Addiction Psychiatry Fellowship

Director: Karen Drexler, M.D.
Address: Substance Abuse Treatment Program (116A) Atlanta VAMC 1670 Clairmont Road, Atlanta, GA 30033
Phone:Fax: (404) 321-6111 x6900(404) 329-4643
E-mail: karen.drexler@va.gov

Level: PGY-5
Positions: 2
Accreditation: ACGME

Addiction Psychiatry Residency Program: The Addiction Psychiatry Residency Program is a one-year program. The Addiction Psychiatry resident must have satisfactorily completed an ACGME-accredited General Psychiatry residency prior to entering the program. Upon completion of the 12-month residency program, and board certification in General Psychiatry, the resident will be board eligible in Addiction Psychiatry. Training in Addiction Psychiatry that occurred during the general residency training will NOT be credited toward the one-year requirement. Training is best accomplished on a full-time basis. If it is undertaken on a part-time basis, the 12-month program must be completed within a two-year period.

To determine the appropriate level of education for a resident who is transferring from another residency program, written verification of the previous educational experiences and a statement regarding the performance evaluation of the transferring resident must be received prior to acceptance into the program.

Residents train at the Atlanta VA Medical Center and affiliated sites. Residents receive direct supervision in evaluation and treatment of men and women of different ages, ethnic and socioeconomic backgrounds with addictions to all of the major classes of addicting substances.

Residents participate in three rotations: VAMC substance abuse treatment program (6 months); Grady Memorial Hospital (3 months); a rotation at Metro Atlanta Recovery Residences (6 weeks) and one at the Ridgeview Institute (6 weeks). Residents receive supervised training in performing patient evaluations, managing rehabilitation and detoxification, and treating psychiatric co-morbidities. They participate in clinical supervision and formal didactic training of general psychiatry residents and medical students. Residents also follow outpatients for individual psychotherapy and medication management throughout the year.

Wednesday morning seminars cover specific reading assignments based on the topic areas covered in the American Board of Psychiatry and Neurology examination and requirements of the Accreditation Council on Graduate Medical Education. Didactics address neurobiology, diagnosis and treatment of all the major classes of addicting substances, pharmacotherapy and psychotherapy, and related topics including public policy, ethics, and medications development.

A more detailed description of our program can be requested by calling Amy Cromwell, Program Coordinator, at 404-727-3293 or email: acromwe@emory.edu.

Affiliated Institutions and Rotations

ATLANTA VETERANS AFFAIRS MEDICAL CENTER (Atlanta VAMC)

Atlanta VAMC serves over 440,000 veterans residing in metropolitan Atlanta and northern Georgia. The medical center is dedicated to providing acute medical, surgical, intermediate, and psychiatric care, and both primary and specialized outpatient services with almost all major specialties and subspecialties represented.

Atlanta VAMC is a dean’s committee, tertiary care facility comprised of 191 operating hospital beds and 100 operating nursing home care unit beds. The facility is located east of Atlanta, Georgia, on the northeast edge of Emory University’s Campus. Atlanta VAMC serves as a primary teaching hospital of the Emory University School of Medicine with a major, highly active research program.

The Substance Abuse Treatment Program (SATP) of the Atlanta VA Medical Center treats over 1,500 veterans each year with a variety of addictive disorders. In order of prevalence, they include nicotine dependence, alcohol dependence, cocaine dependence, cannabis dependence, opioid dependence, benzodiazepine dependence, and others. Over one-third of veterans in the SATP have co-occurring mental disorders including post-traumatic stress disorder, mood disorders, other anxiety disorders, and psychotic disorders.

GRADY MEMORIAL HOSPITAL

Grady Memorial Hospital has been in the heart of downtown Atlanta for over 100 years, located approximately seven miles from the Atlanta VA Medical Center and Emory University. With 1,000 inpatient beds, Grady is a primary teaching hospital of the Emory University School of Medicine and Morehouse School of Medicine. Grady Memorial is the primary hospital for inner city and medically indigent populations in the two largest counties of metro Atlanta. Construction of a $350 million renovation of the physical plant was completed in 1995. Total patient volume in the Emergency Care Center is approximately 100,000 patients per year.

Addiction Psychiatry Residents are required to participate in a full-time, three-month rotation at Grady. The residents split their time between the Drug Dependency Treatment Unit (DDU) -- the city’s largest methadone maintenance program -- and in consultation to the Infectious Disease Program, located in a facility four miles from Grady Memorial and four miles from the Emory Campus. Psychiatrists, clinical psychologists, social workers and clinical nurse specialists provide multidisciplinary clinical supervision and collaboration.

METRO ATLANTA RECOVERY RESIDENCES (MARR)

MARR, Inc., is a private, nonprofit community-based residential addiction treatment program that provides several levels of care. These include intensive outpatient/partial hospitalization, high-intensity residential, low-intensity residential, aftercare, family services, and services for recovering professionals. MARR owns and operates more than 35 recovery residences that offer a therapeutic “community” in which each patient progresses through the recovery process in a family-type environment.

