Inpatient: Substance Use Intervention Team (SUIT)

For their inpatient experience, fellows are assigned to the Rush Substance Use Intervention Team (SUIT) Consult Service and work with medical and surgical inpatients. SUIT is a team-based inpatient consultation service. Fellows work collaboratively as consultants and as members of interdisciplinary teams, including as team leaders when appropriate. The fellow’s participation in SUIT affords repeated opportunities for screening, brief intervention with medical treatments and motivational interviewing, and referral of patients to specialized clinics/treatment centers(SBIRT). Fellows may follow their patients in their outpatient SUIT bridge clinic, offering the opportunity to develop an appreciation for addiction as a chronic disease process. Fellows develop competence in effectively conducting inpatient interviews with Rush’s socio-culturally diverse patients and families, including those with limited language proficiency, literacy, hearing, or sight. 

Outpatient: Substance Use Intervention Team (SUIT)

The Substance Use Intervention Team (SUIT) facilitates the Addiction Medicine Outpatient SUIT Clinic and is supervised by Dr. Jenna Nikolaides and Dr. Nicholas Chien. Fellows conduct comprehensive substance use assessments, prescribe buprenorphine and other medications for addiction treatment, enhance their motivational interviewing skills, and learn to understand the impact of the social determinants of health. Fellows manage SUD across the adult age spectrum, see continuity patients and same-day patients in this clinic model. Fellows have substantial opportunities to teach and supervise medical students and residents during this clinic.

Outpatient: Rush Outpatient Addiction Medicine Program (RAMP)​​​​​​​

Rush Addiction Medicine Program’s Dual Diagnosis Outpatient Clinic is supervised by Addiction Medicine Fellowship Director Dr. Gail Basch. It affords fellows a longitudinal setting to identify and treat common co-occurring conditions, such as medical, psychiatric, and pain conditions. Fellows gain confidence in treating SMI (serious mental illness) along with SUDs in this continuity clinic while working collaboratively with the program director. Fellows manage SUD across the adult age spectrums, SUD in the pregnant patient, and SUD in the medical professionals. Fellows work collaboratively with other Rush departments to care for RAMP patients and create comprehensive treatment plans in a shared decision-making process with the patient affected by SMI and SUD. Telemedicine is incorporated into the RAMP experience.

Hepatology Rotation at Rush University Medical Center  

Fellows rotate through the Hepatology department for four weeks. This immersive experience integrates the fellow with an interdisciplinary team and enhances the fellow’s knowledge of advanced liver disease related to alcohol use disorder and viral hepatitis. Included in this rotation is extensive didactic (both self-directed and with the Section Chief of Hepatology) on gaining confidence in the treatment of Hepatitis C, as many addiction medicine clinicians choose to address viral hepatitis in their future clinical practice. The elective also includes participating with the liver transplantation care team and playing an active role in bolstering continuity of care for patients with advanced alcohol use disorders at RUMC.       

Elective Rotation - Palliative Medicine and Advanced Pain Management 

Fellows rotate through Palliative Medicine for two weeks. The Palliative Inpatient Consultation Service sees patients through RUMC to assist in the evaluation and management of any or all of the following issues: pain and symptom management for patients facing serious, life-limiting illnesses and provide clarification of goals of care, transitions in care to comfort-focused therapies, intensive comfort care for patients being withdrawn from life-sustaining treatments. Palliative Medicine offers a multidisciplinary approach. Fellows assess patients with chronic pain for substance use, addictive disorders, substance-related health problems, and co-occurring psychiatric illness. Fellows may taper prescription opioids to safe doses, prescribe naloxone, initiate buprenorphine-naloxone, or refer to a community methadone/buprenorphine clinic, as appropriate. The fellow is directly supervised by the palliative care physician attendings and functions as an integral member of the interdisciplinary team during this two-week elective. Upon completing this elective, the fellow gains confidence in their skills in advanced pain management and in teaching the REMS Safe Opioid Prescribing Course offered through the American Society of Addiction Medicine, an opportunity available through the Illinois Society of Addiction Medicine for fellows interested in pursuing educational opportunities. 

