Explore every episode of the podcast ASAM Practice Pearls
Dive into the complete episode list for ASAM Practice Pearls. Each episode is cataloged with detailed descriptions, making it easy to find and explore specific topics. Keep track of all episodes from your favorite podcast and never miss a moment of insightful content.
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Title
Pub. Date
Duration
Tackling Tobacco Use Disorder: Challenges, Innovations, and E-Cigarettes
17 Feb 2025
00:24:40
In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. Nancy Rigotti explore current and emerging strategies for treating tobacco use disorder (TUD). They discuss the latest pharmacological interventions, behavioral approaches, harm reduction strategies, and the evolving role of e-cigarettes in smoking cessation.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Peter Selby, MBBS, CCFP(AM), FCFP, FASAM
Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems.
Expert
Nancy Rigotti, MD
Dr. Rigotti is a general internist and Professor of Medicine, Harvard Medical School. Her research aims to reduce tobacco-related diseases by improving the range and delivery of tobacco use treatments, especially in health care systems. She founded the Massachusetts General Hospital's Tobacco Research and Treatment Center, which evaluates tobacco treatment interventions in outpatient and inpatient health care settings in the U.S. and beyond (i.e., India, South Africa). Additionally, she evaluates the risks and benefits of electronic cigarettes and has evaluated safety and efficacy of cytisine/cytisinicline, a new pharmacotherapy, with the goal of gaining its approval for use in the U.S.
📖 Show Segments
00:04 - Introduction
00:18 - Case Scenario: Challenges in Treating TUD
01:50 - Exploring First-Line and Second-Line Treatments
03:17 - Combining Treatments for Better Outcomes
05:13 - Motivating Patients and Harm Reduction Strategies
08:43 - Controversies and Considerations with E-Cigarettes
18:16 - Future Directions in Tobacco Addiction Treatment
21:55 - Key Takeaways
23:20 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
First-line treatments include varenicline and combination nicotine replacement therapy (NRT), while bupropion and single NRT serve as second-line options. Combining medication with behavioral support improves effectiveness.
For those unable to quit completely, harm reduction is essential. E-cigarettes, though not risk-free, are less harmful than traditional cigarettes and may assist with smoking cessation. However, their long-term safety remains uncertain, and FDA-approved treatments should be prioritized.
Educate patients on the risks and benefits of e-cigarettes and favor FDA-authorized options when considering alternatives to smoking.
Tobacco use disorder should be treated as a chronic disease, with treatment plans tailored to patient preferences and tolerability. Motivational interviewing may enhance adherence and engagement.
Quitting is a process that often requires multiple attempts. Encourage progress, learn from setbacks, and celebrate small successes.
New therapies like cytisinicline show promise as effective and potentially safer options for smoking cessation.
Policy measures such as age restrictions for use, taxation, and marketing controls are critical in reducing smoking and vaping, especially among youth.
Free behavioral support programs are available and should be actively recommended to patients during office visits.
🔗 Resources
ASAM’s State of the Art On-Demand Session: Nicotine
Treating Stimulant Use Disorder: Guidelines and Challenges
03 Feb 2025
00:32:14
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Brian Hurley discuss the complexities of stimulant use disorder (StUD). Topics include challenges in managing StUD without FDA-approved medications, the impact of socioeconomic and cultural factors, and practical insights from the ASAM/AAAP guidelines.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM’s President-Elect and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Brian Hurley, MD, MBA, FAPA, DFASAM
Dr. Brian Hurley is ASAM’s President and an addiction physician. He is the Medical Director of the Bureau of Substance Abuse Prevention and Control in the Los Angeles County Department of Public Health. He was the co-chair of ASAM and American Academy of Addiction Psychiatry's Clinical Practice Guideline on the Treatment of Stimulant Use Disorder. He has also led numerous grant-funded projects that advance access to medications for addiction treatment across Los Angeles County and is the program lead for LA County’s Substance Abuse Mental Health Services Administration’s Harm Reduction grant award and the Centers for Disease Control Overdose to Action Local grant award.
📖 Show Segments
00:03 - Introduction
00:42 - Personal Experience with StUD
03:38 - Overview of ASAM and AAAP Guidelines
05:59 - Contingency Management Explained
09:03 - Implementing Guidelines in Practice
13:50 - Addressing Socioeconomic and Cultural Factors
21:46 - Geographic Differences in Stimulant Use
23:49 - Future of StUD Treatment
29:15 - Key Takeaways
31:01 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Patients with StUD should be assessed and placed in the appropriate level of care using the ASAM Criteria.
Contingency management is the most effective treatment for StUD and can be delivered alone or in combination with psychosocial approaches like cognitive behavioral therapy, the Matrix Intensive Outpatient Treatment curriculum, or the community reinforcement approach.
If contingency management is unavailable, explore grants and local resources to implement it effectively.
While no FDA-approved medications exist for StUD, some have shown clinical effectiveness in helping patients reduce stimulant use.
Healthcare professionals need to actively work to address health disparities stemming from long-standing community inequities by ensuring their workforce reflects the communities served, understanding systemic barriers, integrating care into communities, and adopting health-focused, non-carceral approaches.
Treating StUD is not hopeless. Effective treatments exist, and care plans should be tailored to reflect the drug use patterns of the community served.
When administered under specialized care, controlled substances can be clinically effective in managing StUD.
🔗 Resources
Clinical Practice Guideline on the Management of Stimulant Use Disorder, developed by ASAM and AAAP; Access here!
ASAM’s 56th Annual Pre-conference: Stimulant Use Disorder on Thursday, April 24, 2025; Register here!
FREE Webinar Series: Management of Stimulant Use Disorder
GLP-1 Receptor Agonists Explained: Their Potential Role in Addiction Treatment
22 Jan 2025
00:20:36
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts Dr. Stephanie Weiss from the National Institute on Drug Abuse (NIDA) to explore the potential of GLP-1 receptor agonists (GLP-1RA), particularly semaglutide, in treating alcohol use disorder. They discuss the underlying science, current research, and the challenges and implications of integrating these innovative treatments into addiction care.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM’s President-Elect and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Stephanie Weiss, MD, PhD
Dr. Stephanie T. Weiss is a Research Physician with the Translational Addiction Medicine Branch (TAMB) of the NIDA Intramural Research Program. She holds a PhD in pharmaceutical chemistry and a medical degree from the Cleveland Clinic Lerner College of Medicine. Board-certified in emergency medicine, addiction medicine, and medical toxicology, Dr. Weiss focuses on caring for patients with poisonings, overdoses, and medication misuse. Her research interests include novel psychoactive substances, medication misuse, and improving urine drug testing interpretation.
📖 Show Segments
00:03 - Introduction
01:19 - Exploring GLP-1RA in the News
02:49 - Scientific Background of GLP-1 RA
05:38 - Current Research on Semaglutide
07:13 - Study Design and Methodology
10:38 - Potential Applications of GLP-1RA Beyond Alcohol Use Disorder
12:15 - Challenges in Integrating GLP-1RA into Addiction Care
15:16 - Practical Steps for Addiction Care Providers
18:19 – Looking to the Future
19:27 – Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Semaglutide, a GLP-1RA, is currently being studied as a potential adjunctive therapy for alcohol use disorder.
It shows promise for treating various substance use disorders and is generating significant excitement in the addiction medicine field.
Challenges to utilizing GLP-1RA for addiction care include high costs, limited access, and stigma associated with addiction treatment.
For patients with co-occurring conditions such as type 2 diabetes or obesity and alcohol use disorder, semaglutide may offer dual therapeutic benefits.
Future research will shed light on the efficacy and safety of GLP-1RA, but questions remain about long-term effects.
Despite FDA-approved treatments, alcohol use disorder remains severely undertreated. Providers should prioritize these medications while awaiting more data on semaglutide.
It is important to exercise caution when integrating new treatments such as GLP-1RA into practice.
EP 04
🎙 Special Series: Advances in Buprenorphine Education
This episode is part of a special series on improving hospital and clinic-based buprenorphine treatment for opioid use disorder.
In this episode of ASAM Practice Pearls, Dr. Carolyn Chan and Dr. Shawn Cohen welcome addiction medicine expert Dr. Marlene Martin. With extensive experience in helping care teams navigate the complexities of in-hospital substance use, Dr. Martin provides insights on how hospital-based providers can effectively address these challenges with confidence and compassion.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org .
Host
Carolyn Chan, MD MHS
Dr. Carolyn Chan is board-certified in both internal and addiction medicine. She completed her IM residency at UH Hospitals Cleveland Medical Center, followed by an addiction medicine and medical education fellowship at Yale. She provides care in both inpatient and outpatient addiction medicine settings. Currently, she is the Program Director of the University of Cincinnati Addiction Medicine Fellowship and is committed to educating all health professionals on how to provide evidence-based care to individuals with substance use disorders.
Co-Host
Shawn Cohen, MD
Dr. Shawn Cohen is an addiction medicine doctor at Yale New Haven Hospital. He provides care on a hospital-based addiction consult service and is interested in lowering barriers to MOUD, improving the care of patients experiencing alcohol withdrawal, and making the hospital a more person-centered and less stigmatizing place for people who use substances.
Expert
Marlene Martin, MD
Dr. Marlene Martin is an Associate Professor at UCSF and hospitalist at San Francisco General Hospital. She is the founding director of the Addiction Care Team, which provides compassionate, evidence-based care for hospitalized people with substance use disorders. As Director of Addiction Initiatives for the Latinx Center of Excellence, she coleads PEDAL, a Spanish-language addiction training program for community health workers, aiming to improve care for Latine individuals with substance use disorders. Her work focuses on health equity, harm reduction, and innovative care models.
📖 Show Segments
00:05 – Introduction
02:20 – Case Scenario: Managing In-Hospital Substance Use
03:26 – Approaching In-Hospital Substance Use
07:16 – Best Practices for Hospital Policies
12:55 – Handling Substances and Paraphernalia in Hospitals
16:15 – Engaging Stakeholders in Policy Development
17:59 – Navigating Policy Concerns
21:47 – Managing Adverse Outcomes
23:35 – Mitigating Patient Discomfort When a Search Occurs
26:15 – Engaging Nurses in Substance Use Management
28:15 – Revisiting the Case Scenario
30:00 – Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Prioritize compassionate care. Approach in-hospital substance use with empathy, understanding, and kindness to foster trust and better outcomes for both patients and healthcare workers.
Avoid punitive measures. Minimize the involvement of security or law enforcement unless there is an imminent safety threat.
Maintain open communication. Be transparent with patients about hospital policies, concerns, and available support resources.
Follow evidence-based treatment. Provide medications and interventions aligned with best practices for managing substance use disorders.
Incorporate harm reduction strategies. Integrate harm reduction principles into hospital care plans to support patient safety and recovery.
Address root causes. Identify and manage underlying issues such as untreated pain or withdrawal symptoms that may contribute to substance use.
Engage a multidisciplinary team. Involve nursing staff, regulatory teams, and hospital leadership to develop and implement effective partnerships and policies.
Continuously review policies. Regularly update hospital guidelines to reflect evolving best practices and improve outcomes for both patients and staff.
Empower nursing teams. Provide training and resources to help nurses lead addiction care efforts within hospital settings.
Consider patient agreements. Use collaborative agreements with patients as a proactive step before resorting to stricter measures.
Martin M, Snyder HR, Otway G, Holpit L, Day LW, Seidman D. In-hospital Substance Use Policies: An Opportunity to Advance Equity, Reduce Stigma, and Offer Evidence-based Addiction Care. J Addict Med. 2023;17(1):10-12. doi:10.1097/ADM.0000000000001046.
Calcaterra SL, Martin M, Bottner R, Englander H, Weinstein Z, Weimer MB, Lambert E, Herzig SJ. Management of opioid use disorder and associated conditions among hospitalized adults: A Consensus Statement from the Society of Hospital Medicine. J Hosp Med. 2022 Sep;17(9):744-756. doi: 10.1002/jhm.12893. Epub 2022 Jul 26; PMID: 35880813; PMCID: PMC9474708. Read more.
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Balancing Patient Confidentiality and Legal Obligations
03 Mar 2025
00:36:44
EP 03
🎙 Special Series: Advances in Buprenorphine Education
This episode is part of a special series on improving hospital and clinic-based buprenorphine treatment for opioid use disorder.
In this episode of ASAM Practice Pearls, Dr. Stephen Holt and Dr. Shawn Cohen welcome addiction medicine expert Dr. Catherine Trimbur. They explore the delicate balance between protecting patient confidentiality and fulfilling legal responsibilities when responding to requests from parole officers, child welfare agencies, and other external entities.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org .
Host
Stephen Holt, MD, MS, FACP, FASAM
Dr. Stephen Holt has been an attending physician at Yale-New Haven Hospital since 2008 and is an Associate Professor of Medicine at Yale School of Medicine. He is the Director of the Yale Addiction Recovery Clinic and the Associate Program Director for Yale's Primary Care Internal Medicine Residency Program. He is board-certified in Addiction Medicine and Internal Medicine. He has published and lectures frequently on a variety of addiction medicine topics and has won numerous teaching awards at the local, regional, and national levels.
Co-Host
Shawn Cohen, MD
Dr. Shawn Cohen is an addiction medicine doctor at Yale New Haven Hospital. He provides care on a hospital-based addiction consult service and is interested in lowering barriers to MOUD, improving the care of patients experiencing alcohol withdrawal, and making the hospital a more person-centered and less stigmatizing place for people who use substances.
Expert
Catherine Trimbur, MD, MPH
Dr. Catherine Trimbur, triple board-certified in internal medicine, addiction medicine, and palliative care, is an assistant professor at Brown University’s Warren Alpert Medical School. She leads Brown’s Transitions Clinic, providing comprehensive care for formerly incarcerated individuals with serious illnesses and substance use disorders. Dr. Trimbur also offers pain management and palliative care at the Rhode Island Adult Correctional Institute. Committed to medical education, she has developed a curriculum to help residents enhance empathy and reduce stigma in marginalized patient care. She serves on several university and hospital committees related to primary care and health equity.
📖 Show Segments
00:03 – Introduction
02:15 – Case Scenario: Navigating Parole and Child Welfare Requests
03:45 – Differences Between Parole and Probation
06:33 – Navigating Parole and Probation in Patient Care
09:51 – Advocating for Patients: Effective Communication Strategies
13:25 – Advocacy and Education in Interactions with Parole Officers
24:09 – Interacting with Child Welfare Systems
30:00 – Success Stories and Legislative Impact
34:28 – Revisiting the Case Scenario
35:56 – Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Prioritize patient autonomy. Engage patients in decisions regarding information sharing and advocate for their strengths and progress.
Educate stakeholders. Help parole officers, judges, and other officials understand the medical and psychosocial aspects of addiction treatment to foster more recovery-focused decisions.
Clarify legal terminology. Understanding distinctions—such as parole (post‑incarceration supervision) versus probation (prison alternative)—helps providers navigate legal complexities more effectively.
Advocate through documentation. Writing letters to judges and parole officers highlighting patients' progress and health needs can influence decisions, such as waiving fees or avoiding re‑incarceration.
Leverage patient‑controlled testing. Offering urine toxicology screens under patient control can reduce stress and promote adherence with legal requirements.
Foster a supportive approach. Encourage family involvement with a focus on support rather than punishment to achieve better long‑term outcomes.
Address stigma head‑on. Recognize patients' strengths and build trust to improve healthcare experiences and overall engagement.
