Curriculum

Curriculum for the Addiction Psychiatry Advanced Residency Program

1.  CLINICAL EXPERIENCE

Overview: Each addiction psychiatry fellow will complete one year of clinical training that includes a primary placement and a rotation of secondary placements in order to fulfill all the ACGME requirements. The outpatient facilities offer a full range of services, including ambulatory detoxification, intensive outpatient programs, medication treatments (i.e. naltrexone, buprenorphine, others) and dual diagnosis. Inpatient experience is gained during a rotation on the Consultation Liaison (CL) service and the Medical Toxicology service. Addiction fellows have a primary placement in the UCSD Addiction Recovery and Treatment (ART) Program. Other placements include the Veteran's Administration (VA) Substance Abuse Rehabilitation and Recovery Treatment Program (SARRTP), the VA Alcohol and Drug Treatment Program (ADTP), the UCSD Jacob's Medical Center Psychiatry CL and Medical Toxicology rotations, and at the Hazelden Betty Ford Foundation – San Diego clinic Transitional Age Youth Intensive Outpatient Program. Addiction fellows will evaluate the presence and degree of comorbid psychopathology, the need for psychotropic medication to better manage substance abuse and psychiatric symptoms, and suitability of the patient for treatment with various types (e.g., individuals vs. group) and intensities (e.g., outpatient vs. inpatient) of psychosocial services. Addiction fellows will function both as a primary clinician for patients and as a psychiatric backup to non-physician staff. They will learn to work with a team of interdisciplinary staff including addiction therapists, psychologists, social workers, and nursing staff. Fellows will receive individualized supervision and will participate in addiction seminars and in multi-disciplinary clinical rotation conferences. Clinical research opportunities are primarily at the UCSD site.

Primary placement UCSD Addition Recovery and Treatment Program: Each addiction psychiatry fellow will complete one year of clinical training that includes a primary placement at the UCSD Addiction Recovery and Treatment Program. The outpatient facility offers a full range of services, including ambulatory detoxification, intensive outpatient programs, medication treatments (i.e. naltrexone, buprenorphine, others) and dual diagnosis treatment. Addiction fellows will evaluate the presence and degree of comorbid psychopathology, the need for psychotropic medication to better manage substance abuse and psychiatric symptoms, and suitability of the patient for treatment with various types (e.g., individuals vs. group) and intensities (e.g., outpatient vs. inpatient) of psychosocial services. Psychotherapies utilized include couple's therapy, family therapy, group therapy, motivational interviewing/motivational enhancement therapy, and relapse prevention therapy.  Addiction fellows will function both as a primary clinician for patients and as a psychiatric backup to non-physician staff. They will learn to work with a team of interdisciplinary staff including addiction therapists, psychologists, social workers, and nursing staff. Fellows will receive individualized supervision and will participate in addiction seminars and in multi-disciplinary clinical rotation conferences. Clinical research opportunities are primarily at the UCSD site.  Work hours are 8-5 pm, and the fellow will spend approximately 70% at this location.  There is no overnight or on-call expectation.  On-site clinical supervision by a board certified addiction psychiatrist is provided during patient care time where patients are "staffed" with this faculty, as well as an additional 1 hour per week of clinical supervision.

2. SEMINARS AND SUPERVISION

Seminars are offered to the UCSD Addiction Psychiatry Advanced Residency.  Fellows will participate in the core seminar and will be expected to attend Departmental Grand Rounds and clinical rotation conferences. Some of these seminars are interdisciplinary and are attended by psychiatrists, psychologists, social workers, nurses and addiction therapists and in some cases, staff from other medical specialties. Advanced fellows may choose to participate in the elective seminars or in other departmental electives. Addiction fellows spend approximately 4 hours in seminars and supervision per week.

3. RESEARCH

All fellows in addiction psychiatry are generally expected to participate at some level in at least one research or scholarly project whose focus is on substance use disorders. The nature of this involvement will vary but will typically include one or more of the following: serving as psychiatric consultant to the project; assuming responsibility for the analysis of data or writing a paper to be presented at a national meeting and/or for submission to a peer reviewed scientific journal; developing an independent topic of research. In the course of the year fellows may also contribute to a research grant application or human investigations committee proposal. In addition to their clinical supervisors, fellows with an interest in clinical research will be assigned a research mentor. All fellows attend the weekly research seminar at which they learn about reach methodology, ethical/professional conduct of scientific research, and presentation of scientific data.  There is protected time of ½ day for 6 weeks in order to participate in this scholarly project.

 4. TEACHING OPPORTUNITIES

Every addiction psychiatry fellow will present one Clinical Case Conference.  Additionally, each fellow is expected to present in at least one other forum on a topic of interest.  Audiences can include: Child/Adolescent Fellows, Treatment Team Meetings, Primary Care meetings, Multidisciplinary Pain Conference, other UCSD fellows, other UCSD faculty.  In all of their clinical rotations, they will provide consultation, guidance and team leadership for more junior fellows as well as psychology fellows and other master's level clinicians.