Dr. Alan Schatzberg is a renowned American psychiatrist, currently serving as the Kenneth T. Norris, Jr. Professor of Psychiatry and Behavioral Sciences at Stanford University and Director of the Stanford Mood Disorders Center. He is widely recognized for his groundbreaking research into the biology and treatment of depressive disorders.

Dr. Schatzberg reflects on early efforts in the 1980s to biologically subtype depression using markers like MHPG and cortisol. Promising findings—such as low catecholamine output predicting response to noradrenergic agents—highlighted potential, but the field has yet to produce clinically useful biomarkers. This underscores the complexity of psychiatric disorders, which are multifactorial and heterogeneous, making personalized medicine in psychiatry a persistent challenge. Even after four decades, biological psychiatry remains largely dependent on trial-and-error treatment, emphasizing the need for innovative diagnostics.

A pivotal insight discussed is the discovery that naltrexone, an opioid antagonist, blocks ketamine’s rapid antidepressant effects. This challenges the assumption that ketamine’s efficacy stems solely from NMDA receptor antagonism. The involvement of the opioid system raises concerns about addiction liability and suggests that the antidepressant “aha moment” may be partly opioid-mediated, intertwining biological and psychological processes like hope and expectation.

Dr. Schatzberg proposes that placebo responses may be mediated by endogenous opioid release, reframing them as biological phenomena rather than mere psychological artifacts. This reconceptualization has major implications for clinical trial design and understanding patient outcomes, especially with agents like ketamine and psychedelics, where expectation bias can significantly influence results.

The conversation raises safety concerns about the off-label, unsupervised use of ketamine, particularly oral formulations compounded for home use. Historical cases from China and Australia show how easy access can lead to abuse and addiction. Similarly, low-dose buprenorphine shows promise for suicidal ideation, but requires careful monitoring to avoid dependence and withdrawal. These insights highlight the need for regulatory oversight, controlled dosing protocols, and patient registries to ensure safe and effective use.

Dr. Schatzberg revisits his work with mifepristone (RU-486), a glucocorticoid receptor antagonist that showed efficacy in treating hypercortisolic psychotic depression. Though early development hurdles limited approval, ongoing research suggests potential in managing refractory diabetes linked to hypercortisolism. This illustrates how revisiting older findings can open new therapeutic avenues, especially at the intersection of endocrinology and psychiatry.

Dr. Schatzberg’s mentorship of leaders like Dr. Mark George and Dr. Nolan Williams has helped advance treatments such as TMS and neuroimaging biomarkers. His presidencies of the ACNP, Society of Biological Psychiatry, and APA reflect a rare breadth of leadership, shaping research priorities and clinical standards. His commitment to updating foundational textbooks ensures continued education for future generations.

The discussion also explores the methodological hurdles in psychedelic clinical trials, particularly the difficulty of blinding due to the drugs’ distinctive effects. Drs. Schatzberg and Gold propose combining ketamine with naltrexone to create more effective placebos that block antidepressant effects without causing dissociation—an approach that could improve trial rigor and reliability.

This comprehensive dialogue between Dr. Mark Gold and Dr. Joshua Siegel highlights the remarkable scientific advancements and ongoing challenges in the field of psychedelic medicine. By integrating deep neuroscience with clinical rigor and ethical mindfulness, researchers are poised to transform mental health treatment paradigms.

The interview underscores that while psychedelics hold tremendous promise, their safe, effective, and equitable integration into clinical practice depends on maintaining meticulous scientific standards, embracing interdisciplinary perspectives, and thoughtfully addressing societal and regulatory complexities.

In this episode of The Gold Standard, Dr. Mark Gold welcomes Dr. Nicole Avena, a leading expert on food addiction and neuroscience. They discuss her groundbreaking research on sugar addiction, the impact of nutrition on brain health, and the importance of mindful eating. With over 17 million views on her TED talk, Dr. Avena shares insights on how food affects the brain and why this knowledge is crucial for both medical professionals and the public. Join us for a deep dive into the science behind what we eat and its long-term effects on our health.

GUEST: Dr. Charles Zorumski is the Samuel B. Guze Professor and Head of Psychiatry, and Professor of Neuroscience at Washington University School of Medicine (WUSM) in St. Louis. He also serves as Psychiatrist-in-Chief at Barnes-Jewish Hospital and Director of the Taylor Family Institute for Innovative Psychiatric Research.

In this engaging conversation, Dr. Mark Gold interviews Dr. Zorumski about Washington University’s (WashU) transformative impact on psychiatry. The discussion covers the institution’s foundational work in diagnosis, brain imaging, and treatment innovation.

Starting in the 1950s, WashU’s Department of Psychiatry—led by Eli Robbins, Sam Guze, and John Feiner—developed the first reliable diagnostic criteria, forming the basis for the DSM-III. This shift from subjective impressions to reproducible, criteria-based diagnoses enabled rigorous research and clinical trials, reshaping psychiatric practice.

