Symposium to Address How to Fill Gaps in Residency Training on Substance Use Disorders

How can psychiatry training programs across the country best prepare young psychiatrists to treat patients with substance use disorders (SUDs) and dual diagnosis to help address the national addiction crisis? This is the question that will be addressed at the presidential symposium presented by the American Association of Directors of Psychiatric Residency Training (AADPRT) at APA’s 2018 Annual Meeting in New York.

In 2017, AADPRT appointed the Task Force on Addictions Training made up of training directors and addiction experts. The task force is working in active collaboration with APA, the American Association of Addiction Psychiatry, the American Academy of Child and Adolescent Psychiatry, the National Institute on Drug Abuse (NIDA), and other allied organizations. It is in the process of completing national surveys of general psychiatry training directors and child/adolescent psychiatry training directors. The surveys seek to determine how programs are training residents and fellows in addiction psychiatry and what educational resources they need to have in place to provide optimal training as defined by the scientific evidence and expert consensus.

The need for psychiatrists to be effectively trained in substance use and dual diagnosis could not be more pressing. Last November, the Centers for Disease Control and Prevention reported a “record jump in drug overdose deaths last year” to over 50,000, a rapid increase thought to be due to the increased prevalence of fentanyl use. But opioids are not the only problem; for example, the prevalence of alcohol use disorder and high-risk drinking increased 40 percent from 2001-02 to 2012-13. Marijuana is being legalized in many states despite its potential impact on the developing adolescent brain and role as a gateway drug. The “dark net,” bitcoin, and other technological innovations facilitate drug purchasing online by users of any age. Despite the increase in substance use nationally, treatment sources are in short supply. About 90 percent of Americans with treatable SUDs are not in treatment.

Current general psychiatry training guidelines require a minimum of only one month of addiction psychiatry training. Child and adolescent psychiatry fellowships have no specific requirement. The literature suggests that attitudes toward treating patients with an SUD actually deteriorate as residents progress through training. Authors attribute this trend to residents being exposed to patients with SUDs primarily in acute settings, when the patients are intoxicated or in withdrawal, and may not have the opportunity to get to know patients over time and witness them get better.

The symposium, chaired by AADPRT Past President Art Walaszek, M.D., will feature expert speakers with direct experience in addiction science and education. Carlos Blanco-Jerez, M.D., Ph.D., director of the Division of Epidemiology, Services, and Prevention Research at NIDA, will lead off the symposium with an overview on what educators need to know about the science and epidemiology of addictions. Ann Schwartz, M.D., chair of the AADPRT task force and general psychiatry training director at Emory, will discuss the surveys’ findings about gaps and barriers in training.

Andrew Saxon, M.D., director of the Addiction Psychiatry Residency Program at the University of Washington in Seattle, will discuss the current state and future needs of addiction psychiatry fellowships. Justine Wittenauer, M.D., who completed both child/adolescent psychiatry and addiction fellowships and is on staff at Emory, will address the particular issues of how best to train child psychiatrists to prevent and treat addiction. Jeremy Kidd, M.D., M.P.H., an addictions fellow at Columbia University, will offer the perspective of a resident who chose to pursue addiction training. Tristan Gorrindo, M.D., director of education at APA, will describe resources available through APA and its Council on Addiction Psychiatry.

Finally, I will conclude with an outline of AADPRT’s role in addiction training. Dr. Walaszek, general psychiatry training director at the University of Wisconsin School of Medicine and Public Health, will lead the final discussion and present closing remarks. ■

“From Bench to Buprenorphine: The Role of Psychiatry Residencies and Fellowships in Addiction Psychiatry Training” will be held on Sunday, May 6, from 8 a.m. to 11 a.m. For location information, check the APA Meetings App or the program guide distributed on site at the meeting.