ASAM Practice Pearls

In this season 2 finale of ASAM Practice Pearls, Dr. Stephen Taylor sits down with Dr. Timothy Fong to discuss one of the fastest-growing and most overlooked concerns in addiction medicine: gambling disorder. With sports betting now legal in over 40 states and digital gambling accessible on every smartphone, gambling and sports betting are rapidly expanding. This episode breaks down the prevalence, consequences, and unique aspects of gambling disorder and offers practical, actionable guidance on screening, brief intervention, and treatment.

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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

Timothy Fong, MD

Dr. Timothy Fong is the President of the American Academy of Addiction Psychiatry (AAAP) and a clinical professor of psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA. He is board certified in adult and addiction psychiatry. He is the co-director of the UCLA Gambling Studies Program, a program that examines the clinical characteristics of gambling disorder in order to develop effective, evidence-based prevention and treatment strategies. Dr. Fong is also a member of the Steering Committee of the UCLA Center for Cannabis and Cannabinoids, whose mission is to address the most pressing questions about the impact of cannabis legalization through rigorous scientific study and interdisciplinary discourse. He is a member of the UCLA Sports Psychiatry Service and the UCLA Sports Medicine Mental Health Team.

📖 Show Segments

• 00:05 - Introduction
• 02:38 - Modern Day Gambling: Investing vs Gambling vs Betting
• 04:38 - Prevalence and Public Health Impact
• 08:21 - Consequences of Gambling Disorder
• 14:30 - Screen and Clinical Assessment
• 20:03 - Interventions and Treatment Options
• 23:59 - Practice Pearls
• 27:40 - Conclusion

📋 Key Takeaways

• Recognize that we are practicing in a gambling-centered environment: The rapid expansion of mobile sports betting, online wagering, and prediction markets has normalized gambling and lowered perceptions of risk. Clinicians should expect to encounter gambling-related harms more frequently across patient populations.
• Recognize gambling disorder as a serious and potentially life-threatening condition: Gambling disorder is associated with high rates of suicidality, co-occurring substance use disorders, mental health disorders, financial strain, relationship problems, and intimate partner violence. Clinicians should approach it with the same level of concern as substance use disorders.
• Remember that gambling disorder is often a hidden addiction: Patients may appear highly functional, professionally successful, and psychologically intact while experiencing severe financial losses, emotional distress, and compulsive gambling behaviors. Do not rely on appearance or external functioning to assess risk.
• Screen routinely and ask the right questions: Gambling should be assessed alongside substance use during intakes, annual assessments, and follow-up visits. Because many patients do not view sports betting, poker, online wagering, or prediction markets as "gambling," ask specifically about betting behaviors. Consider questions such as:

• Have you ever lied to anybody about spending money on gambling or betting?
• Have you ever increased your bet, wager, or gambling amount to get the same thrill or rush?
• How much time, energy, and money do you spend online trying to make more money?

• Assess financial health as part of both screening and recovery: Ask patients about debt, paycheck-to-paycheck living, loans, and financial stress. Financial difficulties may uncover gambling-related harms that patients are reluctant to disclose, and addressing financial wellness should be part of ongoing recovery planning.
• Think about gambling when patients are not improving as expected: If depression, anxiety, substance use treatment, or other behavioral health conditions are not improving as expected, consider whether an undiagnosed gambling disorder might be contributing to ongoing distress or risk of return to use.
• Use brief physician interventions to increase motivation for change: A nonjudgmental conversation that connects gambling behavior to physical health, mental health, finances, and overall well-being can have a meaningful clinical impact. Just two to three minutes can make a difference. Remember to always frame concerns in a supportive, motivating way.
• Apply a biopsychosocial approach to treatment: Treatment should address biological, psychological, and social factors by supporting healthy sleep, nutrition, and physical activity, treating co-occurring psychiatric and substance use disorders, and connecting patients to appropriate therapeutic and recovery resources.
• Use harm-reduction goals when appropriate: Help patients develop realistic, measurable goals, such as reducing gambling expenditures or limiting gambling frequency. Revisit those goals regularly and adjust the treatment plan based on progress, just as you would for any other substance use disorder.
• Create a gambling disorder toolkit for your practice: Maintain referral pathways to gambling-certified therapists, Gamblers Anonymous meetings, telehealth services, helplines, and digital recovery tools. Incorporate screening tools, patient education resources, and community support into your existing addiction treatment workflows so gambling becomes part of routine clinical care.

🔗 Resources

• ASAM Review Course 2026: Behavioral Addiction: Criteria, Challenges, and Considerations
• ASAM’s Special Interest Group: Behavioral Addictions Community
• Screening Tools:

• Brief Biosocial Gambling Screen (BBGS)
• DSM-5 Criteria for Gambling Disorder
• Emerging Adult Gambling Screen (EAGS-4)
• Gambling Harms Scale-20 (GHS-20)
• Internet Gaming Disorder Test-20 (IGD-20)
• The South Oaks Gambling Screen (SOGS)

• National Gambling Problem Helpline: 1-800-MY-RESET
• Gamblers Anonymous Meeting Locator: GamblersInRecover.com
• Telehealth Gambling Treatment Providers:

• Kindbridge Behavioral Health
• Birches Health

• Digital Recovery App: EVIVE digital health tool
• Voices in Recovery Podcast Series:

• ALL IN: The Addicted Gambler’s Podcast
• The Broke Girl Society

• Gambling Addiction Conferences:

• The National Conference on Problem Gambling (NCPG) Annual Conference
• The International Center for Responsible Gaming (ICRG) Annual Conference on Gambling and Addiction

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!

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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.

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor welcomes back Dr. Stephanie Weiss and is joined by Dr. Anna Lembke to explore an update on GLP-1 receptor agonists for alcohol use disorder (AUD), discussing current research, how things have evolved since the last discussion, 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

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

Stephanie Weiss, MD, PhD

Dr. Stephanie 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.

Expert

Anna Lembke, MD, FASAM

Dr. Anna Lembke received her undergraduate degree in Humanities from Yale University and her medical degree from Stanford University. She is currently Professor and Medical Director of Addiction Medicine, Stanford University School of Medicine. She is also Program Director of the Stanford Addiction Medicine Fellowship, Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, and a diplomate of the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine.

