Substance Use Track (155216)

The Substance Use Track offers opportunities for working with adult and adolescent patients in both civilian and veteran outpatient settings using a variety of evidence-based treatment modalities and models. The multidisciplinary focus provides excellent opportunities for consultation with, and learning from, other professions focused on the management of addictions.

• Center for Drug and Alcohol Program (CDAP)
• Substance Treatment and Recovery Program (STAR)
• Tobacco Treatment Program
• Women's Health and High Risk OB Clinic

Center for Drug & Alcohol Programs (CDAP)

The Center for Drug and Alcohol Programs (CDAP) is an academic medical treatment center providing both inpatient and outpatient treatment as part of a full spectrum of care for addicted patients. It is the clinical arm of MUSC’s Addiction Sciences Division (ASD), which specializes in basic and clinical science approaches to understanding addiction and recovery. The ASD includes a wide range multidisciplinary faculty representing the fields of clinical psychology, experimental psychology, psychiatry, pharmacology, and neuroscience. The ASD also houses the Alcohol Research Center (ARC), directed by Howard Becker, Ph.D., a translational research program that has been specializing in the treatment of alcohol use disorders since its initial funding by NIAAA in 1995. As the clinical extension of the ASD, CDAP actively seeks to translate the latest research findings into clinical practice.

Psychology interns who rotate at the CDAP clinic will receive experience in diagnostic interviewing and assessment as well as the application of evidence-based treatments in outpatient clinical programs. Active intern participation is encouraged in the clinical treatment programs including:

• Motivational Enhancement Therapy Program
• Goal-Based Individual Counseling
• Intensive Outpatient Program
• Opioid Recovery Program (Buprenorphine)
• Sober Living Program
• Relapse Prevention Alumni Group

During the CDAP rotation, interns will gain experience in:

• Diagnostic interviewing, assessment, triage, and treatment engagement as part of daily Walk-In Clinic;
• Applying evidence-based treatment approaches as part of individual and group counseling for patients with substance use and a range of co-occurring disorders;
• Utilizing a wide range of objective biomarkers to inform assessment and measure treatment progress through coordination with the MUSC Clinical Neurobiology Laboratory;
• Conducting specialty assessments and consulting with professionals across disciplines for unique and/or complex populations (e.g., transplant, forensic, recovering professionals, athletes);
• Adjunctive coordination of medication-assisted treatment using FDA-approved pharmacotherapies; and
• Interprofessional team-based approaches to treatment, by learning alongside psychiatrists, psychologists, social workers, pharmacists, and laboratory technicians.

Location of Rotation

Medical University of South Carolina, CDAP Outpatient Clinic

Clinic Hours

Official CDAP hours are Monday through Friday, 9 a.m. to 5 p.m.

Substance Treatment & Recovery Program (STAR)

The purpose of this rotation is to provide extensive clinical experience in substance abuse during the VA rotation. The training experience is based on a "scaffolding approach" in which interns start out observing, then co-leading, then running groups. Interns usually come into a rotation with their own set of skills and experiences, and it is a goal of this rotation to provide an opportunity in which interns can apply and incorporate those skills into the rotation experience whenever possible. Clinical services are currently being offered in-clinic, via home-based telemedicine, and via telephone (social distancing protocols due to COVID-19). Currently, our groups are all being held virtually until COVID-19 protocols change.

Primary goals of this rotation:

• Interns observe groups that use a variety of evidence-based approaches and techniques, including motivational enhancement, cognitive-behavioral, psychoeducational, and process-oriented. (All groups are currently being led via home-based telemental health to observe social distancing).
• Interns will be able to independently conduct groups for patients with chronic substance dependence and addiction, using any combination of the techniques described above. Demonstrating the ability to run groups from all four orientations listed above is necessary to merit an "advanced" competency rating.
• Interns will have a working knowledge of the content and philosophy of the 12-step approach to recovery.

Secondary goals of this rotation will vary depending on the educational needs and preferences of the individual interns. These goals may include the following:

• Interns may follow individual patient progress from initial assessment/evaluation, detoxification/inpatient stay, through intensive outpatient treatment, all the way through aftercare.
• Interns may see patients for individual treatment of substance abuse.
• Intern can observe treatment of addiction from the medical model by attending rounds and team meetings (virtually due to COVID-19).
• Interns may assist the psychologist in program development and/or implement new groups and interventions.
• Interns may assist the faculty in outcome monitoring.

What is expected from the intern:

• Desire to provide the best care possible for our veterans.
• Desire to assist in developing the rotation to provide the optimal training experience for future interns.
• Enthusiasm for group treatment.
• Desire to be an integral member of the treatment team (attend at least one STAR team meeting per week).
• Desire to share knowledge and skills with other member of the team, if applicable.

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

• Accurately diagnose substance use-related disorders among adult veterans.
• Develop evidence-based treatment plans addressing comorbidity between substance use disorders and mood/anxiety disorders (particularly SUD/PTSD) among adult veterans.
• Deliver and monitor individual psychological treatments targeting comorbidity between substance use disorders and mood/anxiety disorders utilizing motivational enhancement, CBT, and exposure therapies.
• Deliver group-based psychological treatments for alcohol and illicit drug use disorders focused on motivational enhancement, addiction therapy, and relapse prevention.
• Deliver group-based psychological treatments for smoking cessation.
• Effectively communicate with interdisciplinary treatment team, supervisors, and other hospital-wide providers via completion of CPRS notes and relevant non-chart communication including encrypted emails, and consultation via phone call and responding to pages.
• Effectively provide evidence-based treatments to poorly served populations, including veterans who are, homeless, unemployed, at economic disadvantage, and low literacy to overcome barriers to the implementation of evidence-based treatments.

