ASAM Practice Pearls

By ASAM EducationMedicine Health & Fitness

ASAM Practice Pearls episodes

April 20Navigating 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.
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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
Takeo Toyoshima, MD
Dr. Takeo Toyoshima is the interim program director for the UCSF Addiction Psychiatry Fellowship. He completed medical school at UCLA, then psychiatry residency, addiction psychiatry fellowship, and forensic psychiatry fellowship at UCSF. His main clinical duties are at the San Francisco VA Health Care System, both in the Addiction Recovery Treatment Services' outpatient and intensive outpatient programs and in the Veterans Justice Outreach Clinic, which treats patients who are criminal justice-involved. In these settings, Dr. Toyoshima supervises UCSF medical students, psychiatry residents, addiction psychiatry fellows, and forensic psychiatry fellows, in addition to other allied health profession trainees. He concurrently serves as the VA site director for the UCSF Psychiatry and the Law Program. Outside of UCSF, Dr. Toyoshima also works in clinical and forensic private practice and serves in various roles in organized medicine (American Psychiatric Association, Northern California Psychiatric Society, California Society of Addiction Medicine, American Academy of Addiction Psychiatry, etc.). His clinical interests are in the intersection of psychiatry, addiction, and forensic matters.
📖 Show Segments
00:05 - Introduction
01:13 - How to Approach the Conversation with Patients 
03:51 - Clarifying Terms and Product Use with Patients
05:52 - Legal and Regional Differences
08:45 - Addressing Patient’s Perceived Pros and Cons of Cannabis
11:19 - Assessing for Cannabis Use Disorder
13:53 - What if a Patient Doesn’t Want to Stop?
15:49 - Approaching Drug Testing with Patients
17:43 - Recommended Treatment Options
20:02  - Cannabis Withdrawal Symptoms
22:08 - Considerations for Adolescents
23:21 - The Risk of Psychosis
24:46 - Harm Reduction
27:22 - Signs of Cannabis Toxicity
31:46 - Key Takeaways
33:20 - Conclusion and Additional Learning Opportunity 
📋 Key Takeaways
Cannabis addiction is real and common: Around 10% of people who start using become addicted, and around 30% of current users meet criteria for cannabis use disorder (CUD).
Ask about products, routes, and potency: Flower, concentrates, edibles, and vapes carry very different risk profiles. Higher potency can lead to faster tolerance and withdrawal.
Work collaboratively with your patients: Let patients educate you about their use, be curious, and use motivational interviewing techniques in conversation.
Use the three Cs to assess CUD: Screen for issues with Control, Consequences, and Cravings, then map findings to the DSM-5 criteria together with the patient.
Recognize cannabis withdrawal: Withdrawal symptoms affect 20–50% of daily users and can include both psychiatric and physical symptoms, such as appetite changes, nausea and vomiting, mild tremors, temperature dysregulation, irritability, anxiety, and mood changes. Sometimes, what patients attribute to anxiety or poor appetite may actually be withdrawal.
Psychosis is a serious risk: Studies show around a 40% conversion to a schizophrenia diagnosis after a cannabis-induced psychotic episode, especially with high-potency products.
No FDA-approved medications exist: Gabapentin and N-Acetylcysteine (NAC) are off-label pharmacotherapy options that show evidence for treating CUD, but treating co-occurring psychiatric disorders is equally important.
Harm reduction is a valid goal: Reducing potency, spacing out use, switching routes, and building in breaks are practical steps when a patient isn't ready for abstinence.
Keep patients coming back: The therapeutic relationship is the most powerful tool, so focus on patient goals and follow-up.
Know your legal landscape and testing limitations: Laws vary by state. Standard urine screens will not detect synthetic cannabinoids, and THC metabolites can persist for weeks.
🔗 Resources
ASAM’s 57th Annual Conference Focus Session: High Risk at Every Stage: Cannabis Exposure During Critical Periods of Development  
ASAM 2025 Review Course: Cannabis Use Disorder: Science, Trends, and Clinical Implications
ASAM 56th Annual Conference:
Cannabinoids and Pregnancy: ASAM Members, Patients and the Public - A Vital Discourse/Debate
Anyone Can Treat!: Master Youth Cannabis Use Treatment for Your Practice Setting
A Simple Guide to Pot, THC and How Much is Too Much: Ramos Barreda A, De Leon K, Urmas S. Los Angeles Times. April 20, 2018. Accessed March 24, 2026.
Cannabis/Marijuana Use Disorder: Yale Medicine. July 24, 2024. Accessed March 30, 2026.
Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis: Starzer MSK, Nordentoft M, Hjorthøj C. Am J Psychiatry. 2018;175(4):343-350. doi:10.1176/appi.ajp.2017.17020223
The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research: National Academies of Sciences, Engineering, and Medicine. 2017. Washington, DC: The National Academies Press.
Transition From Substance-Induced Psychosis to Schizophrenia Spectrum Disorder or Bipolar Disorder: Rognli EB, Heiberg IH, Jacobsen BK, Høye A, Bramness JG. Am J Psychiatry. 2023;180(6):437-444. doi:10.1176/appi.ajp.22010076
Understanding Your Risk for Cannabis Use Disorder: Centers for Disease Control and Prevention. December 5, 2024. Accessed March 30, 2026.
📢 Join the Discussion
Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!
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.
35 min
April 06Kratom 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.
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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
Kirsten Smith, PhD, LMSW  
Dr. Kirsten Smith is a leading expert on kratom, with over 90 peer-reviewed publications on kratom and related topics like kava and tianeptine. From 2023-2025, she was an Assistant Professor at Johns Hopkins University School of Medicine’s Department of Psychiatry. She joined Hopkins after earning her Master’s from the University of Kentucky, PhD from the University of Louisville, and completing a 4-year postdoctoral fellowship at the National Institute on Drug Abuse Intramural Research Program (NIDA IRP). At NIDA IRP, she completed her K99-funded project that involved a national ecological momentary assessment of daily kratom use and a controlled drug administration sub-study that investigated the acute effects of commercial kratom products. Her R00-funded study at Johns Hopkins examined kratom pharmacokinetics/pharmacodynamics of kratom and assessed spontaneous kratom withdrawal among chronic consumers. She also received an R01 to study the safety, tolerability, and abuse potential of kratom in healthy adults, which is ongoing. She has conducted surveys and qualitative research on kratom and 7-hydroxymitragynine (7-OH). Dr. Smith is currently transitioning from academia to clinical practice but consults on kratom regularly and welcomes opportunities for collaboration.