📖 Show Segments

• 00:05 - Introduction
• 04:15 - Latest Developments in Research
• 05:34 - Prescribing GLP-1's Off Label
• 06:28 - Challenges With Prescribing
• 07:36 - Who Benefits From GLP-1's and Who Doesn't
• 09:52 - Potential for Other SUD Treatment Beyond AUD
• 11:18 - Side Effects, Tolerability Concerns, and Adherence Challenges
• 15:11 - Where GLP-1's Fit into the Treatment Toolbox
• 16:19 - Unanswered Questions about GLP-1 Treatment
• 19:14 - GLP-1's Possible Impact on Mood
• 25:11 - Dosing Strategy and Titration Approach
• 26:36 - Life After GLP-1s: Rebound Risk and "Chipping"
• 28:52 - Biggest Surprise from the Research So Far
• 31:05 - Practice Pearls
• 32:34 - Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Emerging evidence continues to build for GLP-1s in AUD: Multiple recent clinical trials of semaglutide for AUD have reported positive findings, with additional studies expected to be published in the coming year. While the evidence base is growing, GLP-1s are not yet FDA-approved for the treatment of substance use disorders.
• Continue to prioritize FDA-approved medications for AUD first: Clinicians should start with established treatments such as naltrexone, acamprosate, and disulfiram before considering off-label GLP-1 therapy.
• Consider GLP-1s for patients with AUD and relevant co-occurring conditions: Patients with refractory AUD who have not responded well to evidence-based treatments and also have obesity, diabetes, binge eating disorder, food addiction, or treatment-resistant depression may be good candidates for a GLP-1 trial.
• Start low and titrate based on efficacy and tolerability: There is currently no established optimal GLP-1 dose for AUD. Clinicians prescribing GLP-1s off-label should begin with low doses and gradually titrate while monitoring symptom improvement and adverse effects. Note: A 7.2 mg injectable semaglutide dose was approved in March 2026 for chronic weight management. Although this dose has not been studied in clinical trials for AUD, its availability may be relevant for patients who experience only a partial response at lower semaglutide doses.
• Prepare patients for common gastrointestinal side effects: Nausea, constipation, diarrhea, abdominal discomfort, belching, reflux, and worsening GERD symptoms are among the most commonly reported adverse effects. Many patients adapt over time, and symptoms may improve despite subsequent dose increases.
• Monitor for changes in mood, motivation, and reward-seeking behaviors: In addition to reduced cravings for alcohol, some patients report diminished interest in food, pleasurable activities, or other rewarding experiences. At the same time, emerging evidence suggests GLP-1s may improve mood in some individuals, though further research is needed.
• Use a multidisciplinary approach to prescribing and monitoring: Collaboration with primary care clinicians, GI specialists, or other medical providers can help address insurance barriers, monitor adverse effects, and support comprehensive patient care.
• Evidence for other substance use disorders remains preliminary: The use of GLP-1s for AUD may be unique due to its caloric content; however, researchers are actively studying GLP-1s for other substance use disorders, but current data are still limited. Clinicians should remain cautious until more robust evidence becomes available.
• Long-term treatment questions remain unanswered: It is still unclear how long patients should remain on GLP-1 therapy, whether benefits persist after discontinuation, and whether some patients experience relapse or rebound symptoms when treatment stops.
• Consider GLP-1s as an additional tool, not a replacement for comprehensive care: The greatest benefit is likely achieved when medications are combined with psychosocial interventions, counseling, mutual-support participation, and ongoing recovery-oriented care.

🔗 Resources

• Season 1 Episode: GLP-1 Receptor Agonists Explained: Their Potential Role in Addiction Treatment
• ASAM 56th Annual Conference:

• The Science of GLP-1 Receptor Agonists: A Rising Tide in Addiction Treatment
• Heavy Hitters: Glucagon-like Peptide-1 (GLP-1) Receptor Agonists for Addiction Treatment

• ASAM 57th Annual Conference Posters:

• GLP-1 Receptor Agonists Improve Outcomes in Patients Receiving Buprenorphine for OUD
• Consequences of GLP-1 Coverage Loss in Alcohol Use Disorder

• Journal of Addiction Medicine Journal Article Activity: The Efficacy of GLP-1 Agonists in Treating Substance Use Disorder in Patients A Scoping Review
• Does Semaglutide Reduce Alcohol Intake in Danish Patients With Alcohol Use Disorder and Comorbid Obesity? Trial Protocol of a Randomised, Double-Blinded, Placebo-Controlled Clinical Trial (the SEMALCO trial) - Klausen MK, Kuzey T, Pedersen JN, et al. BMJ Open. 2025;15(1):e086454. Published 2025 Jan 8. doi:10.1136/bmjopen-2024-086454
• Once-Weekly Semaglutide in Adults With Alcohol Use Disorder: A Randomized Clinical Trial - Hendershot CS, Bremmer MP, Paladino MB, et al. JAMA Psychiatry. 2025;82(4):395-405. doi:10.1001/jamapsychiatry.2024.4789
• Once-Weekly Semaglutide Versus Placebo in Patients With Alcohol Use Disorder and Comorbid Obesity: A Randomised, Double-Blind, Placebo-Controlled Trial - Klausen MK, Justesen SK, Pedersen JN, et al. The Lancet. 2026;407(10540):1687-1698. doi:10.1016/s0140-6736(26)00305-3
• Oral Semaglutide for Alcohol Use Disorder: A Randomized Clinical Trial - Schacht JP, Sakai JT, Raymond K, Shelton R. Am J Psychiatry. Published online July 29, 2026. doi:10.1176/appi.ajp.20260003

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!

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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.

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts Dr. Justin Berk to discuss addiction care for individuals involved in the criminal justice system, including patients in custody and those transitioning back to the community. The conversation explores practical strategies for building therapeutic alliances with incarcerated patients, advocating for evidence-based treatment in correctional settings, and navigating common barriers to care. The episode covers opportunities for clinicians to provide compassionate, patient-centered care that improves outcomes for this high-risk population.

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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

Justin Berk, MD, MPH, MBA, FASAM

Dr. Justin Berk is an addiction medicine physician-researcher and the former Medical Director of the Rhode Island Department of Corrections. He is an Associate Professor in the Departments of Medicine and Pediatrics at the Alpert Medical School at Brown University and the Director for the Center of Health and Justice Transformation at Brown University Health. He completed residency at the Urban Health Combined Internal Medicine – Pediatrics Residency Program at Johns Hopkins Hospital and is Board Certified in Internal Medicine, Pediatrics, and Addiction Medicine. His research and advocacy focus on the intersection of addiction medicine, correctional health, and health equity.

