The program accommodates a total of four fellows each academic year. Each training year is divided into two six-month blocks.
The first six-month block is comprised of clinical rotations shared between and . Fellow rotations at Harris Health include addiction-specific cases in the and outpatient work within the Substance/Addiction Treatment Program. In addition, there will be unique experiences within an Obstetrics-Addictions rotation and Child and Adolescent Addiction Psychiatry clinic. Rotations at The Menninger Clinic, a voluntary long-term inpatient treatment program, will include invaluable experiences working with the addictions faculty in both inpatient and outpatient settings as well as formal assessment and consultation.
The second six-month block is composed of clinical rotations shared between and Texas Children’s Hospital. While training at the MEDVAMC, fellows will have rich experiences with chemical dependency groups, the VA's Opioid Treatment Program which offers Medications for Opioid Use Disorder, addictions-based Consultation- Liaison rotation, and acute withdrawal management inpatient treatment for co-occurring disorders. During these six months, fellows provide addictions telehealth services to children and adolescents throughout southeast Texas through the Texas Child Mental Health Care Consortium – Texas Child Health Access Through Telemedicine (TCHATT) program.
Case conferences and journal clubs allow fellows to engage in interdisciplinary problem-solving with challenging cases, stay connected to other fellows, as well as stay up to date on the most relevant addictions literature.
Overall, these rotations will provide a well-rounded experience for trainees that spans the full spectrum in levels of care for substance use disorder. Fellows will master both FDA-approved and off-label pharmacotherapeutic treatment of use disorders, including buprenorphine and methadone. Fellows will fortify skills in addictions-based therapy, including motivational interviewing, cognitive behavioral therapy, contingency management, and twelve-step facilitation.
Didactics
Fellows are encouraged to attend Baylor Psychiatry's Grand Rounds, which are held every Wednesday throughout the academic year and include a variety of topics related to the history and practice of psychiatry. Fellows are also encouraged to attend Baylor Psychiatry's Journal Club. Additionally, fellows are invited to participate in the MEDVAMC Psychiatry Noon Conference, held every other Monday throughout the academic year.
The clinical faculty leads weekly didactics for the Addictions fellows on Friday afternoons. The Fundamentals of Addictions course focuses on readings from seminal texts in the field, examining the neurobiology of addiction, and studying the mechanism of action, clinical presentation, and treatment for each substance of abuse. The Psychotherapeutics of Addiction course introduces the concept of addiction as a behavioral and psychodynamic phenomenon as well as providing instruction in the treatment of addictive disorders using various psychotherapy modalities (including CBT, DBT, MET, ACT and contingency management). Faculty will also provide separate supervision on addiction group psychotherapy to fellows. Under supervision of an addictions-boarded faculty member, fellows will also present to each other the chapters of The ASAM Principles of Addiction Medicine textbook. This unique format will sharpen presentation skills as well as prepare all fellows for their addictions board examination.
Teaching Opportunities
Fellows participate in teaching medical students and/or resident lectures on addictions-related topics. Every year, the general psychiatry residency holds a 14-lecture seminar on addictions for PGY-1 residents. Fellows historically have provided a lecture each for this seminar. Fellows are provided with instruction and feedback on teaching.
Teaching opportunities exist for fellows who are encouraged to present lectures to general psychiatry residents on addictions-based topics, or to provide medical student/resident education during the consultation/liaison (C/L) or inpatient rotations. In addition to clinical responsibilities, mentorship is provided through both formal and informal supervision of fellows by the clinical faculty.
Research
Addictions faculty mentors are assigned to work with trainees on addictions research and/or Quality Improvement projects to assist with successful identification and completion of scholarly work. Under the guidance of Thomas R. Kosten, M.D., addictions-based research activities include a host of psychiatric researchers, geneticists, immunologists and research associates. Opportunities to participate in pharmacotherapy clinical trials of novel treatments for substance use disorders, pharmacogenetics, and neuroimaging are widely available throughout the Department. In addition, The Menninger Clinic and Harris Health contain a wealth of data on patient treatment and outcomes which can be utilized towards development of an addictions-related research project.
Articles and book chapters published by fellows (partial list):
Truong T, David E. “Substance Use in HIV Populations.” AAHIVM Fundamentals of HIV Medicine. Oxford University Press, 2021.
Ridgeway-Diaz J, Truong T, Gabbard GO. Return of the Repressed: Bong Joon-Ho’s Parasite. Academic Psychiatry, 2020.
