The Transformed Minds Pod

Cannabis is more available, more potent, and more normalized than ever but what does the evidence say about its effects on teenagers?In this episode of Transformed Minds, Dr. O is joined by Dr. Vito, a child, adolescent, and addiction board-certified psychiatrist and faculty member at NYU Grossman School of Medicine, to discuss the latest research on cannabis and adolescent mental health.Together, they examine a landmark 2019 JAMA Psychiatry meta-analysis involving more than 23,000 young people, showing that cannabis use before age 18 is associated with a significantly increased risk of major depression and suicidality in young adulthood. They also discuss what clinicians, parents, schools, and policymakers can do to better protect young people.⏱ Chapters00:00 Why Cannabis Matters More Than Ever00:19 Prevention and Treatment Overview01:33 Budget Cuts and Advocacy02:02 Introducing Dr. Vito05:19 The Landmark JAMA Meta-Analysis09:31 Brain Development and Cannabis11:08 Understanding the Risks14:21 Cannabis and Anxiety: What the Evidence Shows16:46 Suicidality Explained20:23 Trauma and Self-Medication22:34 Legalization and Youth Messaging28:54 Pediatric Screening with CRAFFT & SBIRT33:28 Cannabis-Induced Psychosis33:58 Clinical Case Discussion35:03 Harm Reduction and Treatment36:04 Access to Care and Health Disparities39:12 Advocacy for Future Clinicians41:21 Early Exposure and Risk Stratification44:36 Prevention Policy That Works48:15 A Practical Screening Framework49:45 Research, Policy, and Public Health51:22 The Rafa Foundation & FIRE Initiative56:37 Final TakeawaysFeatured Articles- Gobbi G et al. Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood. JAMA Psychiatry. 2019. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2723657- National Academies of Sciences. The Health Effects of Cannabis and Cannabinoids. 2017. https://nap.nationalacademies.org/catalog/24625If you found this conversation valuable, please like, subscribe, and share it with a pediatrician, school counselor, parent, educator, or colleague.

⚠️ Content Note: This episode includes discussion of depression, suicide, and suicidal thoughts. Please take care while listening.If you or someone you know is struggling or in crisis, help is available. In the U.S. and Canada, call or text 988 to reach the Suicide & Crisis Lifeline. If you're elsewhere, contact your local crisis service or emergency services. If there is an immediate risk of harm, call your local emergency number right away.

All episodes are for educational purposes and not a substitute for professional medical or mental health care.

Can psilocybin help patients with treatment-resistant depression and what does the latest clinical evidence mean for people dealing with both depression and addiction?

In this episode of The Transformed Minds (Host Rx), psychiatrist Dr. O breaks down a landmark 2022 NEJM phase II randomized, double-blind, multicenter trial examining psilocybin therapy for treatment-resistant depression (TRD).

Dr. O explains what qualifies as TRD, walks through the trial's three-arm dosing design (1 mg, 10 mg, and 25 mg plus structured psychological support), and interprets the primary outcome, MADRS score change at three weeks. The 25 mg dose showed statistically significant and clinically meaningful improvement, but the story gets more complex by week 12.

This episode is especially valuable for clinicians, patients, and advocates navigating dual diagnosis care co-occurring depression and substance use disorders. Dr. O covers:

- psilocybin-assisted therapy- treatment-resistant depression, - MADRS depression scale, - psychedelic safety- mental health equity- substance use disorder and depression

Whether you're a mental health professional, someone living with TRD, or simply following the rapidly evolving conversation around psychedelic medicine, this episode gives you the evidence-based framework to think critically, not just hopefully about what psilocybin can and cannot do right now.

Can psilocybin-assisted psychotherapy help reduce heavy drinking in alcohol use disorder?

In this Host Rx episode, Dr. O analyzes the landmark 2022 JAMA Psychiatry randomized clinical trial examining psilocybin combined with psychotherapy for adults with alcohol dependence.

Dr. O explains:
• The study design and outcomes
• How psilocybin may promote cognitive flexibility
• Safety considerations
• Ethical and policy challenges
• What this means for the future of addiction treatment

This episode also explores implementation barriers, reimbursement issues, disparities in access, and the importance of rigorous scientific oversight as psychedelic medicine evolves.

Educational only, not medical advice.

