Meeting #13

Kona, Hawaii

September 14 - 17, 2005



Present at the meeting were Drs. Alisa Busch, Carlos Hernandez-Avila, Randy Brown (all senior scholars), Karin Neufeld, Nioaka Campbell, Jill Williams, Olivera Bogunovic, Timothy Fong (all junior scholars), Marianne Guschwan, Susan Tapert (Associate Directors), and Marc Schuckit (Director), and Marcy Gregg (Administrative Assistant).



I. Wednesday, September 14, 2005

The meeting began with a get-together at the Mauna Kea Hotel, beginning at approximately 5:30 p.m. Introductions were made, and the group briefly reviewed the tasks ahead. The meeting continued during dinner at Brownâs Beach House of the Fairmont Orchid Hotel.



II. Thursday, September 15, 2005

The group reassembled at 8:00 a.m. for a working breakfast and the beginning of the dayâs tasks. Each member introduced themselves and gave a brief background on their home university and roles. Marc Schuckit then reviewed the goals and obligations of AMSP scholars. In addition, he shared the history of the organization and the future directions.

The majority of the morning was spent with a detailed review of how to scholarly review the literature and then organize and present a lecture. Marc Schuckit demonstrated the lecture, giving frequent examples of presentations by prior scholars. A great deal of time was spent going over the importance of a thorough preparation; organization using an outline format; and the development of slides.

Alisa Busch then reviewed her recent AMSP-related accomplishments at Harvard University. Among her activities these last six months has been an expansion of her efforts to demonstrate patient interviews in front of residents, especially using individuals selected from an inpatient detoxification program. Alisa will also be conducting an educational seminar with the addiction fellow in her department. In addition, major efforts on her part have been made to contact persons in the department who represent psychiatry in the revamping of medical school education approaches at Harvard Medical School, with the goal of being certain that substance use disorders are well represented. Alisa has also planned to participate in the informal Friday lunches for medical students planning on entering psychiatry. Additionally, Alisaâs book chapter, ãCo-Occurring Substance Use Disorders and Other Psychiatric Disorders,ä has been published in the Clinical Textbook of Addictive Disorders, 3rd Edition.

Susan Tapert and Marc Schuckit next discussed the medical school activities related to alcohol and drugs at the University of California, San Diego, as well as the alcohol and drug electives. During the first two years of medical school, efforts have primarily focused on dedicated lectures regarding controlling stress offered to medical students and (in a separate venue) to their parents and partners; first-year lectures as part of the Growth and Development course in psychiatry, as well as in the pharmacology introductory course; and a noontime elective series of discussions with medical students dealing with alcohol and drug issues. Second-year medical school activities include two dedicated lectures as part of the psychopathology course, as well as an outreach to medical students planning their independent study courses. Marc and Susan also offer a 10-session pre-clinical elective on substance dependence and its treatment. During the third year, approximately 60 medical students (two at a time) spend three weeks full time with treatment teams from the Alcohol and Drug Treatment Program as part of their rotation through psychiatry; and Marc Schuckit delivers a lecture on comorbidity to all third-year students as part of the required medical school psychiatry rotation. During the fourth year two different electives are offered on the Alcohol and Drug Treatment Program, one inpatient and one outpatient. In addition, lectures are offered yearly to the family practice residents as well as to medical students and residents rotating through the emergency services at the San Diego VA Medical Center. On the psychiatry resident level, all residents rotate through the Alcohol and Drug Treatment Program for two months, and this year two fourth-year residents are rotating through a senior resident position of six months each.

The group next turned to important deadlines for the development of lectures. This included a deadline of November 15th for the junior scholar to have worked with the assigned senior scholar and to have forwarded on to Marc Schuckit the best possible draft of the lecture; and a January 13th (Friday) deadline for having drafts of slides to Marc Schuckit.

Marc Schuckit then circulated to the first-year scholars a list of potential activities they might follow in their medical schools. He and Marcy also gave them an outline of the UCSD elective course for medical students. Finally, the second-year scholars were given an overview of the activities that they should consider in helping junior scholars during this year.

