Meeting #15

Del Mar, California

October 4 - 7, 2006

Present at the meeting were Drs. Schuckit, Guschwan, and Tapert (Director and Associate Directors); along with Drs. Campbell, Williams, Fong, Neufeld, Bogunovic, Bart, Gray, Alvanzo, Pagano, and Mack, as well as Marcy Gregg.

I. Wednesday, October 4th

The group convened in early evening at the L’Auberge Del Mar Hotel. Introductions were made, plans for the subsequent days briefly reviewed, and the structure of the working dinner for that evening was presented. AMSP then reassembled in the dining room of L’Auberge Del Mar for the evening get together and meeting.

II. Thursday, October 5th

The group convened at 8:00 a.m. Marc Schuckit once again introduced everyone, and established the agenda for the major portion of the meetings. The obligations associated with the first- and second-year scholars were reviewed. Several guests were introduced including Dr. Ryan Trim, Dr. Shannon Robinson (who remained a guest throughout the meeting), and Juliann Pierson.

The majority of the morning was focused on the presentation of the lecture on How to Give a Lecture by Marc Schuckit. A special emphasis was placed on information that needed to be considered by the first-year scholars in developing their future lectures. Items that were emphasized included the central importance of preparation; approaches for carrying out a thorough literature review; key aspects of developing an outline; how to choose among various references in the literature; important guidelines for developing effective slides; aspects of an optimal delivery of a lecture; as well as how to answer questions, deal with humor, and so on.

Dr. Nioaka Campbell, a Senior Scholar from the University of South Carolina School of Medicine next reported on her activities with an emphasis on those that related to her accomplishments associated with AMSP. She reported that she was able to attend and present an AMSP poster along with fellow alumnus Marian Fireman, M.D., at the annual ADMSEP meeting in Baltimore. This poster was also used at the recent AAP meeting this month in San Francisco. Nikki also participated in an Issue Workshop for the APA annual meeting this past May where she presented information on women and alcohol use disorders. Dr. Campbell continues to coordinate and give substance use lectures for the vertical curriculum within the medical school as well as direct the Peer Advocate Liaisons program (PALs). In addition, she is compiling substance use disorder questions for resident PRITE reviews into a useable database in lectures, and was invited to review and edit a book chapter on Impulse Control Disorders in the next edition of NMS Psychiatry. Nikki has received approval to develop a substance use selective for MI-MII students and hopes to initiate this before the next meeting. From a career standpoint, Nikki continues to serve as the General Psychiatry Residency Training Director within her department, and was elected Vice President of the South Carolina Psychiatry Association for this year.

The working lunch focused on a discussion of career development issues. Multiple topics were reviewed including how to manage a research or clinical team; problems and challenges regarding steps to optimize respect given by both colleagues and patients (especially the importance of avoiding being addressed by your first name — a particular problem for women in professional settings); optimal aspects of mentoring; conflicts that can develop regarding senior (or first) authorship; ways of handling difficulties when they develop between a junior faculty and senior faculty person; and so on.

Dr. Timothy Fong, a Senior Scholar from UCLA, presented his ASMP lecture on Pathological Gambling and Alcohol Use Disorders. As was obvious during his first year as a scholar, this was a highly-successful and well-organized lecture that was delivered extremely well. Various topics were raised in the discussion, including the importance of numbering slides as part of AMSP to optimize the ability of additional teachers to use the material; the importance of creating an outline based on phrases rather than full sentences; the need to carefully define (and where possible, avoid) acronyms; the importance of incorporating clinical examples whenever possible; the need to give specific information regarding clinical instruments and where they can be obtained (e.g., the South Oaks Questionnaire); and so on.

The meeting ended at 2:30 p.m. New scholars were given copies of Marc Schuckit’s books, handouts were presented to first- and second-year scholars describing their upcoming activities, a brief discussion of DSM approaches was instituted, and plans for the evening (scholars were on their own) were discussed.

