Addictions

Addictions
Dr. Jonathan Lee | jonathan.lee6@va.gov
 

Mission Statement
The VA Bedford Psychology Addictions Training program is rooted in a recovery-oriented, Veteran centered system of care. Our immersive interdisciplinary training experiences prepare trainees to provide culturally competent, evidence-based treatment for substance and behavioral addictions. Trainees are encouraged to develop their individual professional identities and leadership skills through mutual learning with mentors and supervisors, and quality improvement and other system-level experiences.

Our Vision
VA Bedford’s Addictions Training Program seeks to continually improve the quality of training and
mental health services through ongoing education of staff and students in specialized areas of addiction,
prioritizing inter-professional training, modernizing and delivering care through evidenced-based
methods.

Our Values I.D.E.A.
Integrity – We consistently adhere to strong ethical and moral principles. Dignity – We recognize the right of people to be valued and respected for their own sake and to be treated ethically. Excellence – We aim for excellence in training and clinical care through continuous learning, collaboration, and feedback.
Advocacy – We advocate for Veterans, trainees, and colleagues, and empower all in their own self advocacy.

The addictions psychology postdoctoral resident will receive training in the coordination, consultation, and direct delivery of individual and group treatment services for Veterans with addictions to alcohol, drugs, tobacco, gambling, compulsive sexual behaviors, binge eating, and internet gaming, as well as other addictions. The postdoctoral psychology fellowship in addictions has three primary rotations throughout the year: (1) the VA Bedford Tobacco Treatment Program (TTP), (2) the Veteran’s Mental Health and Addictions Program (VMHAP) Intensive Day Treatment Program and Aftercare Programs, and (3) the Behavioral Addictions Clinic (BAC). This combination of rotations will provide the postdoctoral resident a breadth of exposure to a range of addictions common among Veterans as well as gain a depth of experience in delivering clinical services to Veterans with addictions in different stages of recovery. There is an emphasis on conducting comprehensive assessments to inform case conceptualization and applying evidence-based therapeutic approaches within the field of addictions treatment, particularly those involving motivational enhancement, cognitive behavioral therapy, acceptance- and mindfulness based interventions, and recovery-oriented approaches.

The addictions postdoctoral training provides an opportunity to engage in clincial and basic research. Several of the faculty involved in the addictions postdoctoral residency are members of the VISN 1 New England Mental Illness Research, Education, and Clinical Center (VISN 1 New England MIRECC). The mission of the VISN 1 New England MIRECC is to develop innovative treatments and clinical programs for Veterans with co-occurring addictions and mental health disorders. The addictions postdoctoral resident will be able to participate in research and program development activities related to addictions, including opportunities to participate in ongoing clinical trials, prepare and deliver conference presentations, and engage in scientific writing. Consistent with our mission, we aim prepare the postdoctoral fellow for career leadership positions as future program managers and psychology executives. Professional development opportunities are available to focus on cultivating the leadership skills required to achieve operational excellence within a healthcare program. Training in Prosci® Change Management is offered through partnership with VHA Office of Healthcare Transformation to learn how to drive successful organizational change, and training in healthcare quality and process improvement through Lean Six Sigma methodology is also available through Systems Redesign with the opportunity to earn a Lean Six Sigma Yellow Belt. The addictions postdoctoral fellow will be able to participate in organizational change initiatives at the healthcare system as a change management consultant. Initiation of innovative program development and process improvement projects is also welcomed and encouraged. Overall, the VA Bedford addictions postdoctoral fellowship provides a unique learning opportunity for postdoctoral scholars to advance their clinical skillset in diagnosing and treating addictions and cooccurring mental health disorders, and developing their professional identity to be a leader in healthcare leader and in the field of addictions.

VMHAP sub-rotation
VMHAP comprises the Intensive Day Treatment Program (IDTP) and aftercare. IDTP serves Veterans for simple detox care and provides intensive rehabilitation, 30-35 hours of treatment per week. Length of stay varies according to Veteran’s needs but is typically 2 weeks in length. Each Veteran is assigned an interdisciplinary team which coordinates and individualizes overall treatment and discharge planning. Aftercare is an outpatient program that serves Veterans to support ongoing recovery goals and maintain the treatment gains made from more intensive settings, often after the completion of IDTP. The Addictions postdoctoral resident will have the opportunity to conduct program intake assessments, BAM-R and MET assessments, and lead/co-lead psychoeducational groups on various topics including stages of change, medical consequences of tobacco use and cessation, and managing triggers and urges, to name a few. There are also opportunities to gain supervised training in empirically supported treatments including seeking safety, motivational enhancement therapy, and cognitive behavioral therapy for substance use disorders (CBT-SUD).