Use strategic communication. Employ clear, empathetic, and informed communication with legal and welfare authorities to achieve the best patient outcomes.
Be persistent in advocacy. Continuous efforts can drive systemic improvements and enhance support structures for justice‑involved patients.
Push for policy change. Educate legal personnel and support legislative reforms to create a more supportive system for individuals with substance use disorders.
Docs for Health: Find additional resources for healthcare providers working with justice-involved patients including letter templates.
Transitions Clinics: The Transitions Clinic Network is building an innovative healthcare model for individuals returning to the community from incarceration.
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Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!
Creating Realistic Follow-Up Plans for Unstable Patients
03 Mar 2025
00:28:24
EP 02
🎙 Special Series: Advances in Buprenorphine Education
This episode is part of a special series on improving hospital and clinic-based buprenorphine treatment for opioid use disorder.
In this episode of ASAM Practice Pearls, Dr. Shawn Cohen is joined by addiction medicine experts Dr. Carolyn Chan and Dr. Stephen Holt. Together, they explore effective strategies for managing unstable patients and creating realistic follow-up plans that prioritize patient engagement and continuity of care.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org .
Host
Shawn Cohen, MD
Dr. Shawn Cohen is an addiction medicine doctor at Yale New Haven Hospital. He provides care on a hospital-based addiction consult service and is interested in lowering barriers to MOUD, improving the care of patients experiencing alcohol withdrawal, and making the hospital a more person-centered and less stigmatizing place for people who use substances.
Experts
Carolyn Chan, MD MHS
Dr. Carolyn Chan is board-certified in both internal and addiction medicine. She completed her IM residency at UH Hospitals Cleveland Medical Center, followed by an addiction medicine and medical education fellowship at Yale. She provides care in both inpatient and outpatient addiction medicine settings. Currently, she is the Program Director of the University of Cincinnati Addiction Medicine Fellowship and is committed to educating all health professionals on how to provide evidence-based care to individuals with substance use disorders.
Stephen Holt, MD, MS, FACP, FASAM
Dr. Stephen Holt has been an attending physician at Yale-New Haven Hospital since 2008 and is an Associate Professor of Medicine at Yale School of Medicine. He is the Director of the Yale Addiction Recovery Clinic and the Associate Program Director for Yale's Primary Care Internal Medicine Residency Program. He is board-certified in Addiction Medicine and Internal Medicine. He has published and lectures frequently on a variety of addiction medicine topics and has won numerous teaching awards at the local, regional, and national levels.
📖 Show Segments
00:04 – Introduction
00:50 – Case Scenario: Unstable Patient Follow-up
02:17 – Building Low-Barrier Clinics
06:15 – Building Partnerships with Community Resources
09:26 – Troubleshooting Patient Engagement
16:11 – Navigating Complex Patient Scenarios
19:54 – Strategies for Reengaging Patients in Care
23:50 – Reducing Barriers and Integrating Harm-Reduction in Clinics
25:25 – Revisit Case Scenario
27:20 – Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Build strong relationships. Foster connections with patients and providers across inpatient, outpatient, and community settings to ensure seamless transitions.
Prioritize warm handoffs. Maintain continuity of care through compassionate, consistent communication.
Stay proactive. Reach out to patients who miss appointments via phone calls or secure messaging to encourage reconnection and demonstrate support.
Align care with patient goals. Tailor treatment plans to individual needs, acknowledging their personal circumstances and preferences.
Minimize barriers to care. Offer flexible scheduling, telehealth options, and accommodating policies, such as walk-in availability and relaxed late arrival rules.
Emphasize harm reduction. Incorporate approaches like long-acting buprenorphine and methadone when appropriate.
Use monitoring tools thoughtfully. Leverage urine toxicology as a supportive tool rather than a punitive measure.
Adapt treatment plans as needed. Avoid punitive measures and modify strategies when current approaches are ineffective.
Engage community resources. Collaborate with local organizations to support patient re-engagement.
Leverage peer support. Utilize peer recovery coaches or case managers to provide continuous patient support.
Support prescriber confidence. Offer training and resources to address concerns about managing substance use treatment.
Develop sustainable follow-up plans. Implement practical, actionable steps to create personalized follow-up plans that meet patient needs.
Maximize telehealth benefits. Ensure compliance with local and federal regulations while expanding access to care.
American Society of Addiction Medicine. Engagement and Retention of Nonabstinent Patients in Substance Use Treatment: Clinical Consideration for Addiction Treatment Providers. October 2024. Read more.
Henssler J, Müller M, Carreira H, Bschor T, Heinz A, Baethge C. Controlled drinking–non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta‐analysis and meta‐regression. Addiction. 2021 Aug;116(8):1973–1987. doi: 10.1111/add.15329.
Additional information on SUD privacy 42 CFR part 2: View here.
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Overcoming Barriers to MOUD at Discharge: Ensuring Continuity of Care from Skilled Nursing Facilities
03 Mar 2025
00:27:48
EP 01
🎙 Special Series: Advances in Buprenorphine Education
This episode is part of a special series on improving hospital and clinic-based buprenorphine treatment for opioid use disorder.
In this episode of ASAM Practice Pearls, Dr. Stephen Holt is joined by addiction medicine experts Dr. Carolyn Chan and Dr. Shawn Cohen. They explore key challenges and solutions in ensuring continuity of care for patients receiving medication for opioid use disorder (MOUD) during discharge from skilled nursing facilities.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen Holt, MD, MS, FACP, FASAM
Dr. Stephen Holt has been an attending physician at Yale-New Haven Hospital since 2008 and is an Associate Professor of Medicine at Yale School of Medicine. He is the Director of the Yale Addiction Recovery Clinic and the Associate Program Director for Yale's Primary Care Internal Medicine Residency Program. He is board-certified in Addiction Medicine and Internal Medicine. He has published and lectures frequently on a variety of addiction medicine topics and has won numerous teaching awards at the local, regional, and national levels.
Experts
Carolyn Chan, MD, MHS
Dr. Carolyn Chan is board-certified in both internal and addiction medicine. She completed her IM residency at UH Hospitals Cleveland Medical Center, followed by an addiction medicine and medical education fellowship at Yale. She provides care in both inpatient and outpatient addiction medicine settings. Currently, she is the Program Director of the University of Cincinnati Addiction Medicine Fellowship and is committed to educating all health professionals on how to provide evidence-based care to individuals with substance use disorders.
Shawn Cohen, MD
Dr. Shawn Cohen is an addiction medicine doctor at Yale New Haven Hospital. He provides care on a hospital-based addiction consult service and is interested in lowering barriers to MOUD, improving the care of patients experiencing alcohol withdrawal, and making the hospital a more person-centered and less stigmatizing place for people who use substances.
📖 Show Segments
00:03 - Introduction
02:35 - Barriers to Continuity of Care
07:43 - Navigating Prior Authorizations
10:24 - Methadone Discharge Planning
14:19 - Extended-release Buprenorphine at Discharge
17:44 - Engaging Family and Caregivers
19:23 - Staff Education and Advocacy
22:14 - Discharge Planning Example Scenarios
25:11 - Revisit Case Scenario
25:50 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Build relationships with local stakeholders. Collaborate with nursing facility administrators, intake personnel, and buprenorphine clinics to facilitate smoother transitions for patients.
Address stigma and education gaps. Work closely with facilities to improve their understanding of MOUD and the importance of comprehensive addiction treatment.
Be proactive in discharge planning. Arrange follow-up appointments and maintain open communication with all relevant parties to prevent care gaps.
Anticipate common barriers. Stay ahead of issues like prior authorizations by verifying medication access before discharge.
Strive for incremental improvements. Small changes can lead to significant advancements in patient care over time.
Emphasize clear communication. Ensure nursing homes and facilities fully understand discharge plans and patient needs.
Encourage patient engagement. Motivate patients to involve their support systems in their recovery journey.
Methadone Initiation for Opioid Use Disorder in the Emergency Department
19 May 2025
00:28:03
EP 03
🎙 Special Series: ASAM's 56th Annual Conference
This episode is part of a special four-part series spotlighting key sessions from ASAM’s 56th Annual Conference.
In this episode of ASAM Practice Pearls, Dr. Elizabeth Salisbury-Afshar is joined by Drs. Rachel Haroz, Bill Soares, and Ryan McCormack to discuss their session, Methadone Initiation for Opioid Use Disorder in the Emergency Department. The episode covers implementation strategies, regulatory considerations, and practical steps for introducing methadone as a treatment option in emergency care.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, FACPM, DFASAM
Dr. Elizabeth Salisbury-Afshar is a family medicine, preventive medicine/public health, and addiction medicine physician. She is an Associate Professor at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. She is a core faculty member for the Addiction Medicine Fellowship at the University of Wisconsin, and her clinical roles include addiction medicine consult service and serving as medical director of a low-barrier walk-in clinic serving people who use substances. She is also the Program Director of the Preventive Medicine Residency at UW-Madison and Medical Director of Harm Reduction Services at the Wisconsin Division of Public Health. Dr. Salisbury-Afshar's work focuses on expanding access to evidence-based addiction treatment and harm reduction services. She has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar lectures nationally on addiction medicine topics, including the treatment of opioid use disorder, harm reduction, the intersection of addiction and the criminal legal system, and public health approaches to reduce overdose mortality. Dr. Salisbury-Afshar is actively involved in ASAM, where she currently serves as the Vice Chair of the Medical Education Council, Course Director of the ASAM-All Rise treatment courts courses, a member of the ASAM Conference Planning Committee, and the Chair of Harm Reduction Special Interest Group.
Expert
Rachel Haroz, MD, FAACT
Dr. Rachel Haroz is an associate professor in the Department of Emergency Medicine at Cooper Medical School of Rowan University, the division head of toxicology and addiction medicine, and the center head of the Cooper Center for Healing. She is board-certified in Emergency Medicine, Medical Toxicology, and Addiction Medicine, obtaining her BA in Biology from Brandeis University, her MD from Tufts University, and completing a residency in Emergency Medicine and a fellowship in Medical Toxicology. She has spent the last 20 years working in inner city emergency departments, mostly in the Camden area. She helped build and now staffs the Cooper Center for Healing in Camden, New Jersey, an addiction medicine specialty Center dedicated to treating patients with substance use disorders. In 2016, she helped create and implement BupeFirst ED, an initiative to prescribe buprenorphine from the Emergency Department and bridge patients to treatment with various community partners, and in 2019, she helped launch BupeFirst EMS, an innovative program aimed at initiating buprenorphine via paramedics in the field. She is also heavily involved in education as well as various NJ state initiatives to better serve patients struggling with substance use disorders.
Expert
Bill E. Soares III, MD, MS
Dr. William (Bill) Soares is the Director of Harm Reduction Services in the Department of Emergency Medicine at Baystate Medical Center in Springfield, MA, and an Assistant Professor of Emergency Medicine at the University of Massachusetts Chan Medical School-Baystate. He is a practicing emergency and addiction medicine physician researcher who has spent the past 10 years focused on expanding medication treatments and harm reduction services for emergency department patients with opioid use disorder. In his role as Director of Harm Reduction Services, Dr. Soares oversees take-home Narcan, harm reduction safer supply distribution, buprenorphine, and methadone induction programs throughout the four emergency departments in the Baystate Health System. Dr. Soares’s research focuses on clinical decision-making in the emergency department. He has completed a NIDA K08 (1K08DA045933-01) project evaluating provider decisions to prescribe discharge opioid medications to patients presenting with an acutely painful condition. He currently has federal grants from NIDA, AHRQ, and SAMHSA focused on expanding medication treatment and harm reduction for people with substance use disorders. Recently, he led efforts to create a comprehensive inpatient addiction consultation service for the three Baystate community hospitals through a state-level opioid settlement fund grant administered through the Massachusetts Bureau of Substance Use and Addiction Services (BSAS).
Expert
Ryan McCormack, MD, MS
Dr. Ryan McCormack is an Associate Professor of Emergency Medicine at the NYU Grossman School of Medicine and practices clinically in the Bellevue Hospital Emergency Department (ED). He is an NIH-funded clinical investigator who has led several multicenter trials with a history of funding from the National Institute on Drug Abuse (NIDA) and its Clinical Trials Network (CTN) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). His research employs mixed quantitative and qualitative methods and implementation science approaches to translate efficacious behavioral treatments (e.g., motivational interviewing, case management) and pharmacotherapy (buprenorphine, methadone, naltrexone) for substance use disorders into ED settings with a particular focus on highly marginalized patient populations.
📖 Show Segments
00:05 – Introduction
01:16 – The Evolution of Addiction Treatment in Emergency Departments
04:19 – Implementing Methadone Protocols: Steps and Best Practices
09:40 – Building Relationships and Finding Partners
14:32 – Navigating Federal and State Regulations
20:23 – The Importance of Multiple Treatment Options
23:39 – Policy Changes and the Future of Methadone Access
27:18 – Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Promote Multidisciplinary Support: Engage various stakeholders within the hospital, including clinical champions, nurses, residents, and administrative staff, to support methadone initiation.
Partner with OTPs: Establish strong relationships with local Opioid Treatment Programs (OTPs) to ensure continuity of care for patients once they leave the emergency department.
Implement Flexible Protocols: Develop clear, adaptable protocols for methadone initiation that can be tailored to your institution’s specific needs and resources.
Offer Education and Training: Provide education and training to emergency department staff about methadone, including its benefits, dosing, and risk management.
Familiarize Yourself with Policy and Regulations: Understand and navigate federal, state, and local regulations related to methadone. For guidance, use resources such as the State Opioid Treatment Authorities (SOTA).
Support Future Policy Shifts: Advocate for policy initiatives and legislative changes that could make methadone prescribing more flexible and accessible, potentially decentralizing it from tightly regulated OTPs.
Identify a Clinical Champion: Addiction pathways are organized, multidisciplinary care plans to support clinical guidelines and protocols. Identifying a clinical champion to help implement these addiction pathways is important for improving patient care.
Consider Methadone for OUD Treatment in the ED: Methadone is a valuable, life-saving option for treating opioid use disorder. Don’t be afraid to use it.
🔗 Resources
ASAM’s 56th Annual Conference Session: Methadone Initiation for Opioid Use Disorder in the Emergency Department Register HERE
Bridge Treatment: A program of the Public Health Institute that bridges emergency care and community health to create an integrated system that improves health and equity.
Clinical Toolkit - This toolkit provides referral algorithms, dosing strategies, risk stratification, literature/references, a guide to stakeholder recruitment and relationships, and tips of the trade.
Emerging Illicit Substances: What Clinicians Need to Know
12 May 2025
00:17:23
EP 02
🎙 Special Series: ASAM's 56th Annual Conference
This episode is part of a special four-part series spotlighting key sessions from ASAM’s 56th Annual Conference.
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor is joined by Drs. Jeanmarie Perrone and Alaina Steck to explore key insights from their session, Emerging Illicit Substances: What Clinicians Need to Know. The conversation covers emerging drugs of concern, clinical challenges, and practical strategies for clinicians navigating this rapidly evolving field.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Jeanmarie Perrone, MD
Dr. Jeanmarie Perrone is a Professor in the Department of Emergency Medicine and the founding Director of the Center for Addiction Medicine and Policy at the University of Pennsylvania. Dr. Perrone leads programs for the treatment of Opioid and Alcohol Use Disorders in the emergency department (ED) and a virtual telehealth bridge clinic (CareConnect). Her work has been funded by city health departments and by NIDA, PCORI, CDC, and SAMHSA. She has advocated at the state and national levels and contributed to working groups to enhance low-barrier treatment access for substance use disorders. She has been recognized with awards for leadership, education and mentorship and her initiatives have been featured in the media including National Public Radio, the New York Times and USA Today.
