HI,
I finished an addictions fellowship in July this year. I can say that I very much enjoyed my fellowship. I think that it was a helpful experience, not only from a pharmacological standpoint, but also therapeutically as well. My view and empathy towards substance users progressively changed as I went through my training. I started to realize that a lot of my other colleagues still held a somewhat negative stigma/attitude towards substance users, and I am proud to say that because of my training, I feel that my ability to preserve my empathy towards them translates into better patient rapport. I am a big believer in motivational interviewing, which is the heart of the approach towards substance users. Not only is it nonconfrontational, but I feel that 'putting the ball in the patient's" hands highlights the patient's responsibility in recovery, and also takes some pressure off of me to make large and immense changes. Working within this type of program also made me feel much more comfortable with 'harm reduction' as well. In terms of medications, while one could argue that for alcoholism there are only a handful of FDA-approved meds, I find that b/c of my training, I am probably the only one of the faculty in my new position who orders all these meds because I am comfortable with it. There is a lot of research out there to find off-label uses of medications for addictions, and I find it very fascinating. When I get the chance to teach residents about some of these off-label meds, they find it enlightening.
I also believe that while having an addictions fellowship doesn't make your salary that much higher (in academia at least), it did make me more marketable, and I feel more job security given that addiction psychiatrists are rather scant. It's also pretty nice to have that niche, and it gives me gratification that my training has been useful when people (staff or residents) come up to me asking for curbside questions about addictions cases.
In terms of challenges, I think one of the harder things is that when working in addictions, there is a high percentage of homelessness. While i don't have a problem working with the homeless population, when one is homeless, it makes treatment compliance that much more difficult. Also, while I have learned that patients lying to you about their drug use is part of their denial (as defense mechanism), at times it has been challenging to know for sure whether someone is using without having an objective test like a UDS (which can also be falsified).
I now work in a full time outpatient faculty position at a county hospital. While I do not work exclusively with substance abuse, I feel like I have much more tools to work with the 60+% of people who are using in the clinics. I am also part of a team trying to expand substance abuse services in the hospital,and if it weren't for the training, I likely wouldn't have had the privilege to be a part of it.
Do I have any regrets about doing an addictions fellowship? Absolutely not. It was only one year; in my program, there was ZERO call; I feel that it has made me a more well-rounded clinician with a niche, and for me has lead to more job flexibility and job security.
