1.

Title of the certificate course : - Fellowship Course in Deaddiction

2. Course contents/ Syllabus

The candidate should learn the above topics in the context of the following
substance use disorders.

1. Alcohol Dependence
2. Nicotine Dependence
3. Opioid Dependence
4. Inhalant Dependence
5. Sedative Dependence
6. Cannabis Dependence
Other substances dependence (cocaine, stimulants, Hallucinogens etc

Theoretical aspects the candidate should know are -

I. Overview of drug abuse of dependence –

1. Common drugs of abuse and dependence, their acute & chronic
effects.
2. Misuse, abuse & dependence.
3. Etiology of substance use disorders.
4. Diagnostic criteria.
5. Biology of drug abuse / dependence.
6. Withdrawal Syndromes

II. Assessment & Diagnosis –

1. History taking including assessment of complications due to
drug use in various domains – both physical & Psychosocial
(Psychological, social, occupational, financial, legal), treatment
history, amendment & motivation, family & personal history, pre
morbid personality.
2. Examination – Physical & mental status examination.
3. Diagnosis
4. Formulation of a treatment plan.

III. Treatment principles & issues –

1. Basic principles that are common across substances
abused –
Need based, targeting multiple domains, adequate duration,
pharmacological & psychosocial combined, long term
pharmacotherapy, treatment of associated physical problems
referral for psychiatric problems.
2. To gather knowledge about screening instruments- CAGE,
ASSIST, DAMS.
3. To understand principle of brief intervention, its effectiveness,
components & the technique in patients of alcohol dependence
4. Therapeutic intervention
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 I. Pharmacological intervention –
a. For each medication – understand the dosing,
pharmacokinetics, metabolism, mechanism of action, side
effects, drug interactions, compliance issues, costs & use
in patients with substance intoxication & substance
dependence.
b. Detoxifying agents – Benzodiazepines, multivitamins.
c. Anticraving drugs
d. Deterrents
e. Mood stabilizers
f. Antiepileptic
g. Antagonists substitution therapy

II. Treatment of Compliance & Rehabilitation

Multidisciplinary team concept – understand the
Deaddictionist’s role as well as when to consult other health
professionals (experts from various specialities like medicine,
surgery, neurology respective of the complications).

III. Psychological intervention & rehabilitation

a. Understand the Deaddiction specialist’s role in conducting
community meetings for patients as well as self help groups
like alcoholic anonymous & narcotic anonymous.
b. Multidisciplinary team concept –
 Understand the role of occupational therapist &
physiotherapist in occupational & physical rehabilitation.
 Understand the role of social worker in social skill training,
assertiveness training as part of social rehabilitation. To also
understand the issues of compliance, counselling the family
members regarding it & involving them in the therapy.

Activities of the Candidate

Patient Care Activities

 Participate in Deaddiction Outpatient Care 3 days / weeks.

Participate in the Deaddiction The candidate should learn the above topics in the
context of the following substance use disorders.

1. Alcohol Dependence
2. Nicotine Dependence
3. Opioid Dependence
4. Inhalant Dependence
5. Sedative Dependence
6. Cannabis Dependence
 Inpatient / referrals services daily for 12 months
 Nicotine Clinic- one per week
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  Supervise medical residents and students who are posted in Psychiatry
and Deaddiction units.
 Take rotations in General Psychiatry & Medicine.

Academic Activities

 Attend weekly Psychiatry & Deaddiction Journal Club / Case Discussions.

 Present 10 Journal Club sessions per year.
 Attend Interdisciplinary Fellows Research Conference. (Medicine,
Psychiatry).
 Attend a 4 days National Conference of IPS & Preconference workshop.
 Monthly clinical meetings.

Administrative Activities

 Arrange for monthly Case Discussions.

 Maintain a log book of cases, registry of indoor calls and Disorder wise
registry, journal club activities, presentations in meets and conferences.

Research Activity

Research Project of 6-9 month duration (To be submitted 2 months before the
final examination)

DESCRIPTION OF EDUCATIONAL ACTIVITES

 Deaddiction Outpatient Care

 Inpatient / Referrals Service
 Required Rotations : Gen Psychiatry, Medicine
 Post OPD presentation
 Journal Club
 Case Discussion Conference
 Research ( Project )
 Clinical meetings, Conferences
 Independent Study
 Regional / National Programmes and Conference
 Rehabilitation Programme
 Psychotherapeutic Programmes.
 Field visits

Each of these Educational Activities, described fully below, serves to further one or
more of the Post Graduate Certificate Course in Deaddiction Programme’s Core
Competencies. The core competencies relevant to each educational activity are
indicated by listing in bold type.

