PA Mindset Matters

PA's Jessica Spissinger and Mercedes Dodge share practical clinical pearls on cannabis use disorder, including brief history, key compounds (THC vs CBD), FDA-approved synthetic cannabinoids (dronabinol/Marinol, nabilone/Cesamet), and common physiologic effects. They compare pharmacokinetics of inhaled vs oral cannabis, highlight protein binding, lipophilicity, and potential drug interactions, and review detection windows and limits of blood, saliva, urine, and hair testing.   The episode outlines DSM criteria for cannabis intoxication and withdrawal, typical withdrawal symptoms, and supportive management. They discuss evidence and limits for medical use, legal context, and major risks—psychiatric (especially adolescent psychosis risk and bipolar worsening), cognitive impacts, cardiovascular and respiratory concerns, hyperemesis syndrome, pregnancy risks, and contaminants—ending with the takeaway that cannabis is not benign and that behavioral interventions and motivational interviewing are central to treatment.  

What happens when healthcare goes directly to the people who need it most? In this episode of PA Mindset Matters, hosts Mercedes Dodge and Jessica Spissinger welcome Tara Amini, DMSc, PA-C, a physician associate whose work spans street medicine, mobile healthcare, primary care, addiction medicine, and psychiatry in California's Central Valley. With more than 20 years of clinical experience, Tara shares her journey from emergency and correctional medicine to developing mobile healthcare services for people experiencing homelessness and other underserved populations. Through her experiences, we explore how building trust, showing up consistently, and adapting care to patients' circumstances can make a meaningful difference in healthcare access and outcomes. In this episode, we discuss: Street medicine vs. mobile clinics: Bringing comprehensive healthcare beyond traditional clinic walls. Trust and connection: Why consistency, compassion, and relationships matter when caring for vulnerable populations. Integrated care: Addressing addiction, mental health, HIV, chronic illness, and preventive healthcare together. Barriers to treatment: Navigating transportation, housing instability, medication access, and continuity of care. The evolving PA role: Lifelong learning, advocacy, leadership, and clinician resilience. From connecting with patients through their pets to expanding clinical services based on community needs, Tara reminds us that meaningful healthcare often begins with listening and building relationships. Whether you practice in primary care, psychiatry, emergency medicine, addiction medicine, or another specialty, this conversation offers lessons for meeting patients where they are.

Opioid use disorder looks different in the fentanyl era—and clinicians across healthcare need to understand what has changed. In this Mini Mindset episode of PA Mindset Matters, Mercedes Dodge and Jessica Spissinger break down practical, evidence-based approaches to opioid use disorder for clinicians working in psychiatry, primary care, emergency medicine, hospital medicine, pain management, and beyond. In this episode, we discuss: • How fentanyl has changed overdose risk and the clinical landscape • Why detox is not the same as treatment for opioid use disorder • The roles of buprenorphine, methadone, and naltrexone • Why precipitated withdrawal can occur and how COWS can help guide assessment • Why clinicians should treat the patient—not just the clock—when initiating buprenorphine • Naloxone, harm reduction, and overdose prevention • Using PDMP data and urine drug testing as clinical information rather than punishment • How motivational interviewing can start with just one open-ended question • Matching patients to the appropriate level of care and recovery support One of the biggest takeaways: opioid use disorder is a chronic, treatable medical condition, and medications for opioid use disorder are evidence-based treatment.   You do not have to be an addiction medicine specialist to make a difference. Sometimes the first step is simply starting the conversation, reducing stigma, offering naloxone, or connecting a patient with evidence-based treatment.

What does compassionate, stigma-free addiction care look like in clinical practice? In this episode of PA Mindset Matters, hosts Jessica Spissinger and Mercedes Dodge welcome Karen Haessler, PA-C, an addiction medicine PA who shares her journey from paramedicine to building a hospital-wide addiction consult service. Karen offers practical insights into managing alcohol withdrawal, treating opioid use disorder, initiating medications for opioid use disorder (MOUD), and navigating emerging substance use trends, including kratom and fentanyl adulterants. The conversation explores addiction care during pregnancy, perioperative buprenorphine management, harm reduction, and the importance of nonjudgmental language in building therapeutic relationships. Packed with clinical pearls and resources for PAs across specialties, this episode reminds us that compassionate addiction care starts with how we approach our patients.

Alcohol use disorder (AUD) is common, complex, and often under recognized. In this Mini Mindset episode of PA Mindset Matters, hosts Jessica Spissinger and Mercedes Dodge deliver a focused, practical overview of AUD and the essential clinical knowledge every PA should have. From screening tools and risk factors to recognizing intoxication, managing withdrawal, and identifying life-threatening complications, this episode covers the fundamentals of AUD. We also explore CIWA-Ar, thiamine, SBIRT, and medication options, including naltrexone, acamprosate, and disulfiram. Whether you practice in primary care, emergency medicine, psychiatry, or another specialty, this episode offers practical insights to help you recognize AUD and provide compassionate, evidence-based care.

In this episode of The PA Mindset Matters podcast, hosts PA Mercedes Dodge and PA Jessica Spissinger speak with Katie Hodson, PA, an outpatient psychiatry clinician in Wilmington, North Carolina, who focuses on opioid use disorder and co-occurring conditions such as PTSD, stimulant use disorder, anxiety, depression, and bipolar disorder. Katie discusses integrating addiction treatment with psychiatric care, using a collaborative, nonjudgmental approach that sets expectations, avoids punitive responses, and emphasizes meeting patients where they are. She reflects on her path to become a PA and her current clinical work focusing on psychosocial rehabilitation, addresses stigma from families and misconceptions about buprenorphine (including perioperative concerns), and highlights how public policy, housing, food insecurity, and insurance instability drive mental health and substance use outcomes. She also describes close collaboration with therapists, setting boundaries to prevent burnout, and self-care through family, exercise, faith, and grace.

