The overarching objective of the program is to provide psychiatric physicians with advanced training in the skills, clinical judgment, and knowledge necessary to the practice of addiction psychiatry to enable them to assume leadership positions in the field. This mission will be accomplished by attainment of the following general goals embedded within the structure of the core competencies:
Clinical training occurs in inpatient, partial hospitalization, intensive outpatient, outpatient, consultation, dual diagnosis, women specific, and opioid agonist treatment settings. Major goals of training include developing clinical excellence in the diagnosis and treatment of individuals with substance use disorders, broadening scientific knowledge in Addiction Psychiatry, furthering research skills relevant to Addiction Psychiatry, and expanding expertise in teaching Addiction Psychiatry. Close work with a range of interdisciplinary treatment teams is a core aspect of the fellowship.
Core competencies & goals
- Patient care. Develop clinical excellence in diagnostic and therapeutic addiction psychiatry.
- Medical knowledge. Become knowledgeable in addiction psychiatry and the scientific data base underlying the discipline.
- Practice-based learning and improvement. Develop research skills relevant to addiction psychiatry and gain skills in teaching Addiction Psychiatry.
- Interpersonal & communication skills. Develop the special compassion and empathy needed to form therapeutic alliances with addicted patients.
- Professionalism. Develop cognizance of the special ethical issues and cultural needs of addicted patients.
- Systems-based practice. Understand the broad context of Addiction Psychiatry care throughout the U.S. and World.
Develop clinical excellence in diagnostic and therapeutic addiction psychiatry with the following specific objectives:
- Develop the ability to perform and record from the biopsychosocial and functional perspectives an accurate and comprehensive psychiatric evaluation of the patient experiencing psychoactive substance related disorders.
- Develop the capacity to arrive at a differential diagnosis of all substance related disorders including mild, moderate and severe disorders, , intoxication, withdrawal, substance-induced mood, anxiety, delirium, and psychotic disorders.
- Develop expertise in differential diagnosis of co-occurring psychiatric disorders.
- Develop the capacity to create comprehensive treatment plans from a biopsychosocial and multidisciplinary perspective for patients experiencing psychoactive substance related disorders.
- Develop the ability to assess and manage patients experiencing psychoactive substance related disorders in the inpatient, , intensive outpatient, and ambulatory care settings.
- Develop expertise in utilizing multidisciplinary team members in the development of and execution of the comprehensive treatment plan.
- Become experienced in the use of a variety of psychotherapeutic techniques for treatment of psychoactive substance use disorders including motivational interviewing, contingency management, harm reduction, supportive, cognitive-behavioral, relapse prevention, psychodynamic, psychoeducational, couples, family, and group therapies.
- Become adept in intermediate term, individual psychiatric treatment of those experiencing psychoactive substance use disorders in the outpatient setting..
- Gain competence in psychopharmacologic treatment of substance use disorders (including use of opioid agonist therapy, opioid antagonist therapy, nicotine replacement therapy, varenicline, bupropion for smoking cessation, agents such as clonidine, carbamazepine, gabapentin, and benzodiazepines used for medically supervised withdrawal, use of disulfiram and naltrexone) as well as in psychopharmacologic treatment of co-occurring psychiatric disorders.
Goal # 2.
Become knowledgeable in addiction psychiatry and the scientific data base underlying the discipline via the following specific objectives:
- Master the pharmacology and neuropharmacology of all the major substances associated with use disorders including alcohol, opioids, cocaine, amphetamine, MDMA and other stimulants, cannabis, hallucinogens, benzodiazepines, sedative hypnotics, inhalants, and nicotine. This mastery includes knowledge of signs and symptoms of use and dependence, withdrawal, and overdose as well as brain reward systems that subserve addictive processes.
- Understand and be able to recognize the social, psychological, medical, and psychiatric problems that frequently occur with psychoactive substance use including but not limited to problems in family systems, problems women who are pregnant experience while using substances , and problems related to HIV and Hepatitis infections.
- Recognize how factors like criminal justice inequity, poverty, housing disparities, and general stigma associated with substance use influence the diagnosis and treatment of those using substances.
- Recognize the role of racism, sexism, homophobia, and transphobia in the diagnosis and treatment of those experiencing substance use disorders.
- Gainknowledge in the epidemiology of, prevention of, and genetic and congenital aspects of substance use disorders.
- Develop awareness of the economic aspects of and cost effectiveness issues in providing health care services to patients with substance use disorders.
- Grasp the theoretical underpinnings of the various psychotherapeutic modalities used in treatment of psychoactive substance use disorders.
PRACTICE-BASED LEARNING AND IMPROVEMENT
Goal # 3.
Develop research skills relevant to addiction psychiatry via the following specific objecives:
- The ability to use electronic media to obtain scientific literature broadly applicable to addiction psychiatry and specifically applicable to clinical cases.
- The ability to summarize and critique the scientific literature in a circumscribed area of addiction psychiatry and apply this knowledge to the care of patients.
- The ability to analyze practice experience related to addiction psychiatry and perform practice-based improvement activities using a systematic methodology.
- (Optional) The ability to participate in and complete a research project relevant to addiction psychiatry.
Goal # 4.
Gain skills in Teaching Addiction Psychiatry via the following specific objectives:
- Knowledge of the principles and methods of clinical teaching.
- The ability to present clinical or academic material at rounds and conferences.
- The ability to promote the learning process of students and residents.
- Knowledge of the addiction psychiatry literature.
INTERPERSONAL AND COMMUNICATION SKILLS
Goal # 5.
Develop the special compassion and empathy needed to form therapeutic alliances with patients experiencing substance use disorders via the following specific objectives:
- Demonstrate effective oral and written communication skills with patients using substances and with colleagues from other disciplines.
- Maintain a long term (3-9 months) psychotherapeutic engagement with one or more patients experiencing substance use disorders.
Goal # 6.
Develop cognizance of the special ethical issues and cultural needs of addicted patients via the following specific objectives:
- Demonstrate awareness of and appropriate use of the specific confidentiality statutes that protect specified health information of patient experiencing SUD as delineated in 42 CFR part 2.
- Gain experience with, understand, and apply in psychotherapy the unique issues related to those using substances from a wide variety of backgrounds in ethnicity, race, gender, sexual orientation, and age..
SYSTEMS BASED PRACTICE
Goal # 7.
Understand the broad context of Addiction Psychiatry care throughout the U.S. and World.
- Be familiar with the variety of settings in which addiction psychiatry care is delivered including emergency room, inpatient, residential, partial hospital, outpatient, federally licensed opioid treatment program and how patients move back and forth across these settings.
- Be familiar with lack of parity for addiction treatment compared to other forms of addiction treatment and gain awareness of how to advocate for funding of appropriate patient care.
- Be aware of potential stigmatization of patients experiencing substance use and gain skills in helping other health care professionals recognize their own prejudices in order to advocate for appropriate patient care.