Dr. Casey Grover explores the challenging world of benzodiazepines, explaining why these commonly prescribed medications can create more problems than they solve for patients struggling with anxiety and other conditions.

• Benzodiazepines work like alcohol in pill form, enhancing the brain's natural "downer" chemical GABA
• Long-term use leads to tolerance, dependence, and potentially Benzodiazepine-Induced Neurological Dysfunction (BIND)
• The four most commonly prescribed benzos are diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax)
• Benzodiazepine withdrawal can cause seizures months after the last dose, making it particularly dangerous
• Unlike opioid addiction, there are no specialized medications to treat benzodiazepine addiction
• Tapering from benzodiazepines is extremely challenging, often taking months or years with patients experiencing severe rebound symptoms
• Modern medical understanding now recognizes benzos as inappropriate for long-term anxiety treatment
• Case studies demonstrate how patients prescribed benzos for anxiety often never learn proper coping skills and suffer increasingly worse symptoms

Thanks for listening and remember treating addiction saves lives.

To contact Dr. Grover: [email protected]

This is a joint episode between the Addiction Medicine Made Easy Podcast and the Kratom Sobriety Podcast

Check out the Kratom Sobriety Podcast: https://kratomsobriety.com/

Trauma and addiction are deeply intertwined, with unresolved PTSD often driving substance use as people attempt to manage overwhelming emotions and physical sensations.

• Understanding PTSD beyond combat veterans—recognizing both "big T" traumas and accumulated "little t" stressors
• Dr. Grover shares his personal journey with PTSD from emergency medicine and the stigma he faced
• The Adverse Childhood Experiences (ACE) scale reveals how early trauma predicts addiction risk
• Multiple diagnoses often overlap—ADHD, PTSD, and addiction create complex treatment challenges
• Medication options for PTSD include prazosin for nightmares, propranolol for triggering, antidepressants, and more
• Innovative treatments like stellate ganglion blocks can reduce physiological reactivity from trauma
• Trauma-informed care requires providers to create safety and understand the person beyond their addiction
• Breaking stigma requires vulnerability—sharing our stories helps others recognize they're not alone

Visit mdcalc.com to check out the Adverse Childhood Experiences score, and listen to the Last Day podcast episode with Dr. Gabor Maté for more insights on trauma and addiction.

To contact Dr. Grover: [email protected]

We discuss practical strategies for staying up-to-date with addiction medicine research in this collaborative episode between Addiction Medicine Made Easy and the Addiction Medicine Journal Club podcast.

• Featuring a four-person roundtable with Dr. Casey Grover, Dr. John Keenan, Dr. Sonia Del Tredici, and Thomas Bannard
• Understanding why evidence-based medicine matters in addiction care
• Incorporating lived experience into addiction education and combating stigma
• Developing personalized approaches to staying current with medical literature
• Various learning strategies from reading journals to podcasts to collaborative discussions
• Finding your motivation for continuing education in addiction medicine
• Strategies for making learning "stick" through teaching and knowledge application
• Making knowledge "count twice" by developing resources from what you learn
• The value of consistent, sustainable learning processes over ambitious but unrealistic goals

To contact the Addiction Medicine Journal Club Podcast: [email protected]  

To contact Dr. Grover: [email protected] 

Mark MacNichol, a playwright and charity director, shares how his therapeutic approach called Anonymous Drama helps people in recovery and the justice system process trauma and develop emotional wellbeing by viewing their inner thoughts as characters in a play.

• Anonymous Drama is not traditional theater but uses dramatic techniques for therapeutic purposes
• The program helps participants identify characters in their life story, such as the protagonist, the inner critic, and the inner mentor
• Anonymity protocol allows people to explore trauma through fictional characters without revealing personal experiences
• Participants learn to recognize the difference between their negative inner critic and their positive inner mentor
• Over 5,000 people have participated in Anonymous Drama programs, primarily in justice and recovery settings
• The method works by helping people "rewrite their scripts" and develop healthier relationships with themselves
• Mark developed this approach after his own experiences with family addiction and losing his brother to heroin overdose
• Programs are available through an app for individuals or through group sessions
• Financial assistance is available for those who cannot afford the subscription fee

To learn more about Mark's work: https://www.markmacnicol.com/

To contact Dr. Grover: [email protected]

Dr. Amy Swift, Deputy Chief Medical Officer and addiction psychiatrist, shares insights on creating healthcare systems that better serve patients with addiction through reduced stigma, trauma-informed approaches, and greater accessibility. She brings a unique perspective as someone who oversees medical care while remaining deeply connected to patients' experiences, emphasizing the need to understand addiction as a brain disease rather than a moral failing.

• Psychiatry and addiction have historically been separated, with mental health providers often telling patients to "get sober first"
• Understanding executive functioning challenges in addiction helps create more flexible, accommodating healthcare systems
• Stigma against addiction is pervasive in healthcare and actively prevents people from seeking life-saving treatment
• Person-first language and creating welcoming environments are crucial steps in reducing stigma
• Virtually all patients with addiction have experienced trauma, requiring trauma-informed approaches to treatment
• Different trauma responses can drive different patterns of substance use – numbness often leads to stimulant use while hyperarousal leads to depressant use
• Family involvement and education are essential components of effective addiction treatment
• Youth education and prevention efforts are critical, particularly around cannabis and newer substances perceived as harmless
• Healthcare leaders must recognize addiction as a brain disease requiring the same compassion and quality of care as other medical conditions

If you're interested in improving addiction care in your healthcare system or community, focus on reducing stigma, implementing trauma-informed approaches, and creating flexible systems that accommodate the unique challenges faced by those with addiction.

