Meeting #14

Laguna Beach, California

March 15 - 18, 2006

Present at the meeting were Drs. Schuckit, Guschwan, and Tapert (Director and Associate Directors); and Drs. Busch, Brown, Hernandez-Avila, Campbell, Williams, Neufeld, Fong, Bogunovic, and Marcy Gregg.

I. Wednesday, March 15th

The group met at the Surf and Sand Hotel at 6:30 p.m. Introductions were made, and plans for this three-day meeting were discussed. Subsequently, the entire group and accompanying persons shared dinner at Splashes Restaurant in the Hotel.

II. Thursday, March 16th

Work began over breakfast where the specific schedule for the three-day meeting was established. Marc Schuckit let the discussion on coming events including the Research Society on Alcoholism meeting in Baltimore and the International Society of Biomedical Research in Sydney, Australia. Marc then presented his lecture on “How to Give a Lecture.” The goal was to demonstrate how this lecture can be delivered while also gathering input from the scholars on how the new scholars (to join us in our October meeting) might be able to gain the optimal amount from the presentation. Among the suggestions were:

A. Hand out a good example of what the lecture should look like by using material prepared by one of the current scholars.

B. Using slides, present how a lecture by a scholar went from early drafts to more sophisticated drafts.

C. Discuss how to determine whether an article being used as part of the literature review is appropriate level science (including knowing the quality of the journal; considering looking up the citation index rating for the author; looking at the journal’s impact rating; etc).

D. Reminding lecturers that most such presentations are given to medical students during their first and second years, a point at which they know almost nothing about the topic being presented — jargon must be avoided.

E. Discuss more about how to prepare for emergencies (e.g., how the lecture could be delivered without slides).

F. During the discussion of these slides, several themes arose that were returned to during the meeting including the concept of a sentinel slide (the slide that focuses on the most important information presented and without which the lecture would not be likely to be as effective), as well as the dangling word (that can be removed from a slide because it took up an entire line as a remnant of the material presented in the prior line).

Nikki next delivered her excellent lecture entitled: “Alcohol and Women.” This was a fine presentation and an excellent delivery style, with excellent slides. The material was used as a starting point for discussions of issues related to slide clarity, the appropriate number of slides, and additional issues that impacted on all of the presentations.

The next step in the meeting was a working lunch during which issues of career development were discussed. These included how to develop budgets; surviving in academics after a K Award has expired; challenges in keeping appropriate balance between family and work; how university academic service is likely to evaluate the progress of a clinician administrator; as well as controlling time appropriately.

Dr. Jill Williams from the UMDNJ - Robert Wood Johnson Medical School reported on the following updates regarding her activities at her medical school. This included: a new 2-hour lecture on Introduction to Substance Use Disorders for the MS III clerkship. Dr Williams commented that she found the lecture slides of Dr Schuckit and previous scholars particularly helpful in putting together this lecture. She continues to provide the annual lectures on Tobacco Dependence and Club Drugs and Hallucinogens to the MS II students as part of the Behavioral Science and Psychiatry course, which receives good evaluations from students. She also is part of a new subcommittee of the Student Assistance Campus Committee (SACC) to develop informal, lunchtime seminars to trainees (including medical students) on mental health and addictions topics. Dr Williams created an elective for MS IV students in tobacco dependence treatment, which offers students a 2-4 week experience in clinical treatment and/ or research in tobacco dependence. The elective was approved by the curriculum committee and is part of the elective book for students and she currently has one student working with her. Dr. Williams reported that she recently was awarded a grant from the American Legacy Foundation to develop and implement a two-day training on tobacco dependence treatment for psychiatrists and advanced practice nurses. She remarked that the skills she has been developing on putting together lectures from AMSP will be extremely helpful in this grant project and she is considering ways to involve medical students in this training opportunity.

