Addiction Psychiatry Fellowship

The Addiction Psychiatry Fellowship offered through the Boston University Medical Center and the Boston VA Healthcare System provides psychiatric physicians with advanced training in the recognition, diagnosis, and treatment of addictive disorders. A well-rounded and comprehensive series of didactic presentations as well as training at renowned Boston area tertiary care facilities ensures that graduates are clinically competent and knowledgeable in all aspects of addiction treatment. The development of broad expertise and an informed perspective on the addictions encompassing knowledge of the history of substance use disorders, sociological aspects of addictions and public policy, and the role of mutual-support groups in the treatment of addictions is an integral part of the fellowship.

This fully ACGME accredited PGY-V year residency is directed by Dr. John Renner, a widely recognized addiction psychiatrist. Required rotations, which include addictive disorders in adolescent and consult-liaison populations take place at hospitals and treatment facilities throughout the greater Boston area. A significant amount of time is dedicated to Public Health addiction psychiatry and medication assisted treatment with methadone and buprenorphine. Fellows are also provided with substantial elective time and are encouraged to pursue research and other interests, for which a wide variety of mentors are accessible. This one year accredited program meets all requirements for ABPN eligibility in Addiction Psychiatry.

If desired, additional training is also available in a two year VA-funded Interprofessional Advanced Addiction Fellowship Program which is designed to train future generations of VA healthcare leaders. The Advanced Fellowship provides opportunities for further specialization in research in the addictions, and/or management of addiction treatment units and addiction training programs. This advanced program stresses interprofessional training and provides opportunities to work alongside addiction professionals from other disciplines. In the Advanced Fellowship, 75% time is devoted to research, management, and educational activities and up to 25% time to direct clinical service.

Drs. Akiva Daum, Claudia Rodriquez & Joseph Insler with Dr. Renner at the fellowship graduation in June, 2014

Drs. Akiva Daum, Claudia Rodriquez & Joseph Insler with Dr. Renner at the fellowship graduation in June, 2014

PROGRAM DESCRIPTION

BOSTON VA HEALTHCARE SYSTEM

BOSTON UNIVERSITY MEDICAL CENTER

Boston Medical Center

720 Harrison Ave.

DOB, 9th Floor, Room 915

Boston, MA 02118

Phone: 617-638-8548

Fax: 617-638-8542

John Renner Dr. John Renner-Program Director
Veterans Administration Outpatient Clinic
251 Causeway Street
Boston, MA 02114
SPECIALTY: Addiction Psychiatry
Sponsoring Institution: Boston University Medical Center [248077]
DIO Name: Jeff Schneider MD (jeffrey.schneider@bmc.org)
Public Contact Email/Director’s External Email lynne.rose@bmc.org
Original Accreditation Date July 01, 1997
Accreditation Status: Continued Accreditation
Accreditation Effective Date: February 13, 2015
Accredited Length of Training 1 Year(s)
Program Format: Standard
Total Approved Resident Positions 3
Total Filled Resident Positions 2
Last Site Visit Date November 19, 2009
Date of Next Site Visit (Approximate): No Information Currently Present
Self-Study Date (Approximate): April 01, 2020
Program Requires Prior or Additional Accredited GME Training: Yes
Number of Prior or Additional Accredited GME Training Years 4
Program Requires Dedicated Research Year beyond Accredited Program Length No
Brochure: VA fellowship brochure 2015

 



