Meeting #4

Laguna Beach, California

May 16 - 19, 2001



Present at the meeting were Dr. Marc A. Schuckit (Director), Junior Scholars: Donna Londino, Jean-Joel Villier, Christopher Welsh, Lauren Williams; Senior Scholars: Laura Bierut, Marianne Guschwan; Vania Modesto-Lowe, Susan Tapert; and Karen Trocki, RSA Representative, as well as Ulrich Preuss and Valentin Isacescu (guests).



I. Wednesday, May 16th.

The participants assembled at the Surf and Sand Hotel in Laguna on Wednesday afternoon. We met together for a social hour at 7:00 p.m., followed by a pleasant dinner (with a bit of work) at the hotel. The tentative agenda for the subsequent two-and-a-half days was briefly discussed, as was the location for the meeting the next morning.



II. Thursday, May 17th.

The meeting began at 8:00 a.m. in the Dolphin Room for a working breakfast and beginning of the meeting.

The first order of business was the introduction of the two guests and a brief review of the potential agenda. Some modifications were made, and the meeting began.

Marianne Guschwan presented the progress made during her Sr. Scholar year at NYU. Marianne shared progress on a variety of fronts. These included: successful implementation of a mini‑rotation of medical students on the detoxification unit with new students every six weeks; identification of a medical student who is willing to begin to develop a DOC program; successful implementation of a one‑and‑a‑half hour workshop (carried out jointly with Susan Tapert) at the American Academy of Addiction Psychiatry where 30‑to‑40 participants learned how to improve their teaching techniques in substance use disorders and psychiatric conditions; repetition of the same workshop (again for approximately 40 people) at the annual American Psychiatric Association meeting; a workshop carried out at the American Psychiatric Association on career development for young faculty members, with Marianne serving as co‑chair; implementation of a program working with fellows in substance use disorders at NYU regarding the development of teaching techniques; assumption of the chairmanship of the American Psychiatric Association Committee on Treatment Services for Substance Use Disorders; development and implementation of a course on substance use disorders for nursing staff at NYU hospitals; expansion of information on substance use disorders and lecturing techniques to psychiatric residents at NYU; establishment of an ongoing working relationship with the Associate Director of Training and Education for the Division of Alcoholism and Drug Abuse, Dr. Petros Levounis; continuing work with the Director of Medical Student Education for Psychiatry, Dr. Myrl Manley, to ensure that education about substance use disorders is appropriately included in the first and second year curricula which is being revised; being appointed Associate Director of the Division of Alcoholism and Drug Abuse, serving as assistant to Dr. Marc Galanter; being appointed Director of the Substance Abuse Referral Program thereby reaching out to all other services at Bellevue Hospital. Dr. Guschwan continues to work at setting up additional programs including: developing an overview of alcohol and drug education offered between the first year of medical school through addiction fellowship at NYU; attempts to expand the medical students= exposure to AA (although this is being met with a fair amount of resistance); working with Dr. Levounis in developing a four‑week elective on the dual diagnosis and detox units, as well as outpatient programs for second‑year residents; and the implementation of career and movie night programs that will incorporate substance use disorders.

The next issue involved a discussion of career development for first-and-second year scholars. The discussion focused on criteria for deciding whether to take on a requested task. Dr. Schuckit=s advice was to carefully think through why one might say yes: because it's something that would be fun; it would be good for advancing your career; it's an inherent part of the job; it would make somebody with power over you very angry if you said no; and etc. The key point was that there can be many reasons for taking on a task, and it is important to make the decision after having thought through why the effort would be worthwhile. Another related career development issue was how to decide about salary, and the most appropriate approach to negotiating.

Marc Schuckit then presented an update on the lecture "How to Give a Lecture". A brief background review was offered relating to philosophy, preparation, and development of slides. Because this is an area for which a great deal of work has been done by all of the Junior Scholars over the prior six months, and reflecting the fact that each person was about to present a lecture, the focus of the material was on the presentation itself. This lecture has been written up by Marianne Guschwan and Susan Tapert, placed on the website by Susan Tapert and is available to everyone.

