Addiction Psychiatry Fellowship

Director: Karen Drexler, M.D.

Address: Substance Abuse Treatment
Program (116A)
Atlanta VAMC
1670 Clairmont Road
Atlanta, GA 30033

Phone: (404) 321-6111 x6900
Fax:(404) 329-4643

E-mail: karen.drexler@med.va.gov

Level: PGY-5
Positions: 2
Accreditation: ACGME

Addiction Psychiatry Residency Program

The Addiction Psychiatry Residency Program is a one-year program. Residents (Fellows) train at the Atlanta VA Medical Center and affiliated sites. Fellows receive direct supervision in evaluation and treatment of men and women of different ages, ethnic and socioeconomic backgrounds with addictions to all of the major classes of addicting substances. Each fellow participates in four three-month rotations: VAMC partial hospital program, VAMC inpatient detoxification, Metro Atlanta Recovery Residences (MARR), and Grady Memorial Hospital. Residents receive supervised training in performing patient evaluations, managing detoxification and rehabilitation, and treating psychiatric co-morbidities. They participate in clinical supervision and formal didactic training of general psychiatry residents and medical students. The standard inpatient caseload is between 4-6 inpatients and 4-12 outpatients in intensive rehabilitation. Residents also follow outpatients for individual psychotherapy and medication management throughout the year.
Wednesday morning seminars cover specific reading assignments based on the topic areas covered in the American Board of Psychiatry and Neurology examination and requirements of the Accreditation Council on Graduate Medical Education. Didactics address neurobiology, diagnosis and treatment of all the major classes of addicting substances, pharmacotherapy and psychotherapy, and related topics including public policy, ethics, and medications development.
A more detailed description of our program can be requested by calling Jane Langford, Program Coordinator, at 404-321-6111 x-7429.

Affiliated Institutions and Rotations

ATLANTA VETERANS AFFAIRS MEDICAL CENTER (Atlanta VAMC)
Atlanta VAMC serves over 440,000 veterans residing in metropolitan Atlanta and northern Georgia. The medical center is dedicated to providing acute medical, surgical, intermediate, and psychiatric care, and both primary and specialized outpatient services with almost all major specialties and subspecialties represented.
Atlanta VAMC is a dean’s committee, tertiary facility comprised of 191 operating hospital beds and 100 operating nursing home care unit beds. The facility is located east of Atlanta, Georgia, on the northeast edge of Emory University’s Campus. Atlanta VAMC serves as a primary teaching hospital of the Emory University School of Medicine with a major, highly active research program.
The Substance Abuse Treatment Program (SATP) of the Atlanta VA Medical Center treats over 1,500 veterans each year with a variety of addictive disorders. In order of prevalence, they include nicotine dependence, cocaine dependence, alcohol dependence, cannabis dependence, opioid dependence, benzodiazepine dependence, and others. Over one-third of veterans in the SATP have co-occurring mental disorders including post-traumatic stress disorder, mood disorders, other anxiety disorders, and psychotic disorders.
Addiction Psychiatry residents spend three months rotating through the partial hospitalization addiction rehabilitation program (Track 4) and three months on the inpatient detoxification unit. Throughout both rotations, they receive supervised training in the opioid substitution therapy program, the consultation-liaison service, and the substance abuse treatment program walk-in clinics. Residents work within a multidisciplinary team -- four psychiatrists, one clinical psychologist, three social workers, certified addiction registered nurses, and certified addiction counselors.

GRADY MEMORIAL HOSPITAL
Grady Memorial Hospital has been in the heart of downtown Atlanta for over 100 years, located approximately seven miles from the Atlanta VA Medical Center and Emory University. With 1,000 inpatient beds, Grady is a primary teaching hospital of the Emory University School of Medicine and Morehouse School of Medicine. Grady Memorial is the primary hospital for inner city and medically indigent populations in the two largest counties of metro Atlanta. Construction of a $350 million renovation of the physical plant was completed in 1995. Total patient volume in the Emergency Care Center is approximately 100,000 patients per year.