Tim Fong from UCLA next reported the following activities since September of 2005. Regarding educational activities: 1.Tim created a medical student selective called “What every medical student needs to know about drugs, alcohol, gambling and sex” for first year medical students that began in Feb 2006 and will run for 10 sessions. Currently, there are 10 first-year students enrolled and this elective will be offered every year; 2) He created a medical student elective for fourth-year students called “Addiction Psychiatry at UCLA” which is a combination of inpatient and outpatient substance abuse treatment. This rotation will be offered throughout the year and will be repeated every four weeks; 3) Tim will be running a Freshman Seminar entitled “The History of Drugs, Gambling and Alcohol in America” for the Spring Quarter 2006 at UCLA; 4) Since September 2005, 20 UCLA third-year medical students have been rotating through the Addiction Medicine Clinic, as part of their psychiatry rotation.

For talks, Tim gave a “How to Give A Lecture” talk to the 3rd and 4th year psychiatry residents in January 2006. Regarding research projects related to AMSP, he is supervising, Lionel Lee, a medical student from Chicago who is conducting a survey of medical schools to determine how many include pathological gambling in their curriculum. Additional career activities related to AMSP include taking his Addiction Psychiatry Boards this spring and once he passes, Tim will take over as Director of the Addiction Psychiatry program at UCLA, and a K Award entitled “Impulsivity in Pathological Gambling” which will be funded this spring, from NIDA. Finally, Tim is planning a May dinner to host interested medical students to come meet addiction psychiatrists in an informal setting. This will create mentors for medical students while providing them with a snapshot of what life as an addiction psychiatrist is like.

Next, Karin Neufeld from Johns Hopkins University presented her lecture entitled: “Antisocial Personality Disorder.” This was an excellent and engaging talk with fine slides.

The meeting adjourned at 2:30 p.m. for an evening when all scholars were on their own.

III. Friday, March 17th

Following a working breakfast, Olivera Bogunovic presented her lecture entitled: “HIV/AIDS and Substance Use Disorders.” This lecture was excellent, chock full of both details on both AIDS and substance use disorders. The challenge, one approached very thoroughly by Olivera, is how to make all of the technical and important details optimally acceptable to the medical students, while presenting information in a way that makes note-taking (and therefore studying) easier. The group used this excellent lecture as an opportunity to review how one might simplify slides and decrease the number of slides used. With very little additional effort, Olivera will be able to forward to AMSP a fine lecture that will be an important addition to our Web site.

Carlos Hernandez-Avila then delivered his report of his activities at the University of Connecticut Medical School. It has been a very important and productive year for him. During this last six months he has added a lecture on an update of neuropharmacology for alcohol and drugs to the regular informal meeting for faculty. He has also participated in an article in Alcoholism: Clinical and Experimental Research evaluating the use of naltrexone for heavier drinkers (as opposed to alcoholics). For AMSP, Carlos successfully carried out a survey of all AMSP participants over the years, summarizing the information into superb slides, and prepared the material for use by any scholar who wishes to talk about our program. The survey also became the basis for a poster that Carlos is preparing for the Research Society on Alcoholism. Furthermore, Carlos continues all of his regular teaching assignments for medical students, psychiatric residents, and fellows at the University of Connecticut, and has developed several new lectures for international meetings, including one scheduled for the next week in Acapulco, Mexico.

Additionally, Carlos is co-investigator on a four-year research project supported by an unrestricted grant to the National Autonomous University of Mexico (UNAM) School of Medicine by the Grupo Modelo. This project aims to evaluate the prevalence and patterns of alcohol consumption among UNAM students in Mexico City and to evaluate the efficacy of brief interventions in reducing risky drinking in this population. So far 60,000 students have been screened and 8,000 risky drinking individuals identified who they have started to counsel with brief interventions.

Alisa Busch next presented an abbreviated version of her lecture, “Alcohol and Drug Dependence: Comparisons to Other Chronic Disorders.” Alisa was asked to place herself in a situation where she was delivering this lecture to residents in internal medical as part of their orientation. Despite the new audience and the limitation in time (15 to 20 minutes maximum), Alisa demonstrated how her medical student-oriented material could be easily adapted for a new audience. Her delivery was very effective, the material she chose to emphasize appropriate, and the entire lecture worked well. She then delivered a five-minute version of her lecture.

