Addiction Medicine Made Easy | Fighting back against addiction

How I've Come to Understand PTSD In My Practice

• Casey Grover, MD, FACEP, FASAM

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Trauma plays a pivotal role in the journey of addiction, with many individuals using substances as a means to cope with unresolved issues. Addressing PTSD is crucial for effective recovery, as understanding the link between trauma and addiction can empower individuals toward healing. 

In this episode we discuss:
• Trauma and its historical context in PTSD understanding 
• Description of brain responses to trauma and the feedback loop 
• Big T and little t traumas and their cumulative effects 
• The connection between adverse childhood experiences (ACEs) and adult illnesses 
• The importance of a trauma-informed approach in treatment 
• Case studies illustrating the impact of trauma on addiction recovery 
• Recommendations for therapeutic interventions and medication options

I reference a podcast episode at the beginning of the episode. Here's a link to that episode

https://lemonadamedia.com/podcast/trauma-with-dr-gabor-mate/

To contact Dr. Grover: ammadeeasy@fastmail.com

Speaker 1:

Welcome to the Addiction Medicine Made Easy podcast. Hey there, I'm Dr Casey Grover, an addiction medicine doctor based on California's Central Coast. For 14 years I worked in the emergency department, seeing countless patients struggling with addiction. Now I'm on the other side of the fight, helping people rebuild their lives when drugs and alcohol take control. Thanks for tuning in. Let's get started.

Speaker 1:

Today we are going to be talking about post-traumatic stress disorder, also known as PTSD. As a part of my work as a medical director for a drug and alcohol treatment program, I give monthly educational lectures to the staff, and this month I lectured on PTSD. It's a very personal topic for me, as I have been diagnosed with PTSD from my 14 years working as a doctor in the emergency department, and nearly all of my patients have lived through traumatic experiences, and many of them also have PTSD. This lecture is a great overview of the topic. Before we start, I gave this lecture while I was in my car due to my busy schedule, so I apologize, the audio quality isn't perfect given the recording conditions. Okay, let's dig in. Okay, so today we are going to talk about post-traumatic stress disorder, and I apologize that this may be triggering, and I will do my best to keep it educational and also be mindful about the link between trauma and addiction. Okay, so I want to share where this came from.

Speaker 1:

So I was at a high school lecturing parents about drugs and alcohol as a way to inform parents about what their kids may be facing in school, and one of the moms came up to me and said we should chat. And I said okay, and that's the person you see at the center of the screen. Her name is Stephanie Whittleswax. She is the author of a New York Times bestseller about her brother's death from heroin overdose, and she and another woman formed a podcast called Last Day, which was initially about both of their brothers dying of heroin overdose and they wanted to explore the last day of their lives to understand what they could learn about addiction. And if anyone recognizes the person on the right of the screen, that's Dr Gabor Mate, who's one of the world's experts on the link between addiction and trauma. And so Stephanie and I connected. She's writing a book about addiction and we met for coffee and I started learning about the fact that she has this incredibly successful podcast and she encouraged me to listen to it, as the entire first season was on opioid addiction and opioid overdose and we connected. So I went to her daughter's school. She was a parent. She actually came and participated in the naloxone training and I'm working on helping her writing her book. I was able to participate with helping her write one of the chapters Extremely intelligent person and has a great podcast and one of the episodes she let Dr Gabor Mate interview her about her life story to better understand why her brother developed addiction and he went so deep into trauma and the link between addiction and trauma and Stephanie, to her credit, was actually able to share her own life trauma and how she has, as an adult, has developed an addiction to work, and it was absolutely mind-blowing for me as an addiction medicine doctor. I realized I was really missing a lot of the trauma that was contributing to addiction. So I listened to that, maybe in about October, and I've been on about a four to five month journey of trying to understand the link between trauma and addiction. So I will also share that.

Speaker 1:

I personally have post-traumatic stress disorder from my 14 years as a doctor in the emergency department and I'll talk about occupational PTSD as a part of this. So what is PTSD? Ptsd is post-traumatic stress disorder and we are aware of it going back literally thousands of years. There are some descriptions of something that we think to be PTSD in Assyrian soldiers in 1300 BCE. Now, we didn't really understand it for many years and I put some historical names for this condition Railway spine stress syndrome, soldier's heart, traumatic war neurosis, shell shocked there's all these terms that describe the phenomena, but we didn't really understand the why until modern times. So what exactly is post-traumatic stress disorder? And the best way I can describe it is bad things happen to us as a part of life and our brain and body does not know what to do with these bad feelings. And there's a lot of negative energy, which we'll talk about in the actual trauma itself, and a lot of times that negative energy doesn't know where to go and the body stores it almost like a scar, and every time that memory gets touched, that scar hurts, if you will, leading to mental and physical symptoms. So here's the why and I'm sure there are many different reasons why people can explain PTSD happens, but here's how it makes sense to me.

