Alan I. Green, MD, the Raymond Sobel Professor of Psychiatry, who served as chair of the Department of Psychiatry at the Geisel School of Medicine and Dartmouth-Hitchcock (D-H) for nearly 18 years, died Thursday, November 26.
An acclaimed teacher, clinician, and researcher, Green joined the faculty of then Dartmouth Medical School in 2002 as chair of the Department of Psychiatry both at the medical school and D-H—stepping down earlier this year. Green’s dynamic leadership and vision expanded the department into a major provider of psychiatric care throughout Northern New England.
“We will miss Alan’s enthusiasm, dedication, and humor,” says Dartmouth-Hitchcock and Dartmouth-Hitchcock Health CEO and President Joanne M. Conroy, MD. “His work helped improve the lives of countless people around the region and will continue to assist others through the programs he built, the students he has mentored, the patients he served, and the many people he inspired.”
Green was also a member of the advisory board of Dartmouth's Neuroscience Center—bringing together D-H, Geisel School of Medicine, Thayer School of Engineering, and Dartmouth College neuroscience experts to share clinical neuroscience, basic neuroscience, and cognitive neuroscience research.
"Alan was a very special individual,” says Dean Duane Compton, PhD. “He had incredible passion and unlimited drive for science in psychiatry, and in his leadership of the SYNERGY program. He was also deeply perceptive of people’s needs—intuitively offering help when it was most needed. I will miss him very much."
Christine Fitts-Spring, associate chair of administration in the Department of Psychiatry from 2008 - 2019, recalls Green’s energy and respect for colleagues. "Many of us from the department often referred to Dr. Green as the ‘Energizer Bunny’... he just kept going and going. He could rarely sneak up on anyone because he would often hum a tune as he walked through the halls of the hospital and department,” she says.
Prior to joining Dartmouth, Green was an associate professor of psychiatry at Harvard Medical School, directing the school’s Commonwealth Research Center (CRC) since its inception in 1987. Based at the Massachusetts Mental Health Center (MMHC), the CRC is a clinical research center dedicated to studying patients with severe mental illness. Green spent 20 years at the MMHC in various clinical, research, and leadership roles, including the Office of Research Administration and the Neuropsychopharmacology Laboratory. Additionally, he served on the medical staff at both the Brigham and Women's and the Beth Israel-Deaconess Hospitals.
A self-described researcher at heart, Green’s early work involved clinical and biologic studies of patients with schizophrenia and related psychiatric disorders focusing on the action of atypical or novel antipsychotic drugs such as clozapine—a highly effective treatment for schizophrenia that carries serious potential side effects. Taken off the market in the 1970s because of its risks, later studies showed that clozapine was more effective than any other antipsychotic in treating schizophrenia. In the 1980s the Food and Drug Administration approved it for use in patients who were unresponsive to other drugs.
Intrigued by the work of Dartmouth psychiatrist Robert Drake, MD, acclaimed for studying and developing treatments for people who suffer from both severe mental illness and addiction, Green reached out to Drake to see if he would share data he had on patients with schizophrenia who had taken clozapine. Drake complied—those who took the drug experienced a significant decrease in alcohol addiction. Those initial findings led Green to pursue a series of studies about clozapine, which, in turn, helped him to piece together his central theory about schizophrenia and substance use disorders.
Schizophrenia is a disorder associated with abnormalities in an area of the brain that, among other things, regulates brain reward circuitry—the same circuit that allows us to enjoy every day activities can also drive the compulsive drug use that marks addiction. Green’s compassion for those with chronic mental illness has been as consistent as his dedication to this line of research, which led to discoveries about the relationship between schizophrenia and brain reward circuitry.
Through his continued clinical and neurobiological studies of patients with schizophrenia—particularly those with co-occurring substance use disorders—and his medication development studies for patients with alcohol use disorder, Green and his colleagues proposed a neurobiological model suggesting that co-occurring substance use disorder in patients with schizophrenia relates, at least in part, to deficiencies in dopamine-mediated brain reward circuits.
Data also suggested that clozapine limits alcohol and other substance use in these patients—Green and his team continued probing the optimal psychopharmacological strategies for patients with co-occurring disorders through clinical trials, neuroimaging studies in humans, and a series of pharmacologic, neuroimaging, and neurostimulation investigations in animal models.
“Last time I spoke to Dr. Green, he talked to me about having time to reflect and that the most rewarding part of his career had been mentoring junior scientists and students,” recalls Jibran Y. Khokhar, PhD, an adjunct professor of psychiatry at Dartmouth who for the past four years has been working with Green toward establishing safer and more efficacious therapeutics for co-occurring schizophrenia and alcohol use disorder. “As someone who benefitted from that mentorship, I can say that those are not just words. He put his all into mentoring us. I hope that all of us can honor his legacy and pay it forward by doing the same for the people who we mentor.”
His passion for research also led Green to establish the Dartmouth SYNERGY Translational Research Institute, which helps connect researchers at Dartmouth and Dartmouth-Hitchcock to critical resources, such as funding opportunities, technologies, research training, and expertise, speeding the impact of discovery and translating new knowledge into practice.
“Alan Green used his humanity, intelligence, and remarkable energy to improve lives. I met him as a first-year medical student almost 40 years ago and have worked closely with him for many years,” recalls William C. Torrey, MD, interim chair of the Department of Psychiatry. “He skillfully challenged, supported, and inspired his patients, students, and colleagues, frequently leading them to exceed their own self-expectations. Because people mattered to Alan, the work mattered.”