Food isn’t just fuel and obesity isn’t just willpower. We sat down with bariatric surgeon Dr. Mark Vierra to unpack what weight-loss surgery really changes, why genetics and hormones can overpower the best intentions, and how a careful program decides who needs a scalpel and who needs a different plan. From GLP‑1 surges and ghrelin drops to PYY’s “brake,” we walk through how surgery reshapes appetite signals and why even modest weight loss can dramatically improve diabetes and cardiovascular risk.

The conversation goes beyond the operating room. Dr. Vierra explains why five of six referrals don’t get surgery, how he and his partner analyze food diaries, depression, and daily constraints, and when medications like bupropion or GLP‑1s make more sense. We explore binge patterns, the messy reality of predicting who will do well after weight loss surgery, and the tough calls around patients who’ve been told their BMI is destiny when their labs and function say otherwise. The story shifts sharply when we talk alcohol: after gastric bypass, blood alcohol rises faster and stays higher, which raises the risk of alcohol use disorder over time. We share practical ways to screen motives for drinking, plan safeguards with families, and use craving meds thoughtfully.

What ties it all together is respect for biology and the person in front of us. Genetics like MC4R variants and syndromes such as Prader–Willi can drive lifelong hyperphagia; ultra‑processed foods and liquid calories amplify the problem; stigma keeps people from care. We push for a different bias—against soda and engineered foods, not against people—and for care that follows patients long after the incisions heal. If you want a grounded, humane guide to obesity treatment, this conversation delivers clarity without blame.

If this resonated, follow the show, share it with a friend, and leave a review so others can find it. Your support helps us keep building informed, stigma‑free conversations about health.

To contact Dr. Grover: [email protected]

Your brain is ancient, but your world is not. We unpack how a hunter-gatherer reward system runs into modern dopamine superstimuli—engineered foods, infinite feeds, one-click buys, and potent drugs—and why that mismatch can spiral into addiction. Using clear language and vivid examples, we explain cravings, compulsion, and consequences through the lens of dopamine: how normal rewards help us survive, how substances hijack that circuitry, and how constant notifications keep the throttle stuck open.

We go deeper into the factors that raise or lower risk. Genetics account for roughly half of vulnerability and often determine a “drug of choice,” where one person feels sick from alcohol while another feels energized and social. Then we connect the dots between mental health and substance use. Depression, anxiety, ADHD, and PTSD frequently overlap with addiction, and treating one without the other rarely works. The ACEs research shows how chronic childhood stress reshapes the brain and the body, setting the stage for later disease. PTSD flips fight-or-flight on at the wrong time, and many people reach for alcohol or cannabis to blunt nightmares and panic, only to worsen the cycle.

Timing is pivotal. Teen brains run on lower baseline dopamine yet respond fiercely to novelty, making early use more rewarding and more dangerous. We share practical insights about delaying use, protecting brain development, and building real skills for stress, sleep, and conflict. A candid case study ties it together: a young adult mixing alcohol and cocaine, a missed PTSD diagnosis, and a turning point when care shifts to trauma therapy and targeted medications. The takeaway is hopeful and clear—when we treat the pain beneath the substance and rebuild healthy rewards, recovery becomes possible and durable.

If this conversation helped you see addiction more clearly, subscribe, share the episode with someone who needs it, and leave a review with your biggest takeaway. Your support helps more people find science-based care and hope.

To contact Dr. Grover: [email protected]

A brightly colored box at a smoke shop should not hit like an opioid, yet that’s the business model behind “gas station heroin.” We dive into how tianeptine—a foreign antidepressant with mu‑opioid activity—landed on American countertops as a “dietary supplement,” and why that mirrors a broader playbook: repackage potent psychoactives, exploit loopholes, pivot fast when bans arrive, and let consumers pay the price. Joined by Matthew Lowe, executive director of the Global Kratom Coalition, we trace the supply chain from warehouses to wallets and separate leaf kratom from the synthetic isolates hijacking its name.

We break down the risk gradient inside the kratom category: natural leaf with fiber and mixed pharmacology, concentrated extracts that raise potency, and seven‑hydroxymitragynine products that function like a novel opioid. Matthew explains why the FDA’s percentage‑based scheduling of 7‑OH is a smart, surgical fix that preserves traditional use while ejecting synthetic opioids from the “supplement” aisle. We also tackle hemp’s loophole economy—Delta‑8 and Delta‑10 THC derived from hemp yet delivering marijuana‑like effects with far less oversight—plus contamination, cross‑stocking, and the handful of distributors fueling multiple “legal high” trends at once.