A working luncheon was then used to deal with issues related to career development. The first topic was the importance of expanding the activities of AMSP to enhance networking among other interested junior faculty. Among the suggestions was the need to encourage current members and past graduates of AMSP to present symposia at national and international meetings including the AAAP, APA, RSA, and CPDD; the possibility of developing an AMSP newsletter for wider distribution; being certain that the AMSP Web site is connected to all appropriate organizations; sending out an announcement to all graduate scholars that for at least one AMSP meeting each year we will select one or two graduate scholars to attend at AMSP expense (they will be selected based on their current service to AMSP, their activities in their medical school, and their commitment to academics); Nikki Campbell will also look into the possibility of developing a presentation at the psychiatry residency directors meetings.

A second career-related topic was a discussion of steps that might be taken by junior faculty at medical schools to receive at least some salary support for taking on major teaching obligations. It is also possible to receive at least a limited amount of funding from the Robert Wood Johnson Foundation, and to look into developing health services research-related topics that might be funded by NIH or additional agencies.

The next issue related to time management. Marc suggested that one starts by putting the most important potential activities on oneâs calendar (i.e., time with family). It is also possible to then try to coordinate oneâs daily activities in a way that fits in best with personal preferences as well as families (e.g., what time of day you come in and what time you leave). An additional component is the need to build in time for the major activities of interest to be certain that they do not get short changed, at least within the structure of family and free time necessities.

Randy Brown of the University of Wisconsin, Madison next gave his modified lecture on benzodiazepines and related drugs. This was an excellent presentation with highly effective modifications having been carried out since the lecture was first delivered at the New York meeting in the spring of 2005.

At this point, each of the junior scholars listed potential topics they might be interested in for their first-year lectures. Nikki Campbell is considering developing a lecture on substance use, abuse, and dependence in college women. An alternate lecture might be on alcohol dependence in athletes. Jill Williams is considering an overview lecture on pharmacotherapies of nicotine dependence. An alternate lecture for her might be tobacco use and psychiatric comorbidities. Olivera Bogunovic is considering several topics, including the possibility of a lecture on some aspect of geriatric substance use disorders or an overview of HIV and substance disorders. Tim Fong might develop a lecture on alcohol use and alcohol use disorders in pathological gambling. Finally, Karin Neufeld will build upon her knowledge of ASPD and opioid dependence to consider developing a lecture on ASPD: diagnosis, epidemiology, causes, clinical course (especially as it relates to opioid dependence) and treatment.



The meeting ended with a review of the expected activities for the next day. On Thursday each of the participants was on their own regarding late afternoon activities and dinner.



III. Friday, September 16, 2005

The meeting began at 8:00 a.m. with a working breakfast. The first order of the day was the presentation of her lecture by senior scholar Alisa Busch. Consistent with the material presented last year, this was an excellent, well-focused lecture that worked very well. Following presentation of the full material, Marc asked Alisa to demonstrate how her 40-minute lecture could, in an emergency, be cut down to 10 minutes by focusing the four or so major points. Therefore, he suggested that she use her summary slides (slides 30 and 31), place herself in a situation where she is giving a brief introduction to psychiatric residents regarding levels of similarity between substance use disorders and medical or psychiatric conditions, and limit her lecture time to 10 minutes. She did an excellent job, and was able to demonstrate the ease with which an individual can alter the lecture with only a modest amount of preparation.

The group next returned to the goals of networking and publicizing AMSP. One step is to establish posters and presentations describing AMSP at a variety of meetings. Carlos Hernandez-Avila agreed to look through the prior AMSP posters that have been given at the Research Society on Alcoholism, modify the content, and submit the material as a potential poster at the RSA meeting coming up in Baltimore. Furthermore, Marc will determine whether the Journal of Studies on Alcohol might accept and publish for free a small advertisement. If this is accomplished, Marc will ask members of AMSP to help him approach additional journals, including the American Journal of Addiction, Psychiatric Services, Academic Medicine, ACER, as well as Drug and Alcohol Dependence (the major journal for CPDD).

In this vein, Karin Neufeld suggested the possibility of developing a computer interactive approach for the AMSP lecture on ãHow to Give A Lecture.ä In order to be able to do this appropriately, Karin will look into possible volunteers or local funds in Baltimore at Johns Hopkins. She will also let Marc know a ballpark figure on what it might cost to do this optimally and he will look at the AMSP budget to see whether it is possible. A discussion followed regarding whether it might be possible that, once such an interactive approach is developed, perhaps it might also be able to generate funds for AMSP.

