Addiction Fellowship Clinical Rotations

Training sites for the fellowship include the MUSC Institute of Psychiatry, the Ralph H. Johnson VA Medical Center, and Charleston County’s Department of Alcohol and Other Drug Abuse Services (DAODAS), more commonly known as the Charleston Center.

MUSC Institute of Psychiatry

Psychopharmacology Outpatient Rotation

The Psychopharmacology Outpatient rotation at the MUSC Institute of Psychiatry Center for Drug and Alcohol Programs (CDAP) is a required, part-time, twelve-month rotation. During this rotation, fellows participate in a longitudinal psychopharmacology clinic, managing outpatient detoxification, providing psychiatric evaluation and follow-up, and providing individual therapy. This rotation allows the fellow to follow patients for psychopharmacology, and individual therapy, for the entire year of fellowship. Patients have substance use disorders with or without psychiatric disorders. The specialization is dual diagnosis, but many patients have substance use disorders only. Patients are seen for opiate replacement therapy (buprenorphine) and fellows will manage initiation and maintenance of buprenorphine, and may also experience outpatient buprenorphine detoxification. An average caseload for a resident is 20 psychopharmacology management cases, one to two outpatient detoxifications, five buprenorphine cases, and one psychotherapy case. Fellows are supervised by an attending psychiatrist with specialization in addiction psychiatry.

Inpatient Unit (CDAP) Rotation

The inpatient unit rotation at the MUSC Institute of Psychiatry Center for Drug and Alcohol Programs (CDAP) is a required, part-time, four-month rotation. On this rotation, fellows spend their time learning to manage detoxification, learning about the evaluation of individuals with dual disorders, and in developing proficiency in the following therapeutic modalities: individual psychotherapy, cognitive behavioral and brief motivational strategies, family therapy, group therapy, milieu therapy, behavior modification, and psychopharmacology. An average inpatient caseload will be eight to ten patients. The fellows are responsible for supervising and coordinating care of these patients, psychiatric evaluation, medical stabilization, and treatment planning. The fellows supervise medical students, residents, and psychology interns, social workers and nursing staff in providing patient care. Caseloads are reviewed to ensure the appropriate breadth of experience. The inpatient service patients are approximately 54% male, 46% female, 58% African-American, 42% Caucasian, whose ages range from 18- 70. There are 12–18 patients on the unit at any time. Diagnoses include substance use disorders (alcohol, cocaine, opiate, sedative, hypnotics), with or without psychiatric disorders (primarily bipolar disorder, depression, schizophrenia, PTSD, panic disorder, social phobia). The unit is managed using principles of behavior modification. The specialization is dual diagnosis evaluation and treatment, but many patients have only substance use disorders, no comorbidity. All fellows have one hour of individual supervision and one hour of additional supervision (individual or group) each week with the team attending, with additional supervision provided as needed.

Intensive Outpatient Rotation

The Intensive Outpatient rotation at the MUSC Institute of Psychiatry Center for Drug and Alcohol Programs (CDAP) is a required, part-time, two-month rotation. During the intensive outpatient rotation fellows are exposed to individual, group, and family therapy, as well as psychopharmacologic management. Assessment of dual diagnosis is a component of this program. This rotation allows the fellow to gain experience in the continuum of care. Many of the intensive outpatient patients are former inpatients, so the fellow has an opportunity to watch progress through stages of recovery. Fellows will be exposed to all forms of therapeutic intervention by being a participant/observer in the intensive outpatient therapy groups daily for two months. Fellows are provided hands on training for manual based psychotherapy (Cognitive-Behavior Therapy, Motivational Enhancement Therapy, and 12-step Facilitation Therapy) in individual and group therapy settings in this intensive outpatient rotation.

Child and Adolescent Addiction Psychiatry Rotation

The child and adolescent addiction psychiatry rotation is a required, part-time, one-month rotation. During this rotation, fellows participate in outpatient treatment of adolescents with substance use disorders in clinical and research settings. They receive training in and provide evidence-based psychosocial treatments specific to this age group. They additionally learn about evidence-based pharmacological and non-pharmacological approaches to treating co-morbid psychiatric conditions in adolescents with substance use disorders. Fellows gain experience with conducting substance abuse treatment and prevention groups in adolescent psychiatric day treatment and inpatient programs. The supervisor for this rotation is Dr. Kevin Gray, a board certified Child and Adolescent Psychiatrist with four years of additional National Institute on Drug Abuse training in adolescent substance use disorders.

