Researcher devotes career to understanding the causes of alcoholism

By Arthur Lightbourn

Contributor

Local resident Marc Schuckit knew from an early age that he not only wanted to become a physician, but most likely wanted to pursue psychiatry.

“The psychiatry part was: I loved novels, I loved history, and I loved people stories. And in psychiatry you’re dealing with people stories…and you’re dealing with people based on time as opposed to procedures.”

For example, Schuckit said, “If you were seeing me, I would see you based on 45 minutes. You have booked me for a period of time to talk about you and what’s concerning you.

“If I were a surgeon, figuratively, I might see you for 10 minutes dealing with the procedure I’m about to do.” But, as a psychiatrist,

“I like your story more than I like doing surgery on your elbow.”

Today, Schuckit, now 66 and a Distinguished Professor of Psychiatry at UCSD, is a world leader in the research study of alcoholism, particularly the importance of genetic and environmental influences on alcohol dependence.

And, for 30 years, as a clinician, he directed the alcohol and drug treatment program and treated patients at San Diego’s VA Hospital, UCSD’s teaching hospital.

His numerous awards include the President’s Award from the American Psychiatric Association in 1972, the Distinguished Scientist Award from the Research Society on Alcoholism in 1993, the Middleton Award in 1997, and the Lifetime Achievement Gold Medal Award from the Society of Biological Psychiatry in 2005.

And how do you get to be a world leader in the research of alcoholism?

“Persistence,” he said. “Research is a funny business. By its very nature, you open yourself up for criticism. You’re competing with people for scarce dollars to support research...I am proudest that when criticized I learned from it and didn’t say, ‘Ah, I shouldn’t be looking at it anymore.’”

We interviewed Schuckit in his office near the UCSD campus where he heads a team of 11 researchers.

Schuckit is definitely a detail man. He chooses his words thoughtfully, and, even after some 40 years in research, exhibits an obvious excitement and enthusiasm for his work.

Physically, he’s tall and lean. He exercises regularly, scuba dives in tropical waters at least once a year, and is “almost a vegetarian” because of “feeling bad for the animals.”

His father was a butcher.

Schuckit was born and raised in Milwaukee, Wisc., along with two sisters. His grandparents were Jewish immigrants from Lithuania and Romania.

He earned his undergraduate degree in premedical science from the University of Wisconsin in 1964; his medical degree from Washington University, St. Louis, Missouri, in 1968; followed by an internship at Cedars Sinai Medical Center, Los Angeles, and residencies in psychiatry at Washington University and UCSD, completed in 1972.

“When I went to medical school, I had no idea that I would do research,” he revealed “but I needed to help support myself so the first day of medical school I looked for a part-time job.”

The job he found was as an interviewer in a research study of 30-year-old men. “And among the problems you are likely to see among 30-year-old men, alcohol and drugs are way up there.”

He became fascinated with “the patterns of data” and “writing up the data.”

And, for him, asking the right questions and making sense of the data, was, “like a eureka moment.”

He was, as it turned out, and still is, hooked on research.

He divides his years of research into alcoholism into four phases.

“The first question I was lucky enough able to ask, (initially as a medical student and later as a medical resident) was, ‘Alcoholism certainly runs strongly in families, but how would you figure out whether genes were involved?’”

At the time, he recalled, there were limitations in the U.S., on getting the records and funding to ask about genetic conditions, “but

I was lucky enough to have a good adviser who suggested an approach to me where I was able to help tease out the relative importance of being raised by an alcoholic versus having a biological alcoholic parent even if you were never (or only for a limited time) raised by him or her.”

“We published that paper in 1972 … and our data showed that having a biological alcoholic parent was a very strong predictor, far from perfect, but a very strong predictor of your alcoholism risk.

“Whereas being raised by an alcoholic, with its own problems associated with it, did not by itself increase a person’s alcoholism risk.”

