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ASAM Practice Pearls: Daily Summaries Delivered
by ASAM Education
Join ASAM Practice Pearls for in-depth discussions on addiction prevention, treatment, and recovery. Geared toward healthcare professionals and individuals seeking knowledge, this series explores the latest evidence-based approaches to addiction medicine. Listen to interviews with leading experts as they delve into critical topics and share practical tools you can use to improve patient care and promote public health.
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- 4 days ago26 min
Methadone: The Right Dose, Every Day
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 wor
- 2 weeks ago26 min
Advanced Management of Alcohol Withdrawal
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: Benzodiazep
- May 4, 202633 min
Artificial Intelligence and the Future of Addiction Medicine
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, preventive medicine/public health, and addiction medicine physician. Dr. Salisbury-Afshar's work focuses on expanding access to evidence-based addiction treatment and harm reduction services. She has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar lectures nationally on addiction medicine topics, including the treatment of opioid use disorder, harm reduction, the intersection of addiction and the criminal legal system, and public health approaches to reduce overdose mortality. Expert Sara Polley, MD, FAPA, FASAM Dr. Polley is a triple board-certified psychiatrist in adult, child, and adolescent psychiatry and addiction medicine. She provides integrated psychiatric care for youth and families at Vantage Mental Health, a nonprofit clinic serving both Minnesota and Wisconsin. In addition to her clinical work, Dr. Polley is a national consultant, speaker, and educator with the University of Minnesota Medical School. She serves on Minnesota’s Cannabis Advisory Council and holds committee appointments with the American Society of Addiction Medicine (ASAM) and the American Association of Child and Adolescent Psychiatry (AACAP). Dr. Polley is a passionate advocate for outpatient trauma-informed, developmentally appropriate, and family-centered co-occurring care, drawing on both her clinical experience and personal story as the child of a parent lost to addiction. Expert Daniel Kaufmann, PhD, LPC, LMHC Dr. Kaufmann is an Associate Professor at Grand Canyon University as well as the Director of Gaming Services at Kindbridge Behavioral Health. He is the author of The Gamer’s Journey (2024), a book focused on explaining the presence of video games in society as a form of mythological storytelling and how these characters and settings can be used therapeutically for every gamer to complete each phase of the hero’s journey in their own lives. Dr. Kaufmann is currently serving as the co-chair of the APA research task force on video game issues and is working on several nationwide training programs to help mental health professionals understand video games in innovative ways. Dr. Kaufmann's publications cover the areas of video games, personality theory, online education, and counselor development. He offers supervision to an international list of clinicians to help bridge the gap in learning about technological impact on society and specific insights related to effective treatment for clients experiencing games-related issues. 📖 Show Segments 00:05 - Introduction 01:19 - Expert Introduction and Initial Start with AI 04:40 - The Landscape of AI in Addiction Care 06:41 - AI Assists Clinicians Might Not Realize They Are Using 08:13 - AI for Search Tools and Scribes 09:29 - Informed Consent for AI Tools 14:02 - Patient's Reception of AI in Care Conversations 15:41 - AI for Progress Notes and Documentation 19:49 - AI for Patient Advocacy Letters 22:04 - Guidance for Adopting AI Tools 25:35 - Advice for Early-Career Health Care Providers 26:21 - Approaching AI with Curiosity 29:00 - Words of Advice 32:50 - Conclusion and Additional Lea
- Apr 20, 202634 min
Navigating Cannabis and Cannabinoid Use in Today’s Clinical Practice
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. ----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 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
- Apr 6, 202634 min
Kratom and 7-OH: What Clinicians Need to Know
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. ----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 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, po
- Mar 23, 202626 min
Social Determinants of Health: Making an Impact in Addiction Care
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 b
- Mar 9, 202627 min
Optimizing Treatment for Co-occurring Psychiatric and Substance Use Disorders
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 - Consi
- Feb 23, 202624 min
Contingency Management: The Nuts and Bolts of Implementation
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. ----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 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.
About ASAM Practice Pearls
Join ASAM Practice Pearls for in-depth discussions on addiction prevention, treatment, and recovery. Geared toward healthcare professionals and individuals seeking knowledge, this series explores the latest evidence-based approaches to addiction medicine. Listen to interviews with leading experts as they delve into critical topics and share practical tools you can use to improve patient care and promote public health.
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