#Psilocybin #AlcoholUseDisorder #PsychedelicTherapy #AddictionPsychiatry #MentalHealthPodcast

Stimulant overdose deaths are rising rapidly and one of the most effective treatments remains widely misunderstood.

In this episode of Transform Minds Podcast, Dr. O sits down with addiction psychiatrist Dr. Dong Chan Park to explore contingency management (CM), an evidence-based treatment for stimulant use disorder that uses immediate rewards to reinforce recovery behaviors.

Drawing on a 2025 American Journal of Psychiatry cohort study, this conversation examines how contingency management may significantly reduce all-cause mortality while addressing the ethical, clinical, and policy barriers limiting broader adoption.

WHAT YOU’LL LEARN:

• Why stimulant-involved overdose deaths continue to rise
• How contingency management works in real-world addiction treatment
• Why CM is often criticized as “bribery”
• The evidence linking CM to lower mortality
• Trauma-informed approaches to stimulant treatment
• The role of ADHD, housing instability, and relapse triggers in recovery
• How CBT, IOP, and multidisciplinary care support long-term outcomes

FEATURED ARTICLES & RESOURCES:

• Coughlin LN et al. Contingency Management for Stimulant Use Disorder and Association With Mortality. Am J Psychiatry. 2025.
  https://doi.org/10.1176/appi.ajp.20250053
• National Academies of Sciences:
  Medications and Behavioral Treatments for Substance Use Disorders
• SAMHSA:
  Treatment of Stimulant Use Disorders

Recovery is possible. Evidence-based treatment saves lives.

#ContingencyManagement #StimulantUseDisorder #AddictionPsychiatry #MentalHealthPodcast #AddictionRecovery

In this episode, Dr. O examines how self-harm, substance use, and emotional dysregulation interact to increase risk in adolescents and young adults.

Drawing on the Global Burden of Disease Study 2025, this discussion highlights how mental disorders, substance use, and self-harm are leading contributors to disability in ages 10–24.

Key topics include:

• Substance use as a major risk factor for suicidal thoughts and behaviors

• Emotional dysregulation and impulsivity

• Social media and behavioral risk patterns

• Clinical implications for screening and early intervention

Featured research includes:

• Xu et al., Translational Psychiatry 2025

• Jones et al., Substance Abuse 2023

• López-Martínez et al., Behavioral Sciences 2025

RESOURCES:If you or someone you know is in immediate danger, call emergency services (911 in the U.S.) right away.

*U.S.: Call or text 988 (Suicide and Crisis Lifeline) OR Chat via 988lifeline.org

*International: Visit findahelpline.com to find local resourcesYou are not alone. Help is available.

Are dose caps on buprenorphine costing lives? In this episode of the Transform Mind Podcast, Dr. O and Dr. Drits dig into the evidence and the gaps around buprenorphine dosing for opioid use disorder In the fentanyl era, drawing on a 2023 narrative review by Grande and colleagues published in the Journal of Addiction Medicine.

Higher doses are consistently linked to better treatment retention. Yet dose caps persist in clinical practice and insurance policy, even as the opioid supply has fundamentally shifted. Dr. O and Dr. Drits break down why, and what clinicians and patients can do about it.In this episode:

→ Why the "ceiling effect" applies to respiratory depression not to craving or withdrawal relief

→ What the evidence says about retention, fentanyl, and dosing

→ How to advocate for patients within institutional and insurance constraints

→ Common myths about diversion and high-dose buprenorphine

→ Shared decision-making in practice

Learning Objectives

By the end of this episode, listeners will be able to:

1. Describe the evidence base regarding buprenorphine dose limits and clinical outcomes.

2. Explain how buprenorphine pharmacology informs safety at higher doses.

3. Identify policy and systemic factors that influence dosing practices.

Apply evidence-based reasoning to clinical and systems-level decision-making in opioid use disorder care.

Chapters:

00:00 High Dose Benefits

01:23 Podcast Intro Format

02:34 Why Dose Caps Matter

07:48 Guest Perspective Policy Lag

11:27 Dose Limits Today

14:44 Buprenorphine Pharmacology

18:07 Retention Saves Lives

20:31 Fentanyl Needs Higher Doses

22:25 Advocacy Under Limits

24:53 Training And Myths

28:38 Case Dosing Decisions

34:38 Shared Decision Making

37:34 Ceiling Effect Explained

39:24 Key Takeaways

Reference: Grande LA et al. "High-dose buprenorphine for the treatment of opioid use disorder in the context of fentanyl exposure." Journal of Addiction Medicine, 2023.

