The Ultimate IMG Residency Guide: Researching Addiction Medicine Programs

Understanding the Landscape: Addiction Medicine Pathways for IMGs

Before diving into how to research residency programs, you need a clear picture of what “addiction medicine training” actually looks like in North America and how it applies to an international medical graduate (IMG).

Addiction Medicine: Residency vs Fellowship

In most of the United States and Canada, addiction medicine is:

• A subspecialty, usually pursued after a primary residency, most commonly in:
  • Internal Medicine
  • Family Medicine
  • Psychiatry
  • Emergency Medicine
  • Pediatrics (in some tracks)
• Offered as:
  • ACGME-accredited Addiction Medicine Fellowship (often 1 year)
  • Occasionally integrated tracks, combined programs, or focused electives within primary specialties

For many IMGs, the training path is:

1. Match into a core residency (e.g., Internal Medicine, Family Medicine, Psychiatry)
2. Completing residency
3. Apply to an addiction medicine fellowship or other substance abuse training pathway

Some addiction psychiatry fellowships also exist (a separate subspecialty), but this article focuses mainly on addiction medicine fellowship training and how to research residency programs that prepare you for these fellowships.

Why Program Research is Especially Critical for IMGs

As an international medical graduate, you face additional variables beyond what U.S. graduates consider:

• Visa sponsorship (J-1 vs H-1B)
• US clinical experience (USCE) expectations
• Specific ECFMG certification timelines
• Varying comfort levels of programs in training and supporting IMGs
• Cultural and system differences in addiction care between your home country and North America

Because of this, program selection and thorough research can significantly impact:

• Your chance of matching
• Your day-to-day training experience
• Your ability to eventually get into an addiction medicine fellowship
• Your long-term career stability and visa planning

This IMG residency guide walks you through a practical program research strategy so you can identify programs that truly support your goals in addiction medicine.

---

Step 1: Clarify Your Career Goals in Addiction Medicine

You cannot effectively research programs until you know what you want from training. Addiction medicine is broad; your goals shape which programs make sense.

Key Questions to Ask Yourself

1. Do you want to practice primarily as:

   • An addiction medicine subspecialist, or
   • A core specialist (e.g., internist, psychiatrist, family physician) with strong skills in addiction?

2. What type of work setting do you envision?

   • Academic medical center (teaching, research)
   • Community clinic or outpatient addiction center
   • Hospital-based consultation service
   • Public health or policy-focused roles
   • Global addiction medicine initiatives or NGOs

3. How important are these components to you?

   • Research opportunities in addiction science
   • Procedural skills (e.g., managing withdrawal, methadone, buprenorphine, alcohol detox protocols)
   • Integrated care training (co-occurring mental health, HIV, hepatitis C)
   • Psychotherapy/behavioral treatment exposure
   • Advocacy and policy exposure (harm reduction, decriminalization, overdose prevention)

4. What constraints do you have as an IMG?

   • Need for J-1 vs H-1B visa
   • Preference for certain geographic regions (family, cost of living, climate, support networks)
   • Step scores and application profile (to gauge competitiveness)

Translating Goals into Program Features

Once you outline your goals, translate them into program features:

• If you want strong addiction medicine foundation during residency:

  • Look for residency programs with:
    • Dedicated addiction medicine rotations or electives
    • Addiction consult services in the hospital
    • Faculty with addiction medicine certification
    • Strong links to an addiction medicine fellowship

• If you want a path to academic addiction medicine:

  • Prioritize programs with:
    • NIH-funded or institutional research in addiction
    • Opportunities for scholarly projects, QI, or publications in addiction
    • Clearly listed faculty research interests in substance use disorders

This “goal-to-feature” mapping becomes your filter when you start researching programs.

---

Step 2: Build a Structured Program Research Strategy

A strong program research strategy saves time, keeps you organized, and prevents you from applying blindly. This is essential when you might be considering dozens of residency programs and later multiple addiction medicine fellowships.