Medina M, Lee D, Garza DM, Goldwaser EL, Truong T, Apraku A, Cosgrove J, Cooper JJ. Neuroimaging Education in Psychiatry Residency Training: Needs Assessment. Academic Psychiatry, 2020.
Shahin H, Livingston R. A Case of Ischemic Stroke Incidental to the Postelectroconvulsive Therapy Period. Journal of ECT, 2020.
Ayanga D, Shorter D, Kosten TR. Update on Pharmacotherapy for Treatment of Opioid Use Disorder. Expert Opinion on Pharmacotherapy, 2016.
Ng S, Rizvi S, Kunik ME. Prevalence of Homeless Older Adults and Factors Causing Their Homelessness: A Review. The Internet Journal of Geriatrics and Gerontology, 2013.
Training Sites
Located in the Texas Medical Center, MEDVAMC is one of the largest facilities in the VA Medical Center system. A state-of-the-art facility on a 118-acre campus, MEDVAMC has 359 acute-care beds, a 40-bed Spinal Cord Injury Center, and a 141-bed Community Living Center for long-term care. There is also a 40-bed domiciliary residence for homeless veterans. In fiscal year 2008, MEDVAMC served more than 130,000 veterans in the southeast Texas region. Medical, psychiatric and emergency staff are available 24-hours a day, and there are readily accessible general and psychiatric emergency room services. Of note, research conducted at MEDVAMC is supported with more than $26.8 million annually, and currently there are over 640 active research projects taking place.
The MEDVAMC substance abuse program offers a full continuum of care to include inpatient and outpatient detoxification, partial hospitalization, low intensity treatment, a methadone/buprenorphine program, case management, social support services, vocational counseling, and medical and psychiatric care.
Located less than seven miles away from the primary training site, the Menninger Clinic is an established leader in psychiatric clinical care, education, and research. A 126-bed facility, the Menninger Clinic provides comprehensive psychiatric assessment and long-term inpatient psychiatric care for a wide range of issues including drug/alcohol addiction, psychiatric illness and co-occurring disorders, disruptive behavior in the workplace, career stress and burnout, and eating disorders.
Treatment modalities utilized at the Menninger Clinic include milieu therapy, pharmacotherapy, psychodynamic psychotherapy (individual & group), mentalization-based therapy, cognitive-behavioral therapy, dialectical behavioral therapy, motivational enhancement therapy, psychosocial rehabilitation, family therapy, 12- step self-help models, relapse prevention, addiction counseling, nutritional counseling, spiritual counseling, recreational therapy, and psychoeducation. Core faculty for the rotation will consist of four addiction psychiatrists. Additional program-specific faculty (psychiatry, psychology, social work, and other disciplines) will participate throughout the course of the rotation.
Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. The system, which has a special focus on treating the underserved or indigent population, includes 18 community health centers, same-day clinics, mobile health units, and two full-service hospitals (Ben Taub Hospital and Lyndon B. Johnson Hospital). Ben Taub Hospital is a world renowned Level 1 trauma center with 444 licensed acute-care beds and a wide range of specialty outpatient services. Ben Taub Hospital houses a large Emergency Department, which also includes a dedicated Psychiatric Emergency Department. Within immediate walking- distance of Ben Taub Hospital is the Neuropsychiatric Center (NPC), which includes inpatient psychiatric services as well as specialized outpatient psychiatry clinics.
, a nonprofit organization, empowers the LBGTQ community and their families to live healthier, more fulfilling lives. The program consists of state-licensed clinicians, masters-level therapists, skilled educators, support staff, and dedicated volunteers. Because LGBTQ persons face numerous health disparities compared to the general population, the Center has embraced an integrated care model with one-stop access to behavioral health and support services, adult primary care and psychiatry. Recovery programs for addictions include an Intensive Outpatient Program as well as a Supportive Outpatient Program.
aims to empower women and their families to lead healthy, successful, productive, and self-fulfilling lives. It provides services for low-income, indigent women age 18 and above and their children from Harris and surrounding 12 counties. Women in the program face many challenges including trauma history, criminal justice and CPS involvement, homelessness or housing instability. 6,274 women and children received services last year alone, and 90 percent of women and their children in their transitional housing program find permanent housing. Also 64 percent of women in transitional housing program find employment. Substance use recovery programs include but is not limited to residential detoxification and outpatient services.