An additional issue related to outreach and networking was the need to begin to invite graduate scholars to come to the AMSP meetings as guests of our organization (and with all expenses paid). This would accomplish the task of keeping in touch with graduates and continue to expand our impact at medical schools, but could be a bit costly. Therefore, for the next meeting (March of 2006), Marc and Marcy will send an e-mail to all AMSP graduates telling them that one or at most two individuals will be invited to attend. All graduates will be invited to apply, with the selection based on the necessity of their being in full-time academics, their demonstration of how AMSP training has helped them to reach out to alcohol and drug education in their medical schools, as well as their ability to help AMSP over the years.

An additional possibility for networking is now to develop editorials and letters to editors of journals describing AMSP. Karin Neufeld will talk with Drs. Brooner and Balster to see about the possibility of such a letter to the editor or editorial for drug and alcohol abuse. All members of AMSP will also keep their eyes open for articles about medical-alcohol-drug education where a letter to the editor of that specific journal might be welcomed. A related recommendation is to ask all members of AMSP to list the organization (perhaps with a direct link to AMSP) on any university or personal Web sites on which they participate.

The group next turned to issues of recruitment. Marc briefly reviewed the universities from which we have already recruited, and Marcy will be sending out a full list of medical schools for which recruitment is still appropriate. Marc reviewed the recruitment criteria (full-time academics, a solid and funded position at a university, and an interest in alcohol and drugs (although that does not need to be the only basis of a personâs work). A number of potential candidates were discussed, along with the goal of having selected individuals by the end of January 2006.

The senior scholar, Randy Brown of the University of Wisconsin, next presented his accomplishments over the prior six months. These include his passing of his preliminary examination for his Ph.D. (where his training on giving a lecture and developing slides was most helpful). Additional activities include Randy working as a volunteer mentor for family practice residents and medical students where he emphasizes alcohol and drug issues; his lectures to undergraduate social work students; his outreach to the nurse practitionersâ program; his substance-related lectures in the pharmacology course at his medical school; his outreach to community resources; the development of a medical student elective on dependence; the recent publication of a book chapter related to practice guidelines as they apply to substance use disorders; and his invitation to return to the University of California, Davis to give a one-hour lecture as well as a three-hour small group discussion on benzodiazepines (i.e., his topic developed for Alcohol Medical Scholars).

Junior Scholar, Nikki Campbell presented her plans to impact on education at the University of South Carolina at Columbia. Over the next six months as Director of the vertical substance use curriculum, Nikki plans to contact each faculty member who currently presents lectures and reorganize the topics/presentations where needed. Dr. Campbell is scheduled to give approximately 10 hours of didactic lectures to the MI-IV medical students over the next 12 months. As part of the lecture series for the M-III students, essays from each studentâs visit to a 12-step meeting will be reviewed and discussed. In her role as Director of the Peer Advocate Liaisons (PALs) program, in which she supervises students serving their peers as a confidential source of information on available counseling and treatment for substance abuse, Nikki hopes to get residents involved as mentors in this advocacy group. Finally, she hopes to plan an elective rotation for alcohol and drug use issues based on the syllabus posted on the AMSP Web site.

Susan Tapert next delivered an excellent example of a 20-minute scientific-based lecture dealing with the potential impact of cannabinols use on cognitive functioning. The subsequent discussion focused on how educational/review lectures aimed at medical students are very similar in many ways to scientific lectures. Differences between the two types of lectures were discussed.

We next turned to a discussion of potential meeting dates and conference call times for subsequent AMSP activities. The conference call for all first and second-year scholars was established for January 20, 2006 at noon San Diego time (3:00 p.m. East Coast time). All members of AMSP are required to be part of this one-hour call (it wonât be a minute longer) where they will update accomplishments and plans. The next meeting of AMSP will occur in Laguna Beach, California (the Surf and Sand Hotel) beginning on Wednesday, March 15, 2006, at 5:30 p.m. and ending at noon on Saturday, March 18, 2006.

The working lunch was then used to discuss career development issues. This included the challenges involved in building a research or clinical team; issues of delegation of activities vs. intimate control of projects; the roles of women in academics; challenges in getting promoted; and the achievement (and meaning) of tenure.

After lunch, Carlos Hernandez-Avila delivered his lecture on alcohol withdrawal. This was an excellent presentation, after which Marc asked Carlos to use eight specific slides (rather than his original almost 30) and demonstrate a 10-minute lecture as if it were given to psychiatry residents about to enter their first year and who needed information on recognition and treatment of alcohol withdrawal. Marc then demonstrated how the subsequent eight-slide lecture (Marc had named the slides) could now be decreased to a four-slide five-minute lecture with the same essential elements delivered.