Step 2A: Decide Your Primary Pathway

You may be at one of two stages:

1. Pre-residency (choosing core specialty programs)

   • Goal: Find IMG-friendly residencies in Internal Medicine, Family Medicine, Psychiatry, etc., that:
     • Offer substance abuse training
     • Have faculty or rotations in addiction medicine
     • Connect to addiction medicine fellowships

2. Post-residency or senior resident (choosing addiction medicine fellowships)

   • Goal: Identify ACGME-accredited addiction medicine fellowships that:
     • Accept IMGs (and sponsor visas if needed)
     • Align with your career goals (clinical vs research focus)

Your research approach is similar in both stages, but the details differ.

Step 2B: Create a Residency/Fellowship Research Spreadsheet

Use Excel, Google Sheets, or Notion to track program details. Suggested columns (you can adapt as needed):

General Program Info

• Program name
• Institution name
• City, state/region, country
• Specialty (IM, FM, Psychiatry, Addiction Medicine, etc.)
• Website URL
• Program type (Academic / Community / University-affiliated / County / VA)

IMG-Friendliness & Visa

• IMG percentage (if known)
• Recent IMGs in residents/fellows list
• Visa types sponsored (J-1, H-1B, none)
• ECFMG certification deadline
• USMLE Step 1/2 score expectations or cutoffs

Addiction-Relevant Features

• Addiction medicine rotation (Y/N)
• Hospital addiction consult service (Y/N)
• Outpatient substance use clinic (Y/N)
• Availability of substance abuse training curriculum (e.g., didactics, workshops)
• Faculty certified in Addiction Medicine/Addiction Psychiatry (names, roles)
• Access to naloxone/harm-reduction training
• Exposure to MAT (medication for addiction treatment): buprenorphine, methadone, naltrexone

Fellowship & Academic Links

• In-house addiction medicine fellowship (Y/N)
• Affiliated addiction psychiatry or addiction medicine programs
• Research opportunities in addiction
• Publication output (approximate; from faculty pages)
• Mentoring structure (research mentors available?)

Practical Considerations

• Duty hours, call schedule (from program reviews, if available)
• Moonlighting (for fellows or senior residents, if applicable)
• Cost of living index for the city
• Support services (wellness, mental health, IMG support, language/culture support)

You do not need all data at once. Start with essentials (name, specialty, location, visa, addiction exposure, fellowship links), then deepen your research as you narrow your list.

---

Step 3: How to Research Residency Programs with an Addiction Focus

Now we can get specific about how to evaluate residency programs for their suitability as a stepping stone to addiction medicine. This applies to IM, FM, Psychiatry, and sometimes Emergency Medicine.

3.1 Use Official Databases and Filters

ACGME / ERAS / NRMP

• Use ERAS or FREIDA (AMA) to search for:
  • Specialty (e.g., Internal Medicine, Family Medicine, Psychiatry)
  • Visa sponsorship (IMG filter)
  • Program type (community vs academic)

Then manually evaluate programs for:

• Addiction-related rotations
• Faculty with addiction training
• Connection to addiction medicine fellowships

Fellowship Databases (To Work Backwards)

Many successful applicants research addiction medicine fellowships first, then look at which residency programs feed into them.

• Identify ACGME-accredited Addiction Medicine Fellowships:
  • Use ACGME’s public list of accredited addiction medicine programs
  • Use professional society websites (e.g., American College of Academic Addiction Medicine, American Society of Addiction Medicine – ASAM) listings

Then:

• Look at each fellowship’s current and recent fellows:
  • Where did they complete their residency?
  • Which specialties did they come from?
• Note those residency programs in your spreadsheet. This gives you real-world pipelines to addiction medicine.

