Meeting #19

Laguna Beach, California

October 15 - 18, 2008

Attendees: Marc A. Schuckit (Director), Susan Tapert (Associate Director), Marianne Guschwan (Associate Director); and Marcy Gregg (Administrator); First-Year Scholars: Theadia Carey of the University of Michigan, John Wryobeck of the University of Toledo Medical School, Joanna Buczek of the Brigham and Women=s Hospital and Boston University Medical School, Laurie McCormick of the University of Iowa Medical School, and Michelle Lofwall of the University of Kentucky Medical School; and Second-Year Scholars Krishna Balachandra of the University of Alberta Medical School, and Timothy Lineberry of the Mayo Clinic, Rochester, Minnesota. Maritza Lagos was ill and unable to attend.

I. Wednesday evening, October 15th

The group convened in the Surf and Sand Hotel for introductions, explanation of the upcoming schedule during the meeting, a brief review of goals, and discussion. The discussion continued at the hotel through dinner.

II. Thursday, October 16th

The group convened in the Seahorse Room at 8:00 a.m. The meeting began with an introduction of all attendees, along with a brief description of their activities at their universities. Marc Schuckit then gave a history of AMSP, and re-reviewed the schedule.

The major task of the morning was for Marc Schuckit to present the lecture and lead the discussion about How to Give a Lecture, Develop a Paper, and Prepare a Grant. This is the basis for scholarly academic activities and involved interaction among all members. The Associate Directors and the Second-Year Scholars offered suggestions of how the First-Year Scholars might optimally implement the material. Scholars were reminded that this lecture could serve as a basis for material they might choose to present to residents, fellows, or medical students at their own university.

The noon hour was spent dealing with issues related to development of an academic career. These included thoughts on the optimal way to meet with one=s Chair to determine how their performance will be judged, and to review financial obligations; how to balance the need to meet income generation versus spending time with family (including the possibility of cutting back on clinic time by exploring participation in ongoing research activities or developing CME programs); how to manage time and avoid being spread too thin; the assets and liabilities of attempting to incorporate research as a part of academic activities (this is not necessarily a central activity for everyone in an academic role); how to balance time across different organizations supporting one=s salary; and guidelines for deciding whether it is appropriate to take on an additional activity.

Following this discussion, Susan Tapert presented an overview of PowerPoint presentations. This included everything from the basics of setting up slides, to the optimal font, colors, use of animation, spreading out material across slides, etc.

Next, Dr. Timothy Lineberry of the Mayo Clinic in Rochester, Minnesota presented his ideas of optimizing alcohol and drug education in his medical school setting. He has been active at Mayo with a recent 2-1/2 day-Continuing Medical Education Program for which he developed the idea and co-chaired. Mayo Medical School=s 3rd year rotation, now three weeks long rather than four, has required changes in curriculum to meet needs of shorter rotation. Tim is providing lectures on substance abuse impact in the rotation. He is also working with trauma surgery at the Mayo Clinic to implement screening and brief intervention for trauma surgery patients admitted to the hospital. In the interim since the last conference call, Dr. Lineberry has two publications in press related to suicide risk assessment.

Dr. Krishna Balachandra of the University of Alberta Medical School presented his activities to promote alcohol and drug education at the two medical schools for which he has been a faculty member over the prior six months (he recently moved to Alberta from the University of Western Ontario). In the month since his move, he has already introduced AMSP. He modified his lecture which was delivered to 3rd-year nursing students to be delivered by the teaching coordinator following the outline. He is also involved with the CME program and plans to include residents as a part of a special series of lectures devoted to substance use disorders in the spring of 2009. Future plans include completing a brief scan of the lectures provided to medical students and residents to determine if additional teaching would be beneficial.

Finally, Marc Schuckit presented an actual lecture demonstrating the major points in his earlier lecture. The topic was AGenetics of Alcoholism.@ This was presented as a point of discussion rather than as an independent lecture itself. This offered the opportunity of reviewing major points about lecture development, and served as the basis for a relatively broad discussion.