Expert
Alaina Steck, MD
Dr. Alaina R. Steck is an Associate Professor in the Emory Department of Emergency Medicine. She completed her residency training in Emergency Medicine at Boston Medical Center in Boston, MA, and her fellowship in Medical Toxicology at the Emory / Centers for Disease Control and Prevention Combined Fellowship in Medical Toxicology, followed by board certification in Addiction Medicine. She currently serves as the Medical Director of the Grady Medication for Alcohol and Opioid Use Disorder Treatment clinic, the Addiction Medicine Clerkship Director, Assistant Medical Director at the Georgia Poison Center, and Pharmacology Thread Director at the Emory School of Medicine.
📖 Show Segments
00:05 – Introduction
00:59 – An Overview of the Emerging Illicit Substances Session
02:08 – What Practitioners Should Know about Emerging Illicit Substances
03:36 – Specific Substances of Growing Concern
04:35 – Challenges in Clinical Practice
05:33 – Surprising Insights and Discussion from the Session
06:40 – Resources for Recent Data Trends
07:19 – Key Lessons for Practitioners to Implement Now
08:56 – Unique Withdrawal Syndromes
11:27 – Anecdotal Examples of Rising Illicit Substances
14:06 – Communicating with Colleagues
16:14 – Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Emerging Illicit Substances: The landscape of psychoactive substances is evolving rapidly, with new agents continually appearing on the market.
The Rise of Medetomidine as an Illicit Drug Adulterant: Medetomidine, a veterinary anesthetic, is an emerging concern as it seeps into the fentanyl drug supply as a replacement for xylazine in some parts of the country.
New Withdrawal Syndromes: Medetomidine has led to a unique withdrawal syndrome that requires high-dose opioids and other sedative agents for management.
Importance of Naloxone: Despite the emergence of new substances, fentanyl remains a major driver of opioid fatalities, and naloxone is still effective for these overdoses.
Communicate with Colleagues: Regional variations can significantly impact the local drug supply, making communication and information sharing between different parts of the country critical to identifying trends and preparing effective responses.
Utilize Available Resources: Important resources, such as the National Drug Early Warning System and local drug checking services, can inform clinicians about local and national trends.
🔗 Resources
ASAM’s 56th Annual Conference Sessions: Emerging Illicit Substances: What Clinicians Need to Know Register HERE
Opioid Withdrawal and Autonomic Complications Associated with Medetomidine Adulteration: Access Poster HERE
CAMP Webinar Recording: An Emerging Adulterant in Philadelphia: Medetomidine Withdrawal in People Who Use Fentanyl - Discusses the latest findings on medetomidine.
CSFRE NPS Discovery - The Center for Forensic Science Research and Education provides drug and forensic toxicology testing results, trend reports, and emerging new substances data.
Drug Overdose Toxico-Surveillance (DOT) Reporting Program - The Emergency Department Overdose Biosurveillance Project, conducted by the American College of Medical Toxicology in collaboration with CSFRE, assesses the sociodemographic characteristics, clinical information, and contextual data on opioid and/or stimulant overdoses.
National Drug Early Warning System (NDEWS) - Provides real-time surveillance and research on emerging drug trends in the U.S., offering tools like machine learning analyses, online monitoring, and community-based reporting to inform public health responses.
National Forensic Laboratory Information System (NFLIS) - A DEA program that collects and analyzes forensic drug chemistry laboratory data, medical examiner and coroner data, and toxicology laboratory data across the U.S., providing data resources, publications, and a public data query system to support drug enforcement and public health initiatives.
PENN CAMP: Center for Addiction Medicine and Policy – Offers information and resources related to addiction medicine in clinical services, educational programs, community engagement, harm reduction strategies, research initiatives, and policy and advocacy.
StreetCheck: Community Drug Checking – A community-partnered platform that streamlines the collection, analysis, and reporting of drug samples for harm reduction programs, offering tools such as a web-based app, training resources, and real-time drug trend data to help communities respond to the evolving illicit drug supply.
How to Transform Hospitals to Better Care for People with Addiction
05 May 2025
00:26:52
EP 01
🎙 Special Series: ASAM's 56th Annual Conference
This episode is part of a special four-part series spotlighting key sessions from ASAM’s 56th Annual Conference.
In this episode of ASAM Practice Pearls, Dr. Elizabeth Salisbury-Afshar welcomes Dr. Itai Danovitch to explore highlights from his session, Hospitals as a Frontline for Addiction: Lessons from the START Study. They’ll discuss the pivotal role hospitals play in identifying and treating substance use disorders, drawing on insights and outcomes from the START (Substance Use Treatment and Recovery Team) Study.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org .
Host
Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, FACPM, DFASAM
Dr. Elizabeth Salisbury-Afshar is a family medicine, preventive medicine/public health, and addiction medicine physician. She is an Associate Professor at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. She is a core faculty member for the Addiction Medicine Fellowship at the University of Wisconsin, and her clinical roles include addiction medicine consult service and serving as medical director of a low-barrier walk-in clinic serving people who use substances. She is also the Program Director of the Preventive Medicine Residency at UW-Madison and Medical Director of Harm Reduction Services at the Wisconsin Division of Public Health. Dr. Salisbury-Afshar's work focuses on expanding access to evidence-based addiction treatment and harm reduction services. She has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar lectures nationally on addiction medicine topics, including the treatment of opioid use disorder, harm reduction, the intersection of addiction and the criminal legal system, and public health approaches to reduce overdose mortality. Dr. Salisbury-Afshar is actively involved in ASAM, where she currently serves as the Vice Chair of the Medical Education Council, Course Director of the ASAM-All Rise treatment courts courses, a member of the ASAM Conference Planning Committee, and the Chair of Harm Reduction Special Interest Group.
Expert
Itai Danovitch, MD, MBA, DFAPA, DFASAM
Dr. Itai Danovitch is Professor and Chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center in Los Angeles. He earned his bachelor's degree from UC Berkeley and his medical doctorate from the UCLA School of Medicine. He completed a psychiatry residency at Columbia University, an addiction psychiatry fellowship at Cedars-Sinai Medical Center, and a Master of Business Administration at the UCLA Anderson School of Management. Dr. Danovitch’s clinical practice and research are focused on the treatment of substance use disorders and the integration of medical and mental health services. His current research is funded by the National Center for Advancing Translational Sciences (NCATS), the National Institute on Drug Abuse (NIDA), and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). He is the author of over 100 articles and book chapters and co-editor of two books on substance use disorders. Dr. Danovitch served as a Governor-appointed state Commissioner to the California Mental Health Services Commission. He is a Distinguished Fellow of the American Society of Addiction Medicine, a Distinguished Fellow of the American Psychiatric Association, and past president of the California Society of Addiction Medicine.
📖 Show Segments
00:05 – Introduction
00:52 – Why the START Study
02:32 – Study Methodology and Key Findings
05:08 – Key Findings
06:46 – Impact and Practical Applications
12:28 – Challenges in expanding access to Addiction Consultation Services
14:35 – Suggestions for Starting Addiction Consultation Services
17:23 – Benefits of having Addiction Consultation Services
19:03 – Expanding Addiction Consultation Services
23:39 – Proactive Approaches and AI Tools
25:02 – Final Thoughts
26:11 – Conclusion and Additional Learning Opportunities
📋 Key Takeaways
START Study: The START study was a randomized trial conducted at three different sites, focusing on initiating medication for opioid use disorder and connecting patients to aftercare.
Addiction Consultation Services: Addiction consultation services can play an important role in hospitals providing better care for patients with substance use disorders.
Effective Interventions: The study found that addiction consultation services significantly increased the likelihood of patients starting medication for opioid use disorder and being linked to follow-up care.
Importance of Care Managers: Care managers play a significant role in the success of patient treatment. Those who followed up with patients for a month after discharge and addressed any issues that arose were most impactful.
Utilize Available Resources: Initiating addiction consultation services can be effective if you start with available resources and progressively build on them.
Financial Constraints: Financing remains the biggest challenge for expanding access to addiction consultation services despite their proven effectiveness.
Engagement and Early Identification: Identifying and engaging patients early in their hospitalization can prevent delays and improve outcomes.
Interdisciplinary Support: Support from the entire care team, including nurses, social workers, clinical partners, and others, can improve patient care and outcomes.
Educational Component: Training and educational interventions for hospital staff can help increase the adoption and effectiveness of addiction services.
Provide Comprehensive Care: Addiction consultation services can help provide comprehensive care in hospitals for patients with substance use disorders, similar to how other chronic health conditions are managed.
🔗 Resources
ASAM’s 56th Annual Conference Sessions: Hospitals as a Frontline for Addiction: Lessons from the START Study Register HERE
Bridge Treatment: A program of the Public Health Institute that bridges emergency care and community health to create an integrated system that improves health and equity.
📢 Join the Discussion
Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!
Navigating Alcohol Withdrawal Management: Strategies and Insights
28 Apr 2025
00:29:08
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Tessa Steel explore the management of alcohol withdrawal in ambulatory, hospital-based, and ED-initiated care settings. They discuss best practices, risk stratification, medication strategies, and emerging approaches to support effective withdrawal management.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM’s President-Elect and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Tessa Steel, MD, MPH
Dr. Tessa Steel is an Assistant Professor, physician-scientist, and Pulmonary Critical Care Medicine doctor at Harborview Medical Center, a county safety-net hospital operated by the University of Washington in Seattle. She is board-certified in Internal Medicine, Pulmonary Medicine, and Critical Care Medicine. Her clinical and research interests include improving hospital-based treatments for alcohol withdrawal syndrome and using hospitalizations to help people with addiction launch their process of recovery.
📖 Show Segments
00:05 – Introduction
00:16 – Common Alcohol Withdrawal Scenarios
01:53 – Assessing Alcohol Withdrawal Severity
09:24 – The Emergency Department's Role
12:28 – Inpatient Alcohol Withdrawal Management
19:28 – Outpatient Alcohol Withdrawal Management
21:02 – Challenges and Future Directions
27:44 – Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Patient Risk Stratification: Understanding patient history, especially previous alcohol withdrawals, is crucial for predicting the severity of withdrawal symptoms and determining appropriate care settings (home vs. inpatient).
Role of Emergency Departments: Emergency departments are critical access points for initiating alcohol withdrawal management and facilitating the transition to ongoing care for alcohol use disorder (AUD).
Medication Strategies: Consider the various medications beyond benzodiazepines that can treat alcohol withdrawal, such as phenobarbital or gabapentin, to align medication selection with the individual’s needs and the underlying neuropathology of alcohol withdrawal.
Outpatient vs Inpatient Care: Consider a patient’s history and current symptoms to determine whether they can safely undergo withdrawal in an outpatient setting or if they require inpatient care.
Monitoring and Safety: Carefully monitor patients when using sedating agents for alcohol withdrawal management, as they may cause respiratory suppression.
Holistic and Individualized Treatment: Address the AUD in addition to the withdrawal symptoms. Stay open-minded and familiarize yourself with various medication options. Treating alcohol withdrawal requires an individualized, patient-centered approach.
Team-Based Support and Ongoing Education: Interdisciplinary support and continuous education are important in advancing successful system-wide care. Share success stories to engage healthcare providers in AUD care.
Call for Research and Funding: Additional research, including comparative effectiveness research on medications, and funding are needed to improve the quality of alcohol withdrawal care and to further promote transitions from withdrawal management to long-term AUD treatment.
🔗 Resources
PCSS-MAUD Education: Free, comprehensive training, guidance, resources, and mentoring on the prevention, diagnosis, and treatment of AUD.
Assessment and Management of Alcohol Withdrawal – Online Course
Alcohol Withdrawal Syndrome in the Emergency Department – Mini Video
The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management: Access HERE
The ASAM Criteria: The most widely used and comprehensive set of standards for placement, continued service, and transfer of patients with addiction and co-occurring conditions.
ASAM Criteria Curriculum: Explore the different trainings ASAM offers on both the 3rd and 4th Edition ASAM Criteria.
📢 Join the Discussion
Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!
Treating Alcohol Use Disorder: Medication Considerations and Goals Beyond Abstinence
14 Apr 2025
00:37:59
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Melissa Weimer revisit the fundamentals of alcohol use disorder (AUD), discussing medications like acamprosate, disulfiram, naltrexone, topiramate, and others and how to support various treatment goals, whether that means reducing use or achieving abstinence.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM’s President-Elect and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Melissa Weimer, DO, MCR, DFASAM
Dr. Melissa Weimer is board-certified in Internal Medicine and Addiction Medicine, focusing on substance use disorders in hospital settings. She is an Associate Professor of Medicine at Yale School of Medicine and currently the Medical Director of the Yale Addiction Medicine Consult Service (YAMCS) at Yale New Haven Hospital. Dr. Weimer has worked on local, state, and national levels to enhance access to evidence-based treatments for substance use disorders. As an educator, she teaches healthcare students and professionals about substance use disorders and serves as the Associate Program Director of the Yale Addiction Medicine Fellowship program. She is also the Medical Director/Lead Trainer for the SAMHSA-funded Providers Clinical Support System-Medications for Alcohol Use Disorder.
📖 Show Segments
00:05 - Introduction
00:27 - Alcohol Awareness Month and AUD Statistics
01:42 - FDA-Approved Medications for AUD
05:35 - Topiramate and Other Treatment Options
08:21 - Choosing the Right Medication for Patients
14:27 - Barriers to Medication Use and Overcoming Them
17:32 - Telehealth and Network Therapy
19:44 - Integrating Psychosocial Treatments with Medication
26:20 - Patient-Centered Goals and Risk Mitigation
35:06 - Key Takeaways
36:36 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Medications for AUD: Medications for AUD are safe and effective and should be offered to more individuals diagnosed with the disorder.
Setting Goals: Abstinence is not always the required or primary goal. Reducing alcohol use is a valid and beneficial goal that can also be supported with medications.
Comprehensive Approach: Treating AUD requires a multifaceted approach, combining medication with psychosocial interventions.
MAUD and Liver Disease: Medications for alcohol use disorder (MAUD) can be used safely in hospital settings and in patients with liver disease and have been shown to reduce all-cause mortality in individuals with alcohol-related cirrhosis.
Choosing the Right Medication: Tailoring the medication choice to fit the patient's overall profile and preferences can significantly enhance adherence and treatment outcomes.
Addressing Barriers: Institutional barriers and cultural resistance within clinics and recovery spaces must be addressed to normalize and support the use of medication in treating substance use disorders.
🔗 Resources
PCSS-MAUD Education: Free, comprehensive training, guidance, recourses, and mentoring on the prevention, diagnosis, and treatment of AUD.
Integrating Medications for Alcohol Use Disorder and Alcohol Use Services into Primary Care - Online Course
Pharmacotherapy for Alcohol Use Disorder: Best Practices and Clinical Strategies - Online Course
Establishing Goals for Treatment and Recovery - Mini Video
Optimizing Outcomes for Treatment with Medications for Alcohol Use Disorder - Mini Video
Systematic Review of Medications for Alcohol Use Disorder - Webinar
Benzodiazepine Tapering: New Guideline and Clinical Strategies
31 Mar 2025
00:28:14
In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. Emily Brunner explore The Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Benzodiazepine Risks Outweigh Benefits. They discuss key recommendations and best practices for tapering benzodiazepines safely and effectively. Additional topics include the risks and benefits of tapering, common withdrawal symptoms, strategies to support patients while minimizing new dependencies, and navigating patient resistance and fear.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Peter Selby, MBBS, CCFP(AM), FCFP, FASAM
Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems.
