The good news is you should be looking for a PGY-2 spot (which makes things easier with what will be a 4 year gap), and PGY-2 spots are usually less difficult to get though there are fewer of them. You will need a positive LoR from your previous training director. People will want to know what you have been doing in the meantime besides focusing on your recovery. Many programs will see your difficulties as a negative, but others will not. Some programs, such as St Luke's Roosevelt (at least they did) specifically look to take physicians/students in recovery. really, I would mainly want to see a compelling story of your interest in psychiatry (beyond addiction), a good understanding of what psychiatrists do (I'm always surprised how clueless many applicants are), and an indication that you are prepared to deal with the challenges of psychiatry residency. If you can get at least one recent LoR from a psychiatrist who can speak to your aptitude for the field that will be helpful too. It will be hard to get hands on clinical experience but shadowing will suffice. Personally, I look at prior experience of failure and hardship as a positive, but not everyone feels that way. specific programs that always have PGY-2 spots include uwashington, new mexico, maryland/sheppard pratt, hopkins, and cornell. other programs that sometimes do include yale, ucsd, ucla, stanford. programs otherwise may develop openings spontaneously and you can enquire by sending your CV and a cover letter to all programs of interest to let them know of your interest if a spot becomes available. You may also choose to apply for PGY-1 spots and sometimes programs may consider you for a PGY-2 spot as well. PGY-1 spots are through the match, most PGY-2 spots are not through the match and offered on a rolling basis.