The meeting adjourned at 2:30 p.m. That evening, the scholars were on their own for dinner.

III. Friday, October 17th

The morning began with a brief review of some career development issues. This was a carryover of some of the discussions the day before, and included the topic of the elements that go into decisions regarding commitment to any particular project or travel.

Tim Lineberry, a Second-Year Scholar from Mayo Clinic, next presented his fine lecture on Suicide. This was an excellent overview of four related topics: background on suicide; background on substance use disorders; their combination; and treatment-related issues. The slides were excellent (very few required modification) and it was suggested that it might be possible to make the lecture even more effective if Tim focused on three, rather than four related topics.

Susan Tapert, Associate Director of AMSP, next presented an example of a 20-minute lecture related to Neuronal Functioning in Adolescent Substance Users, which was developed for non-professional juvenile hall workers. This was an excellent lecture, after which Susan demonstrated how the exact same slides and similar lecture outline (but with a good deal more detail regarding methodology and specific results) could work as a 20-minute presentation at the Research Society on Alcoholism in a symposium dealing with adolescent substance users. The presentation, as well as the demonstration of how flexible one can be in altering material to meet the needs of specific audiences, was an important addition to our meeting.

Marcy Gregg and Susan Tapert then demonstrated the new format for the AMSP Web site. This is still in development, and all AMSP scholars were asked for input about how to optimize the material and the format being presented.

Associate Director, Marianne Guschwan, next presented a 15-minute lecture about Alcoholics Anonymous as it might be delivered to high school seniors. This was a lecture that modified the prior full lecture developed for medical students, and was an excellent demonstration of the manner in which the material can be presented with various approaches depending on the audience.

The noontime discussion of career development issues was carried out over the lunch hour. Among the topics discussed were the background considerations that go into the development of diagnostic criteria, an update on the DSM-V process, structuring work activities to create a balance with other responsibilities, and related issues dealing with time management.

Second-Year Scholar, Krishna Balachandra of the University of Alberta, next presented his lecture on Integrated Treatment for Comorbid Substance Use Disorder and Psychiatrically Ill Patients. This was a fine lecture, an excellent demonstration of interactions with the audience, and a good use of movement on the part of the lecturer in an effort to keep the audience=s attention.

Theadia Carey from the University of Michigan in Ann Arbor, a First-Year Scholar, next presented some of her plans for the expansion of alcohol and drug education at the University of Michigan. She is planning to improve education by first meeting with the Psychiatry Clerkship Director, Dr. Tamara Gay. She also will research to find out what educational lectures are currently being given to medical students. Dr. Carey is interested in developing an interactive online substance use disorder educational series for medical students and residents. She was directed to contact Dr. Gavin Bart at the University of Minnesota, who has done lectures and posted online.

Michelle Lofwall, from the University of Kentucky Medical School, a First-Year Scholar, next reviewed her plans for her first six months as an AMSP Scholar regarding expansion of alcohol and drug education at her school. In the coming year she is going to 1) revamp her two 50-minute lectures to the 2nd-year medical students on drug and alcohol use disorders; 2) give two 50-minute lectures to the neurology residents on drug and alcohol use disorders; 3) meet with and show the psychiatry medical student clerkship course director, the new family medicine endowed addictions chair, and the Pain Fellowship=s psychologist educator the AMSP website in order to have more substance use disorder lectures presented to these medical students, physicians-in-training, and medical students, and 4) meet with the ob-gyn residency director to see if there would be an opportunity to do a didactic on treatment of opioid dependence during pregnancy. In addition, Dr. Lofwall will start a quarterly addictions movie night for psychiatric residents that will incorporate clinical pearls and hopefully, resident interest in treating addiction.

