Addiction Psychiatry Fellowship

About the Fellowship

Substance use disorder is a major public health problem. Recent research estimates the lifetime prevalence of DSM-5 drug use disorder at 10%¹ and the lifetime prevalence of DSM-5 alcohol use disorder diagnoses at 29%². The cost of substance use to the public is approximately $246 billion per year. Additionally, at least 20% of patients treated in general medical facilities and 30% in general psychiatric units have a co-occurring substance use disorders.

Important advances have been made in the addiction field. Neuroscience has advanced our understanding of addiction as a brain disease. New pharmacological and psychosocial treatments have been developed in the last decade, and the evidence base for their effectiveness is growing.

We look forward to providing an outstanding learning environment for the professional growth and development of our fellows in the Partners HealthCare Addiction Psychiatry Fellowship. The fellowship provides clinical rotations at multiple Harvard Medical School teaching hospitals including:

• Massachusetts General Hospital
• McLean Hospital
• Brigham and Women’s Hospital

Fellows engage in a small tutorial style didactic program with Harvard Medical School faculty, as well as faculty members elsewhere in the city of Boston. Fellows are expected to gain competence and excellence in the practice of addiction psychiatry in public, private and academic settings. Fellows learn evidence-based treatments and enjoy increasing opportunities to participate in the development of the field’s knowledge base through research and writing. We place a special emphasis on a fellow’s active participation in their own education and welcome their input not only in formal committees, but also informally.

The primary goal of the one-year, full-time Partner’s HealthCare Addiction Psychiatry Fellowship is to train outstanding psychiatrists who will become experts in the field of psychiatry. Graduates of the fellowship may pursue careers in the clinical care of individuals with substance use disorders and their families, addiction research, education or a combination of these activities.

The fellowship is a one-year full-time clinical fellowship, but for fellows who have established a research mentorship within Harvard Medical School, we have been able to offer the fellowship half-time for two years to be complemented by a half-time research position.

Fellows receive benefits through Partners Health Care. More information on policies for vacation time, sick leave, holidays, educational leave, family and medical leave act, bereavement time, moonlighting, health and other benefits can be found on the Partners benefits website.

1 Grant BF, Saha TD, Ruan WJ, Goldstein RB, Chou SP, Jung J, Zhang H, Smith SM Pickering RP, Huang B, Hasin DS. Epidemiology of DSM-5 drug use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions -III. JAMA Psychiatry. 2016;73:39-47.
2 Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions- III. JAMA Psychiatry. 2015 AUG; 72(8): 757-66

Curriculum

Program

This one-year full time fellowship in addiction psychiatry is for graduates of accredited psychiatry residencies during the PGY–5 year. The fellowship is designed to meet the objectives of the Accreditation Council for Graduate Medical Education (ACGME). In 1999, the program received full accreditation from the ACGME Residency Review Committee and was re-accredited in 2004 and 2010. Psychiatrists completing the fellowship are eligible to take the ABPN exam for Added Qualifications in Addiction Psychiatry.

We also offer a two-year, half-time option for fellows who are interested. Some fellows have used the other half-time to pursue research interests.

Training Sites

Clinical training is based at four sites:

• Massachusetts General Hospital
• Brigham and Women’s Hospital
• McLean Hospital
• North Charles Foundation

Training Experience

Core training includes an overview of the field of addiction psychiatry with an emphasis on identification, assessment, diagnosis and successful treatment. Training is provided in individual, group and family therapy using a variety of techniques, including:

• Motivational interviewing
• Education
• Cognitive behavioral therapy
• Relapse prevention
• Psychopharmacology
• Dynamic psychotherapy
• Twelve-step facilitation

Training is provided across the spectrum of levels of clinical care including:

• Inpatient
• Residential
• Partial hospital
• Intensive outpatient
• Outpatient
• Hospital consultation
• Methadone maintenance outpatient clinics

Fellows are exposed to a range of twelve-step and other mutual-help programs and learn about integrating these treatment modalities into the overall program for individual patients. Fellows receive exposure to a diverse urban and suburban population from diverse socioeconomic and cultural backgrounds and see patients with a range of substance use disorders, as well as co-occurring psychiatric and medical disorders. Specialized populations (e.g., law enforcement officers and other first responders, physicians and other health care personnel) are also seen. Fellows learn to work in a team model with other professionals including counselors, social workers, nurses, psychologists and physicians from a variety of specialties.

Didactic seminars occur on Wednesday afternoons on core topics in addiction psychiatry with Harvard faculty and other experts from around the Boston area. The fellows meet as a group weekly with the program director and associate program director to review complicated cases, discuss topics not covered in the Wednesday seminars, read and discuss pivotal studies in the field and give academic presentations on topics of interest.

