Addiction Psychiatry Residency Program Home Page
 
INTRODUCTION
PROGRAM MISSION
THE FACULTY
FACULTY PUBLICATIONS
FACULTY RESEARCH
ROTATIONS
DIDACTIC SEMINARS
SALARY & BENEFITS
SEATTLE AREA
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Program Mission

The overarching mission 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:

PATIENT CARE

Goal # 1.        
Develop clinical excellence in diagnostic and therapeutic addiction psychiatry
with the following specific objectives:

  1. Develop the ability to perform and record from the biopsychosocial and functional perspectives an accurate and comprehensive psychiatric evaluation of the patient with psychoactive substance related disorders.
  2. Develop the capacity to arrive at a differential diagnosis of all substance related disorders including abuse, dependence, intoxication, withdrawal, substance-induced mood, anxiety, delirium, and psychotic disorders.
  3. Develop expertise in differential diagnosis of co-occurring psychiatric Axis I and II disorders and substance use disorders.
  4. Develop the capacity to create comprehensive treatment plans from a biopsychosocial and multidisciplinary perspective for patients with psychoactive substance related disorders.
  5. Develop the ability to assess and manage patients with psychoactive substance related disorders in the inpatient, partial hospital, intensive outpatient, and ambulatory care settings.
  6. Develop expertise in utilizing multidisciplinary team members in the development of and execution of the comprehensive treatment plan.
  7. Become experienced in the use of a variety of psychotherapeutic techniques for treatment of psychoactive substance dependence including motivational interviewing, supportive, cognitive-behavioral, relapse prevention, psychodynamic, psychoeducational, couples, family, and group therapies.
  8. Become adept in intermediate term, individual psychiatric treatment of psychoactive substance dependent outpatients.
  9. 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.

MEDICAL KNOWLEDGE

Goal # 2.        
Become knowledgeable in addiction psychiatry and the scientific data base underlying the discipline via the following specific objectives:

  1. Master the pharmacology and neuropharmacology of all the major substances of dependence 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.
  2. Understand and be able to recognize the social, psychological, medical, and psychiatric problems that frequently occur with psychoactive substance use including problems in family systems, problems of the pregnant substance user, and problems related to HIV and Hepatitis C infection.
  3. Gain knowledge in the epidemiology of, prevention of, and genetic and congenital aspects of substance use disorders.
  4. Develop awareness of the economic aspects of and cost effectiveness issues in providing health care services to patients with substance use disorders.
  5. Grasp the theoretical underpinnings of the various psychotherapeutic modalities used in treatment of psychoactive substance dependence.

PRACTICE-BASED LEARNING AND IMPROVEMENT

Goal # 3.        
Develop research skills relevant to addiction psychiatry
via the following specific objecives:

  1. The ability to use electronic media to obtain scientific literature broadly applicable to addiction psychiatry and specifically applicable to clinical cases.
  2. 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.
  3. The ability to analyze practice experience related to addiction psychiatry and perform practice-based improvement activities using a systematic methodology.
  4. (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:

  1. Knowledge of the principles and methods of clinical teaching.
  2. The ability to present clinical or academic material at rounds and conferences.
  3. The ability to promote the learning process of students and residents.
  4. Knowledge of the addiction psychiatry literature.

INTERPERSONAL AND COMMUNICATION SKILLS

Goal # 5.        
Develop the special compassion and empathy needed to form therapeutic alliances with addicted patients via the following specific objectives:

  1. Demonstrate effective oral and written communication skills with addiction psychiatry patients and with colleagues from other disciplines.
  2. Maintain a long term (3-9 months) psychotherapeutic engagement with one or more addiction psychiatry patients.

PROFESSIONALISM

Goal # 6.        
Develop cognizance of the special ethical issues and cultural needs of addicted patients via the following specific objectives:

  1. Demonstrate awareness of and appropriate use of the specific confidentiality statutes that protect specified health information of addicted patients as delineated in 42 CFR part 2.
  2. Gain experience with, understand, and apply in psychotherapy the unique issues related to addicted patients of both genders and from diverse cultutral and ethnic backgrounds and from a spectrum of age groups.

SYSTEMS BASED PRACTICE

Goal # 7.        
Understand the broad context of Addiction Psychiatry care throughout the U.S. and World.

  1. 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.
  2. 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.
  3. Be aware of potential stigmatization of addiction patients and gain skills in helping other health care professionals recognize their own prejudices in order to advocate for appropriate patient care.

ROTATION SPECIFIC GOALS

VA Inpatient/Intensive Support Services (100% time for 2 months)

  1. To develop diagnostic acumen residents will, under faculty supervision, perform psychiatric evaluations (and oversee the medical evaluations) including written assessment with multiaxial diagnosis of an average of six newly admitted patients per week.
  2. To learn medically supervised withdrawal (detoxification) techniques residents will manage, under faculty supervision, withdrawal of all patients who require it.
  3. To learn to create comprehensive treatment plans, residents will participate in multidisciplinary treatment planning for all patients assigned to the team.
  4. To learn to utilize multidisciplinary team members, residents will serve as Assistant Medical Director, under faculty supervision, and will direct and manage the psychiatric and medical aspects of the team treatment planning and implementation process.
  5. To learn psychopharmacology for patients with psychoactive substance dependence, residents will prescribe appropriate medications for substance use disorders and other psychiatric disorders and manage patients on these medications during their inpatient and/or intensive day program stays.
  6. To learn teaching skills residents will participate in teaching and supervision of medical students and physician assistant students rotating through the inpatient and day treatment unit.