Speaker 1:

Our brain as humans is the most sophisticated brain on the planet. However, we share a lot of the same structures with more primitive animals. In other words, the lizard brain has grown and developed into the mammalian brain, the primate brain and eventually the human brain. We keep adding on the older structure to make it more complicated. So if you've ever heard of the term lizard brain, that refers to a very primitive brain that lizards have where they're basically wired for survival, food and sex. That's really it. And when they're threatened they go into a fight-or-flight response. And if you think about it, lizards have very simple brains. And if you think about it, lizards have very simple brains. Lizards don't get post-traumatic stress disorder. If they get threatened, they go into their fight-or-flight response and then they go about their day as long as they survive.

Speaker 1:

Now the human brain is much more complicated. We like to understand things, we like to have reasons, we have philosophy and theory and our brain, as human human tries to understand the trauma, tries to understand why we had the fight or flight event. Why me? Why that day? Why couldn't it have been somebody else? What if it happens again? What if it happens tomorrow? All the what ifs come from the human brain trying to understand the trauma. And here's the issue. We were never meant to understood trauma. We were simply meant to just survive and move on. So I put here squirrels don't get PTSD, they just fight or flight and escape and then move on. And so, unfortunately, the human brain is trying to understand something that was never meant to be understood in the first place.

Speaker 1:

Now there are a couple other responses in humans. We can also fawn, particularly with women who are victims of sexual assault. They have this weird response where they try to really please their aggressor. And then in both animals and humans we can also freeze. So it's probably best fight, flight, freeze or fawn. But just for the sake of this we're going to say fight or flight, just because that's what most people are familiar with.

Speaker 1:

Now, the issue with PTSD in humans is that we end up with this really complex negative feedback loop. So let's say, a person is sexually assaulted, they have their fight or flight response. That memory is seared into their brain. Once the trauma is over. They try to process it, they try to understand it and they can't. Why me? Why that day, what did I do? And so what happens is basically the fight or flight response sends this negative energy up to the human part of the brain. The human part of the brain can't understand it and process it. So that negative energy up to the human part of the brain. The human part of the brain can't understand it and process it, so that negative energy gets unresolved and stored and eventually, when a new trigger comes up that reminds the person of the original assault, that fight-or-flight response triggers again and they try to process it again and it becomes this negative feedback loop.

Speaker 1:

Now how do we diagnose PTSD? The simple answer is, for me is if you have a traumatic history and you have addiction, chances are you have PTSD. Now the official answer is is we use the Diagnostic and Statistical Manual 5th Edition, or the DSM-5, and it's the book in psychiatry that contains all the criteria for every psychiatric diagnosis. And because in psychiatry we can't run a blood test or a scan, we're really just trying to see if the person's symptoms match the criteria and then we give them the diagnosis. So pardon the very small font, but as you can see here there's a lot of complicated criteria for PTSD. The first is they had to have had an exposure to the trauma. Then they have to have intrusive thoughts or memories. They have to try to avoid those thoughts and memories. It has to have a negative effect on their mood and how their brain works. And then they have to be hyper aroused, like they're constantly ready to trigger that fight or flight response again. It has to last for greater than a month, it has to be significant, in other words it's actually affecting their life in a meaningful way, and then it's not from something else. So you can look up these DSM-5 criteria for PTSD. I actually read them to my patients in clinic when I'm trying to make the diagnosis.

Speaker 1:

But here's a simplified way to think about the diagnostic criteria for PTSD. Number one a person was exposed to trauma. Number two they persistently experienced that trauma over and over again, and common things are flashbacks and nightmares. Number two they persistently experience that trauma over and over again, and common things are flashbacks and nightmares. Number three people try to avoid anything that reminds them of the trauma. Number four their mental health declines. And then, number five people are easily triggered or reactive, which can include being hypervigilant, startling easily, not sleeping well, being irritable or engaging or risky and destructive behavior, which includes addiction.

Speaker 1:

So for me, so I have post-traumatic stress disorder from my time in the emergency department. Trauma can happen in many different ways. A person could be traumatized, and they get PTSD. A person could have witnessed a trauma firsthand and they get PTSD. People can get PTSD through their work like firefighters, first responders and police officers, and as I go through this, I can see all the things that happen in my body. So, yes, I have too many horrible stories to remember from the ER. I get flashbacks multiple times a day. I had nightmares for years. I get flashbacks multiple times a day. I had nightmares for years. I still, to this day, will avoid walking through the ER at all costs. My mental health was really declining in the emergency department and absolutely I was having difficulty sleeping and I was hypervigilant in the ER. It really has a profound effect on people. Now, in terms of what actually causes post-traumatic stress disorder, what I'm going to tell you now isn't really science-based, but it's more how it makes sense in my mind and how people have explained it to me.

