Category: Drugs

Going home

West coast and East coast of the U.S. are very different, people always told me. West coast was my home for 6 months – spring and summer. At the summer’s end, I took a long trip home to explore the East coast. This blog is about our journey to NYC, Ocean City (NJ), Millstone and back.
On Monday, we went from Portland, Oregon, to New York City. The Portland cab couldn’t find our address and stopped at the bottom of the block, leaving us to carry our heavy luggage alone. This was his second day at work, and his first airport ride – as we discovered later. He played in a heavy metal band for 11 years, since he came to Portland, and he was a vegan. To our great surprise, he knew many towns in our homeland – Bratislava, Prague and Brno – because he played there with his band. His intimate knowledge of those places made us feel closer to him, as we talked about the live in Portland. People who move to Portland are … bums, they are different. What is it about the city that attracts this special breed of humans? We couldn’t find an answer to that question, but agreed that it is the best city in the States. The driver wanted to give us 5$ discount because of the address issues, but we refused recognizing that starting a new job requires learning new skills, which takes time.
NYC was dirty, crowded and noisy. Our red-eye flight drained away all our energy and motivation to explore the city, so our greatest experience there was a long, morning nap in the Central park.
On Tuesday morning, we woke up in the Ocean City, New Jersey. I chose to stay in the Crossings Motor Inn long time ago. Ten years ago, I spent a summer working in its laundry room. It was my liberation summer, when I gained independence and self-reliance, changing my lifestyle forever. I was just a kid when I was here the first time. I didn’t realize it until now; 10 years of independence. As an adult artist-scientist, I am much more self-aware; I’m also very thankful that my research job allowed me to get here after 10 years and to have a great time, and to relax my tired scientific brain.

Crossings changed me; how has the motel changed?

The motel was no longer owned by my Italian friends; staff and housekeepers were different too. Our housekeeper was Kayla – a quiet student from Russia. J1 students, like her, were experiencing increasingly more problems with obtaining visas for this type of work/ region. Sandy damaged the Jersey shore and left its mark on the Crossings too; the lobby was painted and refurnished. Should I have come back last summer – before the Sandy storm – I would still see the ugly pink countertop in the reception. The season ends in Crossings on September 29th, the receptionist stays with her daughter during winter. The handyman hopes to get a job in the construction; he was able to do so during the last 2 winters
On Friday, we went to visit my cousin in the Millstone Township, in the Lakewood area. After dinner, and a short card game with Cassandra, they drove us to the JFK airport. Journey to the airport was never-ending. The traffic was really bad. We needed to pee badly and struggled to find a toiled. So we left the free-way and found a supermarket, where we were the only white customers. The bathroom smelled badly. Half of the toilet desk was missing and so were the bath tissue and soap. Nobody wanted to use the toilet and when I opened the door to get in, a nearby girl told me to save myself. Under these circumstances, there was no discussion about finding another toiled; we did it there. Luckily, we had just enough time to catch our flight back home. Our home away from home – a second home in Ireland.

Saying bye slowly makes parting easier

Last days of my INVEST fellowship

Visiting research scholars make new friends quickly and parting is not always easy for them. I said bye in Portland (OR) five times:

First, I said bye to my writing group. This was my second group in the last 15 weeks. The first, 10-week course of prompt-based writing was a birthday gift from my wife. I enjoyed the first course so much that I decided to go for a second round. The new beginnings were difficult, because we had a new group and group dynamics; dynamics matters most in writing groups. By the 3rd-4thmeeting, the group juice started to flow and we shared more and more feedback on our writings. Parting with the second group wasn’t easy, but much smoother thanks to my experience with the first group; I felt I belong there.

Second, I said bye to the members of the Western States Node from the Clinical Trials Network. The network has 13 nodes funded by the National Institute for Drug Abuse (NIDA) to conduct clinical trials in addiction science. From the very beginning of my fellowship, I have attended weekly meetings of the team – around 20 in total. Marie made delicious cookies and Lynn gave me clock made of bike parts by a Portland artist. This was a well-chosen gift, because I cycled around Portland every day and really enjoyed it.

Third, I said bye to my colleagues from the Department of Public Health at the Oregon Health and Sciences University (OHSU). The lunch invite went to all faculty and staff, but I was worried that no one would come. I was worried that if I left, nobody will care about it. When I came there, I saw many familiar faces. It felt good because it made me feel like I have an impact on people that I managed to make a connection in a short time. We had a BYO lunch on the lawn. The sky didn’t look like 88 Fahrenheit but the sun shone on us eventually. Some of us sat on a white blanket from the ED which used to warm up patients as they came to ED. Many people showed up, including my mentor Dr Dennis McCartywith his wife; Dennis commissioned cookies and Sarah baked them.

