students and alcohol.
The task force, which was about half college presidents and half well-known researchers in the alcohol field, issued a report in April of 2002 that’s received a great deal of attention. The Web site, www.collegedrinkingprevention.gov, has had over 12 million hits.
We found a number of very alarming things: that something like 1,400 students die every year from combining alcohol consumption with driving and from alcohol toxicity, and half a million students have had alcohol-related accidents or assaults. There are about 8 million college students in the United States. That means that a significant chunk of them have had an influence in their college careers related to alcohol. Non-drinkers are also affected, because the other students who are drinking are coming back to dorms and interfere with sleep and studies. So the ripple effects are enormous. We all wink and nod and say, “Everyone drank in college.” But it’s a much more serious problem than many are aware.
In the process of looking at college drinking, it became clear that many students brought the drinking problems to college with them. In other words, it didn’t begin in college. That leads to the whole issue of underage drinking. That’s a significant issue, and there’s been some movement already within the Institute to address it. Underage drinking is significant in its own right because it leads to problems for young people that often have long-term effects on their lives. It’s where we see the onset of the process that ends in the alcoholism we looked at 30 years ago, only then we were focusing on the end-point rather than the beginning.
KRAUT: So it sounds like one of the new perspectives that’s going to be brought in is the developmental perspective. When I think of developmental psychology I think of the National Institute of Child Health and Human Development or perhaps the National Institute of Mental Health too, the development of psychopathology. But now we’re talking about developmental perspectives in alcoholism.
GOLDMAN: That’s the whole story. It’s the interaction, within a developmental context, between genetics and biological influences on one hand and learning from the experience of alcohol on the other. When I give talks on my own research area, which is essentially about expectancies and cognitive influences on drinking, I often start with my experience a number of years ago of bringing my daughter, who was then about five years old, to see the movie “ET.” In one scene, ET is left at home while Elliott goes to school, and ET breaks into the refrigerator and consumes a six-pack of beer and gets drunk. Of course, ET is connected with Elliott telepathically, so Elliott acts drunk in his classroom and runs around the biology lab, releases all the frogs, the kids have a great time. It winds up with Elliott kissing one of the girls in the class, and everybody gets a big smile on their face. For my five-year-old daughter and many of the kids in the movie theatre, the positive effects of drinking have been laid out, so they know about these things well before the time comes when they have access to alcohol.
The concept of priming is very important in psychology. This is priming not for remembering a word, but rather priming for behavior that has all sorts of consequences. You can point to many places in society where this goes on: movies, advertising, even the experience at home with one’s parents and how they use alcohol. You have all the learning about alcohol placed in a developmental context, interacting with biology, and this is the story about how alcoholic problems arise. Although all the components have been looked at in the past, we are more and more looking at them in concert. To paraphrase T. K. Li: “We can’t make advances in genetics any longer until we do better with behavior.”
My first day on the job here, I attended a workshop at the Institute of Medicine, representing T. K., about sleep, pain and complex disorders, which were essentially behavioral disorders. We had people there from everywhere, including the genome institute. By the end of the day everybody was saying, ‘we’ve got to study behavior. We can’t address these problems at a purely molecular level, because we’re essentially talking about molecular processes that support these complex behaviors. How do we address that unless we get more clarity on what the behavioral systems are doing?’ So I think there’s some hope in the sense that thoughtful, biologically-oriented people are asking for attention to behavior. We have to give it to them in a way they can make sense of it at an operational level.
Diminishing Core of Psychology
KRAUT: That brings up the question of how you combine these perspectives. Do you do it at a multidisciplinary level; that is, do you have different scientists combining on large research projects? Or do you start out in a young scientist’s career, in a graduate student’s career, and have that student acquire different perspectives on research, so you train a behavioral geneticist instead of a geneticist and a behavioral scientist.
GOLDMAN: It has to be done on a number of fronts. I was just looking at the [November, 2003] Observer, where [APS President] Roddy Roediger was talking about training in laboratories versus in classes, breadth versus depth. The same issue pertains here. People can’t become expert in all the relevant areas. The idea is to sensitize researchers so that they’re open to information from other domains and can argue constructively with people from other domains about what the real explanations are. That cross-talk is the key to developing effective solutions to these very complex problems of behavior.
KRAUT: Does that mean you’ll be promoting new models of graduate student training?
GOLDMAN: Absolutely. We’re trying to get people to know enough areas other than their own research so that they can speak with some sense of authority about these other domains.
KRAUT: Does that mean less training is going to take place in the traditional department of psychology?
