Transcript of the Focus Group Meeting

Charles:

The Research Institute (on Addictions; RIA) is also involved in this with us. They are one of our partners in this process and in this notion of creating this Addiction Technology Transfer Center. Clearly the Research Institute's connection to the University was probably important in widening the centers here. We met several times with folks from the Research Institute on how we might work together in this process. They have given us permission, in fact, to use the "Research in Briefs." This brings us to the third thing we are involved with, but before I get there, the other piece of the ATTC is we also have a state wide advisory committee. We have people from mid-state, up-state, down-state, and Western New York who are on the Advisory Committee that will meet a couple of times a year just to help us keep a pulse on what is happening in the areas that they come from and how some of the things that we are thinking about might play. We really didn't want this to be a Western New York initiative; we really want it to be a New York State wide initiative as far as the overall ATTC. The third endeavor we are involved with is this notion around "Research in Brief." Do you all get the "Research in Briefs" at your places?

Comment:

No we don't get it.

Charles:

After you read them, do they go to the side of the table, or maybe they go to the side of the table before you get a chance to read them.

Comment:

I wish I could say I read them all Charles, but I don't. If I see a heading or if I have 10 minutes to sit while I am opening the mail, I will look at them. I have a pile of them that one day I will sit on the beach and read.

Charles:

I think that happens with a lot of folks. One of two things happens. They take a look at the title and it'll say, "The t-cell liver thing, something or other..." and that goes to the corner and we don't read that at all. Then there's another one that looks interesting that you will either put to the side or you will read it and say, "What does it mean for me? This is great information but what can I do with it. There is more information that I would like to have on this particular 'Research in Brief.'" We are talking with the Research Institute around this notion of how can we take these "Research in Briefs" and make them more utilitarian with the person who is a practitioner in the field. I had a copy of one that we kind of put together, and in fact when we are reading this, I will run down and get it real quick and show you what we have done so far and how it might look. I brought you here together, and there are four people who unfortunately weren't here today, to sit with us maybe a couple of times a year, 3-4 times a year. Honestly the number of "Research in Briefs" that have direct utilitarian application of practitioners probably don't come out all that often. There are not a whole lot of them. There are some that come out from time to time. What our thought was is if we could get a group of practitioners together from varying points of the system and varying jobs from people who are actually doing it-the prevention people who are trying to help individuals understand the dangers of and to prevent the use of, and for administrators who do more oversight to supervision-we want to have individuals take a look and read those "Research in Briefs" and think about, "What would I need to know to help me take this information and put it into practice?" That is why they created them at RIA; they want to influence practice. Sometimes the way it is presented is not in a format that you can readily use. So we are working with them around this notion of (ATTC) will talk to you, (ATTC) will get to you, and make sure you have a chance to read the "Research in Briefs." What we will do is garner your questions and take the questions back to RIA to the research scientists who actually did the study. RIA has also offered us a chance to have access to the full research study. What we may do is go over the research study first and see if we can answer the questions from that perspective. If there are questions that don't make a lot of sense for us, we will go back to the research scientists and ask them, "How would you respond to this?" The notion is that we would publish that and make it available to the practice community at large on line-we do have a web site-and in paper form for those people who do not have access to the Internet. That is kind of it in a nut shell. I know I have talked to all of you at some level about this. Do you have any questions about what we are trying to do? I won't ask you if you think it is a great idea, because I think if you thought it was a waste of time you all probably wouldn't be here. Do you have any questions about anything I have brought up this far?

Comment:

No I don't' think so. My understanding is that you are looking for us to review those briefs structured by some questions. Do you all have questions?

Charles:

No, not so much that we will have questions, but we're more interested in your questions.

Comment:

The questions we generate following the review of those briefs.

Charles:

Right. Questions around application, confusion. Maybe there are pieces that don't make a lot of sense.

Comment:

Along the lines of "I see an article and this really looks like something promising or potentially useful. I have to find out more. How do I go about finding more and where do I go?"

Charles:

Not so much where do you go; we will do the work.

Comment:

But "I need more than this because ...."