OVERVIEW

The Boston University Medical Center / Boston VA Healthcare System Addiction Psychiatry fellowship is a one year (PGY V) program that was accredited by the ACGME in 1997.  The program is currently funded for three PGY V Fellows in addiction psychiatry.  We also sponsor a VA funded two year Interprofessional Advanced Addiction Fellowship Program which is designed to train future generations of VA healthcare leaders. The Addiction Psychiatry fellowship provides psychiatric physicians with advanced training in the recognition, diagnosis, and treatment of addictive disorders The VA Outpatient Clinic (OPC) at Causeway Street is the primary site for the fellowship. At this site, residents gain extensive experience working with patients on methadone and buprenorphine.  They also treat a full range of patients with other substance use disorders and co-occurring psychiatric disorders. A well-rounded and comprehensive series of didactic presentations as well as training at renowned Boston area tertiary care facilities ensures that graduates are clinically competent and knowledgeable in all aspects of addiction treatment. The development of broad expertise and an informed perspective on the addictions encompassing knowledge of the history of substance abuse and dependence, sociological aspects of addictions and public policy, and the role of self-help groups and spirituality in the treatment of addictions is an integral part of the fellowship.  To complement outpatient training experiences at the Boston VA, residents also rotate through the inpatient detoxification program at the Brockton VAMC, the Bedford VA (intensive outpatient treatment and geriatric services), the dual diagnosis adolescent rehabilitation program at Bright Futures / Spectrum Health Systems in Methuen, MA, Brigham and Women’s Hospital (addiction consultation services, services for pregnant women, and management of complex inpatient detoxification), and the Boston Public Health Commission (addiction services for men and women). Research opportunities are available at all of the primary rotation sites. This fully ACGME accredited PGY-V year residency is directed by Dr. John Renner, a widely recognized addiction psychiatrist. Required rotations, which include addictive disorders in the geriatric, adolescent, and consult-liaison populations take place at facilities throughout the greater Boston area. A significant amount of time is dedicated to treatment of addictions in the public sector. Fellows are also provided with substantial elective time and are encouraged to pursue research interests, for which a wide variety of mentors are accessible. The two year Advanced Interprofessional Fellowship provides opportunities for further specialization in research in the addictions, and/or management of addiction treatment units and addiction training programs.

 

GOALS AND OBJECTIVES

The Addiction Psychiatry Residency and the Interprofessional Advanced Fellowship in Addiction Treatment provide training for psychiatrists and other clinicians interested in pursuing a career in addiction treatment. The PGY V program is designed as a comprehensive training experience that will meet the requirements for eligibility for the American Board of Medical Specialties certification examination for Addiction Psychiatry.  Through a series of clinical, didactic, and research experiences, residents will develop competence in the following four areas:

  1. The clinical management of patients with substance use disorders utilizing all standard treatment modalities including psychological therapies, social interventions, self-help, and addiction pharmacotherapy:  Under close supervision, residents will be exposed to the full range of interventions from prevention to long-term treatment for chronic populations.  Emphasis will be placed on treatment interventions designed to address the needs of special populations such as the elderly, women including pregnant women, adolescents, minority groups, veterans and other trauma victims.  There will be a special emphasis on individuals with co-occurring psychiatric disorders.  Residents will have the opportunity to follow selected patients at the Causeway CBOC and at the Boston Public Health Commission for the duration of their year of training.  Experience will be gained utilizing managed care treatment models and APA recommended treatment guidelines, and trainees will gain competence in the long-term management of the addictive disorders.
  2. The conceptual foundations of addiction psychiatry:  Based on a rigorous program of reading, review of research articles, didactic seminars, self-directed learning opportunities, and participation in post-graduate courses, the trainee will gain familiarity with the scientific and clinical literature that supports modern addiction psychiatry practice.
  3. Research skills in addiction psychiatry:  Residents will be taught how to critically review the scientific literature, how to utilize basic research assessment instruments and will assist in the implementation of research protocols.  Advanced Interprofessional Fellows will select a mentor who will guide their career development and assist them in the implementation of a specialized clinical, management, educational or research project that can be completed during the two year course of their training.  Under the guidance of senior addiction faculty, they will be expected to prepare scholarly reviews, and develop and implement a research protocol, including data analysis and manuscript preparation.  These experiences will serve as the foundation for a leadership career in the addictions field.
  4. Teaching skills in addiction psychiatry:  Under the supervision of program faculty, trainees will participate in the training and supervision of medical students, junior residents, physician assistants, and other professionals.  Trainees will be expected to prepare and conduct academic seminars and journal club meetings, including the preparation of bibliographies and scientific presentations.

 

TRAINING SITES

Trainees are exposed to a broad range of experiences through rotations at several Boston area facilities.