⚠️ This podcast is for educational purposes only and does not constitute medical advice. Clinical decisions should be made in consultation with a qualified healthcare provider.

#BuprenorphineTreatment #OpioidUseDisorder #MOUD #FentanylCrisis #AddictionMedicine #HarmReduction #TransformMindPodcast

Why does mental health care stay fragmented when the evidence for effective treatment already exists? In this Host Rx episode, Dr. O argues that persistent treatment gaps are a structural problem, not a knowledge problem.

Drawing on a 2023 Lancet Psychiatry paper, Dr. O breaks down what's actually driving fragmentation:

• Insurance design and weak parity enforcement
• Prior authorization delays blocking time-sensitive care
• Scope-of-practice restrictions and workforce shortages
• EHR silos and reimbursement models that don't support collaborative care

She maps the problem across clinical, organizational, and policy levels, and makes the case for structural literacy as the foundation for reform.

00:00 Evidence Versus Architecture01:05 Podcast Welcome And Format02:19 Treatment Gaps Are System Design04:58 Why Care Stays Fragmented06:38 Insurance Shapes Clinical Care07:19 Why Pilots Fail To Scale08:14 Case Study OUD And Depression09:49 Clinician Reflection And Levers10:52 Warm Handoffs And Case Conferences13:45 Why Silos Persist In Practice15:18 What Integration Really Means15:54 Three Levels Of Architecture17:42 Advocacy And Closing MessageFeatured Studies- 2023 Article, The Lancet Psychiatry (ScienceDirect link provided)- Lagisetty PA et al., 2019. Racial disparities in buprenorphine treatment. JAMA Psychiatry.- Parity enforcement advocacy and policy statements from the American Medical Association

Transformed Minds is hosted by Dr. O and covers addiction medicine, psychiatry, and the policy shaping mental health care delivery.

In this episode of Transformed Minds Season 2, Dr. O sits down with addiction medicine specialist Dr. Desai, a CATCH Team Lead Physician (Consult for Addiction Treatment and Care in Hospitals), for a deep clinical dive into alcohol withdrawal management in the hospital setting.

Whether you're a hospitalist, internist, nurse, resident, addiction medicine clinician, or medical student, this episode gives you a practical, bedside framework you can use immediately.

What You'll Learn:

• A practical framework for risk-stratifying alcohol withdrawal at the bedside
• When and how to use CIWA and what most clinicians get wrong
• How to choose between benzodiazepine regimens based on patient profile
• When phenobarbital enters the picture and how to use it safely
• How an interdisciplinary consult model changes outcomes for hospitalized patients with alcohol use disorder

Chapters

• 00:00 Why Early Assessment Matters
• 00:49 Welcome to Transformed Minds
• 02:38 Meet Dr. Desai
• 04:37 What Is the CATCH Team
• 07:26 Alcohol Withdrawal Red Flags
• 13:10 Bedside CIWA and Reassessment
• 15:16 Symptom-Triggered Protocols
• 18:10 High-Risk Withdrawal Timeline
• 20:22 Front-Loading and Fixed Tapers
• 25:58 Complicated Withdrawal and Phenobarbital
• 36:54 Choosing the Right Benzo
• 39:32 Key Takeaways and Wrap Up

Subscribe to Transformed Minds for clinical education on psychiatric and addiction care, advocacy and tips.

In this Host Rx episode, Dr. O examines a critical reality in addiction care: access gaps.

Medications for Opioid Use Disorder (MOUD), including buprenorphine, reduce all-cause mortality by approximately 50%. The evidence is clear. Yet in the United States, who receives these medications often depends on race, income, insurance status, and geography.

What This Episode Covers

- Racial disparities in buprenorphine prescribing.

- Geographic inequities and treatment deserts.

- Medicaid expansion and insurance barriers.

- Adolescent access gaps.

- Telehealth reforms and post-COVID regulatory changes.

- Structural determinants driving opioid mortality.

Grounded in peer-reviewed research and national policy analysis, this episode is designed for clinicians, policymakers, advocates, public health professionals, researchers, and trainees in psychiatry and addiction medicine, as well as anyone who wants to understand why zip code should not determine survival.