Disclosure: There are no relevant financial relationships.
Expert
Katherine Hill, MPH  
Katherine (Katie) Hill is a PhD candidate in Epidemiology of Microbial Diseases at Yale School of Public Health. Her research interests include substance use and harm reduction. Her doctoral research employs mixed methods to evaluate the impact of emerging substances, such as xylazine and kratom, on people who use drugs.
Disclosure: There are no relevant financial relationships.
📖 Show Segments
00:05 - Introduction
01:49 - Defining Kratom 
04:42 - Consumers of Kratom
05:48 - Is Kratom an Opioid
07:29 - Differences Between Kratom and 7-OH
11:39 - Addiction Potential
16:50 - Toxicity, Acute Intoxication, and Toxidrome
18:55 - 7-OH Withdrawal and Overdose
24:16 -  Patient History and Assessment
26:25 - Practice Pearls for Clinicians
30:48 - Patient Motivations and Harm Reduction
33:03 - Conclusion and Additional Learning Opportunity 
📋 Key Takeaways
“Kratom” is often used as a broad term for kratom-derived products: Kratom can refer to powdered leaves, capsules, teas, concentrated extracts, or semi-synthetic 7-OH products, many of which may also contain caffeine, kava, CBD, or other additives. When a patient says they use "kratom," it provides little clinical clarity. Clinicians need to ask which product, form, and brand the patient is using to better understand their usage patterns.
Understand the product your patient is using: Product composition, potency, and co-ingredients of kratom are variable. Clinicians need to gather information on formulation, dosing, frequency, route, motivations, and co-use to gain a clear history. Self-report gives far more insight than current toxicology assays.
Kratom’s pharmacology is complex: Kratom can produce pain relief via the serotonin and opioid system. Effects from kratom also include increases in energy and mood elevation. Some kratom alkaloids and metabolites have atypical mu-opioid receptor activity as well as non-opioid activity, making kratom’s pharmacology complex. Kratom can lead to physical dependence symptoms when consumed regularly.
7-OH is different from natural kratom: 7-hydroxymitragynine is found only in trace amounts in kratom leaves, but exists in much higher levels in commercial semi-synthetic products. These formulations behave differently and have low bioavailability, making their clinical effects distinct.
Mild to moderate dependence and withdrawal are possible: Daily, repeated kratom use commonly leads to tolerance and withdrawal symptoms such as restlessness, irritability, fatigue, and cravings. Severe withdrawal appears uncommon in current data, though more evidence is needed, especially for 7-OH products.
People can develop a kratom use disorder: About 25% of people using kratom meet criteria for kratom use disorder based on modified DSM-5 Criteria, though most presentations appear to be mild to moderate.
Standard drug testing has limitations: Urine assays detect mitragynine, but a positive result can't distinguish between kratom leaf products and 7-OH products containing residual mitragynine. 7-OH is unstable in blood and rapidly metabolized, making detection challenging. Rely on self-report and consider asking patients to bring in their products for better clarity.
Understand motivations for use: Many people who use kratom and 7-OH are not seeking intoxication. They're trying to manage pain or mood, function at work, self-treat withdrawal, etc. Treatment planning should account for these functional goals and incorporate motivational interviewing and shared decision-making.
Help is needed to move the field forward: Researchers are behind front-line clinicians in understanding these substances. There is still a lot that is unknown about kratom and kratom-derived products. Clinicians are encouraged to publish case reports, develop internal protocols, describe withdrawal symptoms, and refine assessments to better guide emerging best practices.
🔗 Resources
ASAM’s 57th Annual Conference Sessions:
General Session: Understanding the Evolving Drug Landscape: From Epidemiology to Clinical Practice
Focus Session: Beyond Kratom: Novel Products Containing 7-OH, Pseudo, MGM, and Kava
Chapter 5: Kratom-related Physical Dependence and Addiction - Smith KE, Singh D, Grundmann O. In: Kratom History, Science and Therapeutic Potential. Academic Press; 2026:59-78. https://doi.org/10.1016/B978-0-443-27412-1.00005-5 
Clinically Characterizing Adults Who Use Kava or Kratom: Substance Use Disorder Assessment Challenges for Increasingly Popular Botanical Products - Hill K, Boyer EW, Smith KE. Drug Alcohol Depend Rep. 2025;17:100394. Published 2025 Nov 9. doi:10.1016/j.dadr.2025.100394
Controversies in Assessment, Diagnosis, and Treatment of Kratom Use Disorder - Smith KE, Epstein DH, Weiss ST. Curr Psychiatry Rep. 2024 Sep;26(9):487-496. doi: 10.1007/s11920-024-01524-1. Epub 2024 Aug 13. PMID: 39134892; PMCID: PMC11344726
The Rise of Novel, Semi-synthetic 7-hydroxymitragynine Products - Smith KE, Boyer EW, Grundmann O, McCurdy CR, Sharma A. Addiction. 2024;120(2):387-388. doi:10.1111/add.16728
National Institute on Drug Abuse (NIDA): Kratom - Learn more about kratom, ongoing research, and additional resources.
📢 Join the Discussion
Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!
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.
35 min
March 23Social 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.
