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ASAM Practice Pearls

ASAM Practice Pearls

By: ASAM Education
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Join ASAM Practice Pearls for in-depth discussions on addiction prevention, treatment, and recovery.

Geared toward healthcare professionals and individuals seeking knowledge, this series explores the latest evidence-based approaches to addiction medicine.

Listen to interviews with leading experts as they delve into critical topics and share practical tools you can use to improve patient care and promote public health.

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Episodes
  • Kratom and 7-OH: What Clinicians Need to Know

    Kratom and 7-OH: What Clinicians Need to Know
    Apr 6 2026
    In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts researchers Dr. Kirsten Smith and Katie Hill to explore the rapidly evolving landscape of kratom and 7-hydroxymitragynine (7-OH). They examine kratom’s complex pharmacology, review current research on kratom and 7-OH, discuss kratom’s addiction potential, withdrawal patterns, and the challenges of kratom in the clinical setting. The episode provides listeners with a basic understanding of kratom and 7-OH products, helping clinicians better understand where to begin when treating patients who use kratom and kratom-derived products. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Kirsten Smith, PhD, LMSW   Dr. Kirsten Smith is a leading expert on kratom, with over 90 peer-reviewed publications on kratom and related topics like kava and tianeptine. From 2023-2025, she was an Assistant Professor at Johns Hopkins University School of Medicine’s Department of Psychiatry. She joined Hopkins after earning her Master’s from the University of Kentucky, PhD from the University of Louisville, and completing a 4-year postdoctoral fellowship at the National Institute on Drug Abuse Intramural Research Program (NIDA IRP). At NIDA IRP, she completed her K99-funded project that involved a national ecological momentary assessment of daily kratom use and a controlled drug administration sub-study that investigated the acute effects of commercial kratom products. Her R00-funded study at Johns Hopkins examined kratom pharmacokinetics/pharmacodynamics of kratom and assessed spontaneous kratom withdrawal among chronic consumers. She also received an R01 to study the safety, tolerability, and abuse potential of kratom in healthy adults, which is ongoing. She has conducted surveys and qualitative research on kratom and 7-hydroxymitragynine (7-OH). Dr. Smith is currently transitioning from academia to clinical practice but consults on kratom regularly and welcomes opportunities for collaboration. Disclosure: There are no relevant financial relationships. Expert Katherine Hill, MPH   Katherine (Katie) Hill is a PhD candidate in Epidemiology of Microbial Diseases at Yale School of Public Health. Her research interests include substance use and harm reduction. Her doctoral research employs mixed methods to evaluate the impact of emerging substances, such as xylazine and kratom, on people who use drugs. Disclosure: There are no relevant financial relationships. 📖 Show Segments 00:05 - Introduction 01:49 - Defining Kratom 04:42 - Consumers of Kratom05:48 - Is Kratom an Opioid07:29 - Differences Between Kratom and 7-OH11:39 - Addiction Potential16:50 - Toxicity, Acute Intoxication, and Toxidrome18:55 - 7-OH Withdrawal and Overdose24:16 -  Patient History and Assessment 26:25 - Practice Pearls for Clinicians30:48 - Patient Motivations and Harm Reduction33:03 - 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 does not appear to cause respiratory depression, but can result in physical dependence symptoms when consumed ...
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    35 mins
  • Social Determinants of Health: Making an Impact in Addiction Care

    Social Determinants of Health: Making an Impact in Addiction Care
    Mar 23 2026
    In this episode of ASAM Practice Pearls, Drs. Stephen Taylor and Sharon Stancliff explore the role of social determinants of health (SDoH) in addiction care. They discuss the biopsychosocial model of addiction and emphasize the importance of understanding social factors such as housing, transportation, and economic stability when providing effective care. They highlight the need for clinicians to engage with patients in their environments, advocate for policy changes, and address racial disparities in addiction treatment, offering practical strategies clinicians can use to support patients facing social challenges. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Sharon Stancliff, MD   Dr. Stancliff is Associate Medical Director for Harm Reduction in Health Care at the AIDS Institute, NYSDOH and sees patients at a shelter in New York City. Dr. Stancliff has been working with people who use drugs since 1990, including the provision of primary care, drug treatment, HIV care, and syringe access. She is currently focused on opioid overdose prevention through expanding access to naloxone and expanding access to buprenorphine in primary care and in less traditional settings, such as syringe exchange programs. Dr. Stancliff graduated from the School of Medicine at the University of California at Davis, did her Family Practice residency at the University of Arizona, and completed the AIDS Institute-sponsored Nicolas Rango HIV Clinical Scholars Program at Beth Israel Medical Center in New York City. She is board-certified in Family Medicine and in Addiction Medicine. She served on the Public Policy Committee of ASAM. 📖 Show Segments 00:05 - Introduction 02:29 - The Role of SDoH in Addiction 06:00 - Prioritizing Competing Social Needs08:57 - The Clinician’s Role in Addressing SDoH12:11 - Making Your Voice Heard14:09 - The Impact of Race on Addiction Treatment16:38 - Tailoring Treatment to Social Context19:31 - Navigating Social Networks and Environmental Challenges22:30 - Key Takeaways24:50 - 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 ...
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    26 mins
  • Optimizing Treatment for Co-occurring Psychiatric and Substance Use Disorders

