Substance Abuse Track (155216)

The Substance Abuse 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 & Alcohol Program (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.

Faculty

Joshua Smith, Ph.D.
Associate Professor

Pain Rehabilitation Program 

This rotation provides training experience in the Pain Rehabilitation Program at MUSC, the first intensive outpatient rehabilitation program for patients with chronic pain and opioid use in South Carolina. The program employs an interprofessional team of providers including pain management and addictions physicians, psychologists, physical and occupational therapists, and nurses to functionally rehabilitate patients with chronic pain while simultaneously discontinuing prescription opioids. Approximately 60% of patients enter the Pain Rehab Program on chronic opioids, and about 80% of these patients fully taper off their pain medications while in the program. Patients complete three psychology groups per day, focused on topics like mindfulness, stress management, sleep hygiene, and activity pacing, in addition to physical therapy, occupational therapy, and medication tapering. Goals of the program include improved functioning, reduced impact of pain on daily life, improved mood and quality of life, and elimination of prescription opioid use.

Both chronic pain and prescription opioid misuse are significant problem across South Carolina, and particularly in rural, underserved areas. Unfortunately, many individuals in these areas need care for chronic pain and/or opioid problems but do not have access to appropriate treatment. To improve access to care, the Pain Rehab Program is working to expand some of its services outside the structured, intensive outpatient programming in Charleston. Outreach to these underserved regions is done using several methods: 1) telehealth screening/assessment with goal of helping patients join the Pain Rehab Program (grants are currently available to assist with lodging and transportation); 2) telehealth brief interventions for those who are unable or unwilling to complete the Pain Rehab Program; and 3) direct outreach and screening via in-person, community visits to underserved areas.

Clinical Activities

  • Interns will provide direct, clinic-based services within the PRP intensive outpatient program on MUSC’s campus. These activities would include pre-program entry assessment to assess extent of opioid use and psychosocial evaluation of chronic pain; group psychotherapy services using cognitive-behavioral and acceptance and commitment therapy approaches to pain management; and individual psychotherapy using motivational interviewing to help patients overcome personal or situational barriers to program participation.
  • Interns will provide telehealth services to 1) screen/assess patients in rural, underserved areas who may be appropriate for Pain Rehab, and 2) provide evidence-based interventions (e.g., MI, CBT, ACT) for patients who, for logistical reasons, cannot participate in the on-campus intensive outpatient program.
  • Interns will participate in monthly outreach/screening trips to rural, underserved communities in South Carolina. These trips will be conducted in conjunction with other MUSC outreach programs.

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

  • Accurately identify patients at risk for OUD using evidence-based screening methods.
  • Effectively and efficiently conduct comprehensive assessments to identify psychological, behavioral, medical, and/or social factors that could impact patient engagement in a chronic pain rehabilitation program.
  • Provide evidence-based psychological interventions (e.g., cognitive behavioral treatment, acceptance and commitment therapy, and motivational interviewing) in both individual and group formats for chronic pain patients.
  • Identify and respond to unique psychosocial challenges associated with diverse patients with chronic pain, especially those that represent treatment barriers facing underserved patients in rural SC counties.
  • Integrate and share psychological data through verbal and written interactions with the interdisciplinary team.
  • Use telehealth service delivery methods effectively to provide all required patient care activities.
  • Document the delivery of services and patient responses to services appropriately and in a timely manner in each patient’s electronic medical record.

Location of Rotation

MUSC Wellness Center

Outreach to rural, underserved areas in South Carolina (estimated once/month). Interns will either join an existing outreach trip on an MUSC-sponsored vehicle or ride in the vehicle of a direct supervisor.

Clinic Hours

8am to 5pm

Faculty

Pain-STAR Program VA

Veterans in the catchment area of the Ralph Johnson VAMC have high rates of OUD. A significant number of those veterans have co-morbid chronic pain (as well as other diagnoses, including mental health and substance abuse problems). At present, in order to receive services in the Interdisciplinary Pain Clinic, patients who have OUD issues must successfully complete a course of substance abuse treatment prior to onset of chronic pain services. The PainSTAR clinic will significantly alter this service flow by providing simultaneous pain and OUD treatment services. In this sense, the PainSTAR program is a smaller version of the MUSC PRP rotation described above, in that it provides integrated and coordinated pain and OUD services, although in a less intensive format than the PRP.

The purpose of this rotation is to provide extensive clinical experience in the intersection between substance abuse, chronic pain, and comorbid medical/psychiatric conditions within the VAMC setting. Referrals to PainSTAR will come from the Interdisciplinary Pain team, the STAR (substance abuse) clinic, primary care services throughout the VA hospital, the Primary Care-Mental Health Integration clinic, and various specialty clinics (e.g., Neurology, Physical Medicine/Rehab). Referred patients will be assessed by the psychology intern, who will staff the case with the interdisciplinary team (consisting of anesthesiologists, psychiatrists, social workers, and the supervising psychologists, Drs. Kathryn Bottonari and Layne Goble). The team will develop a care plan that incorporates pain treatment components and substance abuse treatment .

Interns will provide individual and group treatment addressing both the pain and OUD elements of the care plans. Because the catchment area of the VA is so geographically spread out, a significant portion of services are provided using both home-based (the patient receives services at home) and clinic-based (the patient travels to a nearby community-based outreach clinic, or CBOC) telehealth services. This is especially the case for veterans living in Horry County, which has the highest prevalence of OUD diagnoses, but is the most distant county from the VMAC within SC. Telehealth treatment services will be used extensively to deliver services to those Pain-STAR Clinic patients living in the distant areas of the catchment area. The Pain-STAR clinic training model is based on a "scaffolding approach" in which interns start out observing, then co-leading, then running diagnostic assessments, individual psychotherapy, and group psychotherapy. Because of the large numbers of OUD patients in Charleston, Dorchester, and Horry counties, and the large overlap of OUD and chronic pain, we anticipate that services in this clinic will be in very high demand. Therefore, at least 90% of the intern's training time on this rotation will be centered on OUD-related interventions, and approximately 40% of their clinical activities will involve telehealth service delivery to patients in Horry county (and other rural areas within the catchment area).

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

  • Accurately identify patients at risk for OUD using evidence-based screening.
  • Assess psychological, behavioral, and social factors that could impact patient engagement in a combined OUD/chronic pain treatment program.
  • Provide evidence-based psychological interventions (e.g., cognitive behavioral treatment, acceptance and commitment therapy, and motivational interviewing) in both individual and group formats for OUD patients with chronic pain.
  • Identify and respond to unique psychosocial challenges associated with veteran status, especially those that represent treatment barriers facing patients who live in outlying areas.
  • Integrate and share psychological data through verbal and written interactions with the interdisciplinary team.
  • Use telehealth service delivery methods effectively to provide all required patient care activities.
  • Document the delivery of services and patient responses to services appropriately and in a timely manner in each patient’s VA medical record.

Location of Rotation

Outreach to patients in Horry County and other rural areas within the catchment area.

Clinic Hours

VA hours are 8am-4:30pm

Faculty

 

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.

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.
  • 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 on the inpatient unit.
  • 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 underserved populations, including veterans who are sexual/racial/ethnic minorities, 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.

Faculty

Women's Health and 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 racially and ethnically diverse, 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 underserved, 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 diverse 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.

Faculty