Charles:

"I need more than this. I need some further information about this and about how this might work. I see the research findings but are there more kinds of findings that are useful?" More importantly, "How can I take that information that I see in this 'Research in Briefs' and make it something that I can use?" One of the things we will look at is a spousal situation inventory to help individuals who are beginning to assess coping skills in woman who have partners who have alcohol disorders. "How can I use this?" What would you need to know to help you begin to move that to your practice or to a situation where you find it applicable? Then we take that information back to the research scientist or your questions back to the research scientist. They may have a good answer for us or they may not at all. Then it becomes incumbent upon us to help figure that out here at the ATTC. We will try to find the information and help figure that out. We will help so we can move, again, those things that seem to have some evidence that they are useful and successful and move those back to the practice community, probably state wide.

Question:

What has been the history so far? Have any of the treatment facilities been putting into use any of the information that is coming out of these "Research in Briefs?"

Charles:

Good question. I don't know the answer to that. That might be a question worth assessing, whether or not treatment facilities are in fact getting them and have access to them and what do they do with them once they get them.

Question:

What would be the point of this whole exercise if nobody is doing anything with them?

Charles:

That's a good point. That is something we can do. The numbers are not that large so we could definitely follow through with that. My suspicion is that if they are not doing them here in the Buffalo area where the Research Institute is on Main Street, they are probably not doing it in Ogdensburg. Elaine: Which means all the more reason for groups like this is to find out if no one is using them, then what do we need to do so RIA isn't doing this is vain.

Comment:

It depends on whose desk they land. There might be an administrator who gets these and, for whatever reason, is motivated to pass the knowledge onto front line staff, but then a lot of administrators may not.

Comment:

It is a huge job to do that. I don't mean the passing of the paper, but it is a huge job to implement this. That is a huge job. Somebody has to think about it, somebody has to develop all of the paperwork to be able to do that, and then you have to train the staff. It is a huge job. Elaine: Here is a suggestion. What if, out of the "Research in Briefs" that come across the desks, something strikes someone's fancy and they say, "Somebody else is willing to do this work for me, then I am at least willing to hear more about it." So then you say, "Okay, this is interesting" and you call Charles. You tell him, "This kind of tweaked my interest," and we jump on it and say, "If there is enough interest in your agency, maybe we could do something like come in and do an in-service." This is just a suggestion.

Comment:

That's a great idea. Elaine: What can we do to make it easier for you to be able to utilize this information? In other words, if you had an ideal situation in applying what you see in "Research in Briefs," what would that look like? How can we be there for you to help get this information to you?

Comment:

I have always felt that we have such a gem in our own back yard with the Research Institute, and it seems like they are doing their little research and everybody is doing their treatment, and the two just are not making it together as a bridge in our own community. I have thought that for years. Everybody talks about the fact that when you are out of this area, (people say) "Oh, the Research Institute, that's right in Buffalo. Do you know anybody there?" No, I know a few names, but we don't know anything about what happens.

Comment:

People are totally unaware of its existence.

Comment:

We should have as much publicity about that as we do about Roswell.

Comment:

Structurally and kind of operationally the Research Institute is under UB now?

Charles:

Yes.

Comment:

It changed, right?

Question:

It was standing alone as part of OASAS. Is it under the School of Social Work?

Charles:

No, I asked that question because I thought it was. My understanding is that it is not under the School of Social Work but it is under the auspices of the larger University. I thought it was too. I thought we have a real gem here.

Comment:

Who runs the Research Institute? Elaine: Gerard Connors now, because Brenda Miller who was the Director is now on faculty here, as she runs our Center for Research on Urban Social Work Practice.

Comment:

Which we never hear anything about. Elaine: That's a brand new center. Charles: But, that's an interesting comment, though. It is brand new.

Comment:

I am sure it is new, but people in Buffalo don't know anything about it. I remember when it developed about a year ago or so, because I know I wrote her a letter.

Comment:

If I can pick up on something you said, Charles, about implementing these things. These things come across my desk, and if I think they are relevant I photocopy them. Here is one on social and probing reasons for drinking and predicting alcohol misuse in adolescents. Then you read it and it has a good research base, but when we come to the point where we have to justify all of our programs for funding to OASAS, and every year we have to do that, it is not enough to really cite the article - it may help. Really they want evidence of a program where this research has already been incorporated and has shown results. That is the big gap that you talked about. We can't do it on our own. We don't have the money to do it and unless you (funders) give us the money, we are not going to be able to do it. And you (funders) won't give us the money unless we have already done it or somebody else has done it. So it is a catch 22.