Susan Tapert then demonstrated her lecture on ANeurocognitive Correlates of Substance Use Disorders in Adolescents.@ It was emphasized that the scholars should pay closest attention to the lecture organization, appropriateness of slides, and delivery as examples of materials presented in Marc Schuckit's prior lecture. This was an example of a data-oriented lecture that was being developed for presentation at a scientific meeting.

Donna Londino offered an overview of the progress made over the prior six months at the Medical College of Georgia. Donna has accomplished a great deal in this relatively short period of time including: she has become the Coordinator for Psychiatry for First-Year Medical Student Education, fighting to retain Psychiatry as a separate entity within that year and incorporating as much relevant material for substance use disorders as possible; she has spent a great deal of time updating her knowledge and skills regarding substance use disorders in general, as she had joined AMSP as an expert in adolescent and child psychiatry without much background in alcohol and drugs; Donna has become a central contact person regarding substance use disorder issues at her medical center; she has developed contacts with the group entitled Students for Community Involvement, and has also worked with nursing education groups regarding substance-related issues; Donna participated in a two-hour evening internet chat room on substance-related problems, and has used some of the skills she has acquired as part of AMSP to feel more comfortable during a television appearance; under her direction, the Medical College of Georgia continues to have Friday lunches regarding psychiatric issues, with one per month devoted to substance use disorders, and she is incorporating issues related to substance problems in the once per month movie club; Donna has joined the neurobiology lecture series for PGY2 residents by adding information on prenatal exposure to substances of abuse and consequent childhood behavioral problems; she is now part of a grant that is likely to be funded by the Robert Wood Johnson Foundation regarding HIV, including the role of substance dependence; and Donna is participating in the early stages of research projects. Over the next six months (prior to the Fall, 2001 AMSP meeting), Donna hopes to: implement a clinical elective on substance use disorders incorporating adolescent and adult psychiatry; work to optimize the amount of information on substance use disorders in the Year One of medical school education; and work to expand treatment offered for substance-related problems in the adolescent psychiatric program.

The morning progressed with the demonstration of a lecture entitled ASubstance Use Disorders in African-Americans@ by Jean-Joel Villier. Jean-Joel had spent a great deal of his efforts optimizing the organization of the lecture and the slide copy. He is in the process of expanding the specific amounts of data offered around the lecture outline items, and was given a number of suggestions regarding organization, appropriate sensitivity to concerns of the audience, the need to markedly expand the information offered on dependence (as distinct from use patterns); and how to optimize delivery. He will work with Karen Trocki on the next draft.

Finally, before adjourning, Marc Schuckit discussed his plans to modify the directions given to potential AMSP scholars. These include making it clear that no first-year scholars should join the program unless they are certain they can participate fully in both face-to-face meetings (arriving with an appropriate amount of time before the 6:00 p.m. Wednesday start time and not leaving prior to noon on the Saturday), participate in the conference calls, create lecture material suitable for presentation by December 31st following the first meeting; and so on. The current first-year scholars were told that they must consider the following before deciding whether they would participate as a Senior Scholar, including: the need to fully attend both meetings; participate in conference calls; present at least one lecture as a demonstration to Junior Scholars; and take on a mentorship role with an assigned Junior Scholar throughout the year. Scholars were invited to make suggestions regarding these issues.

The meeting adjourned at approximately 2:30 p.m. with participants to reassemble at 7:00 p.m. for dinner.



III. Friday, May 18th.

The morning began with a review of the day's agenda.

Vania Modesto-Lowe then demonstrated her lecture on AIs there a Role for Medications in the Treatment of Alcohol Dependence?@. The emphasis was placed on demonstrating the most appropriate use of slides, as well as the importance of focusing on flow of logic. This was a useful demonstration of a very effective lecture, and one that highlighted many of the issues relevant to the optimal presentation technique.