Addiction Psychiatry Residents participate in a full-time, three-month rotation at Grady. They spend about 20 hours per week in the adolescent treatment program (DATE) located on a high school campus, about 1.5 miles from Grady Memorial Hospital and eight miles from the Atlanta VA Medical Center. The remainder of time is divided between the Drug Dependency Treatment Unit (DDU) -- the city’s largest methadone maintenance program, the Infectious Disease Clinic, and the Dual Diagnosis Program. Psychiatrists, clinical psychologists, social workers and clinical nurse specialists provide multidisciplinary clinical supervision.

METRO ATLANTA RECOVERY RESIDENCES (MARR)
MARR, Inc., is a private, nonprofit community-based residential addiction treatment program that provides several levels of care. These include intensive outpatient/partial hospitalization, high-intensity residential, low-intensity residential, aftercare, family services, and services for recovering professionals. MARR owns and operates more than 35 recovery residences that offer a therapeutic “community” in which each patient progresses through the recovery process in a family-type environment. The organization owns and operates two gender-specific day treatment primary addiction treatment programs: Men’s Recovery Program (MRC) and the Women’s Recovery Program (WRC). In September 2000, MARR began a program to provide long-term residential addiction treatment services to DeKalb and Fulton County women who are recipients of Temporary Assistance to Needy Families (TANF), along with wraparound services to their dependent children, a program called Right Side Up. Addiction Psychiatry residents rotate through all three of these treatment programs during their three-month rotation. The main treatment and administrative facility is located in northeast metropolitan Atlanta about 10 miles
from the Atlanta VAMC. Most of the MARR treatment facilities are located within 15 miles of the Emory campus, except the Women’s Recovery Center (WRC), which is scheduled to move to Lawrenceville, Georgia (27 miles from Emory) in 2003.

Patients include men and women with primary addictive disorders; depending on the patient population, at least half of the patients have co-occurring psychiatric disorders. The most common psychiatric diagnoses include mood disorders, anxiety disorders, and personality disorders. Treatment approaches include individual and group psychotherapy, psycho-education, 12-step facilitation, behavior modification, therapeutic community, psychopharmacology, recreation therapy, and family therapy. Residents have shared responsibility with other staff for 12-15 outpatients and have three hours per week of individual and group supervision.

The faculty consists of six part-time physicians: five are psychiatrists and one is an internist. The MARR Medical Director is board certified in Addiction Psychiatry. Two of the other psychiatrists are board eligible, and two are board certified in General Psychiatry. One is board certified in Child and Adolescent Psychiatry. In addition, residents work with three to four registered nurses, two family nurse practitioners, and several Master’s level counselors and certified addiction counselors.

Specific Goals/Objectives of Rotations
ATLANTA VAMC – Program includes two three-month rotations, one in intensive inpatient rehabilitation, and the other in intensive outpatient rehabilitation. Patients are evaluated in the walk-in clinic, in consultation on Surgery and Medicine Units, in the Methadone Clinic, and as outpatients. Residents supervise and teach PGY-2 General Psychiatry residents and Emory medical students.

Inpatient Detoxification Unit or Intensive Outpatient Rehabilitation Unit: 20 hours/week

Inpatient Consultation: 6 hours/week

Intake Assessments: 6 hours/week

1. Residents will be able to recognize and address the signs and symptoms of intoxication and withdrawal from major categories of psychoactive substances.
2. Residents will be competent in managing inpatient and outpatient detoxification from all major categories of psychoactive substances.
3. Residents will be able to evaluate patients to determine the most appropriate level of care for addiction treatment using standard criteria such as Interqual and ASAM.
4. Residents will be able to identify the signs and symptoms of psychoactive substance use and dependence and psychiatric co-morbidities.
5. Residents will medically manage psychiatric co-morbidities including post-traumatic stress disorder, schizophrenia, bipolar disorder, depression, and anxiety disorders.
6. Residents will be able to confront and intervene with unhealthy defense mechanisms.
7. Residents will be able to lead multidisciplinary treatment planning to address individual problems within a bio-psychosocial-spiritual framework.
8. Residents will be able to medically manage patients in opioid substitution therapy.
9. Residents will develop group and individual psychotherapy skills including cognitive-behavioral, 12-step facilitation, motivation enhancement, and psychodynamic methods.
10. Residents will provide consultation to Medicine, Surgery, and Intensive Care units for those patients with psychoactive substance dependence.