Charles:

One of the missions of the ATTC is to affect public policy and obviously part of that would be fiscal policy. Perhaps it might be a segue for us to advocate for, or make recommendations to, or help you in that process of trying to come together with OASAS in an effort to find a way to fund some type of pilot or small scale of something along that line in order to assess its viability as a potential. I would like to think that we are going to be more than-what I don't want is to become a training institute. I don't want us to become another training institute. I think there is a lot of good training out there. There is the Institute-Rosemarie Goi's shop that has been around for years and has done a lot of good work-there are training institutes across the state. I am more interested in how do we begin to shape the change in treatment of addictions for the next 10 to 15 years.

Comment:

I think what we were talking about a little while ago is that if there is going to be a real strong connection between research, supposedly what is effective, to practice, then we can go the insurance companies with more validity and credibility. If we are shooting from our hip and ad-libbing as we go, who is going to invest in that even though we may be good at it?

Comment:

If I can speak about being on the front end of this whole operation, working in the methadone setting, if my supervisor doesn't give us the brief or if she doesn't explain what this is all about, then people aren't going to want to do it, number one, number two, they might just look at her and say, "What is this all about? We already have enough work here." I guess that's why we are here too, to see whether or not this stuff is feasible.

Charles:

And it may not. It may look good on paper. It may be a great notion on paper but how does that translate? It might not translate well in the real world. It may force not necessarily the scientists but other parts of that whole community to begin to look at how we do this differently. We might take it back to the scientists and say, "This is a great idea, but they had trouble translating it into something real world. That might be worth while exploring. It might be a new place for you to go with this. You might be able to get more money to begin to move this and make it more useable in a real world setting. What would be the next logical step?"

Comment:

So Charles, am I assuming then that what is coming out of here is not being practiced on at the Institute? No body is doing it? It has never been done? It's just in the head of a scientist?

Charles:

No, most of the scientists have .... Elaine is probably better at it since she has been there. Elaine: These are brief summaries of research that has been done so these are all studies that have been conducted...

Comment:

On real people? Elaine: Yes. In other words, this is a very abridged version of what you would find in a journal article, and I am sure these have all made there way to journal articles. This is just RIA's way of summarizing what they are doing and putting it back on the community and saying, "Look, we are doing this work." This is partly to promote what they are doing but also as Charles said for utility reasons to say, "Here, can you use this? This is what we found." This is stuff that has already been carried out and conducted.

Charles:

They probably don't stick out at you, but they have advertisements in the paper all the time. They are trying to get people to come in and be a part of their work there. Elaine: RIA, as you may or may not know, does have the Clinical Research Center (CRC) downstairs which is their outpatient facility. They used to have inpatient years ago but now they just do outpatient. It may very well be that they are implementing some of their own work. I haven't been there in years.

Comment:

We don't know for a fact that it is. Elaine: It depends on the nature of the research. The folks in the CRC, there's maybe four or five people, and I'm not really sure what theoretical framework they come from when they are working with folks, but some of this might be in practice. I don't know because it has been a couple of years since I have been there.

Comment:

For instance there is one thing, a few years ago we had the big news about Naltrexone or Rivea that was supposed to suppress the pleasure derived from alcohol. I know it is being used to some extent at the ECMC clinics, I don't know about RIA but I certainly thought it was. Has anything yet come out of that so we can say "Two or five years after treatment with Naltrexone, these are the results," that is the sort of thing. You know there is a big flurry when a study comes out that Naltrexone may help alcoholics but then I don't know if the follow ups have been done. If they have, have they been publicized and are they useful? Elaine: That might be one of the things we can do. If one of the scientists at RIA has done research on Naltrexone, we can track the scientist down and say, "Have you done follow-ups on this, and what came out of them?"

Comment:

Right, where else is it being used.

Charles:

There is something else we might also be able to do. One of the things we are working on our web site is beginning to create links to other sites that have utility just not willy nilly all over the place. We may be able to hunt some of those things down and include that kind of information.