📖 Show Segments

• 00:05 - Introduction
• 03:09 - Building Rapport with Patients in Custody
• 08:23 - Evidence for MOUD in Jails and Prisons
• 11:05 - Overcoming Implementation Barriers for Evidence-based Treatment
• 13:11 - Advocating for Patients in Custody
• 17:25 - Reentry and Continuity of Care
• 19:44 - Addressing Diversion Concerns
• 23:22 - Privacy, Autonomy, and Care Coordination
• 24:50 - Lightning Round Q&A
• 28:05 - Practice Pearls
• 29:58 - Conclusion and Additional Learning Opportunity

📋 Key Takeaways

• Recognize the justice system as a critical treatment touchpoint: Approximately 58% of individuals in state prisons and 63% of individuals in jails meet criteria for substance use disorder, making correctional settings an important, and often underutilized, opportunity to initiate evidence-based addiction care.
• Tailor clinical management to the correctional setting: Jails and prisons present distinct clinical challenges, with jails more commonly managing acute intoxication, withdrawal, and trauma, while prisons often focus on chronic disease management and long-term care.
• Use humanistic, patient-centered care to improve engagement and outcomes: Small actions, such as requesting the removal of handcuffs during clinical encounters, advocating for privacy, facilitating necessary evaluations, and coordinating directly with correctional facilities during transitions of care, can build trust and strengthen therapeutic relationships.
• Use hospitalization to close care gaps for patients in custody: When feasible, initiate evidence-based treatments during hospitalization rather than deferring care. Consider starting HCV treatment, optimizing medication for opioid use disorder (MOUD), addressing rehabilitation needs, completing necessary diagnostic workups, and documenting ongoing care requirements.
• Support access to MOUD in correctional settings: Evidence demonstrates that methadone and buprenorphine save lives, reduce overdose risk, improve treatment retention, and improve outcomes, yet many of these treatments remain unavailable in many correctional facilities.
• Recommend and document evidence-based treatment regardless of anticipated barriers: When MOUD is clinically indicated, formally prescribe or recommend treatment, even if continuation is uncertain, to create a clear record of the standard of care and support future treatment access.
• Balance diversion concerns against the benefits of treatment: While diversion of medications such as buprenorphine can occur, concerns are often overstated and should not prevent patients from receiving evidence-based treatment for opioid use disorder.
• Prioritize overdose prevention during the reentry period: Individuals face an exceptionally high risk of fatal overdose immediately after release, making reentry planning, continuity of care, and ongoing treatment engagement essential components of addiction treatment.
• Plan for reentry early and proactively: Because 95% of incarcerated individuals return to their communities, clinicians should address barriers such as insurance coverage, identification, housing, transportation, and continuity of care before release whenever possible.
• Maintain a high index of suspicion for alcohol withdrawal in custody settings: Alcohol withdrawal is a high-risk situation in jails, and is often underrecognized and potentially fatal, requiring early identification, monitoring, and treatment.

🔗 Resources

• The ASAM Criteria, Fourth Edition, Volume 3: Correctional Settings and Community Reentry Volume

• Public comment open until August 31, 2026
• Expected release early 2028 (tentative)

• Treatment of SUD in Jails and Prisons (FREE)
• ASAM Clinical Tips: Treating SUD in Jails and Prisons

• Implementing MOUD Improves Safety, Culture, and Public Health
• Managing Alcohol Withdrawal in Jail Settings

• Additional Treatment Courts Education (FREE)

• Learning Collaborative Sessions (Mentoring) - A Whole Person Approach: Adding Addiction Medicine Services to a Drug Treatment Court Program
• Resources:

• Job Aids
• Treatment Court Resources & Toolkits
• MOUD Guides

• ASAM Public Policy Statement on Treatment of Opioid Use Disorder in Corrections Settings - Adopted by the ASAM Board of Directors on July 15, 2020; revised on January 23, 2025
• Guidelines for Managing Substance Withdrawal in Jails: A Tool for Local Government Officials, Jail Administrators, Correctional Officers, and Health Care Professionals - Bureau of Justice Assistance, Office of Justice Programs, US Department of Justice; June 2023
• Jail and Prison Opioid Project: This website provides data, research, implementation resources, and an interactive database documenting which correctional facilities offer evidence-based treatments such as methadone, buprenorphine, and naltrexone to individuals with opioid use disorder.
• Justice Community Overdose Innovation Network (JCOIN): An NIH-funded national initiative focused on improving how the criminal justice system responds to substance use disorders by advancing research, evidence-based practices, and partnerships between healthcare and justice systems. This website provides research, training, technical assistance, and educational resources to expand access to effective addiction treatment for justice-involved populations.
• Association Between Jail-Based Methadone or Buprenorphine Treatment for Opioid Use Disorder and Overdose Mortality After Release From New York City Jails 2011-17 - Lim S, Cherian T, Katyal M, et al. Addiction. 2023;118(3):459-467. doi:10.1111/add.16071
• Carceral Health Care - Brinkley-Rubinstein L, Berk J, Williams BA. N Engl J Med. 2025;392(9):892-901. doi:10.1056/NEJMra2212149
• Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007-2009 (Revised 2020) - Bronson J, Stroop J, Zimmer S, Berzofsky M. Bureau of Justice Statistics, US Department of Justice; June 2017. NCJ 250546
• Hospitalization Through the Lens of Incarceration - South AM, Haber LA, Berk J. J Gen Intern Med. 2024;39(10):1905-1909. doi:10.1007/s11606-024-08805-8
• Injecting Opioid Use Disorder Treatment in Jails and Prisons: The Potential of Extended-Release Buprenorphine in the Carceral Setting - Berk J, Del Pozo B, Rich JD, Lee JD. J Addict Med. 2022;16(4):396-398. doi:10.1097/ADM.0000000000000942
• Reentry Trends in the United States - Hughes TA, Wilson DJ. U.S. Department of Justice, Bureau of Justice Statistics; 2004
• Uncommon and Preventable: Perceptions of Diversion of Medication for Opioid Use Disorder in Jail - Evans EA, Pivovarova E, Stopka TJ, Santelices C, Ferguson WJ, Friedmann PD. J Subst Abuse Treat. 2022;138:108746. doi:10.1016/j.jsat.2022.108746

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!

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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.

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor welcomes Dr. Itai Danovitch to discuss the descriptive term polysubstance use and methods for evaluating and managing patients with polysubstance intoxication and unknown toxidromes. The conversation covers strategies for assessing altered mental status, maintaining a broad differential diagnosis, safely managing agitation, and providing supportive care while avoiding common cognitive biases. This episode offers listeners practical insights for navigating clinical uncertainty and supporting patients from stabilization to treatment engagement.