Expert
Emily Brunner, MD, DFASAM
Dr. Emily Brunner is board-certified in family medicine and a distinguished fellow in addiction medicine. She has experience treating addiction in both inpatient and outpatient settings. She specializes in trauma-informed clinical treatment of substance use disorders with a comprehensive and compassionate approach. Dr. Brunner has been involved in leadership of the Minnesota Society of Addiction Medicine and is now on the national board of the American Society of Addiction. She is a passionate advocate for improving the care of patients with substance use disorder across the healthcare system, specifically in advocating for increased utilization of medications for opioid use disorder across all levels of care. Minnesota Magazine recognized her as a Top Doctor for Addiction Medicine in 2020 and 2021. She is the medical director of Gateway Recovery and Recovering Hope and does training on behalf of the Hazelden Betty Ford Foundation.
📖 Show Segments
00:05 - Introduction
00:37 - History and Concerns of Benzodiazepine Use
01:59 - Clinical Scenario
03:46 - The Joint Clinical Practice Guideline on Benzodiazepine Tapering
08:15 - Considerations of Risks and Benefits
10:46 - Tapering in Different Settings
12:06 - Monitoring and Managing Symptoms: Underlying Issues vs Withdrawal
15:08 - Synthetic and Illicit Use
17:43 - Managing Side Effects
20:42 - Addressing Patient Fears
22:53 - Differential Diagnosis
24:51 - Final Thoughts and Key Takeaways
27:17 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Guideline Implementation with Clinical Judgment: Implement best practices outlined in The Joint Clinical Practice Guideline on Benzodiazepine Tapering but recognize that it is not a one-size-fits-all instruction manual for conducting tapers.
Physical Dependence vs Addiction: Most patients on long-term benzodiazepines have physical dependence, not addiction. Clinicians should understand the differences to ensure appropriate treatment.
Slow and Flexible Tapering: The tapering process should be slow, and adjustments should be made based on a patient's response to the taper. Temporary dose increases may sometimes be necessary.
Individualized, Patient-Centered Care: Engage patients in treatment decisions, prioritize their comfort and safety, and individualize tapering plans based on medical history, unique needs, and responses to treatment for a more patient-centered treatment approach.
Compassionate Approach: Treat patients with empathy, acknowledge their experiences, and avoid punitive measures. When your patients tell you something or share their experiences, believe them.
Use of Urine Toxicology: Exercise caution when using urine toxicology tests. While they can be a supportive screening tool, many benzodiazepines may not appear, and false negatives are common. These tests should never be used punitively but rather as part of a patient-centered, supportive approach.
Multidisciplinary Support: Utilize a team-based approach with frequent follow-ups, including possible nurse visits, to monitor and support patients through the tapering process.
Risk-Benefit Considerations: Benzodiazepines should never be abruptly discontinued. Clinicians must assess the risks and benefits with each patient before making changes.
Awareness of Withdrawal Risks: Understand the potential dangers of withdrawal, including seizures and increased potential for mortality, and adjust tapering accordingly.
🔗 Resources
Benzodiazepine Tapering Webinar Series: A four-part series designed to provide clinicians with the knowledge and tools necessary to implement evidence-based benzodiazepine tapering strategies across diverse patient populations and practice settings. Register HERE
The Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Benzodiazepine Risks Outweigh Benefits and other resources such as quick-reference tables, charts, and handouts: Access HERE
Provider Pocket Guide: A free, quick-reference digital tool to provide healthcare providers with access to current guidelines in a clear, concise format. Access HERE
How to Help Your Patients Taper from Benzodiazepines: A concise six-page guide that provides evidence-based strategies for safely tapering patients from benzodiazepines. Download HERE
Dr. Heather Ashton’s Benzodiazepine Guide (Ashton Manual): Download HERE
Appropriate Use of Drug Testing in Clinical Addiction Medicine Consensus Document: Intended to guide provider decisions about drug testing to improve the quality of care for patients with addiction. Access HERE
📢 Join the Discussion
Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!
Ketamine Infusion Therapy for Addiction Treatment: The Whys and Hows, The Dos and Don'ts
17 Mar 2025
00:34:45
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Brent Boyett explore the potential of ketamine in addiction treatment. They discuss its history, mechanism of action, current research, clinical applications, risks, and future outlook. The episode offers valuable insights into ketamine’s role in addiction treatment while considering safety and its impact within the biopsychosocial-spiritual model.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM’s President-Elect and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Brent Boyett, DMD, DO, DFASAM
Dr. Brent Boyett is a board-certified specialist in family medicine, addiction medicine, preventive medicine, and dental anesthesiology. He is a Distinguished Diplomat of the American Society of Addiction Medicine and a Diplomat of the American Academy of Family Practice and the American Dental Society of Anesthesiology. With extensive training in addiction disorders, Dr. Boyett travels nationwide to educate others on the effects of opioids, cannabis, and psychedelics on the brain, with a particular focus on the future of psychedelics, especially ketamine. He earned his DMD. from the University of Alabama at Birmingham (1994) and his medical degree from the University of Health Sciences (1998). He then completed a Family Medicine Residency at the University of Mississippi (2001), specializing in internal medicine, anesthesia, and oral surgery. After years in private practice, Dr. Boyett transitioned to addiction treatment and research. He now practices at the North Mississippi Hospital System’s Neuroscience Institute, specializing in pain and addiction treatment. Additionally, he is a certified Ketamine Medical Provider.
📖 Show Segments
00:05 - Introduction
00:14 - Celebrity Encounters with Ketamine
01:58 - History and Medical Use of Ketamine
04:03 - Neuroplasticity and Ketamine
08:17 - Ketamine’s Potential in Treating Addiction
10:57 - Research and FDA-Approval Potential
17:27 - Clinical Procedures for Ketamine Infusion
24:58 - Risks and Concerns with Ketamine Use
28:31 – Accessibility of Ketamine
29:13 - Future of Ketamine
30:29 - Key Takeaways
33:12 – Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Ketamine’s Evolution & Uses: Originally developed as an anesthetic in the 1960s, ketamine is now being explored for its potential in treating substance use disorders, depression, PTSD, OCD, chronic pain, and various other maladaptive conditions.
Neuroplasticity & Addiction: Ketamine enhances neuroplasticity by helping to rewire the brain and restore prefrontal control, which can disrupt addictive patterns.
Clinical Use & Safety: Proper screening, preparation, and professional supervision are essential for the safe and effective administration of ketamine therapy.
Set, Setting & Integration: A supportive treatment environment—including calming music and minimal distractions—combined with post-treatment activities like journaling, cognitive strategies, and lifestyle changes, helps reinforce long-term benefits.
Challenges & Accessibility: Traditional ketamine lacks patent protection, limiting financial incentives for clinical trials. However, newer forms like esketamine offer commercial viability. Treatment remains costly and is often not covered by insurance.
Potential for Misuse: Ketamine should only be administered professionally. Unsupervised and at-home treatments pose risks and should be avoided.
Holistic Treatment Approach: Ketamine is a tool and should be used in conjunction with a comprehensive treatment plan, combined with other therapies (e.g., contingency management and behavioral strategies) to achieve lasting change.
Psychedelic Medicine Special Interest Group: Educates members on the current best evidence in the field of psychedelic medicine used in the treatment of addictive disorders and mental illness. ASAM Members can log in to ASAM Connect to join the community.
Annual Review of Addiction Medicine: Highest Impact Publications 2024-2025
26 May 2025
00:32:55
EP 04
🎙 Special Series: ASAM's 56th Annual Conference
This episode is part of a special four-part series spotlighting key sessions from ASAM’s 56th Annual Conference.
In this episode of ASAM Practice Pearls, Dr. Elizabeth Salisbury-Afshar is joined by Drs. Sarah Wakeman and Joshua Lee to review the most influential addiction medicine publications of 2024–2025. They discuss the criteria used to identify high-impact papers, highlight key findings, and explore how these insights can inform clinical practice and future research.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, FACPM, DFASAM
Dr. Elizabeth Salisbury-Afshar is a family medicine, preventive medicine/public health, and addiction medicine physician. She is an Associate Professor at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. She is a core faculty member for the Addiction Medicine Fellowship at the University of Wisconsin, and her clinical roles include addiction medicine consult service and serving as medical director of a low-barrier walk-in clinic serving people who use substances. She is also the Program Director of the Preventive Medicine Residency at UW-Madison and Medical Director of Harm Reduction Services at the Wisconsin Division of Public Health. Dr. Salisbury-Afshar's work focuses on expanding access to evidence-based addiction treatment and harm reduction services. She has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar lectures nationally on addiction medicine topics, including the treatment of opioid use disorder, harm reduction, the intersection of addiction and the criminal legal system, and public health approaches to reduce overdose mortality. Dr. Salisbury-Afshar is actively involved in ASAM, where she currently serves as the Vice Chair of the Medical Education Council, Course Director of the ASAM-All Rise treatment courts courses, a member of the ASAM Conference Planning Committee, and the Chair of Harm Reduction Special Interest Group.
Expert
Sarah E. Wakeman, MD, FASAM
Dr. Sarah Wakeman is the Medical Director for the Mass General Hospital Program for Substance Use & Addiction Services, Program Director of the Mass General Addiction Medicine fellowship, Senior Medical Director for Substance Use Disorder at Mass General Brigham, and an Associate Professor of Medicine at Harvard Medical School. She received her AB from Brown University and her MD from Brown Medical School. She completed residency training in internal medicine and served as Chief Medical Resident at Mass General Hospital. She is a diplomate and fellow of the American Board of Addiction Medicine and board-certified in Addiction Medicine by the American Board of Preventive Medicine. She served on Massachusetts' Governor Baker’s Opioid Addiction Working Group. Nationally, she serves on the American Society of Addiction Medicine Ethics Committee. Clinically, she provides specialty addiction and general medical care in the inpatient and outpatient setting at Mass General Hospital and the Mass General Charlestown Health Center. Her research interests include evaluating models for integrated substance use disorder treatment in general medical settings, low threshold treatment models, recovery coaching, physician attitudes and practice related to substance use disorder, and screening for substance use in primary care.
Expert
Joshua D. Lee, MD, MSc
Dr. Joshua Lee is a Professor in the Department of Population Health and Medicine/General Internal Medicine and Clinical Innovation at the NYU Grossman School of Medicine. He is Co-Director of the Section on Tobacco, Alcohol, and Drug Use and Program Director of the NYU Fellowship in Addiction Medicine. He is a clinician-researcher focused on addiction pharmacotherapies in primary care and criminal justice populations.
📖 Show Segments
00:05 – Introduction
02:34 – History and Evolution of the Annual Review Session
03:44 – Methodology for Selecting High-Impact Articles
06:52 – Top Papers of the Year: Semaglutide and Fentanyl Seizures
11:44 – Emerging Trends in Addiction Medicine
14:40 – Innovations in Buprenorphine Initiation
18:52 – Landmark Clinical Trials on Reducing Overdose Deaths
26:38 – Impact of Addiction on Adolescents and Parental Loss
31:00 – Final Thoughts
31:50 – Conclusion and Additional Learning Opportunities
📋 Key Takeaways
GLP-1s for Substance Use Disorders: Significant findings showed reduced alcohol consumption among non-treatment-seeking individuals randomized to treatment with semaglutide. Additional findings indicated a link between GLP-1 drugs and improved outcomes in those with cannabis, opioid, and tobacco use disorders, suggesting a potential for improved addiction outcomes.
Fentanyl Seizure Trends: Law enforcement data shows increasing fentanyl seizures, especially in pill form, predominantly in the Western U.S.
Buprenorphine Initiation Strategies: New studies found that in patients with minimal to mild opioid withdrawal, a seven-day injectable buprenorphine induction strategy was associated with a low rate of precipitated opioid withdrawal and kept patients more engaged in treatment after the first dose.
Consult Services Impact on Opioid Use Disorder: Studies show that having an addiction consult team, in addition to the usual care team, increased MOUD initiation rates and post-discharge engagement.
Differences in Overdose Death Rates: While data indicate that overall overdose death rates have declined, minority communities continue to experience an increase in overdose deaths.
Adolescents and Parental Loss to Overdose: Updated data shows that more than half a million children have lost parents in the last decade to drug overdoses.
Delta-8-THC Trends in Younger Populations: Data shows an increase in Delta-8-THC use among adolescents, particularly in non-legal states. We should continue to monitor these trends for future public health interventions.
Declining Rates of Tobacco Products and E-cigarette Use: Recent data shows declining rates of tobacco and e-cigarette use among adolescents; however, there has been an emerging uptick in the use of nicotine pouches, which should be monitored.
🔗 Resources
ASAM’s 56th Annual Conference Session: Annual Review of Addiction Medicine: Highest Impact Publications 2024-2025 Register HERE
Sickle Cell Disease: Intersection of Pain and Addiction
19 Jun 2025
00:22:20
In recognition of Sickle Cell Awareness Day (June 19), this episode of ASAM Practice Pearls features host Dr. Peter Selby and expert Dr. Andrew Smith as they explore the complex intersection of sickle cell disease (SCD), pain, and addiction. They discuss the challenges individuals with SCD face in accessing effective pain management, often compounded by stigma and opioid-related concerns. The episode provides insights into evidence-based treatments, the balance between pain relief and opioid dependence risks, and strategies for compassionate, patient-centered care.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Peter Selby, MBBS, CCFP(AM), FCFP, FASAM
Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems.
Expert
Andrew J. Smith, MDCM
Dr. Andrew J. Smith is a Staff Physician, Pain and Addiction Medicine and Medical Lead of the Interprofessional Pain and Addiction Recovery Clinic at the Centre for Addiction and Mental Health in Toronto. He comes from McGill Medicine, University of Washington Neurology, and UCLA Medical Genetics, initially focusing on neurodevelopmental medicine. Frustrated by how many of his young patients with learning disabilities would fall into substance use problems despite early successes, he retooled in the field of addiction medicine. He became the first in Canada to do a combined clinical fellowship in pain and addictions at CAMH and Mount Sinai Hospital. He now leads an Interprofessional team dedicated to helping people with substance use disorders, severe mental health conditions, and chronic pain improve their pain, function, and quality of life. Dr. Smith is passionate about improving access to better care for patients with chronic pain and addiction, educating patients, families, and clinicians about pain and addiction, and reducing stigma. He is an executive and hub member of ECHO Ontario Chronic Pain — a telementoring resource for primary care clinicians to enhance their skills and confidence in managing more of their own patients who have complex pain and opioid issues.
📖 Show Segments
00:05 - Introduction
00:26 - Dr. Selby’s Journey into Pain Management and Addiction Medicine
02:32 - Understanding Pain in SCD
04:40 - A Holistic Approach to Pain Management
06:15 - Reducing Stigma and Taking a Non-Judgmental Approach
09:16 - Discussing Opioid Use with Patients
12:36 - Assessing Patients with SCD
13:11 - Diagnosing Use Disorders in Patients with SCD
15:33 - Preparing for Emergency Room Visits
17:10 - The Importance of Patient Autonomy
18:31 - A Patient Success Story
21:41 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
“Pain is Pain is Pain”: There are different kinds of pain in SCD. People with SCD experience acute pain from vaso-occlusive crises, chronic pain, sensitization-related pain, and acute flare-ups that may not necessarily be vaso-occlusive.
