Chemical Dependency Detoxification Unit and Addiction Psychiatry

Site: Harlem Hospital Center, New York

  • This is a required two-month inpatient rotation on a 14-bed unit where PGY 1 and PGY 2 residents rotate. The on-duty resident provides back up weekend and night coverage in CEPEP.
  • The teaching faculty on the Detoxification Unit consists of one attending psychiatrist and one attending internist. There are four registered nurses, one on each tour, and four licensed practical nurses. The unit has a staff of addiction counselors, occupational therapist, religious and spiritual workers and community liaison workers. Also, NA/AA meetings every evening along with the availability of religious and spiritual meetings.
  • There is a weekly lecture on substance abuse conducted by the chief of service. Residents are also taught about alcoholism and substance abuse as part of their didactic curriculum. Residents are assigned a topic to research and present during their month's rotation. Rounds, seminars, Grand Rounds, and case conferences comprise the major teaching experience while Residents rotate on this service.
  • The principal Axis I diagnosis is substance abuse and dependence with a majority of the patients being poly-substance abusers. A significant number—10 percent of patients—have a major mental illness and substance dependence. Usually these patients are screened out and admitted to the inpatient psychiatry service. There is a mixture of Axis II personality disorders, antisocial being as high as 50 percent and a significant number with borderline and dependent traits. Hypertension and seizure disorders are major concerns on Axis III. These findings are usually related to alcohol and substance Abuse, but require careful medical follow up and treatment. Residents learn the principle of the 12-Step Program and medical detoxification of patients dependent on a single substance or multiple substances.
  • The Resident carries six-to-seven patients with approximately two admissions per day and an average of four discharges per day on a seven day length of stay unit. Patients are seen individually for psychiatric and physical assessments. They are seen in group therapy and psycho-education therapy which teaches the principles of the 12-Step Recovery Program. There are on-site AA and NA meetings.
  • The Residents receive two hours of individual supervision from the attending each week.
  • All residents participate in the administration of detoxification protocols on CPEP, inpatient psychiatry, and medicine.