When depression, anxiety, insomnia, inattention, or mood instability shows up alongside substance use, the clinical picture can get complicated fast. In this Mini Mindset episode of PA Mindset Matters, we explore how intoxication, withdrawal, rebound symptoms, and neuroadaptation can mimic psychiatric illness—and why good clinical reasoning requires more than matching symptoms to a diagnosis. We discuss: How substance use can act as a clinical chameleon Why building a timeline matters before assigning a psychiatric diagnosis How withdrawal and neuroadaptation can resemble depression, anxiety, ADHD, or bipolar-spectrum symptoms Why the medication may not be the mistake—missing the driver may be Why true co-occurring substance use and psychiatric disorders often require integrated care The clinical question we keep coming back to: What is the substance doing to the clinical picture? And before treating the symptom, ask: What is driving these symptoms—and what does this patient need treated today? Listen for practical, clinician-to-clinician insights you can bring back to primary care, psychiatry, and everyday mental health practice. Follow PA Mindset Matters for more Mini Mindsets and conversations on practical psychiatry, behavioral health, and the reminder that Every PA is a Psych PA.

Addiction medicine touches nearly every area of healthcare, yet many clinicians receive limited training in recognizing and treating substance use disorders. In this episode of PA Mindset Matters, Jessica Spissinger, PA-C, LICSW, CAQ-Psych, and Mercedes Dodge, MPAS, PA-C, CAQ-Psych, sit down with Kerith Hartmann, MPAS, PA-C, an addiction medicine PA at Oregon Health & Science University. Kerith works across inpatient addiction medicine consultation and outpatient care for patients with substance use disorders, complex chronic illness, and overlapping pain concerns. She is also a board member of the Society for Addiction Medicine of PAs and a member of the Motivational Interviewing Network of Trainers. One of her strongest messages: “Learn motivational interviewing—really learn it. Not the concept, the practice.” In this conversation, we discuss: • opioid, alcohol, and stimulant use disorders • medications for addiction treatment • motivational interviewing in real clinical practice • contingency management • harm reduction and reducing stigma • addiction and chronic pain overlap • trauma-informed care • clinician resilience and burnout • building a career in addiction medicine Kerith also shares the personal and professional experiences that led her into this field and reminds us that clinicians do not have to identify as addiction specialists to make a meaningful difference for patients with substance use disorders. Listen to the full conversation on PA Mindset Matters and share it with a colleague who cares for patients affected by substance use. Also available on Apple Podcasts, Spotify, and YouTube. #PAMindsetMatters #AddictionMedicine #MotivationalInterviewing #SubstanceUseDisorder #PhysicianAssociate

You don’t have to work in addiction medicine to care for patients with substance use disorders. Substance use shows up across healthcare—from psychiatry and primary care to emergency medicine, pediatrics, and hospital settings—and it often intersects with anxiety, insomnia, trauma, depression, chronic pain, and relationship stress. In this Mini Mindset episode, Jessica Spissinger and Mercedes Dodge break down practical ways clinicians can recognize substance use disorder, reduce stigma, and feel more confident starting the conversation. In this episode, we discuss: • Why shifting from “Why won’t you stop?” to “What is this substance doing for you?” can change the clinical encounter • The 4 Cs of substance use disorder: control, craving, compulsion, and consequences • How SBIRT can help clinicians screen, intervene, and connect patients with treatment • Using motivational interviewing to move from judgment to curiosity • Evidence-based treatment options for alcohol and opioid use disorders • Harm reduction and the importance of meeting patients where they are • Why alcohol and sedative withdrawal require careful safety assessment • The role of therapy, contingency management, peer support, and other recovery resources Substance use disorder is not a failure of willpower. It is a treatable medical condition influenced by biology, environment, learning, trauma, relationships, and the brain’s reward system. And treatment does not always begin in an addiction clinic. Sometimes it begins with one clinician asking the right question and creating a safe space for an honest conversation. Listen now and follow PA Mindset Matters for more Mini Mindset episodes translating psychiatry, behavioral health, and neuroscience into practical clinical care. 

What happens when we identify opioid use disorder—but the patient still can’t access treatment? In this episode of PA Mindset Matters, Mercedes Dodge and Jessica Spissinger sit down with Arianna Campbell, DMSc, MPH, PA-C, CAQ-EM, DFAAPA, a PA with more than 25 years of emergency medicine experience and nearly a decade working in addiction medicine and healthcare systems change. Arianna shares how a simple question in the emergency department—What are we actually going to do when we identify opioid use disorder?—helped launch work that eventually grew into California Bridge and expanded addiction treatment access across hospitals and communities. We discuss: • Buprenorphine and evidence-based opioid use disorder treatment • Why opioid withdrawal should be treated as a time-sensitive condition • CA Bridge Connect and making treatment easier to find • Stigma, harm reduction, and changing healthcare culture • The role of PAs in addiction medicine • The developing Addiction Medicine CAQ pathway • Why systems change starts with following the patient’s actual journey • Clinician wellness, resilience, and staying grounded Arianna reminds us that improving addiction care is not only about knowing the evidence—it is about creating systems where patients can actually access it. “We need to make it easier for people to get care.” Listen now on PA Mindset Matters.