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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

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 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
• 02:28 - Chapter 59 in The ASAM Principles of Addiction Medicine
• 03:45 - Patient Case: Altered Mental Status
• 06:01 - Polysubstance Use as a Descriptive Term
• 07:53 - Approaching Unclear or Mixed Toxidromes
• 11:36 - Completing a Differential Diagnosis Workup
• 14:54 - Responding When There Is a Lack of Clear Protocols
• 18:39 - Contaminants and the Changing Drug Supply
• 20:39 - Practice Pearls
• 23:33 - Lightning Round Q&A
• 27:35 - Conclusion and Additional Learning Opportunity

📋 Key Takeaways

• Conduct empirical evaluations and avoid confirmation bias: Polysubstance presentations often involve incomplete histories, unexpected substances, or contaminants. Remain comfortable with uncertainty, continually reassess the patient, and adapt management as new information emerges rather than becoming committed to an early diagnosis.
• Keep the differential diagnosis broad when evaluating altered mental status: Do not assume that all episodes of agitation, confusion, or delirium are caused solely by substance use. Consider intoxication, withdrawal, infection, trauma, metabolic disorders, neurologic conditions, and other medical causes.
• Supportive care is the foundation of managing most toxidromes: For many unknown or mixed toxidromes, treatment focuses on maintaining airway, breathing, circulation, temperature regulation, and patient safety while the body metabolizes and clears substances.
• Match agitation management to the underlying cause: Agitation related to withdrawal from central nervous system depressants may require benzodiazepines or barbiturates, while agitation or psychosis unrelated to withdrawal may be better managed with antipsychotic medications. Reassess frequently if symptoms fail to improve as expected.
• Create a calm, low-stimulation environment whenever possible: Reducing environmental stressors, providing reassurance, and avoiding the use of physical restraints (which can worsen agitation and lead to additional complications) can help improve outcomes and reduce complications in patients who are intoxicated or have an altered mental state.
• Toxicology screens are helpful but have limitations: Obtain toxicology testing early when appropriate, but do not rely on it exclusively. Some substances, such as GHB (gamma-hydroxybutyrate), may not be detected on routine screening tests, and negative results do not rule out exposure.
• Use local expertise to understand emerging drug trends: Emerging synthetic substances, contaminants, and adulterants can alter clinical presentations. Local surveillance data and poison control centers are valuable resources for understanding regional drug trends and obtaining management guidance.
• Treat agitation as a medical emergency rather than a behavioral inconvenience: Significant agitation may signal a serious underlying condition and requires prompt assessment, monitoring, and intervention.
• Engage patients with empathy and curiosity: Intoxication and altered mental status can be frightening and traumatic experiences. Use a supportive, patient-centered approach and learn from patients' experiences.
• Stabilization is only the beginning of care: Once a patient has recovered from intoxication or withdrawal, clinicians should engage them in conversations about substance use, provide harm reduction education, assess for substance use disorders, and connect them with evidence-based treatment when appropriate.

🔗 Resources

• The ASAM Principles of Addiction Medicine 7th Edition - Miller SC, Rosenthal RN, Levy S, Saxon AJ, Tetrault JM, Wakeman SE, eds. Wolters Kluwer; 2024.

• Chapter 59: Management of Stimulant, Hallucinogen, Cannabis, Phencyclidine, and Other Drug Intoxication and Withdrawal - Wilkins JN, Gorelick DA, Danovitch I, Athanasiou N, Allen S.

• Implementation Guide for Hospital and Emergency Department Substance Use Disorder Care

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!

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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.

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts Dr. Stephen Holt in a discussion about practical strategies for initiating and managing patients receiving low-dose buprenorphine and long-acting injectable (LAI) formulations. The conversation explores how to match induction approaches to individual patient needs, guidance on dosing, and ways to support ongoing use, cravings, or withdrawal symptoms. This episode offers listeners practical insights for implementing buprenorphine treatment strategies and expanding access to evidence-based care.

----more----

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

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

• 00:05 - Introduction
• 00:45 - Patient Case: Erratic use of Buprenorphine
• 02:23 - Deciding Between Traditional and Low-Dose Induction
• 05:27 - Direct-to-Inject Approach and Access Logistics
• 09:23 - Low-dose Induction Approach
• 10:38 - Considerations for Tailoring Buprenorphine Doses
• 12:37 - Candidates for LAI Formulations
• 14:16 - Initiating LAI Treatment
• 17:56 - Managing Ongoing Use and Breakthrough Symptoms on LAI
• 21:02 - Addressing Co-occurring Substance Use Disorders
• 23:05 - Practice Pearls
• 25:31 - Conclusion and Additional Learning Opportunity

📋 Key Takeaways

• Match your induction strategy to the patient: Patients using short-acting or predictable opioids can follow a traditional induction. For those taking predictable long-acting opioids or methadone, consider a low-dose induction. For patients with erratic use of buprenorphine or fentanyl, consider a direct-to-inject or high-dose induction approach.
• Low-dose induction reduces the risk of precipitated withdrawal: Start a patient with very small amounts of buprenorphine (e.g., 0.5 mg) while the patient continues using their opioid, then gradually increase their buprenorphine dose over approximately 6 days in the outpatient setting.
• Consider direct-to-inject LAI buprenorphine for patients with unstable use: LAI buprenorphine (especially 7-day formulations) allows a gradual receptor transition, reducing withdrawal risk and simplifying care for patients with unstable opioid use patterns.
• Proactively address logistical barriers to offering LAIs: Establish feasible workflows (e.g., specialty pharmacy or buy-and-bill) to reduce access barriers. Another option is to plan follow-up visits a few days later to administer the injection and use sublingual buprenorphine as a bridge, rather than trying to secure LAI same-day access upfront.
• Individualize LAI dosing based on patient use patterns and context: There's no perfect conversion from fentanyl to buprenorphine. Dosing decisions depend on opioid type, level of cravings, and environment. Patients using more than 2-3 bags of fentanyl per day may require the maximum dose of LAI buprenorphine, whereas lighter users may not.
• Offer LAI buprenorphine as a routine option to all patients: No patient is "too stable" or "too unstable" for LAI buprenorphine. While it is especially helpful for patients with erratic adherence, housing instability, or a preference for injections, any patient can benefit. LAI buprenorphine should be offered as a standard option for everyone.
• Breakthrough symptoms on LAIs can be managed with flexible strategies: Options include increasing LAI dose, switching formulations, adding short-term sublingual buprenorphine, and addressing underlying causes of symptoms, such as psychosocial factors.
• Pair medication treatment with additional supports: Even with LAIs, providing behavioral support, psychosocial interventions, and treating co-occurring substance use disorders remain essential for long-term recovery. Schedule frequent visits and encourage behavioral support, group therapy, and psychosocial interventions.
• Start with just one patient: Clinicians hesitant about LAI buprenorphine should start with a single patient. Find a specialty pharmacy in your area and make the connection. The learning curve is manageable, and the impact is often transformative.

