Addiction Medicine Made Easy | Fighting back against addiction

Vaping looks sleek, smells sweet, and gets marketed like a harmless upgrade from cigarettes, but the science and the bedside reality are messier than most people realize. We walk through why e-cigarettes became popular in the first place, starting with a blunt truth: combustible tobacco is one of the most toxic things humans routinely use, and nicotine dependence is powerful. That “need for a safer cigarette” helped launch a global industry that now delivers nicotine in faster, stronger, more appealing ways than early e-cigarettes ever could. 

From there, we get practical and specific about what a vape is and what it does. We break down the basic hardware (battery, heating coil, liquid tank) and how the market evolved from cigarette lookalikes to pens, mods, pods, and today’s disposable devices built around flavors and convenience. Then we dig into the e-liquid itself: nicotine plus solvents like propylene glycol and vegetable glycerin, along with flavoring agents. When those liquids are heated into an aerosol, chemical reactions create new byproducts, and users may also inhale metals shed from the coil. If you’ve ever wondered what you’re actually pulling into your lungs with each puff, this section will sharpen your questions fast. 

The core medical focus is EVALI, or e-cigarette and vaping acute lung injury. We explain the symptoms (cough, shortness of breath, low oxygen, fluid in the lungs), why it can be mistaken for asthma, pneumonia, bronchitis, or even COVID, and why clinicians often diagnose it by ruling out other causes. We also cover why THC cartridges and refillable products raised risk in the 2019 outbreak, including what researchers learned about vitamin E acetate and toxic exposure when it’s heated. We close with what prognosis can look like, from improvement after stopping to permanent lung damage. 

If this helped you think more clearly about vaping risks, share it with someone who vapes, then subscribe and leave a rating or review so more people can find the show.

To contact Dr. Grover: [email protected]

“Lived experience” is one of the most powerful tools in addiction medicine, and one of the easiest ways to accidentally get it wrong. When we tell a patient “I’ve been there,” we can create instant trust and reduce shame. We can also, without meaning to, steer care toward our own story, our own recovery path, or our own triggers. 

I sit down with Randall Law, a psychiatry physician assistant in Idaho who works in residential and outpatient addiction treatment with a heavy focus on dual diagnosis. Randall shares his own mental health journey, including an episode of manic psychosis that spiraled into a life-threatening crisis in Hawaii during COVID, and how he rebuilt his life and returned to clinical practice. We talk openly about anxiety, stability, and the daily work of staying well while caring for patients in some of their hardest moments. 

From there we get practical: when should a clinician share personal history, and when should we keep it private? Randall lays out simple decision rules for self-disclosure, and I share ways I flag the difference between anecdote and evidence so patients know what they are hearing. We also discuss validating psychosis without reinforcing delusions, why motivational interviewing and bedside manner are not “extras” in psychiatry, and how lived experience can support both patient recovery and provider resilience. 

If this conversation helps you think differently about boundaries, bias, peer support, or compassionate communication, please subscribe, share the episode with a colleague, and leave a review so more people can find the show.

To contact Dr. Grover: [email protected]

Most CBD products leave clinicians and patients guessing: unclear labels, inconsistent dosing, and the lingering worry of THC exposure. I’m Dr. Casey Grover, and as an addiction medicine physician I came into this conversation skeptical because I treat cannabis use disorder and I’ve seen how “cannabis-adjacent” products can go sideways in real life. Then I sat down with Pulak Sharma, founder and CEO of Kazmira Therapeutics, and Dr. Marwaha, an internal medicine physician, to dig into what changes when CBD is treated like a true medical therapy rather than a supplement.

We talk about what “prescription-grade” CBD actually means, including 503A compounding standards, a vertically integrated process, and why THC-free purity matters for prescribing, drug testing concerns, and patient safety. Dr. Marwaha shares how he’s using high-dose pure cannabidiol as an adjunct for generalized anxiety and chronic pain, especially in older adults who can’t tolerate NSAIDs or who become confused or sedated on typical options like gabapentin or muscle relaxers. We also get practical about what to monitor: medication interactions, liver function tests, and the real-world side effects he sees most often, like drowsiness and nausea.

We don’t dodge the evidence gaps. Instead, we discuss how structured outcomes tracking (think GAD-7 and PHQ-9) could build credible data around reduced reliance on benzodiazepines, opioids, and other higher-risk meds, and how telemedicine may expand access while keeping protocols consistent. We even explore what’s next, from nanoemulsion tech for faster onset to endometriosis pain and veterinary use where THC can be toxic to pets.

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To contact Dr. Grover: [email protected]

To learn more about Kazmira's work: https://www.kazmiratx.com/

One-med-at-a-time sounds tidy on paper, but alcohol use disorder rarely behaves like a tidy problem. Dr. Reb Close and I sat down to discuss treating alcohol use disorder, and we’ve learned that many patients do better when we treat AUD the way we treat other chronic conditions: with a multimodal plan that targets more than one pathway and stays anchored to the person’s real reason for drinking. 