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 DEADDICTION OUTPATIENT CARE

Description: Under the supervision of an attending physician, the candidate sees 8-

10 new patients and 30-40 follow-up patients during OPD. The candidate documents
the out patients visit in the patient’s records. The candidate discusses and advises
the patient regarding diagnoses and therapies. Diagnosis & treatment are supervised
by the attending faculty. Whenever appropriate, the candidate prepares a letter of
consultation or an update to referring physicians and coordinates care between other
health care providers.

Time involved: 3 days per week

Educational content: Patients seen represent a wide range of ages, from children
to the elderly. Alcohol dependence and opioid dependence are the common
substance use disorders seen. Nicotine dependence including beedi smoking,
gutkha & tobacco chewing is also very common. Other substance use disorders are
cannabis, inhalants, benzodiazapines, stimulants & cocaine. Emphasis is placed on
correct assessment of withdrawal syndromes & neuropsychiatric complications. The
skills of history taking, mental status examination, Psychoeducation & Motivation
interviewing are also emphasized.

Core Competencies:
Patient Care, Medical Knowledge, Practice-Based Learning and improvement,
Communication, Interpersonal Skills, Professionalism.

DEADDICTION INPATIENT/ REFERRAL SERVICE

Description: The candidate attends to all indoor patients admitted in Deaddiction

Centre. The candidate acts as a junior resident for an average of 2-3 referrals of
patients referred from medicine / Surgery / Paediatrics / Orthopaedics / dermatology
wards / ICUs / Emergency medical services / other medical – surgical sub
specialties. The candidate also acts as assistant team leader during those rotations
when medical residents or medical students are posted in Deaddiction unit.

Time involved: 9 months.

Educational content: Alcohol withdrawal, Opioid withdrawal, Delirium Tremens,

Cannabis induced psychosis are the common problems for which patients are
admitted and treated indoors.

Core Competencies:

Patient Care, Medical Knowledge, Practice – Based Learning and Improved

Communication and Interpersonal Skills, Professionalism.

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 REQUIRED ROTATION

General Psychiatry

Description: The candidate spends time with faculty/ Psychiatry in the department
of Psychiatry.

Time: Two months

Educational content:
History taking and mental status examination, Diagnosis and treatment of
schizophrenia, mood disorders, anxiety disorders, somatoform disorders. Attending
suicide clinic, child guidance clinic & group meetings for patients and relatives.

General Medicine

Description: The candidate will spend time with an attending OPD and wards in
General Medicine.

Time: - One month

Educational content- The General Medicine will include time spent in observing
patients of Anaemia, Liver cell failure, Hepatitis ,Tuberculosis.

SAMPLE SCHEDULE FOR CANDIDATE

Indoor patients Deaddiction Indoor Deaddictio Indoor Deaddict

& reference Out patient patients & n OPD patients & ion OPD
rounds references reference group
+ Nicotine rounds therapy
Clinic Disulfira
m Clinic
Community OPD Family Research Lectures /
Meeting admissions Group Work/ Case
Individual OPD Discussion
Therapy Admission s / Self
Study +
Yoga
Therapy

Emergency Calls – Twice a week

Management of Withdrawal Syndromes

- Delirium Tremens
- Substance Intoxication
- Substance Induced Psychosis
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WEEKLY PSYCHIATRY ACADEMICS

Time involved: Weekly for 1 hour throughout one year of course.

Description: Psychiatrist and visiting faculty (both) will present lectures 4 times a
month. Psychiatry Conference will be attended by candidates, psychiatry residents &
medical students during psychiatry rotation. Topics include Substance use disorder
and basic science related to Deaddiction. There will be lectures on therapy, legal
issues .Emphasis will be on case based approach.

Method of evaluation: Attendance and participation

Deaddiction / Psychiatry

Time involved- Monthly for 1 hour throughout the year of course.

Description: - Sessions are attended by faculty and candidates, and any medical
residents or students taking the psychiatry rotation. One attendee presents 2
research articles from peer-reviewed journals. The emphasis is on critique of
research methods as well as on content. Presentations are by faculty and
candidates; each candidate presents 10 cases in a year.

Educational content : Indian Journal of Psychiatry, British Journal of Psychiatry,

American Journal of Psychiatry, ‘Addiction’ Journal, ACTA Psychiatrica Scandiavia,
Journal of Mental & nervous diseases, Psychiatry, Neurology, Neurosurgery.

Core Competencies: Medical Knowledge, Practice-Based Learning and

Improvement, Communication and Interpersonal Skills, Professionalism.

CASE DISCUSSIONS
Time Involved: - Monthly for 1 hour throughout course.

Description: - Candidate presents 5 to 6 case discussion during the year of training.

For each conference, the candidate presents a patient with difficult management
issues, both diagnostic and therapeutic intervention.

