Peter Monti is the director of the Center for Alcohol and Addiction Studies at Brown University. The center recently celebrated its 30th anniversary with a colloquium where researchers from around the country discussed adolescent drinking, the effects of marijuana, and other topics in the area of substance use and treatment.
PBN: What progress has been made in the past 30 years in the field of addiction studies?
MONTI: We have come a long way in understanding the neurobiological and learning-based underpinnings of addictive behavior. We have also made great strides with respect to assessment and treatment. We’ve developed psychological treatments, such as cognitive behavioral therapy, as well as pharmacological treatments that have specific targets, for example reduction of craving that leads to less drinking. We have effectively disseminated these treatments throughout Rhode Island and the entire country through scientific publications and workshops at professional meetings.
PBN: What has been your most important contribution to the field of addiction studies? You wrote a book, what’s it about?
MONTI: Understanding the bio-psycho-social determinants of substance use and abuse and how to ameliorate abuse through treatments like cognitive behavioral interventions, coping skills training, pharmacotherapy, etc. An example of a psycho-social determinant might be difficulty dealing with social situations or difficulty with assertiveness. If you can teach a person assertiveness training, then they might not feel pressured to drink in a social situation.
My book is called “Treating Alcohol Dependence.” It presents a theory of addictive behavior based on social learning theory. The role of reinforcement, for example, in drinking behaviors and ways to substitute more adaptive behaviors for abusive drinking. It also identifies high risk situations in which people drink and provides various tools to cope with those situations without drinking. For example, stress in a social situation that might lead a person drink.
PBN: What local work has the center done?
MONTI: Most of the center’s work done in the state studies people in the state and generalizes from that work to the larger community. For example, the iSay project studies the paths to drinking that local adolescents take and the determinants that lead to substance abuse problems in adulthood. Understanding trajectories of substance use and abuse is important and is likely to have implications for treatment.
We’re also very interested in the problem of alcohol and HIV/AIDS. About three years ago we received a multi-million dollar center grant to study the relationship between alcohol and AIDS. We do some of that work through Lifespan and the Miriam Hospital and other parts get done at Fenway Clinic in Boston or as far away as Uganda and South Africa. Some of the work is focused on understanding the underpinnings of the relationship between alcohol and HIV. For example, we are following cohorts of people who have HIV who are either heavy or light drinkers over a period of several years and we’re measuring a variety of things, including brain activity through imaging – through techniques called medical resonance spectrometry and diffusion tensor imaging. The result of this work will give us a sense of the ways in which drinking affects brain function in people who are HIV positive. This work is underway, so we don’t have any results to share yet, but we’re finishing up assessment of the baseline of the study.
Other aspects of this work are teaching people who are heavy drinkers to drink less. At the Fenway Health Clinic in Boston, patients are undergoing treatments to reduce their alcohol intake and we’re seeing whether or not it has any effects on biomarkers for HIV disease.
We’re also taking a look at people who are not infected with HIV but engage in heavy alcohol use and risky sexual behaviors, people who have sex without condoms or with multiple partners. Those studies are taking place here in Rhode Island at several community hospitals in the context of emergency rooms. We’re seeing if we can engage patients in a brief therapy to foster safer sex and drinking behavior. We have some promising preliminary findings that were presented at a meeting in Sapporo, Japan last year. Basically, patients who participant in a brief treatment are drinking less at a nine month follow-up assessment. There is some suggestion that they may be engaging in less risky sex.
PBN: What the most exciting aspect of your work?
MONTI: The exciting part for me is training the next generation of researchers. And a lot of the efforts of our center are focused on training, both of Brown undergraduate and graduate students, but most emphasis is on post-doctoral training. We produce some of the best addiction scientists in the country.
There has never been a more exciting time in science, and particularly in the science of addiction. And as teachers of scientists, we need to encourage and support young researchers and we need to be particularly sensitive to the fact that we are now looking at reductions in spending at the federal level. We need to help junior folks through this period of reduced funding; otherwise we could lose a lot of ground if these young people go into different fields.
PBN: What major obstacles still exist in the field? What does the future hold for the CAAS?
MONTI: Perhaps the biggest obstacle is funding. As you know funding at the NIH has been cut back a great deal and nearly all of our work is funded through NIH. Nevertheless, we will continue to try to understand the relationship between alcohol and HIV. For example, we have a recently funded study focused on analyzing how doctors talk to HIV patients about their alcohol use. By analyzing these conversations, we hope to be able to predict the best way to approach these topics.
We will continue to be the place where effective treatments for substances of abuse are developed and disseminated to the field. Sometimes the scientific literature is not translated into care of the patient. We are trying to translate what we do in the laboratory and then report in the scientific literature and get that to ultimately affect patient care.