We walk through how we think about combination medication strategies for alcohol cravings, including naltrexone, acamprosate, gabapentin, baclofen, and topiramate. You’ll hear the practical “why” behind pairing meds, how we set expectations for naltrexone response, and how targeted dosing can give patients more control during high-risk moments. We also talk about monthly extended-release naltrexone (Vivitrol) and how we approach add-on oral dosing without overdoing it. 

Just as important, we keep coming back to the central clinical question: what does alcohol do for you? If drinking is driven by anxiety, insomnia, or trauma, the best AUD treatment may start with sleep, PTSD symptoms, nightmares, or triggers rather than another anti-craving pill. We close by zooming out to what best practice really looks like: therapy or groups, good sleep, nutrition, exercise, treatment of co-occurring mental health conditions, and more than one medication when it fits. 

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To contact Dr. Grover: ammadeeasy@fastmailcom

Burnout doesn’t always announce itself with a crash. Sometimes it creeps in while you’re still achieving, still leading, still doing “all the right things” until you notice you’re dreading shifts, snapping at people you love, or feeling numb with patients. That’s where our conversation goes, with James Maskalyk, an emergency physician in downtown Toronto, the first wellness director in his division, and someone who has helped bring emergency medicine training and wellness thinking to Ethiopia.

We get honest about what high-stress healthcare work does to the body and mind: shift work, chronic cortisol, trauma exposure, PTSD, and the subtle slide into depersonalisation. We also talk about the system problem, not just the individual problem, when pay and performance are tied to throughput instead of the quality of care and the humanity of the clinician. Along the way, we share the moments that changed how we see “wellness,” including the realization that medicine is an act of empathy and you can’t pour from an empty cup.

Then we move into practical, real-world tools: taking meaningful time away (including month-long sabbaticals), creating space inside the ER for small moments of connection, building peer support, and doing debriefs that help teams process what they just lived through. We also discuss journaling, creative work, and therapy as ways to build vocabulary for what you’re carrying so you can make changes earlier, not years later. If this resonates, subscribe, share it with a colleague, and leave a review so more healthcare workers can find it.

To contact Dr. Grover: [email protected]

Dr. Maskalyk's substack: https://jamesmaskalyk.substack.com/

The idea sounds caring and practical: if my teen is going to drink anyway, I’d rather it happen at home where I can supervise it. I’m Dr. Casey Grover, and after years in emergency medicine and now addiction medicine, I keep hearing this “safe at home” approach framed as a way to teach responsible drinking and prevent future addiction. The problem is that good intentions are not the same as good outcomes, and the research on parental permission is far less comforting than most families expect. 

We walk through six studies that directly test whether allowing underage alcohol use (and the same logic often applied to cannabis) provides a protective effect. Across surveys and longitudinal data, the pattern points in one direction: permissive attitudes and permission to drink at home are associated with more frequent use, higher quantities, and more alcohol-related harms later on. We dig into findings on teens drinking without parental knowledge, the risk of alcohol being taken from the home, and how early “sips” or “tastes” can predict heavier drinking in late adolescence even after controlling for other factors. 

We also get practical about what helps. The evidence supports clear boundaries, consistent discipline around drinking, and direct communication about risks. One of the most sobering insights is how often parents underestimate how much teens drink, especially when parents believe that controlled access at meals is protective. If you’re a parent, caregiver, clinician, or student, you’ll leave with concrete takeaways you can use in real conversations at home and in the clinic. 

If this was useful, subscribe, share it with someone raising a teen, and please leave a review so more people can find Addiction Medicine Made Easy. Huge thanks to Central Coast Overdose Prevention for supporting the show, and remember: treating addiction saves lives.

To contact Dr. Grover: [email protected]

Getting someone from fentanyl to buprenorphine can be one of the hardest transitions in addiction medicine, and not because people “don’t want it.” The pharmacology is unforgiving: start too soon and precipitated withdrawal can hit fast, loud, and memorable enough that patients never want to try bupe again. We sit down with Dr. Reb Close to talk through a newer approach that’s gaining traction, Direct To Inject (DTI), and what it looks like when you actually do it in the real world. 

We explain why fentanyl’s long tail changes everything, then map the options we offer patients: macrodosing, microdosing with a cross taper, microdosing without a cross taper, and DTI. You’ll hear how DTI uses a weekly long-acting injectable buprenorphine dose that comes on over about 24 hours, effectively creating a built-in “microdose ramp” while the patient navigates that first day. We also get specific about comfort meds, safety counselling, and how we handle the common moment where someone feels terrible but hasn’t taken any of the meds meant to help. 