Educational content: Discussion of patients with diagnostic or treatment issues

such as Alcohol Dependence, Opioid Dependence. Cannabis Dependence, Inhalant
Dependence, Delirium Tremens, Nicotine Dependence, Substance Induced
Psychosis.

DEADDICTION RESEARCH MEETINGS

Time Involved: Weekly for 1 hour throughout the year of course.

Description: Sessions will be attended by faculty and candidates. Candidates and

faculty review progress on ongoing research projects or present new research
projects for critical review.

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Educational content: Research protocol including data collection, analysis and
interpretation of ongoing projects as well as relevance of such research endeavours.
Each week research topics will be presented by one of the candidates or faculty
discussing progress on an ongoing project or the start up of a new research project.

RESEARCH
Time Involved: Five half days per week during 9 months of the course.

Description: The candidate carries out a research project including planning,

literature search, data gathering, data analysis, and report writing under the direction
of one of the faculty members in Deaddiction Centre. The candidate submits a copy
of the research work to the MUHS & or if appropriate, abstracts are prepared and
articles submitted for presentation and / or publication.

Educational Content: Varies greatly with the project. Will always include experience
in searching the medical literature, evaluating previous published work,
understanding scientific method, learning to express ideas in succinct, clear English.
In the case of clinical project will include experience setting up a computer database
and applying appropriate statistical methods.

LOCAL PSYCHIATRIC SOCIETY CLINICAL MEETINGS.

Time Involved: Every month for 3 hours throughout the year of candidateship.

Description: These conferences are attended by Psychiatrists from all teaching and
nonteaching hospitals as well as residents and candidates. They are conducted in
different hospitals by rotation.

Educational content: Interesting and challenging cases and topics are presented
and discussed.

INDEPENDENT STUDY

Time Involved: Free time on weekdays and evenings and weekends; total
estimated as five to ten hours per week.

Description: The candidate is expected to read and to study substance use

Disorders on own and to spend some time outside of the regular workday engaged
in this.

Educational content: It is expected that self – study will be used to supplement

material presented in other educational activities and that it should include problems
in management of common diseases and those rare clinical topics not encountered
during clinical rotations.

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Strengths and Weaknesses: Covers wide range of material but unsupervised.

I. Curriculum of the course: - Complete copy of the curriculum enclosed.

II. Teaching Scheme : - Total periods allotted to each topic:
a) Daily evaluation of cases ( assessment & diagnosis)
b) Management of cases in OPD ( twice a week ) and IPD (daily)
c) Daily clinical rounds with faculty members.
d) Daily Post OPD presentations
e) PG clinic (case presentation) ( one per week)
f) Monthly ( Inter Hospital Deaddiction) clinical meetings
g) Slide presentations in interesting case meetings ( one per week )
h) Journal Club (one per week)
i) Clinical Research work
j) Indian Psychiatry Society Conferences ( Zonal & National )

3. Proposed Teaching and learning Methods

In Deaddiction Outpatient Care

There will be one-on-one teaching both in the examining room in the presence of the
patient and away from the patient in the department. Emphasis will be placed on
obtaining a thorough history and performing physical & mental status examination
(by example, if necessary), establishing an appropriate differential diagnosis,
deciding an appropriate management. The Psychiatrist responsible for the outpatient
session will always be present in the OPD and every patient will be seen by the
attending physician. The attending faculty will review all completed records for
medical care and thoroughness of documentation. He or she will also review all
letters of consultation for clarity and accuracy.

In Deaddiction IPD: Most of the teaching in the inpatient/referred calls will take
place during teaching rounds at the bedside. Candidates will be encouraged to add
to the discussions on rounds with information from relevant articles in the medical
literature especially as it pertains to new concepts in treatment. Candidates are
expected to act as teachers to house staff and medical students who are posted in
Deaddiction unit.

In General Psychiatry: Primarily the candidate will serve in an apprentice capacity

to the faculty/ Therapist.

In General Medicine: Primarily the candidate will serve as an observer.

In weekly academics: Formal lectures and group discussions when others give
lectures, informal discussion during sessions. Self study & learning through teaching.

In case discussions: Following each presentation, group discussion concerning

patient management issues is participated by all of the attendees. A relevant
literature review has been prepared prior to the discussion.
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In Deaddiction research meetings
: Following each presentation, group discussions concerning the research project will
be conducted by all of the attendees. The discussions will focus on the hypothesis,
methods of data collection and interpretation and the results. Suggestions for
improving the research project will be entertained.

In research : Self Study. Apprentice style one to one learning for computer skills and
direct personal instruction to teach general research and writing skills.
Local Psychiatric Society Clinical Meetings: Case presentation, discussions and
review of literature.