Dual Diagnosis Complexity: Individuals with SCD may have co-occurring pain and addiction. Effective treatment plans need to address both components without invalidating the patient's experience of pain.
Build Rapport and Use a Holistic Approach: Establishing a trusting and safe environment is crucial. Practitioners should take a trauma-informed and motivational approach to reduce stigma and defensiveness, addressing not only the physical aspects of pain but also the psychological, social, and contextual factors.
Patient Autonomy and Collaboration: Empower patients by involving them in the decision-making process and providing them with information and options to improve treatment adherence and outcomes.
Use of Buprenorphine: Buprenorphine has been effective in treating chronic pain in patients with SCD and can be used in divided doses or as a single dose, providing a safer alternative to traditional opioids.
Universal Precautions Approach: Screening for risk factors and potential opioid misuse should be part of the assessment process. Practitioners should normalize discussions about substance use and develop a non-judgmental dialogue.
Emergency Department Challenges: Educate both patients and emergency department staff about managing pain in patients with opioid use disorder. Care passports can help guide treatment during episodes of pain crisis.
ASAM’s Motivational Interviewing Courses: Explore the different courses and resources ASAM offers to develop techniques and practice skills in motivational interviewing.
I Believe in Therapy Toolkit by SCDAA: A resource that addresses the stigma surrounding mental health in the Black community and encourages seeking therapy and support.
Engaging and Retaining Young People in OUD Treatment: Making the Wish Come True
09 Jun 2025
00:32:47
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor welcomes Dr. Marc Fishman for an insightful conversation on improving engagement and retention of youth in medication treatment for opioid use disorder (MOUD). They examine the unique challenges young people face and present developmentally informed strategies—including prevention, family involvement, and assertive outreach. The discussion highlights the importance of a medication-first approach and building partnerships with schools and communities to foster long-term recovery.
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Looking for this episode's transcript? Download it HERE
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Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Marc Fishman, MD
Dr. Marc Fishman is a specialist in addiction psychiatry and addiction medicine. He is a member of the faculty of the Department of Psychiatry at the Johns Hopkins University School of Medicine. He leads Maryland Treatment Centers, which offers programs for residential and outpatient treatment of SUD and co-occurring disorders in adolescents, young adults, and adults. He has been a principal investigator on numerous research studies in addiction and has published extensively in the field. His academic focus has been on medication treatment for OUD and other SUDs, treatment of opioid use disorder in youth, models of care, and treatment engagement strategies. Dr. Fishman served as a co-editor for past editions of ASAM’s Patient Placement Criteria, leading the adolescent section, and served as the chief editor for the ASAM PPC Supplement on Pharmacotherapies for Alcohol Use Disorders. He was a member of the Guideline Committee that developed the ASAM National Practice Guideline for the Treatment of OUD in 2015 and its update in 2020. He is the chair of the Adolescent SIG for ASAM. He is a Past President of the Maryland Society of Addiction Medicine and a current member of its Board.
📖 Show Segments
00:05 – Introduction
00:17 – Introductory Vignette: Pediatric Onset of Addiction
02:26 – Current Statistics and Challenges in Youth OUD
03:58 – Early Intervention
05:38 – Three Types of Prevention
06:17 – Barriers and Challenges to Effective Treatment for Youth
10:36 – The Role of Family in Treatment
15:47 – Unique Strengths of Youth
17:44 – Extended-Release Medications for OUD
21:21 – Motivating Youth in Treatment
24:49 – Engaging Schools in Care
26:56 – Assertive Approaches to Youth OUD Treatment
29:32 – Final Thoughts
31:47 – Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Initiate Early Intervention: Addiction is a developmental disorder of pediatric onset. Early intervention is necessary to prevent the disorder from progressing to its advanced stages.
Encourage Family Involvement: Incorporate family or a designated concerned significant other in the treatment process to support the young patient and improve adherence.
Implement Youth-Specific Treatment Approaches: Understand the unique developmental and psychological challenges youths face, and tailor engagement methods to include humor, their interests, therapeutic alliances, and empathy.
Promote Collaboration with Other Youth-Friendly Settings: Collaborate with schools, pediatricians, and other primary care practitioners to identify and support youth with substance use to promote treatment and facilitate their reintegration into educational environments.
Adopt an Assertive Approach: Utilize assertive outreach methods, such as frequent texting and continuous communication, to maintain young patients' engagement in their treatment plans.
Employ a Medication Forward Approach: Advocate for the use of medications for opioid use disorder (MOUD) early in the treatment process as a foundational step towards recovery.
Integrate Holistic Treatment Plans: Develop multi-component treatment plans that address not only the substance use but also the overall well-being and functional aspects of the young person’s life.
Utilize Extended-Release Medications: Extended-release medications, such as buprenorphine and naltrexone, are safe and effective options that can improve adherence and retention in treatment among young people.
Promote Location-Based Interventions: Make treatments accessible by integrating them into environments where youths already are, such as schools, family practices, specialized addiction treatment settings, or juvenile justice settings.
Set Realistic Expectations: Medication doesn’t have to be a lifelong commitment. Focus on the present moment, setting realistic, short-term treatment goals to establish initial stabilization and momentum for recovery.
🔗 Resources
ASAM’s 56th Annual Conference Session: Improving Outcomes for Youth OUD Treatment Register HERE
Youth Opioid Recovery Support (YORS) Intervention Study: A clinical trial designed to improve medication adherence in young adults 18–28 with opioid use disorder (OUD) through home delivery of extended-release medications, family involvement, digital communication outreach, and contingency management to increase treatment engagement and reduce return to use rates.
EP 02
🎙 Special Series: ASAM's 57th Annual Conference
This episode is part of a special three-part series spotlighting key sessions from ASAM’s 57th Annual Conference.
In this episode of ASAM Practice Pearls, In this episode of ASAM Practice Pearls, Dr. Stephen Taylor is joined by Drs. Tessa Steel and Melissa Weimer to discuss highlights from their Annual Conference session, Advanced Management of Alcohol Withdrawal: Case-Based, Evidence-Informed Solutions. Together, they explore the challenges of managing severe and resistant alcohol withdrawal syndrome (AWS), effective assessment tools, escalation strategies, and care considerations for high-risk or medically complex patients.
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Looking for this episode's transcript? Download it HERE
Get credit for listening! Claim your 0.5 CEs HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Melissa Weimer, DO, MCR, DFASAM
Dr. Melissa Weimer is board-certified in Internal Medicine and Addiction Medicine, focusing on substance use disorders in hospital settings. She is an Associate Professor of Medicine at Yale School of Medicine and currently the Medical Director of the Yale Addiction Medicine Consult Service (YAMCS) at Yale New Haven Hospital. Dr. Weimer has worked on local, state, and national levels to enhance access to evidence-based treatments for substance use disorders. As an educator, she teaches healthcare students and professionals about substance use disorders and serves as the Associate Program Director of the Yale Addiction Medicine Fellowship program. She is also the Medical Director/Lead Trainer for the SAMHSA-funded Providers Clinical Support System-Medications for Alcohol Use Disorder.
Expert
Tessa Steel, MD, MPH
Dr. Tessa Steel is an Assistant Professor, physician-scientist, and Pulmonary Critical Care Medicine doctor at Harborview Medical Center, a county safety-net hospital operated by the University of Washington in Seattle. She is board-certified in Internal Medicine, Pulmonary Medicine, and Critical Care Medicine. Her clinical and research interests include improving hospital-based treatments for alcohol withdrawal syndrome and using hospitalizations to help people with addiction launch their process of recovery.
📖 Show Segments
00:05 - Introduction
01:39 - Prevalence and Risk
02:54 - Assessment Tools and Common Pitfalls
08:41 - Escalating Pharmacological Strategy
17:02 - Intubation Decisions and ICU Considerations
21:57 - Key Takeaways
25:37 - Conclusion and Additional Learning Opportunity
📋 Key Takeaways
Use the right tools to assess alcohol withdrawal: There are several tools that can be used to monitor alcohol withdrawal symptoms and severity, including CIWA-Ar, mMINDS, and RASS; however, it's important to note that CIWA-Ar is not appropriate for patients with altered mental status or inability to self-report. Instead, use mMINDS, RASS, or other objective tools.
Treating alcohol withdrawal is about preventing brain injury, not just controlling agitation: Each withdrawal episode progressively upregulates NMDA receptors and worsens the risk of future brain hyperexcitation through a process called “kindling”. Inadequately treated brain hyperexcitation leads to neuron cell death, resulting in permanent brain damage. Therefore, effective management of alcohol withdrawal presents an opportunity to limit and prevent brain injury.
Match your pharmacology to the physiology and know what each drug is actually doing: Benzodiazepines give you GABA agonism only. Phenobarbital addresses the GABA agonism and glutamate antagonism and is much longer acting, hitting both sides of the main imbalance in the brain caused by alcohol. Dexmedetomidine helps control autonomic instability related to norepinephrine signaling but won't prevent seizures. Ketamine can directly antagonize NMDA-driven hyperexcitation when GABA-directed therapy isn't enough. Propofol gives you titratable cortical suppression once a patient requires intubation.
Front-load benzodiazepines early and monitor closely: When using benzodiazepines for severe alcohol withdrawal, give enough of the medication up-front. Falling behind is very hard to recover from; do not give a dose and walk away for hours without re-evaluation.
Always broaden your differential diagnosis: Severe alcohol withdrawal rarely occurs in isolation. Comorbid illnesses, such as infection, sepsis, trauma, or hepatitis, amplify the neurobiologic stress response and can make withdrawal look refractory when the real driver is something else.
Intubation is a high-stakes decision in this population: Intubation is a trade-off. In complex patients, such as those with advanced liver disease, active infection, or malnutrition, mechanical ventilation risks include secondary ventilator-associated pneumonia and prolonged sedation due to impaired drug clearance. The decision to ventilate should be deliberate, but once made, it should utilize titratable continuous sedation to reliably quiet brain excitation.
Hospitalization is an opportunity for engagement: AWS stabilization is not alcohol use disorder (AUD) treatment, and getting a patient safely through withdrawal is necessary but not sufficient. Withdrawal management should be a bridge to longitudinal AUD care, including shared decision-making, addiction consultation, and medications for AUD.
🔗 Resources
Advanced Management of Alcohol Withdrawal: Case-Based, Evidence-Informed Solutions Annual Conference Session: Available in ASAM eLearning Center starting May 26, 2026
CIWA-Ar – The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is a validated, 10-question tool used to objectify the severity of alcohol withdrawal.
mMINDS - The Modified Minnesota Detoxification Scale (mMINDS) is a 9-item tool to objectively score symptoms for patients with alcohol withdrawal.
RASS - The Richmond Agitation-Sedation Scale (RASS) is a 10-point scale used to objectively assess agitation and sedation levels in patients who cannot communicate.
📢 Join the Discussion
Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!
In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Artificial Intelligence and the Future of Addiction Medicine
04 May 2026
00:33:40
EP 01
🎙 Special Series: ASAM's 57th Annual Conference
This episode is part of a special three-part series spotlighting key sessions from ASAM’s 57th Annual Conference.
In this episode of ASAM Practice Pearls, Dr. Elizabeth Salisbury-Afshar is joined by Drs. Sara Polley and Daniel Kaufman to explore highlights from their Annual Conference session, Artificial Intelligence and the Future of Addiction Medicine. Together, they discuss how artificial intelligence is reshaping addiction medicine, including the many ways AI is already being used in clinical care. The conversation focuses on informed consent, maintaining clinical judgment, and ethical considerations.
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Looking for this episode's transcript? Download it HERE
Get credit for listening! Claim your 0.5 CEs HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, FACPM, DFASAM
Dr. Elizabeth Salisbury-Afshar is a family medicine, preventive medicine/public health, and addiction medicine physician. Dr. Salisbury-Afshar's work focuses on expanding access to evidence-based addiction treatment and harm reduction services. She has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar lectures nationally on addiction medicine topics, including the treatment of opioid use disorder, harm reduction, the intersection of addiction and the criminal legal system, and public health approaches to reduce overdose mortality.
Expert
Sara Polley, MD, FAPA, FASAM
Dr. Polley is a triple board-certified psychiatrist in adult, child, and adolescent psychiatry and addiction medicine. She provides integrated psychiatric care for youth and families at Vantage Mental Health, a nonprofit clinic serving both Minnesota and Wisconsin. In addition to her clinical work, Dr. Polley is a national consultant, speaker, and educator with the University of Minnesota Medical School. She serves on Minnesota’s Cannabis Advisory Council and holds committee appointments with the American Society of Addiction Medicine (ASAM) and the American Association of Child and Adolescent Psychiatry (AACAP). Dr. Polley is a passionate advocate for outpatient trauma-informed, developmentally appropriate, and family-centered co-occurring care, drawing on both her clinical experience and personal story as the child of a parent lost to addiction.
Expert
Daniel Kaufmann, PhD, LPC, LMHC
Dr. Kaufmann is an Associate Professor at Grand Canyon University as well as the Director of Gaming Services at Kindbridge Behavioral Health. He is the author of The Gamer’s Journey (2024), a book focused on explaining the presence of video games in society as a form of mythological storytelling and how these characters and settings can be used therapeutically for every gamer to complete each phase of the hero’s journey in their own lives. Dr. Kaufmann is currently serving as the co-chair of the APA research task force on video game issues and is working on several nationwide training programs to help mental health professionals understand video games in innovative ways. Dr. Kaufmann's publications cover the areas of video games, personality theory, online education, and counselor development. He offers supervision to an international list of clinicians to help bridge the gap in learning about technological impact on society and specific insights related to effective treatment for clients experiencing games-related issues.
📖 Show Segments
00:05 - Introduction
01:19 - Expert Introduction and Initial Start with AI
04:40 - The Landscape of AI in Addiction Care
06:41 - AI Assists Clinicians Might Not Realize They Are Using
08:13 - AI for Search Tools and Scribes
09:29 - Informed Consent for AI Tools
14:02 - Patient's Reception of AI in Care Conversations
15:41 - AI for Progress Notes and Documentation
19:49 - AI for Patient Advocacy Letters
22:04 - Guidance for Adopting AI Tools
25:35 - Advice for Early-Career Health Care Providers
26:21 - Approaching AI with Curiosity
29:00 - Words of Advice
32:50 - Conclusion and Additional Learning Opportunity
📋 Key Takeaways
AI is already embedded throughout addiction care: Clinicians are integrating AI into their daily practice, including ambient scribes, literature search tools, helping write progress notes, billing systems, and EMR-driven risk alerts.
Informed consent for AI use requires careful consideration: Clinicians should consider the risk to the patient and the potential impact if the tool were to fail to help determine the appropriate level of AI-informed consent. Consider the risks of the tool failing, the likelihood of catching errors, and whether the patient has the ability to opt out before deciding whether to notify, obtain consent, or determine if consent is even needed.
AI scribes can free up significant time: Using ambient scribes can allow clinicians to focus more on the patient and the therapeutic relationship and less on documentation; however, clinicians must still review all AI-generated content carefully, never treating it as a finished, accurate product.
AI should support, not replace, clinical judgment: AI can be used as a resource to aid clinical administrative work, but it is not a substitute for diagnosis, treatment planning, or medical decision-making. The clinician remains responsible for all care decisions.
