A substantial portion of the addiction fellow's time is spent rotating in the Cincinnati Veterans Affairs Medical Center, one of three VA "National Centers of Excellence in Substance Abuse". These experiences are augmented with significant time spent in a variety of non-VA clinical settings, ensuring adequate exposure to a wide array of demographic populations (adolescents, women, pregnancy, etc.). Very importantly, we ensure that several of these clinics (co-exsisting disorders and outpatient rehabilitation, buprenorphine maintenance, methadone maintenance) last the whole year of training, to ensure a longitudinal exposure to the patient and her or his addiction-related illness course.
The Addiction Medicine-Research Fellow's time is fairly similar to that of the Addiction Psychiatry Fellow's in the first year of the two-year training, with a majority of the second year being spent in research-related activities. However, Year 2 includes continuation of the same longitudinal clinic experiences from the first year (Buprenorphine, Methadone, Co-Existing Disorders, Psychotherapy, etc.)—again, ensuring a longitudinal training experience.
Overall, rotations include training in:
- Adolescent Clinic and day hospitalization
- Detoxification (outpatient and inpatient)
- Residential Rehabilitation
- Buprenorphine Maintenance Clinic
- Methadone Maintenance Clinic
- Co-Existing Psychiatric Disorders Clinic
- Pregnancy and Opioids Clinic
- Maternal-Fetal Clinic
- Nicotine Clinic
- Consultation & Liaison
- Addiction Specialty Psychotherapy Clinic (Motivational Interviewing, Cognitive-Behavioral, Relapse Prevention, etc)
- Co-Existing Chronic Pain and Addiction
Addiction-Specific Psychotherapy Training
The American College of Graduate Medical Education (ACGME) requires Addiction Psychiatry Fellowships to provide “experience in the use of various psychotherapeutic modalities involved in the ongoing management of the chronic substance abusing patient, including individual psychotherapies (e.g., cognitive-behavioral therapy), couples therapy, family therapy, group therapy, motivational enhancement therapy, and relapse prevention therapy.” Moreover, the ACGME outlines suportive and psychodynamically-oriented approaches as being valued in training as well.
The University of Cincinnati (UC) Addiction Psychiatry Fellowship trains only graduates of 4-year ACGME-accredited psychiatry residencies, wherein formalized psychotherapy training and experience is provided. The UC Addiction Psychiatry Fellowship extends this to include addiction-specific training.
Such therapy is generally characterized as brief, focal (choosing a specific focus to work on in the therapy), and time-limited (typically no more than 8-12 sessions in duratiion). Fellows screen patients for such therapy, conduct therapy, and seek supervision on the course of therapy from a designated psychotherapy supervisor. Supervision generally involves recording therapy sessions for later use in supervision. Fellows complete readings as assigned by the psychotherapy supervisors. Fellows are required to perform a certain number of therapies, as outlined in her/his Procedure Logger via MedHub software. Fellows also receive Motivational Interviewing training alongside psychiatry residents.
Addiction Research/Medicine Fellows are approached similarly, but with far more limited psychotherapy skillsets expected. These fellows receive didactics, co-facilitate group psychotherapy and also conduct more limited individual psychotherapy (MI, MET, supportive, etc.) under supervision. These skills are felt to be central to effective training for non-psychiatry addiction specialist physicians.
Moreover, Cincinnati is home to one of the very top psychoanalytic training programs in the country, the Cincinnati Psychoanalytic Society and Institute. Please visit their website to learn more about optional training opportunities including one, two, and five year psychotherapy training experiences.
Adolescent Substance Abuse Program, Inc.
The Adolescent Substance Abuse Programs (ASAP) is dedicated to providing professional, ethical, and caring outpatient treatment for substance abuse in a family centered environment. Their abstinence based programs are diverse, providing for both outpatient and also two options for Intensive Outpatient Services. Care is backed by interdisciplinary, team-based meetings to optimize outcomes. Family-specific sessions are available, as are on-site 12-step, community-based recovery programs.
Cincinnati VA Medical Center (VAMC)
The primary training site is the Cincinnati VA Medical Center, a Joint Commision certified 115 acute bed hospital providing five levels of care: primary, secondary, tertiary, restorative, and extended care. It is a Dean's Committee affiliate for the College of Medicine and is a training site for 26 specialties, including Psychiatry, Internal Medicine, Neurology, Surgery, Ob/Gyn, PM&R, and many Medical/Surgical Subspecialties. The VCAMC was selected nationally as one of the three VA Clinical Programs of Excellence in Substance Use Disorders, and funds most of both fellowships training. The CVAMC addiction care line features roughly 70 addiction-dedicated staff including nearly 10 physicians (with board certification in Addiction Medicine, Addiction Psychiatry, Family Medicine, Internal Medicine, and Psychiatry including some of the first physicians to be buprenorphine waivered in the US).