Clinical experience

Core Clinical Sites

• Massachusetts General Hospital
• Brigham and Women’s Hospital
• McLean Hospital
• North Charles Foundation

Clinical Rotations

• Inpatient/Day Treatment Rotation
  Alcohol and Drug Abuse Treatment Program
  McLean Hospital
  50%
• Addiction Consultation & Evaluation Service Rotation
  Brigham & Women’s Hospital
  40%
• Outpatient Rotation
  Alcohol and Drug Abuse Outpatient Treatment Program, McLean Hospital
  OR
  West End Clinic, Mass General
  40% 
• Outpatient Opioid Treatment Program Rotation
  (Methadone and Suboxone Treatment)
  The North Charles Foundation Inc.
  10%
• Outpatient Cognitive Behavioral Therapy Rotation
  West End Clinic, Mass General
  10% 
• Outpatient Rotation
  Alcohol and Drug Abuse Outpatient Treatment Program (McLean Hospital)
  OR
  West End Clinic, Mass General
  40%
• Outpatient Cognitive Behavioral Therapy Rotation
  West End Clinic, Mass General
  10% 

Educational Activities

This seminar takes place weekly and is in tutorial style. The seminar covers core topics in addiction psychiatry specified in a curriculum outlined by the American Psychiatric Association Textbook of Substance Abuse Treatment (Galanter M, Kleber HD, Eds. APPI Press, Inc., 2008, 4th Edition). Each fellow is provided with this textbook and asked to prepare the chapters from the text assigned to the weekly seminars. Seminar leaders also assign additional readings as appropriate to their topics. Faculty conducting the seminars include leading clinicians, educators, and researchers across Harvard Medical School’s teaching hospitals as well as faculty from other institutions such as Boston University and Brandeis University.

Core Seminar Topics

• Epidemiology of substance use disorders
• Findings from neuroimaging
• Neuropharmacology of addiction
• Psychosocial treatment modalities such as psychodynamic psychotherapy, cognitive behavioral therapy, motivational interviewing, relapse prevention, self-help such as Alcoholics Anonymous alcohol
• Pharmacotherapy of substance use disorders such as suboxone treatment of opioid use disorders and methadone maintenance treatment
• Pharmacotherapy of detoxification and of alcohol use disorders
• Specific substances of abuse such as alcohol and other CNS depressants; amphetamines, methamphetamine, and cocaine; opioids and narcotic analgesics; prescription drug abuse; hallucinogens; cannabis; club drugs; nicotine
• Treatment of substance use and co-occurring disorders; Gambling as a co-occurring behavioral problem
• Substance abuse in special populations such as adolescents, women and geriatrics
• Treatment of substance abuse and chronic pain
• Cross-cultural addiction psychiatry
• Research design
• State regulations and confidentiality
• Screening for drug and alcohol use disorders and use of urine drug screening
• Professionals with addictions
• HIV, hepatitis C and substance use disorders

Individual Supervision

Individual Supervision is, for many trainees, the most important and powerful component of their fellowship. It is individualized, personal, immediate and clinically-based. Optimally it is a forum to discuss all clinically relevant material with someone who has been around the block a few times.

Residents will have regularly scheduled supervision, which is usually divided as follows:

• 1 hour/week individually with rotation supervisor
• 1 hour/week with program director and other fellows
• 2 hours/week with additional faculty

Rotation-based Clinical Rounds

Rotation-based clinical rounds provide rotation-based opportunities to discuss clinical cases and receive peer supervision. These rounds take place in a number of locations:

• Inpatient service
• Outpatient rotation at McLean Hospital
• West End Clinic
• Within the partial hospital rotation

Clinical rounds covers topics in addiction treatment and promote effective treatment resource utilization through quality assurance and utilization review.

North Charles Seminar

North Charles Seminar takes place weekly during the fellows' methadone maintenance and outpatient opioid treatment rotation.

Grand Rounds

The Mass General and McLean Departments of Psychiatry sponsor grand rounds from September through June. At McLean Hospital, these are held on Thursday 12-1 and at Mass General on Friday 8:30-9:30.

Nationally and internationally known speakers are invited for formal presentations to the hospital community. These rounds are an excellent opportunity to meet and hear from some of the most well-known individuals in the field. While most of the presentations are oriented to General Psychiatry, addiction psychiatry topics are generally included in the course of the year.

Journal Club

Journal Club takes place monthly. Articles are selected jointly by faculty and fellows for their relevance, timeliness and interest. Fellows are taught how to review different types of articles and how to use the information from the articles in clinical practice

McLean Hospital ADATP Research Seminar

McLean Hospital ADATP Research Seminar takes place monthly. Faculty present their current research at these seminars and topics may include research trials from the NIDA Clinical Trials Network studies, women and substance use disorders, HIV and substance use disorders, chronic pain and substance use disorders, among others.

Additional Opportunities

A variety of other educational opportunities are available. The Partners Graduate Medical Education Office sponsors seminars and retreats during the year. In Addiction, most fellows will attend the American Academy of Addiction Psychiatry annual meeting in December. The Cambridge Hospital/Harvard Medical School continuing medical education office sponsors a two-day conference on Addiction Psychiatry in March each year and this provides another opportunity for learning in the field as well.

