The LLU Addiction Medicine Fellowship aims to train physicians in whole person care, preventing illness and promoting the recovery of people experiencing substance use disorders. Our goal is to improve physical, psychological, social, economic, cultural and spiritual health for those we serve.

Program Highlights

During your time in our fellowship program, you will:

  • Intervene with patients ranging in age from adolescents to geriatrics.
  • Provide care to a wide array of patient demographics served by diverse healthcare systems.
  • Apply motivational interviewing and other therapies, including cognitive behavioral therapy and contingency management.
  • Gain meaningful knowledge about neuroscience and psychopharmacotherapy.
  • Diagnose and manage chronic pain.
  • Evaluate and treat psychiatric comorbidities.
  • Render harm reduction.
  • Integrate aspects of public health into the treatment of addiction.

Program Components

Curriculum

View a block diagram outlining a potential rotation schedule (the order of the rotations may not be as shown). To learn more, rotation descriptions are below.

Research

Fellows are required to participate in one quality improvement project during the course of training. If you opt for an additional year, you can obtain a masters in public health and also qualify for board certification in preventive medicine.

Education Activities

You'll attend weekly lectures hosted by the American College of Academic Addiction Medicine (ACAAM) and network with programs, experts, and addiction fellows across the country. The topics, mapped by the Addiction Medicine Board examination, range from neurobiology to the social determinants of care.

During local weekly discussions, you will have the opportunity to give critical reviews of lecture material and journal articles, prepare for local grand rounds and national presentations, and present root cause analyses and morbidity reviews.

You're also encouraged to focus on your own wellness and participate in the Physician Vitality program.

Rotations

Our program emphasizes patient-centered, compassionate, evidence-based care.” 

The Loma Linda Addiction Medicine Fellowship rotations include 2 months on the acute care consultation service, 1 month on the BMC inpatient Adult Substance Use Recovery and Wellness unit, 2 months split between the partial hospitalization unit, adolescent program and eating disorders, 2 months at the VA Loma Linda Substance Treatment and Recovery (STAR) clinic, 1 month at the VA PM&R, 2 months split between VA Interventional Pain, Methadone, and SAC Health clinic, 1 month at the Orange County Jail, and 1 month at Behavioral Health, County of San Bernardino.  Please see the block diagram below, which illustrates this schedule.   

In development are clinics and electives focusing on maternal/fetal health; substance use prevention and treatment in the community; and a consultation service for the VA emergency department and inpatient units. 

Fellows have Continuity Clinic 1 session per week.  Wednesdays are devoted to teaching and case discussion. 

Each Fellow receives 6 weeks of combined vacation and sick leave and 1 week of CME.  Vacation and CME are distributed throughout the year.   

There is no mandatory on-call.  Moonlighting within ACGME guidelines is allowed. 

Loma Linda University

The Loma Linda University Medical Center includes acute care hospitals, an inpatient substance use treatment unit in a free-standing psychiatric hospital at the Behavioral Medical Center (BMC), and outpatient facilities at the Behavioral Health Institute (BHI), which is across the street from the BMC. 

Consultation Service- Loma Linda Hospitals (2 months)

Our Addiction Medicine Consultation Service is busy, receiving 30-50 consultations per day. We support Loma Linda Medical Center’s tertiary care hospital including the emergency department, hospital and ICU.  GI and cardiac transplant teams value our assessments and treatment recommendations. Loma Linda is a level 1 trauma center.  Consultations are also requested on the Labor and Delivery floor of Loma Linda Children’s Hospital.  (Robert Watrous, MD, Site Director) 

LLU Behavioral Medicine Center

Inpatient Unit (1 month) 

Addiction Fellows manage the acute withdrawal and stabilization of adult patients in the  18 bed Adult Substance Use Recovery and Wellness unit of the Behavioral Medical Center. This program includes a tract for patients with substance use disorders and chronic pain.  Addiction Fellows oversee medical students, psychiatric residents and other trainees (Adley Dason, MD MPH, Site Director) 

Partial Hospitalization Program (6 weeks) 

The partial hospitalization program helps patients along their path to recovery.  Addiction Fellows assess patients and contribute to their treatment planning

LLU Behavioral Health Institute

Outpatient mental health programs are housed in the LLU Behavioral Health Institute. 

Adolescent Program (6 wks)  

During this rotation, Addiction Fellows perform comprehensive assessments of adolescents with psychiatric and concomitant substance use disorders.  The Fellows participate in multidisciplinary treatment planning, and attend the after-school program 3 evenings/week.  The Fellows interact with the adolescents, and with their family members and schools, as appropriate.  Marijuana use and on-line gambling are commonly addressed in the Adolescent program.   

