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The Addiction Fellow’s clinical time is associated with UC Health and the Cincinnati Veterans Affairs Medical Center, ensuring adequate exposure to a wide array of demographic populations and a wide breadth of diagnosis and severity of substance use disorders. We have developed robust clinical and didactic experiences to train all fellows in SUD comprehensively.
All fellows will receive four weeks of vacation. There are no weekend clinical or call responsibilities. Fellows will alternate in two-month blocks between inpatient and outpatient rotations described below.
Fellows will have their own panel of patients at the outpatient addiction sciences division (ASD) clinic, for which they will care longitudinally throughout the year. They will have two half-day sessions weekly to care for this panel of patients to gain expertise in caring for patients within a chronic disease model of addiction and providing care that combines pharmacological and behavioral treatments for SUD. This panel will include individuals in opioid treatment programs (methadone, buprenorphine, and ER naltrexone). This clinic uniquely offers a low-barrier care model, and patients can walk in four days a week, with no appointment necessary to start addiction treatment. During outpatient rotations, fellows will complete comprehensive assessments for individuals who use walk-in services at ASD.
This clinic provides SUD treatment integrated within an internal medicine practice at Hoxworth. Fellows will provide comprehensive addiction treatment services integrated within this unique model.
The Cincinnati VAMC has a dual-diagnosis clinic where fellows will spend 1-2 days during their outpatient blocks providing care for veterans with substance use disorders and co-occurring mental health diagnoses. Fellows will be exposed to diverse patient cases and navigate the management of complex addiction and psychiatric clinical cases.
The Cincinnati VAMC Tobacco Cessation clinic, where fellows will spend time during an outpatient block, will give them the opportunity to explore the complexities of addressing nicotine addiction among veterans. Fellows will engage in direct patient care, conducting assessments and providing evidence-based pharmacotherapy. They will collaborate closely with a multidisciplinary team, including pharmacists and nurses, to develop personalized treatment plans. They will also refine their skills in motivational interviewing and relapse prevention counseling strategies. Opportunities for both individual and group-based models of care for tobacco cessation are available.
The Cincinnati Contingency Management clinic offers fellows the chance to implement innovative strategies in addiction treatment. Fellows will actively utilize contingency management principles focusing on positive reinforcement to promote recovery and adherence to treatment among veterans with substance use disorders. They will collaborate closely with an interprofessional team to develop an understanding of the role of incentives and rewards in behavior change. They will identify patients in the VA-SUDEP clinic that they can follow longitudinally during at least one outpatient block to deliver contingency management.
Fellows will rotate for at least two half-days a week for one month at Adolescent Substance Abuse Programs (ASAP). ASAP provides outpatient treatment for substance use disorders in a family-centered environment. Their abstinence-based programs are diverse, offering both outpatient and 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.
Fellows will spend approximately 4.5 months in divided blocks through the year on the hospital-based Addiction Consult Services at UC Medical Center. This service provides comprehensive assessment, diagnosis, treatment, and linkage to care for adults with substance use disorders who are hospitalized. Fellows provide support for relevant medical and psychiatric conditions associated with SUD and develop experience in acute pain management for individuals with SUD. The consult team is staffed by a board-certified addiction medicine or addiction psychiatry attending, a social worker, and a peer to provide team-based care to patients.
The VAMC has an inpatient medically supervised withdrawal clinical unit. All fellows will spend 2 weeks learning about the assessment, triage, and treatment for individuals requiring medical management of their withdrawal syndromes.
Didactics will occur weekly, and fellows will be protected from their clinical duties for half a day. We utilize a combination of the American College of Academic Addiction Medicine (ACAAM) Addiction Medicine Didactic Curriculum, as well as faculty experts from the following UC Division of Addiction Science Faculty, UC Center for Addiction Research Faculty, and Cincinnati VAMC
All fellows will be required to participate in scholarly activity and all fellows at a minimum will be expected to complete the following.
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.
One of the primary training sites is the Cincinnati VA Medical Center, a Joint Commission 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 CVAMC addiction care line features roughly 50 addiction-dedicated staff including 6 physicians (with board certification in Addiction Medicine, Addiction Psychiatry, Family Medicine, Internal Medicine, and Psychiatry).
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.
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.
In summary, this fellowship provides a robust scope and depth of addiction specific services including:
Evidence-based addiction specific psychotherapies including:
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.
Additional supervisory processes
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 ClubThe 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 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.
Cincinnati Psychoanalytic Institute (optional)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.
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