BOSTON MEDICAL CENTER:

Boston Medical Center (BMC), one of the major clinical, research and teaching institutions in New England, is located 3 miles from the primary training site at the Boston VAOPC.  It was formed in 1996 by the merger of Boston City Hospital and University Hospital.  As the primary teaching institution of Boston University School of Medicine, it has extensive experience treating minority and disadvantaged populations, many of whom have substance abuse problems; 48% of the patients are covered by Medicare (31%) or Medicaid (17%) and reside in the inner city.  BMC has 547 active beds.  The population served by Psychiatry includes 40% African-American, 20% Latino, 30% Caucasian and 10% Caribbean, African, Bosnian and other recent immigrants.  BMC is the primary medical backup for an affiliated group of 10 neighborhood Health Centers that service the Boston inner city.  The Health Centers serve many elderly and minority patients; several operate outpatient substance abuse counseling programs on site.  BMC Addiction Services Programs are operated under the direction of the Boston Public Health Commission and are composed of four programs: 1) The Alcohol & Drug Clinic that provides drug free individual, group and family counseling, relapse prevention and risk reduction behavioral programming for patients with less than 2 years sobriety, 2) The Alternative Recovery Program, an acupuncture detoxification program, 3) The Triage & Transportation Program, which is a central intake and substance abuse referral service based in the Emergency Room of BMC that had 3,811 contacts last year.  Of this group, there were 76% males, 24% females, 43% African-American, 30% Caucasian and 26% Latino.  Consultations are provided to the Emergency Service and the inpatient units that serve a mainly minority population with an extremely high incidence of addiction and AIDS-related illnesses.  Case Conferences are held on a monthly basis with addiction medicine trainees and faculty at BMC.

VA BOSTON HEALTHCARE SYSTEM:

  • JAMACIA PLAIN CAMPUS
  • WEST ROXBURY CAMPUS
  • CAUSEWAY STREET OUTPATIENT CLINIC (CBOC)
  • BROCKTON CAMPUS

The VA Boston Healthcare System is the primary tertiary care referral center for five New England states, as well as a large primary care system that serves eastern Massachusetts. VA Boston comprises three main campuses, Jamaica Plain, West Roxbury and Brockton plus six community-based outpatient clinics.  The 188 bed West Roxbury Campus is the site for the acute inpatient Medical, Surgical, Neurological and Rehabilitation Services.  Acute Psychiatry, a Spinal Cord Injury Rehabilitation Program, an inpatient hospice program, a transitional care unit, nursing home unit and specialized substance abuse programs reside within the 418 bed inpatient beds and outpatient facilities at the Brockton Campus.  Training programs are overseen by a Dean’s Committee co-chaired by the deans of Harvard Medical School and BUSM.  VA Boston is one of the primary training affiliates of the BUSM Department of Psychiatry and is the sponsor for the Harvard South Shore Psychiatry Residency Training  Program..