3.2 Deep Dive into Program Websites

Once you have a preliminary list, go to each residency program’s official website. Specifically look for:

1. Curriculum & Rotations Page

   • Search for:
     • “Addiction medicine”
     • “Substance use disorders”
     • “Substance abuse”
     • “Consult liaison psychiatry” (often includes SUD)
   • Look for:
     • Dedicated rotations in addiction medicine, detox units, methadone clinics
     • Exposure to MAT clinics or opioid treatment programs
     • Integrated addiction training in primary care or psychiatry clinics

2. Faculty Profiles

   • Identify faculty with:
     • Addiction Medicine certification (American Board of Preventive Medicine or others)
     • Addiction Psychiatry certification
     • Research focus on substance use, harm reduction, alcohol or opioid use disorders
   • These faculty are potential mentors and indicators that the institution values addiction medicine.

3. Research & Publications

   • Check departmental research pages:
     • Any labs or centers focusing on:
       • Opioid use disorder
       • Alcohol-related disease
       • Harm reduction
       • Behavioral addictions
     • Any ongoing clinical trials in addiction

4. Affiliated Addiction Services

   • Hospital-based services:
     • Inpatient withdrawal management
     • Addiction consult teams
     • Co-occurring disorders units
   • Outpatient services:
     • Methadone or buprenorphine clinics
     • Dual-diagnosis clinics
     • Homeless outreach or harm-reduction clinics

Make notes in your spreadsheet: “Strong addiction exposure,” “Minimal,” or “None apparent.”

3.3 Evaluate IMG Friendliness Alongside Addiction Strength

A program with excellent addiction medicine exposure is not helpful if they never interview or sponsor IMGs. For each program:

• Search for:
  • “International medical graduate” on the program site
  • Resident/fellow bios and look for non-U.S. medical schools
• Check:
  • Program FAQs: “Do you sponsor J-1 or H-1B visas?”
  • ECFMG and exam score requirements
• If unclear, consider a brief, polite email to the program coordinator:
  • Introduce yourself as an IMG
  • Ask if they typically sponsor visas and if IMGs are encouraged to apply

Balance IMG-friendliness with addiction training quality. Many IMGs succeed by targeting programs that are:

• Moderately competitive
• Visibly IMG-supportive
• Strong or growing in addiction medicine

---

Step 4: Researching Addiction Medicine Fellowships as an IMG

If you are nearing the end of residency or already in practice, your focus shifts to addiction medicine fellowship programs.

4.1 Identify Fellowship Programs and Basic Eligibility

Start with:

• The ACGME-accredited Addiction Medicine Fellowship list
• Professional society resources (ASAM, ACAAM, etc.)

For each fellowship, determine:

• Which primary specialties are accepted (IM, FM, Psychiatry, EM, etc.)
• Visa sponsorship policies (J-1 only, J-1 + H-1B, or no visa)
• Whether they have prior IMG fellows (check fellows’ bios or alumni pages)

4.2 Evaluate Clinical Training Scope

Addiction medicine can look very different from one fellowship to another. When evaluating residency programs for how well they prepare you, or fellowships themselves, consider:

1. Clinical Variety

   • Inpatient vs outpatient balance
   • General hospital consultation vs dedicated addiction units
   • Detoxification services (alcohol, benzodiazepine, opioid)
   • Co-occurring psychiatric disorder management
   • Special populations:
     • Pregnant individuals with SUD
     • Adolescents
     • Patients with HIV/HCV
     • Justice-involved populations

2. Medication-Assisted Treatment (MAT) Exposure

   • Buprenorphine inductions in hospital and clinic
   • Methadone maintenance through OTPs
   • Naltrexone for alcohol and opioid use disorders
   • Management of long-acting injectable formulations

3. Behavioral and Psychosocial Treatment

   • Exposure to:
     • Motivational interviewing
     • CBT for SUD
     • Contingency management
   • Work with:
     • Social workers
     • Peer recovery specialists
     • Community outreach teams

4. Systems-Level and Public Health Perspective

   • Policies on harm reduction:
     • Naloxone distribution
     • Syringe services
     • Safe consumption programs (where legal)
   • Collaboration with public health departments or NGOs
   • Involvement in policy or advocacy projects

Programs that explicitly describe these experiences on their website, or highlight them in program brochures, offer richer and more comprehensive substance abuse training.

