Department Faculty

Jonathan Buchholz, MD

Mark Duncan, MD

Norah Essali, MD

Ray Hsiao, MD

Matt Iles-Shih, MD, MPH

Kate Rean, MD

Joseph Reoux, MD

Richard Ries, MD, FAPA, FASM

Julia Ruark, MD, MPH

Andrew Saxon, MD

Justin Stamschror, MD

Tim Bondurant, MD

Clinical training occurs in inpatient, partial hospitalization, intensive outpatient, outpatient, consultation, dual diagnosis, women specific, and opioid agonist treatment settings. Major goals of training include developing clinical excellence in the diagnosis and treatment of individuals with substance use disorders, broadening scientific knowledge in Addiction Psychiatry, furthering research skills relevant to Addiction Psychiatry, and expanding expertise in teaching Addiction Psychiatry. Close work with a range of interdisciplinary treatment teams is a core aspect of the fellowship.

Core competencies & goals

• Patient care. Develop clinical excellence in diagnostic and therapeutic addiction psychiatry.
• Medical knowledge. Become knowledgeable in addiction psychiatry and the scientific data base underlying the discipline.
• Practice-based learning and improvement. Develop research skills relevant to addiction psychiatry and gain skills in teaching Addiction Psychiatry.
• Interpersonal & communication skills. Develop the special compassion and empathy needed to form therapeutic alliances with addicted patients.
• Professionalism. Develop cognizance of the special ethical issues and cultural needs of addicted patients.
• Systems-based practice. Understand the broad context of Addiction Psychiatry care throughout the U.S. and World.

The Addiction Psychiatry Residency Program has a great many options for clinical rotations, and an individualized schedule can be designed depending on each resident’s prior experience and interests. Clinical rotations are available at a number of possible sites. Most residents complete about two months of inpatient work and 10 months of outpatient work, which they select from among the choices listed here.

VA Puget Sound Addiction Inpatient and Outpatient Stabilization Program

This inpatient program is co-located with inpatient psychiatry and has two dedicated beds out of a total of 24. Most common diagnoses are alcohol use disorder and alcohol withdrawal, mood disorders, PTSD, and numerous co-occurring medical problems with most patients having multiple diagnoses. Residents typically spend 2 months full-time on this rotation. Residents do medical and psychiatric evaluations on newly admitted patients and direct the medically supervised withdrawal, medical, and psychiatric care for these patients. After the first month of orientation and training, residents serve as acting medical director and take primary responsibility for clinical and administrative tasks under faculty supervision. Residents also consult on addiction disorders occurring among the general psychiatry inpatients and to inpatients on medicine and surgery.

VA Puget Sound Outpatient Co-occurring Disorders Unit

This clinic has approximately 120 active veterans who experience a full range of substance use disorders as well co-occurring psychiatric disorders in the moderate-severe range. The predominant psychiatric disorders are PTSD, mood/bipolar disorders, and psychotic spectrum. Residents gain experience in evaluating and stabilizing new patients as well as provide psychopharmacologic treatment for veterans already established in treatment. Residents work as an integral part of the interdisciplinary team and are expected to attend the staff meeting whenever possible in order to participate in treatment planning and a comprehensive approach to care. If interested and depending on schedule constraints, residents are able to gain individual or group psychotherapy experience with this population. Psychology and social work interns as well as psychology, social work, and chaplain fellows also rotate through the clinic. This rotation can be done part-time for 6-9 months.

General Addictions Treatment

The census of the intensive outpatient programs is 200-300 patients at any one time. Most common diagnoses are alcohol use disorder, cocaine use disorder, opioid use disorder, depressive disorders, PTSD, and numerous serious medical disorders with most patients having multiple diagnoses. Residents spend their time evaluating new patients, doing group therapy, providing individual case management for 1 to 2 patients at a time, providing psychopharmacologic services to patients, and participating in treatment team meetings. Residents will get considerable exposure to use of the addiction medications disulfiram (Antabuse), naltrexone (ReVia, Vivitrol), and acamprosate on this rotation. General psychiatry residents rotate through this program. Psychology and social work interns as well as psychology, social work, nursing, and occupational therapy fellows also rotate through the clinic. This rotation can be done part-time for 3-9 months.