Comment:

Charles, I am sure that some of the research if not all of it is driven also by what money is out there and what grants are available for research. I think one thing that would make an impact on the credibility of the "Research in Briefs" in the eyes of counselors in this area is that if people listened on an ongoing basis as to what their issues are and what they're encountering, not just a one day or a half a day session, but if someone (and I don't know if you have the resources) could come to the meetings (and we have all kinds of meetings, every month, standing meetings), if people from the research field could hear first hand what the issues are, then they would find out what is most important. Because if it is not important, they are not going to read it and it won't be applied no matter how interesting and well written it is.

Charles:

We're going to do one of these (RIBs) today. And I don't want to cut you off because this is the kind of stuff that is useful for us. This was kind of a brain storm and it looked like it might have some legs so let's explore it, so I am interested in your comments.

Comment:

I would be remiss if I wasn't laying my cards on the table. The only reason (my supervisor) is letting me come here is as a representative of the poor step child of the field, which is prevention and it always has been. It has always been the DARE program, the enthusiastic amateurs. I think that is all changing in particular with managed care. Very few people are getting the kind of treatment they need, certainly inpatient. I get things from my HMO all the time about prevention, cancer, eat right, exercise, drink a lot of water, and everything under the sun. There is very little about alcohol and substance abuse, but it seems to be that it is the most cost effective way. I think we are gong to see more funding in that field and a much higher level of professionalism with a credential coming out in the fall. That's the thing if we could pick these up. I just put together all the "Research in Briefs." We have about 20 periodicals in our office and I put them all on a clip board because I am behind, and it is like 2 inches thick. Headlines help but if we had bullets at the top-implications for treatment, implications for prevention, implications for EAPs or insurers-of the study, etc. Something like that would help but also more research done on prevention as opposed to the treatment end of it. What works in prevention? What programs do work? How does the influence of parental drinking help us when we are out there talking to teenagers?

Charles:

Any other comments? Good point.

Comment:

The only other thing I would say about the implementation, if we are talking here about "Let's all look at it, let's read it, and see what questions we have for scientists," my first reaction to that is- I'm a business owner, I don't own or run a treatment facility, but if I did and I were the head of a treatment facility, that would be a real risky thing for me to do. "Okay staff, let's do this and implement this and have our clients be the guinea pigs." That is very risky unless I knew this worked somewhere else. I'm not sure I would want to stick my client's neck out to see if something works if it hasn't been tested. Now it would be a whole interesting concept to think that Buffalo, because we are here with the Research Institute, our Buffalo treatment facilities could be the guinea pigs and be the ones who are out there and sticking their necks out and are on the cutting edge and will let you know the rest of the state in our three state region what works and doesn't work. That would be a fascinating, interesting concept if we would get everyone to buy into it. But I'm real curious to know, how do we know if this stuff works? Where has it been tested? If not, maybe we should start thinking about doing that. I don't know. I just have a lot of questions about that.

Charles:

I think it is a lot to consider more fully. As Elaine did point out, most of this research has been done on live people. Elaine: You are looking for replication above and beyond the actual study.

Comment:

Maybe I don't know yet how many people are involved in the study and I may have premature comments about that.

Charles:

When you are reading this and when we are talking about putting together questions that might need to be answered, that is certainly a valid legitimate question. Has it been replicated elsewhere? Is it a replication of something else that has been done some place else? What was the sample size like? Who was in the sample size? Those are things that are relatively easy for us to get. That is right in the heart of the research article. We would have access to that. We could get that stuff much easier than probably some of the more heady stuff.

Comment:

The question is, do they do that with the sample and is anybody else in the state doing this? That is my question.

Comment:

Can I say one quick thing? I just want to echo the sentiments of this gentleman about the feasibility of it. Being in methadone, I am not trying to isolate what we do, but sometimes it is construed differently and there is still somewhat of a stigma out there. We serve a pretty hard core population. I guess I am just wondering off the top of my head how this stuff could apply maybe down the road and if it could work and how it would be implemented with the people that we see.

Comment:

If it can work with that group, it can work anywhere. It is a hard core group. Twenty-five year heroine addicts.