Affiliated with the VA Boston Healthcare System is the Causeway Street Community Based Outpatient Clinic.  Causeway Street is a freestanding facility located in downtown Boston, approximately 6 miles from the Jamaica Plain Campus.  The Clinic provides primary care services along with psychiatric and substance abuse subspecialty care. The Causeway Psychiatry Clinic is one of the largest in the VA system and includes a Substance Abuse Treatment Program (SATP) with over 25,000 visits per year and over 1,600 patients seen in treatment each year.  John Renner, M.D. is Associate Chief of Psychiatry at the VA Boston Healthcare System, and Director of Mental Health Services/Chief of the Substance Abuse Treatment Program at the Causeway Street CBOC.  The SATP includes two major units, the Dual Diagnosis Clinic which primarily treats patients with a wide range of substance use disorders and co-occurring psychiatric disorders and the Drug Dependence Treatment Center, which provides methadone treatment services for 160 veterans with opiate use disorder.  Methadone treatment patients range in age from 27 to 76; over 50% are positive for Hepatitis C, but less than 3% are HIV positive. The SATP also provides office-based buprenorphine treatment for approximately 130 veterans, and an intensive dual diagnosis long-term rehabilitation program that follows approximately 150 patients.  The SATP is the primary addiction psychiatry training site for PGY III general psychiatry residents from the Boston University Medical Center Program.  In addition, the SATP serves as an elective addiction rotation site for the Harvard South Shore General Psychiatry Residency Training Program.  It is also the site for the Addiction Medicine elective clerkship for BUSM students.  Other trainees involved in the SATP are physician assistant trainees from the Massachusetts College of Pharmacy and Health Sciences.  Diagnostic groups treated at the OPC include substance abuse (40%), psychosis (40%), anxiety disorders (30%), depression (20%), and organic brain disorders (5%).  Patients are 95% male, 80% white, 15% black, and 5% Hispanic.  Treatment approaches utilized in the SATP include individual and group psychotherapy, motivational enhancement therapy, cognitive behavioral therapy (primarily relapse prevention approaches and the “seeking safety” protocol), and addiction pharmacotherapy, including office-based buprenorphine treatment, methadone maintenance, disulfiram and extended-release naltrexone treatment, and pharmacotherapy for co-occurring psychiatric disorders.  Faculty include 2 full-time and 1 part-time board certified psychiatrists with subspeciality certification in addiction psychiatry, 2 other part-time board certified psychiatrists, 2 psychologists, 5 social workers and 4 nurse clinicians. Addiction residents receive 1 to 2 hours per week individual supervision, and 1 to 2 hours seminars and case conferences per week.  All addiction psychiatry residents spend 8 weeks full-time at the SATP and then continue 8 hours per week for the duration of their residency in order to follow patients for long-term outpatient care.

The emergency department is located at the West Roxbury Campus, where there is also an active psychiatry Consultation-Liaison (C/L) Service.  Patients seen in the VA Boston Healthcare System have a full range of medical, surgical, psychiatric and substance use disorders.  The population is 85% male and ranges in age from 18 to 90.  The average age for all patients is 58.4 years.  Patients requiring complicated medical management are admitted to the medical service for detoxification.

 

BROCKTON VAMC INPATIENT SUBSTANCE ABUSE TREATMENT PROGRAM

 

AFFILIATED SITES:

  • BRIGHAM AND WOMEN’S HOSPITAL

As an integrated part of the West Roxbury VA Consultation-Liaison rotation, residents spend 24 hours per week for 12 weeks on the Consultation-Liaison service for Brigham and Woman’s Hospital (BWH), Division of Medical Psychiatry in the Department of Psychiatry.  BWH is an internationally known teaching hospital, an affiliate of the Partners Health Care System and a core teaching institution of Harvard Medical School.  Trainees work under the supervision of Joji Suzuki MD, a graduate of our addiction psychiatry residency and the Director of the Division of Addiction Psychiatry. Claudia Rodriguez MD, another graduate of our addiction psychiatry residency, also provides supervision. The Division of Medical Psychiatry provides addiction consultation services to all inpatient medical units including the emergency room, ICUs, burn-trauma, orthopedics, obstetrics, and a variety of outpatient clinics including primary care, and acts as the primary addiction education service for BWH staff.  BWH treats a mixed patient population, including 55% minorities and 40% women.  The Division of Medical Psychiatry consults on 800-900 addiction patients per year. Residents gain experience in managing acute medical illnesses complicated by substance use disorders. In particular, residents gain considerable experience managing acute pain, and buprenorphine inductions in hospitalized patients. Residents also obtain a supervised experience learning motivational interviewing from Dr. Suzuki, a member of the Motivational Interviewing Network of Trainers. Supervision is provided by two psychiatrist board certified in addiction psychiatry and board-certified psychosomatic medicine attendings on the C/L service. Residents are formally assigned to supervise PGY1 psychiatry residents from the Harvard Longwood Program, HMS 3rd year psychiatry clerks, and HMS 4th year students in their addiction elective.

  • EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL, BEDFORD, MA

Experience on an intensive day treatment substance abuse rehabilitation program is provided at the Intensive Day Treatment Program (IDTP) based at the Bedford VA.  The Bedford VA has 410 beds, a 50 bed domiciliary and a variety of intensive rehabilitation programs, including services for geriatric patients and substance abuse patients.  Based on ASAM placement criteria, the Addiction Severity Index, Cognitive Behavioral Treatment, and Psycho-education, the IDTP is the central component of a comprehensive, state of the art substance abuse treatment program.  Under the direction of Nitigna Desai, MD, the IDTP offers 35 hours per week of individual and group treatment for veterans who have just completed detoxification.  Typically these patients have a history of multiple prior treatment attempts, additional mental illness and are at high risk for relapse.  Three to four weeks of intensive services are provided as a bridge to a less intensive level of outpatient care.  Residents spend 20 hours/week at the IDTP for 12 weeks.  While at the IDTP residents will get to follow these patients in early recovery while facing the challenges of dual diagnosis, PTSD/SUD issues and medical complexities. They will also get to co-lead a psycho-education group addressing medical consequences and specific group for geriatric age patients with a staff psychiatrist, provide consultation on the management of geriatric patients with substance abuse-related problems and participate in daily clinical rounds and a weekly addiction teaching session/journal club. They will also get exposure to use of ambulatory detoxification protocols and proficiency in use of all alcohol and opiate use disorder interventions including buprenorphine/naloxone, oral naloxone, acamprosate, and extended- release naltrexone injection. Supervision is provided by Dr. Desai, who is a board certified addiction psychiatrist. Dr. Desai has been involved with teaching, training and research in the field of addiction and dual diagnosis as well as in geriatric addiction. She has participated and published in the area of psychopharmacological interventions for dual disorders for last 20 years.

In 2015, Dr. Desai was recognized by VA for nearly twenty years shepherding EXCELLENCE in addiction services, particularly her efforts to champion innovations in evidence-based care – including Contingency Management, Seeking Safety and opiate agonist treatment.

In 2015, Dr. Desai was recognized by VA for nearly twenty years shepherding EXCELLENCE in addiction services, particularly her efforts to champion innovations in evidence-based care – including Contingency Management, Seeking Safety and opiate agonist treatment.

 

  • BRIGHT FUTURES / SPECTRUM HEALTH SYSTEMS, METHUEN, MA

Bright Futures is a 90 day residential program for court-referred adolescent males (age13-20) with substance use disorders and co-occurring psychiatric disorders that is operated by Spectrum Health Systems under a contract with the Massachusetts Department of Youth Services. It serves as the Department’s state-wide substance abuse residential treatment program.  It is a level 111.5 “dual diagnosis capable” program that provides trauma-informed individual, group and family services, pharmacotherapy, motivational counseling, and educational services.  Fellows spend 20 hours/week at this facility for 4 weeks, participating in assessment, treatment planning, and individual and group psychotherapy.  They also participate in the full-time academic program that is presented onsite by special education teachers.

 

SCHOLARLY ACTIVITY

This is a major priority of the Addiction Psychiatry Residency and the Interprofessional Advanced Fellowship Program.  Trainees who elect the 2 year advanced fellowship program may elect to spend a majority of their time doing research.  They may elect either a basic science, quality improvement or a clinical research experience.  All fellows are encouraged to review the literature and research topics of interest.  They are expected to conduct training seminars for junior residents several times a year.  Selected residents may also elect a combined Addiction Psychiatry Residency – Master’s Degree program at the Boston University School of Public Health.  One tuition reimbursed position is available annually in the BU School of Public Health for the Boston University Medical Center Psychiatry Residency Training Program.  Trainees are also eligible to attend courses sponsored by the Division on Addictions at Harvard Medical School and educational meetings organized by the Interest Group on Alcoholism and the Addictions of the Massachusetts Psychiatric Society.  The VA also provides up to $850 dollars per year for educational tuition and travel reimbursement for Addiction Psychiatry Residents.  For further information on fellowship benefits please consult the BMC website www.bmc.org/gme/housestaff/benefits.htm . VA funding is also available to support research activities for PGY VI residents or fellows who elect the 2 year program.

 

NIGHT CALL

There is no required night call for Addiction Residents or Interprofessional Advanced Fellows.  Residents and fellows will be paid for elective night call at BMC during their addiction training.  These night call options are subject to the RRC mandated 80-hour work week limit, and must be approved by the training program director.  Trainees are also allowed to moonlight at other sites with approval of the training program director.