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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
Sharon Stancliff, MD  
Dr. Stancliff is Associate Medical Director for Harm Reduction in Health Care at the AIDS Institute, NYSDOH and sees patients at a shelter in New York City. Dr. Stancliff has been working with people who use drugs since 1990, including the provision of primary care, drug treatment, HIV care, and syringe access. She is currently focused on opioid overdose prevention through expanding access to naloxone and expanding access to buprenorphine in primary care and in less traditional settings, such as syringe exchange programs. Dr. Stancliff graduated from the School of Medicine at the University of California at Davis, did her Family Practice residency at the University of Arizona, and completed the AIDS Institute-sponsored Nicolas Rango HIV Clinical Scholars Program at Beth Israel Medical Center in New York City. She is board-certified in Family Medicine and in Addiction Medicine. She served on the Public Policy Committee of ASAM.
📖 Show Segments
00:05 - Introduction
02:29 - The Role of SDoH in Addiction 
06:00 - Prioritizing Competing Social Needs
08:57 - The Clinician’s Role in Addressing SDoH
12:11 - Making Your Voice Heard
14:09 - The Impact of Race on Addiction Treatment
16:38 - Tailoring Treatment to Social Context
19:31 - Navigating Social Networks and Environmental Challenges
22:30 - Key Takeaways
24:50 - Conclusion and Additional Learning Opportunity 
📋 Key Takeaways
View addiction through a biopsychosocial lens: Addiction involves complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. It doesn’t develop solely from biological factors, making it essential to address SDoH during treatment.
Prioritize patients’ social needs: Housing instability, poverty, transportation access, food insecurity, and other environmental factors significantly impact a patient’s ability to engage in treatment and are often overlooked.
Focus on safety, stability, and patient goals: Abstinence-only approaches are outdated. Treatment should prioritize whether patients are safer, more stable, and more engaged in care, even if they're still using substances. Focusing on harm reduction and incremental progress promotes patient-centered care and improves engagement.
Engage patients in the community and provide low-threshold care: Meet patients where they are, shelters, streets, and needle exchanges, to better understand their challenges and build trust with populations that might fear traditional healthcare settings. Offering low-threshold community care rather than requiring clinic visits reduces barriers to access and further supports relationship-building.
Tailor treatment to social realities: Adjust prescription lengths, visit frequency, and monitoring based on each patient’s circumstances (e.g., shorter prescriptions if someone can't safely store medications in a shelter, longer prescriptions to reduce transportation barriers).
Recognize how race and criminalization shape treatment access: The war on drugs disproportionately harms people of color, creating cycles of incarceration, overdose risk, and barriers to housing and employment.
Address loneliness and isolation: Many patients on buprenorphine often lack social support. Helping them identify healthy networks and community spaces can reduce loneliness and support recovery.
Advocate for system-level change: Clinicians should make their voices heard by engaging with legislators, health departments, and professional organizations like ASAM to help shape policies that support low-threshold, flexible, and equitable addiction treatment options.
🔗 Resources
ASAM’s DEI Online Education Series (FREE):  
Taking Action to Minimize Inequalities in Addiction Medicine
Addressing Intersectionality within Addiction Medicine  
Health Disparities in Substance Use Disorder 
Setting the Stage: Racism in the History of Substance Use and Addiction 
Advancing Racial Justice and Health Equity In the Context of Addiction Medicine: ASAM’s public statement to recognize, understand, and counteract the adverse effects of America’s historical, pervasive, and continuing systemic racism, specifically with respect to addiction prevention, early intervention, diagnosis, treatment, and recovery.
Structural Competency Working Group: An organization founded in the San Francisco Bay Area in 2014 that develops and shares curricula, workshops, and resources to help healthcare professionals recognize and address the social and structural determinants of health.
Structural Competency: provides training materials and resources designed to help healthcare professionals understand and address the social, political, and economic structures that shape health disparities, supporting the broader mission of the Structural Competency Working Group.
One Doctor’s Experience Shows the Battle for the Future of Addiction Medicine: Pattani A. NPR via Houston Public Media. January 5, 2026.
📢 Join the Discussion
Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!
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
March 09Optimizing 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.
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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
Smita Das, MD, PhD, MPH  
Dr. Smita Das is board-certified in psychiatry, addiction psychiatry, and addiction medicine. She studied chemistry and statistics at Stanford University, earned her Master’s in Public Health at Dartmouth College, and completed her MD/PhD in Community Health at the University of Illinois at Urbana-Champaign. Dr. Das completed her psychiatry residency and served as chief resident at Stanford, followed by an addiction psychiatry fellowship at UCSF. She has over two decades of research experience in healthcare quality and addiction. Dr. Das is a former chair of the APA Council on Addiction Psychiatry, a past president of an APA District Branch, and a member of the APA Advisory Council for Workplace Mental Health. She previously served as Director of Addiction Treatment Services at the Palo Alto VA and as Vice President of Psychiatry at Lyra Health. Currently, Dr. Das practices in addictions at Stanford School of Medicine as a Clinical Associate Professor.
📖 Show Segments
00:05 - Introduction
03:58 - Common Co-occurring Psychiatric Conditions 
05:37 - Prevalence and Substance-Specific Co-occurrences
08:35 - Distinguishing Primary vs Substance-Induced Symptoms
11:33 - Screening Tools and Measurement-Based Care
14:25 - Pharmacological Management Challenges
18:11 - Breaking Through Treatment Barriers
21:46 - Special Populations: Adolescents, Older Adults, and Peripartum Patients
25:12 - Key Takeaways
26:45 - Conclusion and Additional Learning Opportunity 
📋 Key Takeaways
Co-occurrence is the rule, not the exception - Approximately half of people with substance use disorders also have another mental health condition, making integrated treatment essential.
Screen for both conditions routinely - Use validated screening tools, such as PHQ-9 for depression, GAD-7 for anxiety, NIDA screeners for substance use, and the Columbia scale for suicidality to identify co-occurring conditions early.
Treat both conditions together - Research consistently shows that integrated, concurrent treatment of psychiatric and substance use disorders leads to better outcomes.
Take a thorough history - Understanding the relationship between psychiatric symptoms and substance use is important for proper diagnosis and treatment planning.
