EP 01

Special Series: ASAM’s 56th Annual Conference

This episode is part of a special four-part series spotlighting key sessions from ASAM’s 56th Annual Conference.

In this episode of ASAM Practice Pearls, Dr. Elizabeth Salisbury-Afshar welcomes Dr. Itai Danovitch to explore highlights from his session, Hospitals as a Frontline for Addiction: Lessons from the START Study. They’ll discuss the pivotal role hospitals play in identifying and treating substance use disorders, drawing on insights and outcomes from the START (Substance Use Treatment and Recovery Team) Study. 

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Host

Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, FACPM, DFASAM

Dr. Elizabeth Salisbury-Afshar is a family medicine, preventive medicine/public health, and addiction medicine physician. She is an Associate Professor at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. She is a core faculty member for the Addiction Medicine Fellowship at the University of Wisconsin, and her clinical roles include addiction medicine consult service and serving as medical director of a low-barrier walk-in clinic serving people who use substances. She is also the Program Director of the Preventive Medicine Residency at UW-Madison and Medical Director of Harm Reduction Services at the Wisconsin Division of Public Health. Dr. Salisbury-Afshar’s work focuses on expanding access to evidence-based addiction treatment and harm reduction services. She has over 14 years of experience practicing in medically underserved settings. Dr. Salisbury-Afshar lectures nationally on addiction medicine topics, including the treatment of opioid use disorder, harm reduction, the intersection of addiction and the criminal legal system, and public health approaches to reduce overdose mortality. Dr. Salisbury-Afshar is actively involved in ASAM, where she currently serves as the Vice Chair of the Medical Education Council, Course Director of the ASAM-All Rise treatment courts courses, a member of the ASAM Conference Planning Committee, and the Chair of Harm Reduction Special Interest Group.

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 current 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
• 00:52 – Why the START Study
• 02:32 – Study Methodology and Key Findings
• 05:08 – Key Findings
• 06:46 – Impact and Practical Applications
• 12:28 – Challenges in expanding access to Addiction Consultation Services
• 14:35 – Suggestions for Starting Addiction Consultation Services
• 17:23 – Benefits of having Addiction Consultation Services
• 19:03 – Expanding Addiction Consultation Services
• 23:39 – Proactive Approaches and AI Tools
• 25:02 – Final Thoughts
• 26:11 – Conclusion and Additional Learning Opportunities

Key Takeaways

• START Study: The START study was a randomized trial conducted at three different sites, focusing on initiating medication for opioid use disorder and connecting patients to aftercare.
• Addiction Consultation Services: Addiction consultation services can play an important role in hospitals providing better care for patients with substance use disorders.
• Effective Interventions: The study found that addiction consultation services significantly increased the likelihood of patients starting medication for opioid use disorder and being linked to follow-up care.
• Importance of Care Managers: Care managers play a significant role in the success of patient treatment. Those who followed up with patients for a month after discharge and addressed any issues that arose were most impactful.
• Utilize Available Resources: Initiating addiction consultation services can be effective if you start with available resources and progressively build on them.
• Financial Constraints: Financing remains the biggest challenge for expanding access to addiction consultation services despite their proven effectiveness.
• Engagement and Early Identification: Identifying and engaging patients early in their hospitalization can prevent delays and improve outcomes.
• Interdisciplinary Support: Support from the entire care team, including nurses, social workers, clinical partners, and others, can improve patient care and outcomes.
• Educational Component: Training and educational interventions for hospital staff can help increase the adoption and effectiveness of addiction services.
• Provide Comprehensive Care: Addiction consultation services can help provide comprehensive care in hospitals for patients with substance use disorders, similar to how other chronic health conditions are managed.

Resources

• ASAM’s 56th Annual Conference Sessions: Access HERE
• Hospital Addiction Consultation Service and Opioid Use Disorder Treatment: The START Randomized Clinical Trial: Ober AJ, Murray-Krezan C, Page K, et al. JAMA Intern Med. doi:10.1001/jamainternmed.2024.8586
• Pilot randomized controlled trial of a hospital-based substance use treatment and recovery team (START) to improve initiation of medication for alcohol or opioid use disorder and linkage to follow-up care: Ober AJ, Osilla KC, Klein DJ, et al. J Subst Use Addict Treat. 2023;150:209063. doi:10.1016/j.josat.2023.209063
• The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder: Ober AJ, Murray-Krezan C, Page K, et al. Addict Sci Clin Pract. 2022;17(1):39. Published 2022 Jul 28. doi:10.1186/s13722-022-00320-7
• A Taxonomy of Hospital-Based Addiction Care Models: a Scoping Review and Key Informant Interviews: Englander H, Jones A, Krawczyk N, et al. J Gen Intern Med. 2022;37(11):2821-2833. doi:10.1007/s11606-022-07618-x.
• Clinical implementation of AI-based screening for risk for opioid use disorder in hospitalized adults: Afshar, M., et al. Nature Medicine. 2025. DOI: 10.1038/s41591-025-03603-z
• Contextual barriers and enablers to establishing an addiction-focused consultation team for hospitalized adults with opioid use disorder: Evans SK, Ober AJ, Korn AR, et al. Addict Sci Clin Pract. 2024;19(1):31. doi:10.1186/s13722-024-00461-x
• Post-hospitalization Care Transition Strategies for Patients with Substance Use Disorders: A Narrative Review and Taxonomy:
  Incze MA, Kelley AT, James H, et al. J Gen Intern Med. 2024;39(5):837-846. doi:10.1007/s11606-024-08670-5
• The addiction consultation service for hospitalized patients with substance use disorder: An integrative review of the evidence: Danovitch I, Korouri S, Kaur H, et al. J Subst Use Addict Treat. 2024;163:209377. doi:10.1016/j.josat.2024.209377
• Bridge Treatment: A program of the Public Health Institute that bridges emergency care and community health to create an integrated system that improves health and equity.

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