Randy Brown next reported on achievements at the University of Wisconsin, Madison. Dr. Brown has had an active research year, having 3 publications accepted in peer-reviewed scientific journals as senior author. He has also had presentations of his doctoral dissertation research accepted for presentation at 2 major international conferences: the National Institute on Drug Abuse/College on Problems of Drug Dependence Annual Conference and the Annual Meeting of the International Harm Reduction Association. Randy’s dissertation research involves examination of the influence of participant characteristics (such as demographics, criminal history and substance use history) and case management characteristics (such as frequency of court appearances, substance misuse treatment modality, and frequency of urine drug screens) upon the likelihood of substance misuse treatment completion among drug court participants. Dr. Brown was also invited to be first author on a chapter on screening and assessment for substance use disorders in a widely read reference for primary care providers, Health Promotion and Disease Prevention in Clinical Practice, 2nd Edition. He has also received his second NIH grant in the form of a $75,000 administrative supplement that will be used to examine substance misuse treatment drop-out among African-Americans in the criminal justice system. Dr. Brown also submitted an NIH R01 application in January of this year. A funding decision regarding this application will be made in July-August 2006.

Randy continues his heavy involvement in the teaching of physicians in training as well, is the Director of the 4th year medical student Clinical Addiction Elective, and has formulated 4 new didactic lectures for the elective. He also has involved students in outreach to injection drug users around the state of Wisconsin. Medical students participate in training opioid users in basic life support and the administration of naloxone to rescue individuals who have suffered an opioid overdose, and has also been involved in presentations to users regarding prevention of HIV and hepatitis C. Dr. Brown has been an invited lecturer in several local forums, delivering one lecture annually to undergraduate sociology students on the public health importance of drug use and crime, one lecture annually to nurse practitioner students on substance withdrawal syndromes, and he was an invited to speak for the Wisconsin Department of Health and Human Services Teleconference Series where he presented on the importance of alternatives to incarceration for offenders with substance use disorders. His lecture on benzodiazepine use disorders has been inserted into the regular schedule of lectures for Grand Rounds for family practice residents at the University of Wisconsin.

Dr. Brown has also influenced clinical practice on a large scale with his development of an instructional video and clinical assessment instruments designed to improve the assessment of patients with chronic pain for the development of opioid use disorders.

Dr. Timothy Fong from UCLA next presented his excellent lecture, “Pathological Gambling and Alcohol Use Disorders.” This lecture involved an impressive style of delivery and ease of presentation of material, especially regarding pathological gambling. The discussion focused on how to deliver this important topic in a manner that generates the greatest level of confidence by the medical students. The slides used were highly effective and clear, and this lecture will be another important addition to the AMSP Web site.

The career development discussion over a working lunch included a wide range of items. These included some of the overall assets of an academic career; steps required in picking a journal appropriate for a specific article (including writing the Editor when in doubt regarding whether the material might be deemed appropriate for that journal); the process that goes on during reviews of papers; the process related to reviews of grants; and the importance of each of these areas on promotion).

Following lunch, second-year scholar Carlos Hernandez-Avila was asked to take his 45-minute lecture aimed at medical students and modify it as a 15-minute lecture, “Alcohol Withdrawal: Pathophysiology, Diagnosis and Treatment,” but now as would be delivered to alcohol counselors working in a detoxification facility. The lecture worked extremely well with a fine demonstration of how the same basic lecture can be fairly easily modified for different audiences, remembering that being focused on the needs of the audience is the single most important step in developing a lecture. It is remarkable the amount of information that can be passed on to an audience within a relatively short period of time.

Karin Neufeld then reported on her accomplishments at Johns Hopkins University Medical School. Since our last meeting she had productive meetings with the following individuals: 1) Raymond DePaulo, M.D., Chair of the Department of Psychiatry. The outcome of this meeting was introducing him to the AMSP mission and her involvement in the organization. In response he requested that she join the medical school curriculum committee this spring and contribute to the development of the new medical school curriculum. He also invited Marc Schuckit to speak to the faculty in June on his work in the genetics of alcoholism. 2) Tom Koenig, M.D. the Dean for Student Affairs at Johns Hopkins University received information regarding AMSP and expressed interest in making use of the resources it had to offer. 3) Dean MacKinnon, is the Department of Psychiatry faculty member responsible for the psychiatry curriculum offered in the first and second years of medical student training. Results of this meeting include a new 1.5-hour lecture slot for 1st year medical students to be given by Karin Neufeld on March 21st, 2006 on the outcomes of treatment for substance use disorders. 4) Meetings with the psychiatry residency directors (John Lipsey and Karen Swartz) resulted in the plan to include each of the 8 PGY-1 interns in a 2-week rotation, including 80 hours of exposure to clinical work being carried out at Addiction Treatment Services. This will begin in July of 2006.

