Psychiatry

Addiction Psychiatry Fellowship Curriculum

The Addiction Psychiatry program at IU School of Medicine is the first in the United States to author and adopt a curriculum guide and textbook, called the “2 x 4 Model” in which addiction psychiatrists are trained to lead multidisciplinary clinical teams that fully integrate mental health, addiction services and evidence based treatments.

The 2 x 4 Model

The 2 x 4 Model: A Neuroscience-based Blueprint for the Modern Integrated Addiction and Mental Health Treatment System,” authored by the IU School of Medicine Addiction Psychiatry Fellowship program director, Andy Chambers, MD, serves as the core reading and curriculum guide for this program. The textbook provides a foundation for the neuroscience and clinical care of patients with either simple or complex forms of addiction and mental illness comorbidities.

“The 2 x 4 Model” is a design and operational manual for the fully integrated addiction and mental health treatment program that is staffed and led by addiction psychiatrists. Teams of addiction psychiatrists, allied psychiatrists, therapists and nursing professionals provide comprehensive yet individualized addiction and mental health care to patients longitudinally. This care is provided regardless of what particular comorbid combination of addiction(s) or mental illness(s) a patient may have—without referring them to an outside treatment program and for as long as it takes to get patients into stable recovery.

The core design principal of the 2 x 4 Model Clinic is graphically represented by a 2 x 4 grid. On the vertical (Illness) dimension, the clinic commits to the comprehensive treatment of both mental illness and addiction disorders with equal prioritization. On the horizontal axis, this integrated mission is practiced through the use of diagnostic, psychotherapeutic and pharmaceutical (or neuromechanical) tools as well as professional communications.

Learning Objectives

Model Addiction Psych

The Addiction Psychiatry Fellowship at IU School of Medicine aims to help physicians gain mastery of eight components in order to integrate them as leaders of real-world teams. Fellows also learn how to assess clinical programs for fidelity to the 2 x 4 Model Design and to know how to build them.

In line with the 2 x 4 Model, Addiction Psychiatry fellows are expected to

  • Diagnose: Become adept with diagnosing all the major forms of addiction(s) and mental illness(s) in whatever combination they may present in an individual patient or across a population of diverse patients
  • Treat: Learn to provide (and lead whole teams in providing) comprehensive treatment plans and recovery strategies that involve integration of psychotherapies, experiential therapies, and medication treatment tools for addiction/mental illness combinations
  • Train: Acquire skills and expertise in the education of trainees and allied professionals along with communication skills with broader health care and criminal justice officials as needed to protect the integrity and effectiveness of treatment and recovery and to defend patients against dehumanization and stigma

In developing and refining these skills, Addiction Psychiatry Fellows participate in the ‘Triad of Academic Medicine’ as applied to the field of Addiction Psychiatry including:

Conducting longitudinal outpatient care in a variety of settings and across a diversity of demographic groups, spanning the life cycle, and acute (e.g. withdrawal) and chronic phases of substance use disorders.

Gaining experience as a teacher of medical students, psychiatry residents and allied professionals with subject-matter expertise in addiction psychiatry. Co-leading a CME-supported regional academic forum and lecture series (the IU School of Medicine Addiction Psychiatry Symposium).

Pursuit of a research project, study or analysis within the field of Addiction Psychiatry that is expected to result in a peer-reviewed publication. Examples of publications from Addiction Psychiatry Fellowship alumni include:

  • Ehret, JC, Day, PS, Wiegand, R, Wojcieszek, J, Chambers, RA (2007) “Huntington disease as a dual diagnosis disorder: data from the National Research Roster for Huntington Disease Patients and Families” Drug and Alcohol Dependence 86: 283-286.
  • Chambers, RA, McClintick, JN, Sentir, AM, Berg, SA, Runyan, M, Choi, KH, Edenberg, HJ (2013) “Cortical-striatal gene expression in neonatal hippocampal lesion (NVHL)-amplified cocaine sensitization” Genes, Brain and Behavior, 12:564-575.
  • Rao, KN, Sentir, AM, Engleman, EA, Bell, RL, Hulvershorn, LA, Breier, A, Chambers, RA (2016) “Toward Early Estimation and Treatment of Addiction Vulnerability: Radial-arm Maze and N-acetyl Cysteine before Cocaine Sensitization or Nicotine Self-Administration in Neonatal Ventral Hippocampal Lesion Rats” Psychopharmacology, 233:3933-3945
  • Sajid, A, Whiteman, A, Bell, RL, Greene, MS, Engleman, EA, Chambers, RA (2016) “Prescription drug monitoring program data tracking of opioid addiction treatment outcomes in Integrated dual diagnosis care involving injectable naltrexone” American Journal on Addictions, 25: 557-564, DOI: 10.1111/ajad.12441
  • Arnado, CL, Andraka-Christou, B, Allgood, K (2017). “Psychiatric Co-morbidities in Pregnant Women with opioid use disorders: Prevalence, Impact, and Implications for Treatment”. Current Addiction Reports; 4(1): 1-13.
  • Zarse, EM, Neff, MR, Yoder, R, Hulvershorn, L, Chambers, JE, Chambers, RA. (2019) “The Adverse Childhood Experiences Questionnaire: Two Decades of Research on Childhood Trauma as a Primary Cause of Adult Mental Illness, Addiction, and Medical Diseases”, Cogent Medicine, 6: 1581447; https://doi.org/10.1080/2331205X.2019.1581447