The day ended with a review of potential topics for each of the scholars, along with possible second-year supervisors to include the Director and Associate Directors in light of the illness of one of a second-year scholar). These were to be discussed among scholars, and the topic revisited on Saturday. The meeting adjourned at 2:30 p.m. with a free afternoon for the group.

IV. Saturday, October 18th

The meeting began with a review of the materials that still needed to be covered before adjournment. The group got together at 8:00 a.m. in the Seahorse Room.

Krishna Balachandra then demonstrated how his 40-minute medical school lecture on Comorbidity could be modified as a 20-minute introduction to the Emergency Room Service for first-year ER residents. Immediately following that presentation, Tim Lineberry demonstrated his 20-minute presentation for suicide hotline workers, modifying his original lecture on Suicide. Marc Schuckit, then took his Alcohol Genetics lecture that had been demonstrated on Thursday, and carried out an exercise asking the scholars to select a specific audience and to work with Marc on how he might modify the original 34 slide, 45-minute lecture for a 20-minute lecture for a different audience. The audience that was selected was a Kiwanis meeting, and the goal was to present material on genetics of alcoholism over 20 minutes, setting the stage for fund raising with that group.

Marcy Gregg next presented an overview of the AMSP Web site functioning in recent months. There were about 12,000 visits per month, and about 2000 downloads of the material presented on the Web site. Visits came either directly, or from Google, Yahoo, Operation Cork, and a variety of other sources. During this time frame, information was requested in Russian, Polish, French, Dutch, Czech, Swedish, Italian, Spanish, Hungarian, Japanese, Romanian, Macedonian, Finnish, as well as 12 additional languages. Thus, the Web site is being widely utilized across the world for education regarding alcohol and drugs.

As part of the evaluation of the Web site, Marcy followed through with the request from one of our prior scholars to highlight how often his lecture had been visited. This was important because that scholar was now up for promotion at his University, and needed to demonstrate that his activities in academics were having a national and international impact. Impressively, over the last 4+ years, his specific lecture had been visited by 15,000 viewers, and had a total of 10,500 downloads. This is an impressive performance for the scholars and our Web site.

The next topic was the dates for the two remaining upcoming meetings. The spring AMSP meeting 2009 will begin on Wednesday, April 1, 2009 at a hotel in New York. Marcy, Marianne and Marc will work on the specific hotel. All scholars are reminded of the IMPORTANCE of arriving in mid-afternoon on Wednesday, April 1st so they are available to convene the meeting in late afternoon of that day.

The fall meeting in 2009 will begin on Wednesday, October 7th in Hawaii. The specific meeting site has not yet been selected, but scholars were also reminded of the importance of being certain they arrive the day before if needed, or ensure their arrival will be no later than Wednesday afternoon October 7th. The only change from the usual meeting schedule will be that Saturday morning will begin at 7:00 a.m. and end at 11:00 a.m. for the Hawaii meeting in order to allow scholars to return home on Saturday if they wish.

Laurie McCormick of the University of Iowa, a First-Year Scholar, next presented her plans for the development of alcohol and drug education at her University. Dr. McCormick plans to meet with the Chemical Dependency Service Director (Dr. Jill Liesveld) to discuss ways to improve the rotation for medical students. This will include: 1) discussing the possibility of having a medical students choose an AMSP lecture to present at a group therapy session for patients in the partial hospital program by the end of their week rotation; 2) encourage medical students rotating on the service to join Doctors Ought to Care (DOC) for high school students education; 3) develop a plan for involvement of faculty or residents to present at AMSA organizations for alcohol awareness week next October; and 4) discuss current lecture modification with AMSP resources for medical student lectures.