The dayâs activities ended with a discussion of the goals appropriate for Saturday morning, as well as the pre-dinner and working dinner get-together that evening.

The group met in the lobby of the hotel at 7:15 p.m. to go to the neighboring Hapuna Beach Hotel for an evening get-together and dinner.



IV. Saturday, September 17th

Participants reassembled at 8:00 a.m. for the working breakfast. We began with Jill Williams from the UMDNJ - Robert Wood Johnson Medical School, who reported on some ideas for the upcoming year. She plans to review the current medical student didactic curriculum on substance abuse in details with the Medical Student Director of Education from the Department of Psychiatry (S. Atdjian). In particular, Jill will assess the current medical student curriculum for tobacco dependence as well as other areas of deficiency and redundancy to help her to identify areas of the curriculum that need improvement. Dr. Williams will explore with Dr. Atdjian ways that Dr. Williams can gain increased opportunities to interact with medical students on the topic of substance abuse. This might include a special mentoring session on careers in substance abuse. A second initiative will be to develop a formal medical student elective for MS-IVs in tobacco dependence. This will be described as a 2-4 week elective of clinical and/or research activity for medical students to enhance their understanding and to further develop their skills in tobacco assessment and treatment. She will set a goal of supervising at least one medical student per year in this elective capacity. Jill plans to continue her work as a member of the UMDNJ Student Assistance Committee (SAC), which oversees issues regarding current students who are experiencing problems with substance abuse or other problems, and plans to explore ways in which she can expand her role in teaching other UMDNJ trainees in substance abuse.

Randy Brown of the University of Wisconsin then gave an alternative 15-minute version of his lecture on benzodiazepines. Because he was beginning in the morning after a late night of work and dinner, he faced the challenge of trying to place the information on benzodiazepine dependence and treatments into a perspective that would be lively. A number of suggestions were offered including the need to include more case histories, and work to avoid a cadence of speech dictated by specific slides. Randy was able to demonstrate how the material could be delivered in an approximate 10-minute format without slides.

Olivera Bogunovic next presented her plans for activities at the University of New York at Buffalo. Olivera serves as a person in charge of the substance use disorders curriculum for psychiatric residents, so she will meet with the directors of the detox unit, the chair, and the residency director regarding how to improve substance use disorders-related material. She hopes to develop a binder of handouts to be given to medical students and/or psychiatric residents; she will join the medical education committee; she will work with third and fourth-year medical students in developing a rotation related to substance use disorders; Olivera plans to survey fourth-year medical student curricula issues regarding substance use disorders; she hopes to develop new lectures including an elective based on the AMSP model; and look into developing clinically relevant material regarding substance use disorders as presented to medical students and psychiatric residents.

Susan Tapert next delivered a lecture on PowerPoint. Because the scholars already had a fairly high level of sophistication with this approach, the emphasis was placed on animation and creation of graphs.

In the next item, Karin Neufeld, a first-year scholar from Johns Hopkins, reviewed her goals for the next six months. She identified three individuals at the medical school with whom she would arrange meetings: 1) Raymond DePaulo, M.D., Chair of the Department of Psychiatry. The goal for this meeting would be to remind him of the AMSP mission and her involvement in the organization and to ask for any feedback on ways to positively impact medical school teaching and within the department. 2) Tom Koenig, M.D. (file:///C:/Eudora/Attach/(http://www.hopkinsmedicine.org/dome/0305/feature3.cfm) is the new Associate Dean for Student Affairs at Johns Hopkins University and is actively involved in reformulating the medical student curriculum. Meeting with him will serve to inform him of resources available through AMSP and allow for direct advocacy for increased emphasis on substance use disorders education. 3) James Potash, M.D., M.Ph., is the Department of Psychiatry faculty member responsible for the psychiatry curriculum offered in the first and second years of medical student training.

Other goals were to: 1) Organize a series of lunchtime meetings for medical students entitled ãDealing with the Stress of Medical Schoolä where substance use disorders can be discussed in an informal setting over lunch. Marc Schuckit offered to send copies of a lecture he developed for just such a purpose; 2) Continue delivering an eight-week intern training course offered to psychiatry interns (PGY-1) that is repeated six times throughout the year; 3) Advocate for increasing the PGY-1 experience on the Addiction Treatment Services (ATS) units, including a one-month inpatient rotation with faculty of ATS; 4) Teaching lunchtime seminars to non-medical clinical staff at the local community psychiatry clinic in order to improve their knowledge about the identification and treatment of substance use disorders; and 5) Developing an interactive computer program of the lecture ãHow to Give A Lectureä for possible use among fellows and faculty members and future distribution by AMSP.