VA Puget Sound Opioid Maintenance Treatment Program

The clinic has almost 300 patients with opioid use disorder receiving medication assisted treatment. Most patients have co-occurring psychiatric disorders and multiple medical disorders. Residents evaluate new patients, order methadone, buprenorphine, and naltrexone, provide adjunctive psychiatric care, work with nurse practitioners and physician assistants to provide medical care, and attend treatment team meetings. Psychology interns as well as psychology, social work, nursing, and occupational therapy fellows also rotate through the clinic. This rotation can be done part-time for 6-10 months.

VA Puget Sound Consultation and Evaluation

The clinic evaluates about 1000 patients per year. Most common diagnoses are substance withdrawal, alcohol use disorder, cocaine use disorder, opioid use disorder, depressive disorders, PTSD and numerous serious medical disorders with most patients having multiple diagnoses. Residents spend their time evaluating new patients, consulting to medical and surgical wards, and performing medically supervised withdrawal and stabilizing patients destined for treatment in one of the other addiction components. This rotation can be done part time for 3-10 months.

Women’s Addiction Treatment

This program treats women only in a gender specific program. Treatment approaches include medication management, group therapy and individual therapy/case management. Residents will treat veterans with primary addiction issues although most women will also have another psychiatric disorder in addition to substance use disorders. Residents can provide psychopharmacologic, individual, and group psychotherapeutic treatment to women Veterans. This rotation can be done part-time for 3-10 months.

Harborview Medical Center Outpatient Severe Mental Illness/Dual Diagnosis Program

This unit treats dual diagnosis patients who require emergent inpatient stabilization. Responsibility will shift from apprentice to primary responsibility over the course of the first month. Diagnoses include acute intoxication/withdrawal states and other psychiatric disorders from adjustment disorders to schizophrenia. Work includes interviewing, diagnosis, orders, physical exams, team leading, charting, rounds, co-leading groups, discharge summaries. This rotation can be done full-time or part-time for 3-6 months.

Harborview Medical Center Addictions Program Intensive Outpatient Program (HAP IOP)

This clinic treats addiction patients in intensive group therapy. Residents will serve as psychiatric consultants and also function as group therapists. One highlight of this program is the Women’s Addiction Recovery program which treats a substantial number of drug court referred women. This program has won both in internal Harborview merit award from patient feedback and a King County Exemplary award for innovative programs in 2008. There is a corresponding Men’s track also, with special content. Each of these IOP programs are probably best experienced as one day rotations over the course of 4-6 months or so, such that a combination of both groups and individual sessions can be experienced, and so that progress across time can be both fostered and observed by the Fellow. Often the Fellow may be doing auxiliary psychiatric therapy or medications to enhance the group therapy treatment. A unique opportunity available here is supervision using Twelve Step Facilitation, and evidence based treatment to enhance linkage and successful utilization of community 12 step meetings. Best day of the week for the Women’s Track is Fridays. The Men’s IOP track meets on M T and Th evenings such that the rotations could be on one of those days starting at noon and ending at 8 pm.

Harborview Medical Center Consultation and Motivational Interviewing

This program provides consultation and motivational interviewing to patients with substance use disorders who are hospitalized on medical or surgical units in Harborview. Dr Chris Dunn, well known national trainer in in Motivational Interviewing, will work one-on-one with Fellows taking this rotation which works well in combination with the IOP rotations. Residents will learn and practice fundamentals of motivational interviewing. This rotation can be done part-time for 4-6 months.

Harborview Medical Center Addictions Program – Suboxone Track

This track provides the opportunity for Fellows to learn how to best use Suboxone for opiate dependence, and as well participate in both group, 1:1 psychotherapy and psychiatric medications management with their assigned patients. They may also learn to use 12 step facilitation as part of this rotation as this is a key part of our suboxone recovery track.

Seattle Children’s Adolescent Consultation and Evaluation

This elective is offered by the Adolescent Substance Abuse Program at Seattle Children’s Hospital, the premier pediatric hospital in the five state region. Fellows will evaluate and manage adolescents with psychoactive substance dependence and co-occurring psychiatric disorders in the hospital’s outpatient psychiatry clinic. The large outpatient psychiatry clinic serves many adolescents of both sexes with a wide range of ethnic and racial backgrounds and a wide spectrum of socioeconomic backgrounds. Fellows work closely with the adolescent addiction psychiatry attending who receives many referrals and consultation requests from community physicians and mental health/chemical dependency treatment providers. Fellows have opportunities to see patients individually or jointly with the attending to learn about adolescent-specific interventions and psychotherapeutic techniques. General psychiatry residents and child psychiatry fellows also rotate through the clinic. This rotation can be done part-time for 4-6 months.