Know the most common co-occurring conditions - Depression, generalized anxiety disorder, ADHD, psychotic disorders, and trauma-related disorders such as PTSD are the most common co-occurring psychiatric conditions with SUDs. There are also specific substance-disorder pairings to be aware of, such as alcohol and depression, opioids and chronic pain/PTSD/depression, stimulants and bipolar/psychosis, benzodiazepines and anxiety, and cannabis and psychosis.
Be aware of medication challenges - Consider drug interactions, such as benzodiazepines and opioids, symptom overlap like withdrawal mimicking psychiatric symptoms, misuse and diversion risks, and the proper timing of pharmacological interventions.
Address systemic barriers - Break down silos between addiction and psychiatric care through better communication, education, advocacy for parity, and coordinated treatment approaches.
Tailor care for populations with unique clinical needs - Adolescents, older adults, and peripartum patients need age-appropriate screening and treatment strategies that address their unique presentations and challenges.
🔗 Resources
ASAM 2025 Review Course: Psychiatric Co-morbidities: Complexities of Diagnosis and Care
Alcohol Use Disorder and Common Co-occurring Psychiatric Conditions
ASAM 55th Annual Conference: Co-occurring Disorders: Integrating Prevention, Intervention and Evidence
Screening Tools: 
PHQ-9  - Patient Health Questionnaire-9
BAM – Brief Addiction Monitor 
C-SSRS – Columbia-Suicide Severity Rating Scale 
GAD-7 - General Anxiety Disorder-7
NIDA’s 3-Question Screener 
📢 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
February 23Contingency 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.
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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
Brian Hurley, MD, MBA, DFASAM  
Dr. Brian Hurley is an addiction physician and the Medical Director of the Bureau of Substance Abuse Prevention and Control in the Los Angeles County Department of Public Health. He currently serves as Immediate Past President of the ASAM Board of Directors. He has served on a variety of committees and councils at ASAM, including originating ASAM's Motivational Interviewing course and co-authoring the ASAM and AAAP National Practice Guideline on the Treatment of Stimulant Use Disorder. Dr. Hurley has led and facilitated projects funded through competitive grants from the U.S. Substance Abuse and Mental Health Services Administration, the U.S. Centers for Disease Control and Prevention, and the California Department of Health Care Services’ Opioid Response Programming in partnership with The Center at Sierra Health Foundation. These projects support harm reduction services and increase the availability of addiction medications in public sector programs across Los Angeles County.
📖 Show Segments
00:05 - Introduction
02:44 - Evidence and Effectiveness 
04:45 - Use in Treating Substance Use Disorders
07:38 - How Contingency Management Works in Practice
08:54 - Integrating With Other Treatments
11:49 - Barriers: Payment, Medicaid, and State Differences
15:29 - Organizational Readiness and Staff Buy-In
18:49 - Digital Therapeutics and Virtual Delivery
20:37 - Addressing Misconceptions
21:31 - Importance of Objectivity and Role Separation
23:35 - Conclusion and Additional Learning Opportunity 
📋 Key Takeaways
Implement Incentive-Based Treatment: Research shows that providing incentives for objective behaviors, like abstinence, medication adherence, or even attendance, significantly improves treatment outcomes and drives positive behavior change in patients with use disorders.
Utilize Contingency Management for Use Disorders: Contingency management can benefit those with stimulant, cannabis, tobacco, alcohol, and opioid use disorders.
Set Clear Criteria and Immediate Rewards: Success depends on clear criteria, prompt incentives, and consistent application.
Integrate with Comprehensive Care: Contingency management works well alongside counseling, medication, and comprehensive care programs.
Secure Sustainable Funding and Coverage: Sustainable payment models and organizational buy-in are essential for widespread adoption.
Utilize Digital and Virtual Tools: Virtual delivery is effective, especially when paired with ongoing engagement in treatment programs.
Assign Dedicated Incentive Administrators: The person delivering incentives should not be the patient’s primary counselor or physician to maintain fairness and consistency.
Structure Programs for Lasting Change: Plan for contingency management interventions to last several months, focusing on building sustainable, long-term behavior change. Contingency management is not a lifelong intervention.
🔗 Resources
Contingency Management: Overcoming Implementation Barriers to Bring Science to Practice
Treatment of Stimulant Use Disorder Course (6 hours)
Treatment of Stimulant Use Disorder Online Course (2 hours)
The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder
📢 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.
25 min
February 09Understanding Medetomidine: Emerging Challenges for Addiction Medicine
In the Season 2 premiere of ASAM Practice Pearls, Drs. Stephen Taylor and Jeanmarie Perrone follow up on Season 1’s episode, Emerging Illicit Substances: What Clinicians Need to Know. Together, they discuss how medetomidine has continued to spread to different regions and what has changed over the past year. They explore strategies for managing medetomidine withdrawal, keeping patients safe, and preparing for this growing public health threat. 
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Looking for this episode's transcript? Download it HERE
Get credit for listening! Claim your 0.5 CEs HERE
Have an idea for a future episode? Share it with us at [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
Jeanmarie Perrone, MD, FASAM, FACMT  
Dr. Jeanmarie Perrone is a Professor in the Department of Emergency Medicine and the founding Director of the Center for Addiction Medicine and Policy at the University of Pennsylvania. Dr. Perrone leads programs for the treatment of Opioid and Alcohol Use Disorders from the emergency department and via a virtual telehealth bridge clinic (CareConnect). Her work has been funded by city health departments and by NIDA, PCORI, CDC, and SAMHSA. She has advocated at the state and national level and contributed to working groups to enhance low-barrier treatment access for substance use disorders and improving toxicosurveillance. She has been recognized with awards for leadership, education, and mentorship.
📖 Show Segments
00:05 - Season 2 Introduction
01:03 - New Drug Crisis: Medetomidine 
02:34 - Pharmacology and Withdrawal Symptoms
05:58 - Clinical Management and Patient Care
08:22 - Public Health and Harm Reduction
11:56 - Regional Impact and Future Concerns
15:21 - Key Takeaways and Action Items
19:26 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Recognize the symptoms: Medetomidine withdrawal presents with refractory vomiting and tremors and is complicated by severe hypertension and tachycardia, within 2 hours of last use.