Featured Research

- Lagisetty et al., 2019. Buprenorphine Treatment Divide. JAMA Psychiatry. -

-Krawczyk et al., 2022. Policy Impact on Buprenorphine Access. JAMA Network Open.

-Goedel et al., 2021. Structural Determinants of Treatment Access. American Journal of Psychiatry.

-Samples et al., 2022. Telehealth and Buprenorphine Access. Health Affairs.

-Williams et al., 2023 .Treatment Inequities and Policy Reform. Lancet Psychiatry.

-Priest et al., 2022. Adolescent Treatment Access. Journal of Adolescent Health.

-Clinical guidance: SAMHSA and CDC.

Episode Chapters

00:00 Welcome to Transformed Minds

01:27 Why Access Matters

04:11 Research on Treatment Gaps

07:07 Clinician Pipeline and Policy

11:16 Frameworks and Care Models

12:31 Buprenorphine vs Methadone Systems

16:07 Geography, Youth, and Trauma

20:04 Case Study: Marcus

22:58 How Buprenorphine Works

25:50 Access Is the Treatment

27:35 Screen for Structural Barriers

30:55 Final Call to Advocate

Because where you live should not determine whether you survive.

Does incarceration actually reduce substance use or does it make it worse?In this episode of The Transformed Mind, Dr. Owusu sits down with forensic and addiction psychiatrist Dr. Jason Barrett to examine the growing body of evidence showing that incarceration is not a deterrent to drug use and may actually increase risk after release, even after controlling for prior substance use.Using longitudinal research on formerly incarcerated Black Americans as a foundation, this conversation moves beyond statistics to explore the lived realities of incarceration, reentry, trauma, and gaps in addiction treatment. Together, they unpack why relapse after release is not a moral failure, but a predictable outcome of disrupted care, untreated trauma, and structural barriers like housing instability, loss of insurance, and lack of access to evidence-based treatment.This episode covers:- Why incarceration predicts drug use independent of prior useCarceral trauma, racialized trauma, and loss of autonomy- Why court-mandated treatment often fails without readiness- The role of clinicians as the “last bridge” for patients- Medication access in jails and prisons (and why continuity of care matters)- How community organizations, peer specialists, and policy reforms can reduce harm- Why addiction should be treated like diabetes, not punished like misconductThis episode is essential listening for clinicians, trainees, policymakers, community advocates, and anyone seeking a more honest, evidence-based conversation about addiction and the justice system.🎧 Listen on Spotify, Apple Podcasts, and wherever you get your podcastsFeatured resources:Rich JD, Wakeman SE, Dickman SL. Return to illicit drug use post-incarceration among formerly incarcerated Black Americans. Drug Alcohol Depend. 2018;187:77–82.Brinkley-Rubinstein L. Incarceration as a social determinant of health. Lancet Public Health. 2018;3:e165–e166.Binswanger IA, et al. Mortality after prison release. N Engl J Med. 2007;356:157–165.National Academies of Sciences. Medications for Opioid Use Disorder Save Lives. 2019.Subscribe for weekly conversations on psychiatry, addiction, and structural health00:00 – Welcome & episode overview02:10 – Why this conversation matters right now04:40 – Intergenerational incarceration, foster care, and homelessness07:30 – Lack of treatment inside jails and prisons10:15 – Why incarceration predicts drug use even after prior use is controlled14:20 – “What does the substance do for you?”18:45 – Trauma, PTSD, ADHD, and untreated psychiatric drivers23:10 – The myth that incarceration stops drug use27:30 – Court-mandated treatment vs readiness for change32:40 – Stages of change and why forced care often fails37:15 – Being the only bridge left for a patient41:50 – Carceral trauma and racialized trauma47:10 – What forensic psychiatry actually is51:30 – How clinicians should assess incarceration history56:20 – Addiction treatment during incarceration: what the evidence shows1:01:10 – Medicaid gaps, reentry, and continuity of care1:07:30 – Community organizations, peer specialists, and rehabilitation1:14:40 – Addiction vs diabetes: dismantling stigma1:21:10 – Case presentation: post-release escalation explained1:28:50 – Evidence-based interventions before release1:35:30 – Final reflections and key takeaways