Susan Tapert then handed out information regarding the AMSP website. We were all pleased with the level of use the website demonstrated, exemplified by an average of 44 hits per day in May of 2001. Most of the individuals seemed to have sought out the AMSP website directly, while a substantial minority found their way to us through the connections to the websites at the Research Society on Alcoholism and the National Institute of Drug Abuse. The hook-up via the National Institute of Alcohol Abuse and Alcoholism website is soon to be implemented. Susan's review of the days in the past year when activity was at its highest on the website demonstrated that the series of lectures offered at various meetings by AMSP scholars are having a major impact on how people view and use the website itself.

Our discussion next turned to the progress made in developing copyright for materials listed on the website. The major issue here is that we want to preserve the website for everyone to use for free, and therefore must take steps to be certain that no one takes material from the website, copyrights it, and then charges for its use. We have two potential avenues to pursue, one which would copyright each specific lecture, and the other which would utilize the website as a newsletter/periodical which is updated every several months. Susan and Marcy will look into the best way for us to go and then proceed.

Susan Tapert next presented the overview of progress made at UCSD. The only "permanent" AMSP site is San Diego, and therefore, the progress made each six months has to be looked at from the standpoint of the long-term commitment of UCSD staff. In the interim since the prior AMSP meeting, Susan once again offered an elective on substance use disorders for first and second year medical students. There was enthusiastic support, although a smaller number of participants than had been hoped. The feedback from the students has been excellent. Susan and Marc Schuckit are discussing ways of using a flyer to medical students, reaching out to the UCSD division of DOC, and other mechanisms to optimize participation in the future. Susan next handed out an overview of the alcohol and drug education activities at UCSD from first-year medical students through fellows. The UCSD scholars are working with the Doctors Ought to Care (DOC) program, and Susan has met with the Associate Dean assigned to DOC, Dr. Covelle. Finally, the UCSD group shared the handout used at the American Psychiatric Association meeting where the course on How to Give a Lecture was held under the direction of both Susan and Marianne Guschwan, and participants were informed that additional information and slide copy could be obtained from the AMSP website.

Next, Lauren Williams presented her lecture on the AFetal Alcohol Syndrome (FAS): An Overview.@ This was an excellent overview of the topic developed by a Junior Scholar, and it was felt with a small amount of work would be appropriate for loading on the website.

All junior scholars were reminded that changes in the lecture outline, updates and references, and alterations and slides should be completed by July 1, 2001 at which time they will be loaded on the website.

The Washington University update was next offered by Senior Scholar, Laura Bierut. Laura's review was important for a particular reason: she emphasized the fact that even scholars who have a prior track record in research or substance use disorders can gain a great deal from AMSP. Over the prior six months, the accomplishments at Washington University included the continuation and solidification of the second-year medical student lecture series which now has more information about substance use disorders and for which the mandatory attendance at AA meetings has received excellent reviews by students. Laura continues to participate in the curriculum reform efforts at Washington University, and her presence there has allowed her to push for the importance of substance use disorders information as part of the core curriculum. Her efforts have resulted in a representation of substance use disorders in the now fully-implemented first-year revision which had been piloted by Laura. An important development is that through her activities on AMSP she has gained enhanced visibility at Washington University and is now turned to by the Dean, clinicians, and students when issues relating to substance use disorders arise. A new program is now being offered to third-year residents and involves practice guidelines on identification and treatment of substance use disorders, and Laura has successfully implemented alcohol education as part of a continuing medical education internal medicine board review course. As a result of her interactions on AMSP, she has also implemented a course on How to Teach which is offered to medical students and for which substance use disorders is one of the topics used. Finally, Laura was able to offer some advice regarding consideration of whether AMSP is useful as a two-year program. She felt that the gains made at Washington University during Year One would have been likely to have disappeared had she not had the continuing support of the AMSP group in the second year, as well as the knowledge that she was going to be reporting every three-to-six months to us. As with most institutions, Laura feels that once something can be placed into the curriculum and then continued into its second year, it is very likely to develop an inertia of its own that markedly enhances the probability of its continuation in years to come.

