Probing epidemic social afflictions

Linda Cottler, Ph.D., investigates array of risks rising out of substance abuse

Linda B. Cottler, Ph.D. (center), discusses an outreach plan for a program to reduce high-risk behaviors among substance-abusing women with colleagues (from left) Joyce Balls, a master's student and communications health outreach supervisor; Catina Meeks, a Ph.D. student project coordinator; Erik Rasmussen, Ph.D., a postdoctoral fellow; and Peter Fahnestock, a fourth-year medical student.

Sometimes our fates are decided by chance. Chance certainly changed things for Linda B. Cottler, Ph.D., professor of epidemiology in psychiatry. In 1974, she was working as a nurse in the pediatric neurology department at St. Louis Children's Hospital when she decided it was time to leave her native St. Louis in search of new challenges.

"I threw a dart at a map of New England, and it landed on Farmington, Connecticut," Cottler recalled. "I didn't think that was such a hot idea, so the next closest place was Boston."

With her cat and her television, she headed for the East Coast. The rest of the nation was focused on the Symbionese Liberation Army's kidnapping of heiress Patty Hearst, which occurred while she was making the move, but she was trying to find motels that would allow cats.

A new career

Since then, she has spent years conducting studies of men and women at high risk for problems from substance abuse.

"It can really get to you when you see that things don't change, that people are not in a mind-set to change," she said. "The other thing is when you attempt to do the follow-up and find out that the person has died. And we find that an overwhelming proportion have either overdosed, or died from some kind of a homicide or an attack or something else related to drug use."

But Cottler believes that when studying people at high risk for problems, it's important to remember that a random factor might be all that separates that person's fate from her own.

In 1980, after she completed a master's degree in public health, a professor at Boston University told Cottler about a possible job back in St. Louis. "It was going to involve working with Lee Robins. When I called her, I learned she was getting ready to start a major national project called the ECA study," Cottler said. ECA stands for Epidemiological Catchment Area. It was the largest survey of the prevalence of mental illness in the general population. Cottler interviewed for the job while visiting family and friends back in St. Louis.

Lee N. Robins, Ph.D., the University Professor of Social Science and a professor of social science in psychiatry, noted that Cottler did not have any psychiatry experience when she came to interview for the job. "But she had worked on a project in Boston where she gathered data on children with birth defects, and the ECA study allowed her to use many of those epidemiology skills," Robins said. "Besides, no one had ever done anything like what we did on the ECA project, so it was impossible to have direct experience. And I was impressed with her energy and work ethic. As it turned out, she certainly was the right choice as our project coordinator."

When Cottler returned to St. Louis, it wasn't quite as simple as packing her cat and her television. She had married and had a 9-month-old daughter. Her husband, Matt, originally from New Jersey, had lived next door to her in Boston.

He gave up his job to come with her to St. Louis, and she went to work on the ECA study. The project eventually gathered so much information about Americans' mental health that data from the study still are providing insights about the impact and prevalence of all types of psychiatric disorders, from depression to alcoholism to schizophrenia.

The ECA study was the focus of Cottler's professional life for seven years, but it wasn't the entire focus. "It was sometime in the first week on the job that Lee said, 'I think you should get your doctorate,'" Cottler said.

As Robins explained it: "In our field, it's important to have the proper qualifications, and I could see that Linda was going to have the talent to create and run big projects of her own, so I told her she ought to get the degree in order to become a principal investigator herself. And fortunately, her husband and family were both flexible and very supportive."

During those years, Cottler had three daughters, Emma, now 20, Laura, 16, and Sara, 15. All have grown to be musicians. Emma is in her second year at Emory University, majoring in music and studying the harp. Laura plays flute, oboe and volleyball, while Sara plays bassoon and runs track.

Two were born while she was working on the ECA during the day and completing her Ph.D. at Washington University at night. Although she works hard now to keep her work and home lives separate, in those days it was nearly impossible.

"When we were doing the development of the questionnaire for the ECA, I was pregnant and working on my dissertation," she recalled. "I can remember being home with Emma in the bathtub and the questionnaire on the bathroom floor as I tried to get some work done while bathing her. My husband, Matt, was working nights at McDonnell-Douglas, and it was just crazy. Working full-time, going to school while raising three kids isn't something I'd necessarily recommend. It all worked out for the best, but I couldn't have made it through without Matt."

And she has been very involved in the lives of her daughters. The Cottlers live in Kirkwood, and the girls have attended Kirkwood High School, where Matt and Linda were co-presidents of the PTO last year. This year, they are co-chairs of the Parent Network.

"When we open the school doors to the community, Linda is here, whether it's a band concert, a school play, or some other activity," said Franklin McCallie, principal at Kirkwood. "She and Matt provide a great positive energy at our school, and I think our kids really understand how much better our school is because of the involvement of parents like the Cottlers."

The Cottler family, spring break 1999, enjoys the beach in Destin, Fla. Matt and Linda are in back with (left to right) daughters Sara, Emma and Laura in front.

In 1987, after Cottler completed her doctorate in sociology, she became a research instructor in psychiatry at the University. Her first grants, approved in 1988, dealt with a theme that has been central in her work ever since -- the relationship between substance abuse and the risk for AIDS.

She has investigated factors involved in drug use and learned about the profile of the at-risk people who become substance abusers and engage in high-risk sexual activity. Many trade drugs for sex, have more than one partner or use dirty needles -- all formulas for HIV exposure.

Cottler's team also has designed and studied programs in which part of the treatment for substance abuse is delivered by the peers of people trying to stop or reduce their drug and alcohol use. They found that using peer educators can be more effective than standard treatment programs for substance abusers. And lately, she has started to look at gender-focused prevention programs that address the special needs of women who abuse alcohol or take drugs.

Studying gambling

And when the explosion happens, she plans to be at ground zero, just as she was 20 years ago when the ECA was launched.

"At the time, Lee had the initiative to ask questions about three things that almost no other sites in the study addressed: tobacco dependence, high-risk sexual activity and gambling," Cottler said. "We have this gold mine of data about gambling that's just about ready for a 20-year follow-up. If we can get a grant to study gambling status and look at the long-term outcome, we could learn a lot."