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 Harris County Health System and The Menninger Clinic. Fellow rotations at Harris Health include addiction-specific cases in the Emergency Department at Ben Taub Hospital 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 Michael E. DeBakey VA Medical Center and other community affiliates such as the Montrose Center and Santa Maria Hostel. 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 conduct outpatient work at The Montrose Center, which carries a special emphasis on serving the LGBTQ population, while care at the Santa Maria Hostel allows trainees to make a powerful impact on the recovery of female patients, particularly those struggling with addiction during the perinatal and postpartum periods.
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.