Early-career clinicians face a unique risk: Relying on AI before developing foundational clinical skills could lead to long-term competency gaps. Instead, use AI-generated content as a learning tool to develop necessary skills rather than as a shortcut.
Data privacy and HIPAA compliance are non-negotiable: Before adopting any AI tool, clinicians must verify where patient data is sent, who has access, and whether it is protected from being fed into wider internet systems.
Approach AI with curiosity and keep an open mind: AI isn’t going away. Learn how to work with it to help enhance your clinical practice. Educate yourself and use your own judgment on what may or may not be relevant for your own practice.
🔗 Resources
Artificial Intelligence and the Future of Addiction Medicine Annual Conference Session: Available in ASAM eLearning Center starting May 26, 2026
In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Listening First: The Future of Women's Addiction Treatment
04 Aug 2025
00:28:34
In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. Hendree Jones discuss the importance of implementing gender-responsive and trauma-informed care in addiction treatment. They offer insights on recognizing trauma in patients, creating safer treatment environments, addressing gender-specific treatment gaps, and emphasizing the importance of language and empathy in clinical practice. Together, they highlight the positive impact that a compassionate and inclusive approach can have on patient care and treatment outcomes.
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Looking for this episode's transcript? Download it HERE
We want to hear from you! Please take our short, five-minute survey HERE
or email us at education@asam.org.
Host
Peter Selby, MBBS, CCFP(AM), FCFP, FASAM
Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems.
Expert
Hendree Jones, PhD
Dr. Hendree Jones is a licensed psychologist and an internationally recognized expert in the development and examination of both behavioral and pharmacologic treatments for pregnant women and their children in risky life situations. She was the Division Director of UNC Horizons for a decade and, in May of 2023, stepped into a Senior Advisor role for Horizons to take on several national policy and international policy projects. Expertscape ranks Dr. Jones as a top world expert in neonatal abstinence syndrome and opioid-related disorders. She has received continuous National Institutes of Health funding since 1994 and has written more than 350 publications. Dr. Jones has also authored two books, one on treating patients for substance use disorders and the other on comprehensive care for women who are pregnant and have substance use disorders. She has also written multiple textbook chapters on the topic of pregnancy and addiction, as well as 17 courses for adult learners on topics of substance use disorder treatment (WISE, CHILD, PEERS, ALLIES, etc.). Dr. Jones has co-authored multiple national and international guidelines on the topic of caring for pregnant and post-pregnant patients with substance use disorders and their children, including those published by the WHO, SAMHSA, and ASAM. She also co-authored both the women’s and children’s section of the UN International Standards for the Treatment of Drug Use Disorders and the UN guidelines on prevention and treatment for girls and women. In 2020, Dr. Jones won the ASAM R. Brinkley Smithers and Distinguished Scientist Award. In 2024, she won the MED Brady-Schuster Division 28 American Psychological Association award for lifetime achievement for contribution to addiction science. She consults for the UN and the WHO and is a member of the NIH’s HEAL multidisciplinary working group and the Advisory Committee on Research on Women's Health. Dr. Jones has been involved in over 43 projects around the world focused on improving the lives of children, women, and families.
📖 Show Segments
00:05 - Introduction
01:09 - Patient Story: The Impact of Trauma on Women with Addictions
03:34 - Principles of Gender Responsive and Trauma-Informed Care
05:41 - Language and Communication in Addiction Treatment
08:06 - Challenges and Solutions in Implementing Trauma-Informed Care
17:17 - Biological and Gender Differences in Addiction
17:30 - Addressing Treatment Gaps for Women in Addiction Care
23:56 - Practical Steps for Trauma-Informed Care in Clinical Practice
27:08 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Implement Trauma-Informed Care: Trauma plays a significant role in women's addiction, requiring a trauma-informed approach to care that considers not just the events but also the lasting effects and individual experiences of trauma.
Create Safe, Supportive Environment: Fostering a safe, transparent, and non-punitive environment is crucial for effective trauma-informed care. This includes considering physical surroundings, psychological safety, and the overall treatment environment to create a more welcoming and less anxiety-inducing environment.
Use Respectful, Non-Stigmatizing Language: The language used by providers can significantly impact the comfort and dignity of patients. Avoiding stigmatizing terms and promoting respectful communication are essential to building trust between healthcare providers and patients.
Implement a Gender-Responsive Approach: There are biological and social differences in how women experience addiction and substance use. Healthcare providers need to address these unique needs, such as offering targeted support and addressing gender-specific triggers.
Address Systemic Issues and Barriers: Barriers to implementing trauma-informed care can be both systemic and cultural. Securing buy-in from all stakeholders, addressing staff concerns and fears, and ensuring consistent and positive reinforcement of new practices are important steps in overcoming organizational and cultural barriers.
Foster Collaborative Care: Engaging patients as partners in their own treatment plans through shared decision-making and understanding their individual needs and triggers can enhance engagement and outcomes. This collaborative approach also applies to interactions with team members and creating a supportive work environment.
Engage with Compassion and Curiosity: Maintaining empathy, validating patients' experiences, being genuinely curious about their needs and stories, and using mindfulness techniques can build stronger, more supportive patient-provider relationships, ultimately improving recovery.
🔗 Resources
ASAM’s Women and Addiction Education and Resources: Explore HERE
Trauma-Responsive Care for Women with Substance Use Disorders – Factsheet
Patient-Centered Care for Women with Substance Use Disorders – Online Course
Engaging Families and Care Providers in Women’s SUD Treatment
Substance Use Among Aging Women
Pregnancy and Substance Use Disorders
Dressing Motivated Behaviors in Women with SUD
NIDA Substance Use in Women Research Report: Provides an overview of how women not only use and respond to substances differently than men but also face unique biological, psychological, and social barriers in developing, experiencing, and treating substance use disorders.
Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes:
Intimate Partner Violence, Pregnancy, and Substance Use Disorder:
Soper R, Jones H. Intimate Partner Violence, Pregnancy and Substance Use Disorder. In: Wright (Ed.), Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes. Cambridge University Press; 2018:41-48.
Treatment Approaches in Women with Substance Use Disorders Who Become Pregnant: Jones H. Treatment Approaches in Women with Substance Use Disorders Who Become Pregnant. In: Wright T (Ed.), Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes. Cambridge University Press; 2018:72-83.
The ASAM Principles of Addiction Medicine (Seventh Edition):
Neurologic-Informed Care: Integrating Brain Injury Awareness into Addiction Medicine
21 Jul 2025
00:25:38
In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. John Corrigan explore the intersection of brain injury and addiction treatment. They introduce the concept of neurologic-informed care and discuss how cognitive impairments from brain injuries impact addiction recovery. The episode explores practical strategies for screening, treatment, and creating supportive environments to enhance outcomes for individuals with co-occurring brain injury and substance use disorder.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Peter Selby, MBBS, CCFP(AM), FCFP, FASAM
Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems.
Expert
John Corrigan, PhD, ABPP
Dr. John Corrigan is a professor in the Department of Physical Medicine and Rehabilitation at Ohio State University and Director of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation. His research interests include a focus on education and treatment for individuals with co-occurring brain injury and substance use, a critical area in both clinical practice and public health. Dr. Corrigan is Editor-in-Chief of the Journal of Head Trauma Rehabilitation. He has been the PI and co-PI of the Ohio Regional Traumatic Brain Injury Model System since 1997 and chaired the Executive Committee of the TBI Model Systems Project Directors from 2007-2017. Dr. Corrigan is the National Research Director for the Brain Injury Association of America. Since 2013 he has served as the Director of the Ohio Brain Injury Program, which is the designated lead agency in the state of Ohio for policy and planning related to living with brain injury. He has more than 200 peer reviewed publications and has received many awards for his service and research in brain injury rehabilitation, including the Brain Injury Association of America’s William Fields Caveness Award, the 2007 Robert L. Moody Prize, the Gold Key Award from the American Congress of Rehabilitation Medicine, and the Lifetime Achievement Award from the International Brain Injury Association.
📖 Show Segments
00:05 - Introduction
02:20 - Understanding Neurologic-Informed Care
05:53 - The Hidden Epidemic in Addiction Medicine
08:03 - Anoxic and Hypoxic Brain Injuries
15:19 - Practical Screening and Treatment Modifications
22:05 - Accommodations and Environmental Factors
24:48 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Recognize and Screen for Brain Injuries: Brain injuries, including traumatic brain injuries (TBI) and anoxic/hypoxic injuries, are common but often overlooked in mental health and addiction treatment. Standardized screening at intake, using detailed patient histories and cognitive assessments, is crucial for accurate identification and effective care planning.
Implement Neurologic-Informed Care: Similar to trauma-informed Care, this approach integrates an understanding of neurologic impairments into all aspects of treatment. It highlights the importance of understanding cognitive limits, modifying care approaches, and fostering an environment that supports recovery for those with neurological impairments.
Understand Cognitive Impacts on Recovery: Brain injuries often impair attention, memory, processing speed, and executive function—issues that can impact treatment adherence and be mistaken for a lack of motivation. These impairments can also increase the risk of substance misuse and make recovery more challenging.
Adapt Treatment Environments and Methods: Creating supportive environments, such as reducing noise, adjusting lighting, and allowing for restlessness, along with practical strategies like visual aids, repetition, and hands-on tools, can help individuals with cognitive impairments better engage in treatment, retain information and make the behavior changes needed for successful recovery.
Address Sleep Disorders: Sleep disturbances are common in both brain injury and substance use populations. Identifying and treating sleep disorders can improve cognitive functioning and support overall treatment success.
Individualized Care to Reduce Substance Use Risks: Individuals with brain injuries face an increased risk of substance misuse and relapse. Individualized, neurologically informed accommodations can reduce these risks and support more sustainable recovery outcomes.
🔗 Resources
Accommodating the Symptoms of Traumatic Brain Injury: This booklet from the Ohio Valley Center for Brain Injury Prevention and Rehabilitation provides clear guidance on understanding the effects of TBIs and offers practical, individualized accommodation strategies to support full participation in work, school, and community life.
Modifying Clinical Interventions for TBI: This brief from the ACL's Traumatic Brain Injury (TBI) Technical Assistance and Resource Center (TARC) highlights considerations and best practices for diagnosing and treating behavioral health disorders in people with TBI.
SAMHSA Advisory: Treating Patients with TBI: This Advisory summarizes key elements of TBI and describes its relevance to behavioral health, including recommendations for behavioral health professionals.
Traumatic Brain Injury and SUD Series: The Mid-America and Mountain Plains Addiction Technology Transfer Centers (ATTCs), in partnership with the National Association of State Head Injury Administrators (NASHIA), offer recorded webinars and a toolkit on the intersection between brain injury and substance use disorders.
The ASAM Criteria: The most widely used and comprehensive set of standards for placement, continued service, and transfer of patients with addiction and co-occurring conditions. Chapter 19 of the 4th Edition Adult version addresses cognitive impairment and neurologic-informed care.
ASAM Criteria Curriculum: Explore the different trainings ASAM offers on both the 3rd and 4th Edition ASAM Criteria.
📢 Join the Discussion
Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!
When Behavior Becomes Addiction: What Clinicians Need to Know
07 Jul 2025
00:26:53
In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. Emily Brunner explore behavioral addictions—including gaming, gambling, sex, and social media. They discuss how these behaviors impact the brain, how they present clinically, and how to recognize and treat them using evidence-based approaches. The episode emphasizes the importance of validating these conditions and offering appropriate care.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Peter Selby, MBBS, CCFP(AM), FCFP, FASAM
Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems.
Expert
Emily Brunner, MD, DFASAM
Dr. Emily Brunner is board-certified in family medicine and a distinguished fellow in addiction medicine. She has experience treating addiction in both inpatient and outpatient settings. She specializes in trauma-informed clinical treatment of substance use disorders with a comprehensive and compassionate approach. Dr. Brunner has been involved in leadership of the Minnesota Society of Addiction Medicine and is now on the national board of the American Society of Addiction. She is a passionate advocate for improving the care of patients with substance use disorder across the healthcare system, specifically in advocating for increased utilization of medications for opioid use disorder across all levels of care. Minnesota Magazine recognized her as a Top Doctor for Addiction Medicine in 2020 and 2021. She is the medical director of Gateway Recovery and Recovering Hope and does training on behalf of the Hazelden Betty Ford Foundation.
📖 Show Segments
00:05 - Introduction
02:03 - How Behavioral Addictions Compare to Substance Use Disorders
04:18 - Clinical Presentation and Initial Screening
06:19 - Emerging Neuroscience and Research
09:15 - Diagnostic and Screening Tools
12:56 - Patient Experience in the Healthcare System
14:13 - Evidence-based Interventions
19:11 - Co-occurring Conditions and Risk Factors
21:14 - Advice to Clinicians
23:40 - Regulation and Future Directions
25:53 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Behavioral Addictions are Real Diseases: Behavioral addictions such as gaming, gambling, and social media are increasingly recognized as legitimate disorders. They share similar brain mechanisms and clinical presentations with substance use disorders, including loss of control, impaired functioning, and continued use despite harm.
Emerging Neuroscience: Studies using fMRI have shown changes in brain structures in gaming and gambling disorders similar to those in substance addiction.
Screening and Diagnosis: Various validated screening tools exist for different behavioral addictions; it is crucial to familiarize oneself with and integrate them into clinical practice.
Treatment Approaches: Evidence-based treatments include cognitive-behavioral therapy (CBT), motivational interviewing, and contingency management. Additionally, certain medications, such as naltrexone and bupropion, have also shown some evidence of effectiveness. GLP-1 agonists may be another option in the future.
Co-Occurring Conditions: Individuals with behavioral addictions often have co-occurring mental health issues such as anxiety, depression, and other substance use disorders.
Regulatory Needs: There is a need for better regulation to protect young people from addictive technologies and predatory behaviors.
The Importance of Listening: Patients often feel dismissed when discussing behavioral addictions. Take patients' reports seriously and consider treatment options when appropriate.
🔗 Resources
ASAM’s 56th Annual Conference Session - Games, Sex, and Social Media: Current Perspectives Register HERE
Bergen Social Media Addiction Scale: A screening instrument to measure dependence on social media.
Hypersexual Behavior Inventory: A screening instrument to help measure compulsive sexual behavior.
Lie-Bet Questionnaire: A screening instrument used to screen for gambling addiction.
The IGDT-10: A screening instrument to assess internet gaming disorder.
The South Oaks Gambling Screen: A 20-question screening instrument for gambling addiction.
Yale Food Addiction Scale: A screening instrument designed specifically to assess signs of addictive-like eating behavior.
The ASAM Criteria: Call for Applications for Behavioral Addiction Volume Editors - ASAM is seeking experts in behavioral addictions (e.g., problem gambling, internet/social media addiction, problem gaming, compulsive sex, pornography addiction, and food addiction) to serve as Editors for the Fourth Edition of The ASAM Criteria, Behavioral Addictions Volume. This volume will propose principles for managing behavioral addiction and organizing the addiction treatment system.
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Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!
Navigating Cannabis and Cannabinoid Use in Today’s Clinical Practice
20 Apr 2026
00:34:13
In this episode of ASAM Practice Pearls, Drs. Stephen Taylor and Takeo Toyoshima address the misconception that cannabis is not addictive. They discuss how clinicians can better understand the cannabis products their patients are using, navigate the changing legal landscape, and assess for cannabis use disorder using the “Three Cs” framework. The conversation highlights treatment strategies like motivational interviewing and harm reduction, managing cannabis withdrawal, the risk of psychosis from high-potency products, and emerging pharmacotherapy options. Throughout the episode, they offer practical strategies for keeping patients engaged in care.