To contact Dr. Grover: [email protected]

Addiction medicine specialists Dr. Casey Grover and Dr. Reb Close share essential information about using naloxone (Narcan) to save lives during opioid overdoses. They discuss how naloxone administration differs between hospital settings and community response, emphasizing that having this medication readily available is crucial in today's world of fentanyl-contaminated street drugs.

• Naloxone should be as normalized and common as fire extinguishers in homes and workplaces
• In medical settings, naloxone can be carefully titrated to prevent precipitating severe withdrawal
• In community settings, the protocol is simple: administer nasal naloxone, call 911, wait for help
• Only 4% of naloxone prescriptions are actually picked up at pharmacies, making direct distribution essential
• Almost all street drugs now contain fentanyl, placing anyone who uses illicit substances at risk of opioid overdose
• Effective community training includes brief videos, hands-on demonstrations, and normalizing the medication
• Emerging substances in the drug supply (xylazine, synthetic benzos) make naloxone even more important
• Framing naloxone as a tool to help others rather than oneself can overcome stigma-based resistance

If you want to conduct a naloxone training in your community and need resources like videos, slide decks, or handouts, please email Dr. Grover. 

Together we can ensure everyone has the knowledge and tools to prevent overdose deaths.

To contact Dr. Grover: [email protected]

Dr. Casey Grover explores the complexities of ketamine, examining its medical benefits, potential for addiction, and growing presence in both therapeutic and recreational settings.

• Originally developed as a dissociative anesthetic for surgery that doesn't suppress breathing
• Now recognized for treating treatment-resistant depression, PTSD, and suicidal ideation
• Can reduce suicidal thoughts as quickly as 90 minutes after administration
• Also effective for severe pain, alcohol withdrawal, and certain emergency situations
• Recreational use has increased dramatically with seizures up 350% between 2017-2022
• Creates a trance-like "K-hole" state that users seek for altered perception and relaxation
• Long-term use can cause "ketamine bladder" – potentially requiring surgical intervention
• No FDA-approved medications exist specifically for treating ketamine addiction
• For-profit ketamine clinics often charge $500-1,250 per treatment without comprehensive care
• Matthew Perry's death highlights the dangers of ketamine misuse, even under medical supervision
• Most patients with addiction histories should approach ketamine therapy with extreme caution

Thank you for tuning in to the Addiction Medicine Made Easy Podcast. Together we can improve how addiction is treated and save lives.

To contact Dr. Grover: [email protected]

In this episode, Dr. Casey Grover explores how integrating behavioral health and addiction services into primary care settings can transform healthcare delivery and dramatically improve access to treatment. Dr. Grover speaks to psychologists Patti Robinson and Jeff Reiter about their work creating integrated primary care practices and clinics. 

• Healthcare in the US is siloed, forcing patients to navigate separate systems for physical health, mental health, and addiction
• Mental health specialization creates artificial barriers when generalist counselors could help many addiction patients
• Integrated care places behavioral health providers in primary care settings with same-day, brief (15-30 min) appointments
• Primary care doctors welcome the support while mental health providers need retraining to adapt to the flexible model
• Physical clinic design matters—providers should be within 15-20 feet of each other for true integration
• "Pathways" can be created for specific populations like those with opioid use disorder
• Patients overwhelmingly appreciate the convenience and comprehensive approach of integrated care

Visit speaktoyourdoctor.com for resources to share with your medical provider about implementing integrated behavioral health services.

To contact Dr. Grover: [email protected]

Discover how stimulating specific points on the ear can dramatically reduce opioid withdrawal symptoms through an FDA-approved device called the ST Genesis. Shelley Halligan, President of Speranza Therapeutics, explains the science behind percutaneous nerve field stimulation and its remarkable effects on patients struggling with addiction.

• The device works by targeting cranial nerves in the ear to activate the parasympathetic nervous system
• Small electrical pulses delivered continuously for five days can significantly reduce withdrawal symptoms
• Clinical applications include shortening the waiting period before starting Suboxone treatment
• The technology may help prevent precipitated withdrawal, a major barrier to recovery
• Patient case studies show dramatic symptom reduction within minutes of application
• Preliminary evidence suggests effectiveness for alcohol and other substance withdrawals
• Research is underway to develop a 10-day version specifically for fentanyl withdrawal
• The device empowers patients by giving them more control over their treatment timeline
• Implementation in emergency settings could transform overdose follow-up care
• Healthcare providers can receive free training to incorporate this technology into practice

Visit speranzatherapeutics.com to learn more about the ST Genesis device and provider training opportunities.

To contact Dr. Grover: [email protected]

Urine drug testing provides critical insights for addiction treatment, helping clinicians understand what substances patients are actually using and how the drug supply is rapidly changing. Matthew Rutledge, founder of MD Labs, shares his expertise on testing methodologies, detection capabilities, and emerging trends in substance use.

• Different drug test types include basic immunoassay cups (similar to pregnancy tests), which detect drug shapes but can have false positives/negatives
• Liquid and Gas chromatography with mass spectrometry provides highly accurate substance identification down to nanogram levels
• Developing tests for novel substances takes 2-4 months, requiring standards and validation across hundreds of specimens
• Poppy seed muffins can genuinely cause positive opiate tests depending on seed source and patient body mass
• Unexpected test results require clinical judgment—some exposures may occur through contamination, intimate contact, or environmental exposure
• Integration of pain and addiction medicine allows better co-management of patients with both conditions
• Emerging threats include nitazine opioids, exotic benzodiazepines, and tianeptine ("gas station heroin")
• Test adulteration methods (vinegar, bleach, dilution) can be detected through validity testing for oxidants, creatinine levels, and specific gravity

To contact Dr. Grover: [email protected]