Community Addiction Medicine at PCC Wellness Center​​​​​​​​​​​​​​​​​​​​​

Fellows are supervised by the Associate Program Director, Dr. Ruchi Fitzgerald, and Dr. Kathleen McDonough. ​​​​​​​Fellows will rotate longitudinally in a community addiction medicine experience on the West side of Chicago at PCC Wellness Center. Fellows rotate on the inpatient consult service (AMC) in a safety net hospital. Fellows learn to provide culturally sensitive care to a vulnerable patient population that accesses PCC Wellness Center (Federally qualified health center) and West Suburban Medical Center, serving the Austin neighborhood of Chicago. Fellows gain expertise in caring for pregnant and parenting persons with SUD, providing care for infants affected by perinatal substance exposure, and integrating SUD treatment with the treatment of Hepatitis C. Fellows have numerous opportunities to design their longitudinal experience. PCC Community Wellness operates as a hub-and-spoke model for addiction treatment.

PCC Wellness Center and West Suburban Hospital is located in the Austin neighborhood of Chicago. PCC Community Wellness Center (PCC) began in 1980 as the Parent-Child Center, a three-room clinic at West Suburban Medical Center that offered prenatal, postpartum, and infant care for Chicago’s underserved Austin Community. Fellows will work with family medicine residents and family medicine maternal child health fellows in conjunction with the Addiction Medicine Team that the Family Medicine Department directs.

Opioid Treatment Program Rotation at Family Guidance Centers

Fellows rotate with the clinical team at an opioid treatment program (OTP, methadone for treating opioid use disorder, OUD) in underserved areas of Chicago. Fellows gain knowledge of the use of methadone for the treatment of OUD by learning the systems of care in an OTP and how an underserved population accesses methadone. Fellows work closely with the lead physician and lead nurses/counselors in an interdisciplinary team during this rotation and have ample opportunities for bidirectional learning for the Family Guidance Team.

Outpatient Community Addiction Medicine Thresholds

Thresholds is one of the oldest and largest recovery services providers for persons with mental illnesses and substance use disorders in Illinois. Located in the Garfield Park neighborhood of Chicago, a community with disproportionately high rates of opioid overdoses, poverty, and gun violence. Fellows will rotate longitudinally one afternoon in a longitudinal experience and care for patients affected primarily by opioid use disorders in collaboration with therapists and recovery coaches. Fellows will independently see patients in partnership with therapists and recovery coaches. Fellows gain confidence in caring for patients within criminal deflection programming. Fellows gain valuable insight into the racial, social, and economic determinants of health, the importance of the behavioral health team, and the value of community organizations in Chicago. Fellows have numerous opportunities to engage in community overdose prevention/harm reduction efforts. The Thresholds experience offers valuable insight into the social and economic determinants of health for the fellow, the importance of the behavioral health team, and the value of community organizations in Chicago. 

Research, Education and Scholarship

The leadership of the addiction medicine program is committed to advancing the research and scholarship interests of the addiction medicine fellows. Each fellow will pursue scholarly activities in addiction medicine in alignment with the American Academy of Addiction Medicine goals. The ACGME objectives for the addiction medicine fellow Fellows are encouraged to pursue scholarly activity in addiction medicine. Fellows participate in the Rush University Research and Compliance Online Courses before engaging in a research project to write a research proposal and submit a project for IRB approval. Fellows are matched to mentors within RUMC (including meeting the physicians in the department of their primary board specialty) and the community based on their specific interests. Fellows have numerous opportunities to formally teach other clinicians (through the Illinois Society of Addiction Medicine) and medical students and gain confidence in teaching the buprenorphine waiver course and the REMS safe opioid prescribing course. Should Fellows express interest in grant writing or other academic interests, they will be directed to the appropriate mentoring pathways available at Rush University.

Rush Opioid Use Disorder Treatment Fellowship ECHO Program for Practicing Providers

Fellows participate longitudinally in the non-ACGME ECHO program to train primary care providers to assess and treat OUD. Dr. Nichole Gastala directs this program. Its primary goal is to increase access to OUD treatment services in areas of Illinois that have limited or no access to treatment. Fellows participate in an immersive weekend alongside other clinicians and have the chance to become familiar with the hub and spoke ECHO education dissemination model for OUD.