4.3 Academic and Career Development Support

For IMGs interested in academic careers, research is key. Look for:

• Ongoing addiction research projects and funding
• Clear description of:
  • Required scholarly projects
  • Protected time for research
  • Expectations for presentations or publications
• Mentorship structure:
  • Dedicated mentor(s) assigned to each fellow
  • Access to statisticians or research infrastructure
• Career support:
  • Job placement after fellowship
  • Networking within ASAM and other professional organizations

4.4 Assess the Culture and Support for IMGs

Addiction medicine often deals with vulnerable and stigmatized populations. As an IMG, you also navigate another layer of adaptation—new health system, culture, and communication styles. While researching programs:

• Look for:
  • Testimonials or alumni stories from IMGs
  • Diversity, equity, and inclusion statements that feel substantive, not cosmetic
  • Faculty with international backgrounds or global health interests
• Ask during interviews:
  • How do they support fellows adjusting to a new system?
  • Are there language or communication resources?
  • What is the team culture like in high-stress addiction settings (e.g., dealing with overdose, relapse, complex psychosocial issues)?

Programs that demonstrate empathy and structure for trainee wellbeing often create better environments for IMGs.

---

Step 5: Use Multiple Information Sources Beyond Official Websites

Program websites are curated; to truly evaluate residency programs and fellowships, you need multiple perspectives.

5.1 Contact Current or Recent Residents/Fellows

This is one of the most powerful research tools—and often underused by IMGs.

How to approach:

1. Identify:
   • Current residents/fellows on program websites
   • Alumni listed in program or hospital directories
2. Reach out via:
   • Email (preferred, professional)
   • LinkedIn
   • Professional association networks

What to ask (politely, concisely):

• “How strong is the program’s training in addiction medicine or substance use disorders?”
• “Are there opportunities to work with an addiction consult service or specialized clinics?”
• “How supportive is the program toward IMGs?”
• “What are the challenges you’ve faced as a resident/fellow here?”
• “Would you choose this program again, knowing what you know now?”

Always respect their time and keep messages focused.

5.2 Use Professional Societies and Conferences

For addiction medicine, key organizations include:

• ASAM (American Society of Addiction Medicine)
• ACAAM (American College of Academic Addiction Medicine)
• Regional addiction medicine societies

Actions you can take:

• Attend virtual or in-person conferences (many offer discounted student/resident rates)
• Join interest groups or trainee sections
• Introduce yourself to program leaders or fellowship directors during networking sessions
• Ask about:
  • IMG experiences
  • Program priorities
  • How to strengthen your application profile

This not only informs your program research strategy but also builds relationships that may help during applications.

5.3 Use Match Data and Program Reputation Carefully

Look at:

• NRMP “Charting Outcomes” (for IMGs and by specialty)
• Fellowship match data, when available
• Institutional reputations in addiction research (e.g., large NIDA-funded centers)

But remember:

• The “top” academic name is not always the best fit for your goals and visa needs.
• A smaller community or hybrid program might offer more hands-on substance abuse training and closer mentorship.

Aim for a balanced list:

• A few aspirational programs (more competitive)
• A core set of realistic programs where your profile matches well
• Some “safety” options that are IMG-friendly and clinically strong

---

Step 6: Putting It All Together – Example Scenarios for IMGs

To make all this more concrete, here are two example IMG scenarios and how they might apply this research approach.

Scenario 1: IMG Interested in Psychiatry + Addiction Medicine

• You decide to pursue Psychiatry residency first.
• You want strong training in co-occurring mental health and SUD, with a long-term goal of addiction medicine or addiction psychiatry fellowship.