Through his research and the research of others, it was estimated that 60 percent of the risk for alcoholism is genetic and 40 percent environmental.

“Therefore,” he concluded, “a person may carry vulnerability, but no one is born with a predestination to become alcoholic.”

During the Vietnam conflict, Schuckit served in the U.S. Navy for two years at the Naval Health Research Center in San Diego, continuing his research into alcoholism.

During the second five-year phase of his research, while a senior resident at UCSD, while in the Navy, and later on the faculty of UCSD’s medical school, he focused on what is inherited that increases or decreases the risk of alcoholism.

At the time, it was known that certain gene mutations caused alcohol reactions among 40 percent of Asian people (such as flushing or painful allergic reaction), acting as deterrents and reducing their alcoholism risk; and also that highly compulsive people were more at risk of developing a dependency for alcohol, drugs, gambling, etc.

He concluded, in the mid-1970s, that people who were less sensitive to alcohol were more likely to drink heavily.

The third phase of his work into mid-1980s was a series of studies trying to determine if a low sensitivity to alcohol is indeed a risk factor for alcoholism.

“In our work and in other people’s work, we discovered: A. that in most studies the children of alcoholics, before the alcoholism developed, showed a low sensitivity to alcohol; that Native Americans also show a low sensitivity; among Asians, only Koreans have a high risk for alcoholism; and, Jews, who have a low alcoholism risk overall, show a high sensitivity to alcohol.

“If you get a lot of kick per drink (high sensitivity)” he explained, “you have a low risk for alcoholism,” he said. “If it takes a lot of booze to give you the kick (low sensitivity), you have a high risk for alcoholism.”

One of his major studies launched in 1978 involved individuals from 453 San Diego families with a follow-up 10 years later.

The question was: Did the low sensitivity to alcohol at age 20 predict a significant increased risk for alcoholism by age 30?

“And, indeed, it did,” Schuckit concluded, “not perfect, but a very strong relationship, somewhere between a doubling and tripling of the risk.”

Then, as part of his lab’s research, with collaborations, he focused on finding genes that contributed to a low sensitivity or response to alcohol.

“We have [identified] five gene variations that very likely to be contributing to a low response to alcohol.”

And what is it in the environment that may be facilitating how a low sensitivity to alcohol produces heavier drinking?

“Here’s what I understand from the environmental studies,” he said. “Depending on what age you are, with a low response to alcohol, you tend to drink a lot per occasion, part of the environment is the drinking among peers, (“You hang out with friends who spend as much time drinking as you do.”), which changes your view of what is acceptable drinking.

“The combination of heavy peer drinking, unhealthy expectations of what is acceptable drinking and using alcohol to cope with stress, are major contributors to how low sensitivity to alcohol leads its way to heavy drinking.

“The environment … is to me is the key to prevention,” he said.

“The final phase of his work,” he hopes, “will be to take what we’ve learned over the last 30 years and try to see if it’s useful in a prevention trial.”

So, he says, if he can raise the money through a grant, he will launch a new project to identify older teens or young adults who are not yet alcoholic, characterize them as low sensitivity or not to alcohol, and put together a prevention approach that teaches them about how important the low sensitivity is, what it means to them, and how important the influences of heavy-drinking peers are, and so on.

“If you wanted to say what has my research been about over the last 30 or so years, it is understanding enough about causes [of alcoholism] to work to help prevent it.”

Statistics indicate about 15 percent of men and 8 to 10 percent of women in the U.S. become alcoholic at some time during their lives.

Asked if he anticipates in future the incidence of alcoholism may be reduced, he said, “My fantasy is that in 20 years from now public knowledge of the dangers associated with heavy alcohol use will gradually have a greater and greater impact and that people may be as harsh in not accepting heavy drinking and drunkenness as we are about smoking.”

Asked if he takes a drink now and then, he said, “Yes, but only good chardonnay and cabernet, with the emphasis on ‘good’.”