Elective Rotations: Substance Abuse and Concurrent Disorders Program

Elective Rotation: Substance Abuse and Concurrent Disorders Program


Location

Royal Ottawa Mental Health Centre


Brief Description of Rotation

The Substance Use and Concurrent Disorders Program comprises a number of interrelated services referred to as a continuum of care. The Resident can design a rotation to meet his or her interests.

The following services are offered:

  • Outpatient Assessment and Treatment Planning
  • Inpatient Detoxification - Medical and Psychiatric Assessment
  • Inpatient Rehabilitation Program (Meadow Creek)
  • Outpatient Education Program
  • Outpatient Psychiatric Follow-up (Dual-Diagnosis patients)
  • Women's Support Group
  • Relapse Prevention Program
  • Adolescent Assessment, Treatment Planning, and Follow-up
  • Family Program

Supervision

Principal Supervisor: Allan Wilson, MD, PHD Program Director

Additional Supervisors:

  • John Grymala, MD Staff Physician
  • Ted Schnare, MD Staff Physician
  • Robert Milin, MD Staff Psychiatrist

This will be tailored to the specific interests of the resident. Depending on the interests of the resident, supervision in such modalities as group and family therapies may be provided by non-physician staff.


Description of Supervision

For outpatients, supervision will be scheduled on a regular basis at which time the resident can discuss cases with the supervisor. The frequency of supervision will depend on the resident's experience, the stage of the rotation, and the type of therapy and patients the resident chooses to see.


Objectives

The objectives will depend on the interests of the resident. Objectives for the various programs follow:


Outpatient Service

  • Learn to assess the severity of addiction problems
  • Learn to match patients to appropriate treatment
  • Learn techniques for engaging patients in the treatment process
  • Learn to assess psychiatric disorders in actively using patients
  • Learn appropriate pharmacotherapy for recovering addicts
  • Develop skills in motivational interviewing and confrontation therapy
  • Learn the principles of treating the dually-diagnosed patient
  • Learn to assess the severity of substance abuse in the dual-diagnosis patient
  • Learn to develop a treatment plan for the dual-diagnosis patient
  • Follow dual-diagnosis patients after rehabilitative treatment to monitor their psychiatric problems
  • Learn to recognize the limitations of the dual-diagnosis patient for participation in insight-oriented therapy

Assessment and Stabilization Unit (ASU)

  • Learn to recognize and treat abstinence syndromes
  • Learn psychopathology associated with specific drugs of abuse
  • Learn to assess and treat dually-diagnosed patients
  • Learn pathophysiology of chronic alcohol and drug abuse

Meadow Creek Addiction Treatment Program (MCATP)

  • Learn to work with a multidisciplinary team
  • Learn motivational counseling and confrontation techniques
  • Learn group therapy techniques
  • Understand the reasons for insight-oriented therapy in treating addictions
  • Learn the effects of intensive, insight-oriented therapy on dually-diagnosed patients
  • Learn to tailor addictions therapy to meet the needs of the dually diagnosed patient
  • Learn to predict prognosis for recovery from treatment participation

Women's Support Group

  • Learn those issues of particular relevance to women in recovery
  • Learn the dynamics created by such issues during recovery
  • Learn group therapy techniques
  • Learn to recognize and develop a treatment plan for women's issues which are beyond the scope of the Addiction Program (e.g.: sexual abuse, need for parenting skills)

Relapse Program

  • Learn relapse dynamics
  • Learn cognitive-behavioural relapse intervention
  • Learn group therapy techniques
  • Learn the role of pharmacotherapy in relapse prevention

Family Program

  • Learn the systemic model of family dynamics
  • Learn to assess the dynamic disruptions in a family as a result of addiction
  • Learn systemic family therapy techniques
  • Learn group therapy skills
  • Learn to do systemic family/marital therapy

Adolescent Service

  • Learn to assess the severity of substance abuse in adolescents and teenagers
  • Learn to develop a treatment plan for patients
  • Follow patient post-rehabilitative treatment for residual adjustment and psychiatric problems
  • Learn appropriate pharmacotherapeutics for addicted youth
  • Develop skills in communicating with the family members of adolescent patients

Cognitive Objectives

Cognitive objectives are similar for most services within the Substance Use and Concurrent Disorders Program. Important cognitive objectives follow:

  • Know what historical information is critical to diagnosis, treatment planning, and prognosis
  • Know the theory behind cognitive-behavioural and insight-oriented addictions theory
  • Understand the difference between the disease model of addiction and the behavioural model
  • Understand the rationale for the use of motivational counseling and confrontation intervention in treating addictions
  • Know which treatment modalities work and which do not
  • Understand the limitations of individual therapies in treating addiction
  • Understand the reasons why group therapy is pivotal to addictions treatment
  • Understand why systems theory is important in dealing with addicted families
  • Acquire an understanding of the high-risk paradigm and why it is important to addictions research
  • Understand why a specialized approach to pharmacotherapy is important with addicted patients
  • Understand the principles of physical dependence and withdrawal
  • Know how to access information on topics in addiction
  • Understand the differences in approach to the dually-diagnosed patient and the addicted patient
  • Understand the theory behind treating the dually-diagnosed patient

Skill Objectives

  • Demonstrate the ability to diagnose substance abuse
  • Demonstrate the ability to assess the severity of substance abuse
  • Demonstrate the ability to utilize and to formulate a treatment plan
  • Demonstrate the ability to communicate effectively with other agencies to realize the treatment plan
  • Demonstrate the ability to work harmoniously with an interdisciplinary treatment plan
  • Demonstrate the ability to act as a group therapist
  • Demonstrate the ability to formulate clinical research questions

Attitudinal Objectives

  • Learn to view addicted patients as having a positive prognosis
  • Develop an eclectic approach to difficult patients, based on knowledge about the effectiveness of various treatment modalities
  • Convey a positive attitude to the patient

Expectations and Opportunities

The resident may develop his or her rotation in consultation with the principal supervisor. A great deal of flexibility is offered. Service requirements are considered as being secondary to the educational experience, and thus the number of patients seen will not be onerous and time will be available for educational and research activities. The Substance Use and Concurrent Disorders Program offers a rich clinical resource and a flexible and educationally-oriented staff.


Work Structure

All residents will be expected to see patients for assessment as the first step in learning about the treatment process. Residents will be expected to spend some time on the ASU to familiarize themselves with detoxification and assessment procedures. Depending on interest, this can range from a few days to months. The remainder of the rotation can be tailored to the resident's interests.


General Information

Residency Level: Suitable rotations can be developed for residents at any level.

Rotation Length: Because of the complexity of the continuum of services offered, a minimum rotation is two months with three months or longer being preferred.

Suitable for Half-Time: Although it is possible to do a rotation on a half-day basis (5 days a week), this limits the services on which the resident can work.

Number of Residents: One

Related Rotations that contribute to the above maximum: Space limitations limit the rotation to one Psychiatry resident. The Substance Use and Concurrent Disorders Program also supports Family Practice residents.

For More Information, Please Contact:

Debbie Hall, Postgraduate Coordinator
The Ottawa Hospital (General Campus), 501 Smyth Road, Ottawa, ON, K1H 8L6
Phone: 613-737-8955
Email: dehall@toh.ca


All visiting elective residents must comply with the University of Ottawa policies and timelines.

More Information on Visiting Electives