Fellowship Prepares Physicians to Aid Recovery of Patients With Chemical and Behavioral Addictions

In 1956, the American Medical Association formally classified addiction as a disease. However, despite decades of ensuing medical research and a growing public awareness of this often-crippling disorder, a staggering 43% of U.S. adults who require substance use or mental health treatment never receive it.

Although numerous barriers, including societal stigma and poor proximity to treatment, can stand in the way of recovery, a unique citywide fellowship in Cleveland, Ohio, is doing its part to improve the accessibility and quality of addiction care. Established in 2000 at University Hospitals, the program has since broadened to include clinical rotations at Cleveland Clinic, MetroHealth and the Louis Stokes Cleveland Department of Veterans Affairs Medical Center.

Among the largest addiction medicine fellowships in the country, the 12-month program is designed to provide fellows with a strong foundation in the prevention, identification and treatment of substance use disorders and co-occurring conditions. Through a series of supervised clinical rotations in a wide variety of inpatient and outpatient settings, fellows work alongside a diverse faculty of more than 30 experts with backgrounds in psychiatry, family medicine, internal medicine, and emergency medicine among other specialties.

Power of diversity

Cleveland Clinic psychiatrist Akhil Anand, MD, explains the program is designed to allow physicians to “take a deep dive” into the management of addictive disorders using evidence-based, client-centered psychosocial, pharmacologic and psychotherapeutic interventions. By moving through multiple hospital- and community-based practice settings, including the county jail, outpatient addiction and subspeciality clinics, adult and adolescent residential treatment facilities, and a local bridge clinic, participants are exposed to virtually every facet of addiction care, he notes.

“Two key components of any successful addiction medicine program are a diverse patient population and committed, passionate faculty – and we’re fortunate to have both,” says Dr. Anand, who directs the program. “Our fellows receive support and instruction from virtually every addiction provider in Cleveland – a unique benefit that refines their knowledge, improves their clinical confidence and helps prepare them to be addiction leaders in their own communities.”

Although the program’s collaborating institutions are only a few miles apart, each provides care to a distinctly different patient population, says Dr. Anand. He notes that this diversity enables fellows to see patients with a multitude of addictions – from opioids and alcohol to stimulants like cocaine and methamphetamine. Participants also receive education in the management of behavioral addictions like gambling, a growing problem in the Midwest.

“Cleveland is a big city, so we see patients at both ends of the socioeconomic spectrum with a host of psychiatric illnesses,” Dr. Anand says. “Few fellowships provide access to such a broad range of presentations.”

Program fundamentals

Among the multilayered didactic topics covered by the program are graphic medicine and addiction, inpatient and outpatient detoxification, motivational interviewing, racial and gender disparities in patients with substance use disorders, alcohol-associated liver disease, transplant psychiatry, population health, risk management, and the treatment of eating disorders. Fellows also receive training in the management of special populations, including adolescents and patients with late-life addictions.

“Addiction is treatable disorder, but the chronic nature of the disease demands a multidisciplinary approach,” Dr. Anand says. “To this end, we’ve developed a rich, diverse stable of experts who have allowed our fellows to explore a comprehensive list of addiction-related problems and potential solutions.”

The didactic sessions are so popular, in fact, that they’ve begun to attract other learners from across the city, including medical students, residents, and psychology trainees. “It's fun to see how enriching these sessions can be for anyone interested in understanding the neurobiological and behavioral aspects of addiction,” he says.

Building bridges

The program continues to receive rave reviews from its fellows, but it provides ample benefits to its preceptors as well, Dr. Anand says. Faculty from the program’s participating institutions have developed personal and professional connections that are further improving accessibility to care citywide.

Thanks to its robust curriculum, the fellowship is growing rapidly and shows no signs of slowing down. Dr. Anand says he has been fielding calls from other medical centers across the country whose faculty are interested in modeling the Ohio-based program, which is accredited by the Accreditation Council of Graduate Medical Education.

“Our curriculum is generating buzz in the field of addiction medicine, which is really exciting, and the caliber of our applicants continues to get higher every year,” he says. “As we continue to grow, I hope we become an example to other institutions by demonstrating what is possible when an entire city comes together to support the needs of its citizens.”

For more information on the program, please contact Elizabeth Pavlick, Fellowship Coordinator, at epavlick@metrohealth.org.