III. Friday, October 6th

The meeting began at 8:00 a.m. with the delivery of the lecture focusing on the Antisocial Personality disorder and Substance Use Disorders by Senior Scholar, Karin Neufeld from Johns Hopkins University. This was a highly effective lecture, especially notable for the manner in which a specific clinical case (Gary Gilmore) was taken from the newspapers and history books and emphasized in different aspects of the lecture. The material was clearly presented, the slides easy to understand, and the model of presentation highly engaging. The discussion focused on how to optimally weave case histories into various aspects of the presentation, as well as the challenging nature of presenting information regarding biological findings.

Marc highlighted several of the slides, pointing out that, for most such visual aids, no more than seven lines of information can be given. The group discussed the assets and approaches toward various forms of animation; the effective way that the ASPD criteria were paraphrased was discussed; the potential assets (as well as liabilities) of asking questions directly to the audience was discussed; and the particularly effective use of references throughout the lecture was reviewed.

Marc Schuckit next demonstrated how outlines and slide copies can be used in the lecture setting.

He developed a lecture on genetics of alcoholism specifically for AMSP, and handed out both the outline and slide copy. This was not a demonstration of an actual lecture, but carried an emphasis on how AMSP lectures can be developed for the website.

Next, Senior Scholar Olivera Bogunovic from the State University of New York Upstate at Buffalo presented her excellent lecture on HIV/AIDS, and Substance Use Disorders. This was a particularly challenging lecture because of the need to balance levels of detail versus helping the audience to focus on the global picture. The material was remarkably informative, with many of the slides effectively covering complex data. For the next day, Dr. Bogunovic was invited to demonstrate to first-year scholars how such a comprehensive lecture might be cut back to an approximate 10-minute introduction to the topic as might be delivered to first- and second-year medicine or psychiatric residents rotating through an emergency room.

The career development issues reviewed during the working lunch included: how to best determine the criteria for promotion in a person’s own career line and university; the importance of NIH funding for individuals in the research line who are being evaluated for promotion to Associate Professor; lengths of time likely to be spent as Assistant, Associate, and Full Professors; and challenges in trying to balance home and work pressures. The latter was especially important regarding difficulties with promotion that women might face after taking time off for pregnancy and spending time with the baby.

After lunch, Senior Scholar, Dr. Nioaka Campbell from the University of South Carolina School of Medicine presented her AMSP lecture on alcohol use disorders in women. Again this was an excellent lecture with a fine style of delivery. The members of AMSP were particularly impressed with the way that Dr. Campbell mixed into the lecture her own personal experiences as a Professor and Clinician at a university in the south. Specific slides were discussed, and additional information (e.g., including a slide that demonstrates the AUDIT questionnaire for alcohol problems) was noted.

Subsequently, second-year scholar, Dr. Jill Williams from UMDNJ-Robert Wood Johnson Medical School reported on the following updates that she has been involved in at her medical school. She has a new role as the Associate Program Director of the RWJMS Addiction Psychiatry Residency Program. Here, one of her first responsibilities will be to review the didactic curriculum for addictions residents and she expects to draw on lectures from the website as a resource. She continues to give a new two-hour lecture on Introduction to Substance Use Disorders for the MS III clerkship (three to six times per year) and other lectures on Club Drugs and Tobacco to MS II (Behavioral Science course) and general psychiatry residents. She also was reappointed to the Student Assistance Campus Committee (SACC) for another three years. This committee is responsible for identifying and screening students who may be having difficulty with mental health or addictions issues. To increase the visibility of substance abuse issues to medical students and other university trainees, she helps the committee organize lunchtime sessions and invite outside speakers. Finally, in her role as a tobacco trainer to mental health professionals, Dr. Williams has a two-day training on tobacco dependence treatment for psychiatrists and advanced practice nurses scheduled for November 3rd and 4th, 2006. This will be repeated in March 2007 and twice per year after that. Skills she has improved through AMSP have been helpful in her success as a trainer. Dr. Williams has completed her K Award in July 2006 and was awarded an R01 on Nicotine Intake in Schizophrenia, which started August 1, 2006.

