ASAM Practice Pearls

By ASAM EducationMedicine Health & Fitness

ASAM Practice Pearls episodes

September 07Gambling and Sports Betting Addiction: Screening and Interventions
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 [email protected].
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!
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.
29 min
August 24GLP-1s in Addiction Medicine: An Update Since Our Last Conversation
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 [email protected].
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!
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.
34 min
August 10Addiction Care in Custody: Trust, Treatment, and Advocacy
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 [email protected].
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!
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.
31 min
July 27Polysubstance Intoxication: Managing the Unknown
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 [email protected].
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!
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.
29 min
July 13Individualizing Buprenorphine: Low-dose Induction to Long-acting Injectables
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.
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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 [email protected].
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
Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!
In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
27 min
June 29Enhancing Addiction Care Through Care Touchpoints
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
Have an idea for a future episode? Share it with us at [email protected].
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!
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.
26 min
June 15Implementing Substance Use Care Across Care Settings: ED to Ongoing Care
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.
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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 [email protected].
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!
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.
28 min
June 01Methadone: 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.
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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 [email protected].
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!
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.
27 min
May 18Advanced 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.
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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 [email protected].
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!
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.
27 min
May 04Artificial 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.
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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 [email protected].
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
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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.
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