Charles:

Why don't we choose one and review it real quick. It should probably take a couple of minutes to review it, and then we will give a couple of minutes to think about it, or you can jot down some notions of what strikes you about this particular one.

Comment:

Which one are we going to do, so we don't waste a lot of time here?

Charles:

It seems to me it'll probably be easier if we just do one. Why don't we look at the comparison of three interventions on pretreatment drop out. Elaine: The one that Charles selected seems to be a bit more on intervention whereas this other one is just describing an inventory that was tested. It is still relevant but this one might be more typical of what you would see in a "Research in Brief." I just noticed that was done by Paul Stasiewicz who is also the director of the Clinical Research Centers, the CRC. He oversees the outpatient treatment that is provided and also does research, too. Rob Stalker was an MSW student a year ahead of me, and I think he was the first intern at RIA and I was the second in 1998. Rob Stalker is over at Native American Community Services now. (Pause while participants read the first of two designated "Research in Briefs.")

Charles:

Any ideas, anything that jumps out? What kinds of things does it engender for you as far as questions or thoughts?

Comment:

It is absolutely true for me in our office. Our goal is always to give someone an appointment within 48 hours after the initial call. Within that, we have a very, very low no show rate. For those people who we cannot put in 48 hours because of their convenience, then we do make that phone call 24 hours before the appointment which surprises me somewhat that there is very little difference between (study groups) 2, 3, and 4, because when we do make that phone call we get a much higher rate than if we don't make the phone call. Those are my observations from our office.

Charles:

I sort of think that is common sense. If we worked with addicts, it probably makes sense that the sooner you have an appointment, people come in. I am going to speak of somebody who came-well in a past life I was a journalist, and so I really like kind of punchy and direct language. I know we all in our fields have our short hands and jargons, and drop the right phrases to impress the right people and get the right money, and it's a necessary part of the working world. I got to the end of this and was musing all over this, and it is interesting that the no contact is not much better than the phone call or what not. Finally I get to almost the last paragraph to find out what the thing says. And rather than a head line of saying "A Comparison of Three Intervention on Pretreatment Drop Out Rates in an Outpatient Substance Abuse Clinic" the headline could be "Callers Who Get Appointments Within Two Days More Likely to Show Up For Treatment." It's like newspaper pyramid style. I think more of that, because we are over-papered, would really save a lot of a time. "Oh, that's interesting. I sort of knew that but here it is." Charles This would have been more likely to have been read if you reveal the bottom line.

Comment:

That's a very good point.

Charles:

You are both in the field. Does this engender any thoughts about things you would like to know more about? Does it make intuitive sense to you or was it not a good one to chose for the first one?

Comment:

It makes sense. I guess I am surprised that group two didn't have a higher rate of retention.

Comment:

I think the other thing we become aware of in our field is that if we over convenience our clients, then we are watering down the problem. We want to be able to say to them, "You need to get in here within 48 hours because if you don't, you are gong to lose something very valuable."

Comment:

Could you clear that up? Are you saying that....

Comment:

I am saying that if we over convenience and allow clients to dictate too much at the very beginning when they are going to come in, then we begin to water down the message. The message is that we have something very important to impart to you. I.e., if you have a heart condition, you want to get in to see that cardiologist right away. If you have a drinking problem, you need to get in to see me right away.

Comment:

But the real world is, people come in at their own convenience. Certainly in my field they do. I am not disagreeing with you ----, but if we somehow let people know that that was our attitude, we wouldn't be in business in our field. Maybe yours is a little different, but ours is totally at the convenience of that employee and as a matter of fact, whenever I go out and do orientations to employees, I always say, "We don't have an agenda. This is your agenda. You want it, you come. If this is your agenda, we do whatever it is that you need." I know that is real different at treatment facilities, because treatment facilities have to sort of crack a bit of a whip. It is very different from my field, and I have a lot of people who come in with addiction problems. I just have to be open and ready for them when they are ready to come in.

Comment:

The other thing we found out in our field in the last three or four years, because of the integral involvement of the court programs, is that when the person in the black robe speaks, they jump. Our attendance rate is much higher now when people are being pursued and prompted by the court.