WashU also pioneered brain imaging, progressing from early PET scans to advanced fMRI and precision functional mapping. These tools have helped link psychiatric symptoms to specific brain circuits, reinforcing the integration of neurobiology into psychiatry. A strong culture of mentorship has supported this interdisciplinary approach.

In treatment, WashU remains a leader in electroconvulsive therapy (ECT) for treatment-resistant conditions and has been at the forefront of testing rapid-acting antidepressants like ketamine and nitrous oxide. The institution has also advanced neuromodulation techniques such as vagal nerve stimulation and transcranial magnetic stimulation (TMS).

Dr. Zorumski highlights the translational success of neurosteroid research, particularly allopregnanolone, which led to FDA-approved treatments for postpartum depression and epilepsy. The conversation concludes with emerging research on psychedelics like psilocybin, where precision brain imaging is helping to uncover therapeutic mechanisms.

Key Insights

This in-depth conversation between Dr. Mark Gold and Dr. David Smith explores the origins, evolution, and current challenges of addiction medicine in the United States. Dr. Smith, a pioneer in the field, recounts his groundbreaking work starting in 1967 with the founding of the Haight Ashbury Free Clinic during the “Summer of Love” in San Francisco.

He narrates the shift in societal and medical perspectives on addiction—from a criminal issue to a recognized medical specialty—and highlights the clinic’s innovative approach integrating medical, psychiatric, and addiction treatments.

The discussion covers key historical milestones such as federal funding triggered by the Vietnam War, the emergence of methamphetamine and cannabis addiction, the adoption of clinical toxicology and drug testing protocols, and the impact of workplace safety initiatives like the Exxon Valdez case.

Dr. Smith also addresses the complexities of substance use in contemporary society, emphasizing the potency and dangers of modern cannabis, the opioid epidemic, and the evolving role of harm reduction versus recovery-oriented care. The conversation touches on the re-emergence of psychedelic research with cautious optimism, the importance of 12-step programs in recovery, and the challenges addiction medicine faces amid political and social backlash.

The interview closes with a recognition of the continuing need for education, compassion, and scientifically grounded treatment to improve outcomes for individuals and communities struggling with addiction.

In this enlightening interview between Dr. Mark Gold and Dr. Sarah Vinson, they discuss Dr. Vinson’s remarkable journey to becoming the youngest chairman in a psychiatry department in the United States. She shares her experiences from growing up in rural Florida and her evolution from aspiring pediatrician to a leader in child and adolescent psychiatry, specifically focusing on trauma and forensic mental health. Throughout the conversation, they delve into significant topics such as the impact of race on mental health assessments, the importance of culturally informed care, and the necessity for mental health professionals to understand the community dynamics that influence their patients. Dr. Vinson also emphasizes the need for diversity within medical teams and the critical role of understanding social determinants of health to improve patient outcomes. The discussion highlights societal challenges while maintaining a hopeful outlook on the future of mental health practice in under-served communities.

GUEST: Sarah Vinson, MD: Dr. Sarah Y. Vinson is a triple board certified physician who specializes in adult, child & adolescent, and forensic psychiatry. Associate Professor of Psychiatry and Pediatrics, Morehouse School of Medicine, Founder and Principal Consultant – Lorio Forensics.

HOST: Mark S. Gold, MD, DFASAM, DFLAPA: Dr. Gold is a world-renowned expert on addiction-related diseases and has worked for 50+ years developing models for understanding the effects of opioids, tobacco, cocaine, and other drugs, as well as food, on the brain and behavior. He is professor (neuroscience), chief, Dizney distinguished professor, chairman (psychiatry), University of Florida College of Medicine, emeritus eminent scholar, and 17th U.F. distinguished alumni professor. He is also an adjunct professor in the Department of Psychiatry at Washington University School of Medicine, St. Louis, MO.

(c) Hatherleigh Behavioral Health: Leader in Postgraduate Education. Visit us at www.hatherleigh.com

In a comprehensive dialogue, Dr. Mark Gold converses with cannabis expert Dr. Kevin Hill to explore the clinical implications of cannabis use, focusing on its increasing potency over time and the implications for public health and addiction treatment. Dr. Hill recounts his journey from premed to cannabis specialization, sparked by his work in a partial hospital program helping patients with cannabis use disorders. He highlights a significant evolution in understanding cannabis use disorders, with recent statistics indicating that 30-35% of adult users may develop such disorders, soaring from the previously noted 10%. This rise correlates with the increased potency of cannabis strains currently available, which contain much higher THC levels than in past decades, raising alarms regarding potential health risks.

Throughout the discussion, Dr. Hill advocates for informed consent and better education for both patients and healthcare providers, particularly regarding the risks inherent in cannabis use for vulnerable groups, including those with psychiatric conditions and pregnant women. He stresses the alarming effects of regular cannabis consumption on individuals predisposed to psychotic disorders and points to the emergence of cannabis hyperemesis syndrome (CHS) as a byproduct of higher potency strains, with existing treatments often inadequate.