🔗 Resources

• ASAM 57th Annual Conference Sessions:

• Enhancing Access with Direct-to-Inject Buprenorphine: Evidence and Implementation
• Long-Acting Injectable Buprenorphine for Birthing and Parenting People with OUD
• LAI Buprenorphine in Criminal Justice Settings: Strategies and Tools for Implementation

• ASAM Clinical Tips Advanced Buprenorphine Video Series: Explore HERE
• Extended-Release (XR) Buprenorphine Formulations Resource Guide - This resource guide compares two formulations of extended-release (XR) buprenorphine, a long-acting treatment for opioid use disorder (OUD). It highlights differences in dosing, administration, and logistics to support informed clinical decision-making.
• ASAM Clinical Considerations: Buprenorphine Treatment of Opioid Use Disorder for Individuals Using High-potency Synthetic Opioids - Weimer MB, Herring AA, Kawasaki SS, Meyer M, Kleykamp BA, Ramsey KS. J Addict Med. 2023;17(6):632-639. doi:10.1097/ADM.0000000000001202
• Extended-Release 7-Day Injectable Buprenorphine for Patients With Minimal to Mild Opioid Withdrawal - D'Onofrio G, Herring AA, Perrone J, et al. JAMA Netw Open. 2024;7(7):e2420702. Published 2024 Jul 1. doi:10.1001/jamanetworkopen.2024.20702

📢 Join the Discussion

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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.

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Mike Fingerhood discuss the importance of enhancing addiction care through community support and compassionate touch points. They explore how providing access to basic needs can serve as entry points into treatment for individuals struggling with addiction, the effect of compassionate interventions on clinical outcomes, and the challenges related to funding and community acceptance for addiction services.

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Looking for this episode's transcript? Download it HERE

Get credit for listening! Claim your 0.5 CEs 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

Michael I. Fingerhood, MD, FACP, DFASAM

Dr. Michael I. Fingerhood is a Professor of Medicine and Public Health at Johns Hopkins University and Chief of the Division of Addiction Medicine at Johns Hopkins Bayview Medical Center. Dr. Fingerhood created The Comprehensive Care Practice in 1994, a primary care practice largely devoted to providing care to individuals with substance use disorder. The practice has been innovative in integrating buprenorphine treatment into the primary care setting for over 650 individuals. He has also co-created novel buprenorphine treatment programs for a community center, church, and a mobile van outside the Baltimore Detention Center. Dr. Fingerhood received the Health Equity Leadership Award from the Baltimore City Health Department. He is the co-author of the ASAM Handbook of Addiction Medicine. Dr. Fingerhood serves on the ASAM Board of Directors as Ex-Officio, Chair of the Medical Education Council. In addition, he has co-authored over 80 research papers and received NIH research funding continuously over the past 30 years.

📖 Show Segments

• 00:05 - Introduction
• 01:48 - Patient Letter
• 04:13 - Redefining Harm Reduction
• 06:26 - Low-threshold, High-impact Intervention
• 09:30 - Translating Interventions into Clinical Outcomes
• 11:14 - Community Engagement and Overcoming Resistance
• 13:21 - Funding and Support of Care Touchpoint Programs
• 15:05 - Changing Mindsets and Moving Towards Acceptance
• 20:59 - Use of Test Strips
• 22:46 - Practice Pearls
• 23:51 - Conclusion and Additional Learning Opportunity

📋 Key Takeaways

• Every interaction matters: A single compassionate encounter can plant the seed for change, reinforcing that every person is worth the effort and the investment.
• Stigma is a barrier to treatment: Reducing stigma through peers, integrated care environments, and direct patient relationships is essential to change how clinicians and communities approach addiction.
• Low-threshold services are high-impact entry points to care: Access to showers, laundry, naloxone, HIV and hepatitis C testing, and safe spaces restores dignity, builds trust, and often serves as the first step toward recovery and ongoing engagement in healthcare.
• Recovery starts before substance use stops: Labeling someone as "not ready" puts the burden on the individual; instead, clinicians should ask, "What can I do?" Progress should be defined by making today better than yesterday, recognizing that meaningful change can begin at any touchpoint.
• Peers are essential to engagement and trust: Peer support provides a nonjudgmental connection, helping individuals feel understood and empowering them to engage in care on their own terms.
• Compassionate care drives measurable clinical outcomes: Integrated, compassionate care models improve engagement, increase hepatitis C cure rates, support HIV treatment, and reduce overall healthcare costs.
• Community buy-in is critical for success: Engaging law enforcement, local leaders, and community associations, while actively supporting community needs, turns potential opposition into a partnership.
• Syringe services and naloxone distribution save lives: These evidence-based interventions reduce infectious disease transmission and overdose risk while creating opportunities to connect individuals to broader care.
• Make test strips available: Providing tools to detect unwanted contaminants such as xylazine or medetomidine helps individuals make informed decisions and reduce harm in an ever-evolving drug supply.

🔗 Resources

• The American Society of Addiction Medicine Handbook of Addiction Medicine, Third Edition
• Charm City Care Connection Impact Report
• Integration of Buprenorphine Treatment with Primary Care: Comparative Effectiveness on Retention, Utilization, and Cost - Hsu YJ, Marsteller JA, Kachur SG, Fingerhood MI. Popul Health Manag. 2019;22(4):292-299. doi:10.1089/pop.2018.0163
• Targeting Community-Based Naloxone Distribution Using Opioid Overdose Death Rates: A Descriptive Analysis of Naloxone Rescue Kits and Opioid Overdose Deaths in Massachusetts and Rhode Island - Zang X, Macmadu A, Krieger MS, et al. Int J Drug Policy. 2021;98:103435. doi:10.1016/j.drugpo.2021.103435

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!

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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.

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts Dr. Sarah Wakeman to discuss substance use care in the emergency department, sharing highlights from ASAM's new implementation guide for hospital and emergency department (ED) substance use disorder (SUD) care. Together, they explore the gap between evidence-based addiction treatment and current hospital/ED practice, how frontline non-specialist clinicians can provide effective SUD care, practical implementation models, and how to build seamless care transitions from the ED to ongoing treatment.

----more----

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

Sarah Wakeman, MD, FASAM

Dr. Sarah Wakeman is the Senior Medical Director for Substance Use Disorder at Mass General Brigham, Director of the Mass General Brigham Program for Substance Use and Addiction Services, 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 of the American Board of Addiction Medicine and board certified in Addiction Medicine. 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 focuses on the integration of addiction care into general medical settings and opioid use disorder treatment.

