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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
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.
Blocks 1–6
| Block | 1 | 2 | 3 | 4 | 5 | 6 |
|---|---|---|---|---|---|---|
| Site | VA‑STAR | VA‑STAR | VA‑PM&R | VA Pain & Acadia | VA Pain & Acadia | BMC |
| Rotation Name | Addiction Clinic New & future ind. harm reduction, opiate agonist Rx, intensive outpatient, PTSD, geri psych | Addiction Clinic New & future ind. harm reduction, opiate agonist Rx, intensive outpatient, PTSD, geri psych | Musculoskeletal Dx & Rx | VA Interventional Pain (2 days/week) Acadia Methadone & Buprenorphine (2 days/week) SACS (0.5 day/week) | VA Interventional Pain (2 days/week) Acadia Methadone & Buprenorphine (2 days/week) SACS (0.5 day/week) | Adult Inpatient Residential |
| % FTE / month — inpatient (4.5 mo total) | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 1.00 |
| % FTE / month — outpatient (7.5 mo) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 0.00 |
Blocks 7–12
| Block | 7 | 8 | 9 | 10 | 11 | 12 |
|---|---|---|---|---|---|---|
| Site | BMC/BHI | BHI | LLUH | LLUH | Co. San Bernardino | Orange County Jail |
| Rotation Name | 2 weeks Adult Inpatient Residential 2 weeks Eating Disorder & PM Adolescent | Adult Partial Hospitalization & PM Adolescent | Consult Service to Hospital Inpatient Floors & ED | Consult Service to Hospital Inpatient Floors & ED | Program Development & Evaluation for San Bernardino County Treatment Facilities & MH/Addictions Clinic | Primary and Addictions Health Care for the Incarcerated |
| % FTE / month — inpatient (4.5 mo total) | 0.50 | 0.00 | 1.00 | 1.00 | 0.00 | 1.00 |
| % FTE / month — outpatient (7.5 mo) | 0.50 | 1.00 | 0.00 | 0.00 | 1.00 | 0.00 |
Schedule Notes
Continuity Clinic:
Social Action Community Health System (SACHS) FQHC (3 Fellows)
VA Loma Linda Addictions Clinic (3 Fellows)
Didactics:
Every Wednesday, 11:00 am–1:00 pm: ACAAM National Curriculum
1:30–3:30 pm Local Discussions
Vacation and CME may be taken for intervals lasting 1 day to 2 weeks, upon approval from the Program Director
(total: 6 weeks of paid vacation/sick leave and 1 week of CME).
Key
- VA – Jerry L. Pettis Memorial Veterans Hospital and Ambulatory Care Center (ACC)
- BHI – Loma Linda University Behavioral Health Institute (outpatient)
- BMC – Loma Linda University Behavioral Medical Center (inpatient)
- LLUH – Loma Linda University Hospital (inpatient)
- Acadia – Acadia Comprehensive Treatment Centers, Colton
(methadone and buprenorphine)
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.
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.
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 and also in downtown Redlands.
Learn more about getting your graduate medical education at LLU.
Our addiction medicine consultation service is busy, receiving 30-50 consultations per day. We utilize the most interesting consults for teaching and support Loma Linda University 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.
Site Director: Robert Watrous, MD
Inpatient Unit (1 month)
You’ll 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. You’ll oversee medical students, psychiatric residents, and other trainees.
Site Director: Adley Dason, MD MPH
Partial Hospitalization Program (6 weeks)
The partial hospitalization program helps patients along their path to recovery. You’ll assess patients and contribute to their treatment planning.
Residential Treatment - Substance Use Recovery Wellness (1 Month)
You’ll manage the withdrawal and stabilization of adult patients in the 12-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. You’ll oversee medical students, psychiatric residents and other trainees
Site Director: Adley Dason, MD MPH
Outpatient mental health programs are housed in the LLU Behavioral Health Institute.
Adolescent Program (6 weeks)
During this rotation, you’ll perform comprehensive assessments of adolescents with psychiatric and concomitant substance use disorders. You’ll participate in multidisciplinary treatment planning and attend the after-school program 3 evenings/week. You’ll also 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.
