Substance use disorder continues to increase in incidence and prevalence throughout the United States. The goal of this rotation is for residents to be able to recognize, diagnose, and treat substance use disorders. Residents will be able to manage acute withdrawal, develop treatment plans, and utilize motivational interviewing to help develop a positive therapeutic relationship with patient struggling with substance use disorder both in the inpatient and outpatient setting.
Residents will be able to medically manage patients with substance use disorders, help patients navigate barriers to care, biopsychosocial contributions to substance use disorders, work with social workers and other team members, and develop an individualized treatment plan for each patient.
1. Residents will care for patients with a wide range of substance use disorders including; misuse of prescribed medications, non-prescribed substances, alcohol, and misuse of dietary supplements. Residents will care for patients with substance use disorders in both the inpatient and outpatient setting.
2. Residents will learn to address medical, and psychiatric co-morbidities and complications of substance use disorders.
3. Residents will attend lectures on various aspects of common substance use disorders.
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's review, and the attending faculty physician receives periodic feedback after sufficient residents have completed the elective to maintain anonymity.
1. Patient Care
a. The resident will be able to conduct a patient-centered history, utilizing
motivational interviewing to obtain the overarching, personal dimensions
of the patient’s substance use disorder, as well as the essential
details of each substance including amount, frequency, route, first use,
duration of use, and last use.
b. The resident will be able to obtain a complete substance use history including:
substances used, onset and duration of use, route of use, complications
of use physical, mental, and legal, treatment history, prior successes
and efforts, withdrawal experiences or complication.
c. The resident will be able to diagnose substance use disorders using DSM-V criteria.
d. The resident will be able to perform a relevant physical examination and
identify withdrawal manifestations, and comorbid psychiatric complications.
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 partner with the patient and utilize motivational
interviewing to identify patient’s readiness to change.
g. The resident will be able to identify a harm reduction approach for patients
who are pre-contemplative building therapeutic relationships and helping
patient increase their overall health and well-being. The resident will
be able to meet the patient where they are and help them progress towards
their goals of health.
h. The resident will be able to identify a management plan. Work with social
workers, groups, counselors, and other physicians on their care team and
community organizations like AA to help the patient build a group of sober support.
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
substance use disorder.
b. The resident will be able to effectively communicate with other team members
and physicians to help patients navigate the medical system.
c. The resident will practice motivational interviewing and compassionate
care with patients.
4. Professionalism
a. The resident will be able to identify stressors, negative past experiences
and how stigma can affect patients with substance use disorder. The resident
will utilize this understanding to ensure the patient receives good, respectful
care. The resident will also develop a deeper understanding of the patient’s
barriers to care, commendable progress, and at times, even the increased
frustration patients experience.
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 patients with a substance use disorder.
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 on
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 patients with a substance use disorder and their complex problems in
the biological, psychological, and social aspects of their lives.
b. The resident will be able to refer consultations to addiction specialists
effectively, including how to introduce and discuss the 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 help patients identify resources in the community
often needed and used by addiction medicine patients, including utilizing
social workers, counselors, and substance use navigators.