GOLDMAN: I hope that doesn’t happen, though I unfortunately already see signs that it is happening. Not because we are making decisions to train our students differently. It’s happening by people voting with their feet, and going elsewhere. For example, as subgroups within psychology become more sophisticated about biological science, the people involved start calling themselves neuroscientists, and centrifugal forces break up psychology and move people who are essentially psychologists into other domains.
The reason I hope it doesn’t happen is there’s a core of psychology that I’ve always firmly believed in. Many years ago we used to study the old systems and theories, and psychology doesn’t do that so much anymore. But discussing the problems at a methodological, philosophical level is how we really need to approach the behavioral domain. It is this core understanding of how to approach behavioral problems that ties us together. It’s a core I’m afraid we’re losing and we need to reclaim.
KRAUT: Will there be new money for training grants and fellowships in transdisciplinary research?
GOLDMAN: Many existing funding mechanisms aren’t being used sufficiently. People need to request support for these transdisciplinary models, rather than within localized areas. That will make a difference. Transdisciplinary research has become so important that NIH leadership has made a commitment to it. Dr. Elias Zerhouni, the Director of NIH, has even built it into his plan for the future of NIH, which is called the Roadmap. New funding for transdisciplinary research at NIH will be a part of this plan.
KRAUT: I know this was true a couple of years ago, my guess is it still is true, the PhD most represented among your grantees is psychology.
GOLDMAN: We give about $100 million of our $300 million in our research grant budget to psychologists. NIAAA is one of the big benefactors of psychology.
KRAUT: So let’s talk a little more about the subdisciplines of psychology. When you talk about basic science in psychology, cognition and neuroscience and motivation and expectancy, and so on, even social psychology, there are people out there who are studying basic mechanisms in those areas. You’re making the case that their sophistication should be brought to research on alcoholism. How do you attract those people, those students, to NIAAA?
GOLDMAN: Ultimately it’s going to come down to whether there’s funding available. It’s of some concern to us. Although funding has increased in recent years, as everyone’s talking about, the funding is now flat for the next short period of time at least.
Having said that, however, this is a very complex health and scientific problem, one that should attract behavioral scientists. Alcohol problems are everywhere. Other than depression, they’re probably the single most pervasive mental health problem out there. But alcohol problems don’t attract sufficient attention because society has to some extent adjusted to them, by seeing alcohol problems as a natural way of life. Society says, “It’s unfortunate that these things happen, but everybody drinks and we’ve already gone through the experience of prohibition. No one wants to shut down drinking entirely, so we have to live with it.”
One of the ways we live with it is we discount how much of a problem alcohol abuse is in this country. It’s far and away a larger problem than any other drug, and yet the amount of money spent studying alcohol is disproportionate. It’s not enough to deal with the problem. If people are interested in working on society’s problems, alcohol is a big one.
Another reason to study alcohol is that it joins very important theoretical and scientific currents that are running through psychology right now. If you want to understand how cognition interacts with motivation within a developmental perspective, and you want not just a subjective report of discomfort, but also a countable action – like how many drinks you take over a certain amount of time – that’s the alcohol field. I’ve always been in the alcohol field in part because it allows me to study fundamental mechanisms and processes in psychology, using alcohol as a domain in which I study those kinds of mechanisms. It forces me into contact with the real world. It also crosses drugs and behavior, which is another important domain. So I think it’s an incredibly attractive area. All psychologists can study this. What we’re talking about is an ability to do tremendous work in elucidating psychological processes, using alcohol as a domain, and at the same time being able to work on a really serious problem in society.
Behavior Through the Microscope
KRAUT: You’ve been here for six months as one of the highest-ranking behavioral scientists at NIH. How do you think behavior is seen in a more biomedical environment like NIH?
GOLDMAN: Biologists are very comfortable with chemistry, and chemists are comfortable with biology – both have some interaction typically with physics. By contrast, we’re a little different, so the cross-talk becomes more difficult, and sometimes the value of behavioral science becomes questioned. I think everybody knows and acknowledges that we can’t do what we need to do without focusing on behavior. The question is how that happens and what kinds of discussions take place, because very often people start talking about behavioral science without realizing that’s what they’re talking about. But of course when you start looking at the manifestations of problems out there in the world like use of tobacco, heart disease, overeating and obesity, which is a big interest now, these are behavioral disorders, or at least disorders that have a huge behavioral component to them.
KRAUT: Let’s take this further. What you often hear directors of NIH institutes touting is the latest neurotransmitter, or the gene for X, or the latest technology that shows the wonderful pictures of the brain at work. Less visible is the model of cognitive processing that’s behind that picture, that MRI. But my sense is that behavior is making in-roads in those areas, and that, if anything, there’s a growing sophistication in behavioral science in those areas.