📖 Show Segments

• 00:05 - Introduction
• 02:57 - The Gap in ED and Hospital Addiction Care
• 05:50 - Setting Realistic Expectations for Frontline Clinicians
• 08:19 - Critical Elements of Care for Non-specialists
• 12:07 - Implementation Systems
• 17:15 - Effective Transitions of Care
• 21:48 - Closing the Feedback Loop: Sharing Success Stories
• 24:37 - Practice Pearls
• 26:23 - Conclusion and Additional Learning Opportunity

📋 Key Takeaways

• Treat the underlying disorder, not just the acute presentation: While effective treatments for SUDs have existed for decades, many emergency departments and hospitals still don’t consistently deliver evidence-based addiction care during admission, often only treating the complications without addressing the underlying condition.
• Addiction care should be the standard, not the exception: Initiating medications (e.g., buprenorphine, methadone, naltrexone), managing withdrawal, and linking patients to care should be an expectation for all frontline clinicians.
• Consider the seven core competencies as your quality checklist for SUD care: Screening, withdrawal management, overdose response, medication initiation, co-occurring conditions, linkage to care, and risk reduction should all be addressed for every SUD patient.
• Systems change can start small and scale: Even without large resources, hospitals can enhance care through clinical pathways, order sets, education, and peer champions, making best practices easier to implement in everyday workflows. Having a peer champion can help implement these practices by normalizing the behavior, providing real-time support, and making the change feel achievable.
• Think of system change like motivational interviewing: Approaching the system and framing addiction care in terms the institution already cares about and is familiar with can help make change.
• Provide warm handoffs and follow-up: The highest-risk period is the first week post-discharge. Effective models, like Bridge Clinics and low-barrier care connections, can ensure a timely, essential transition to ongoing treatment.
• Bring success stories back to the ED: Community partners and clinicians should share success stories with ED clinicians to reinforce the impact of their interventions and motivate continued engagement.

🔗 Resources

• Implementation Guide for Hospital and Emergency Department Substance Use Disorder Care
• ASAM’s 57th Annual Conference Session: Implementing Hospital and ED SUD Care: Translating ASAM Guidance into Action

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!

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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.

EP 03 🎙 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. Elizabeth Salisbury-Afshar is joined by Drs. Ruth Potee and Ari Kriegsman to explore highlights from their session, The Right Dose, Every Day. Together, they challenge the algorithmic, punitive approaches to methadone treatment, instead promoting individualized, patient-centered care. They share their clinical and philosophical approaches to methadone treatment, including split dosing, missed-dosing protocols, and expanded take-home medications, offering practical insights to help you advocate for your patients and collaborate across care settings.

----more----

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, public health and general preventive medicine, and addiction medicine physician. Her work focuses on expanding access to evidence-based addiction treatment and harm reduction services, and she has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar is a Professor at the University of Wisconsin-Madison where she works clinically on an inpatient addiction consult team and is the Medical Director of a low-barrier walk-in clinic for people who use substances. Dr. Salisbury-Afshar is the Vice Chair of ASAM’s Medical Education Council and the Vice Chair of the Conference Program Planning Committee.

Expert

Ruth Potee, MD, DFASAM, FAAFP

Dr. Ruth Potee is a board-certified Family Physician and Addiction Medicine physician who works across Massachusetts. She attended Wellesley College, Yale University School of Medicine, and did her residency at Boston University, where she remained an assistant professor of Family Medicine for eight years. She is currently the Medical Director for Behavioral Health Network and the Franklin County House of Corrections. She oversees 10 methadone clinics, including the first county jail-based methadone clinic in the United States. She was named Franklin County Doctor of the Year by the Massachusetts Medical Society in 2015 and has won multiple teaching awards from medical students and residents.

Expert

Ari Kriegsman, MD, FASAM

Dr. Ari Kreigsman is the Medical Director of the Carlson Recovery Center, an ASAM 3.7 Level Facility in Springfield, MA. He is also the Medical Director of the BHN Springfield OTP. He is board-certified in Internal Medicine and Addiction Medicine. He is a graduate of Weill Cornell Medical College, and completed his residency in Social Internal Medicine at Montefiore/Albert Einstein College of Medicine.

📖 Show Segments

• 00:05 - Introduction
• 02:30 - Philosophy of Methadone Treatment
• 06:42 - Training Gaps & Need for Individualized Clinical Decision-Making
• 08:29 - Caring for Patients with Unique Clinical Needs
• 10:13 - Rethinking Missed Dose Protocols
• 14:58 - Split Dosing Considerations
• 17:04 - Take-Home Medications
• 22:21 - Practice Pearls
• 25:36 - Conclusion and Additional Learning Opportunity

📋 Key Takeaways

• Patients choosing methadone choose life: Orient care around the patient's own goals, which is often staying alive and getting their life back. Clinical decisions should align with the patient’s goals and be tailored to each individual.
• Promote individualized dosing over rigid protocols: Clinicians should feel empowered to use clinical judgment for methadone dosing. There is no single protocol, and each patient's history, comorbidities, pain, and life circumstances should guide the dosing plan.
• Non-punitive missed dose approaches are safe and evidence-based: In most cases, patients who miss doses and continue using opioids can safely resume their previous (or nearly previous) methadone dose. Steep dose reductions can increase the patient's risk of overdose or worsen their substance use disorder.
• Split dosing is underused and often essential: Pregnant patients, those with chronic pain, shift workers, and anyone experiencing side effects at peak dosing are strong candidates for split doses.
• Take-home medications should be the default, not the reward: No other medication requires a patient to travel daily just to receive it. Methadone take-home medication should be treated as a right unless there's a specific safety concern that outweighs the benefits.
• Break down the silos between OTPs and the broader healthcare system: All providers, including hospital and ER clinicians, should familiarize themselves with their local OTP medical directors, establish warm handoff relationships, and feel confident advocating for patients, including requesting that aggressive induction doses or split doses be continued upon transfer to an OTP.

🔗 Resources

• The Right Dose Every Time Annual Conference Session: Register HERE
• ASAM 55th Annual Conference Session: Clinicians Advocating for Methadone Reform: Community Engagement and Empowerment
• 8.12 Federal Opioid Use Disorder Treatment Standards: 42 CFR 8.12
• Association Between Increased Dispensing of Opioid Agonist Therapy Take-Home Doses and Opioid Overdose and Treatment Interruption and Discontinuation - Gomes T, Campbell TJ, Kitchen SA, et al. JAMA. 2022;327(9):846-855. doi:10.1001/jama.2022.1271
• Evaluation of a Novel Patient-Centered Methadone Restart Protocol - Christine PJ, Blum J, Tillman AR, et al. JAMA Netw Open. 2025;8(8):e2529393. Published 2025 Aug 1. doi:10.1001/jamanetworkopen.2025.29393
• Individualizing Methadone Treatment with Split Dosing: An Underutilized Tool - Braun HM, Potee RA. J Subst Use Addict Treat. 2023;152:209096. doi:10.1016/j.josat.2023.209096
• Treatment Retention, Return to Use, and Recovery Support Following COVID-19 Relaxation of Methadone Take-Home Dosing in Two Rural Opioid Treatment Programs: A Mixed Methods Analysis - Hoffman KA, Foot C, Levander XA, et al. J Subst Abuse Treat. 2022;141:108801. doi:10.1016/j.jsat.2022.108801

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!

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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.

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.