Other goals that were met included: 1) Delivering an eight-week intern training course offered to psychiatry interns (PGY-1) that is repeated four times throughout the year; 2) Teaching 6 lunchtime seminars to medical and 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; 3) Exposure of PGY 4's to "How to Give a Lecture" by the residency director, who plans to use the slides and lecture outline from the AMSP Web site.

Next, Olivera Bogunovic from the Medical School of the State University of New York in Buffalo presented her report. She noted that the participation in AMSP enhanced her ability to increase the amount of education on alcohol and drugs at State University of New York, Buffalo. She met with the chairman, and the person in charge of the medical school curriculum and reviewed the current curriculum. She created an elective for the fourth-year medical students to rotate with her on the inpatient rehab unit. Also she met with first- and second-year medical student psychiatry interest dinners and discussed topics related to substance abuse. Regarding psychiatry residents, Dr. Bogunovic offers 14 hours of lecture -- two for first-year, six for second-year and six for third- and fourth-year residents. She has made several changes in the curriculum and has included lectures from the AMSP Web site (Clinical Assessment of Alcohol Use, Benzodiazepines and Similar Drugs: Misuse, Abuse and Dependence, Opioid Antagonist Tx). Also Psychiatry residents started rotating with her on the inpatient rehab unit during their addiction rotation. She has worked with several residents on their grand rounds presentation using Marc's lecture (how to give a lecture). She will also give a lecture to the child fellows on substance use disorders in adolescence. She has been invited to give an in service to emergency room physicians on the management of alcohol withdrawal and will be using the lecture from the AMSP Web site. She also became a reviewer for the journal Addictive Diseases and had a poster presentation at the AAAP on pathological gambling in the elderly.

Subsequently, Alisa Busch from Harvard University updated the group on her accomplishments over the prior six months. She has had several new teaching opportunities including having presented a lecture on the identification and treatment of substance use disorders to the second-year MD-PhD students at Harvard Medical School. She will also be providing a lecture on the medical consequences and treatment of substance use disorders to the peer educators/counselors at Harvard University. Regarding research, Dr. Busch has a research study recently accepted for publication in the Journal of Mental Health Administration and Behavioral Health Services Research. The study examines the differential effect of a managed behavioral health carve-out on the quality of care for persons diagnosed with schizophrenia alone vs. those with co-occurring substance use disorders. She also recently began pilot work examining the treatment and policy implications of when mothers leveraged to adhere to psychiatric or substance use disorder treatment, else risk losing custody or parental rights of their children. Lastly, a few months ago Alisa’s Career Development Award was funded by the National Institute of Mental Health. The grant will study quality of care for persons with bipolar disorder and as part of the grant Alisa will receive specific training in assessing quality for patients with co-occurring substance use disorders.

The meeting adjourned at 2:30 p.m., with the group on their own until 7:00 p.m. when everyone would reassemble for dinner. Dinner that evening was at the restaurant, 5 Feet, in downtown Laguna Beach. This was an excellent get together that included both scholars and significant others with a first-class Pan-Pacific Chinese cuisine.

IV. Saturday, March 18th

The day began with the presentation of the lecture developed by Jill Williams entitled: “Assessment and Pharmacological Treatment of Tobacco Dependence.” This lecture demonstrated Jill’s superb command of the material, a fine set of slides, and a very effective presentation style. The major challenge after the lecture was to try to find suggestions to cut back on the number of slides a bit, and to slightly modify a few of the excellent set of slides presented. This was the last of our new lectures from our first-year scholars, and once again underscored the tremendous amount of work and excellent skills demonstrated by every one of the five new lectures to be added to the AMSP website.