Treat aggressively with clonidine, an alpha-2 adrenergic agonist, and olanzapine: Use high doses of clonidine (0.2-0.4 mg, as often as every 2 hours) combined with alpha-2 adrenergic agonists for concurrent opioid withdrawal, and olanzapine to help control nausea and vomiting to prevent escalation to the ICU.
Use dexmedetomidine for severe cases: Approximately one-third (or more) of patients require dexmedetomidine infusion in the ED or ICU to manage symptoms. Coordinate early with critical care if symptoms worsen despite initial treatment.
Distinguish from alcohol or benzodiazepine withdrawal: If a patient presents with what looks like alcohol or benzodiazepine withdrawal but doesn't respond to benzodiazepines or barbiturates, consider adding dexmedetomidine. If the patient responds to the dexmedetomidine, medetomidine withdrawal should be considered.
Update naloxone education: Teach patients and bystanders that the goal for naloxone is improved respiratory effort, not wakefulness. Medetomidine may keep the person sedated even after successful opioid reversal.
Provide medetomidine test strips: In areas with lower medetomidine prevalence, test strips can help patients identify and avoid adulterated supplies.
Monitor the local drug supply: Connect with drug-checking programs in your area to learn which adulterants are present and at what prevalence.
Report suspected cases to your local health department: Help track the spread of medetomidine by reporting suspected cases. Public health surveillance is essential.
🔗 Resources
Medetomidine: Rising Adulterant in the Illicit Drug Supply - Download HERE
ASAM’s 57th Annual Conference Focus Session: Pharmacologic Innovations in Alpha-2 Agonist Withdrawal Management in EDs and ICUs
Center for Addiction Medicine and Policy by Penn Medicine: Medetomidine -Review current information on Pennsylvania’s medetomidine withdrawal protocol.
Substance Use Philly: Medetomidine - Review current information from the city of Philadelphia on medetomidine, including its effects, treatment, and harm reduction recommendations, and available resources for community members, non-medical organizations, and healthcare providers.
Responding to Overdose and Withdrawal Involving Medetomidine - Philadelphia Department of Public Health. Division of Substance Use Prevention and Harm Reduction. June 10, 2025.
Medetomidine Palm Card - Department of Public Health, City of Philadelphia -
An informational card on medetomidine withdrawal that can be used for patient education and guidance to healthcare providers on managing medetomidine withdrawal.
Emergence of Medetomidine in the Illicit Drug Supply: Implications for Emergency Care and Withdrawal Management - Lynch MJ, Pizon AF, Yealy DM. Ann Emerg Med. Published online January 22, 2026. doi:10.1016/j.annemergmed.2025.12.004
A Powerful New Drug Is Causing a “Withdrawal Crisis” in Philadelphia - The New York Times
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In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
21 min
August 31, 2025Overdose Awareness: Preventing, Responding, and Intervening
In recognition of International Overdose Awareness Day, the Season 1 finale of ASAM Practice Pearls explores recent trends in overdoses. Drs. Stephen Taylor and Alexander Walley discuss the increase of fentanyl and other contaminants in the drug supply, the impact of racial and geographic disparities, and the importance of community-specific responses. They highlight the value of compassionate overdose care, data-driven interventions, and strategies to help individuals post-overdose. Together, they discuss the need to lower barriers to treatment and foster future leaders in addiction medicine.
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Looking for this episode's transcript? Download it HERE
We want to hear from you! Please take our short, five-minute survey HERE
or email us at [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
Alexander Y. Walley, MD, MSc, DFASAM 
Dr. Alexander Y. Walley is Professor of Medicine at Boston University Chobanian & Avedisian School of Medicine, primary care physician and addiction specialist at Boston Medical Center focused on the medical complications of substance use, specifically HIV and overdose. He leads research studies on overdose prevention and the integration of addiction specialty care and general medical care. He is a founder of Boston Medical Center’s inpatient addiction consult service and walk-in substance use care bridge clinic. Dr. Walley was a founding director of the Grayken Addiction Medicine Fellowship and is the president of the American College of Academic Addiction Medicine. He serves as the medical director for the Massachusetts Department of Public Health’s Bureau of Substance Addiction Services, the Overdose Prevention Program, and the SafeSpot Overdose Prevention Hotline.
📖 Show Segments
00:05 - Introduction
00:17 - Epidemiology and Geographical Areas of Concern
07:15 - Racial, Geographic, and Socioeconomic Disparities
08:58 - Contaminants in the Drug Supply Affect Overdose Response
13:03 - Engaging Patients with Post-Overdose Care
18:18 - Approaching Conversations About Overdose Risk
23:42 - Tools for Overdose Prevention
26:19 - Policy, Protocols, and Treatment Innovationsr
30:41 - Training the Next Generation
33:23 - Final Thoughts on the Overdose Crisis
34:05 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Understand the Evolving Nature of the Opioid Epidemic: The overdose crisis has progressed through distinct waves, from prescription opioids, to heroin, to fentanyl, and now to increasingly complex combinations with stimulants and synthetic substances.
Address Racial, Ethnic, and Geographic Disparities: Marginalized populations and rural communities often face greater risk and reduced access to prevention, harm reduction, and treatment resources, requiring intentional, equity-focused interventions.
Respond to Emerging Drug Supply Contaminants: The presence of non-opioid substances like xylazine complicates overdose response, as naloxone may not reverse all effects, requiring expanded training and protocols for responders.
Promote Compassionate Overdose Response: In the event of an overdose, the priority is to restore breathing quickly and safely. Use only the amount of naloxone necessary and offer supportive, nonjudgmental care throughout the recovery process.
Encourage Practical Overdose Prevention Strategies: Most fatal overdoses occur when people use alone. Help patients develop practical safety plans, such as not using alone, developing safety plans, using drug checking tools, and maintaining access to naloxone to reduce overdose risk.