Tim Fong, a first-year scholar from UCLA, then reviewed his plans for the upcoming six months. First, he will work with the first and second-year medical school curriculum director to get 1-2 lectures on substance abuse into the curriculum (currently, no lectures are given). Tim will work to have one problem-based learning case centered on substance abuse. Second, he will aim to create a substance abuse elective series, modeled after Drs. Schuckitâs and Tapertâs course at UCSD. Specific plans will include monthly lunch meetings throughout the course of the year comprised of lectures, patient interviews, film discussions, and substance abuse career discussions. Potential funding sources for these lunches could be from pharmaceutical sponsors, the Deanâs office, or Dr. Fongâs research group. Thirdly, he will create a formal sub-internship in substance abuse for fourth-year medical students. Finally, as an exploratory project he will consider collecting data from medical students on their knowledge, beliefs, and attitudes about substance use disorders prior to implementing these programs.

For the psychiatry residents and addiction psychiatry fellows, Tim plans to deliver the ãHow to Give A Lectureä presentation in their formal substance abuse didactic series. Additionally, he will have the addiction psychiatry fellow serve as a mentor for medical students and will motivate the fellow to expand teaching activities with the medical students.

This discussion led to the possibilities for expanding medical student participation in AMSP-related activities. These include the possibility of working with Marilyn King of the American Psychiatric Association regarding sending medical students to the American Psychiatric meeting, as well as helping select students interested in substance use disorders in the CMHS program (Center for Mental Health Services).

In the next formal session, Marianne Guschwan delivered a 15-minute version of her lecture on spirituality. This was a fine demonstration of how a topic often considered as ãsoftä by medical students can be delivered in a highly effective way.

Carlos Hernandez-Avila next reviewed his accomplishments at the University of Connecticut. These include placing an introductory lecture on substance use disorders onto the University of Connecticut Web site; carrying out a case conference once per month with medical students and residents with an emphasis on substance use disorders; developing a lecture for first-year residents related to alcohol/opioids/cocaine emergency problems; joining the committee that selects the next group of psychiatric residents; publishing a chapter on inhalants in the ãManual of Psychopharmacology of Addictive Disorders;ä interacting with the state pharmacy program to expand their information on substance use disorders among individuals with ADHD; and helping to train counselors in substance-related fields.

The report on the Web site was then delivered by Marcy Gregg and Susan Tapert. In recent months we have had almost 10,000 visits per month, including almost 19,000 hits (i.e., the number of subsections of the Web site visited when an individual came to the site). The vast majority of individuals using the Web site have had prior experience with the AMSP Web address, and represent persons from the United States, Canada, Europe, Asia, Oceania, South America, and Africa. Among the more commonly visited lectures were those on substance use disorders in athletes, basic pharmacology of alcohol, medical consequences of alcohol use disorders, and personality-related lectures.

The meeting ended with a review of major assignments. These included:

1. The senior-junior scholar teams include Karin working with Susan; Tim with Alisa; Olivera with Marianne; Jill with Carlos; and Nikki working with Randy.

2. The reminder that the junior scholar lectures are due to Marc Schuckit before November 15, 2005.

3. The conference call (mandatory for all junior and senior scholars) occurs for one hour on Tuesday, December 20, 2005 at noon San Diego time (3 oâclock East Coast time). This will be arranged by Marcy Gregg who will send out a reminder to everyone.

4. January 15, 2006 is the date when close to final updated lecture outlines, references, and slides are due to Marc.

5. The next AMSP meeting is planned for Laguna Beach, California (hopefully the Surf and Sand Hotel) beginning at 5:30 p.m. on Wednesday, March 15th and ending no sooner than noon on Saturday, March 18th.

6. Marc Schuckit reminded all scholars to be certain to number the pages in their outlines; number the slides; give an AMSP attribution to all slides; limit the use of the term abuse to the DSM definition; avoid the term ãaddictionä as it is not scientifically defined; limit use of the term ãbingeä to periods of heavy substance use lasting for days while giving up usual obligations.

The meeting adjourned at 11:00 a.m. on Saturday, September 19th to allow people to make their flight back to the mainland.

Marc A. Schuckit, M.D.

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