GOLDMAN: Complex behavior is essentially the culmination, result, or interaction of all kinds of other elements. Clearly behavior is built on biology. There wouldn’t be any behavior without biology. On the other hand, is it enough just to pick out elements within biology for psychologists to study? The elements don’t explain the whole. Down to the genes and within cells and protein construction, what we’re getting are the building blocks of behavior. But if they’re the building blocks of behavior we have to know something about behavior to be able to relate behavior to its building blocks.
KRAUT: One trend I see in biological research is to go ever smaller, where behavioral science has already been through its reductionist phase and is now at a more sophisticated level, where there are, for example, elegant mathematical models of cognitive thought to be tested and developed. Is there some sense of a mismatch? That behavior is much more of a sophisticated science than biology?
GOLDMAN: It’s certainly a much more difficult science, and it’s sophisticated in the sense that there are clearly more interactive elements, because all those interactive elements at the biological level are part of explanations of behavior – they have to be. But then there are other influences on behavior that range up to cultural and political levels. Those biological systems are essentially the reception points for those influences. They are the reception and retention points, that’s how it becomes manifest. So, intrinsically, one has to know the biology, but that’s not enough, because there are other influences.
There’s a lot of discussion at NIH about gene and environment interactions. I have had conversations about these issues with many behavioral scientists from other NIH institutes as well as with Dr. Raynard Kington, who is the Deputy Director of NIH, but was formerly the Director of the NIH Office of Behavioral and Social Science Research (and by the way, also spent some time as Acting Director of NIAAA). This topic gets really interesting when you consider that environment means different things to different people. Molecular biologists might consider the environment to be the environment within cells, or within even the nucleus of the cell, the material surrounding DNA. Lots of work is being done on transcription now – all kinds of interesting things are being found out about how genes interact with each other to actually produce RNA and proteins, and so on. So that’s an environment – each gene is in the environment of other genes. The nucleus has the environment of the cell around it. The cell has the environment of the interstitial fluid that’s between the cells, and also the other cells it interacts with. It goes all the way up the line, it hits the skin and you start interacting with the real world. Suddenly, we act as though there’s something different going on – it’s now behavior. It’s discontinuous. But why is it discontinuous? It’s just one more level. It’s like saying the division point between the nucleus and the cell or the cell and the fluid around it crosses a domain and enters new territory. No one thinks that these biological boundaries change the entire way you have to think about the problem, yet we seem to think we cross into a new domain when we get outside the skin.
In fact, if you look at some fundamental notions that have been around science for quite a long time, like conservation of function and structure, many of these things are actually the same, just at different levels. Each system is interacting with its environment; each level is interacting with larger and larger environments. Ultimately, what does survival depend on? It depends on the level of the environment outside the skin. So I would argue that all of those other systems are recruited to deal ultimately with this largest level of interaction, which is the level of the skin and the outside environment.
A Look Around, a Look Ahead
KRAUT: Where do you see some of the most exciting breakthroughs taking place in behavior and alcohol research?
GOLDMAN: Alcohol is a very interesting domain for behavioral research. Think about a circumstance in which someone’s had something to drink, becomes a little intoxicated, is behaving in a released way with friends, and then there’s a knock on the door and some emergency has happened. Boom. They’re not acting that way anymore. The same level of alcohol is on board, but their behavior is not the same. The point here is that the reasons for using alcohol and the effects of alcohol are not all based on chemistry. In different cultures, at different times, even in the same person, the effects of alcohol can be different. There’s a range of behavior that’s permissible within the context of alcohol use. If it was only chemistry, we would be robotic. It would be automatic that we behave in certain ways when we drink, but we don’t. One of the most promising areas for advancing our understanding of alcohol – which I think is very interesting, because it also helps us advance the understanding of psychology – is the mind/body problem. That’s what it’s all about. And to advance our understanding of how that all takes place, alcohol is a perfect domain in which to work.
KRAUT: Is cognitive science poised to have an important impact in the alcohol field?
GOLDMAN: Cognitive science has been increasingly important to the alcohol field. Research that I’ve done on expectancy shows that not only do people hold certain expectancies of what kinds of effects they’re going to experience when they drink, but, for example, using cognitive methodology to prime those expectancies can actually get one to drink. They won’t necessarily know that they’re been primed. These studies are using old techniques in technology, like the Stroop technique, for new purposes. People can be given expectancy words using the Stroop and wind up drinking more, without their knowledge that, in fact, the primed words have driven their drinking. So the interface between cognitive psychology and alcohol research is hot and getting hotter.
KRAUT: How about social psychology?