Leverage Real-Time Data for Community Action: Tools like OD Map and CDC dashboards provide real-time insights that can help inform timely, targeted community responses to emerging overdose patterns.
Lower Barriers to Evidence-Based Treatment: Expanding access to care through same-day treatment, low-barrier programs, and integrated support services, such as housing, education, and employment, helps improve outcomes and reduce overdose deaths.
Remove Barriers to Treatment and Support Systems: Expanding access to care, integrating social supports, and investing in workforce development, including training future addiction medicine leaders, are important for sustainable progress.
🔗 Resources
The ASAM Principles of Addiction Medicine (Seventh Edition):
The Harm Reduction Approach to Caring for People Who Use Substances: Miller S, Rosenthal RN, Levy S, Saxon AJ, Tetrault JM, Wakeman SE. (Eds), The ASAM Principles of Addiction Medicine (Seventh Edition). American Society of Addiction Medicine, Inc.; 2024:1509-1529.
A Call for Compassionate Opioid Overdose Response: Russell E, Hawk M, Neale J, Bennett AS, Davis C, Hill LG, Winograd R, Kestner L, Lieberman A, Bell A, Santamour T, Murray S, Schneider KE, Walley AY, Jones TS. Int J Drug Policy. 2024 Nov;133:104587. doi: 10.1016/j.drugpo.2024.104587. Epub 2024 Sep 18. PMID: 39299143.
Understanding and Addressing Widening Racial Inequalities in Drug Overdose: Friedman JR, Nguemeni Tiako MJ, Hansen H. Am J Psychiatry. 2024 May 1;181(5):381-390. doi: 10.1176/appi.ajp.20230917. PMID: 38706336; PMCID: PMC11076008.
National Syndromic Surveillance Program (NSSP): Provides expertise and technical assistance to support public health professionals.
Safe Spot (1-800-972-0590): A toll-free, 24/7 confidential service that provides overdose safety planning and response to people using drugs alone.
State Unintentional Drug Overdose Reporting System (SUDORS): Provides detailed information on the characteristics and circumstances of overdose deaths to inform drug overdose prevention and response efforts.
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36 min
August 18, 2025Perinatal Substance Use Care: Listening, Trust, and Treatment
In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Cara Poland explore the unique challenges of perinatal substance use care. They discuss the impact of stigma, the importance of compassionate care, and the use of medications for addiction treatment in pregnancy. Additionally, they address polysubstance use, physiological changes during pregnancy, and the critical postpartum period, sharing insights from their clinical experience and emphasizing a patient-centered, non-judgmental approach to improve treatment outcomes for mothers.
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Looking for this episode's transcript? Download it HERE
We want to hear from you! Please take our short, five-minute survey HERE
or email us at [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
Cara Poland, MD, MEd, FACP, DFASAM 
Dr. Cara Poland is ASAM’s Vice President, is board-certified in Addiction Medicine, and is a faculty member at Michigan State University. In 2018, Dr. Poland identified the need to strengthen our country’s Addiction Medicine workforce. Dr. Poland leads MI CARES, which trains physician-level addiction specialists in Michigan and across the country. The program also teaches physicians-in-training, resident physicians, social work students, social work practitioners, APRNs, and PAs. Her didactic program involves purposeful education to train healthcare providers to treat persons with SUDs in a kind, compassionate, destigmatized way. Dr. Poland has a special interest in treating pregnant people and their families living with a substance use disorder.
📖 Show Segments
00:05 - Introduction
00:15 - New York Times Excerpt
03:07 - Substance Use and Overdose Risk During Pregnancy
04:07 - Addressing Stigma in Addiction Treatment
19:18 - Effective Support Systems for Pregnant People with Addiction
13:56 - Medication for Opioid Use Disorder During Pregnancy
18:00 - Postpartum Care and Overdose Risk
27:06 - Polysubstance Use and Alcohol Use Disorder
33:38 - Key Takeaways
35:10 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Recognize Pregnancy as a Motivator for Change: Pregnancy can inspire individuals to seek help and begin recovery. Leveraging this motivation through empowering, respectful care can improve outcomes for both parent and baby.
Understand Vulnerability in Substance Use: Addressing underlying vulnerabilities that often contribute to substance use, such as trauma, mental health conditions, and social factors, through compassionate care is essential to supporting recovery.
Foster Trust by Reducing Stigma: Creating nonjudgmental healthcare environments, along with respectful, supportive patient-provider relationships, encourages engagement and improves treatment outcomes.
Promote Evidence-Based Treatment During Pregnancy: Medications for opioid and alcohol use disorders are safe and effective during pregnancy. Addressing misinformation and normalizing these treatments can help improve access and reduce harm.
Normalize Return to Use as Part of Recovery: Recovery is rarely linear. Approaching return to use with empathy, as a step in the process, encourages long-term engagement and helps reduce shame.
Deliver Empathic, Individualized Care: Active listening, empathy, and individualized care planning help build trust, deepen understanding, and guide effective, patient-centered interventions.
Implement Team-Based Support: Pregnant individuals with substance use disorders often face complex medical, social, and behavioral health challenges. Coordinated, interdisciplinary care is essential for addressing these needs holistically.
🔗 Resources
ASAM’s Clinical Tips Microlearning Video Series: Women and Addiction
Engaging Families and Care Providers in Women’s SUD Treatment
Substance Use Among Aging Women
Pregnancy and Substance Use Disorders
Dressing Motivated Behaviors in Women with SUD
ASAM’s Women and Addiction Education and Resources: Explore HERE
Patient-Centered Care for Women with Substance Use Disorders – Online Course
Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants: Substance Abuse and Mental Health Services Administration. HHS Publication No. (SMA) 18-5054. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018.
Your Words Matter – Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder: Offers tips on how to use person-first language and which terms to avoid using to reduce stigma and negative bias when discussing addiction or substance use disorder with pregnant women and mothers.