The organization operates four gender-specific residential primary addiction treatment programs: Men’s Recovery Program (MRC); MARR South Men’s Program; Women’s Recovery Program (WRC); and Right Side Up, a program for women and children. Right Side Up provides long-term residential addiction treatment services to DeKalb and Fulton County women who are recipients of Temporary Assistance to Needy Families (TANF), along with wraparound services to their dependent children. Addiction Psychiatry residents rotate through all four of these treatment programs. The main treatment and administrative facility is located in northeast metropolitan Atlanta about 10 miles from the Atlanta VAMC.

Patients include men and women with primary addictive disorders; depending on the patient population, at least half of the patients have co-occurring psychiatric disorders. The most common psychiatric diagnoses include mood disorders, anxiety disorders, and personality disorders. Treatment approaches include individual and group psychotherapy, psycho-education, 12-step facilitation, behavior modification, therapeutic community, psychopharmacology, recreation therapy, and family therapy. Residents have shared responsibility with other staff for 12-15 outpatients and have three hours per week of individual and group supervision.

RIDGEVIEW INSTITUTE

Founded in 1976 in suburban Atlanta, Ridgeview Institute has earned a national reputation for quality care and treatment for mental health and addiction problems. Ridgeview Institute provides a comprehensive continuum of care for children, adolescents, adults, and seniors with psychiatric, emotional, and addictive disorders. Their inpatient, partial hospitalization, and outpatient treatment options are cost-effective and provide patients with individualized treatment in a supportive and nurturing environment. In 1977, Ridgeview set the standard for treatment of the impaired health professionals to include physicians, nurses, pharmacists, corporate executives, college professors, attorneys, and ministers suffering from alcohol or drug addiction.

Inpatient, partial hospitalization, and intensive outpatient treatment is provided to adults, impaired professionals, children, adolescents, and seniors. Treatment approaches include a broad spectrum of specialty groups and services and the 12-Step programs of recovery. Psycho-educational and process groups are provided for patients and families to include cognitive restructuring, emotive therapies, and the experience of learning to live free of addiction.

Specific Goals/Objectives of Rotations

ATLANTA VAMC – Program is a 6-month rotation in outpatient intensive rehabilitation, opioid agonist therapy, and consultation. Patients are evaluated in consultation on Surgery and Medicine inpatient units, in the Methadone Clinic, and as outpatients. Residents supervise and teach PGY-2 General Psychiatry residents as well as Emory medical students.

Atlanta VAMC Opiate Agonist Clinic: 2 hours/week

Intensive Outpatient Rehabilitation Unit:: 24 hours/week

Inpatient Consultation: 6 hours/week

Outpatient Follow-up: 4 hours/week

1. Residents will be able to recognize and address the signs and symptoms of intoxication and withdrawal from major categories of psychoactive substances.
2. Residents will be able to evaluate patients to determine the most appropriate level of care for addiction treatment using standard criteria such as Interqual and ASAM.
3. Residents will be able to identify the signs and symptoms of psychoactive substance use and dependence and psychiatric co-morbidities.
4. Residents will medically manage psychiatric co-morbidities including post-traumatic stress disorder, schizophrenia, bipolar disorder, depression, and anxiety disorders.
5. Residents will be able to confront and intervene with unhealthy defense mechanisms.
6. Residents will be able to lead multidisciplinary treatment planning to address individual problems within a bio-psychosocial-spiritual framework.
7. Residents will be able to medically manage patients in opioid substitution therapy.
8. Residents will develop group and individual psychotherapy skills including cognitive-behavioral, 12-step facilitation, motivation enhancement, and psychodynamic methods.
9. Residents will provide consultation to Medicine, Surgery, and Intensive Care units for those patients with psychoactive substance dependence.

GRADY HEALTHCARE SYSTEM – Patients are seen in two programs:

Grady Healthcare System’s Methadone Clinic – 16 hours/week/3 months (Drug Dependency Unit)

Infectious Disease Clinic – 16 hours/week/3 months

1. Residents will be able to identify the signs/symptoms of psychoactive substance use and dependence and psychiatric co-morbidities.
2. Residents will medically manage psychiatric co-morbidities (in both adults and adolescents with addiction) to include post-traumatic stress disorder, schizophrenia, bipolar disorder, depression, and anxiety disorders.
3. Residents will be able to confront and intervene with unhealthy defense mechanisms.
4. Residents will be able to lead multidisciplinary treatment planning to address individual problems within a bio-psychosocial framework.
5. Residents will gain experience in opioid substitution therapy.
6. Residents will develop psychotherapy skills to include group, individual, and family interventions and treatment.
7. Residents will provide consultation to the Infectious Disease Program on patients with HIV and psychoactive substance abuse disorders, with or without other psychiatric co-morbidities.