Comment:

Big consequence there.

Charles:

In its raw form, as you see it, what I'm hearing is the only real issue is you are surprised that group two is so low. With this particular one, it makes intuitive sense with regards to your history with this particular client, what you want to know is what happened, how come group two, the phone call, was so low.

Comment:

Of course the other question too, is how many more than 48 hours was group two offered an appointment. Was it two weeks? Was it three days? Elaine: The phone call is a mean of 124 hours and the appointment was 133 hours.

Comment:

One hundred twenty-four hours after the initial call? Elaine: Yeah, was their first visit. So, five days is 120 hours.

Comment:

That's not bad, five days. Elaine: So, if it went 5 days, you had a 50/50 chance of them showing up, but if you got them in within 2 days, you had almost a 75 percent chance of them showing up.

Charles:

Let me ask this, if you had just gotten this, would this have been confusing, the table and the charts? I'm just curious about that. I know we talked about means-I don't think they give standard deviations-well, they do.

Comment:

I don't think it is in and of itself confusing, I think it's written backwards. As I said, you know, the conclusion is at the end and should be at the beginning and the previous study should be at the end. Who cares about that?

Comment:

I think that is a very good point from a journalistic stand point.

Comment:

We want to make sure that we don't want to give the Research Institute the message that they need to dumb down the message, but they need to repackage it.

Charles:

So that it kind of grabs you. This would have been one that you kind of looked at and said, "This is kind of interesting, I'll read it later." But if it said, "If you can get these folks appointments within 48 hours, the chances are significantly greater that they're gonna show. It is twice as likely that they will show."

Comment:

I don't think that any of this stuff has to be eliminated or anything, but it should be written at least at the beginning in a sort of way that would make a brief item in Time or Newsweek, that the general public would say, "Oh, I never knew that."

Charles:

Stuff like those were the only two things that kind of grabbed you. One is a comment about how they could repackage it and make it better and the other one was being curious about why (group) number two was so low. One of the reasons might have been the time frame. It just shows that even if you make a phone call, if they don't physically get there, they are probably not going to get there. But we might need to push that up somewhat.

Comment:

I think it is even more interesting that no contact was higher than either the phone call or the card.

Charles:

That is a good question. Do the scientists have a response to that? Do they have an idea about why that might be?

Comment:

Or is maybe the sample just too small? Elaine: I would probably guess, and this is certainly not to justify the omission of the alternative explanations, but my guess is that for the sake of brevity they didn't include the alternative hypotheses. If you were to refer back to the journal article which came from, I think "Addictive Behaviors," that there would be, in fact, a full write up of his thoughts. But it is still a valid point. Is there a space where we can expand and provide those kind of explanations?

Comment:

Charles, I was just going to piggy back on what ---- already said, but I think it depends where the person already is with their drug use or addiction. If you have somebody mandating them to go somewhere, especially a drug court or something like that, chances are-I know they don't talk about it in here-it is probably going to raise the standard rates of percentage of people who are going to show up. Other people who are self-referred, or for what ever reason thought it would be a good idea, they probably wouldn't be as inclined to go. I think there are other variables there.

Charles:

Might be probably intervening. There might be a way to get that intervening stuff to you so you can better assess. If they are all voluntary clients, that is something different than somebody who has been referred by a judge so you know that they are going to get there regardless because otherwise they are going to be in jail.

Comment:

The point I was attempting to make is this article is very relevant to the field, that prompting is very important, and that the ultimate prompt is the judge. Our show rate has shown that.

Charles:

Jail does strange things to people. It makes them incredibly compliant, in most cases.

Comment:

If it is a non-mandated case, again, just logically speaking, after 48 hours the crisis is probably over. Crisis is gone. Strike while it is hot in those 48 hours. If you wait (the client says), "Well, I feel better already, I don't need to come anymore." So, maybe that is a real good reason why 2, 3, and 4 is about the same. Crisis is over.

Charles:

We have a few more minutes, can we take a look at the next one? (Pause while participants read the second of two designated "Research in Briefs.") Any ideas? What kind of questions does this generate for you?

Comment:

I think my initial response is that there is a lot of information here that is condensed. I'm not sure if it is the style or if it's their attempt to put a lot of information in a small amount of space, but it is difficult to read, I found, because of that.

