Addiction Psychiatry Fellowship

 Dr. Ajagbe , MBBS
 Program Director

Program Overview

The Fellowship has changed as of September 2022.  Dr. Ajagbe has taken over as Program Director. Dr. Johnson has retired, although he will continue to teach the fellow seminar and supervise the addiction psychiatry fellows.  This preserves the neuropsychoanalytic sensibility.

Fellows will continue to spend 2.5 days per week at Upstate; 2 half days doing neuropsychoanalytic treatment of addiction with transference focused psychotherapy, one morning doing Upstate Hospital consults and going on consult rounds with the toxicology fellows and their fellowship director Ross Sullivan M.D., half a day working up and hearing pain evaluations along with neurology, family medicine and internal medicine residents, and pain fellows.

The time at Upstate also includes a half day of academic work: The fellow seminar, supervision, academic projects. Crouse Hospital is the site for methadone and buprenorphine maintenance, day treatment, and inpatient rehab. To give a wide spectrum of approaches, one half day is at Helio Health, another addiction treatment service.

Concepts

At its core addiction is an attachment disorder. Instead of being able to enter normal adult development, teenagers start to address emotional difficulties by squashing feelings with drugs. The core of outpatient treatment involves psychotherapy.

"Pain" is a complex affect. Opioids regulate human relationships as well mediating brain responses to peripheral signals. The epidemic of opioid prescribing must be addressed by diagnosing pain drivers, recognizing the importance of brain-mediated pain/opioid induced hyperalgesia, and addressing emotional issues that are camouflaged by opioid maintenance.

We use neuroscience innovation to guide treatment.

Relapse involves three driving forces:

• Emotional issues that are covered over by drugs.  We respond acutely with diagnosis of psychiatric and pain issues, immediately beginning treatment with psychotherapy and medication; initially transference focused psychotherapy.
• Life long craving.  ALL drug addiction addressed, especially nicotine. Using one addictive drug turns on craving for others.
• Post acute withdrawal (PAW). Opioid PAW addressed with low dose naltrexone, result followed with the cold pressor test for pain tolerance.  Alcohol dependent patients – support person asked to administer disulfiram for first year sober.

A selection of papers authored by our Program Director can be found here:

• Merrell E., Johnson B. (2022) Using New Technology and Concepts on the Oldest Addiction on Earth, Alcoholism. In: Patel V.B., Preedy V.R. (eds) Handbook of Substance Misuse and Addictions. Springer, Cham. https://doi.org/10.1007/978-3-030-67928-6_57-1

Papers

• Siembida J, Johnson B. Depression in Fibromyalgia Patients May Require Low-Dose Naltrexone to Respond: A Case Report. Cureus  2022;14(2): e22677. doi:10.7759/cureus.22677
• RingwoodT, FelldinB, CoxL, KirschM, JohnsonB. Drive and Instinct – How They Produce Relatedness and Addiction, Frontiers in Psychology 2021; DOI: 10.3389/fpsyg.2021.657944
• AnuguV, RinghisenJ, JohnsonB. CASE REPORT: CAUSE AND TREATMENT OF “HIGH OPIOID TONE” AUTISM", Frontiers in Psychology 2021. DOI: 10.3389/fpsyg.2021.657952 
• JacksonD, SinghS, Zhang-JamesY, FaraoneS, JohnsonB. The effects of low dose naltrexone on opioid induced hyperalgesia and fibromyalgia. Frontiers in Psychiatry 2021; doi: 10.3389/psyt.2021.593842
• Tabi S, Heitner S, Shivale S, Minchenberg S, Faraone S, Johnson B. Opioid addiction / pregnancy and neonatal abstinence syndrome: a preliminary open-label study of buprenorphine maintenance and drug use targeted psychotherapy (DUST) on cessation of addictive drug use. Frontiers in Psychiatry Front Psychiatry. 2020;11:563409.  doi: 10.3389/fpsyt.2020.563409.
• Fibromyalgia, Autism, and Opiod Addiction
• Addiction and Will
• Ameliorative Response to Detoxification
• Cannabis and Pain
• Engineering Neurobiological Systems: Addiction
• Pleasure Principle
• Cold Pressor Time

Areas of Study

Through teaching, experience and supervision, fellows learn the fundamental principles of addiction psychiatry.

You would become a master of the field by participating in the following activities:

• Outpatient detoxification.
• Psychotherapy of addicted patients
• Supervision of residents and medical students at Commonwealth Place Addiction Rehabilitation and Crouse Hospital Chemical Dependency Addiction Psychiatry Outpatient Clinic
• Weekly attendance at Methadone Maintenance rounds coordinating shared cases and starting your own Buprenorphine Maintenance program if you would like
• Attending and presenting at the academic conferences at Day Treatment and Commonwealth Place
• Inpatient hospital rounds combined with Toxicology Fellows led by Ross Sullivan M.D.
• Working with the Dr. Johnson on special projects in adolescent addiction, pain, and prescription drug abuse

Application Process

• Applications are submitted via the ERAS Service.
• We will be utilizing the NRMP Match for recruitment.
• For more information, please visit the American Academy of Addiction Psychiatry (AAAP) Fellowship website, the ERAS website, and the NRMP Match website.