From street-based care to clinic workflows, we share what withdrawal severity looks like across patients, when DTI is not a good option, how we think about methadone switches, and why we often push toward high-dose monthly injectable buprenorphine for a longer protective tail. If you care about practical fentanyl-era buprenorphine induction, retention, and overdose prevention, this one is for you. Subscribe, share with a colleague, and leave a review so more people can find the show.

To contact Dr. Grover: [email protected] 

Walking out of treatment can feel like being dropped right back into the fire: the bills are higher, relationships are still strained, triggers are everywhere, and the old “solution” of numbing out is suddenly right there again. We wanted a clearer answer to a common question from patients, families, and clinicians: what is sober living, and how does it actually help?

I sit down with Gerald Lott, host of the Seeds of Recovery podcast, author, and executive director of Sauk Valley Voices of Recovery in Illinois. Gerald breaks down sober living as real-life practice with guardrails: peer-led structure, house rules, curfews, chores, and meeting requirements that taper over time. We also talk about the differences between a recovery home (treatment without walls), sober living, Oxford House style models, and why it’s essential to vet programmes carefully because predatory sober homes do exist.

A huge thread running through our conversation is connection. Gerald explains why recovery built only on shared trauma can fade as you stabilise, and how “tribe” and affinity groups like sports, music, fishing, running, art, and service can keep connection growing in long-term recovery. We get practical about life skills too: budgeting, work routines, repairing relationships, and how recovery coaching turns big goals into weekly steps.

If you care about addiction recovery, relapse prevention, sober living programmes, or how peer recovery specialists support lasting change, this one is for you. Subscribe, share with someone who needs a next step after treatment, and leave a review so more people can find the show.

* Note * - there is some adult language in this episode

To contact Dr. Grover: [email protected]

GLP-1 medications are everywhere right now, and not just because people are losing weight. We’re starting to see something far more interesting for addiction medicine: semaglutide may reduce alcohol cravings and heavy drinking, and early data hints it could influence other compulsive behaviors too. I recorded this talk after giving it as a lecture to my colleagues, and it’s one I’ve wanted to share for a long time because the science is moving fast and the clinical questions are piling up.

We walk through what GLP-1 drugs actually are, how gut hormones like GLP-1 and GIP shape appetite, digestion, and glycaemic control, and why side effects like nausea and bloating are so common. I also clear up the most confusing practical point patients run into: Ozempic versus Wegovy and Mounjaro versus Zepbound are often the same molecules labelled for different indications, and insurance coverage usually follows those rules.

Then we get into the addiction evidence. I review three recent randomized controlled trials from 2025 to 2026 studying semaglutide for alcohol use disorder, including injectable and oral versions. The results aren’t magic, but they’re meaningful: fewer drinks on drinking days, fewer heavy drinking days, and lower craving scores compared with placebo, plus secondary findings that raise new research questions about nicotine and cannabis. Finally, I share two de-identified patient cases that show why GLP-1s can be a game-changer for some people and only a small nudge for others, especially when depression, grief, anxiety, or PTSD is the true engine behind drinking.

If this helped you think differently about recovery tools, subscribe, share the show with a colleague or friend, and leave a review so more people can find it.

To contact Dr. Grover: [email protected]

In this episode, Dr. Grover sits down with his daughter to discuss some of the more subtle aspects of quitting smoking. If you're wondering why it was his daughter, well - she was home when the recording was happening and it just felt right. 

Smoking isn’t just nicotine, it’s a whole stress ritual hiding in plain sight. We’ve both seen it: someone can do the brutal work of getting sober from alcohol or stopping opioids, yet cigarettes or vaping stay glued to their day. So we slow down and ask a more honest question: if nicotine gum, lozenges, and patches can cover withdrawal, why does quitting smoking still take so many serious attempts?

We break nicotine dependence down in plain language, including why nicotine can feel like both an upper and a downer, what nicotine withdrawal looks like, and how nicotine replacement therapy fits into a real smoking cessation plan. Then we get into the part people rarely name: the behavioral addiction. The hand-to-mouth routine becomes automatic, and the body starts craving the motion and timing just as much as the chemical.

From there we lay out three hidden reinforcers that make smoking and vaping feel calming: paced breathing that works like an anxiety exercise, the built-in permission of a smoke break, and the walk away from people that restrictions and stigma often force. We also connect this to early recovery and post-acute withdrawal syndrome (PAWS), when the brain is already dysregulated and anxiety can run high at work. If quitting removes your breathing, breaks, and escape all at once, of course cravings surge.

Listen for practical ways to replace the ritual without keeping the smoke: schedule breaks on purpose, keep the walk, practice box breathing, and use evidence-based supports when needed. If this helps you or someone you love, subscribe, share the episode, and leave a review so more people can find it.

To contact Dr. Grover: [email protected]