In the evening, I said bye to the three of my best friends and neighbours plus their dog – Sonic. We stayed up late, talked, ate and listened to great music. Sonic honoured us with two carpet pees which destined him into his kennel for the rest of the night.

Fourth, I said bye to my dentist. Seth was a 3rd year dentistry student at OHSU School of Dentistry and helped me through many long visits. He reminded me about my appointments every Sunday night. Seth called me on Friday evenings and when he didn’t get an answer, he called back on Sunday night. He even called me when he had a cancellation to check if I had time to get some work done. When we parted, he pushed a bag full of toothbrushes and toothpastes into my hand; so that I take care of myself and my teeth. We had a lot in common, especially the taste for adventure. I surprised my wife with a hot balloon ride for her birthday last Thursday and he treated his wife with the same ride for their 3rd anniversary.

Fifth, I said bye to my mentor, Dr Dennis McCarty. When I arrived to the department that morning, it was pretty empty and my heart sank because I haven’t had a chance to say bye to Dennis. But he came later. Dennis helped me to improve and expand my writing. I’ve read four books on writing, borrowed from him, during the my fellowship. I’ve never read so much about writing in my life. Dennis introduced me to science writers, e.g. Atul Gawandeor Carol Cruzan Morton, science writing, e.g. JRF publications, and science writing competition – the Wellcome trust prize. We met at the career crossroads – an emerging science apprentice and a seasoned mentor. He taught me that research project management is unlike any other research skills: you don’t learn these things by reading books or in the classroom, but through the apprenticeship. He was not only my mentor, but at times, acted like my guide, counsellor, teacher, proof reader, father and friend.


My point here – that saying bye slowly makes parting easier – should interest most visiting research scholars. Beyond this limited audience, however, my point should speak to anyone who faces parting with many good friends.

Doing research with busy doctors – an open space world

Family doctors are notoriously busy. Lack of their time is the number #1 barrier of doing anything outside their patient workload, including research. And yet, some enthusiasts get involved in the research endeavour, believing it can enhance primary care.

Knowing this, I looked for ways to do research with busy family physicians for my INVEST fellowship in Portland, OR. I needed to get them in one room and ask the group a couple of questions about their recent resident training initiative, SBIRT Oregon. The only time when my doctors were all in the clinic was right after another meeting. One of them suggested doing an open meeting technology. The phrase vaguely rang a bell with me.

‘Open space’ describes the process by which a wide range of individuals, in any organisation, can facilitate creative meetings around a complex theme of importance to all stakeholders 1. While a theme may be important to all stakeholders, they may have differing perspectives and responses, so this approach permits all voices to be heard and facilitates a process where stakeholders move from conflicting views to consensus. The approach has been widely used in commerce, religious communities, (non-)governmental agencies and war zones 2.

How did this work for us?

Our field ‘experiment’ lasted for about 90 minutes with two meetings in one room, right after each other. The meetings were unrelated, but 3/4 of the participants from the first meeting were scheduled for the second meeting too. I and my co-facilitator arrived well ahead of the first meeting. As doctors started to show up for the 2nd meeting – the 1st meeting was still in progress – some people were confused; others patiently listened to people talking at the 1st meeting. I found it very useful to sit on the 1st meeting and the transition to the 2nd meeting was much easier – all were in their seats already.

All in all, this set up had many advantages for multiple meetings with extra busy attendees. It can help solve problems and it works best with many people attending your meeting, but maybe it’s not ideal for research focus groups. A tip for a freshman facilitator: it’s amazing how much powerful an incentive for research can food be, especially pizza.

__
1http://www.michaelherman.com/cgi/wiki.cgi
2http://www.openspaceworld.com/papers.htm

Relationships of drug users change, but slowly

relationships change

Are social relationships sensitive to therapeutic change?

The ‘‘Phase Model of Change’’ –  a famous model in psychotherapy – says that change in overall functioning in life, including interpersonal problems, occurs during later phases of therapy. Well-being and symptoms take precedence. Social problems may last long, but this cross-sectional Slovakian study showed it’s worth asking drug users about their relationships. Intrusiveness and affectionate support seem to be the key players.

Read More: http://informahealthcare.com/doi/abs/10.3109/14659891.2013.790496

Helping agonist patients with alcohol problems: A NEW guide for primary care staff

What should doctors do differently when screening for alcohol use and delivering brief interventions for agonist patients in primary care? General principles remain the same like for other people, but:
  1. the screening and treatment processes should be more systematic and proactive in all problem drug users, especially in those with concurrent chronic illnesses or psychiatric co-morbidity,
  2. lower thresholds should be applied for both identification and intervention of problem alcohol use and referral to specialist services,
  3. special skills and specialist supervision is required if managing persistent/dependent alcohol use in primary care.