Substance Use Disorders

The fellow will be directly involved in patient care in the context of several settings of the Preferred Family Healthcare network of Adolescent Substance Use treatment centers, all of which will occur at the Northrup Unit less than one mile from the Washington University School of Medicine. The primary setting will be at the combined residential/intensive outpatient “Northrup” unit on Northrup Avenue, about a 5 minute drive from the WUSM medical center. This facility holds up to 12 residential and 40 IOP (Intensive Outpatient) patients. It is staffed with a multi-disciplinary team. Secondary setting includes utilizing telemedicine link to other IOP and residential settings within the Preferred Family Healthcare network of St. Louis County. Fellows will participate by in a variety of ways, including:

• Assessing patients recently admitted to the residential facility for up to 2-3month rehabilitation using patient and family centered evaluations.
• Learn how to take thorough substance use histories and ask about more obscure drugs.
• Determine co-morbid psychiatric disorders and assess their contributions or coincidence with drug abuse.
• Assess and continue treatment of patients that are in the IOP portion of treatment program and are only at the facility 3-4 days a week
• Appreciate the role of the family in the treatment of the patient and in determining psychiatric medication for treatment of drug use, withdrawal, or psychiatric co-morbidities.
• Understand the role of individual, group, and milieu therapies in the care of the patient and the various trained professionals that deliver this care
• Observe and eventually direct group therapy in the residential setting and appreciate it’s role in improving patient outcomes
• Practice the skills of Motivational Interviewing in initial assessment and follow up appointments for patients.
• Planning dispositions, outpatient care, and ongoing substance use treatment for patients upon completing residential care
• Observe and understand the role of the 12-step programs such as NA and AA in the patient’s overall care and outpatient follow-up.

The fellow will grow in their knowledge with the aid of supervised clinical activities, divisional didactics, and assigned readings from the adolescent substance use literature. The fellow will gain:

• Understanding of the DSM-5 criteria for Substance Use Disorders and how it relates to the old diagnoses Substance Abuse and Dependence from the DSM-IV.
• Appreciation of the epidemiology of drug use in teens and rates of certain drugs in high schools.
• Ability to understand the slang words teens invent for certain drugs of abuse.
• Appreciation of the few clinical trials in teen substance use treatment and limitations of their implementation in current clinical settings.
• Knowledge of subjects that are common on ABPN exams

Various forms of practice based learning will be incorporated into the supervised clinical activities, readings, and group supervision during this rotation, including:

• Self-appraisal of one’s own knowledge with regards to epidemiology, causes, neurological mechanisms, and treatments for teen substance use disorders.
• Gaining experience in delivering various evidence-based psychotherapies for substance use disorders, especially learning to contrast paternalistic approaches with motivational interviewing.
• Appreciation of the different substance use problems seen in different socioeconomic populations.
• Understanding the culture of adolescents influences drug use, as well as the influences of legal, ethical, and political forces.
• Encouraging the use of literature searches for evidence-based treatments and how they apply to patient care in our unique settings

The fellow will continue to develop their ability to show compassion and sensitivity to teens and their family as they struggle with substance use issues. They will be able to develop new relationships with other professionals that have dedicated their lives to helping adolescent substance abusers by:

• Understanding their own and/or family members and or friends’ issues, struggles, and experiences with substance use in the past and reflecting on how this may give them initial emotional reactions to patient’s experiences and statements.
• Learning to respond professionally despite the types of initial reactions mentioned above: not by denying these reactions but by understanding what they are and where they come from; then taking a stance of providing the best care for their patient
• Demonstrating the ability to function with other professionals with differing roles in the therapeutic settings of residential and outpatient care
• Completing evaluations and notes in a timely manner
• Being committed to ongoing professional development

The fellow will engage in effective communication not only to patients, but also to families, probation officers, and treatment staff. This communication includes:

• Learning to speak with teens from various settings in a meaningful way while collecting information for diagnostic and therapeutic purposes
• Linking via telemedicine in order to evaluate and treat patients at remote locations
• Gathering information from family members, staff, probation officers, and schools in the context of current HIPAA laws
• Communicating with attending and staff with regards to days they may be off, sick, or running late due to other responsibilities
• Presenting cases succinctly and accurately

The fellow will understand more about system based care by:

• Understanding the roles of other providers in the adolescent substance use treatment centers, including nurses, therapists, technicians, high school staff, art therapists, music therapists, administrative, and clerical staff.
• Working with therapists, social workers, probation officers, and family in order to establish appropriate disposition on graduating from residential and outpatient rehab programs