The afternoon continued with a preliminary discussion by first-year scholars regarding their potential topics. Here, Dr. Anika Alvanzo announced her interest in developing a lecture on alcohol and intimate partner violence; Dr. Maria Pagano expressed an interest in a lecture on the role of altruism (including reaching out to others) in enhancing outcome for the treatment of alcohol use disorders; Dr. Gavin Bart discussed a potential lecture on the relationships between alcohol use disorders and obesity (including the results of gastric bypass surgery); Dr. Larry Gray presented his interest in attention deficit hyperactivity disorder, conduct disorder, and fetal alcohol effects as they might relate to the risk for alcohol or drug problems. Dr. Avram Mack discussed a possible lecture on cannabinoids and violence.

The official activities of the afternoon ended with a presentation of her recent accomplishments and future plans by second-year scholar, Dr. Olivera Bogunovic of SUNY Buffalo. Here, she related that during the last three months she has continued her teaching assignments for medical students and psychiatric residents. She was asked to meet with the Benjamin Rush (Psychiatry Interest group) and host a meeting on substance use disorders. Since she will be moving to McLean, the Chairman of her Department and the Residency Program Director have asked her to tape her lectures for psychiatry residents for the addiction curriculum. So far she has taped eight lectures, with some using topics from the Alcohol Medical Scholars Program website. She was also invited to give Grand Rounds on opioid dependence and buprenorphine treatment for the internal medicine residents. Since she is a co-program director for geriatric psychiatry, she is planning to develop a website for geriatric psychiatry with lecture topics for the fellows. Olivera has applied for a grant from the local foundations. Also, she had a poster accepted at the Annual Meeting of Addiction Psychiatry on HIV and Substance Use Disorders. She gave the lecture “How to Give a Lecture” to the psychiatry residents.

The group adjourned at 2:30 p.m. with a discussion of the working dinner planned for the evening. Various free time activities were also discussed, and scholars were reminded that the meeting will begin again on Saturday, October 7th at 8:00 a.m.

IV. Saturday, October 7th

The meeting began with the presentation of her lecture on Assessment and Pharmacological Treatment of Tobacco Dependence by Senior Scholar, Dr. Jill Williams from the UMDNJ - Robert Wood Johnson Medical School. This was a fine and effective lecture that was beautifully delivered. Topics of discussion included some thoughts on the optimal references that might be used, assets and liabilities of considering offering costs of specific treatments; whether a few additional slides might be reinserted to facilitate transitions between sections of the lecture (they had originally been deleted at Marc’s request because of efforts to limit the number of slides); and so on.

Next, the group had the opportunity of hearing two of the original 40-minute lectures now refocused on a 10-minute lecture to first- and second-year emergency room residents. These lectures by Dr. Bogunovic and Dr. Fong were excellent and demonstrated how: any lecture can be modified for almost any audience (but the needs of the audience must be primary); an effective lecture can be delivered with 10 or fewer slides; and that the lectures being developed for AMSP can be effective when modified for a wide range of settings.

The first-year scholars next briefly reviewed some of their potential plans for their medical schools over the upcoming six months. In this context, Dr. Avram Mack from Georgetown University hopes to resubmit his application for financial support to increase education on alcohol and drugs throughout the medical school; increase his participation in the four-week medical school clerkship; and will consider whether a Doctors Ought to Care (DOC) group might be appropriate for Georgetown, while also reaching out to family medicine for some issues regarding substances (e.g., smoking cessation). Finally, he will consider instituting a medical student elective on addictions.

Dr. Larry Gray from the University of Chicago recognizes the need to disseminate information about alcohol and substance use disorders throughout the University of Chicago. First, he will begin to identify and network with the existing experts in substance use disorders at the University of Chicago. In addition to his colleagues in the Department of Pediatrics, he will seek out the experts in the allied departments of child psychiatry, psychiatry, psychology, in the community outreach departments of the University. In addition, he has offered the Pediatric Residency Program Director to give the lecture on “How to Give a Lecture” to pediatric residents and medical students. Fellows in Developmental and Behavioral Pediatrics will also be given this lecture. Finally, he will attempt to identify print or web-based resource that support the knowledge gained about presentation preparation and delivery of improved lectures.