----more----

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: Register HERE

• Handouts from session:

• Yale New Haven Health System Phenobarbital Guidance
• Supplemental Content from Wolpaw et al, 2025

• 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
• Medication Matters: Selecting the Right MAUD and Optimizing Outpatient Medically Managed Withdrawal – Online Course
• Who is at Risk of Alcohol Withdrawal? Management in Ambulatory Care – Online Course
• Medications for Alcohol Use Disorder: Considerations for Patients with Comorbid Conditions – Digital Resource
• Outpatient Management of Alcohol Withdrawal – Digital Resource
• Treatment of Severe and Complicated Alcohol Withdrawal Syndrome – Digital Resource
• Alcohol Withdrawal Syndrome in the Emergency Department – Mini Video

• Hospital-wide Implementation, Clinical Outcomes, and Safety of Phenobarbital for Alcohol Withdrawal. Wolpaw BJ, Oren HO, Quinnan-Hostein et al. JAMA Netw Open. 2025;8(8):e2528694. doi:10.1001/jamanetworkopen.2025.28694 2025
• Phenobarbital for Alcohol Withdrawal Syndrome Dosing Guidelines - Yale New Haven Health; 2020. Accessed April 28, 2026. PDF
• The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management - American Society of Addiction Medicine. J Addict Med. 2020;14(3S Suppl 1):1-72. doi:10.1097/ADM.0000000000000668
• 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!

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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.

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.

----more----

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, public health and general preventive medicine, and addiction medicine physician. Her work focuses on expanding access to evidence-based addiction treatment and harm reduction services, and she has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar is a Professor at the University of Wisconsin-Madison where she works clinically on an inpatient addiction consult team and is the Medical Director of a low-barrier walk-in clinic for people who use substances. Dr. Salisbury-Afshar is the Vice Chair of ASAM’s Medical Education Council and the Vice Chair of the Conference Program Planning Committee.

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: Register HERE
• 2 in 3 physicians are using health AI-up 78% from 2023 - Henry TA. American Medical Association. February 26, 2025. Accessed April 25, 2026
• 77% of Americans Embrace AI in Behavioral Health, but Only with Transparency and Strong Safeguards - GlobeNewswire Qualifacts. February 18, 2026. Accessed April 25, 2026
• A Scoping Review of AI-Driven Digital Interventions in Mental Health Care: Mapping Applications Across Screening, Support, Monitoring, Prevention, and Clinical Education - Ni Y, Jia F. Healthcare (Basel). 2025;13(10):1205. Published 2025 May 21. doi:10.3390/healthcare13101205
• Clinician Experiences With Ambient Scribe Technology to Assist With Documentation Burden and Efficiency - Duggan MJ, Gervase J, Schoenbaum A, et al. JAMA Netw Open. 2025;8(2):e2460637. Published 2025 Feb 3. doi:10.1001/jamanetworkopen.2024.60637
• Commercial Products Using Generative Artificial Intelligence Include Ambient Scribes, Automated Documentation and Scheduling, Revenue Cycle Management, Patient Engagement and Education, and Prior Authorization Platforms - Kunze KN, Bepple J, Bedi A, Ramkumar PN, Pean CA. Arthroscopy. 2025;41(11):4950-4955. doi:10.1016/j.arthro.2025.05.021
• Ethical Considerations for Clinical Adoption of Ambient Digital Scribe Technology - Anderson TN, Mohan V, Gold JA. J Am Med Inform Assoc. 2026;33(3):770-775. doi:10.1093/jamia/ocaf227
• Ethical Obligations to Inform Patients About Use of AI Tools - Mello MM, Char D, Xu SH. JAMA. 2025;334(9):767-770. doi:10.1001/jama.2025.11417
• New Doc on the Block: Scoping Review of AI Systems Delivering Motivational Interviewing for Health Behavior Change - Karve Z, Calpey J, Machado C, Knecht M, Mejia MC. J Med Internet Res. 2025;27:e78417. Published 2025 Sep 16. doi:10.2196/78417
• Patient Attitudes Toward Ambient Artificial Intelligence Scribes in Clinical Care: Insights From a Cross-Sectional Study - Chandrasekaran R, Moustakas E. J Am Med Inform Assoc. 2026;33(2):263-272. doi:10.1093/jamia/ocaf218
• Role of the States in the Future of AI Regulation - Mello MM, Childs PB, Roberts JL. JAMA Health Forum. 2025;6(9):e255020. Published 2025 Sep 5. doi:10.1001/jamahealthforum.2025.5020
• Teen and Young Adult Perspectives on Generative AI: Patterns of Use, Excitements, and Concerns - Hopelab, Common Sense Media, Center for Digital Thriving at Harvard Graduate School of Education. Published 2024. Accessed February 2026

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!

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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.

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
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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

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.

🔗 Resources

• ASAM’s 57th Annual Conference Focus Session: High Risk at Every Stage: Cannabis Exposure During Critical Periods of Developmenthttps://elearning.asam.org/products/high-risk-at-every-stage-cannabis-exposure-during-critical-periods-of-development/?referral=APP_Ep6_4
• ASAM 2025 Review Course: Cannabis Use Disorder: Science, Trends, and Clinical Implications
• ASAM 56th Annual Conference:

• Cannabinoids and Pregnancy: ASAM Members,Patients and the Public - A Vital Discourse/Debate
• Anyone Can Treat!:Master Youth Cannabis Use Treatment for Your Practice Setting

• A Simple Guide to Pot, THC and How Much is Too Much: Ramos Barreda A, De Leon K, Urmas S. Los Angeles Times. April 20, 2018. Accessed March 24, 2026.
• Cannabis/Marijuana Use Disorder: Yale Medicine. July 24, 2024. Accessed March 30, 2026.
• Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis: Starzer MSK, Nordentoft M, Hjorthøj C. Am J Psychiatry. 2018;175(4):343-350. doi:10.1176/appi.ajp.2017.17020223
• The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research: National Academies of Sciences, Engineering, and Medicine. 2017. Washington, DC: The National Academies Press.
• Transition From Substance-Induced Psychosis to Schizophrenia Spectrum Disorder or Bipolar Disorder: Rognli EB, Heiberg IH, Jacobsen BK, Høye A, Bramness JG. Am J Psychiatry. 2023;180(6):437-444. doi:10.1176/appi.ajp.22010076
• Understanding Your Risk for Cannabis Use Disorder: Centers for Disease Control and Prevention. December 5, 2024. Accessed March 30, 2026.

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!

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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.

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.

