About

The MetroHealth Addiction Medicine program provides comprehensive training in a variety of inpatient and outpatient settings. Fellows will experience:

Three months of inpatient training with time spent in a dual-diagnosis unit and substance use disorder rehabilitation units.
The inpatient consultation service and will assist in the consultation.
Outpatient longitudinal clinics focused on office-based opioid treatment (OBOT), treatment of alcohol use disorders and comorbid medical and psychiatric disorders.
A corrections medicine rotation focused on safe detoxification and use of medication assisted treatment in a criminal justice setting.
Outpatient pain management clinic.
Outpatient Mother and Child Dependency.
Elective experience with the Cleveland methadone clinic or other electives tailored to the interests of the fellow.

Mission

Prepare the fellows for the independent practice of addiction medicine in a variety of settings
Prepare the fellows to respond to patients and their families with empathy and concern.
Graduate fellow who can respond to the emotional, psychological, and emotional needs of their patients
Insure advanced training in non-procedural pain management
Provide education that prepares the fellows for successful completion of board certification
Educate the fellows in a variety of clinical settings including maternal clinics, inpatient services, consultation services, correctional medicine, and outpatient clinics serving a variety of clients
Train fellow to successfully manage those with substance abuse disorder such that the patient improves their quality of life
Advance training and research in addiction medicine allowing the fellows to continue their education post training

Overall Objectives

Patient Care:

Perform comprehensive assessment, diagnosis, and treatment of patients with substance-related health problems and SUDs along a continuum of care, including inpatient/residential, outpatient treatments, early intervention, harm reduction, and prevention

Provide care to patients in different settings, such as inpatient medically managed withdrawal programs, SUD treatment programs, consultation services, and integrated clinics

Provide care to SUD patients with diversity in age, gender, socioeconomic status, limited language proficiency or literacy, and comorbid medical and psychiatric conditions

Screen, deliver brief intervention, and conduct motivational interviewing

Work with an interdisciplinary team that includes other medical specialists, counselors, psychologists, family members and/or other stakeholders involved in the patient’s care

Provide continuity of care to patients

Medical Knowledge:

Apply the medical model of addiction, including a basic knowledge of neurobiology and changes in brain structures associated with addiction to patient treatment plans

Discuss pharmacology of common psychoactive substances, including alcohol, nicotine, stimulants, sedative-hypnotics, depressants, opioids, inhalants, hallucinogens, and cannabinoids

Apply knowledge of epidemiology of substance use, SUDs, and the genetic and environmental influences on the development and maintenance of these disorders to patients

Discuss impact of substance use, including psychosocial and medicolegal implications, in diverse populations and cultures, such as in women, neonates, children, adolescents, families, the elderly, sexual and gender minorities, patients with physical or mental trauma or other injuries, military personnel and dependents, health care professionals, employees, and persons involved in the criminal justice system

Identify common behavioral addictions in patients treated for substance use disorder

Discuss prevention of SUDs, including identification of risk and protective factors

Screen and conduct brief intervention strategies appropriate to substance use risk level, and referral to treatment

Use comprehensive assessments and re-assessments, including diagnostic interview, use of standardized questionnaires, lab tests, imaging studies, physical examinations, mental status examinations, consultative reports, and collateral information in the development of treatment plans

Identify and treat common co-occurring conditions, such as medical, psychiatric, and pain conditions seen in patients

Match patient treatment needs with levels of intervention, including crisis services, hospitalization, and SUD treatment programs

Provide pharmacotherapy and psychosocial interventions for SUDs across the age spectrum

Demonstrate management of intoxication and withdrawal

Describe mechanisms of action and effects of use of alcohol, sedatives, opioids, and other drugs and the pharmacotherapies and other modalities used to treat them

Prescribe controlled medications to patients with or without SUDs, including accessing and interpreting prescription drug monitoring systems

Discuss effects of substance use, intoxication, and withdrawal on pregnancy and the fetus, and the pharmacologic agents prescribed for the treatment of intoxication, withdrawal, and management, including opioid, alcohol, and the sedative hypnotic withdrawal

Practice-Based Learning and Improvement:

Develop skills to systematically analyze practice using quality improvement methods

Plan to implement improved practice habits

Analyze current addiction medicine literature applicable to assessment, diagnosis, and treatment of patients affected by SUD and substance-related health problems

Interpersonal Communications Skills:

Develop consistent and effective communication strategies to relate to patients affected by SUDs and other substance-related health problems

Effectively communicate with patients’ families and others affected by addiction related behaviors

Relate with patient care team to provide an interdisciplinary approach to treatment

Collaboratively consult as a member of the care team

Professionalism:

Maintain professional boundaries

Recognize biases in self and others and how they affect overall patient care

Systems-Based Practice:

Demonstrate ability to develop lifelong learning skills and attitudes

Identify personal growth areas

Credential Awarded:

There is no current certification for Addiction Medicine APPs. There are organizations that will be developing this and we will participate once the criteria are set.