Dual Disorders: Chicken, Egg...or Both

Presented By MARK S. GOLD, MD

Provided by RiverMend Health Institute

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Release date: June 9, 2016

Valid through: June 9, 2017

Topic: Substance Abuse, Depression

Media: On-Demand

Estimated Time to Complete Activity: 60 minutes

Target Audience

This CME activity is intended for physicians, psychiatrists, physician assistants, psychologists, and allied mental health advocates.

Program Overview

Substance Abuse and Depression are commonly associated by experts, patients, and families. Does depression cause tobacco, alcohol and drug use? Does use of drugs that target the brain's reinforcement and mood centers cause depression? Evidence for both points of view exist and will be presented, as well as a logical approach to evaluation and treatment which involves a complete medical, neurological, addiction, and psychiatric evaluation and treatment, when indicated. Dr Gold the author of numerous peer reviewed articles, texts, and guidelines on this subject.

Learning Objectives

Upon completion of this activity, participants should be better able to: 

  1. Review research findings that demonstrate that addiction is a treatable brain disease
  2. Understand and incorporate into their practice the relationship between substance abuse, eating disorders, depression and other psychiatric disorders
  3. Review diagnostic and treatment issues for co-occurring substance use and psychiatric illnesses
  4. Review examples of common co - occurring disorders such as tobacco smoking and schizophrenia, alcohol and anxiety and cocaine and depressive dx

Continuing Education

APA, American Psychological Association

RiverMend Health Institute is approved by the American Psychological Association to sponsor continuing education for psychologists.  RiverMend Health Institute maintains responsibility for this program and its content.

APA CE credit Awarded: 1.0

ADACGBA, Approved Continuing Education Provider

RiverMend Health Centers, a RiverMend Health LLC entity, maintains responsibility for this program and its content. RiverMend Health LLC is a ADACGBA Approved Continuing Education Provider and may offer ADACBGA approved hours for events that meet ADACBGA requirements. Provider #15-55-03-916

ADACBGA Continuing Education Units Awarded: 1.0

NAADAC, The Association for Addiction Professionals

RiverMend Health Institute is a NAADAC Approved Continuing Education Provider and may offer NAADAC- National Certification Commission approved hours for events that meet NAADAC requirements. Provider # 867.

NAADAC Continuing Education Units awarded: 1.0

NBCC, National Board of Certified Counselors

RiverMend Health is an NBCC-Approved Continuing Education Provider (ACEP™) and may offer NBCC approved clock hours for events that meet NBCC requirements. The ACEP solely is responsible for all aspects of the program. Provider #6573.

NBCC CE credit Awarded: 1.0

CBBS, California Board of Behavioral Sciences

This course meets the qualifications for continuing education credit for MFTs, LPCCs, LEPs and/or LCSWs as required by the California Board of Behavioral Sciences. RiverMend Health Institute Provider #4688.

CBBS CE credit awarded: 1.0

CDR, Commission on Dietetic Registration

RiverMend Health Institute is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians registered (CDR). Registered dietitians (RDs) and dietetic technicians registered (DTRs) will receive continuing professional education units (CPEUs) for the completion of this program. CDR Provider #R1656.

CDR CPEU awarded: 1.0




Mark S. Gold is a translational researcher, author, and inventor best known for his work on the brain systems underlying the effects of opiate drugs, cocaine and food. He an author and inventor who has published over 1000 peer reviewed scientific articles, texts, and practice guidelines. His work is widely cited by his peers. It includes citation classics in cocaine neurobiology, opioid addiction neurobiology and treatment, food and process addictions. He has been called a groundbreaking researcher, father of medication assisted recovery, the first to translated rat experiments into theory and treatments for human addicts, mentor of the next generation of addiction researchers and clinicians.