GOLDMAN: Social psychology has always been important. Take the example I gave a moment ago of having fun with your friends and then shifting. This is essentially a social phenomenon. It’s always been clear that alcohol has different effects in different social contexts. You could have the same amount to drink out at dinner with your boss that you might have at a party with your friends, and the display of the behavior will be completely different, because the effects respond to social circumstances. Social psychologists are all over the alcohol field.
KRAUT: You’ve talked about the real world – what about those who study organizations and industrial aspects of your work?
GOLDMAN: Alcohol has always been known to be a problem in organizations. When I lived in Michigan, there used to be the old cliché that you shouldn’t buy a car that was built on a Monday or a Friday, because on Monday the drinking influence still lingers, and on Friday they’re starting early. The effects of alcohol in terms of organizational structure, function, and cost are obvious. There’s also research into the use of alcohol as part of the socialization process in corporations – the so-called “three-martini lunch.” The requirement to drink with other people in business has always been a concern and continues to be of concern.
KRAUT: What about prevention?
GOLDMAN: As we become more and more aware of the fact that alcohol problems begin with young people, it becomes clearer and clearer that prevention is one of the big places to be. Our culture essentially trains children to drink, and to drink in certain ways, and to expect that certain kinds of drinking are appropriate. To really change the problems, we’re going to have to change the culture and environment. In fact, the report from our college student drinking task force was partially entitled ‘Changing the Culture.’ How do you get people to lower their drinking or stop their drinking when alumni are coming to college football weekends and they’re drinking, where the bars are located all over campus, just ready for the students to come and drink? It’s all around us.
I testified before the Senate Committee on Governmental Affairs after we did the college drinking report. Also testifying was a father who had just lost his freshman son at the University of Maryland in February 2002. His son was rushing a fraternity, and as part of the rush he had to lie down under a keg. Beer was poured into his mouth, and when he became incapacitated on the floor they put a funnel in his mouth and poured more alcohol down his throat. When he passed out they put him in a room to sleep it off. He died. The father testified he had a long talk with his son before he left for college about marijuana and drugs, but he didn’t realize that the real problem was going to be alcohol. That’s the real problem, and people don’t know it. So part of the issue in prevention is changing the culture, getting people to reorient about the issues of alcohol, and not just sweep this under the rug.
KRAUT: At the research level, is there methodological sophistication in place to determine whether prevention works or not? Is there a way to evaluate what actually does change behavior?
GOLDMAN: The methodology has become incredibly sophisticated. Within psychology, there are complex statistical methods, such as growth curve analysis, that measure change over time in a very sophisticated way. Psychologists have developed methodology that has recharged and energized the field of alcohol prevention.
KRAUT: So it seems you’re saying that NIAAA is primed, with the right research being funded, to make important changes.
GOLDMAN: No question about it. As an institute and as a field, we have a new level of sophistication. The awareness is now so acute as to what the problem is that all sorts of good things are primed to happen, if only the funding and the support for this work continues.
KRAUT: Okay, you’ve been here six months. Let’s look ahead – now you’re here two years and you’re reflecting on your term at NIAAA. What would it take for you to consider this a success?
GOLDMAN: It would be bringing behavioral science into the fold on such a routine basis that people no longer felt they needed to cross a boundary or a bridge. Nowadays, you couldn’t think of looking at problems of alcohol without immediately getting into areas like chemistry, it’s intrinsically part of what we do. That has to happen for behavior as well – that you can’t move on a problem until the behavioral scientists are in the room, producing what they produce in tandem with all the others. In two years, I don’t see changing the world, but what I do see is being able to make even the most basic biomedical scientist ask, ‘Where are the behavioral people? We need them to tackle this problem.”
KRAUT: Coming back to where we started, what’s interesting about your position here is that sense of moving from science to public service. Is that an ethic that you can in some way promote? If someone said to me, there’s an opening for the director of NIMH, and if we could find a qualified behavioral scientist, that person would get the job. I’m not sure, in this hypothetical situation, that I would be able to twist the arm of anyone at that level enough to come to Washington for two years.
GOLDMAN: For me it was how could I not do it? When you characterize it as performing a service, it sort of makes the eyes glaze over. But, in fact, it’s not so much service; it’s changing your science. What science is really all about, from a personal point of view, is that in five or ten years someone’s going to tell the story of your field, and you’re going to be a part of it, because you’ve contributed such an essential building block that they can’t tell the story without the piece you contributed. How is that different from coming to NIH and influencing the way the field operates on a problem, so that the story in the future can’t be told without that re-structuring of the way the problem is attacked? So it’s not a service thing, in the sense that you come and do paper pushing from in-box to out-box. Rather, you’re reconfiguring the way that problem is viewed and addressed. Ultimately, it’s the same task.