Ralph H. Johnson VA Medical Center

Substance Abuse Treatment Center (SATC) Rotation

The Substance Abuse Treatment Center is a required, part-time, longitudinal rotation at the Ralph H. Johnson VAMC. The clinical duties for the addictions fellow at the SATC - VAMC involve participation in the outpatient substance abuse clinic. The patient population for the fellow’s clinic is derived from patients who have significant psychiatric comorbidity and will benefit from both pharmacotherapy and/or psychotherapy provided by the fellow. These patients are specifically selected by the SATC director, Tara M. Wright, MD, to ensure that the fellows are provided a diverse clinical experience. The goal of the clinic is to provide an opportunity for the fellow to provide longitudinal care (psychopharmacological management, brief therapy, monitoring for relapse) to veterans. A significant number of these patients have been initially stabilized through their participation in the 28-day outpatient program. The patient population includes diagnoses of a variety of substance use disorders, with a focus on alcohol abuse/dependence, cocaine abuse/dependence, marijuana abuse/dependence, opioid abuse/dependence and nicotine dependence. By design, a majority of the patients in this particular clinic have co-morbid, non-substance induced axis I and/or II disorders that require longitudinal treatment. A primary focus of the clinic is the identification and treatment of co-morbid disorders in substance abuse patients.

Consult-Liaison Rotation

This is a required part-time, two-month rotation at the Ralph H. Johnson VA Medical Center. Located within the MUSC Medical Center campus, the Ralph H. Johnson VAMC operates this daytime emergency and consultation team, with coverage provided by members of the Psychiatry service at the VAMC who have faculty appointments in the Department of Psychiatry and Behavioral Sciences. Fellows perform consultative evaluations on patients in the Emergency Department, outpatient clinics, and on the inpatient medicine and surgery services. Learning takes place through supervised clinical experiences, case presentations and discussions, as well as guided readings, didactic lectures, and self-directed learning. The patient population is 90% male and 50% African American. Prevalent diagnostic groups are major depression, schizophrenia, bipolar illness, schizoaffective illness, substance use disorders, anxiety disorders including PTSD, personality disorders, and delirium. The addiction psychiatry fellows preferentially evaluate and follow those patients presenting with acute substance intoxication or withdrawal, or those patients with direct medical or psychiatric complications of substance use.

Pain Clinic Ambulatory Care Pain Management

This is a required, part-time, two-month rotation at the Ralph H. Johnson VA Medical Center. During their rotation with the Interdisciplinary Pain Team (IDPT) at the VA Medical Center, fellows will work closely with the IDPT team members (Anesthesiology, Psychology, Nursing, and Pharmacy) as well as providers associated with patient care in the assessment and treatment of Veterans referred to this clinic. Patients are typically referred to the IDPT by their primary care provider for the assessment and treatment of chronic non-cancer pain. The following services are available through the IDPT: Patient education, Medical examination, Psychosocial assessment, Interventional procedures, Medication management, Pharmacy counseling and rational polypharmacy, Acupuncture, Cognitive behavioral therapy, Mindfulness based stress reduction, Assessment for implantable devices and Biofeedback. The rotation will consist of participation in the diverse clinical activities of the IDPT, during which the fellows will see patients under the supervision of the clinic faculty. The primary supervisors of this rotation are Dr. Robert Friedman, MD (IDPT Clinical Director, Anesthesiologist) and Dr. Layne Goble, PhD (Clinical Psychologist). Together, they will provide the fellow the experience of working with a multidisciplinary team to offer comprehensive treatment to individuals struggling with chronic non-cancer pain.

Charleston Center

Charleston Center Substance Abuse Treatment Center (SATC)

Charleston Center Substance Abuse Treatment Center (SATC) is a required, twelve-month, part-time rotation. During this rotation, fellows participate in a longitudinal psychopharmacology clinic (four hours per week), providing psychiatric evaluation, follow-up, and individual therapy. Fellows perform these initial evaluations and follow patients referred from the methadone maintenance clinic, the 28 day detoxification unit, and "A New Life Program for Women" (a program for women with children below the age of two and pregnant women struggling with addictive disorders). Fellows are provided the opportunity to practice independently during this rotation. Patients have a wide array of substance use disorders, and a substantial number also have comorbid psychiatric disorders. While the specialization is dual diagnosis, the fellow will also see patients with substance use disorders only. The fellow has the unique opportunity to work with pregnant, postpartum, and lactating women struggling with dual diagnoses disorders. An attending psychiatrist with a specialization in addiction supervises fellows. The medical director of the Charleston Center, an internist with ASAM certified addiction specialization, is also available and provides supervision to the fellows.

Methadone Maintenance Clinic

The Methadone Maintenance Clinic rotation at the Charleston Center is a required, part-time, two-month rotation. This rotation is designed to give the addictions fellow knowledge and practical experience in diagnosing and treating opiate addiction using an opiate replacement modality. The patient population is that of Charleston Center’s opioid treatment program (OTP), many of whom these have other substance use problems and psychiatric co-morbidities that must also be addressed. Supervision is provided by an ASAM certified addictionologist with more than twenty years of experience in treating this patient population. Additional support is available through interaction with the physician assistant, nurse practitioner, and clinical counselors who staff the program.