The morning's agenda then turned to a discussion of the new AMSP Junior Scholars scheduled to begin in August. Marc shared some thoughts on the criteria used to select individuals for AMSP, and presented the names of the four individuals selected to begin. The fifth potential candidate, an individual from Columbia University, was also discussed with input from the scholars that this individual did appear to be appropriate for the group. Marc will carry out further conversations with him and make a decision soon regarding offering the fifth position. Scholars were asked to keep their eye open regarding any individual who might appear outstanding for a sixth position. However, unless someone is identified for whom this year would be the only year appropriate, Marc would prefer the sixth position to be used to support meeting attendance by two substance use disorders fellows who are currently working at UCSD to allow them to gain additional information on optimal teaching techniques they might be able to carry back with them to Germany. This is consistent with the goal of AMSP in developing a cadre of lectures on the website that will be useful world-wide.

Marc Schuckit then carried out a brief discussion of how to review articles for journals. Scholars will be sent one or more manuscripts for mock reviews during their tenure.

Regarding career development, a brief discussion ensued regarding a career development issue of optimal approaches for clinical supervision. Marc shared the guidelines that, as with a lecture, it is important to know exactly what it is you hope to accomplish, focus on the period of time (for example, once a week for a month) during which the supervision will occur, and adapt the approach to that which will be most likely to be successfully accepted by the students. Marc gave examples of clinical supervision sessions he is currently carrying out with medical students and psychiatric residents.

In the final formal presentation of the day, the Junior Scholar, Donna Londino presented her overview and lecture on A Substance Use Disorders and the Family.@ Once again, this was an excellent lecture that will be a useful addition to the website with only a moderate amount of additional work.

Jean-Joel Villier then presented the accomplishments made over the last six months at Howard University. Jean-Joel has established a strong and continuing working relationship with the Chief of Substance Use Disorders at Howard, Dr. Gullatte. She has assigned him many of the lectures relating to substance use disorders at Howard University, and he has incorporated into the curriculum AMSP lectures on Medical Consequences of Alcoholism, the Introduction to Substance Use Disorders and Categories of Drugs of Abuse, and Pharmacology. In addition, Dr. Villier has participated in Grand Rounds. Similar to Dr. Bierut and Dr. Londino, Jean-Joel notes that he is now becoming recognized as a contact person regarding substance use disorders problems and optimizing sharing of information at his university. In this role he has established a lecture on substance use disorders for psychiatric residents, and has also produced lectures for nursing and physician assistant students. He is most fortunate that DOC has a strong tradition at Howard, and he has joined their efforts, accompanying the students on their visits to two high schools in an effort to determine how he might best help them with their outreach to young people. Over the upcoming six months, Dr. Villier hopes to gather more information on cataloging what is offered as part of the curriculum at Howard relating to alcohol and other substance use disorders, to consider implementing the elective on alcoholism and other drug problems (using as a template the elective at UCSD which is posted on the AMSP website), and hopes to begin to work with internal medicine and Ob-Gyn in order to deliver AMSP-based lectures on the fetal alcohol syndrome and medical consequences of alcoholism. As his lecture on substance use disorders in African-American progresses, he plans to have a slot given to him in the Department of Psychiatry Grand Rounds. An additional suggestion is the possibility that Dr. Villier take advantage of the fact that he is in the Washington DC area to see if his medical school could facilitate any outreach between AMSP and the Congress, especially the Black Caucus.