🔗 Resources

• ASAM’s 57th Annual Conference Sessions:

• General Session: Understanding the Evolving Drug Landscape: From Epidemiology to Clinical Practice
• Focus Session: Beyond Kratom: Novel Products Containing 7-OH, Pseudo, MGM, and Kava

• Chapter 5: Kratom-related Physical Dependence and Addiction - Smith KE, Singh D, Grundmann O. In: Kratom History, Science and Therapeutic Potential. Academic Press; 2026:59-78. https://doi.org/10.1016/B978-0-443-27412-1.00005-5
• Clinically Characterizing Adults Who Use Kava or Kratom: Substance Use Disorder Assessment Challenges for Increasingly Popular Botanical Products - Hill K, Boyer EW, Smith KE. Drug Alcohol Depend Rep. 2025;17:100394. Published 2025 Nov 9. doi:10.1016/j.dadr.2025.100394
• Controversies in Assessment, Diagnosis, and Treatment of Kratom Use Disorder - Smith KE, Epstein DH, Weiss ST. Curr Psychiatry Rep. 2024 Sep;26(9):487-496. doi: 10.1007/s11920-024-01524-1. Epub 2024 Aug 13. PMID: 39134892; PMCID: PMC11344726
• The Rise of Novel, Semi-synthetic 7-hydroxymitragynine Products - Smith KE, Boyer EW, Grundmann O, McCurdy CR, Sharma A. Addiction. 2024;120(2):387-388. doi:10.1111/add.16728
• National Institute on Drug Abuse (NIDA): Kratom - Learn more about kratom, ongoing research, and additional resources.

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!

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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.

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.

----more----

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.

🔗 Resources

• ASAM’s DEI Online Education Series (FREE):

• Taking Action to Minimize Inequalities in Addiction Medicine
• Addressing Intersectionality within Addiction Medicine
• Health Disparities in Substance Use Disorder
• Setting the Stage: Racism in the History of Substance Use and Addiction

• 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.
• One Doctor’s Experience Shows the Battle for the Future of Addiction Medicine: Pattani A. NPR via Houston Public Media. January 5, 2026.

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!

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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.

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.

----more----

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
• Alcohol Use Disorder and Common Co-occurring Psychiatric Conditions
• ASAM 55th Annual Conference: Co-occurring Disorders: Integrating Prevention, Intervention and Evidence
• Screening Tools:

• PHQ-9 - Patient Health Questionnaire-9
• BAM – Brief Addiction Monitor
• C-SSRS – Columbia-Suicide Severity Rating Scale
• GAD-7 - General Anxiety Disorder-7
• NIDA’s 3-Question Screener

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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.

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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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
• Treatment of Stimulant Use Disorder Course (6 hours)
• Treatment of Stimulant Use Disorder Online Course (2 hours)
• The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder

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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.

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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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
• ASAM’s 57th Annual Conference Focus Session: Pharmacologic Innovations in Alpha-2 Agonist Withdrawal Management in EDs and ICUs
• Center for Addiction Medicine and Policy by Penn Medicine: Medetomidine -Review current information on Pennsylvania’s medetomidine withdrawal protocol.
• 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.
• Responding to Overdose and Withdrawal Involving Medetomidine - Philadelphia Department of Public Health. Division of Substance Use Prevention and Harm Reduction. June 10, 2025.
• 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.
• Emergence of Medetomidine in the Illicit Drug Supply: Implications for Emergency Care and Withdrawal Management - Lynch MJ, Pizon AF, Yealy DM. Ann Emerg Med. Published online January 22, 2026. doi:10.1016/j.annemergmed.2025.12.004
• A Powerful New Drug Is Causing a “Withdrawal Crisis” in Philadelphia - The New York Times

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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.

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):

• The Harm Reduction Approach to Caring for People Who Use Substances: Miller S, Rosenthal RN, Levy S, Saxon AJ, Tetrault JM, Wakeman SE. (Eds), The ASAM Principles of Addiction Medicine (Seventh Edition). American Society of Addiction Medicine, Inc.; 2024:1509-1529.

• A Call for Compassionate Opioid Overdose Response: Russell E, Hawk M, Neale J, Bennett AS, Davis C, Hill LG, Winograd R, Kestner L, Lieberman A, Bell A, Santamour T, Murray S, Schneider KE, Walley AY, Jones TS. Int J Drug Policy. 2024 Nov;133:104587. doi: 10.1016/j.drugpo.2024.104587. Epub 2024 Sep 18. PMID: 39299143.
• Understanding and Addressing Widening Racial Inequalities in Drug Overdose: Friedman JR, Nguemeni Tiako MJ, Hansen H. Am J Psychiatry. 2024 May 1;181(5):381-390. doi: 10.1176/appi.ajp.20230917. PMID: 38706336; PMCID: PMC11076008.
• National Syndromic Surveillance Program (NSSP): Provides expertise and technical assistance to support public health professionals.
• Safe Spot (1-800-972-0590): A toll-free, 24/7 confidential service that provides overdose safety planning and response to people using drugs alone.
• State Unintentional Drug Overdose Reporting System (SUDORS): Provides detailed information on the characteristics and circumstances of overdose deaths to inform drug overdose prevention and response efforts.

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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.

🔗 Resources

• ASAM’s Clinical Tips Microlearning Video Series: Women and Addiction

• 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

• ASAM’s Women and Addiction Education and Resources: Explore HERE

• Patient-Centered Care for Women with Substance Use Disorders – Online Course

• Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants: Substance Abuse and Mental Health Services Administration. HHS Publication No. (SMA) 18-5054. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018.
• Your Words Matter – Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder: Offers tips on how to use person-first language and which terms to avoid using to reduce stigma and negative bias when discussing addiction or substance use disorder with pregnant women and mothers.
• The ASAM Principles of Addiction Medicine (Seventh Edition):

• Substance Use During Pregnancy: Weaver MF, Jones HE, Wunsch MJ. Substance Use During Pregnancy. In Miller S, Rosenthal RN, Levy S, Saxon AJ, Tetrault JM, Wakeman SE. (Eds), The ASAM Principles of Addiction Medicine (Seventh Edition). American Society of Addiction Medicine, Inc.; 2024:1509-1529.

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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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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

• ASAM’s Clinical Tips Microlearning Video Series: Women and Addiction

• 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.
• Your Words Matter – Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder: Offers tips on how to use person-first language and which terms to avoid using to reduce stigma and negative bias when discussing addiction or substance use disorder with pregnant women and mothers.
• 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):

• Substance Use During Pregnancy: Weaver MF, Jones HE, Wunsch MJ. Substance Use During Pregnancy. In Miller S, Rosenthal RN, Levy S, Saxon AJ, Tetrault JM, Wakeman SE. (Eds), The ASAM Principles of Addiction Medicine (Seventh Edition). American Society of Addiction Medicine, Inc.; 2024:1509-1529.

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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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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.
• INROADS Issue Brief: Opioid Use Among Persons with Traumatic Brain Injury:In this brief, we will discuss the relationship between TBI, opioid use disorder, and targeted policy solutions to improve short- and long-term outcomes.
• 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.

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