Behavioral Addictions Clinic (BAC) sub-rotation
Behavioral addiction is a form of addiction that involves a compulsion to engage in a rewarding non-drug related behavior despite negative consequences to the person's physical, mental, social, or financial well-being. Types of behavioral addictions addressed in the BAC include gambling, compulsive sexual behavior (e.g., frequent sexual partners, problematic use of pornography), binge eating disorder, excessive internet use, (e.g., online shopping, playing video games), and compulsive buying. Rates of gambling disorder and compulsive sexual behavior (i.e., dysregulated sexual behaviors; e.g., excessive use of pornography, frequent casual sexual partners) are higher among Veterans than non-Veterans. There is growing demand for behavioral addiction treatment services within VHA, particularly among returning combat Veterans. The BAC provides cutting-edge training to the addictions postdoctoral resident on the assessment and treatment of behavioral addictions which commonly co-occur with conditions such as PTSD, sexual trauma, substance use, and anxiety among Veterans. The BAC operates on a short-term treatment model where the focus of the individual and group treatment services is on assisting Veterans to obtain mastery over the problematic behaviors for which they have been referred. After successful completion of the BAC treatment services, the Veterans are then referred to their main treatment providers to address other remaining mental health service needs as appropriate. The BAC is the only specialty outpatient clinic in VHA that focuses the training for psychology postdoctoral residents on best practices for assessing and treating problem gambling, compulsive sexual behavior disorder, and binge eating disorder, and it has been recognized as a leader in VHA for assessing and treating behavioral addictions. The addictions postdoctoral resident will have the opportunity to be trained in effective brief treatments for behavioral addictions, including acceptance commitment therapy, cognitive behavioral therapy, and mindfulness-based relapse prevention. The postdoctoral resident will also gain experience conducting intakes and assessments, engaging in differential diagnosis pertaining to behavioral addictions, providing clinical consultations to providers, managing administrative roles in the clinic, organizing outreach and educational events, and providing brief individual and group psychotherapies as well as psychoeducation for Veterans.

Tobacco Treatment Program sub-rotation
VA Bedford Tobacco Treatment (TTP) is nationally recognized for its model of care delivery and ability to increase access to care for Veterans. The TTP serves the entire medical center and surrounding outpatient clinics. Tobacco treatment is multidisciplinary and represented by psychology, nursing, psychiatry, and pharmacy. The goals of the TTP are to 1) provide assessment and intervention to Veterans at all stage of change with respect to quitting tobacco, 2) increase awareness of the negative health effects of tobacco use for Veterans, staff, and 3) provide education and consulation to healthcare providers on the changing tobacco landscape and evidence- based treatments. The addictions postdoctoral fellow will receive exposure to conducting focused tobacco dependence assessments, delivering intensive short-term empirically supported treatment for tobacco users at all stages of change with regard to quitting tobacco (e.g., motivational, cognitive-behavioral, and acceptance- and mindfulness-based approaches), and facilitating motivational and psychoeducational groups for tobacco cessation. There is a weekly interdisciplinary TTP team meeting, where cases are presented, and treatment plans are discussed and modified. There is strong emphasis on the cultivation of interdisciplinary case conceptualization as clinical practice guidelines for tobacco cessation focus on the integration of tobacco cessation medications with intensive psychosocial treatment.

Learning objectives
1. Develop case conceptualization skills in working with Veterans presenting with addictions and co-occurring disorders.

2. Acquire proficiency in performing comprehensive assessments for Veterans presenting with addictions and being able to provide feedback.

3. Skillfully deliver evidence-based treatments for addictions including motivational interviewing, cognitive behavioral therapy, and acceptance- and mindfulness-based treatments.

4. Develop professional identity as a psychologist working collaboratively as a member of the interdisciplinary treatment team through case presentations, consultation with providers from other disciplines, and outreach and education.

5. Understand the range of treatment approaches for people with addictions, particularly motivational enhancement therapy, CBT, and recovery-oriented approaches to addictions treatment.

6. Understand the concept of co-occurring disorders and the interrelationship between mental illness
and addictions.

7. Familiarity with the different stages of recovery from addictions, particularly as applied to group psychotherapy processes.

8. Provide interventions from the principles of psychosocial rehabilitation.

9. Assist with administrative oversight by managing consults, conducting intakes, and managing clinic assignment.

10. Develop familiarity with methods for evaluating the efficacy of various approaches to addictive behaviors.

11. Engage in research opportunities (e.g., participate in clinical trials, conference presentations, and/or
manuscript preparation).

Target professional experiences
1. Participate in the CBT-SUD seminar and consultation series.

2. Co-lead psychotherapy groups for Veterans at different stages of recovery from addictions (early
recovery, middle and/or late recovery groups).

3. Provide individual psychotherapy for Veterans with addictions.

4. Actively participate in interdisciplinary team meetings.

5. Coordinate addictions treatment with other medical and mental health providers and collaborate in
Veteran care through delivery of co-visits.

6. Assume select administrative clinical duties including clinical intakes and managing consults.

7. Participate in program development, outreach, and education activities.

8. Contribute to research focused on addictions which may result in a poster and/or a manuscript.