Finally, Vania Modesto-Lowe, a Senior Scholar, reviewed the accomplishments at the University of Connecticut over the prior six months. These have included the incorporation of four lectures on substance use disorders to third-year medical students rotating through psychiatry at their major teaching hospital, with the expansion of these efforts to students rotating through psychiatry at other University of Connecticut Medical School facilities as of July, 2001. Furthermore, she has incorporated a fellow studying substance use disorders into the lecture series, a step that will hopefully help this individual to also utilize AMSP material to facilitate the further development of his or her career. Dr. Modesto-Lowe has delivered her lecture on the role of medications in the treatment of alcoholism to psychiatric residents at the University of Connecticut, is now part of the first-year introductory (crash) course given to psychiatrists---focusing her lecture on substance use problems, and is working on the development of an addictions rotation for PGY3 residents. A wonderful development is that Dr. Modesto-Lowe has just been named Director of the University of Connecticut Fellowship for Substance Use Disorders. In addition to all of these activities, Dr. Modesto-Lowe continues to carry out lectures in the community.

The day=s activities ended with a wonderful and thoughtful presentation of gifts and thanks to Marcy Gregg for all of her wonderful work in facilitating our AMSP meetings. Marc Schuckit also bashfully accepted a lovely gift and card.



IV. Saturday, May 19th.

The morning began with some reflections on the fact that Senior Scholars will be rotating off. Everyone expressed a strong desire to maintain an ongoing relationship which will include: all graduates will be kept on the e-mail and mailing lists so they know how things are progressing; Marcy and Marc will notify graduates (as well as current scholars) when Marc is attending a meeting where all might get together (for example the American Psychiatric Association), and graduates are always invited to attend AMSP meetings (unfortunately, at their own expense). Marianne Guschwan will attend and participate in the next meeting scheduled for October 2001 in Hawaii. We will also continue to look for other opportunities to maintain close working relationships.

Chris Welsh then offered his lecture on @ Substance Use Disorders in Health Care Professionals.@ This is a successful lecture that with only a modest amount of work will be a very useful addition to the website.

Marcy and Marc then presented the attending Senior Scholars with their graduation plaque, along with warm wishes and the hope that everyone will have the chance to maintain close contact.

Lauren Williams next updated the group on her activities over the prior six months at the University of Miami. Immediately following the prior meeting, Lauren went to Carl Eisdorfer, her Chair, and reviewed her plans. Carl facilitated her contact with the Physicians Recovery Network who, in conjunction with other staff at the University of Miami, were planning programs at the medical school B taking steps to expand these interactions to include direct contact with medical students. Lauren also followed through on her plan to begin cataloging what is being taught about substance use disorders in Miami. As a result, contact was made with a colleague interested in addictions, and this led to establishment of an Addiction Day program for medical students, medical and psychiatric residents (attendance being mandatory for the latter) which will involve setting forth information on alcohol and drug-related issues and the discussion of a panel made up of prominent department chairs at that university. The goals and objectives for the education of physicians in substance use disorders was also instituted as part of the plans for revisions of the educational program in the second year of medical school, and Lauren is working with a student to establish the DOC program. Over the next six months she hopes to begin a rotation for one-to-two medical students on the Addiction Unit, develop a lecture focusing on substance use disorders for the Medical Student Orientation, and enhance the quality and intensity of teaching and case presentations on her unit.

The next order of business was a demonstration of the AMSP lecture, ADevelopmental Factors in Substance Use and Approaches to Intervention and Prevention,@ developed by Karen Trocki. This was an excellent example of the optimal use of slides, and an emphasis on the importance of looking at psychosocial and environmental factors as well as biological influences when dealing with alcohol dependence and other substance use problems.

