Core Rotations
Residential Substance Abuse Treatment Program
The Boise VA has an 18 bed domiciliary with a 28 day substance use disorder treatment program. The program focuses on psychosocial treatment and relapse prevention supported by medical and psychiatric management, detox interventions, and MAT. Admitted patients are veterans from the local and regional area. Alcohol, opioid, stimulant and benzo/sedative use disorders are the most commonly seen. Patients have a variety of comorbid medical and psychiatric illnesses treated during residential care. Fellows will participate in admission evaluations (including detoxification, initiation of MAT and stabilization of medical and psychiatric comorbidities), case management, co-leading of groups, and interdisciplinary team meetings. Fellows will work with coordination of referrals between other services to ensure patients continue treatment after discharge.
Inpatient Substance Use Disorders Consult Service
The inpatient substance use disorders consult service sees patients admitted to the Boise VA Medical Center. Common consultations are for assistance with alcohol withdrawal, delirium tremens, management of patients stable on buprenorphine, and evaluation for initiation of MAT. Fellows will work closely with inpatient medical teams, inpatient psychiatry service, and medical social work to assist in the medical management and psychosocial interventions for substance use disorders and to ensure appropriate transition to outpatient services or residential care.
Ambulatory Alcohol Detox Clinic
The Ambulatory Alcohol Detox Clinic sees referrals from the ED, inpatient medicine, primary care and the intensive outpatient substance use program. The clinic provides safe and effective treatment for alcohol withdrawal in the outpatient SUD clinic setting allowing patients to engage in psychosocial services concurrent to medical detox. The clinic also assists in transition from inpatient to outpatient services to provide ongoing medical care thus decreasing hospital length of stay and providing earlier engagement with outpatient services. Fellows will work with nursing, social work, and nurse practitioners in clinic and provide evidence-based treatment of alcohol withdrawal and initiation of MAT for alcohol use disorder. Fellows will be part of a multidisciplinary team ensuring that patients engage in services including individual case management, IOP groups, referral to psychiatry, and coordination with primary care providers. Fellows will also assist in the evaluation of patients admitted to medical service to transition to outpatient care.
Opioid Treatment Program
Fellows will evaluate and manage the complex primary care needs of patients receiving medication for addiction treatment at Raise the Bottom Opioid Treatment Program. They will rotate through both the Nampa and Boise sites, which service distinct patient populations with different cultural and socioeconomic backgrounds. Fellows will have the opportunity to perform OTP intakes and initiate buprenorphine, naltrexone and methadone treatment and will work on an interdisciplinary team to comprehensively manage patients receiving opioid use disorder medications.
Minor Rotations
Intensive Outpatient Program
The Intensive Outpatient Program at the Boise VA provides 20 hours of outpatient SUD groups, case management and individual therapy for veterans of all ages and genders. The IOP program transitions veterans from residential care and uses ASAM criteria to determine level of care. Fellows will work with social workers, substance abuse counselors, nurses, and addiction medicine specialists and will facilitate outpatient groups, participate in multidisciplinary team meetings and assist in the evaluation and treatment of substance use disorders.
Inpatient Substance Use Disorders Consult Service
St. Luke’s Boise Hospital is an acute care facility with a full emergency department and 300 adult beds. The facility has both Adult and Child and Adolescent Psychiatry consult teams. Consult teams sees acutely medically ill patients with co-morbid psychiatric and substance use disorders as well as patients admitted for primary psychiatric illness. Treatment focuses on diagnosis and multimodal treatment with psychosocial interventions, psychiatric medication management, detox interventions, and MAT. Patients admitted are from the local and regional area with a variety of comorbid medical and psychiatric illnesses as well as alcohol, opioid, stimulant and benzo/sedative use disorders. Fellows will participate in Emergency Department and inpatient evaluations (including detoxification, initiation of MAT and stabilization of medical and psychiatric comorbidities), develop treatment plans and collaborate with a multidisciplinary team to implement the treatment plan. Fellows will also work closely with team social workers on coordination of referrals between other services and ensuring patients continue treatment after discharge. Fellows will see patients of all ages, genders, and socioeconomic status.
Comprehensive Pain Management
The Comprehensive Pain clinic is a multi-disciplinary specialty clinic with collaboration from pain medicine, addiction medicine, internal medicine, pain psychology and clinical pharmacy. Patients are seen for evaluation of pain with emphasis on function and risk mitigation. The fellow will participate in all aspects of the pain clinic including evaluation of substance use disorders, procedures (joint injections, Battlefield acupuncture), CBT for pain groups, non-opioid pain treatment, and safe opioid prescribing. Fellows will participate in multidisciplinary case reviews and development of treatment plans.
Adolescent Addiction Treatment
Recovery 4 Life provides intensive outpatient treatment, medication management and harm reduction services. They provide MAT services, counseling, and peer support for adolescents and adults. Recovery 4 Life partners with Ada County Mental Health Court and Drug Diversion programs to provide treatment for clients with severe mental illness and substance use disorders and have a site in Caldwell, Idaho that sees a large portion of Latinx youth and clients of lower socioeconomic status than the Boise site. During their rotation fellows will attend and facilitate adolescent specific groups at the Boise and Caldwell locations. They will participate in weekly case management meetings and work closely with patients engaged in the criminal justice system.
Elective Rotations
Tobacco Cessation Clinic
The Boise VA tobacco cessation clinic is run primarily by clinical pharmacists. Veterans interested in cessation are offered medication assistance, including nicotine replacement therapy. The veterans have frequent follow up and clinicians use motivational interviewing techniques to help achieve and sustain remission. Fellows will be able to rotate through the smoking cessation clinic as an elective and will work with clinical pharmacists in evaluation and management of patients with tobacco use disorder.
Primary Care Medication Assisted Treatment Clinic
The primary care MAT clinic at the Boise VA sees veterans of all ages and genders with opioid use disorder for buprenorphine induction and maintenance. Fellows will evaluate patients for opioid use disorder and participate in induction and maintenance of buprenorphine for OUD. Medical and psychiatric comorbidities will be managed and/or referred as appropriate. Fellows will also participate in the didactics for internal medicine, nurse practitioner, and psychiatry residents as well as mental health and primary care clinical pharmacy trainees and medical students who all rotate through this clinic.
Veteran’s Justice Outreach
The Veteran’s Justice Outreach program at the Boise VA works with local/county court systems to assist patients who are enrolled in Veteran’s Court, a problem-solving court for veterans with drug related legal charges. Fellows can participate in the VJO program as an elective and will work with VA social workers in assisting veterans in accessing services and engaging in treatment services and will be a liaison providing medical expertise and education to the Veteran’s court team.
Pain Procedures
Fellows will have the opportunity to rotate with Dr Longnion for a procedure-based rotation targeting non-opioid pain management options. These procedures can include, but are not limited to, epidural injections, auricular acupuncture, nerve blocks, trigger point injections in addition to ketamine and lidocaine infusions.
Research/QI Elective
Fellows will have the opportunity to work on a research question or project related to substance use disorders.
Advocacy Elective
Fellows will advocate for patients with substance use disorders through the route of their choice. This rotation will be fellow-driven. Addiction Medicine Faculty have many community connections, which will allow fellows to make connections and have a meaningful impact during their one-year fellowship. Fellows will be encouraged to write op-ed pieces, testify at the Idaho State Legislature Sessions and work on government committees and pharmacy and therapeutics committees to drive policy changes that will support patients with substance use disorders.