Junior Scholar Dr. Gavin Bart from the University of Minnesota hopes to present the two pathophysiology core-curriculum lectures on addictive diseases to the second-year medical school class. He will ask to provide the two behavioral health lectures on the addictive diseases in the first-year medical school curriculum. He will begin to develop a clinical elective in addiction medicine for third- and fourth-year medical students. At the graduate level, he will be course director for a 16 lecture addiction curriculum for second and third year psychiatry residents. He is currently awaiting a funding decision for a University of Minnesota training grant (T32) in Psychoneuroimmunology that includes a course he designed that will give clinical experiences in addiction medicine to postdoctoral students conducting addiction-related bench science.

Junior Scholar, Dr. Anika Alvanzo from the Virginia Commonwealth University Medical Center also hopes to survey current activities regarding substance use disorders, will propose expanding her involvement in second-year medical student education regarding substance use disorders; will work with the medical house staff regarding developing a noon conference lecture related to substances; will discuss substance use education with the Residency Director in Medicine; and hopes to be able to enhance input in the current course on the “Foundations of Clinical Medicine.” She will also identify what is currently being taught in the VCU Medical School curriculum in relation to substance use disorders, and will identify the presenters and course directors. She would like to add a formal didactic workshop on alcohol and/or other substance use disorders to the 2007-2008 M2 Foundations of Clinical Medicine (FCM) curriculum. She will explore the possibility of adding a substance use disorder case to the current case-based curriculum.

Finally, Junior Scholar Dr. Maria Pagano from Case Western Reserve University School of Medicine (CWRU SOM) will become a member of the Residency Education Committee; is planning to meet with the Dr. Mary Ellen Davis, Training Director of the Psychiatry Residency Program, to highlight AMSP’s mission to seek ideas for ways Dr. Pagano to enhance the training of the residents regarding substance use disorders; she will meet with Dr. Robert Ronis, Chair of the Psychiatry Department, to explore the possibility of obtaining APA accreditation for a child clinical post-doctoral residency program, to discuss having a leadership role in this training program, with an emphasis placed on candidates interested in alcohol and drug-related problems; she will continue to develop the lecture series in the Addiction Fellowship, recruiting speakers for it who have recent publications on treatment of substance use disorders, and she will confer with Dr. Chris Delos Reyes (an AMSP alumnus) on the potential for offering AMSP lectures to these fellows.

Next, second-year scholar from UCLA, Dr. Timothy Fong reviewed his recent accomplishments at UCLA. Since June of 2006, Tim has completed the following educational and research activities at UCLA: 1) funding for the Addiction Psychiatry fellowship was secured by two separate donors. This will allow the fellowship to be operational for at least three years. 2) The first medical student to enter the addiction psychiatry sub-internship rotated through in August 2006. Three more fourth-year students are scheduled for the fall and winter months. 3) Tim will be repeating a medical student selective entitled “What Every Medical Students Should Know about Drugs, Alcohol, Gambling and Sex,” starting in October 2006. Twenty-five first-year medical students have signed up. 4) The network of addiction advisors from the community has been established, there are eight members of the volunteer clinical faculty that have agreed to mentor and supervise psychiatry residents on a one-on-one basis. 5) Grant Rounds on opiate dependence and gambling are planned for the Internal Medicine and Family Medicine departments this fall. 6) Tim has also created a research elective for medical students and the first medical student will begin in Tim’s lab in October, 2006. 7) Tim has been confirmed as the Addiction Psychiatry Fellowship director by the Department. 8) Tim in now three months into his K23 Career Development Award focusing on Impulsivity in Pathological Gambling. 9) Tim continues to serve on the Medical Staff Committee, which assists impaired faculty and residents to ensure that they receive treatments and referral.

