Addiction Medicine
Educational Purpose And Goals
The purpose of the Addiction Medicine curriculum is to supplement resident learning by highlighting the specific knowledge, attitude, and skills needed to manage patients with alcohol and other substance use disorders, including prescribed medications and other non-proprietary drug use. The goal of the rotation is for residents to be able to diagnose and treat substance use disorders. After this rotation, the resident should feel comfortable managing acute withdrawal, making the proper diagnosis of use disorder and/or other co-morbidities, and working with the primary team to develop a treatment plan that medically optimizes chances of recovery and success.
Principal Teaching Methods
1. Residents will care for patients with a wide range of disorders related
to the use and
misuse of prescribed medications, non-prescribed substances, and alcohol.
Residents will care for patients with substance use disorders seen in
ambulatory practices and the
resident continuity clinics as schedule permits. Under faculty supervision,
residents may
participate in Street Medicine, wherein they will provide care to unsheltered
patients with substance use disorders.
2. Residents will learn to address medical, surgical and psychiatric co-morbidities and
complications of addictive disorders.
3. Residents will attend lectures on various aspects of common addictive disorders.
Methods of Evaluation
Resident Performance
Faculty complete competency-based electronic resident evaluation forms in New Innovations. The evaluator gives a formative assessment of core competency performance and shares this evaluation with the resident; it is also available for online review by the resident at their convenience.
Program and Faculty Performance
Upon completion of the rotation, residents complete a rotation evaluation form commenting on the faculty, facilities, and service experience. These confidential evaluations are available for the Program Director to review, and the attending faculty physician receives periodic feedback after sufficient residents have completed the elective to maintain anonymity.
Specific Competency Objectives
1. Patient Care
a. The resident will be able to conduct a patient-centered history to obtain the
overarching, personal dimensions of the patient’s addiction and its context.
b. The resident will be able to elicit via relationship-centered interviewing,
the essential
details of the patient’s addiction: types and amounts of substances
used/misused,
duration of use, pattern of use, age at first use and first misuse, prior
problems, prior
withdrawal experiences, legal problems, personal problems, environmental
circumstances fostering substance use, prior efforts to stop and their
success, wish to
stop now, status as pre-contemplative vs. contemplative, what has worked
in the past,
associated psychiatric problems, and associated medical problems related
or unrelated
to the substance use.
c. The resident will be able to diagnose substance-related and addictive disorders
using DSM-V criteria.
d. The resident will be able to perform a relevant physical examination and identify
evidence, for example, of cirrhosis of the liver, withdrawal manifestations, and
organic mental symptoms.
e. The resident will be able to succinctly summarize and synthesize in the
patient’s chart
the biopsychosocial aspects of the patient’s addiction.
f. The resident will be able to articulate key decision-making issues for
each patient,
particularly being able to identify what stage of change the patient exhibits.
g. The resident will be able to identify a management plan for those who
are precontemplative (wish to do nothing): follow-up visits for further
discussion, measures
to decrease usage, and available support.
h. The resident will be able to identify a management plan for those who are
contemplative (actively considering treatment): involve relevant family members,
provide information about resources (AA, friends, religious organizations,
professional); and encourage their use, support, and wise counsel.
i. The resident will be able to identify a management plan for those who
wish to take
action: negotiation of referral to addiction specialists, remaining involved with the
patient, communicating with the specialist; support, wise counsel, and
comanagement with regular visits, and treatment of co-morbid medical and
psychiatric
problems.
2. Medical Knowledge
a. The resident will develop the knowledge base in addiction medicine to become
proficient within their general specialty practice.
b. The resident should understand the epidemiology and various manifestations of the
spectrum of alcohol and substance use disorders in adults.
c. The resident should become familiar with available multiple treatment
modalities,
including pharmacotherapy for the management of alcohol and other substance use
disorders.
3. Interpersonal and Communication Skills
a. The resident will be able to integrate relationship-centered communication skills to
gain a biopsychosocial understanding of the patient’s addiction.
b. The resident will be able to use similar skills in relating effectively
to other team
members in the consult service and clinic.
c. The resident will be able to practice humanistic medicine with addiction patients.
4. Professionalism
a. In sometimes difficult patients with addiction, the resident will be able to always
exhibit respect, understanding of the patient’s vantage point, acknowledge the
patient’s plight, and find something praiseworthy about the patient.
b. The resident will be able to become the patient’s ally, provide
support and counsel in a primary care setting, and provide information
and other resources needed by the
patient.
c. The resident will be sensitive to cultural, disability, lifestyle, and
gender differences
in addiction medicine patients.
d. The resident will be able to articulate, understand, and practice in a
way consistent
with ethically sound, patient-centered practices.
5. Practice Based Learning and Improvement
a. The resident will be able to critically appraise the literature and apply
this knowledge
to the patient.
b. The resident will be able to make self-assessments of his/her impact with addiction
patients and also learn to identify their own attitudes and emotions that might
interfere with high quality care.
6. Systems Based Practice
a. The resident will be able to recognize and address the systems aspect
of the addiction
patient’s problems in their biological, psychological, and social
complexity.
b. The resident will be able to refer consultations to addiction specialists
effectively,
including recognizing first the need to negotiate this referral with the patient.
c. The resident will be able to recognize the cost impact of addiction problems as well
as provide cost effective care for these patients.
d. The resident will be able to involve families and significant others in
the patient’s
care and decision-making.
e. The resident will be able to help patients identify resources in the community often
needed and used by addiction medicine patients.
