Addiction Medicine Made Easy | Fighting back against addiction

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 conditionsIf 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: ammadeeasy@fastmail.com

Join Dr. Reb Close, an emergency medicine physician and addiction medicine specialist, as he shares critical insights on using naloxone to combat the opioid crisis. He emphasizes the importance of making naloxone as ubiquitous as fire extinguishers in our communities. Discussions cover the stark differences in naloxone usage between medical settings and the streets, as well as strategies to destigmatize its use. With over 90% of street drugs now containing fentanyl, the urgency for community training and quick response in overdose situations is more crucial than ever.

Explore the dual nature of ketamine, balancing its medical benefits for conditions like treatment-resistant depression against the risks of misuse. Discover how ketamine can quickly reduce suicidal thoughts, but also hear about the alarming rise in recreational use and its dangerous side effects, including severe addiction issues. Learn about the phenomenon of the 'K-hole' and the real health concerns tied to long-term use. With no FDA-approved treatments for ketamine addiction, caution is essential, especially for those with a history of substance abuse.

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 careVisit speaktoyourdoctor.com for resources to share with your medical provider about implementing integrated behavioral health services.To contact Dr. Grover: ammadeeasy@fastmail.com

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 practiceVisit speranzatherapeutics.com to learn more about the ST Genesis device and provider training opportunities.To contact Dr. Grover: ammadeasy@fastmail.com

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 gravityTo contact Dr. Grover: ammadeeasy@fastmail.com

Today we speak with Dr. Samantha Harte about her experience living as a high-functioning person with addiction and how perfection masks internal struggles. She shares her journey from overdosing on cocaine as she was accepted into her doctoral program to becoming an author and recovery coach helping others find authentic healing.• High-functioning addiction often hides behind external success and achievements• Control and perfectionism become secondary addictions that receive cultural reinforcement• Traditional recovery approaches can face resistance from high-achievers who struggle to admit powerlessness• Dr. Harte discusses writing her book "Breaking the Circuit" after losing her sister to overdose• Trauma-informed recovery approaches help address the underlying childhood experiences driving perfectionism• Self-compassion and making amends to yourself are crucial parts of healing for perfectionists• Both Dr. Harte and Dr. Grover share personal experiences of maintaining outward success while struggling internally• Physical healing and spiritual healing are interconnected in authentic recoveryIf something Dr. Harte shared resonates with you, please reach out. Dr. Samantha Harte, responds to her own DMs. Connect with her, book a free discovery call, and don't ignore the call if something pierces you – she's here to wake you up and light your soul on fire.To contact Dr. Grover: ammadeeasy@fastmail.com

Dr. Casey Grover explores the history, neuroscience, and treatment approaches for methamphetamine use disorder, highlighting how methamphetamine releases more dopamine than any other known substance.• Methamphetamine was widely used during World War II by German, Japanese, and Allied forces to enhance performance• Modern meth production shifted from ephedra to P2P method, creating cheaper, more potent meth with worse psychiatric effects• Meth causes dopamine release up to 1,400 ng/dL of dopamine compared to cocaine (400), sex (200), and food (150), severely damaging reward centers• Many methamphetamine users have undiagnosed ADHD and are inadvertently self-medicating• Effective medications include bupropion, topiramate, atomoxetine, viloxazine, guanfacine, and mirtazapine• Contingency management (reward-based incentives) shows significant efficacy for methamphetamine addiction treatment• Combination therapies using bupropion with naltrexone show promise for reducing meth use• Treating underlying mental health conditions and providing housing/social support remains essential for recoveryTo contact Dr. Grover: ammadeeasy@fastmail.com

The discussion delves into treating opioid and alcohol use disorders through medication-assisted approaches. It emphasizes addiction as a challenge of self-regulation, distinguishing between dependence and disorder. Key medications like buprenorphine are highlighted for their effectiveness in reducing cravings and overdose risk. The podcast also tackles the fentanyl crisis and encourages the use of person-first language to combat stigma, promoting a more compassionate understanding of addiction. Off-label medications for alcohol treatment are discussed, offering further insights into comprehensive care.

This episode is an interview with Matt Butler, a singer-songwriter who has performed in jails and prisons across America for a decade. He shares how music creates transformative spaces for healing in correctional environments.• Matt's musical journey began after writing songs for a documentary about recovery high schools• Music penetrates emotional defenses faster than conventional approaches, allowing inmates to be vulnerable• Songs like "Good Friday" and "Time to Be a Man" directly speak to experiences of addiction and incarceration• Hypervigilance in prison environments makes trauma processing nearly impossible• Music temporarily changes the atmosphere, allowing emotional expression typically suppressed for survival• Trauma and addiction form a vicious cycle that's particularly difficult to break while incarcerated• Reentry challenges include practical barriers like employment, housing, and basic skills deficits• Many successful recovery stories involve people transforming their past struggles into purpose by helping others• Creating spaces where people feel safe and accepted is essential for healing from addiction and traumaPlease check out Matt's album Reckless Son, the one-man show he performs in correctional facilities across the country.To contact Dr. Grover: ammadeeasy@fastmail.com