Director and Chair: Ara Anspikian, MD, Loma Linda Department of Psychiatry
Eating Disorders (2 weeks)
You’ll observe the treatment for patients with different types of eating disorders and learn how eating disorders are similar and different from substance use disorders.
Continuity Clinic (Throughout the Year)
SAC Health is a Federally Funded Healthcare Center with a busy Substance Use Recovery clinic. You’ll provide pharmacotherapy for these patients’ substance use disorder(s) in collaboration with addiction therapists who render counseling, and family physicians who provide primary care.
Infectious Disease Pre-Exposure Prophylaxis (PrEP) Clinic (Several Sessions)
You’ll become proficient counseling and prescribing PrEP.
Rotation Directors: Jennifer Veltman, MD, and Kristine Carr, MD
The VA Loma Linda Healthcare System serves 78,000 Veterans in the San Bernardino and Riverside Counties of California. Patients are seen in person and also via video or phone.
VA Substance Treatment & Recovery (STAR) (2 Months & 1 Year Continuity Clinic)
The STAR outpatient medical clinic supports veterans who want harm reduction, who opt for induction onto buprenorphine or methadone, who benefit from withdrawal management and abstinence, as well as those who are in long term recovery. Substance use treatment takes into account the veteran’s comorbid psychiatric and medical diagnoses which often include PTSD and chronic pain.
While the most frequent substances are nicotine, alcohol, cannabis, stimulant, sedative hypnotic, and opioids, we also have veterans with disorders involving anabolic steroids, PCP, inhalants, pornographic stimulation, gambling, and military sexual trauma
Site Director: Samantha Ayoub, MD MPH
Faculty: Michael Miller, MD; Ralph Clark MD MPH; Lori Karan, MD
VA Substance Treatment & Recovery (STAR) Intensive Outpt Counseling Sessions
You’ll also attend sessions nine hours per week for 30 days to experience cognitive behavioral counseling, mindfulness, dialectical behavioral therapy, relapse prevention, and more. The goal is for you to understand the challenges and processes of recovery.
VA Geriatric Psychiatry (1 Afternoon a Week for 2 Months)
Peter Leong, MD, geriatric psychiatrist, helps addiction fellows improve their skills in psychiatric assessment.
VA Psychiatry Consultation and Liaison Service (1 Month)
The VA Inpatient Psychiatric Consultation and Liaison Service evaluates patients with behavioral issues, often including patients with psychiatric diagnoses and/or concomitant substance use disorders. Evaluations for suicidality, conservatorship, and performing an assessment of the ASAM dimensions of care are common reasons for referral.
Rotation Director: Mark Ard MD, trained/certified in psychiatry, ethics, C&L psychiatry, and addiction medicine.
The goal of both the PM&R and Interventional Pain rotations is for you 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 lower back pain is emphasized.
VA Physical Medicine and Rehabilitation
You’ll learn to evaluate and treat musculoskeletal pain including the role of home exercises, stretches, ice and heat, chiropractic, acupuncture, tens, and joint injections.
VA Interventional Pain
You’ll utilize a range of non-opioid medications to treat pain, including ketamine. You’ll also learn the benefits, risks, and potential side effects of epidural injections, facet blocks, nerve ablations, and the use of spinal cord stimulators.
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.
As a fellow, you’ll 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). You’ll be able to compare and contrast the use of these two pharmacotherapies.
Site Director: Joseph Mott, MD
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. You’ll 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.
Site Director: Jonathan Watson, MD, 2022- 23 Teacher of the Year
This rotation emphasizes both program administration and the clinical care mental health patients with substance use disorders in San Bernardino County. It includes:
- Systems analysis, strategic planning, and program development to optimize substance use disorders (SUD) services for the residents of San Bernardino County
- Medical director activities for individual SUD clinics and programs
- Laboratory director activities (interpreting drug tests), and directing laboratory services/contracts
- 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.
Site Director: Jonathan Avalos, MD
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.