Clinical Training

About the Clinical Experience

Each addiction psychiatry fellow will complete one year of clinical training that includes primary placement in the UC San Diego Addiction Recovery and Treatment Program and a rotation of secondary placements in order to fulfill all the ACGME requirements and to have a broad and balanced experience.

Training Sites & Services

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 Medical Toxicology service and the Veteran’s Administration (VA) Substance Abuse Rehabilitation and Recovery Treatment Program (SARRTP). Other placements include the VA Substane Use Disorder Treatment Programs, the Vista Hill ParentCare Adolescent and Pregnant Women Treatment program, the Family Health Centers San Diego substance use disorders clinic, and the Neighborhood Care medication assisted treatment clinic.

Treatment & Therapy

Addiction fellows will evaluate the presence and degree of comorbid psychopathology, the need for psychotropic medication to better manage substance use 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.

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 UC San Diego site.

Schedule & Supervision

Clinical research opportunities are primarily at the UC San Diego 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.

See the Rotation Block Schedule

Addiction Recovery & Treatment Program

Location: UC San Diego Health Psychiatry - La Jolla

At the end of the rotation, residents will be able to:

Conduct a thorough substance use history
Characterize the psychological and social systems of the patient and its impact on patient's current disorders or functioning
Explain psychosocial and medication treatment options to patients considering their values in the treatment in order to come to an informed and shared treatment plan
Lead specific group based therapies
Conduct ambulatory detoxification from alcohol and benzodiazepines in patients who are medically stable enough to do so
Understand systems and provision of care in a team-based approach within an Intensive Outpatient Program
Describe medication treatments, risks and benefits, and pros and cons as informed by research data for addiction treatment
Recommend the appropriate level of addiction treatment, for example medical detox, outpatient, intensive outpatient, or residential, based on the assessment of the patient's needs and the evidence base for each intervention
Conduct patient encounters using a motivational interviewing style
Participate in coordinated care of a patient with a multidisciplinary team

Addiction Psychiatry

Location: VA San Diego

At the end of the rotation, residents will be able to:

To conduct a thorough interview with substance use disorder patients that will detail the drug use history, prior treatment, patient motivation for treatment and comorbidity.
To use treatment methods such as motivational interviewing and supportive confrontation to help move externally motivated patients to internally motivated patients involved in their own care.
To apply the chronic illness model to treatment in attending to their addicted patients recognizing the potential for relapse and working with it.
To be able to assist addicted patients in moving through the different levels of treatment in this system including outpatient, inpatient, aftercare and the dual diagnosis program.
Ability to function as a primary therapist or co-therapist for addicted patients.
To develop skills and comfort in a group therapy format.
As part of recovery treatment, to learn to utilize Motivational Interviewing and Relapse Prevention techniques. One should know how AA functions, the nature of a mutual help program, the role of a sponsor, and what constitutes the Smart Recovery program.
To be able to differentiate a Substance-induced disorder from an Independent psychiatric disorder.
To look at these patients developmentally and from the standpoint of their overall functioning including personal assets, ability to relate to others, and liabilities.
To gain further experience in the treatment of the co-morbid psychiatric disorders seen in this patient population such as mood and psychotic disorders.
To develop the ability and comfort in setting limits with patients based on program rules when necessary.
To gain experience in working as the physician member of a multidiscliplinary treatment team.
Teaching Goals
Teaching of the medical students with a focus on time-line history taking, substance use disorders, motivational interviewing and relapse prevention. In addition, psychiatric diagnosis and psychopharmacology.

Consultation - Liason

Location: VA San Diego Health System

At the end of the rotation, resident will have the ability to:

Perform basic consultation assessment of patients with addiction including chart review, patient interview, diagnostic formulation treatment recommendations.
Interact effectively with medical/surgical treatment team regarding care of patients with addiction issues.

Adolescent

Location: Hazelden Betty Ford Foundation (HBFF)

At the end of the rotation, residents will be able to:

Evaluate adolescents and transitional age youth with substance use disorders for psychiatric co-morbid disorders
Conduct a thorough developmental history (including ascertaining their early school performance, attachment, behaviors)
Characterize the family system of the patient and its impact on patient's current disorders or functioning
Explain treatment options to parents and patients considering their values in the treatment of the child in order to come to an informed and shared treatment plan
Lead specific group based therapies as the primary intervention for adolescents and transitional age youth

Medical Toxicology

Location: UC San Diego Medical Center (Hillcrest)

At the end of the rotation, residents will be able to:

To develop expertise in the diagnosis and treatment of acutely and chronically poisoned patients. This encompasses intentional and accidental poisoning from pharmaceutical agents, plants and venomous animals, household products, and from industrial exposures
To become familiar with the medical effects of hazardous materials, and to become competent in managing the medical complications seen after hazardous material incidents
To participate in the training of medical personnel ranging from paramedics to physicians in training
To become knowledgeable in basic pharmacology, drug interactions and pharmacokinetics, and to provide these services to physicians in the clinical setting.
To promote expertise in the operation of a regional poison center and in the public services provided by such a center

IV.C.1. The curriculum must be structured to optimize fellow educational experiences, the length of these experiences, and supervisory continuity. (Core)

IV.C.1.b) The assignment of rotations must be structured to minimize the frequency of rotational transitions. (Core)

IV.C.2. The program must provide instruction and experience in pain management if applicable for the subspecialty, including recognition of the signs of addiction. (Core)