GRADY HEALTHCARE SYSTEM – Patients are seen in three programs:

Booker T. Washington High School – 16 hours/week (adolescent program)

Grady Memorial Hospital Methadone Clinic – 8 hours/week

Infectious Disease Clinic – 8 hours/week

1. Residents will be able to identify the signs/symptoms of psychoactive substance use and dependence and psychiatric co-morbidities.
2. Residents will medically manage psychiatric co-morbidities (in both adults and adolescents with addiction) to include post-traumatic stress disorder, schizophrenia, bipolar disorder, depression, and anxiety disorders.
3. Residents will develop the skills to treat addicted adolescents.
4. Residents will be able to confront and intervene with unhealthy defense mechanisms.
5. Residents will be able to lead multidisciplinary treatment planning to address individual problems within a bio-psychosocial framework.
6. Residents will gain experience in opioid substitution therapy.
7. Residents will develop psychotherapy skills to include group, individual, and family interventions and treatment.
8. Residents will provide consultation to the Infectious Disease Program on patients with HIV and psychoactive substance abuse disorders, with or without other psychiatric co-morbidities.

MARR – Patients are evaluated in three programs:

Men’s Program – 16 hours/week

Women’s Program – 12 hours/week (includes Right Side Up)

Professionals’ Program – 4 hours/week

1. Residents will be able to recognize and address the signs and symptoms of intoxication and withdrawal from major categories of psychoactive substances.
2. Residents will be competent in managing outpatient detoxification from alcohol, opioids, and sedative-hypnotics.
3. Residents will be able to confront and intervene with unhealthy defense mechanisms.
4. Residents will be able to lead multidisciplinary treatment planning to address individual problems within a bio-psychosocial-spiritual framework.
5. Residents will gain experience as advocates for professionals in recovery with respect to licensure issues.
6. Residents will develop psychotherapy skills in working with men, women, and their children in group, individual, and family sessions.
7. Residents will develop skills to treat addicted women through pregnancy and postpartum.
8. Residents will medically manage psychiatric comorbidities in patients seeking treatment for substance use disorders.

Didactics Curriculum

Wednesday mornings are reserved for academic activities. Residents participate in Didactics lectures (8:00-11:00) to include small group discussions with experts in Pharmacology, Neuroimaging, Clinical Care, and Epidemiology. Schedule of lectures for current academic year – along with references to be reviewed before and during lectures – is enclosed in resident handbook.

Residents are expected to spend Wednesday afternoons seeing long-term patients and pursuing scholarly activities. Each resident is expected to complete at least one scholarly activity to include a research paper, review paper, or other activity approved by the Program Director.

Emory has a diverse faculty devoted to researching addiction --- from Molecular Neuroscience, to Rodent and Primate Animal Models, to Human Neuroimaging, Clinical Trials, and epidemiological studies. Residents may elect to pursue research projects in any of these areas.

Staff

Addiction Psychiatry staff currently consists of two full-time addiction psychiatrists who are certified by the American Board of Psychiatry and Neurology with the added qualification in Addiction Psychiatry and one who is board eligible in Addiction Psychiatry. In addition, we have two addictionologists who are board certified in Child and Adolescent Psychiatry, one addictionologist with special training in community psychiatry, and two full-time clinical psychologists with experience in treatment of psychoactive substance use disorders.

Qualifications
Applicants must complete a psychiatry residency program before beginning the addiction psychiatry residency program (PGY-5) and should be qualified to obtain a Georgia State License. Detailed information about our program can be requested in writing or by calling Jane Langford at 404-321-6111, x-7429. A complete packet and application will be mailed to you. Applicants are required to provide three letters of reference (one from his/her General Psychiatry Program Director), a copy of medical license, his/her Curriculum Vitae, and a copy of his/her medical school diploma, transcripts, and a letter from the dean.

 

7/3/03

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