Moreover, the conversation touches on the inconsistent regulatory environment surrounding cannabis, where state laws sometimes lack a scientific foundation. Dr. Hill strongly encourages evidence-based policymaking to mitigate risks associated with cannabis use. Dr. Gold brings to light the growing negotiation between traditional addiction recovery models and newer paradigms, such as the “California sober” approach, which embraces limited cannabis usage.

Both experts underscore the significance of relying on peer-reviewed research over anecdotal evidence in guiding treatment decisions. By sharing experiences from the NFL Pain Management Committee, they address the delicate balance of supporting athletes facing substance use issues while monitoring their substance use. The discussion ends with a call for holistic, patient-centered therapies that integrate psychotherapy and tackle co-existing mental health disorders, underlining the pressing need for advanced treatments for cannabis use disorder.

GUEST: Kevin P. Hill, M.D., M.H.S., is an addiction psychiatrist, Director of the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center (BIDMC), and an Associate Professor of Psychiatry at Harvard Medical School.

HOST: Mark S. Gold, MD, DFASAM, DFLAPA: Dr. Gold is a world-renowned expert on addiction-related diseases and has worked for 50+ years developing models for understanding the effects of opioids, tobacco, cocaine, and other drugs, as well as food, on the brain and behavior. He is professor (neuroscience), chief, Dizney distinguished professor, chairman (psychiatry), University of Florida College of Medicine, emeritus eminent scholar, and 17th U.F. distinguished alumni professor. He is also an adjunct professor in the Department of Psychiatry at Washington University School of Medicine, St. Louis, MO.

(c) Hatherleigh Behavioral Health: Leader in Postgraduate EducationFor more, please visit http://www.hatherleigh.com

In this engaging dialogue between Dr. Gold and his guest Robert Dupont, MD, the two discuss significant milestones in Dr. Dupont’s medical career, particularly his pioneering work in addiction treatment and substance use research. From their heartfelt reminiscences to profound insights on addiction, they explore Dr. Dupont’s journey from his early passion for psychiatry, sparked by his childhood reading of “The Human Brain,” to his influential role at the National Institute on Drug Abuse (NIDA) and the groundbreaking narcotics treatment administration he established in Washington, D.C. The conversation captures not only the challenges faced within the field of addiction treatment but also highlights the transformative impact of holistic care versus pharmacological-only approaches. Dr. Dupont emphasizes the critical interplay between human relationships and supportive communities for effective recovery, championing organizations like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) as pivotal in sustaining individuals in their recovery journeys.

GUEST: Robert Dupont, MD: Robert DuPont was the first Director of the National Institute on Drug Abuse and served as the second White House Drug Czar under President Gerald R. Ford. DuPont became the founding President of the Institute for Behavior and Health, Inc. DuPont also served as Clinical Professor of Psychiatry at the Georgetown University School of Medicine.HOST: Mark S. Gold, MD, DFASAM, DFLAPA: Dr. Gold is a world-renowned expert on addiction-related diseases and has worked for 50+ years developing models forunderstanding the effects of opioids, tobacco, cocaine, and other drugs, as well as food, on the brain and behavior. He is professor (neuroscience), chief, Dizney distinguished professor, chairman (psychiatry), University of Florida College of Medicine, emeritus eminent scholar, and 17th U.F. distinguished alumni professor. He is also an adjunct professor in the Department of Psychiatry at Washington University School of Medicine, St. Louis, MO.

(c) Hatherleigh Behavioral Health: Leader in Postgraduate EducationFor more, please visit http://www.hatherleigh.com

This engaging dialogue between Dr. Gold and Dr. Fuehrlein serves as a

celebratory reminder of how far addiction psychiatry has come and the

promising advancements that lie ahead. As the conversation navigates

through personal histories, mentorship, innovative treatment approaches,

and the challenges of stigma, it reinforces the critical importance of

continued research and education in the field. The insights gleaned from

this discussion not only highlight the evolution of addiction

psychiatry but also underscore the shared commitment of professionals to

improve patient outcomes and foster a better understanding of substance

use disorders within society. As the sector evolves, it holds

near-boundless potential for future advancements, ultimately striving

for a world where addiction is met with compassion, understanding, and

effective treatment options.

GUEST: Brian S., Fuehrlein, MD, PhD: Dr. Fuehrlein is currently an

Addiction Psychiatry Fellow at Yale University and has accepted a

position as Clinical Assistant Professor and Director of the Addiction

Psychiatry Consult Service in the Department of Psychiatry at the

College of Medicine, University of Florida, Gainesville, FL.

HOST: Mark S. Gold, MD, DFASAM, DFLAPA: Dr. Gold is a world-renowned

expert on addiction-related diseases and has worked for 50+ years

developing models for understanding the effects of opioids, tobacco,

cocaine, and other drugs, as well as food, on the brain and behavior. He

is professor (neuroscience), chief, Dizney distinguished professor,

chairman (psychiatry), University of Florida College of Medicine,

emeritus eminent scholar, and 17th U.F. distinguished alumni professor.

He is also an adjunct professor in the Department of Psychiatry at

Washington University School of Medicine, St. Louis, MO