For more information about the Addiction Psychiatry Residency please contact:

John A. Renner, MD

Director, Addiction Psychiatry Residency Training Program

VA-Outpatient Clinic

251 Causeway Street

Boston, MA 02114

Telephone:  617-248-1022

FAX:          617-248-1121

e-mail:        john.renner@va.gov

Program Coordinator: Lynne Rose  lynne.rose@bmc.org   Tel: 617-638-8548

 

INTERPROFESSIONAL ADVANCED FELLOWSHIP IN ADDICTION TREATMENT

The primary goal of this specialized, two-year advanced fellowship is to train future generations of VA leaders to design and conduct innovative and cutting edge research that will enhance our understanding of addictions and its co-morbidities, to become proficient in evidence-based clinical care for substance use disorders and associated co-morbidities such as PTSD, and to learn to effectively manage teams, services (clinical or research), and/or training programs. The program is designed to have a strong interprofessional focus and is open to both physicians, psychologists, and other healthcare professionals. We have assembled an outstanding faculty that can provide training in the conduct of research in basic biological sciences, psychopharmacology and medication development, treatment outcomes, and/or service delivery related to the addictions, clinical mentorship across a broad range of clinical training sites (including programs for Veterans with addictions and PTSD, and specialized programs for women Veterans and returning Veterans), and management training experiences at all levels of the organization. Fellows will spend 75% of their time in educational, management, and research training, and 25% in direct clinical care activities. A focus on individualized training and the availability of a unique blend of educational, clinical, management, and research opportunities should ensure a high quality learning experience for each fellow. The trainee will be joining an academically rich and vibrant training environment that includes programs affiliated with Boston University School of Medicine and Harvard Medical School for physicians, psychiatrists, psychologists, and other allied health professionals.

 

Research Options:

The VA Boston Healthcare System is home to researchers in basic neuroscience, epidemiology, clinical assessment, medication development, and pharmacological and psychosocial treatment and services outcome research. In collaboration with researchers affiliated with Boston University and Harvard Medical School, fellows have the opportunity to work with researchers whose work is focused on: (1) the effect of ethanol on nervous system development, (2) signaling pathways and neural plasticity in models of addiction and PTSD, (3) factors involved in relapse and re-hospitalization following treatment for addictions, (4) psychosocial treatments for addiction, (6) novel pharmacotherapies for addiction, (6) psychosocial interventions for PTSD in Veterans with substance use disorders, (7) technological advances (e.g., Web and mobile applications) in reaching and intervening with combat Veterans with problem drinking and PTSD, (8) interplay of emotion regulation and information processing in the treatment of addiction, and (9) integration of substance-related and medical health care.

 

Qualifications:

A basic requirement for applicants is U.S. citizenship. Additional requirements for physicians include:  1) completion of an ACGME accredited residency program, 2) a full and unrestricted license to practice in the U.S. or any of its territories, 3) board certified or eligible, and 4) if a graduate of a foreign medical school, must have evidence of ECFMG certification that is valid indefinitely. For psychologists this includes: 1) completion of an APA-accredited doctorate in clinical or counseling psychology (or meeting APA criteria for re-specialization training) and 2) completion of an APA-accredited psychology internship. Applicants are expected to have a primary interest in a VA career focused on developing, implementing, and managing programs, teaching, and/or conducting research to ultimately improve healthcare for Veterans with substance use disorders.

 

Interprofessional Fellowship Application Procedures:

Please submit a letter of interest, CV, and the names of three references. The letter of interest should describe an applicant’s interest in the program, a summary of educational, clinical, and research experience relevant to application, and a statement of career goals. All materials for the Advanced Fellowship should be submitted electronically to BostonAddictionFellowship@va.gov.  Please contact John Renner, M.D. (617-248-1022, john.renner@va.gov) or Deborah Brief, Ph.D. (857-364-4689, deborah.brief@va.gov) for further information about positions for physicians and psychologists, respectively. Additional information about faculty and specific training experiences is available upon request.