Comment:

I would have stopped reading a long time before if this was on my desk. I would have read the first few paragraphs and I would have put it down. It didn't grab my interest at all. It was too wordy.

Comment:

I know (the author) so I suppose I should be careful what I say. I suppose I'm glad it's being done. I did finish it, and I wondered, "Well, why am I reading this?" Because it seems to me that it is still at the mid point without conclusions. They speculated that older women through experience do this and more research needs to be done. Nothing has been done with men. Quite frankly I finished it and I don't think there is anything in there that I learned that I wouldn't have known from a combination of common sense and experience.

Comment:

Exactly.

Comment:

So why was this on my desk?

Charles:

We are not sure how that is going to work at this point because we never talked to a scientist and have no idea how wordy or not wordy they are. But this is our initial way of looking at this. Some of the questions that I came up with when I was reading was that much of what these women experience can be called care giver distress. So I wondered, "Is that the same as co-dependency? Can it be modified for men?" It is quite possible in your field that you run into a situation where the problem drinker is in fact the woman in the house. Can this be used with drugs also. It talks purely about alcohol, but it is the "Research Institute on Addictions" so can it be used with drugs? One of the most interesting things that got me was worrying about people who had trauma or post traumatic stress disorder, pretending that the administrator is her partner and say exactly what she would say to her partner. I started wondering about domestic violence and some other things. Do you want to recreate those kinds of things? Those are some of things that jumped out when I was reading it. I guess I'm hearing an underlying theme, for lack of a better term, these are not well written.

Comment:

Isn't that interesting, because that is what we are picking up.

Charles:

It is hard to talk about utility because I can't get through them. When I can get through them, I may not get there because the way it is set up from the jump street is I may or may not read it. That is interesting.

Comment:

I'm not saying they aren't well written; they are written for a very specialized audience who is familiar with that sort of stuff. People outside of the field find it real slow going.

Comment:

Again, without dumbing it down, I'm wondering if there is a way of imparting the information to the therapist and the counselors who are looking for the information, enhance the utility of it, and then somewhere in the journal say, "If you want more information on the technology and research aspect..." is there a web site?

Charles:

RIA maintains a web site. They do put the "Research in Briefs" on the site. Elaine: Actually, these came off the website so the web address is on the front of the page.

Question:

Presuming this is an abstract to a much longer and more detailed article, which is written by the author, do they also do the abstract?

Charles:

The researcher does not do the abstract.

Comment:

I think that is where you have to work. The person doing the abstract has to change this in a very specialized academic writing into a way that is much more broadly applicable.

Question:

Charles, do you want us, in our focus group when we meet again, if you want us to meet again...

Charles:

Oh, I do. This is good stuff.

Comment:

...it sounds like maybe we are a little off track because it is the first time. You want us more to analyze the research?

Charles:

Not so much analyze the research but look at what you are seeing and think, "How am I going to do this? What do I do?"

Comment:

Not whether or not we're going to read it, but once we read it, what are we going to do with it.

Charles:

And that's a good point. That's a very good point. And I don't think any of us ever considered that. This is very useful information. I will probably look at trying to reconvene this again in about a month. Would it make sense to send you the articles first and have a chance to look at them? I know some people won't have had the opportunity, but that is okay. When you come in, then we wouldn't have to go through all the preliminary stuff next time. We could get down to business.

Comment:

We could knock off a few of them if we had them ahead of time.

Charles:

That makes sense to me. What we will do is choose articles and refer them to you. We will get them in the mail to you maybe a week before. My experience, which is based upon me, if it gets there too early, it gets thrown on the pile and I won't find it again.

Comment:

We'll need a phone call.

Charles:

Forty-eight hours a head of time. We have already got some literature, some data to support that notion. We can do that.

Comment:

What was the percentage today?

Charles:

Fifty. Well, considering we knew two weren't coming, actually out of a possible five, we are only missing one. Would it make some sense to try to get the entire original article? Some of these can be unwieldy, they can be long. Since we are talking about "Research in Brief," lets stick with that. We will have it available to us so that won't be a problem. If you want to see it, we will have it.