An update on progress in the prior six months at the University of Maryland was next presented by Chris Welsh. For first-year medical students, Chris: is working with the person in charge of medical student education to be certain that substance use disorders are included; has established procedures for optimizing the quality of both lecture material and clinical supervision regarding substance use disorders; worked with a DOC-like program helping the students enhance their information on combined pharmacological and psychological approaches prior to an outreach visit to a Navajo Indian Reservation; made a television appearance to talk about inhalants; worked with the students in their outreach regarding substance use problems at a City Health Fair; and he has identified a first-year medical students who will help him in implementing a "substance use problems in the movies" elective-type program. For second- and third-year medical students: Chris is participating in the revision of the medical school program overall, with the aim of being certain that substance use disorders are represented; he is working with lecturers in other courses (e.g., pharmacology) to be certain that clinical aspects of alcohol dependence and related problems are appropriately presented; Chris is increasing the amount of dedicated time on an addition unit as part of a psychiatry rotation; he is helping to expand the lecture series related to substance use disorders as part of the third-year rotation; and he worked closely with a medical student who is part of a television documentary series with his role as a discussant regarding the importance of substance use problems. For psychiatric residents, he is working to be certain that all residents have a six-week dedicated block related to an alcohol and drug treatment program (currently that's only being done for half of the first-year residents); is striving to be certain that alcohol dependence and other similar disorders are appropriately represented as part of the psychiatric consultation service; and he has developed a new lecture for fourth-year residents dealing with the pharmacological and psychological approaches to substance use disorders. Finally regarding education within the medical school, Chris is working closely with the Coordinator of Substance Use Disorders Education at the University of Maryland, with the probability that he will be able to take over this position within the next several years. Chris continues to work with the community and has delivered two lectures to pain units, has joined a state-wide task force dealing with problems related to the drug Ecstacy, and has delivered lectures to the nursing school and as part of the block of education offered at the Health Sciences Center regarding HIV-related problems.

Vijay Ramchandani provided a copy of an update of his accomplishments at Indiana University.

These include: a lecture on genetics of complex diseases including alcoholism added into the Medical Genetics course for second year medical students, which was developed and given by Tatiana Foroud; a new lecture on making the diagnosis of dependence and brief interventions in the chemical dependency rotation for third-year students; a target for increasing alcohol education in OB/GYN and Pharmacology; the development of a core‑book designed to be a source of information for medical students about alcohol and other drugs, which will form the basis of material covered throughout the four years in various courses throughout the curriculum; being recently appointed as Assistant Scientist and part‑time Assistant Professor in the Department of Medicine, a move that will allow him to be in an even better position to influence and enhance the level of medical education in alcohol and other drugs

The group discussed plans for the next AMSP meeting which will begin at 6:00 p.m. on Wednesday, October 17th, at the Kapalua Bay Resort in Maui, Hawaii. All scholars were reminded that it is very important that they attend the entire meeting and make plans not to leave before noon the following Saturday. It's important to remember that Kapalua Bay is between one hour and one hour-and-a-half travel from the Maui airport.

The group began to consider potential dates for the Spring, 2002 meeting. Tentatively, the meeting will begin on Wednesday, May 1, 2002, and a number of potential venues are being discussed. This includes the possibility of meeting south of San Francisco in Big Sur or in Monterey-Carmel, or situating a future meeting in London (as all of the new scholars are from the East Coast, and it may be less costly to hold a meeting in London than to transport people to the West Coast or to Hawaii).

Marianne Guschwan shared some thoughts regarding coordination of future workshops at national and international meetings. Both she and Susan Tapert are eager to see the workshop on teaching techniques on how to give a lecture continue, and it appears as if future efforts will incorporate current Junior Scholars including Chris Welsh, Donna Londino, and Lauren Williams, and that a graduating scholar, Vania Modesto-Lowe, might also become part of the presentations perhaps at the American Psychiatric Association meeting as well as the American Academy of Addiction Psychiatry. Marianne will proceed with those applications.

Marc then offered suggestions for effective time management, which included criteria for setting priorities and making good career decisions.

The final order of business was to turn the meeting over to Susan Tapert to demonstrate how, once Power Point slides have been developed, they can be effectively used in presentations. Susan allowed Marc Schuckit (affectionately known as all-thumbs Charley when it comes to computers) to try it out, and the group concluded that if he can do it, anyone probably can. Susan reminded us all that the lecture material that she has developed on producing and delivering Power Point slides is now part of the website lecture on How to Deliver a Lecture.

The meeting adjourned with everyone eager to implement some of the lessons learned, and each of looking forward to getting together at the subsequent meeting. Everyone will be contacted by Marcy to establish the conference call, probably the last week in August or the first week in September.

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