Addiction Psychiatry Fellowship Curriculum
Didactic sessions cover the scope of psychobiological aspects of substance abuse and addiction, including:
- Neurobiology of alcohol, cocaine, opioid, narcotic and nicotine addiction, detoxification, and management
- Addiction in subpopulations such as women, adolescents, and the elderly
- Diagnosis and management of common co-morbidities, notably hepatitis, HIV, and other infections, and co-occurring psychiatric disorders
- Facilitation in addiction group counseling programs such as 12-Step
- Assessment and screening methods
- Pharmacotherapies for addiction
Rotations
UT Southwestern Addiction Clinic faculty and staff include addiction psychiatrists, an addiction psychologist, two advanced practice providers, one licensed clinical social worker, three licensed professional counselors, and one licensed chemical dependency counselor. We provide daily outpatient substance use disorder treatment services such as addiction pharmacotherapy, individual therapy, and group therapy.
Fellows see patients in the Addiction Clinic under the supervision of an attending physician. Fellows have an opportunity to attend intensive outpatient program groups. They play an active role in the teaching and training of medical students and other trainees rotating through the clinic.
Texas Health Presbyterian Hospital Dallas (THD) is the 898-bed flagship hospital of the Texas Health Resource System. The Psychiatry Department provides medically supervised inpatient withdrawal treatment for substance-dependent patients and an intensive outpatient program. Fellows participate as a member of the treatment team, providing individualized clinical care and addressing the needs of the substance-dependent patient and eating-disordered patient, as well as those with co-morbid conditions.
You will have the flexibility necessary to meet your educational goals and interests, such as the opportunity to conduct group therapy, individual therapy, or manage the pharmacological needs of patients.
You will also be encouraged to participate in the training of third-year medical students rotating through the Department for their psychiatry clerkship. The THD Psychiatry Department staff strives to provide you with the clinical experience, supervision, and mentoring that fulfills your training objectives.
Psychiatry Consultation-Liaison Service
Fellows have a required 4-month rotation at Parkland Hospital, the 892-bed, tertiary-care, county hospital adjacent to UT Southwestern Medical Center. You will be responsible for performing and documenting inpatient psychiatric consultations on patients presenting with, or found secondarily to have, substance abuse problems. You will also be responsible for providing ongoing psychotherapy and/or medication management to any of these patients for whom it is indicated.
As a full-time fellow, you will generally have a caseload of five to 10 patients at any one time. This includes three to five new inpatient consults and between 10 and 15 follow-up visits per week. Other members of the consult-liaison psychiatry team are: PG-2 and PG-4 psychiatry residents, a psychosomatic medicine resident, attending psychiatrists, attending psychologists, psychology trainees, medical students, and occasionally neurology residents and geriatric psychiatry residents.
Integrated Family Planning Opioid Program
The Perinatal Intervention Program (PIP) and the Integrated Family Planning Opioid Program (IFPOP) together optimize the addiction-related health care of pregnant and post-partum women who are cared for within the Parkland Health & Hospital System (PHHS). Because PHHS delivers more babies than any hospital in the nation, clinical care providers encounter many women with substance use disorders. The PIP program is funded by both PHHS and a state Medicaid program, and the IFPOP program is funded by a separate state grant. The combined team that manages the PIP and IFPOP services consists of four physicians, two licensed chemical dependency counselors, and three midwives/nurse practitioners. Importantly, the team works closely with many community partners who have a shared interest, including NEXUS Recovery Center, the New Connections Program in the Center for Addiction Research Studies within the University of Texas at Arlington, various methadone clinics, Parkland Addiction Psychiatry, and Dallas County Jail Health.
The PIP providers focus on pregnant women who present to PHHS from one of Parkland’s Women's Health Clinics in the community or come to Parkland's emergency department. All patients in Parkland’s Women's Health Clinics who present with a new pregnancy are screened with a validated instrument (NIDA-Assist), and those who screen “positive” are sent to the Maternal Fetal Medicine clinic for a Thursday morning appointment, where they receive pregnancy care and a detailed biopsychosocial evaluation by a member of the team. On average, 12-18 patients are seen in the morning. There are admitted patients who are seen Monday through Friday. The PIP team answers calls from the obstetrics service 24/7. Patients who are in opioid withdrawal are mostly started on methadone, with some started on buprenorphine.
The IFPOP program uses screening instruments to identify women with substance use disorders who are not pregnant but are in between pregnancies. This program engages patients and initiates buprenorphine in appropriate situations. Many IFPOP patients were first identified when they were PIP patients.
The Integrated Pain Clinic at Moody Outpatient Center is a highly specialized clinic where patients with complex chronic pain syndromes are referred for treatment. The Integrated Pain Clinic uses traditional and alternative medicine modalities. Addiction Psychiatry fellows will be exposed to the different modalities including pharmacotherapy, counseling, and acupuncture. Cases range from chronic back pain to cancer pain, sickle cell disease, and cases in which there is concern of opioid use disorder and/or opioid dependence. The objective of the rotation is to understand the complex relationship between pain, opioid dependence, and opioid use disorder. This clinic site won the 2023 Healthcare Design Award through the American Institute of Architects (learn more).
Fellows will generally see between 2 and 5 patients daily, which may include a new patient evaluation. Fellows will work in an interdisciplinary team that includes pharmacists, family medicine physicians, acupuncturists, and physician assistants.
Addiction fellowship residents rotating through the VA Medical Center participate in the diagnosis, treatment, treatment planning, and continuing care of veterans between the ages of 18 and 65 years. Inpatient, outpatient, and inpatient residential treatment programs are all directly part of your experience. Treatment with opioid maintenance therapies, including methadone and buprenorphine, are part of the rotation experience.
You will respond to calls from consultation-liaison and emergency services during regular working hours in collaboration with an attending addiction psychiatrist. There is no after-hours on-call requirement.
Supervision on the rotation is provided by UT Southwestern Medical School faculty trained and certified in addiction psychiatry and addiction medicine, with frequent contact on a daily basis between trainees and clinical teachers. In addition to the clinical work with patients, the VA Medical Center has a vigorous educational program, which includes weekly Grand Rounds, a monthly journal club, and supervised reading with selected faculty.
Fellows rotate two days a week, on Mondays and Thursdays, to the Nexus Recovery Center, a substance use disorder treatment program for women 13 years and older. It has a unit for withdrawal management, an inpatient residential treatment program, outpatient programs, and a buprenorphine clinic, plus a day care on site, with transport for middle school kids, and high school teachers who come to campus to teach.
The Teen Recovery Program is a dual-diagnosis program for teenagers with mental illness and co-occurring substance abuse issues. It is an intensive outpatient program with a group-based treatment model. Fellows participate in initial substance abuse evaluations and provide psychiatric management as appropriate and participate in group therapy under the direction of site director David Atkinson, M.D.
