Our Story

For more than 150 years, San Francisco General Hospital has been a frontline responder to public health crises. Now, amidst a skyrocketing addiction epidemic, with 2 people dying daily of a preventable drug-related deaths and increasing alcohol-related deaths, ACT's services are vital. Fragmented care makes it difficult for our patients to access substance use services in the community. ACT links our patients to community services as part of San Francisco's treatment network while also contributing to national solutions to our addiction epidemic.

Dr. Sarah Leyde, (2019-20 Addiction Medicine Fellow) presents on stimulant-induced heart failure to the SFGH Division of Cardiology. Dr. Leyde created Hearts Plus, a contingency management program that provides addiction and heart failure care.

ACT answers the call

Almost half of SFGH's patients have an addiction. Before ACT, a system to address addiction care did not exist. This meant that patients were inconsistently offered addiction treatment despite it being the cause of their visit.

We obtained seed funding for ACT in January 2019. Emergency department visits and hospitalization present key touchpoints to offer substance use services, including harm reduction, evidence-based treatment, and linkage to care.

Our Patients

People identified by our city as the most marginalized are individuals ACT prioritizes during emergency department visits and hospitalizations to reduce the harms of substance use while addressing the medical and psychosocial complications of addiction. Half of the patients with SUD we see are unconnected to community care.

Compared to patients without substance use disorders, our patients with sustance use disorders face unique challenges:

2x

more likely to have a mental illness

5x

more likely to experience homelessness

5x

more likely to self-discharge prior to completing treatment

1.5x

more likely to be re-hospitalized within 30 days

Patient Stories

Learn more about our services and our patients' journeys below.

Helping Mr. J heal his heart, reconnect with purpose, and reduce methamphetamine.

Addressing the Root Cause

Mr. J was admitted with methamphetamine-induced severe heart failure. Through motivational interviewing, ACT learned he was was one of 13 siblings raised in a poor community devastated by drugs. He had had recovered from a cocaine use disorder and was happily married until a hurricaine took his home and wife. Displaced and widowed, he relocated to California to be near remaining family and began using methamphetamine to escape sleep and the traumatic nightmares.

Our Role

Mr. J aimed to heal his heart, find a sense of purpose, and stop methamphetamine. ACT educated him about the effects of methamphetamine on his heart and connected him to outpatient behavioral addiction treatment. By elucidating the root causes of his use, empowering him through knowledge, and connecting him to addiction care, he has moved towards healthier behaviors and has an improved quality of life free of methamphetamine.

Supporting Ms. M's desire to stop opioid use and connecting her to community care

Cutting the Red Tape

Ms. M had an opioid use disorder, untreated mental illness, and was experiencing homelessness. On many occasions she had attempted obtaining buprenorphine for her heroin use but was unable to find a prescriber. She was discovered unconscious after a fentanyl overdose in the street, where she had been assaulted and was admitted to ZSFG. As a result of her trauma and co-occurring stimulant use disorder in the setting of untreated mental illness, she experienced suicidal ideation and psychosis.

Our Role

Diagnosed her severe opioid use disorder for which she had been seeking treatment, counseled her on evidence-based treatment options, supported her team in initiating buprenorphine, and linked her to a community opioid treatment program for integrated SUD and psychiatric care.

Helping Mr. G stop drinking, recognize underlying trauma, and reconnect with his family

Building Connections

Mr. G was in his early 50s with a history of childhood trauma. He had been a successful chef until lost his wife, son, and career to severe alcohol use disorder. He was hospitalized ~every six weeks with complications of alcohol use.

Our Role

Built rapport over three hospitalizations and strengthened Mr. G’s connection with his primary care doctor. His goal was to stop drinking to reconnect with his son. He identified depression and trauma underlying his use and wanted a medication to reduce drinking. He started attending primary care appointments more consistently where his doctor referred him to a psychologist. His recurring admissions decreased, and on his last admission he told ACT that seeing a psychologist for the first time made him hopeful for change.

Our Impact

In 2019, ACT saw more than 400 patients. ACT more than doubled our impact in 2020. We saw 3,453 patients, started at least 600 on evidence-based medications for adiction, discharged 74 patients to residential, and expanded services to 7-days a week. ACT serves people with all substance addictions, including:

Alcohol (31%)
Opioid (29%)
Methamphetamine (19%)
Cocaine (10%)

What We Do

Collaborate as an interprofessional team of addiction medicine physicians, nurse practitioners, patient navigators, and licensed vocational nurses to help patients navigate the system of care during and after healthcare system touchpoints in partnership with staff, clinicians, and community partners.
Assess people with unhealthy alcohol, tobacco, and other drug use for an addiction, evaluate their goals and readiness for change, and help them move towards healthier behaviors.
Initiate life-saving evidence-based addiction treatment.
Ally with community partners to link patients to integrated SUD services.
Use strength-based, patient-centered communication to reduce stigma and the harms of substance use.
Educate hospital staff and clinicians.
Adocate for and empower patients to self-advocate.

Some of San Francisco's addiction medicine community at the Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) in 2018 in San Francisco.

Learn more about the people powering our work

Explore the community, medical, and funding partners that make our impact possible. Meet the team running and evaluating the Addiction Care Team.

Our Partners

Meet the Team

In the News

Learn more about our work by reading some recent articles.

We've all seen the signs of addiction in San Francisco. What is harder to identify is the cause.

Breaking the Cycle

SF General Hospital Foundation

Before the ACT, patients suffering complications from alcohol and drug use were treated for immediate medical conditions but the underlying root causes...were not addressed.

Kaiser hooks up S.F. General Hospital with $3M to address root cause of addiction

SF Business Times

The staggering national toll of the opioid epidemic, combined with new knowledge about the nature of addiction, has increased demand for cutting-edge addiction treatment.

Expanding Access to Cutting-Edge Care

UCSF Department of Medicine 2019 Annual Report

ACT has increased staffing from 50% time of one attending physician, one patient navigator, and two fellows in 2019, to 100% time of one attending physician, three patient navigators, and four fellows in 2020.

Substance Use Trends in SF through 2019

Dept. of Public Health, San Francisco, CA

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Financial contributions directly fund and sustain our work for years to come.

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ACT falls under the Division of Hospital Medicine at San Francisco General Hospital and spans the emergency department and hospital. Soon we will be expanding to inpatient psychiatry and psychiatric emergency services.