The ASAM Principles of Addiction Medicine (Seventh Edition):
Substance Use During Pregnancy: Weaver MF, Jones HE, Wunsch MJ. Substance Use During Pregnancy. In Miller S, Rosenthal RN, Levy S, Saxon AJ, Tetrault JM, Wakeman SE. (Eds), The ASAM Principles of Addiction Medicine (Seventh Edition). American Society of Addiction Medicine, Inc.; 2024:1509-1529.
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37 min
August 04, 2025Listening First: The Future of Women's Addiction Treatment
In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. Hendree Jones discuss the importance of implementing gender-responsive and trauma-informed care in addiction treatment. They offer insights on recognizing trauma in patients, creating safer treatment environments, addressing gender-specific treatment gaps, and emphasizing the importance of language and empathy in clinical practice. Together, they highlight the positive impact that a compassionate and inclusive approach can have on patient care and treatment outcomes.
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Looking for this episode's transcript? Download it HERE
We want to hear from you! Please take our short, five-minute survey HERE
or email us at [email protected].
Host
Peter Selby, MBBS, CCFP(AM), FCFP, FASAM
Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems.
Expert
Hendree Jones, PhD
Dr. Hendree Jones is a licensed psychologist and an internationally recognized expert in the development and examination of both behavioral and pharmacologic treatments for pregnant women and their children in risky life situations. She was the Division Director of UNC Horizons for a decade and, in May of 2023, stepped into a Senior Advisor role for Horizons to take on several national policy and international policy projects. Expertscape ranks Dr. Jones as a top world expert in neonatal abstinence syndrome and opioid-related disorders. She has received continuous National Institutes of Health funding since 1994 and has written more than 350 publications. Dr. Jones has also authored two books, one on treating patients for substance use disorders and the other on comprehensive care for women who are pregnant and have substance use disorders. She has also written multiple textbook chapters on the topic of pregnancy and addiction, as well as 17 courses for adult learners on topics of substance use disorder treatment (WISE, CHILD, PEERS, ALLIES, etc.). Dr. Jones has co-authored multiple national and international guidelines on the topic of caring for pregnant and post-pregnant patients with substance use disorders and their children, including those published by the WHO, SAMHSA, and ASAM. She also co-authored both the women’s and children’s section of the UN International Standards for the Treatment of Drug Use Disorders and the UN guidelines on prevention and treatment for girls and women. In 2020, Dr. Jones won the ASAM R. Brinkley Smithers and Distinguished Scientist Award. In 2024, she won the MED Brady-Schuster Division 28 American Psychological Association award for lifetime achievement for contribution to addiction science. She consults for the UN and the WHO and is a member of the NIH’s HEAL multidisciplinary working group and the Advisory Committee on Research on Women's Health. Dr. Jones has been involved in over 43 projects around the world focused on improving the lives of children, women, and families.
📖 Show Segments
00:05 - Introduction
01:09 - Patient Story: The Impact of Trauma on Women with Addictions
03:34 - Principles of Gender Responsive and Trauma-Informed Care
05:41 - Language and Communication in Addiction Treatment
08:06 - Challenges and Solutions in Implementing Trauma-Informed Care
17:17 - Biological and Gender Differences in Addiction
17:30 - Addressing Treatment Gaps for Women in Addiction Care
23:56 - Practical Steps for Trauma-Informed Care in Clinical Practice
27:08 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Implement Trauma-Informed Care: Trauma plays a significant role in women's addiction, requiring a trauma-informed approach to care that considers not just the events but also the lasting effects and individual experiences of trauma.
Create Safe, Supportive Environment: Fostering a safe, transparent, and non-punitive environment is crucial for effective trauma-informed care. This includes considering physical surroundings, psychological safety, and the overall treatment environment to create a more welcoming and less anxiety-inducing environment.
Use Respectful, Non-Stigmatizing Language: The language used by providers can significantly impact the comfort and dignity of patients. Avoiding stigmatizing terms and promoting respectful communication are essential to building trust between healthcare providers and patients.
Implement a Gender-Responsive Approach: There are biological and social differences in how women experience addiction and substance use. Healthcare providers need to address these unique needs, such as offering targeted support and addressing gender-specific triggers.
Address Systemic Issues and Barriers: Barriers to implementing trauma-informed care can be both systemic and cultural. Securing buy-in from all stakeholders, addressing staff concerns and fears, and ensuring consistent and positive reinforcement of new practices are important steps in overcoming organizational and cultural barriers.
Foster Collaborative Care: Engaging patients as partners in their own treatment plans through shared decision-making and understanding their individual needs and triggers can enhance engagement and outcomes. This collaborative approach also applies to interactions with team members and creating a supportive work environment.
Engage with Compassion and Curiosity: Maintaining empathy, validating patients' experiences, being genuinely curious about their needs and stories, and using mindfulness techniques can build stronger, more supportive patient-provider relationships, ultimately improving recovery.
🔗 Resources
ASAM’s Women and Addiction Education and Resources: Explore HERE
Trauma-Responsive Care for Women with Substance Use Disorders – Factsheet
Patient-Centered Care for Women with Substance Use Disorders – Online Course
ASAM’s Clinical Tips Microlearning Video Series: Women and Addiction
Engaging Families and Care Providers in Women’s SUD Treatment
Substance Use Among Aging Women
Pregnancy and Substance Use Disorders
Dressing Motivated Behaviors in Women with SUD
NIDA Substance Use in Women Research Report: Provides an overview of how women not only use and respond to substances differently than men but also face unique biological, psychological, and social barriers in developing, experiencing, and treating substance use disorders.
Your Words Matter – Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder: Offers tips on how to use person-first language and which terms to avoid using to reduce stigma and negative bias when discussing addiction or substance use disorder with pregnant women and mothers.
Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes:
Intimate Partner Violence, Pregnancy, and Substance Use Disorder:
Soper R, Jones H. Intimate Partner Violence, Pregnancy and Substance Use Disorder. In: Wright (Ed.), Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes. Cambridge University Press; 2018:41-48.
