Atlanta Veterans Affairs Medical Center (Atlanta VAMC)
Atlanta VAHCS, a Joint Commission accredited medical facility sits on 26 acres in Decatur, Georgia—just minutes from downtown Atlanta. The main medical center is a level 1A tertiary care facility providing patient-centered healthcare via an array of comprehensive medical, surgical, geriatric specialty services, as well as state-of–the-art diagnostic testing throughout 14 sites of care. With 346 inpatient beds, including a 40-bed homeless domiciliary, and a 21-bed SUD Residential Treatment Program, the Atlanta VAHCS is uniquely positioned to serve the healthcare needs of more than 130,000 enrolled Veterans living in 50 counties across northeast Georgia. The Health Care System, also a teaching hospital, provides hands-on and state-of-the-art technology, education and research to residents in collaboration with Emory University School of Medicine and Morehouse School of Medicine.
The Substance Abuse Treatment Program (SATP) of the Atlanta VAHCS treats over 3,500 veterans affected by substance use disorders each year. SATP provides a full spectrum of substance use disorder treatments. The addiction fellows work in the following clinics/programs:
The Evaluation, Stabilization and Placement (ESP) Clinic: This clinic provides comprehensive assessments of veterans with substance use disorders (with or without co-occurring mental health conditions), and offers ambulatory detoxification (where appropriate), pharmacotherapy, and facilitates treatment referrals. The program is staffed with addiction psychiatrists, clinical psychologists, nurse practitioners, registered nurses and social workers. Addiction fellows learn how to conduct both comprehensive and focused assessments, provide ambulatory detoxification, and prescribe medication assisted treatment for substance use disorders.
The Intensive Outpatient Program (IOP): Group therapy is the main component of the intensive outpatient programs. Individual counseling, medication management, case management, and vocational training are also important components. IOP is considered as an ASAM level 2 There are several IOPs in SATP including an evening IOP.
The Opioid Agonist Treatment Clinic (OATC): The OATC clinic provides methadone induction and maintenance for patients with opioid use disorder. It also provides buprenorphine (Suboxone) treatment for patients who need close monitoring. It consists of a multidisciplinary team to care for these veterans. Addiction fellows have the opportunity to learn about the medical and legal aspects of methadone maintenance, participate in treatment team meetings and follow individual patients.
The Buprenorphine Clinic: This clinic is embedded within the ESP clinic and provides office based buprenorphine treatment for veterans suffering from opioid use disorder. Addiction fellows learn how to induce, stabilize, and maintain veterans on buprenorphine/naloxone and buprenorphine in an office-based setting. The clinic provides ongoing care for veterans and collaborates with other programs within SATP as well as other programs in the Atlanta VAHCS to manage complex needs. Additionally, the clinic provides the buprenorphine extended-release injection (Sublocade) for appropriate patients.
The Addiction Psychiatry Consult/Liaison Service: The inpatient SATP C/L Service consults to the medical and surgical teams caring for veterans who are admitted to the inpatient units of the Atlanta VAHCS who are suffering from active substance use disorders. C/L assists with a myriad of issues such as: opioid, benzodiazepine and complicated alcohol withdrawal; substance use that causes or contributes to serious medical problems; decision-making capacity. In addition, C/L conducts substance use disorder assessments; makes psychotropic medication recommendations; assesses suicide risk and facilitates transfers to the acute inpatient psychiatric unit when needed, and provides treatment recommendations and referrals. Addiction fellows learn how to manage complicated withdrawal, gain experience in buprenorphine induction in the inpatient setting, and learn how to manage addiction treatment in medically complicated patients.
The Atlanta VA Domiciliary Residential Rehabilitation Treatment Program (DRRTP): The DRRTP provides residential rehabilitative services to veterans who are homeless or at significant risk of being unsheltered. The substance treatment component of the DRRTP provides ASAM level 3 treatment for patients with substance use disorders and encompasses residential services that are described as co-occurring capable, co-occurring enhanced, and complexity capable. The program serves the complex needs of veterans in a multidisciplinary approach based on a supportive residential model. The multidisciplinary staff includes round the clock Nursing as well as specialists in Nutrition, Social Work, Chaplaincy, Pharmacy, General Medicine, Psychology, and Psychiatry. The DRRPT is also a VA training site for the previously mentioned disciplines. The Addiction Psychiatry fellows work with an attending psychiatrist and the team and learn how to manage individuals with substance use disorders and other complications.
Emory University/Emory Healthcare System
Addiction Psychiatry Fellows rotate in three unique programs at the Emory Healthcare System:
- The Emory Healthcare Addiction Services/Emory Adolescent Substance Use Treatment Services (EAST):The Emory Healthcare Addiction Service implements a multidisciplinary treatment approach for the management of substance use for individuals ages 14 years old and older. EAST is a specialized subdivision of the Emory Addiction Services and provides specialized care to people ages 14-26 years old. The clinic utilizes the Community Reinforcement Approach (CRA), a cognitive behavioral model for substance use treatment.