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Looking for this episode's transcript? Download it HERE
Get credit for listening! Claim your 0.5 CEs HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Takeo Toyoshima, MD
Dr. Takeo Toyoshima is the interim program director for the UCSF Addiction Psychiatry Fellowship. He completed medical school at UCLA, then psychiatry residency, addiction psychiatry fellowship, and forensic psychiatry fellowship at UCSF. His main clinical duties are at the San Francisco VA Health Care System, both in the Addiction Recovery Treatment Services' outpatient and intensive outpatient programs and in the Veterans Justice Outreach Clinic, which treats patients who are criminal justice-involved. In these settings, Dr. Toyoshima supervises UCSF medical students, psychiatry residents, addiction psychiatry fellows, and forensic psychiatry fellows, in addition to other allied health profession trainees. He concurrently serves as the VA site director for the UCSF Psychiatry and the Law Program. Outside of UCSF, Dr. Toyoshima also works in clinical and forensic private practice and serves in various roles in organized medicine (American Psychiatric Association, Northern California Psychiatric Society, California Society of Addiction Medicine, American Academy of Addiction Psychiatry, etc.). His clinical interests are in the intersection of psychiatry, addiction, and forensic matters.
📖 Show Segments
00:05 - Introduction
01:13 - How to Approach the Conversation with Patients
03:51 - Clarifying Terms and Product Use with Patients
05:52 - Legal and Regional Differences
08:45 - Addressing Patient’s Perceived Pros and Cons of Cannabis
11:19 - Assessing for Cannabis Use Disorder
13:53 - What if a Patient Doesn’t Want to Stop?
15:49 - Approaching Drug Testing with Patients
17:43 - Recommended Treatment Options
20:02 - Cannabis Withdrawal Symptoms
22:08 - Considerations for Adolescents
23:21 - The Risk of Psychosis
24:46 - Harm Reduction
27:22 - Signs of Cannabis Toxicity
31:46 - Key Takeaways
33:20 - Conclusion and Additional Learning Opportunity
📋 Key Takeaways
Cannabis addiction is real and common: Around 10% of people who start using become addicted, and around 30% of current users meet criteria for cannabis use disorder (CUD).
Ask about products, routes, and potency: Flower, concentrates, edibles, and vapes carry very different risk profiles. Higher potency can lead to faster tolerance and withdrawal.
Work collaboratively with your patients: Let patients educate you about their use, be curious, and use motivational interviewing techniques in conversation.
Use the three Cs to assess CUD: Screen for issues with Control, Consequences, and Cravings, then map findings to the DSM-5 criteria together with the patient.
Recognize cannabis withdrawal: Withdrawal symptoms affect 20–50% of daily users and can include both psychiatric and physical symptoms, such as appetite changes, nausea and vomiting, mild tremors, temperature dysregulation, irritability, anxiety, and mood changes. Sometimes, what patients attribute to anxiety or poor appetite may actually be withdrawal.
Psychosis is a serious risk: Studies show around a 40% conversion to a schizophrenia diagnosis after a cannabis-induced psychotic episode, especially with high-potency products.
No FDA-approved medications exist: Gabapentin and N-Acetylcysteine (NAC) are off-label pharmacotherapy options that show evidence for treating CUD, but treating co-occurring psychiatric disorders is equally important.
Harm reduction is a valid goal: Reducing potency, spacing out use, switching routes, and building in breaks are practical steps when a patient isn't ready for abstinence.
Keep patients coming back: The therapeutic relationship is the most powerful tool, so focus on patient goals and follow-up.
Know your legal landscape and testing limitations: Laws vary by state. Standard urine screens will not detect synthetic cannabinoids, and THC metabolites can persist for weeks.
In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Kratom and 7-OH: What Clinicians Need to Know
06 Apr 2026
00:34:42
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts researchers Dr. Kirsten Smith and Katie Hill to explore the rapidly evolving landscape of kratom and 7-hydroxymitragynine (7-OH). They examine kratom’s complex pharmacology, review current research on kratom and 7-OH, discuss kratom’s addiction potential, withdrawal patterns, and the challenges of kratom in the clinical setting. The episode provides listeners with a basic understanding of kratom and 7-OH products, helping clinicians better understand where to begin when treating patients who use kratom and kratom-derived products.
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Looking for this episode's transcript? Download it HERE
Get credit for listening! Claim your 0.5 CEs HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Kirsten Smith, PhD, LMSW
Dr. Kirsten Smith is a leading expert on kratom, with over 90 peer-reviewed publications on kratom and related topics like kava and tianeptine. From 2023-2025, she was an Assistant Professor at Johns Hopkins University School of Medicine’s Department of Psychiatry. She joined Hopkins after earning her Master’s from the University of Kentucky, PhD from the University of Louisville, and completing a 4-year postdoctoral fellowship at the National Institute on Drug Abuse Intramural Research Program (NIDA IRP). At NIDA IRP, she completed her K99-funded project that involved a national ecological momentary assessment of daily kratom use and a controlled drug administration sub-study that investigated the acute effects of commercial kratom products. Her R00-funded study at Johns Hopkins examined kratom pharmacokinetics/pharmacodynamics of kratom and assessed spontaneous kratom withdrawal among chronic consumers. She also received an R01 to study the safety, tolerability, and abuse potential of kratom in healthy adults, which is ongoing. She has conducted surveys and qualitative research on kratom and 7-hydroxymitragynine (7-OH). Dr. Smith is currently transitioning from academia to clinical practice but consults on kratom regularly and welcomes opportunities for collaboration.
Disclosure: There are no relevant financial relationships.
Expert
Katherine Hill, MPH
Katherine (Katie) Hill is a PhD candidate in Epidemiology of Microbial Diseases at Yale School of Public Health. Her research interests include substance use and harm reduction. Her doctoral research employs mixed methods to evaluate the impact of emerging substances, such as xylazine and kratom, on people who use drugs.
Disclosure: There are no relevant financial relationships.
📖 Show Segments
00:05 - Introduction
01:49 - Defining Kratom
04:42 - Consumers of Kratom
05:48 - Is Kratom an Opioid
07:29 - Differences Between Kratom and 7-OH
11:39 - Addiction Potential
16:50 - Toxicity, Acute Intoxication, and Toxidrome
18:55 - 7-OH Withdrawal and Overdose
24:16 - Patient History and Assessment
26:25 - Practice Pearls for Clinicians
30:48 - Patient Motivations and Harm Reduction
33:03 - Conclusion and Additional Learning Opportunity
📋 Key Takeaways
“Kratom” is often used as a broad term for kratom-derived products: Kratom can refer to powdered leaves, capsules, teas, concentrated extracts, or semi-synthetic 7-OH products, many of which may also contain caffeine, kava, CBD, or other additives. When a patient says they use "kratom," it provides little clinical clarity. Clinicians need to ask which product, form, and brand the patient is using to better understand their usage patterns.
Understand the product your patient is using: Product composition, potency, and co-ingredients of kratom are variable. Clinicians need to gather information on formulation, dosing, frequency, route, motivations, and co-use to gain a clear history. Self-report gives far more insight than current toxicology assays.
Kratom’s pharmacology is complex: Kratom can produce pain relief via the serotonin and opioid system. Effects from kratom also include increases in energy and mood elevation. Some kratom alkaloids and metabolites have atypical mu-opioid receptor activity as well as non-opioid activity, making kratom’s pharmacology complex. Kratom can lead to physical dependence symptoms when consumed regularly.
7-OH is different from natural kratom: 7-hydroxymitragynine is found only in trace amounts in kratom leaves, but exists in much higher levels in commercial semi-synthetic products. These formulations behave differently and have low bioavailability, making their clinical effects distinct.
Mild to moderate dependence and withdrawal are possible: Daily, repeated kratom use commonly leads to tolerance and withdrawal symptoms such as restlessness, irritability, fatigue, and cravings. Severe withdrawal appears uncommon in current data, though more evidence is needed, especially for 7-OH products.
People can develop a kratom use disorder: About 25% of people using kratom meet criteria for kratom use disorder based on modified DSM-5 Criteria, though most presentations appear to be mild to moderate.
Standard drug testing has limitations: Urine assays detect mitragynine, but a positive result can't distinguish between kratom leaf products and 7-OH products containing residual mitragynine. 7-OH is unstable in blood and rapidly metabolized, making detection challenging. Rely on self-report and consider asking patients to bring in their products for better clarity.
Understand motivations for use: Many people who use kratom and 7-OH are not seeking intoxication. They're trying to manage pain or mood, function at work, self-treat withdrawal, etc. Treatment planning should account for these functional goals and incorporate motivational interviewing and shared decision-making.
Help is needed to move the field forward: Researchers are behind front-line clinicians in understanding these substances. There is still a lot that is unknown about kratom and kratom-derived products. Clinicians are encouraged to publish case reports, develop internal protocols, describe withdrawal symptoms, and refine assessments to better guide emerging best practices.
In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Social Determinants of Health: Making an Impact in Addiction Care
23 Mar 2026
00:26:17
In this episode of ASAM Practice Pearls, Drs. Stephen Taylor and Sharon Stancliff explore the role of social determinants of health (SDoH) in addiction care. They discuss the biopsychosocial model of addiction and emphasize the importance of understanding social factors such as housing, transportation, and economic stability when providing effective care. They highlight the need for clinicians to engage with patients in their environments, advocate for policy changes, and address racial disparities in addiction treatment, offering practical strategies clinicians can use to support patients facing social challenges.
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Looking for this episode's transcript? Download it HERE
Get credit for listening! Claim your 0.5 CEs HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Sharon Stancliff, MD
Dr. Stancliff is Associate Medical Director for Harm Reduction in Health Care at the AIDS Institute, NYSDOH and sees patients at a shelter in New York City. Dr. Stancliff has been working with people who use drugs since 1990, including the provision of primary care, drug treatment, HIV care, and syringe access. She is currently focused on opioid overdose prevention through expanding access to naloxone and expanding access to buprenorphine in primary care and in less traditional settings, such as syringe exchange programs. Dr. Stancliff graduated from the School of Medicine at the University of California at Davis, did her Family Practice residency at the University of Arizona, and completed the AIDS Institute-sponsored Nicolas Rango HIV Clinical Scholars Program at Beth Israel Medical Center in New York City. She is board-certified in Family Medicine and in Addiction Medicine. She served on the Public Policy Committee of ASAM.
📖 Show Segments
00:05 - Introduction
02:29 - The Role of SDoH in Addiction
06:00 - Prioritizing Competing Social Needs
08:57 - The Clinician’s Role in Addressing SDoH
12:11 - Making Your Voice Heard
14:09 - The Impact of Race on Addiction Treatment
16:38 - Tailoring Treatment to Social Context
19:31 - Navigating Social Networks and Environmental Challenges
22:30 - Key Takeaways
24:50 - Conclusion and Additional Learning Opportunity
📋 Key Takeaways
View addiction through a biopsychosocial lens: Addiction involves complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. It doesn’t develop solely from biological factors, making it essential to address SDoH during treatment.
Prioritize patients’ social needs: Housing instability, poverty, transportation access, food insecurity, and other environmental factors significantly impact a patient’s ability to engage in treatment and are often overlooked.
Focus on safety, stability, and patient goals: Abstinence-only approaches are outdated. Treatment should prioritize whether patients are safer, more stable, and more engaged in care, even if they're still using substances. Focusing on harm reduction and incremental progress promotes patient-centered care and improves engagement.
Engage patients in the community and provide low-threshold care: Meet patients where they are, shelters, streets, and needle exchanges, to better understand their challenges and build trust with populations that might fear traditional healthcare settings. Offering low-threshold community care rather than requiring clinic visits reduces barriers to access and further supports relationship-building.
Tailor treatment to social realities: Adjust prescription lengths, visit frequency, and monitoring based on each patient’s circumstances (e.g., shorter prescriptions if someone can't safely store medications in a shelter, longer prescriptions to reduce transportation barriers).
Recognize how race and criminalization shape treatment access: The war on drugs disproportionately harms people of color, creating cycles of incarceration, overdose risk, and barriers to housing and employment.
Address loneliness and isolation: Many patients on buprenorphine often lack social support. Helping them identify healthy networks and community spaces can reduce loneliness and support recovery.
Advocate for system-level change: Clinicians should make their voices heard by engaging with legislators, health departments, and professional organizations like ASAM to help shape policies that support low-threshold, flexible, and equitable addiction treatment options.
Advancing Racial Justice and Health Equity In the Context of Addiction Medicine: ASAM’s public statement to recognize, understand, and counteract the adverse effects of America’s historical, pervasive, and continuing systemic racism, specifically with respect to addiction prevention, early intervention, diagnosis, treatment, and recovery.
Structural Competency Working Group: An organization founded in the San Francisco Bay Area in 2014 that develops and shares curricula, workshops, and resources to help healthcare professionals recognize and address the social and structural determinants of health.
Structural Competency: provides training materials and resources designed to help healthcare professionals understand and address the social, political, and economic structures that shape health disparities, supporting the broader mission of the Structural Competency Working Group.
In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Optimizing Treatment for Co-occurring Psychiatric and Substance Use Disorders
09 Mar 2026
00:27:51
In this episode of ASAM Practice Pearls, Drs. Stephen Taylor and Smita Das discuss co-occurring psychiatric and substance use disorders (SUD). They explore the most common psychiatric conditions seen alongside addiction, share strategies for distinguishing primary psychiatric disorders from substance-induced symptoms, and review approaches to screening, treatment planning, and integrated care. The conversation highlights practical screening tools, medication considerations, and populations with unique clinical needs, emphasizing the importance of treating both conditions concurrently.
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Looking for this episode's transcript? Download it HERE
Get credit for listening! Claim your 0.5 CEs HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Smita Das, MD, PhD, MPH
Dr. Smita Das is board-certified in psychiatry, addiction psychiatry, and addiction medicine. She studied chemistry and statistics at Stanford University, earned her Master’s in Public Health at Dartmouth College, and completed her MD/PhD in Community Health at the University of Illinois at Urbana-Champaign. Dr. Das completed her psychiatry residency and served as chief resident at Stanford, followed by an addiction psychiatry fellowship at UCSF. She has over two decades of research experience in healthcare quality and addiction. Dr. Das is a former chair of the APA Council on Addiction Psychiatry, a past president of an APA District Branch, and a member of the APA Advisory Council for Workplace Mental Health. She previously served as Director of Addiction Treatment Services at the Palo Alto VA and as Vice President of Psychiatry at Lyra Health. Currently, Dr. Das practices in addictions at Stanford School of Medicine as a Clinical Associate Professor.
📖 Show Segments
00:05 - Introduction
03:58 - Common Co-occurring Psychiatric Conditions
05:37 - Prevalence and Substance-Specific Co-occurrences
08:35 - Distinguishing Primary vs Substance-Induced Symptoms
11:33 - Screening Tools and Measurement-Based Care
14:25 - Pharmacological Management Challenges
18:11 - Breaking Through Treatment Barriers
21:46 - Special Populations: Adolescents, Older Adults, and Peripartum Patients
25:12 - Key Takeaways
26:45 - Conclusion and Additional Learning Opportunity
📋 Key Takeaways
Co-occurrence is the rule, not the exception - Approximately half of people with substance use disorders also have another mental health condition, making integrated treatment essential.