(Ara Anspikian, MD, Director, Adolescent Program, and Chair, Loma Linda Department of Psychiatry) 

Eating Disorders (2 wks) 

Addiction Fellows will observe the treatment for patients with different types of eating disorders and learn how eating disorders are similar and different from substance use disorders. 

SAC Health (FQHC) (6 sessions minimum)

SAC Health is a Federally Funded Healthcare Center with a busy Medications for Addiction Treatment (MAT) clinic.  Loma Linda Addiction Medicine Fellows provide pharmacotherapy for these patients’ substance use disorder(s) in collaboration Addiction Therapists who render counseling, and family physicians who provide primary care. 

VA Loma Linda Healthcare System 

The VA Loma Linda Healthcare System serves 78,000 Veterans in the San Bernardino and Riverside Counties of California. 

VA Substance Treatment and Recovery (STAR) Clinic (2 months) 

During the outpatient STAR clinic rotation, Fellows evaluate, motivate, and treat Veterans who are willing for harm reduction, who are working towards abstinence, who opt for buprenorphine or methadone, who have chronic pain and addiction, and/or who are maintaining recovery.  The management of these Veterans’ substance use disorders often takes place in the context of complex medical and psychiatric co-morbidities.  Notably, the VA patient panel also includes Veterans who have been stable on methadone maintenance over 10 years. 

Overdose protection with naloxone is provided to all at-risk patients. Fentanyl test strips and syringe exchange services are available at the VA. 

The VA attendings collaborate as a team.  In addition to certification in addiction medicine, they have primary specialties in preventive medicine, internal medicine, and psychiatry. 

Fellows also benefit from special training in geriatric psychiatry and in the treatment of nicotine/tobacco use disorder during their rotation at VA Loma Linda.  (Michael Miller, MD, Site Director)  

VA PM&R and Interventional Pain

The goal of both the PM&R and Interventional Pain rotations is for Addiction Fellows to hone their musculoskeletal exam, further their diagnostic skills, and learn techniques of treating pain other than relying merely on opioids.  The diagnosis and treatment of low back pain is emphasized. 

Physical Medicine and Rehabilitation (1 month) 

During the PM&R rotation, Fellows learn to diagnose and treat musculoskeletal pain including home exercises, stretches, ice and heat, chiropractic, acupuncture, tens, and joint injections. 

Interventional Pain (1/2 time over 2 months) 

During the interventional pain rotation, Fellows utilize a range of non-opioid medications to treat pain. They learn the benefits, risks, and potential side effects of epidural injections, facet blocks, nerve ablations, and the use of spinal cord stimulators. 

Acadia, Colton Comprehensive Treatment Center (Opioid Use Disorders) (16 sessions)

The treatment of opioid use disorder with either methadone or buprenorphine has been shown to decrease mortality, reduce illicit drug use, reduce seroconversion to human immunodeficiency virus, reduce criminal activity and increase positive social function.  However, methadone treatment for opioid use disorder is governed by such strict regulatory requirements, that separate specialized opioid treatment centers have been established in order to adhere to these regulations.  The Loma Linda Addiction Medicine Fellows rotate at the Colton Comprehensive Treatment Center to become proficient in methadone treatment.  Since Colton Comprehensive Treatment Center employs both methadone, a full mu agonist with NMDA activity, and buprenorphine, a partial mu agonist with kappa antagonist activity, the Fellows will be able to compare and contrast the use of these two pharmacotherapies. 

Orange County Jail (1 month)

The Orange County Central Jail houses 1428 inmates and the Women's Jail houses 386 inmates. The rotation is a blend of primary care, mental health care, and addiction medicine. The Fellows get a “behind the walls” experience and learn about gangs and the subculture of persons who are incarcerated. They learn further about social inequities. The Orange County Jail was specially selected because it is a progressive jail where addiction issues are addressed, and buprenorphine is commonly prescribed. (Jonathan Watson, MD, Site Director, 2022-23 Teacher of the Year)  

San Bernardino County Public Health (1 month) 

This rotation emphasizes both program administration and the clinical care mental health patients with substance use disorders. It includes: a) Systems analysis, strategic planning, and program development to optimize substance use disorders (SUD) services for the residents of San Bernardino County b) Medical Director activities for individual SUD clinics and programs c) Laboratory Director Activities (interpreting drug tests), and directing laboratory services/contracts d) Clinical care of substance use disorder patients in mental health clinic settings Cross-cutting themes include regulatory compliance, budgeting, human resources (staffing, training, resource allocation), information systems, adapting the implementation of the electronic medical record, navigating complex organizational systems, relationship building, and effective advocacy at the system level. (Jonathan Avalos, MD, Site Director) 

Continuity Clinics

All Fellows have a half-day per week Addictions outpatient Continuity Clinic throughout the year.  For 2023-2024, the Continuity Clinics included 3 Fellows at SAC Health and 3 Fellows at the STAR VA Loma Linda.