METRO ATLANTA RECOVERY RESIDENCES (MARR) – 6 weeks

1. Residents will be able to recognize and address the signs and symptoms of intoxication and withdrawal from major categories of psychoactive substances.
2. Residents will be competent in managing outpatient detoxification from alcohol, opioids, and sedative-hypnotics.
3. Residents will be able to confront and intervene with unhealthy defense mechanisms.
4. Residents will be able to lead multidisciplinary treatment planning to address individual problems within a bio-psychosocial-spiritual framework.
5. Residents will gain experience as advocates for professionals in recovery with respect to licensure issues.
6. Residents will develop psychotherapy skills in working with men, women, and their children in group, individual, and family sessions.
7. Residents will develop skills to treat addicted women through pregnancy and postpartum.
8. Residents will medically manage psychiatric comorbidities in patients seeking treatment for substance use disorders.

 RIDGEVIEW – 6 weeks

1. Residents will be able to recognize and address the signs and symptoms of intoxication and withdrawal from major categories of psychoactive substances.
2. Residents will be competent in managing detoxification from alcohol, opioids, and sedative-hypnotics.
3. Residents will be able to confront and intervene with unhealthy defense mechanisms.
4. Residents will be able to lead multidisciplinary treatment planning to address individual problems within a bio-psychosocial-spiritual framework.
5. Residents will gain experience as advocates for professionals in recovery with respect to licensure issues.
6. Residents will develop psychotherapy skills in working with men, women, and their children in group, individual, and family sessions.
7. Residents will develop skills to treat addicted adolescents.
8. Residents will medically manage psychiatric comorbities in patients seeking treatment for substance use disorders.

Didactics Curriculum

Wednesday mornings are reserved for academic activities. Residents participate in Didactics lectures ( 8:00-12:00) to include small group discussions with experts in Pharmacology, Neuroimaging, Clinical Care, and Epidemiology. Schedule of lectures for current academic year – along with references to be reviewed before and during lectures – is enclosed in resident handbook.

Residents are expected to complete at least one scholarly activity to include developing a lecture, writing a review paper, a research paper, or other activity approved by the Program Director.

Emory has a diverse faculty devoted to researching addiction --- from Molecular Neuroscience, to Rodent and Primate Animal Models, to Human Neuroimaging, Clinical Trials, and epidemiological studies. Residents may elect to pursue research projects in any of these areas.

In addition, residents who wish to participate in an additional six months of full-time residency training in addiction clinical research may do so to prepare future addiction psychiatrist clinical and translational scientists. The program is available through a NIDA-funded T-32 research-training program in the neurobiology of addiction, directed by Michael J. Kuhar, Ph.D. The strategies of this research track are to increase the flexibility of training requirements, to require research literacy, and to create patient-oriented research training curricula.

Faculty

Addiction Psychiatry faculty currently consists of four full-time addiction psychiatrists who are certified by the American Board of Psychiatry and Neurology.  In addition, we have several addictionologists and clinical psychologists with experience in treatment of psychoactive substance use disorders. Faculty members in General Psychiatry, Child Psychiatry, Psychosomatic Medicine, and addiction research provide didactic instruction and appropriate clinical research supervision.

How to Apply

Applicants must complete a psychiatry residency program before beginning the addiction psychiatry residency program (PGY-5) and must obtain a Georgia Medical License. Detailed information about our program can be requested in writing or by calling Amy Cromwell at 404-727-3293 or email.  Applicants are required to provide three letters of reference (one from his/her General Psychiatry Program Director), his/her Curriculum Vitae, a copy of his/her medical school diploma, transcripts, and a letter from the dean, and USMLE exam scores.

ABPN Certification

Our goal is to prepare residents for ABPN Board Certification in Addiction Psychiatry. To that end, residents must first become certified in General Psychiatry. Each resident  takes an addiction  MCQ exam, uses a procedure logger to ensure that a minimum number of identified scenarios are handled, and takes a self-evaluation to measure comfort levels for a wide variety of cases. Site supervisors use a checklist of skills to observe and evaluate residents handling several patients. These exercises serve to measure skills and knowledge in Addiction Psychiatry while preparing the resident for ABPN certification.

Evaluations

Each resident is evaluated at the beginning and end of each rotation by his/her attending psychiatrists in the knowledge and practice of Addiction Psychiatry and in the six general competencies for all physicians, as outlined by the ACGME: Patient Care; Medical Knowledge; Practice-Based Learning; Interpersonal Skills; Professionalism; and Systems-Based Practice. Evaluations are based on direct observation of patient care and weekly supervision. Residents evaluate the quality of teaching by clinical attendings and lecturers.

Updated: October 2007

 

 

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