Second-year scholar, Dr. Karin Neufeld from John Hopkins University reviewed her recent activities. These included delivery of a poster presentation regarding the academic and professional impact of AMSP at the First Annual Symposium on Research in Medical Education at Johns Hopkins University school of Medicine. Significant interest was generated among colleagues attending the conference and potential collaboration with faculty in the Department of Pediatrics. Dr. Neufeld also helped present a similar poster with colleagues at the Research Society on Alcoholism in June of 2006. Dr. Schuckit gave an invited lecture to the faculty at the School of medicine at Johns Hopkins School of Medicine in June of 2006 on the level of response to alcohol and its genetic underpinning. This presentation was in response to coordination efforts by Dr. Neufeld. New endeavors include the development of a quarterly half-day educational seminar series for community providers of methadone substitution treatment in learning to identify co-occurring psychiatric disorder and comorbid pain complaints. Dr. Neufeld also continues to attend the Department of Psychiatry’s Educational Policy Committee meeting where plans for improving the curriculum with regard to motivated behaviors (such as substance use disorders) are underway. Dr. Neufeld also revealed the recent preparation of a chapter on comorbid psychiatric disorders and substance use. The specific chapter is: Brooner, RK, Neufeld KJ, King VL, Kidord MS, Stoller KB. Antisocial Personality in Patients with Substance Use Disorders: Evaluation and Treatment. In: Nunes EV, Selzer J, Levounis P (Eds.), Substance Dependence and Co-Occurring Psychiatric Disorders: Best Practices for Diagnosis and Treatment. Kingston: Civic Research Institute, in press. At the end of each chapter the editor agreed to include the AMSP website as a reference.

Associate Director, Dr. Susan Tapert, delivered an excellent, informative presentation on creating slides using PowerPoint. She demonstrated how to use various PowerPoint features, compared the different fonts, their sizes and colors, and she gave helpful suggestions on formatting choices that are more likely to produce effective slides. Dr. Tapert also demonstrated different types of animation and which ones are the most appropriate to use.

Next, Marcy Gregg reviewed the Web-site activities in recent months. This has been a particularly impressive year for the website with the number of hits increasing by from 30% up to 74% in each month compared to the relevant period in the prior year. Particularly heavy use was noted in March and May, and about 95% of the users of the website are involved in a repeat visit. The major referring sites have included the Alcohol Medical Scholars Program direct visits, as well as Google, Yahoo, MNS, and Project Cork. Visits continue from all continents.

The potential dates for the Spring meeting were next discussed. Because of busy schedules, the only time that fit everyone was a start date of Wednesday, March 28, 2007 at 5:00 p.m. in New York City, with an adjournment the following Saturday at 12:00 noon. If problems develop regarding this date, the first fallback date would begin on May 2nd, and the second on May 9th. At the current time, all scholars should plan for the March 28th date.

The Conference Call for all first- and second-year scholars was also established. This will occur on Thursday, January 11, 2007 at 3:00 p.m. East Coast time, 2:00 p.m. Central time, and noon, San Diego time.

Key deadlines for first-year scholars to have material to Marc Schuckit were then reviewed. These include:

1. No later than December 15, 2006 will be the date that all scholars will have what they consider to be a close to final draft of their outline to Marc Schuckit. It is assumed that many of the scholars will have sent earlier rough drafts to Marc, and that all scholars will work through their Senior Scholars in developing the lecture and before sending things on to Marc. However, the entire process of sending a close to final draft of the outline must be accomplished by December 15th.

2. January 15, 2007 is the absolute deadline for getting the (very close to) finalized version of the outline, references, and slide copy (attempting to limit each lecture to no more than 30 slides if at all possible) to Marc Schuckit.

3. March 1st is the deadline for forwarding to Marc the truly final version of all outlines, references, and slides. Most scholars will then choose to deliver their lectures to colleagues or appropriate students at their university in preparation for the March 28th start date for our meeting.

The meeting adjourned at 12:00 noon on Saturday, October 7th.

Marc A. Schuckit, M.D.

Layout and design by Brian Klima