The CVAMC provides a robust scope and depth of addiction specific services including:
- Inpatient and outpatient detoxification services
- Outpatient and residential rehabilitation services
- Clinics specifalizing in methadone and buprenorphine maintenance
- Tobacco/nicotine specialty clinic with a Master certified tobacco treatment specialist
- Gambling services, with certified gambling treatment specialist
- Co-existing psychiatic disorders speciality clinic, with interdisciplinary staffing
- Co-morbid PTSD and addiction specialty clinic, with interdisciplinary staffing
- Opioid overdose education and naloxone distribution services
- Addiction-specific consultation-liaison services
- Veterans drug court services with addiction specialty care
Evidence-based addiction specific psychotherapies including:
- Motivational Interviewing/Motivational Enhancement Therapy
- Cognitive Behavioral Therapy Acceptance and Commitment Therapy
- Contingency management for cocaine users
- Behavioral Couples Therapy
- Mindfulness Based Therapy
- Seeking Safety group therapy
- Video-teleconference treatment to rural or logistically challenged patients
- Secure electronic messaging for patients
- Electronic "health building" system to enhance home-based care
Finally, the CVAMC has decades of clinical experience with addiction-related population based health and prevention (Hepatitis C, etc.)
UC Physicians Company, LLC - Opioid Treatment Program
Led by physicians of University of Cincinnati College of Medicine/UC Health Psychiatry and Behavioral Neuroscience, the addiction services program began in 2006. Methadone assisted treatment is provided for patients with opioid use disorders, backed by a comprehensive multi-disciplinary approach to include physicians, nursing assistance, case management and psychosocial counseling. There are approximately 500 active patients receiving methadone as part of their treatment. Office-based buprenorphine services are also provided. There is special emphasis given to the pregnant patient on methadone. Intensive Outpatient Services are also available, as are services for co-existing disorders. As well, patients may be eligible for ongoing local research studies.
UC Health Maternal-Fetal Medicine
Specializing in the management of high-risk pregnancy and complications of pregnancy, UC Health Maternal Fetal Medicine is an interdisciplinary team that provides complete care for women and their babies during pregnancy and beyond. Maternal Fetal Medicine physicians see patients in various locations and hospitals throughout the Cincinnati region, including University of Cincinnati Medical Center, The Christ Hospital, Mercy Anderson and Mercy Fairfield. They also work in conjunction with the Fetal Care Team at Cincinnati Children’s Hospital Medical Center in one of the largest fetal surgery programs in the nation. Physicians have board certification in OB/Gyn, Addiction Medicine, and Addiction Psychiatry.
Cincinnati Psychoanalytic Institute
This is a non-profit educational institution that offers post-graduate training to mental health professionals - one of few in the U.S. The curriculum is geared to mental health professionals who want to become analysts and to professionals in the fields such as social work, counseling, psychology and pastoral care who want to expand their skills to help the people they serve. This is an optional add-on experience that only a well-qualified fellow may pursue.
Didactic Curriculum includes a large number of lectures within the areas of General Addiction Psychiatry/Medicine, Neurobiology and Psychopharmacology, Therapeutic Modalities, Special Populations-Special Needs, Administrative Issues and Research.
The official textbook for the Addiction Medicine and Addiction Psychiatry Fellowships is Principles of Addiction Medicine
(LWW Press), with the Program Director of these fellowships serving as editor-in-chief
of this textbook. This is the official textbook of the American Society of Addiction Medicine. Various other references supplement readings as well, including the American Psychiatric Association's Textbook of Substance Abuse Treatment
Additional supervisory processes
- Weekly meetings with the Program Directors
- Structured written feedback on rotations
- 360 Degree Feedback Sessions from multidisciplinary staff and patients
- Clinical Skills Examinations with live patients
- Scholarly Project
- Addiction-specific psychotherapy training
- Procedure Logger
Fellow Scholarly Activities
It is a requirement that Fellows participate in scholarly activities. The Fellow's weekly schedule is set well below the 80 hour maximum to ensure adequate time for activities such as Journal Club, Grand Rounds, and authoring medical articles on addiction psychiatry topics, or traditional research.
Fellows are expected to either create their own scholarly project or participate in formal research activities. Either approach affords strengthening the Fellow's knowledge in a specific subject, raising her/his confidence in publishing in the peer-reviewed medical literature, and affords opportunities to deepen her/his teaching and public speaking experiences. Scholarly activity may include authoring and preparing for publication a medical article, or presenting at Grand Rounds. Co-authorship is further encouraged, as this makes for an easier learning curve, enhances fellow-faculty collaboration and team-based learning, and better ensures the paper will be successful towards publication. Regarding formal research activities, this may include involvement in faculty members' existing research grants/contracts, or pursuing their own research question/project under faculty supervision/ mentorship.
In our experience, due to the clinical demands of this one-year fellowship, the latter is only feasible if the Fellow intends to remain with the University of Cincinnati or Cincinnati VAMC after their Fellowship training.
Addiction Sciences Journal Club
The Addiction Sciences Division provides an addiction-specific journal club every other month. An original research paper is presented by a fellow or other trainee, with discussion facilitated by a selected faculty member. Here, Fellows are carefully paired with a faculty discussant to enhance their learning on how to review scientific papers, interpret statistics and conclusions, and present and discuss relevant opinions with the audience in attendance. This is open to all medical students, residents, fellows, and UC, VA , and CCHMC staff who wish to become more familiar with the advanced literature in substance use and addiction related disorders. CME's and CEU's as well as lunch are provided free of charge.