Your strategy:

1. Use FREIDA to find psychiatry programs that:
   • Sponsor J-1/H-1B
   • Have a moderate or higher proportion of IMGs
2. From these, shortlist programs that:
   • List addiction rotations or dual-diagnosis units
   • Have faculty with addiction medicine or addiction psychiatry certifications
   • Are affiliated with addiction fellowship programs
3. Contact current residents to verify:
   • Actual addiction exposure
   • Research/mentorship availability
   • IMG experiences
4. Apply with a personal statement clearly linking:
   • Your interest in psychiatry
   • Specific motivation for addiction medicine
   • Any prior work or electives related to SUD

Scenario 2: IMG Internal Medicine Resident in Home Country Planning U.S. Career in Addiction Medicine

• You are in your final year of IM residency outside the U.S.
• You plan to apply to U.S. addiction medicine fellowships after completing your home residency (where allowed by certification rules).

Your strategy:

1. Review addiction medicine fellowship eligibility:
   • Confirm whether your non-U.S. residency is acceptable
   • Clarify any board certification or licensing requirements
2. Identify fellowship programs that:
   • Have a history of accepting IMGs
   • Sponsor your required visa type
   • Offer robust clinical SUD experiences
3. Strengthen your profile meanwhile:
   • Engage in addiction-related clinical work or research in your current setting
   • Join ASAM or similar international addiction organizations
   • Present or publish addiction-related work if possible
4. Network:
   • Attend virtual ASAM or ACAAM meetings
   • Talk to program directors or faculty about your non-U.S. training and how they view it
5. Keep a detailed spreadsheet and timeline:
   • Application deadlines, required exams (e.g., USMLE steps, if needed), licensing steps

---

Frequently Asked Questions (FAQ)

1. As an IMG, should I prioritize IMG-friendliness or addiction medicine strength when choosing residency programs?

You need both, but the balance depends on your profile:

• If your exam scores and CV are very strong, you can aim for academic centers with excellent addiction medicine exposure, even if IMG representation is lower.
• If your profile is moderate or borderline for competitiveness, prioritize IMG-friendly programs that still offer meaningful substance abuse training (rotations, electives, mentors).
• A practical rule: don’t apply to programs that clearly state they do not sponsor visas or never take IMGs, regardless of addiction strength.

2. How can I demonstrate genuine interest in addiction medicine in my residency or fellowship applications?

You can show interest through:

• Clinical experiences with patients with SUD (even if not in a formal addiction clinic)
• Research, QI projects, or audits involving:
  • Alcohol use disorder
  • Opioid use disorder
  • Tobacco cessation
• Participation in:
  • Addiction-related student groups
  • Harm reduction or community outreach
  • Conferences (ASAM, local addiction meetings)
• Personal statement:
  • Reflect on a specific case or experience that shaped your motivation for addiction medicine
  • Connect your background (e.g., country’s SUD challenges) to your career goals

3. How do I know if a program genuinely supports IMGs and not just lists “IMGs welcome”?

Signs of genuine IMG support include:

• Multiple current residents/fellows from international schools
• Clear communication about visa sponsorship and ECFMG requirements
• Alumni pages showing successful IMG graduates
• Program leadership or faculty with international backgrounds
• Positive feedback from current IMGs when you reach out to them
• Structured onboarding (e.g., orientation for those new to the U.S. system)

If responses to your polite questions are welcoming, specific, and encouraging, that’s a good sign.

4. Are community programs worse than academic centers for future addiction medicine fellowship applications?

Not necessarily. Many addiction medicine fellowships value:

• Strong clinical skills
• Commitment to caring for patients with SUD
• Letters of recommendation from respected clinicians

Community programs can actually provide:

• High-volume exposure to real-world addiction cases
• Close supervision and procedural experience
• Opportunities to lead quality improvement projects in SUD management

Academic centers often have more research infrastructure, which can help for academic careers. But a community residency plus targeted research or electives in addiction can still be an excellent pathway into fellowship and a rewarding addiction medicine career.

---

By using a systematic, goal-driven approach to program research, you can move beyond guesswork and marketing language. As an international medical graduate with a passion for addiction medicine, combining thorough program evaluation, networking, and strategic applications will significantly improve your chances of finding the right training environment—one that supports both your professional growth and your personal journey toward becoming an addiction medicine expert.