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Department of Psychiatry

Department of Psychology
 

Addiction Psychiatry Fellowship

Curriculum


 

The fellowship consists of twelve months of clinical training for PGY-V addiction residents.  Residents have an option of spreading the clinical training over two years at 50% time and having 50% time for research. 

Involuntary Commitment Service (Denver C.A.R.E.S.)

 
The addiction resident performs evaluations and manages patients referred to Denver C.A.R.E.S. (the community detoxification facility) for involuntary commitment for alcoholism or drug abuse treatment and for guardianship related to substance use disorders. Duties on this service include preparation of physician certificates, reports to the court, court testimony, orders for patients on this service, and referral of patients to DHMC for medical evaluation. Occupational therapy evaluation and psychological testing can be ordered as part of the evaluation.
Goal

To provide experience in the evaluation of patients under the Colorado statutes for involuntary commitment for alcoholism and drug abuse, for guardianship, and in working cooperatively with representatives of the legal system and State Department of Health in this process.

Objectives

    1. Medical Knowledge (topics to be covered – must cover and assess)
          • Colorado commitment statutes for alcoholism and drug abuse
    2. Patient Care Skills (including technical skills to be learned and demonstrated – must cover and assess)
          • Conduct evaluations for civil commitment and guardianship
    3. Interpersonal and Communication Skills
          • Communicate evaluation findings and recommendations to the court through a written evaluation
          • Communicate evaluation findings and recommendations to the court through testimony
    4. Professionalism
          • Demonstrates ethical behavior including respect for patient privacy & autonomy, appropriate boundaries, demeanor, dress
          • Responds to communications from patients and healthcare providers in a timely manner
          • Provides care within scope of practice and competence; seeks supervision when needed
    5. Systems-Based Practice
          • Understands Colorado commitment statutes for alcoholism and drug abuse
          • Collaborates with healthcare team members, works effectively as a team member and collaborates with the Alcohol and Drug Abuse Division coordinator for involuntary commitments and the City Attorney for Mental Health who handles involuntary commitments
    6. Practice-Based Learning and Improvement
          • Uses relevant resources for guiding and improving patient care—libraries, information technology, drug information databases

Outpatient Behavioral Health Services (OBHS)

The addiction resident works on both the Opioid Replacement Team and the Substance Use Disorders Service. On the ORT, the resident learns and practices all aspects of medication assisted treatment for Methadone, attends weekly treatment planning meetings, and confers with the multidisciplinary team. On SUDS, the addiction resident evaluates and treats complex patients with medications for alcohol dependence, buprenorphine for opioid dependence, and monitored benzodiazepine management and tapers. The resident will spend one afternoon per week in a continuity clinic seeing ongoing patients for individual addiction therapy, which may include medications described above.
Goals

    1. To provide clinical experience in outpatient treatment for substance use disorders.
    2. To provide clinical experience with the assessment of substance use disorders in the outpatient setting including issues of referral to more intensive levels of care.
    3. To provide clinical experience with the assessment and treatment of comorbid psychiatric and medical disorders in addicted outpatients.
    4. To provide experience with working on a multidisciplinary outpatient team.
    5. To provide clinical experience with urine monitoring and monitoring of medications for addiction in outpatient treatment

Objectives

    1. Medical Knowledge (topics to be covered – must cover and assess)
          • Guidelines for appropriate placement regarding level of care
          • Diagnoses: DSM-IV substance use disorder diagnoses
          • Individual and group treatment of substance abusing populations
          • Knowledge of urine monitoring and potential cross-reactivity
          • Knowledge of the use of psychotropic medications in the substance abusing population
    2. Patient Care Skills (including technical skills to be learned and demonstrated – must cover and assess)
          • Conduct outpatient treatment of patients with substance use disorders, including intensive outpatient treatment
          • Conduct thorough initial assessments of patients with substance use disorders
          • Treat comorbid psychiatric disorders in addicted outpatients
          • Experience with urine monitoring and monitored disulfiram in an outpatient setting
          • Management of maintenance opiate replacement therapy
    3. Interpersonal and Communication Skills
          • Work with and lead a multidisciplinary team
    4. Professionalism
          • Demonstrates ethical behavior including respect for patient privacy & autonomy, appropriate boundaries, demeanor, dress
          • Responds to communications from patients and healthcare providers in a timely manner
          • Provides care within scope of practice and competence; seeks supervision when needed
    5. Systems-Based Practice
          • Understands referral sources
          • Collaborates with healthcare team members (addiction counselors, dispensing nurses and nurse practitioners), works effectively as a team member
          • Understands and complies with regulations regarding opiod replacement therapy
          • Practice-Based Learning and Improvement
                • Uses relevant resources for guiding and improving patient care—libraries, information technology, drug information databases

12-Step Programs

Goals

    1. To teach the basic principles and program of Alcoholics Anonymous.
    2. To provide an opportunity for direct involvement with AA and Alanon and to experience how 12-Step programs work for recovering individuals.
    3. To teach how to use and integrate AA principles and an AA program in psychotherapy and patient aftercare programs.

Learning Objectives

    1. Knowledge of an effective recovery aftercare program.
    2. Knowledge of non-addicted family member issues with recovering addict/alcoholic.
    3. Knowledge of 12-Step Program

Clinical Objectives

    1. Ability to lead an aftercare group, including understanding principles of aftercare contracts, monitoring, reporting to appropriate employment or monitoring authority, facilitating group process, confronting denial, supporting recovery.
    2. Understanding issues related to spouse/family denial, enabling, education about addiction, need for 12-Step meetings, and helping them with their own recovery.
    3. Attendance at AA and/or other 12-Step meetings to become familiar with these programs and learn how to apply the principles of these groups to clinical addiction psychiatry practice

Tutorial Objectives

    1. Readings for the book Alcoholics Anonymous, 12-Step and 12 Traditions, and Narcotics Anonymous to provide the necessary factual knowledge of 12-Step Programs
    2. To understand the addiction and recovery process through individuals who have experienced it and how psychiatric treatment can be integrated into and facilitate recovery.

Adolescent Substance Use Disorders and Comorbidity Subspecialty Clinic and Clinical Course

Objectives

    1. To gain an understanding of current assessment and treatment standards for adolescents with conduct disorder, substance use disorders, and other co-morbidities.
    2. To gain an understanding of appropriate levels of care (inpatient, outpatient, group) and intervention strategies (cognitive, behavioral, psychotherapy, pharmacotherapy, family therapy, contingency contracting, urine monitoring) for adolescents with CD and SUD and other comorbidity.
    3. To gain a sense of competence and comfort in providing treatment to adolescents with CD, SUD and other co-morbidities.

Additional Training

Electives

Residents are encouraged to discuss elective interests with the program director. Residents can use one half day for six months for elective work. Recently, residents have served on the Board of the Colorado Nurse Health Program as an elective. The following elective courses are open to addiction residents (contact the faculty member listed for details, schedules and syllabi):

Addiction Psychaitry Reading Seminar

The resident will demonstrate his knowledge of the above topics through his ability to participate in discussion of the assigned reading for the seminar.