Screen for both conditions routinely - Use validated screening tools, such as PHQ-9 for depression, GAD-7 for anxiety, NIDA screeners for substance use, and the Columbia scale for suicidality to identify co-occurring conditions early.
Treat both conditions together - Research consistently shows that integrated, concurrent treatment of psychiatric and substance use disorders leads to better outcomes.
Take a thorough history - Understanding the relationship between psychiatric symptoms and substance use is important for proper diagnosis and treatment planning.
Know the most common co-occurring conditions - Depression, generalized anxiety disorder, ADHD, psychotic disorders, and trauma-related disorders such as PTSD are the most common co-occurring psychiatric conditions with SUDs. There are also specific substance-disorder pairings to be aware of, such as alcohol and depression, opioids and chronic pain/PTSD/depression, stimulants and bipolar/psychosis, benzodiazepines and anxiety, and cannabis and psychosis.
Be aware of medication challenges - Consider drug interactions, such as benzodiazepines and opioids, symptom overlap like withdrawal mimicking psychiatric symptoms, misuse and diversion risks, and the proper timing of pharmacological interventions.
Address systemic barriers - Break down silos between addiction and psychiatric care through better communication, education, advocacy for parity, and coordinated treatment approaches.
Tailor care for populations with unique clinical needs - Adolescents, older adults, and peripartum patients need age-appropriate screening and treatment strategies that address their unique presentations and challenges.
🔗 Resources
ASAM 2025 Review Course: Psychiatric Co-morbidities: Complexities of Diagnosis and Care: Register HERE
Alcohol Use Disorder and Common Co-occurring Psychiatric Conditions: Register HERE
ASAM 55th Annual Conference: Co-occurring Disorders: Integrating Prevention, Intervention and Evidence: Register HERE
In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Contingency Management: The Nuts and Bolts of Implementation
23 Feb 2026
00:24:54
In this episode of ASAM Practice Pearls, Drs. Stephen Taylor and Brian Hurley explore contingency management as an evidence-based treatment for substance use disorders. They address common concerns and share practical strategies for implementing contingency management in real-world clinical settings, offering listeners actionable insights and best practices for integrating contingency management into comprehensive care.
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Looking for this episode's transcript? Download it HERE
Get credit for listening! Claim your 0.5 CEs HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Brian Hurley, MD, MBA, DFASAM
Dr. Brian Hurley is an addiction physician and the Medical Director of the Bureau of Substance Abuse Prevention and Control in the Los Angeles County Department of Public Health. He currently serves as Immediate Past President of the ASAM Board of Directors. He has served on a variety of committees and councils at ASAM, including originating ASAM's Motivational Interviewing course and co-authoring the ASAM and AAAP National Practice Guideline on the Treatment of Stimulant Use Disorder. Dr. Hurley has led and facilitated projects funded through competitive grants from the U.S. Substance Abuse and Mental Health Services Administration, the U.S. Centers for Disease Control and Prevention, and the California Department of Health Care Services’ Opioid Response Programming in partnership with The Center at Sierra Health Foundation. These projects support harm reduction services and increase the availability of addiction medications in public sector programs across Los Angeles County.
📖 Show Segments
00:05 - Introduction
02:44 - Evidence and Effectiveness
04:45 - Use in Treating Substance Use Disorders
07:38 - How Contingency Management Works in Practice
08:54 - Integrating With Other Treatments
11:49 - Barriers: Payment, Medicaid, and State Differences
15:29 - Organizational Readiness and Staff Buy-In
18:49 - Digital Therapeutics and Virtual Delivery
20:37 - Addressing Misconceptions
21:31 - Importance of Objectivity and Role Separation
23:35 - Conclusion and Additional Learning Opportunity
📋 Key Takeaways
Implement Incentive-Based Treatment: Research shows that providing incentives for objective behaviors, like abstinence, medication adherence, or even attendance, significantly improves treatment outcomes and drives positive behavior change in patients with use disorders.
Utilize Contingency Management for Use Disorders: Contingency management can benefit those with stimulant, cannabis, tobacco, alcohol, and opioid use disorders.
Set Clear Criteria and Immediate Rewards: Success depends on clear criteria, prompt incentives, and consistent application.
Integrate with Comprehensive Care: Contingency management works well alongside counseling, medication, and comprehensive care programs.
Secure Sustainable Funding and Coverage: Sustainable payment models and organizational buy-in are essential for widespread adoption.
Utilize Digital and Virtual Tools: Virtual delivery is effective, especially when paired with ongoing engagement in treatment programs.
Assign Dedicated Incentive Administrators: The person delivering incentives should not be the patient’s primary counselor or physician to maintain fairness and consistency.
Structure Programs for Lasting Change: Plan for contingency management interventions to last several months, focusing on building sustainable, long-term behavior change. Contingency management is not a lifelong intervention.
🔗 Resources
Contingency Management: Overcoming Implementation Barriers to Bring Science to Practice: Register HERE
Treatment of Stimulant Use Disorder Course (6 hours): Register HERE
Treatment of Stimulant Use Disorder Online Course (2 hours): Register HERE
In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Understanding Medetomidine: Emerging Challenges for Addiction Medicine
09 Feb 2026
00:20:47
In the Season 2 premiere of ASAM Practice Pearls, Drs. Stephen Taylor and Jeanmarie Perrone follow up on Season 1’s episode, Emerging Illicit Substances: What Clinicians Need to Know. Together, they discuss how medetomidine has continued to spread to different regions and what has changed over the past year. They explore strategies for managing medetomidine withdrawal, keeping patients safe, and preparing for this growing public health threat.
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Looking for this episode's transcript? Download it HERE
Get credit for listening! Claim your 0.5 CEs HERE
Have an idea for a future episode? Share it with us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Jeanmarie Perrone, MD, FASAM, FACMT
Dr. Jeanmarie Perrone is a Professor in the Department of Emergency Medicine and the founding Director of the Center for Addiction Medicine and Policy at the University of Pennsylvania. Dr. Perrone leads programs for the treatment of Opioid and Alcohol Use Disorders from the emergency department and via a virtual telehealth bridge clinic (CareConnect). Her work has been funded by city health departments and by NIDA, PCORI, CDC, and SAMHSA. She has advocated at the state and national level and contributed to working groups to enhance low-barrier treatment access for substance use disorders and improving toxicosurveillance. She has been recognized with awards for leadership, education, and mentorship.
📖 Show Segments
00:05 - Season 2 Introduction
01:03 - New Drug Crisis: Medetomidine
02:34 - Pharmacology and Withdrawal Symptoms
05:58 - Clinical Management and Patient Care
08:22 - Public Health and Harm Reduction
11:56 - Regional Impact and Future Concerns
15:21 - Key Takeaways and Action Items
19:26 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Recognize the symptoms: Medetomidine withdrawal presents with refractory vomiting and tremors and is complicated by severe hypertension and tachycardia, within 2 hours of last use.
Treat aggressively with clonidine, an alpha-2 adrenergic agonist, and olanzapine: Use high doses of clonidine (0.2-0.4 mg, as often as every 2 hours) combined with alpha-2 adrenergic agonists for concurrent opioid withdrawal, and olanzapine to help control nausea and vomiting to prevent escalation to the ICU.
Use dexmedetomidine for severe cases: Approximately one-third (or more) of patients require dexmedetomidine infusion in the ED or ICU to manage symptoms. Coordinate early with critical care if symptoms worsen despite initial treatment.
Distinguish from alcohol or benzodiazepine withdrawal: If a patient presents with what looks like alcohol or benzodiazepine withdrawal but doesn't respond to benzodiazepines or barbiturates, consider adding dexmedetomidine. If the patient responds to the dexmedetomidine, medetomidine withdrawal should be considered.
Update naloxone education: Teach patients and bystanders that the goal for naloxone is improved respiratory effort, not wakefulness. Medetomidine may keep the person sedated even after successful opioid reversal.
Provide medetomidine test strips: In areas with lower medetomidine prevalence, test strips can help patients identify and avoid adulterated supplies.
Monitor the local drug supply: Connect with drug-checking programs in your area to learn which adulterants are present and at what prevalence.
Report suspected cases to your local health department: Help track the spread of medetomidine by reporting suspected cases. Public health surveillance is essential.
🔗 Resources
Medetomidine: Rising Adulterant in the Illicit Drug Supply - Download HERE
Substance Use Philly: Medetomidine - Review current information from the city of Philadelphia on medetomidine, including its effects, treatment, and harm reduction recommendations, and available resources for community members, non-medical organizations, and healthcare providers.
Medetomidine Palm Card - Department of Public Health, City of Philadelphia - An informational card on medetomidine withdrawal that can be used for patient education and guidance to healthcare providers on managing medetomidine withdrawal.
In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Overdose Awareness: Preventing, Responding, and Intervening
31 Aug 2025
00:35:04
In recognition of International Overdose Awareness Day, the Season 1 finale of ASAM Practice Pearls explores recent trends in overdoses. Drs. Stephen Taylor and Alexander Walley discuss the increase of fentanyl and other contaminants in the drug supply, the impact of racial and geographic disparities, and the importance of community-specific responses. They highlight the value of compassionate overdose care, data-driven interventions, and strategies to help individuals post-overdose. Together, they discuss the need to lower barriers to treatment and foster future leaders in addiction medicine.
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Looking for this episode's transcript? Download it HERE
We want to hear from you! Please take our short, five-minute survey HERE
or email us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Alexander Y. Walley, MD, MSc, DFASAM
Dr. Alexander Y. Walley is Professor of Medicine at Boston University Chobanian & Avedisian School of Medicine, primary care physician and addiction specialist at Boston Medical Center focused on the medical complications of substance use, specifically HIV and overdose. He leads research studies on overdose prevention and the integration of addiction specialty care and general medical care. He is a founder of Boston Medical Center’s inpatient addiction consult service and walk-in substance use care bridge clinic. Dr. Walley was a founding director of the Grayken Addiction Medicine Fellowship and is the president of the American College of Academic Addiction Medicine. He serves as the medical director for the Massachusetts Department of Public Health’s Bureau of Substance Addiction Services, the Overdose Prevention Program, and the SafeSpot Overdose Prevention Hotline.
📖 Show Segments
00:05 - Introduction
00:17 - Epidemiology and Geographical Areas of Concern
07:15 - Racial, Geographic, and Socioeconomic Disparities
08:58 - Contaminants in the Drug Supply Affect Overdose Response
13:03 - Engaging Patients with Post-Overdose Care
18:18 - Approaching Conversations About Overdose Risk
23:42 - Tools for Overdose Prevention
26:19 - Policy, Protocols, and Treatment Innovationsr
30:41 - Training the Next Generation
33:23 - Final Thoughts on the Overdose Crisis
34:05 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Understand the Evolving Nature of the Opioid Epidemic: The overdose crisis has progressed through distinct waves, from prescription opioids, to heroin, to fentanyl, and now to increasingly complex combinations with stimulants and synthetic substances.
Address Racial, Ethnic, and Geographic Disparities: Marginalized populations and rural communities often face greater risk and reduced access to prevention, harm reduction, and treatment resources, requiring intentional, equity-focused interventions.
Respond to Emerging Drug Supply Contaminants: The presence of non-opioid substances like xylazine complicates overdose response, as naloxone may not reverse all effects, requiring expanded training and protocols for responders.
Promote Compassionate Overdose Response: In the event of an overdose, the priority is to restore breathing quickly and safely. Use only the amount of naloxone necessary and offer supportive, nonjudgmental care throughout the recovery process.
Encourage Practical Overdose Prevention Strategies: Most fatal overdoses occur when people use alone. Help patients develop practical safety plans, such as not using alone, developing safety plans, using drug checking tools, and maintaining access to naloxone to reduce overdose risk.
Leverage Real-Time Data for Community Action: Tools like OD Map and CDC dashboards provide real-time insights that can help inform timely, targeted community responses to emerging overdose patterns.
Lower Barriers to Evidence-Based Treatment: Expanding access to care through same-day treatment, low-barrier programs, and integrated support services, such as housing, education, and employment, helps improve outcomes and reduce overdose deaths.
Remove Barriers to Treatment and Support Systems: Expanding access to care, integrating social supports, and investing in workforce development, including training future addiction medicine leaders, are important for sustainable progress.
🔗 Resources
The ASAM Principles of Addiction Medicine (Seventh Edition):
Perinatal Substance Use Care: Listening, Trust, and Treatment
18 Aug 2025
00:36:30
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Cara Poland explore the unique challenges of perinatal substance use care. They discuss the impact of stigma, the importance of compassionate care, and the use of medications for addiction treatment in pregnancy. Additionally, they address polysubstance use, physiological changes during pregnancy, and the critical postpartum period, sharing insights from their clinical experience and emphasizing a patient-centered, non-judgmental approach to improve treatment outcomes for mothers.
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Looking for this episode's transcript? Download it HERE
We want to hear from you! Please take our short, five-minute survey HERE
or email us at education@asam.org.
Host
Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.
Expert
Cara Poland, MD, MEd, FACP, DFASAM
Dr. Cara Poland is ASAM’s Vice President, is board-certified in Addiction Medicine, and is a faculty member at Michigan State University. In 2018, Dr. Poland identified the need to strengthen our country’s Addiction Medicine workforce. Dr. Poland leads MI CARES, which trains physician-level addiction specialists in Michigan and across the country. The program also teaches physicians-in-training, resident physicians, social work students, social work practitioners, APRNs, and PAs. Her didactic program involves purposeful education to train healthcare providers to treat persons with SUDs in a kind, compassionate, destigmatized way. Dr. Poland has a special interest in treating pregnant people and their families living with a substance use disorder.
📖 Show Segments
00:05 - Introduction
00:15 - New York Times Excerpt
03:07 - Substance Use and Overdose Risk During Pregnancy
04:07 - Addressing Stigma in Addiction Treatment
19:18 - Effective Support Systems for Pregnant People with Addiction
13:56 - Medication for Opioid Use Disorder During Pregnancy
18:00 - Postpartum Care and Overdose Risk
27:06 - Polysubstance Use and Alcohol Use Disorder
33:38 - Key Takeaways
35:10 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Recognize Pregnancy as a Motivator for Change: Pregnancy can inspire individuals to seek help and begin recovery. Leveraging this motivation through empowering, respectful care can improve outcomes for both parent and baby.
Understand Vulnerability in Substance Use: Addressing underlying vulnerabilities that often contribute to substance use, such as trauma, mental health conditions, and social factors, through compassionate care is essential to supporting recovery.
Foster Trust by Reducing Stigma: Creating nonjudgmental healthcare environments, along with respectful, supportive patient-provider relationships, encourages engagement and improves treatment outcomes.
Promote Evidence-Based Treatment During Pregnancy: Medications for opioid and alcohol use disorders are safe and effective during pregnancy. Addressing misinformation and normalizing these treatments can help improve access and reduce harm.
Normalize Return to Use as Part of Recovery: Recovery is rarely linear. Approaching return to use with empathy, as a step in the process, encourages long-term engagement and helps reduce shame.
Deliver Empathic, Individualized Care: Active listening, empathy, and individualized care planning help build trust, deepen understanding, and guide effective, patient-centered interventions.
Implement Team-Based Support: Pregnant individuals with substance use disorders often face complex medical, social, and behavioral health challenges. Coordinated, interdisciplinary care is essential for addressing these needs holistically.