Beyond policy, we talk people. When regulators finally pull a dangerous product, dependent users are often left stranded. We outline a practical path: better labeling that discloses opioid activity and dependence risk, age gates, potency caps, and targeted enforcement against unapproved drugs sold as supplements. Just as crucial, clinicians need straightforward guidance to assess what patients took, why they took it, and how to transition them to safer, evidence‑based care without stigma.

Curious how these products keep showing up, what “novel synthetic opioid” really means, and how we can protect choice where risk is low while acting decisively where harm is high? Press play, share this episode with a friend, and leave a review with the one reform you think would make the biggest difference. If this helped you learn something new, subscribe so you never miss an update.

To contact Dr. Grover: [email protected]

Have you ever wondered what it's like to practice Addiction Medicine? In this episode I speak about what we do in Addiction Medicine - both generally as well as how we do things in our practice on the Central Coast of California. 

I share how our clinic treats substance use with low‑barrier access, kind care, peer support, and long‑acting injectables while partnering with therapists to address trauma and ADHD that often drive relapse. 

I also review two cases that reveal how PTSD and undiagnosed ADHD change the treatment plan and the outcome.

Topics Discussed:

• What an addiction medicine visit includes  
• Medications for alcohol and opioid use disorder  
• The "three‑legged stool" of meds, therapy, and groups to treat addiction
• Levels of care and smooth transitions  
• Dual diagnosis as the rule, not the exception  
• Low‑barrier access through walk‑ins and telemedicine  
• Person‑first language to reduce stigma  
• Peer support as lived‑experience expertise  
• Long‑acting injectables to boost adherence  
• Mobile street medicine and carceral care partnerships

To contact Dr. Grover: [email protected]

Dr. Casey Grover welcomes Dr. Sarah Nasir, an addiction medicine specialist, for an insightful conversation about effectively communicating with patients and addressing common myths in addiction treatment.

• Personal journeys into addiction medicine that transformed both doctors' understanding of substance use disorders
• The science behind medication-assisted treatment and why it's not "trading one addiction for another"
• How the body adapts to chronic opioid use through three key mechanisms: reducing natural chemicals, decreasing receptors, and increasing metabolism
• Why recovery takes time: "It's easier to break something than to fix it"
• The critical connection between trauma, PTSD, and addiction
• Integration of life coaching principles into addiction treatment
• Creating authentic connection as a cornerstone of effective recovery
• Addressing stigma around medications in recovery communities and sober living facilities
• The difference between dependence and addiction in patient education

If you're a healthcare provider treating patients with addiction, thank you for your life-saving work. For everyone else, thank you for taking time to learn about addiction – it's a fight we cannot win without awareness and action.

To contact Dr. Grover: [email protected]

Mental health conditions and addiction are deeply intertwined, creating complex treatment challenges that require addressing both simultaneously. Dr. Mark Hrymoc, an addiction psychiatrist, shares insights on effectively treating dual diagnosis patients through parallel treatment plans that address both substance use and underlying mental health conditions.

• Dual diagnosis (co-occurring disorders) describes patients with both mental health conditions and substance use disorders
• Many patients use substances to self-medicate underlying mental health conditions rather than for euphoria
• 50-80% of patients with addiction also have PTSD or significant trauma histories
• SSRIs like Zoloft and Lexapro are first-line treatments for anxiety disorders including PTSD
• Prazosin is effective for PTSD-related nightmares
• Propranolol, clonidine, and gabapentin offer non-addictive options for anxiety management
• ADHD is a major risk factor for developing substance use disorders
• Non-stimulant options like Strattera, Qelbree, and Wellbutrin should be tried first for ADHD with comorbid addiction
• Insomnia treatment options include trazodone, mirtazapine, quetiapine, and newer DORA medications
• Ketamine therapy shows promise for treatment-resistant depression and suicidality

Remember, treating addiction saves lives.

To contact Dr. Grover: [email protected]

Dr. Casey Grover shares his personal struggle with food addiction and binge eating while exploring the science behind why certain foods trigger addictive behaviors in the brain. He examines how the food industry deliberately engineers products to maximize pleasure and consumption through carefully calibrated combinations of sugar, fat, and salt.

