What is Addiction Psychiatry?

Addiction Psychiatry is an official subspecialty of general psychiatry. The American Board of Psychiatry and Neurology, Inc. certification for Addiction Psychiatry began in 1993. The ABPN is one of 24 member boards of the American Board of Medical Specialties (ABMS).

ABPN offers certification in the subspecialty of Addiction Psychiatry to physicians who have completed accredited residency programs in general psychiatry. To sit for the Addiction Psychiatry boards, fellows are required to submit documentation of successful completion of an ACGME-approved fellowship training in Addiction Psychiatry beginning no sooner than the PGY-V level.

Applicants can obtain information and application procedures for the Addiction Psychiatry boards from the American Board of Psychiatry and Neurology by calling 847-945-7900 or visiting the ABPN Web site.

How many Addiction Psychiatry fellowships are there?

As of fall of 2017, there were 47 Addiction Psychiatry fellowships and 1,098 actively certified Addiction Psychiatrists in the U.S. View an up-to-date list of active fellowships.

What are the key criteria for choosing an addiction fellowship?

Like with medical school and residency, there will of course be multiple factors applicants will use to determine which fellowship is the best fit, some of which may have little to do with the fellowship itself (geography, proximity to friends and loved ones, etc.).

As for aspects of the fellowships themselves, applicants will want to concern themselves with the availability of key faculty and facilities. Education in Addiction Psychiatry is dependent on being able to see a variety of patients with addiction issues under the supervision of trained experts in Addiction Psychiatry. Applicants will want to have a good understanding of where fellows rotate and which faculty members have ultimate responsibility for their supervision or mentorship. While all fellowships are required to have at least two physician faculty who are ABPN certified in Addiction Psychiatry, some fellowships will exceed this threshold. Other fellowships may offer special opportunities for access to seasoned physicians in other specialties, dedicated psychologist and social work mentors, and other special electives. All these are things each unique applicant should ask about and take into consideration.

How many slots do most fellowships have?

Most fellowships have 1-2 slots though some have as many as 5-7 slots. See a complete and up-to-date listing of fellowships and their available slots.

How long is addiction fellowship?

The typical curriculum is a 12-month curriculum. Per the ACGME, fellowship can be completed in no less than 12 months and no more than 2 years.

What are fellowships obligated to provide to their fellows?

All Addiction Psychiatry fellowships must be approved by ACGME. The ACGME has extensive program requirements for accredited Addiction Psychiatry fellowship programs, learn more in the ACGME Program Requirements for Graduate Medical Education in Addiction Psychiatry document.

To summarize, the requirements in place are meant to ensure that trainees who have completed these fellowships have had exposure to sufficient levels of addiction care within a broad healthcare delivery system (or systems) to provide competent care to patients with substance related disorders as well as manage patients with dual diagnoses of addictive disorders and other co-morbid psychiatric illnesses.

These programs are expected to do the following:

  • Hire a dedicated program director and protect sufficient time for their program director to fulfill his or her educational and administrative responsibilities.
  • Identify additional core faculty and stipulate what their responsibilities will be for teaching, supervision and evaluation of the fellows.
  • Provide access to a range of medical, psychiatric and addiction care facilities including but not limited to an inpatient general medical hospital, a day treatment program, multidisciplinary ambulatory clinics, community and self-help programs.
  • Provide access to patients of both genders, as well as from the full range of ages and socioeconomic, educational and cultural backgrounds.
  • Expose trainees to a number of specific substance use disorders as well as both biological and psychosocial treatment modalities (p.13); see also the Addiction Psychiatry milestones below.
  • Provide access to appropriate reference materials and didactic conferences (important topics are listed by the ACGME on p.12).
  • Monitor for the well-being of fellows, educate them about the risks of fatigue and provide for specific work-hour protections.
  • Create evaluation committees (“Clinical Competency Committees”) to conduct semi-annual reviews to ensure fellows are progressing on the ACGME milestones toward promotion. Fellows must also receive quarterly, documented, formative feedback on their performance.
  • Evaluate faculty performance annually.
  • Perform an annual program evaluation by an internal “Program Evaluation Committee” that results in an annual report with a written plan of action based on the report.
  • Have at least 80% of their graduates over a 6 year period sit for and pass the ABPN Addiction Psychiatry boards on their first attempt.

What are the required aspects of Addiction Psychiatry fellowship curriculum?

Fellows are expected to become proficient in managing a broad array of patients including:

  • Those with primary SUD and with SUD co-morbid with various other psychiatric illnesses including:
    • Inpatients on medical/surgical units with acute and chronic SUD (including acute intoxication and overdose)
    • Inpatients on psychiatric and dual diagnosis units
    • Outpatient cases where there is a broad spectrum co-morbid psychopathology,
    • Special populations including pregnant patients, patients with complications of SUD including HCV and HIV, and patients with chronic pain, and patients dependent on various medications
  • Family members of patients with SUD and/or comorbid psychiatric illness

In addition, fellows are expected to:

  • Be able to employ methods of quality improvement to improve systems of care and to improve patient safety (Fellows are asked to participate in both a safety project and a quality improvement project during their fellowships).
  • Critically analyze research reports from major medical journals and professional organizations and assimilate findings into their practice. Fellows are also asked to participate in developing or evaluating new research findings.
  • Develop strong communication skills for working collaboratively with multidisciplinary teams.
  • Demonstrate professionalism.
  • Demonstrate awareness of the importance of system-based practice including cost-awareness and the importance of risk-benefit analysis.
  • Serve in a supervisory capacity for residents and medical students.
  • Attend at least 70% of required didactics by the ACGME though obviously most will want to attend a higher rate whenever possible.

Details of the Addiction Psychiatry Milestones

What is the difference in a clinical and research addiction fellowship, and how can I do both?

The specifics of clinical addiction fellowships are addressed in the previous FAQ. These fellowship programs are regulated by the ACGME in the same way that general psychiatry residency programs are regulated.

In addition to clinical fellowships, however, there are a number of NIH research fellowships for additional training in various research aspects of addiction, including epidemiology, preclinical drug/device development, clinical drug/device/therapy trials, translational, neuroimaging, etc. Both NIDA and NIAAA sponsor institutional postdoctoral training programs which are commonly referred to as “T32 fellowships,” as the grant-type awarded to the institution is referred to as a T32. While these programs may not be specific for psychiatrists or even physicians–as they often offer training for internists, pediatricians, family physicians, etc., as well as postdoctoral Ph.Ds.–they are often excited to train psychiatrists who have promising potential careers in clinical research.

The models for these fellowships vary. Some may integrate the ACGME and T32 components (ex. 50% time split between each over the course of 2 years) versus consecutive completion of each fellowship (ex. 1 year of ACGME followed by 1-2 years of T32 training). Each model would permit the fellow to sit for the ABPN Addiction Psychiatry board examination. Some T32 fellowship do not include the ACGME Addiction Psychiatry clinical component. You should inquire from any T32 fellowships if they offer ACGME-accredited Addiction Psychiatry fellowship training.

More information on T32 fellowships

NIDA-sponsored T32 fellowships

NIAAA-sponsored T32 fellowships