After working on state dependency of memory, amphetamines and sleep neurobiology Gold proposed a novel model for opiate action, dependence, and withdrawal changing the way opiate action was understood. This locus coeruleus theory of opiate and drug withdrawal is a mainstay of 2016 theory and practice, even though he proposed it in 1978. Gold is the senior author on the discovery paper and was awarded a patent for the discovery of new uses for clonidine which remains widely used for opiate withdrawal and pain management. Drs. Gold and Herbert Kleber were the first to suggest use of clonidine and naloxone in rapid detoxification and sequential use of clonidine and Naltrexone. Gold demonstrated successful treatment of Physician and Business Executive addicts using detoxification, monitored therapy, and Naltrexone in the early 1980s which was pivotal to Naltrexone’s approval by the FDA after the failed NIDA trial .

During 1980s Gold and Dackis developed a new theory for cocaine action, dependence, and withdrawal based on his understanding of the neuroscience of dopamine-rich areas of the brain. While most at the time did not consider cocaine addictive because of the lack of a classic withdrawal syndrome, Gold proposed a dopamine theory of pathological attachment, loss of control and addiction. This work not only helped to reclassify cocaine as addicting but reduced the importance of withdrawal to the nosology of addiction. Gold had many of the first reports related to cocaine and crack, including cocaine and panic disorders, cocaine and cardiovascular accidents and symptoms, cocaine and body temperature and was the first to describe crack smoking. His work increased interest in dopamine in pleasure and addictions. Gold completed a 5 year State Department study on opium smoking , second and third hand exposure in the Children of Afghanistan. His work reduced stigma, served as the basis for many educational and prevention campaigns and changed the lives of addicts with basic and applied science leading to new evidence-based treatment. Dr. Gold is a multiple patent holder and translational researcher who has been a mentor of many of the leaders in addiction medicine and psychiatry.

Gold also has worked for over 30 years trying to understand overeating as related to drug of abuse or addiction models. He described Food Addiction in several classic papers and texts. With Bart Hoebel and Nicole Avena he advanced this food addiction work showing glucose and fructose corn syrup self-administration, dependence and withdrawal. This work has stimulated the field and is summarize in Brownell & Gold’s Oxford University text Food Addiction.

He is a Distinguished Alumnus of Washington University, Florida and Yale University. Gold was a Professor, Eminent Scholar, Distinguished Professor, Distinguished Alumni Professor during his 25 years at the University of Florida and one of the Directors of the McKnight Brain Institute.

He has served as a Consultant to ONDCP, NIDA, the State Department and other Governmental Agencies, Professional Sports, and CASA-Columbia University . He just gave a keynote at the CADCA Conference in Washington DC, meeting again with Drug Czar Botticelli.

Gold is an inventor who has had a number of inventions and use patents that have been sold . For example, his discovery of Clonidine as an opiate-like drug for acute opiate withdrawal led to a use patent and also use in pain was sold to Boerhinger Ingelheim . He has also sold patents to Sandoz- Novartis and licensed others through UF. He was a Founding BOD member of Viewray, the MR guided radiotherapy inventor and leader. He is also a long-time BOD member of Axogen (cadaver nerve transplantation) and helped them with their translational research and trials. Most recently, he joined the BOD of Magstim in the UK, the inventors of TMS. He is currently as an (Adjunct) Professor of Psychiatry at Washington University in St Louis, and the Chairman of the Scientific Advisory Boards for RiverMend Health- a national provider of addiction, eating disorders, and obesity evaluation and treatment. Gold has been awarded a number of national awards for his research including the Foundations Fund Prize (APA) , the McGovern Award for Lifetime Achievement (ASAM-ABAM 2015), National Leadership Award (NAATP) , Silver Anvil, PRIDE and DARE awards for his career in research and prevention (2015) .

Since his retirement as a full-time academic, Gold lectures at Medical Schools, Grand Rounds around the USA and at international and national scientific meetings on his career, bench-to-bedside science in eating disorders, obesity, and addictions.

Disclosures of Conflicts of Interest

  • No financial relationships relevant to this field of study.

Instructions for Participation and Credit

There are no fees for participating and receiving credit for this activity. During the accredited period, participants must read the learning objectives and faculty disclosures; study the educational activity; and complete the post-test and the evaluation form. If you pass the post-test and complete the evaluation, your certificate will be available immediately for download in PDF format.

Hardware and Software Requirements

Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. You will need a PDF viewer such as Adobe Reader to view PDF files.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.