Location of Rotation

Ralph H. Johnson VA Medical Center

Clinic Hours

STAR hours are 8 a.m. to 4:30 p.m., Monday through Friday.

Tobacco Treatment Program (TTP)

Clinical experiences are geared toward the delivery of psychological services to patients who smoke and have a variety of medical issues and chronic illnesses. Interns work in an outpatient clinic at Hollings Cancer Center and in all inpatient hospitals at MUSC (Main Hospital, Ashley River Tower Hospital, Institute of Psychiatry, and Children’s Hospital), providing one-on-one patient care.

Hollings Cancer Center Tobacco Treatment Program Outpatient Clinic

Interns see patients for individual psychotherapy geared toward helping them change their tobacco use and manage chronic medical and psychiatric problems and associated psychosocial complications. Although our primary charge is for cancer patients treated at Hollings, patients from a variety of other clinics are seen (e.g., cardiology, pulmonology, etc.). Patients are seen in our dedicated clinic space and the medical floors and in infusion settings. In addition to tobacco treatment, interns provide services for improving other psychological issues (e.g., depression). Interns will get hands-on experience in multidisciplinary treatment, providing motivational interviewing and cognitive behavioral psychotherapy. Interns are expected to communicate relevant treatment-planning information to a variety of medical disciplines including physicians, physician-assistants, nurses, and nurse-practitioners.

MUSC Health Tobacco Treatment Program Inpatient Care

Interns conduct brief evaluations and psychotherapeutic interventions for admitted inpatients for all patients in our hospitals. Interns administer interventions to both patients and their family members, including the parents of children admitted to our Children’s Hospital.

By the end of the rotation, the intern will be able to:

• Accurately assess nicotine dependence and strength of nicotine dependence, and psychosocial factors and co-morbid mental health diagnoses among patients served by the TTP.
• Develop evidence-based treatment plans for nicotine dependence and other diagnoses.
• Effectively use techniques of motivational interviewing and other motivational enhancement strategies to address health behavior change.
• Effectively deliver Cognitive Behavioral Therapy to patients in the Tobacco Treatment Program.
• Work effectively in consultation with professionals within an interdisciplinary team setting.
• Identify and respond to the unique psychosocial challenges associated with the full range of patients who are engaged in psychiatric and medical care. 

Location of Rotation

Hollings Cancer Center, MUSC

Clinic Hours

8 a.m. to 5 p.m., Monday through Friday

Women's Health & High Risk OB Clinic

Patients in the Women’s Health and High Risk OB Clinic are referred for psychiatric and behavioral risk factors related to pregnancy (OB population) as well as outside of pregnancy (GYN population). Patients present with high levels of trauma exposure, co-morbid psychiatric disorders, and substance use problems (including opiate use disorders) or high risk for opiate misuse. The patient population is heterogeneous, with high levels of socioeconomic disadvantage (approximately 80% low income). There is a high need for integrated medical and behavioral health care; until recently, the only services available were brief, supportive counseling and medication management provided by a consulting psychiatrist and psychiatry residents as well as brief psychological intervention to GYN populations by a psychology intern. Beginning in the 2020-2021 internship training year, integrated services provided by clinical psychology trainees will be expanded to serve high risk OB patients, including those seeking MAT and empirically supported intervention/relapse prevention for OUD during pregnancy.

Interns in the Women’s Health and High Risk OB Clinic will work with both obstetric (OB) and gynecological (GYN) populations, screening patients for the presence of psychiatric (depression, anxiety, bipolar disorder, PTSD) symptoms and substance abuse risk behaviors and make a determination about the type of services recommended for the patient. These may include counseling around wellness and general health, prenatal dietary and lifestyle management, psychotherapeutic interventions or emotional disorders, and/or interventions to reduce substance use, including MAT for OUD; services will be delivered both in person and via tele-health. Interns will function as part of a multidisciplinary team of OBGYN physicians, nurses, psychiatry residents and fellows, and clinical psychology professionals. In addition to individual counseling, intern training opportunities may include facilitation of virtual groups for relapse prevention of OUD in OB populations, utilizing telehealth to maximize patient reach.

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

• Effectively screen for mood, anxiety, trauma-related, and substance use problems among low-resource, high-risk women.
• Deliver, with fidelity, evidence-based and best practice interventions to reduce mood, anxiety, PTSD, and substance use problems, as well as short-term health-related counseling (e.g., weight management, health maintenance).
• Provide effective behavioral health intervention to support MAT for OUD in appropriate patients.
• Use telehealth service delivery methods effectively to provide all required assessment and intervention activities.
• Interact and consult effectively with a multi-disciplinary (OBGYN physicians, psychiatrists, psychiatry residents and fellows, nurses) treatment team within a primary care setting.
• Educate multi-disciplinary health care providers about behavioral health factors that affect health care delivery.
• Document the delivery of services and patient response to services appropriately in each patient's MUSC electronic health record.
• Accurately monitor, demonstrate sensitivity, and apply knowledge of others as individuals and cultural beings in assessment, treatment, and consultation.

Location of Rotation

The Women’s Health and High Risk OB Clinic intern operates out of 2 clinical sites - one that is on the MUSC main campus downtown (1 day per week) and another clinical site in North Charleston that is approximately 15 miles (approximately 20 min drive) off the main campus (1 day per week). Interns are required to provide their own transportation to the site.

Clinic Hours

Hours at the downtown location are 8 a.m. to 5 p.m.
Hours at the North Charleston location are 8 a.m. to 4:30 p.m.