VA Co-Occurring Disorders Unit (10-33% time for 3-9 months)

  1. To develop diagnostic acumen residents will, under faculty supervision, perform psychiatric and medical evaluations including written assessment with multiaxial diagnosis of 15-25 patients.
  2. To learn psychopharmacology for patients with psychoactive substance dependence and co-occurring psychotic and other disorders , residents will prescribe appropriate medications for substance use disorders and other psychiatric disorders and manage patients on these medications.
  3. To learn group therapy techniques with dual diagnosis patients, residents will co-lead a therapy group under faculty supervision.

VA Intensive Outpatient Program (10-33% time for 3-9 months)

  1. To develop diagnostic acumen residents will, under faculty supervision, perform psychiatric and medical evaluations including written assessment with multiaxial diagnosis of an average of one newly admitted patient per week.
  2. To learn to create comprehensive treatment plans for outpatients and to learn to conduct ongoing individual outpatient treatment, residents will serve as primary individual therapist for one to three active intensive outpatients and develop treatment plans for these patients.
  3. To learn to utilize multidisciplinary team members, residents will serve as Assistant Medical Director, under faculty supervision, and will direct and manage the team treatment planning and implementation process.
  4. To learn group therapy techniques residents will be able to co-lead, observe and participate in supervision of support, psychoeducational, process, relapse prevention and introduction to 12-step groups.
  5. To learn psychopharmacology for patients with psychoactive substance dependence, residents will prescribe appropriate medications for substance use disorders and other psychiatric disorders and manage patients on these medications during their intensive outpatient participation..  Specifically residents will learn to perform naloxone challenge tests on opioid dependent patients requesting naltrexone therapy.  Residents will prescribe naltrexone and follow these patients over time on their medication.  Residents will also prescribe disulfiram, acamprosate, and naltrexone for alcohol dependent patients and learn how to monitor these patients over the course of their treatment.
  6. To learn teaching skills residents will participate in the teaching and supervision of general psychiatry residents rotating through the outpatient service.

VA Opioid Treatment Program (10-33% time for 3-9 months)

  1. To learn about evaluation of opioid dependence and use of agonist therapy, residents will, under faculty supervision, perform psychiatric and medical evaluations including written assessment with multiaxial diagnosis of an average of one newly admitted opioid agonist patient per week.  They will follow these patients over time for appropriate adjustment of buprenorphine or methadone doses.
  2. To learn to create comprehensive treatment plans for outpatients and to learn to conduct ongoing individual outpatient treatment, residents will serve as primary individual therapist for one to three opioid substitution patients and develop treatment plans for these patients.
  3. To learn to utilize multidisciplinary team members, residents will serve as Assistant Medical Director, under faculty supervision, and will direct and manage the team treatment planning and implementation process in the Opioid Substitution program.

VA Primary Care Consultation (10-25% time for 3-9 months)

  1. To learn to provide consultation, residents under faculty supervision will perform consultations requested by primary care.
  2. Residents will learn to see the referring provider as their customer. Residents will learn to determine what questions and concerns the primary care provider has about the patient and will learn to communicate a succinct, well-crafted treatment plan to the primary care provider.
  3. Residents will learn techniques of brief interventions and motivational interviewing to intervene with patients in the primary care setting.
  4. Residents will learn to develop a therapeutic alliance with poorly motivated patients to assist the patients in transferring their addiction treatment to the specialty addiction setting when indicated.

Seattle Children’s

  1. To learn to evaluate children and adolescents with substance use disorders.
  2. To learn treatments specific to children and adolescents with substance use disorders.
  3. To learn family management approaches for families of children and adolescents with substance use disorders.

Harborview Dual Diagnosis

  1. To develop diagnostic acumen residents will, under faculty supervision, perform psychiatric and medical evaluations including written assessment with multiaxial diagnosis of  patients.
  2. To learn psychopharmacology for patients with psychoactive substance dependence and co-occurring psychotic and other disorders , residents will prescribe appropriate medications for substance use disorders and other psychiatric disorders and manage patients on these medications.
  3. To learn group therapy techniques with dual diagnosis patients, residents will co-lead a therapy group under faculty supervision.
  4. Residents will learn principles of 12-step facilitation therapy.

Harborview Consults

  1. To learn motivational interviewing and brief interventions, residents will observe supervisor performing these modalities and then deliver these modalities under supervision.
  2. To learn to communicate their findings to referring providers, residents will write cogent consultation notes that address the pertinent issues.
 
Department Harborview Medical Center UW Medical Center VA Puget Sound Health Care System