Rotations

Addiction Psychiatry fellows at IU School of Medicine train at four clinical sites that are staffed by fellowship-trained, board-certified addiction psychiatrists who serve as the training site director, enabling fellows to experience different systems and patient demographic groups under the guidance of accomplished experts.

The site directors are trained in or are closely familiar with the 2 x 4 Model, and the training sites emulate the 2 x 4 Model with some degree of site-specific variation or are in the process of building 2 x 4 Model programs.

The training sites are located in the central Indiana region and are geographically close to the IU School of Medicine—Indianapolis campus and other universities with programs in the basic and clinical neurosciences, including Purdue University, Butler University and University of Indianapolis. Most fellows have longitudinal training experiences (at least a year long) at two or more of these sites.

Eskenazi-Midtown Mental Health Center

The Midtown Community Mental Health Center, based in central Indianapolis, is one of the largest Community Mental Health Centers in the Midwest. This facility is tightly linked with Eskenazi Hospital, a full-service community medical/surgical hospital that contains general emergency psychiatry services and a psychiatric inpatient unit. Midtown operates a Methadone treatment program and has a fully integrated adult dual-diagnosis treatment service, which has the distinction of being the first fully operational 2 x 4 Model Clinic. Midtown serves a racially and gender-diverse urban population of patients and families, spanning the life cycle, with a special focus on perinatal addiction psychiatry.

VA-Roudebush Hospital

The VA has long served as a key training site for IU School of Medicine fellows in addiction psychiatry and continues to serve as the key site for the school’s PGY-2 general psychiatry residents performing their required core rotations in Addiction Psychiatry. The VA offers robust opportunities to help U.S. Soldiers, Marines, Airman and Seamen in their recovery from PTSD and other forms of mental illness and addiction comorbidities in a general medal-psychiatric system supported by a powerful IT-EMR system with national reach. This VA facility also hosts integrated dual-diagnosis services and a methadone program.

Adult and Child Health

Adult and Child is a Community Mental Health Center that serves the downtown urban core and south side of Indianapolis as well as the south-of-Indianapolis cites of Greenwood, Franklin and Columbus. Adult and Child has a rich history and well-connected missions in family psychiatry through its long-standing relationships with area public schools, criminal justice systems, and Indiana Department of Child services. Adult and Child has embarked on an aggressive and systematic approach to fully integrate brain/behavioral health and primary care at most of it sites, where psychiatrists, therapists, nurse practitioners and primary care doctors work side by side.

Valley Oaks Health

Valley Oaks Health is a Community Mental Health Center serving Lafayette and reaching south to the northern Indianapolis suburbs. Unique among the program’s training sites, Valley Oaks provides a more suburban and rural setting for addiction psychiatry training and practice, serving populations who live in areas where the addiction epidemic has hit especially hard but where professional resources and infrastructure are in especially short supply.

IU Neuroscience Center

The IU Neuroscience Center located in North Downtown Indianapolis is the educational, research and administrative headquarters of the IU School of Medicine Department of Psychiatry and the Addiction Psychiatry Training Program. The center also houses the headquarters of the allied brain-health specialties, including neurosurgery, neurology, neuropsychology, and core basic and clinical neuroscience laboratories. The general adult psychiatry clinic at the IU Neuroscience Center is across the street from the adult psychiatry inpatient unit and ECT service at Methodist Hospital, the core urban teaching hospital of IU Health.

The IU Neuroscience center is the site for the key lecture series that addiction psychiatry fellows participate in (as both teachers and learners), including the Addiction Psychiatry Symposium, Departmental Grand Rounds, and core medical student and psychiatry residency lecture series in Addiction Psychiatry.