    Optimizing Treatment for Co-occurring Psychiatric and Substance Use Disorders
    Mar 9 2026
    In this episode of ASAM Practice Pearls, Drs. Stephen Taylor and Smita Das discuss co-occurring psychiatric and substance use disorders (SUD). They explore the most common psychiatric conditions seen alongside addiction, share strategies for distinguishing primary psychiatric disorders from substance-induced symptoms, and review approaches to screening, treatment planning, and integrated care. The conversation highlights practical screening tools, medication considerations, and populations with unique clinical needs, emphasizing the importance of treating both conditions concurrently. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Smita Das, MD, PhD, MPH   Dr. Smita Das is board-certified in psychiatry, addiction psychiatry, and addiction medicine. She studied chemistry and statistics at Stanford University, earned her Master’s in Public Health at Dartmouth College, and completed her MD/PhD in Community Health at the University of Illinois at Urbana-Champaign. Dr. Das completed her psychiatry residency and served as chief resident at Stanford, followed by an addiction psychiatry fellowship at UCSF. She has over two decades of research experience in healthcare quality and addiction. Dr. Das is a former chair of the APA Council on Addiction Psychiatry, a past president of an APA District Branch, and a member of the APA Advisory Council for Workplace Mental Health. She previously served as Director of Addiction Treatment Services at the Palo Alto VA and as Vice President of Psychiatry at Lyra Health. Currently, Dr. Das practices in addictions at Stanford School of Medicine as a Clinical Associate Professor. 📖 Show Segments 00:05 - Introduction 03:58 - Common Co-occurring Psychiatric Conditions 05:37 - Prevalence and Substance-Specific Co-occurrences08:35 - Distinguishing Primary vs Substance-Induced Symptoms11:33 - Screening Tools and Measurement-Based Care14:25 - Pharmacological Management Challenges18:11 - Breaking Through Treatment Barriers21:46 - Special Populations: Adolescents, Older Adults, and Peripartum Patients25:12 - Key Takeaways26:45 - Conclusion and Additional Learning Opportunity  📋 Key Takeaways Co-occurrence is the rule, not the exception - Approximately half of people with substance use disorders also have another mental health condition, making integrated treatment essential. Screen for both conditions routinely - Use validated screening tools, such as PHQ-9 for depression, GAD-7 for anxiety, NIDA screeners for substance use, and the Columbia scale for suicidality to identify co-occurring conditions early. Treat both conditions together - Research consistently shows that integrated, concurrent treatment of psychiatric and substance use disorders leads to better outcomes. Take a thorough history - Understanding the relationship between psychiatric symptoms and substance use is important for proper diagnosis and treatment planning. Know the most common co-occurring conditions - Depression, generalized anxiety disorder, ADHD, psychotic disorders, and trauma-related disorders such as PTSD are the most common co-occurring psychiatric conditions with SUDs. There are also specific substance-disorder pairings to be aware of, such as alcohol and depression, opioids and chronic pain/PTSD/depression, stimulants and bipolar/psychosis, benzodiazepines and anxiety, and cannabis and psychosis. Be aware of medication challenges - Consider drug interactions, such as benzodiazepines and opioids, symptom overlap like withdrawal mimicking psychiatric symptoms, misuse and diversion risks, and the proper timing of pharmacological interventions. Address systemic barriers - Break down silos between addiction and psychiatric care through better communication, education, advocacy for parity, and coordinated treatment approaches. Tailor care for populations with unique clinical needs - Adolescents, older adults, and peripartum patients need age-appropriate screening and treatment strategies that address their unique presentations and challenges. 🔗 Resources ASAM 2025 Review Course: Psychiatric Co-morbidities: Complexities of Diagnosis and Care: Register HERE ...
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    28 mins
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