Faculty

Roger D. Weiss, MD
Director, Partners HealthCare Addiction Psychiatry Fellowship
Chief, Division of Alcohol and Drug Abuse, McLean Hospital
Professor of Psychiatry, Harvard Medical School

Olivera Bogunovic, MD
Associate Program Director, Partners Healthcare Addiction Psychiatry Fellowship
Medical Director of Ambulatory Services, Alcohol and Drug Abuse Treatment Program, McLean Hospital

Craig Boyajian, MD
Psychiatrist-in-Charge, Inpatient Program
Alcohol and Drug Abuse Treatment Program, McLean Hospital
Instructor, Harvard Medical School

Hilary Smith Connery, MD, PhD
Clinical Director, Alcohol and Drug Abuse Treatment Program, McLean Hospital
Division of Alcohol and Drug Abuse
Assistant Professor of Psychiatry, Harvard Medical School

A. Eden Evins, MD, MPH
Director, Center for Addiction Medicine, Massachusetts General Hospital
William Cox Family Associate Professor of Psychiatry in the Field of Addiction Medicine, Harvard Medical School

Martha T. Kane, PhD
Clinical Director, Center for Addiction Medicine
Clinical Director, Substance Use Disorders Strategic Initiative
Clinical Director, Ambulatory Psychiatry
Massachusetts General Hospital

Janice F. Kauffman, RN, MPH, CAS, LADC 1
Vice President, Addiction Treatment Services, North Charles Foundation, Inc.
Director, Addiction Consultation, Cambridge Health Alliance
Assistant Professor of Psychiatry, Harvard Medical School

Joji Suzuki, MD
Medical Director, Addiction Psychiatry Service, Department of Psychiatry, Brigham and Women's Hospital
Assistant Professor of Psychiatry, Harvard Medical School

Vinod Rao, MD, PhD
West End Clinic, Mass General

Shelly Greenfield, MD, MPH
Professor of Psychiatry, Harvard Medical School
Kristine M Trustey Endowed Professor of Psychiatry, McLean Hospital
Chief Academic Officer, Chief of the Division of Women’s Mental Health, McLean Hospital
Director of Clinical and Health Services Research and Education in the Division of Alcohol and Drug Abuse, McLean Hospital

Mark Albanese, MD
Medical Director Addiction Treatment Services, North Charles Foundation, Inc.

How to Apply

Eligibility

Eligible candidates will have completed an ACGME–accredited psychiatry residency program prior to start date of the fellowship.

Timeline

• April 1st – May 31st: We accept applications from April 1 until October 31, but preference is given to applications received by May 31
• October: We try to make final decisions in October

The Fellowship Training Committee will review all applications and the Training Director may conduct a telephone interview before extending an invitation for an interview. Applicants provide their own transportation and accommodations. Information regarding convenient hotels and rates may be available from the fellowship coordinator.

Required Documents

The following documents will be necessary to process your application.

Sent electronically:

• Universal Application for Residency National Recruitment Matching Program. Although we don’t go through the match, we use the Universal Application for Residency
• Current curriculum vitae
• Personal statement describing your interests, achievements and career goals
• Current headshot (a digital photo is preferred, but a passport size photo by mail is acceptable if digital photo is not available)
• Signed statement that the applicant has received the GME policies. Please review the Partners GME Policies (these policies are reviewed annually and are subject to change for any successive academic year) before signing the statement.

Sent via fax & mail:

• ECFMG Certificate (if applicable)
• USMLE I, II, III scores
• Full Massachusetts Medical License (USMLE III) (must be obtained prior to the start date of the fellowship)
• DEA X license to prescribe suboxone (must be obtained prior to the start date of the fellowship)
• Copy of Visa (if applicable)

NOTE: We strongly advise that applicants begin the process of applications for the full licensure in the state of Massachusetts by January 1 of their potential training year if they anticipate moving to the state. If there are documents from previous positions or schools where you have trained that you think may be difficult to obtain, we suggest that you begin this process to obtain those documents as soon as possible.

Letters of recommendation

Four letters of recommendation are required. One letter must be from the residency program director documenting successful completion and graduation from the program.

Letters must come under a separate cover (they cannot come from the candidate). Please ask your supervisors to send the letters by email to Roger D. Weiss, MD (rweiss@mclean.harvard.edu) with a copy to Scott Provost (sprovost@mclean.harvard.edu) with the hard copy to follow.

Submitting Your Application

Applications for the fellowship should be submitted electronically to Dr. Roger Weiss with a copy to Scott Provost. While email is preferred, if necessary, hard copies of letters of recommendation can be sent via mail to:

Roger D. Weiss, MD
Director, Partners HealthCare Addiction Psychiatry Fellowship
Chief, Division of Alcohol and Drug Abuse
McLean Hospital, Proctor House III
115 Mill Street
Belmont, MA 02478