• Food addiction involves an intense dopamine response to certain foods that varies between individuals based on genetic predisposition
• The food industry uses "bliss point" science to make products as addictive as possible
• Ultra-processed foods make up over half the average American diet despite increasing risks of various diseases
• Eating disorders (anorexia, bulimia, binge eating) are mental health conditions where food behaviors are merely the symptoms
• Treatment options include SSRIs, topiramate, naltrexone/bupropion combinations, and potentially GLP-1 medications
• Weight loss surgery fails to address the underlying mental health aspects of food addiction
• Dr. Grover's personal experience with naltrexone showed how it made previously pleasurable foods taste "flat"

If you found this episode helpful, please consider supporting Central Coast Overdose Prevention (https://ccodp.org/) and the work we do to treat addiction and prevent overdoses. Together we can improve how addiction is treated and save lives.

To contact Dr. Grover: [email protected]

This episode is the fourth and final episode of a four part series on stigma.

This episode is done in collaboration with Central Coast Overdose Prevention (CCODP) and was made possible by California Overdose Prevention Network Accelerator funding from the Public Health Institute's Center for Health Leadership and Impact.

First responders face unique mental health challenges due to the high-stress nature of their work, but stigma often prevents them from seeking help when they're struggling. Dr. Casey Grover, firefighter/paramedic Jesse, and firefighter/paremedic Evan discuss the psychological toll of being the ones who save lives, including PTSD, addiction, and the struggle with vulnerability.

We also hear from Dr. Reb Close, who worked as an Emergency Medicine physician for over 20 years.

• First responders naturally prioritize others over themselves, often neglecting self-care
• "Normalization of deviance" occurs when first responders gradually develop unhealthy coping mechanisms
• PTSD is a permanent brain change that many first responders experience but fear admitting
• Female first responders face additional challenges and scrutiny in male-dominated professions
• The pressure to appear perfect creates barriers to seeking help, even when struggling severely
• First responders often judge themselves more harshly than they judge others
• Addiction can develop as a way to self-medicate trauma and stress
• Recovery is possible when first responders become willing to be vulnerable and uncomfortable
• Those with established careers have the social capital to break stigma by sharing their experiences

If you're a first responder struggling with mental health or addiction issues, please know that help is available and seeking it early can prevent tremendous suffering. You are not alone, and recovery is possible.

To Contact Dr. Grover: [email protected]

This episode is the third episode of a four part series on stigma.

This episode is done in collaboration with Central Coast Overdose Prevention (CCODP) and was made possible by California Overdose Prevention Network Accelerator funding from the Public Health Institute's Center for Health Leadership and Impact.

In this episode, Wendy Solorio shares her raw, emotional journey as a mother supporting her daughter Gabrielle through addiction and into recovery, highlighting the often-overlooked impact on families and caregivers.

• First recognizing her daughter's addiction during high school while dealing with guilt and shame as a parent
• Reaching emotional breaking points while preparing for the worst possible outcomes
• Navigating the healthcare system and waiting for treatment beds during crisis moments
• Facing financial devastation with treatment costs of $40,000 and maxing out multiple credit cards
• Experiencing stigma from coworkers, friends, and even law enforcement
• Dealing with the trauma that remains even after 2.5 years of her daughter's sobriety
• Finding support through therapy, medication, and select family members
• Advocating for better education among first responders and healthcare providers
• Emphasizing the critical role of substance use navigators in emergency departments
• Offering advice to other parents: "Care for the caregiver, never stop self-educating, have tough conversations"

To contact Dr. Grover: [email protected]

This episode is the second episode of a four part series on stigma.

This episode is done in collaboration with Central Coast Overdose Prevention (CCODP) and was made possible by California Overdose Prevention Network Accelerator funding from the Public Health Institute's Center for Health Leadership and Impact.

In this episode, Gabrielle shares her powerful journey from fentanyl addiction to recovery, highlighting the unexpected moment of compassion from a correctional officer that changed everything. Her story reveals how respect and dignity can transform recovery outcomes, while exploring the deep impact of self-stigma and family support.

She shares her experience:

• Hitting rock bottom on Christmas Eve 2022 after stealing her mother's car during active fentanyl addiction
• Experiencing six overdoses, with each one bringing her closer to death
• Finding transformation through a year-long program at Teen Challenge
• Encountering a correctional officer who showed unexpected compassion and dignity
• Battling intense self-stigma despite having family who never gave up on her
• Receiving an ultimatum from her pregnant sister that became a powerful motivator
• Learning that recovery meant becoming a different person, not just the same person without drugs
• Moving from shame about her addiction to being open about her recovery journey
• Finding ways to help others by showing kindness and treating "humans like humans"
• Building a life she couldn't have imagined three years ago, working six days a week and helping with her sister's child

If you or someone you know is struggling with addiction, remember you don't have to do it alone. There are many avenues to recovery, and compassion can make all the difference.

To Contact Dr. Grover: [email protected]