Addiction Psychiatry Fellowship Curriculum

The Addiction Psychiatry program at IU School of Medicine is the first in the United States to author and adopt a curriculum guide and textbook, called “The 2 x 4 Model” in which addiction psychiatrists are trained to lead multidisciplinary clinical teams that fully integrate mental health, addiction services and evidence-based treatments.

The 2 x 4 Model

“The 2 x 4 Model: A Neuroscience-based Blueprint for the Modern Integrated Addiction and Mental Health Treatment System,” authored by IU School of Medicine Addiction Psychiatry Fellowship program alum R. Andrew Chambers, MD, serves as the core reading and curriculum guide for this program. The textbook provides a foundation for the neuroscience and clinical care of patients with either simple or complex forms of addiction and mental illness comorbidities.

Apply

Applicants can apply at any time to this program. Details about eligibility and the process for applying to the Addiction Psychiatry Fellowship are available on the application page.

Application Information

“The 2 x 4 Model” is a design and operational manual for the fully integrated addiction and mental health treatment program that is staffed and led by addiction psychiatrists. Teams of addiction psychiatrists, allied psychiatrists, therapists and nursing professionals provide comprehensive yet individualized addiction and mental health care to patients longitudinally. This care is provided regardless of what particular comorbid combination of addiction(s) or mental illness(s) a patient may have—without referring them to an outside treatment program and for as long as it takes to get patients into stable recovery.

The core design principal of the 2 x 4 Model Clinic is graphically represented by a 2 x 4 grid. On the vertical (Illness) dimension, the clinic commits to the comprehensive treatment of both mental illness and addiction disorders with equal prioritization. On the horizontal axis, this integrated mission is practiced through the use of diagnostic, psychotherapeutic and pharmaceutical (or neuromechanical) tools as well as professional communications.

The 2 x 4 Model emphasizes the integration of mental health and addiction diagnostic work, psychotherapies, medications and professional communications.

the 2x4 model, showing diagnostics, psychotherapy, pharmacotherapy and communications across the top, intervening with mental illness and addiction on the bottom

Learning Objectives

The Addiction Psychiatry Fellowship at IU School of Medicine aims to help physicians gain mastery of eight components in order to integrate them as leaders of real-world teams. Fellows also learn how to assess clinical programs for fidelity to the 2 x 4 Model Design and to know how to build them.

In line with the 2 x 4 Model, Addiction Psychiatry fellows are expected to:

Diagnose: Become adept with diagnosing all the major forms of addiction(s) and mental illness(s) in whatever combination they may present in an individual patient or across a population of diverse patients
Treat: Learn to provide (and lead whole teams in providing) comprehensive treatment plans and recovery strategies that involve integration of psychotherapies, experiential therapies, and medication treatment tools for addiction/mental illness combinations
Train: Acquire skills and expertise in the education of trainees and allied professionals along with communication skills with broader health care and criminal justice officials as needed to protect the integrity and effectiveness of treatment and recovery and to defend patients against dehumanization and stigma

In developing and refining these skills, Addiction Psychiatry Fellows participate in the ‘Triad of Academic Medicine’ as applied to the field of Addiction Psychiatry including:

Conducting longitudinal outpatient care in a variety of settings and across a diversity of demographic groups, spanning the life cycle, and acute (e.g. withdrawal) and chronic phases of substance use disorders.

Gaining experience as a teacher of medical students, psychiatry residents and allied professionals with subject-matter expertise in addiction psychiatry. Co-leading a CME-supported regional academic forum and lecture series (the IU School of Medicine Addiction Psychiatry Symposium).

Pursuit of a research project, study or analysis within the field of Addiction Psychiatry that is expected to result in a peer-reviewed publication. Examples of publications from Addiction Psychiatry Fellowship alumni include:

Rao, KN, Sentir, AM, Engleman, EA, Bell, RL, Hulvershorn, LA, Breier, A, Chambers, RA (2016) “Toward Early Estimation and Treatment of Addiction Vulnerability: Radial-arm Maze and N-acetyl Cysteine before Cocaine Sensitization or Nicotine Self-Administration in Neonatal Ventral Hippocampal Lesion Rats” Psychopharmacology, 233:3933-3945
Sajid, A, Whiteman, A, Bell, RL, Greene, MS, Engleman, EA, Chambers, RA (2016) “Prescription drug monitoring program data tracking of opioid addiction treatment outcomes in Integrated dual diagnosis care involving injectable naltrexone” American Journal on Addictions, 25: 557-564, DOI: 10.1111/ajad.12441
Arnado, CL, Andraka-Christou, B, Allgood, K (2017). “Psychiatric Co-morbidities in Pregnant Women with opioid use disorders: Prevalence, Impact, and Implications for Treatment”. Current Addiction Reports; 4(1): 1-13.
Zarse, EM, Neff, MR, Yoder, R, Hulvershorn, L, Chambers, JE, Chambers, RA. (2019) “The Adverse Childhood Experiences Questionnaire: Two Decades of Research on Childhood Trauma as a Primary Cause of Adult Mental Illness, Addiction, and Medical Diseases”, Cogent Medicine, 6: 1581447; https://doi.org/10.1080/2331205X.2019.1581447
Patterson, D. K., Pollock, D., Carter, C. S., & Chambers, J. E. (2021). Treating Opioid Use Disorder in Peripartum Mothers: A Look at the Psychodynamics, Neurobiology, and Potential Role of Oxytocin. Psychodynamic psychiatry, 49(1), 48–72. https://doi.org/10.1521/pdps.2021.49.1.48
Adams, Z. W., Smoker, M. P., Marriott, B. R., Mermelstein, S. P., Ojo, O., Aalsma, M. C., & Hulvershorn, L. A. (2024). A Statewide Consultation Helpline for Rapid Linkage to Services for Youths With Opioid Use Disorder and Other Substance Use. Psychiatric services (Washington, D.C.), 75(10), 979–985. https://doi.org/10.1176/appi.ps.20230289
Chambers, J. E., Perkins, S. M., Mosesso, K. M., Ahdoot, A., Arnaudo, C. L., & Chambers, R. A. (2025). Adverse childhood experiences, insecure attachment, and appointment compliance in an outpatient addiction psychiatry treatment population. The American journal on addictions, 34(3), 334–341. https://doi.org/10.1111/ajad.13673
Chambers, R. A., & Masterson, K. G. (2025). Introduction to addiction psychiatry. Cambridge University Press.

Rotations

Addiction Psychiatry fellows at IU School of Medicine train at four clinical sites that are staffed by fellowship-trained, board-certified addiction psychiatrists who serve as the training site director, enabling fellows to experience different systems and patient demographic groups under the guidance of accomplished experts.

The training sites are located in the central Indiana region and are geographically close to the IU School of Medicine—Indianapolis campus and other universities with programs in the basic and clinical neurosciences, including Purdue University, Butler University and University of Indianapolis. Most fellows have longitudinal training experiences (at least a year long) at two or more of these sites.

Eskenazi-Midtown Mental Health Center

Eskenazi Mental Health Center

The Eskenazi Mental Health Center, based in central Indianapolis, is one of the largest community Mental Health Centers in the Midwest. This facility is tightly linked with Eskenazi Hospital, a full-service community medical/surgical hospital that contains general emergency psychiatry services and a psychiatric inpatient unit. The center operates a Methadone treatment program and has a fully integrated adult dual-diagnosis treatment service, which has the distinction of being the first fully operational 2 x 4 Model Clinic. The center serves a racially and gender-diverse urban population of patients and families.

Roudebush

VA-Roudebush Hospital

The VA has long served as a key training site for IU School of Medicine fellows in addiction psychiatry and continues to serve as the key site for the school’s PGY-2 general psychiatry residents performing their required core rotations in Addiction Psychiatry.

The VA offers robust opportunities to help U.S. Soldiers, Marines, Airman and Seamen in their recovery from PTSD and other forms of mental illness and addiction comorbidities in a general medal-psychiatric system supported by a powerful IT-EMR system with national reach. This VA facility also hosts integrated dual-diagnosis services and a methadone program.

Individual looking at brain images on a computer screen

Aspire Indiana Health

Aspire has continued to expand its healthcare for people with substance use disorder (SUD), including the 2019 merger with Progress House, the oldest and largest recovery residence in Indiana, and opening Mockingbird Hill Recovery Center, an addiction treatment center in Anderson in 2021. Aspire is the largest provider of recovery beds in Indiana. It also treats Hoosiers with SUD on an outpatient basis at its health centers in Boone, Hamilton, Madison and Marion counties.

IU Health Neuroscience Center

The IU Health Neuroscience Center located in North Downtown Indianapolis is the educational, research and administrative headquarters of the IU School of Medicine Department of Psychiatry. The center also the home of neurosurgery, neurology, neuropsychology, and core basic and clinical neuroscience laboratories. Fellows will get the opportunity to engage with therapists, including Dawn Goodman-Martin, LMHC, LCAC. The general adult psychiatry clinic at the IU Neuroscience Center is across the street from the adult psychiatry inpatient unit and ECT service at Methodist Hospital, the core urban teaching hospital of IU Health.

The IU Health Neuroscience center is the site for the key lecture series that addiction psychiatry fellows participate in (as both teachers and learners), including the Addiction Psychiatry Symposium, Departmental Grand Rounds, and core medical student and psychiatry residency lecture series in Addiction Psychiatry.