Next, John Wryobeck, a First-Year Scholar from the University of Toledo Medical School, presented his plans for expansion of alcohol and drug education at his University. He plans to meet with his department=s chair, clerkship director, and residency training director to develop a plan to carry out a survey of existing medical school and residency courses and training opportunities offered on alcohol and drug assessment and intervention. In carrying out this initial step he hopes to come in contact with most of the clerkship and residency directors and inform them of his clinical specialty in this area, as well as to make them aware of the Alcohol Medical Scholars website and the availability of lectures on a variety of alcohol-related topics at this site. After Step One he plans to use this information to expand the learning opportunities for both medical students and residents in the area of alcohol assessment and intervention.

The final report on plans to optimize education on alcohol and drugs was presented by First-Year Scholar, Joanna Buczek from Boston University Medical School. Dr. Buczek is considering the following potential activities: For medical students: meet with a director of medical student psychiatry education and discuss substance use disorders teaching to offer her support in developing seminars/lectures; put more emphasis on extending students= exposure to patients with SUD in the Introduction to Clinical Medicine course; and make more consistent attempts to utilize resources available through the AMSP website for teaching third-year medical students. For psychiatry residents: she plans to improve her talks on dual Diagnosis and Elderly Substance Abuse for PGY-1 residents; attempt to contact previous AMSP scholars who practice in the Boston area and explore working together on developing a seminar, lecture, or workshop for residents; and suggest to the BU psychiatry residents to view one of the movies on alcohol or drug issues at one of their monthly Film Forum series. With regards to fellows, she will explore whether any of the AMSP lectures should be offered to the Addiction Psychiatry and Psychosomatic fellows; encourage fellows to view the AMSP website and utilize the resources for their own teaching; and participate in the Fellows Journal Club and encourage selection of articles on SUD. Finally, with regards to hospital activities: she hopes to collaborate with the director of hospitalists service and the chief of emergency medicine on reviewing and updating hospital guidelines on management of ethanol and opioid withdrawal.

The following are the dates on which aspects of the development of new lectures by First-Year Scholars are due.

1. On November 15, 2008, First-Year Scholars are expected to have sent a workable draft of their lecture to their advisor. The next several months will be used as time for the First-Year Scholar and the advisor to work on successive drafts of the lecture, sending copies of all correspondence to Marc Schuckit.

2. January 15th, 2009 is the absolute latest due date for which the lecture outlines, references, etc. (i.e., slides if possible but not mandatory) are to be sent to Marc Schuckit. Marc will then work with each of the scholars to try to develop a final draft of the lecture. At the same time, scholars will continue to work with their advisor, as well as with Marc on the final development of slides. This process will continue until about February 15th, 2009.

3. All lectures, outlines, references, and slides are to be finished by March 1st. This gives the opportunity for the scholar to practice the lecture and to revise further if needed.

The Conference Call for all First- and Second-Year Scholars, as well as AMSP staff, is scheduled for Tuesday, January 13th, 2009 at 12:00 noon, San Diego time (1:00 p.m. Mountain Time, 2:00 p.m. Central Time, and 3:00 p.m. East Coast Time). Participants are asked to be sure they have set aside the time and are in a quiet place where they can participate. The Conference Call will last no longer than 60 minutes.

The final assignments of topics and advisors are as follows:

1. Michelle Lofwall will develop a lecture on Opioid Dependence in Pregnancy and work with Second-Year Scholar, Tim Lineberry.

2. John Wryobeck will develop a lecture that is an Introduction to Motivational Interviewing, working with Krishna Balachandra.

3. Laurie McCormick will develop a lecture on Eating Disorders and Alcoholism, and work with Susan Tapert.

4. Theadia Carey will develop a lecture on the Importance of the Therapeutic Alliance in Substance Use Disorders Treatment, working with Marianne Guschwan.

5. Joanna Buczek will develop a lecture on Special Needs of Populations Undergoing Alcohol Withdrawal (medically ill " the elderly, " pregnancy) working with Marc Schuckit.

The meeting ended with a return to a discussion of career development issues. Following this period, the group adjourned at 12:00 noon to return to their universities.

Marc A. Schuckit, M.D.

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