- The Addiction Alliance of Georgia (AAG): The Addiction Alliance of Georgia is a new collaboration between Emory Healthcare and the Hazelden Betty Ford Foundation. The two organizations plan to engage both public and private partners to provide comprehensive treatment, recovery support, research, and educational services to people across the state of Georgia. The Alliance will expand outpatient services at Emory as well as develop an IOP (scheduled to begin early 2022) and higher levels of care.
- The Emory Healthcare Veterans Program (EHVP): The EHVP is part of the Warrior Care Network®. It is a nationally renowned program that provides comprehensive, evidence-based care for veterans with trauma-related conditions such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), military sexual trauma (MST), anxiety, and depression related to military service. The addiction psychiatry fellows work with attending psychiatrists, and the primary focus is on patients with both trauma-related conditions and substance use disorders.
Grady Memorial Hospital
Grady Memorial Hospital has been in the heart of downtown Atlanta for over 100 years, located approximately seven miles from the Atlanta VA Medical Center and Emory University. With 1,000 inpatient beds, Grady is a primary teaching hospital of the Emory University School of Medicine and Morehouse School of Medicine. Grady is the primary hospital for medically underserved populations in the two largest counties of metro Atlanta. The total patient volume in the Emergency Care Center is approximately 100,000 patients per year.
Addiction Psychiatry Fellows participate in a full-time, two-month rotation at Grady. The fellows split their time between:
- Grady MOUD Clinic: The opioid use disorder clinic at Grady Memorial Hospital provides comprehensive outpatient care (ASAM Level of Care 1.0) for patients with OUD. Funded by the Department of Behavioral Health and Developmental Disabilities, the clinic provides medications for OUD management (buprenorphine, extended-release naltrexone), group and individual counseling, peer support, case management, and access to psychiatric and medical services at no cost to patients who are uninsured. The patient population faces many challenges not typically seen in other office-based treatment settings, including high rates of job insecurity, housing instability, trauma, severe concurrent substance use disorders, and untreated psychiatric and medical comorbidities. Fellows work collaboratively with the entire care team--physicians trained in Addiction Medicine, Addiction Psychiatry, and Medical Toxicology; Certified Drug and Alcohol Counselors (CADC's); and Certified Addiction Recovery and Empowerment Specialists (CARES)--to develop and implement care plans for patients in various stages of recovery.
- The Infectious Disease Program (IDP) Clinic: The IDP clinic is an integrated, multi-specialty, multidisciplinary, outpatient clinic serving individuals infected with HIV/AIDS. As an important component of the IDP, the Center for Well Being provides comprehensive services including mental health (including evaluation, consultation, and treatment services), substance use (including substance use evaluation, consultation, and treatment services for patients with co-occurring disorders), and wellness-based resources/services to all patients in IDP. The IDP emphasizes an interdisciplinary approach to patient care. During this rotation, fellows gain invaluable experience in working collaboratively with other clinicians and providers in a multidisciplinary care setting.
The Dekalb County Drug Court (DCDC) Program
The DeKalb County Accountability Courts (DCAC) consist of a trio of judicially supervised court treatment programs, which include the DeKalb County Drug Court (DCDC), the DeKalb County Felony Mental Health Court (DCFMHC), and the DeKalb County Veterans Treatment Court (DCVTC). The three accountability courts are alternative sentencing programs designed for felony-level offenders whose criminal and addictive behavior has led them into the criminal justice system. Like most accountability court programs, DeKalb County Superior Court offers intensive, cognitive behavioral, evidence-based treatment programs to those offenders who have disproportionately impacted DeKalb County. DeKalb’s model is well known and respected both around the state and the country.
The DCAC specifically targets moderate-risk/ moderate to high-needs and high-risk (recidivism) and high-needs (service needs) participants. The primary goals of the DeKalb County Accountability Courts are to reduce recidivism and incarceration rates in DeKalb County by providing quality evidence-based treatment services. The participants are accountable to themselves and the DeKalb County community.
The addiction fellows will have first-hand exposure to how the program works, what type of treatment modalities are used and the interface between the judicial system and substance abuse treatment.
Talbott Recovery Campus
Talbott Recovery (TRC) is part of the Universal Health Services (UHS) family of treatment centers. It was first created by Dr. G. Douglas Talbott in the 1980s as the first treatment program specifically designed to meet the requirements of physicians suffering from the disease of addiction. Talbott provides state-of-the art treatment programs designed to treat the whole patient and family. Patients are provided comprehensive, individualized treatment of addiction (alcohol, drug use, and other addictive disorders) and its related medical, psychological, spiritual, and work-related problems, along with a thorough immersion in the twelve step fellowships. Co-occurring mental health disorders are also treated during the patient's length of stay, which is typically between 4 to 12 weeks. One of Talbott's strengths is their success at treating impaired professionals, such as medical professionals, attorneys, and airline pilots.
Fellows rotate through these services at Talbott:
- Multidisciplinary-Multiday 72-Hour Assessments - pre-admission
- Psychiatric Evaluations/Addiction Medicine Assessments - post admission
- Groups Psychotherapy
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Outpatient Ambulatory Detoxification
- Medication-Assisted Pharmacotherapy (including naltrexone and buprenorphine)
- Young Adult Treatment
- Impaired Professionals Program (including Caduceus and HIMS programming)