Randy Brown then took on the challenge of using no more than 8 to 10 slides to modify his original 45-minute lecture, “Benzodiazepines and Other Drugs, to fit a 15-minute slot as part of a pharmacology course reviewing the clinical application of pharmacology material. Following several impressive and riveting slides of his wonderful new baby (slides that did not count in the goal of eight) and he showed tremendous flexibility in being able to modify a lecture, the final product that would be useful in many medical school settings.

Nikki Campbell from the University of South Carolina in Columbia, South Carolina next presented the report of her accomplishments over the past six months. She presented 2 workshops to female undergraduate athletes, coaches and trainers at Columbia College. She has continued to coordinate the vertical curriculum at the school of medicine with 12 lecture hours for MI-M4 students per year. Nikki reports that as the director of the PAL program (Peer Advocate Liaisons), she has seen an increase in medical student interest for serving as a peer liaison within the medical school. In the residency program, she has given a lecture to PGY2-4 residents on PRITE review of substance use disorders. Nikki is scheduled to give ‘How to Give a Lecture’ to the residency research interest group this spring. From a career development standpoint, Nikki reports that she was promoted as of January 1st, and is now the Director of Residency Training for the general psychiatry residency program at the Univ. of South Carolina School of Medicine.

Carlos Hernandez-Avila next shared the results of his survey of AMSP current scholars and graduates developed in preparation for his presentation of an AMSP-based poster at the Research Society on Alcoholism in Baltimore, Maryland in June. Not only was this a beautifully presented overview with excellent and effective slides, but the information acquired by Carlos is very important in helping us to evaluate the progress of AMSP. Among the most prominent findings were the large increase in teaching time, the diversity of topics covered, and the impact demonstrated in the medical school curricula for AMSP scholars. This included an almost doubling of the proportion of scholars who were teaching medical students, comparing their efforts in this area before and after AMSP. Carlos’ lecture will be added to the web site as part of a self-evaluation process that we hope to be able to repeat in future years.

Marcy Gregg next presented a brief overview of the website activities. Between September of 2005 and February of 2006 there was a persistent increase in the number of visits, pages viewed, and almost all other aspects of the AMSP website. In January of 2006 there were 12,513 page views (per month) from 12, 212 visitors. These came from among 28,241 hits during January of 2006, and included visitors from North America, Europe, Asia, Oceania, South America, and Africa. The specific lectures visited were fairly equally distributed except for a higher rate of visits for the lecture on athletes and the list of videos. A substantial proportion of the people who came to the AMSP website visited us directly, but by far and away most found their way to us through Google either in the United States, Australia, or the U.K. Additional important sources of visitors were through and Project Cork (a substance use disorders-related library service).

Susan Tapert subsequently presented a wonderful overview of different forms of animation that might be used in PowerPoint. Because all of our scholars had developed some level of sophistication with PowerPoint, this was an effective “round table” discussion led by Susan as much if not more than it was a formal lecture.

Susan then demonstrated how the same approaches that have been taught in AMSP with an emphasis on lectures to medical students can be useful regarding outlines and slides for a scientific audience. She chose a rather technical area related to brain imaging, and once again demonstrated that material can be presented with a limited number of slides, and that the organization and flow of topics is an essential element in helping the audience to understand the material presented.

The remaining issues covered on Saturday morning included:

A. A hearty and sincere thanks to Marcy Gregg for all of the work that she did in making this meeting possible.

B. The time was established for our next conference call which will be noon (Pacific Time) and 3:00 p.m. East Coast time on Monday, June 12th. It is important that all scholars including the graduating second-year scholars be present.

C. The date and place of the next meeting was reviewed: this will begin at 5:00 p.m. on Wednesday, October 4th, 2006 and end at noon on Saturday, October 7th, 2006, taking place at the L’Auberge Del Mar Resort and Spa, Del Mar, CA, a beautiful resort about 25 miles north of the San Diego airport. This excellent and world-class hotel is a five-minute walk from the ocean in a beautiful section of San Diego.

D. The graduating senior scholars were given applause, whistles, stomping on the table, and other accolades as they were offered their graduation plaques.

The group adjourned at noon on Saturday, March 18, 2006.

Marc A. Schuckit, M.D.

Layout and design by Brian Klima