Training sites include:

VA Puget Sound Health Care System

Harborview Medical Center

Seattle Children’s

The UW Alcohol and Drug Abuse Institute is a multidisciplinary research center which coordinates research and training about addiction throughout the University and works closely with faculty of the Addiction Psychiatry Residency Program. The Alcohol and Drug Abuse Institute has its own library as a learning resource available to residents.

Summer Seminar: July & August

Residents participate in a didactic series which serves as an introduction to major concepts surrounding common substances of use: Cannabis, Stimulants, Alcohol, Tobacco, and Opioids. Participants include physicians and medical students from addiction medicine and psychosomatic medicine to promote interdisciplinary learning and collaboration.

September-June

Center of Excellence in Substance Addiction Treatment and Education (CESATE) Seminar:

Residents participate with multidisciplinary post-graduate fellows (addiction medicine, psychology, social work, nursing, and chaplain) in weekly seminars. The Seminar Series is organized by and led by faculty member Kendal Browne, PhD, which includes the following topics:

• Diagnosis – DSM-5
• Models and Theories of Addiction
• Basic Pharmacology and Drug Effects
• Epidemiology of Substance Abuse
• Psychiatric Diagnosis I
• Natural Change
• Psychiatric Diagnosis II
• Etiologic Models
• Racial & Gender Disparities in Addictions
• Treatment Seeking and Engagement
• Self Help: 12-Step Programs and Alternatives
• Biological Markers of Alcohol and Drug Use
• Detoxification
• Clinical Assessment
• Motivational Treatments
• Behavioral Therapies
• Pharmacotherapy
• Treatment Outcomes
• Measurement-based care and VA QI Processes
• Social Policy
• Pain Management
• Epidemiology and Treatment of Co-occurring PTSD and Substance Abuse
• Contingency Management
• Harm Reduction
• Spirituality and Substance Abuse
• Nicotine and Smoking Cessation
• Final Integration

UW Housestaff Association (UWHA) Collective Bargaining Agreement

The University of Washington Housestaff Association (UWHA) is the certified labor union and exclusive bargaining representative for the majority of residents and fellows in the UW School of Medicine (UW SOM) and in the UW School of Dentistry (UW SOD).

• UWHA Contract (Effective 7/1/20 – 6/30/22)
• UW Resident/Fellow Stipend Schedule for UWHA Members (Effective 7/1/20 – 6/30/22)

Benefits

The UW Summary of Benefits for Residents and Fellows summarizes the various benefits that UW provides to employees.

Information on vacation and sick leave can be found here: UW/UWHA Contract.

In summary:

• Residents will receive a minimum of twenty-four (24) days (18 weekdays and 6 weekend days) of paid vacation at the start of each one (1) year appointment period.
• Residents are entitled to 1 personal holiday per calendar year.
• Residents will receive seventeen (17) days (12 weekdays and 5 weekend days) of paid sick time at the start of each one (1) year appointment period.
• Residents have one week per year of educational leave, which they may use at their discretion. They are especially encouraged to attend the Annual Meeting of the American Academy of Addiction Psychiatry. Residents may apply for funding to offset some of the expenses of this meeting through AAAP Home – American Academy of Addiction Psychiatry (aaap.org).
• For holidays, we follow the UW Calendar.
• If Monday through Friday are taken as vacation or sick leave, the prior or following Saturday and Sunday are recorded as vacation or sick leave.
  • If the workday before and the workday after a weekend are recorded as vacation or sick leave, then the weekend days must also be recorded as vacation or sick leave.
  • That is, Friday before and the Monday after are taken as vacation or sick leave, then the weekend between is coded as vacation or sick leave.

• See ERAS website for details ERAS 2022 Participating Specialties & Programs (aamc.org)
• Qualifying applicants must provide documentation of the following:
• • Proof of completion of general psychiatry residency program or good standing in program with graduation prior to fellowship start date
  • Proof of medical licensure and eligible for an unrestricted physician medical license in the state of Washington
  • DEA license

 

Our program uses the Electronic Residency Application Service (ERAS) to process applications. Visit the ERAS website to learn more.

Applicants may begin applying on July 3, 2024 via ERAS for 2025-26 fellowship class.

Interviews: September 13- October 30 2024

Offers November 30, 2024.

For more information, please contact Fellowship Director Jonathan Buchholtz, MD, at Jonathan.Buchholz@va.gov.