Treatment Approaches in Women with Substance Use Disorders Who Become Pregnant: Jones H. Treatment Approaches in Women with Substance Use Disorders Who Become Pregnant. In: Wright T (Ed.), Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes. Cambridge University Press; 2018:72-83.
The ASAM Principles of Addiction Medicine (Seventh Edition):
Substance Use During Pregnancy: Weaver MF, Jones HE, Wunsch MJ. Substance Use During Pregnancy. In Miller S, Rosenthal RN, Levy S, Saxon AJ, Tetrault JM, Wakeman SE. (Eds), The ASAM Principles of Addiction Medicine (Seventh Edition). American Society of Addiction Medicine, Inc.; 2024:1509-1529.
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29 min
July 21, 2025Neurologic-Informed Care: Integrating Brain Injury Awareness into Addiction Medicine
In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. John Corrigan explore the intersection of brain injury and addiction treatment. They introduce the concept of neurologic-informed care and discuss how cognitive impairments from brain injuries impact addiction recovery. The episode explores practical strategies for screening, treatment, and creating supportive environments to enhance outcomes for individuals with co-occurring brain injury and substance use disorder.
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Looking for this episode's transcript? Download it HERE
Have an idea for a future episode? Share it with us at [email protected].
Host
Peter Selby, MBBS, CCFP(AM), FCFP, FASAM
Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems.
Expert
John Corrigan, PhD, ABPP
Dr. John Corrigan is a professor in the Department of Physical Medicine and Rehabilitation at Ohio State University and Director of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation. His research interests include a focus on education and treatment for individuals with co-occurring brain injury and substance use, a critical area in both clinical practice and public health. Dr. Corrigan is Editor-in-Chief of the Journal of Head Trauma Rehabilitation. He has been the PI and co-PI of the Ohio Regional Traumatic Brain Injury Model System since 1997 and chaired the Executive Committee of the TBI Model Systems Project Directors from 2007-2017. Dr. Corrigan is the National Research Director for the Brain Injury Association of America. Since 2013 he has served as the Director of the Ohio Brain Injury Program, which is the designated lead agency in the state of Ohio for policy and planning related to living with brain injury. He has more than 200 peer reviewed publications and has received many awards for his service and research in brain injury rehabilitation, including the Brain Injury Association of America’s William Fields Caveness Award, the 2007 Robert L. Moody Prize, the Gold Key Award from the American Congress of Rehabilitation Medicine, and the Lifetime Achievement Award from the International Brain Injury Association.
📖 Show Segments
00:05 - Introduction
02:20 - Understanding Neurologic-Informed Care
05:53 - The Hidden Epidemic in Addiction Medicine
08:03 - Anoxic and Hypoxic Brain Injuries
15:19 - Practical Screening and Treatment Modifications
22:05 - Accommodations and Environmental Factors
24:48 - Conclusion and Additional Learning Opportunities
📋 Key Takeaways
Recognize and Screen for Brain Injuries: Brain injuries, including traumatic brain injuries (TBI) and anoxic/hypoxic injuries, are common but often overlooked in mental health and addiction treatment. Standardized screening at intake, using detailed patient histories and cognitive assessments, is crucial for accurate identification and effective care planning.
Implement Neurologic-Informed Care: Similar to trauma-informed Care, this approach integrates an understanding of neurologic impairments into all aspects of treatment. It highlights the importance of understanding cognitive limits, modifying care approaches, and fostering an environment that supports recovery for those with neurological impairments.
Understand Cognitive Impacts on Recovery: Brain injuries often impair attention, memory, processing speed, and executive function—issues that can impact treatment adherence and be mistaken for a lack of motivation. These impairments can also increase the risk of substance misuse and make recovery more challenging.
Adapt Treatment Environments and Methods: Creating supportive environments, such as reducing noise, adjusting lighting, and allowing for restlessness, along with practical strategies like visual aids, repetition, and hands-on tools, can help individuals with cognitive impairments better engage in treatment, retain information and make the behavior changes needed for successful recovery.
Address Sleep Disorders: Sleep disturbances are common in both brain injury and substance use populations. Identifying and treating sleep disorders can improve cognitive functioning and support overall treatment success.
Individualized Care to Reduce Substance Use Risks: Individuals with brain injuries face an increased risk of substance misuse and relapse. Individualized, neurologically informed accommodations can reduce these risks and support more sustainable recovery outcomes.
🔗 Resources
Accommodating the Symptoms of Traumatic Brain Injury: This booklet from the Ohio Valley Center for Brain Injury Prevention and Rehabilitation provides clear guidance on understanding the effects of TBIs and offers practical, individualized accommodation strategies to support full participation in work, school, and community life.
INROADS Issue Brief: Opioid Use Among Persons with Traumatic Brain Injury: In this brief, we will discuss the relationship between TBI, opioid use disorder, and targeted policy solutions to improve short- and long-term outcomes.
Modifying Clinical Interventions for TBI: This brief from the ACL's Traumatic Brain Injury (TBI) Technical Assistance and Resource Center (TARC) highlights considerations and best practices for diagnosing and treating behavioral health disorders in people with TBI.
SAMHSA Advisory: Treating Patients with TBI: This Advisory summarizes key elements of TBI and describes its relevance to behavioral health, including recommendations for behavioral health professionals.
Traumatic Brain Injury and SUD Series: The Mid-America and Mountain Plains Addiction Technology Transfer Centers (ATTCs), in partnership with the National Association of State Head Injury Administrators (NASHIA), offer recorded webinars and a toolkit on the intersection between brain injury and substance use disorders.
The ASAM Criteria: The most widely used and comprehensive set of standards for placement, continued service, and transfer of patients with addiction and co-occurring conditions. Chapter 19 of the 4th Edition Adult version addresses cognitive impairment and neurologic-informed care. 
ASAM Criteria Curriculum: Explore the different trainings ASAM offers on both the 3rd and 4th Edition ASAM Criteria.
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26 min