Speaker 1:

We have big T's and we have little t's. So big T's are a way to reference large, complicated, singular events a stabbing, a shooting, a near fatal car accident, sexual assault. It's like an event that's horrible and you don't want to have to go through it again. It can be many big T's in a row, like I have one patient who was a soldier in Central America and was forced to, you know, assassinate other soldiers and engage in battle. He has lots of big T's. Little T's are smaller, more micro traumas that add up over time. So when a person has a big T, it leaves a big emotional scar in their brain. Little T's would be like a persistently verbally abusive parent Bullying, persistent bullying from a sibling. It's not one big event, but it's many small events that add up over time and the small individual scars add up to have the cumulative effect of a big scar and of course, you can have both.

Speaker 1:

Now, as I mentioned, there's many different ways that a person can be exposed to trauma that leads to PTSD. You can experience it directly. You were robbed at gunpoint. You can have witnessed it firsthand, as in you were there when a car accident happened and you saw the person die in front of you. There can even be some cases where the trauma that a loved one or very, very close friend experiences affects you as well, as you help them try to deal through the negative emotions of their trauma. One of my patients was telling me that her husband was a Vietnam veteran and was horribly traumatized and she talked about for her. She experienced PTSD through her husband, which can absolutely happen. And then you can get exposed to trauma through work. Like me, I still to this day get flashbacks all the time about early COVID and several of my most horrible cases. The one that stands out to me the most is a young woman who hung herself successfully and she died and we couldn't resuscitate her. And that could be through your work as a first responder. I've met hospital social workers that have PTSD. I just want to acknowledge that it's important that we acknowledge that you can get it professionally Now.

Speaker 1:

Very closely linked with PTSD are ACEs, adverse Childhood Experiences, and I want to give a little bit of history on this. So everyone's heard of Kaiser. That's a hospital system in many states. It's in our region not so much, but it's very strong in the San Francisco Bay Area and in Southern California and I used to work at Kaiser when I Francisco Bay Area and in Southern California and I used to work at Kaiser when I was in my training in my residency.

Speaker 1:

And Kaiser is all about prevention. They've realized that if people don't get sick, you don't have to spend the money to take care of them because they're not sick. So Kaiser's big into prevention and so Kaiser was doing some research on why people get ill Heart disease, diabetes, high blood pressure, depression, anxiety, addiction what actually causes people to get ill as adults and what they found is that there was a correlation between adverse childhood experiences and adult illnesses. This is if a child is a victim of physical abuse, physical neglect, there's a household member who has severe mental health issues, sexual abuse affecting the child, loss of a parent due to death, abandonment or divorce, emotional abuse, emotional neglect, a household member with addiction, a household member who was incarcerated or witnessing domestic violence in the home. There's actually 10 criteria. And so, yes, kaiser found that all of these adverse childhood experiences were correlated with adult illness, and it's not the traumatic experience specifically, but it's multifactorial.

Speaker 1:

In other words, if you have a family member with mental illness and addiction, what's your nutrition like? Do you have access to exercise? Do you have stable housing? Do you get good access to education? Do you have enough to eat? So, in other words, children living in an unstable environment or, frankly, a traumatic environment, has a profound effect on their growth and development in many different facets, and I've talked to my patients. One of my patients had eight of these. One of my very dear friends who helps me in many ways. She's helping me learn about trauma through her trauma. She has nine and one of my other patients has eight. I personally have one which was the death of a parent. But if you look at these and start to really screen in patients with addiction, you will find that a lot of our patients with addiction have a significant number of adverse childhood experiences.

Speaker 1:

Now, medicine is not set up to understand trauma. Okay, medicine is all about diagnoses. We ask the question what's wrong with you? So you come to the doctor and your stomach hurts. We run ultrasounds, cat scans, blood work and we give you a diagnosis right, it's gastritis, that's too much acid in the stomach, it's appendicitis, let's say you're tearful and you're crying. We give you the diagnosis of depression. And this is actually one of the things that made me leave the emergency department is we would see people really struggling with drugs and alcohol and emotions and we just focused on the diagnosis and not the person's story.

Speaker 1:

So I spoke to over 5,000 children in 2024. I went to, I think, 27 different schools and if I ask those kids, what do you want to be when you grow up? Nobody says addicted, in jail, homeless, injecting substances. They've got better plans and yet we all know people who are in jail, in and out of prison, injecting drugs, addicted. Something happened right and that's this book's suggestion. It's by Bruce Perry and Oprah Winfrey. Yes, that, oprah, and it's the title of the book is what Happened to you and that's what I encourage healthcare providers to do when they're struggling with a patient's behavior. What happened to you? Because that really asks the question what traumatic experiences did you have in your life that led you to, at 35 years old, being incarcerated, using meth and hallucinating in the emergency department? That wasn't part of the plan when you were in third grade department. That wasn't part of the plan when you were in third grade.

Speaker 1:

So I'm going to make a point here to really just drive home the profound effect of trauma and the relationship with trauma and addiction, and realize I'm exaggerating. To make a point, I am very aware that patients have drug and alcohol cravings. But when I talk to my patients, usually what they feel is something that they don't like and they want to feel better and the drug or the alcohol makes that bad feeling temporarily go away. We all know it doesn't fix it and I think deep down our patients don't, but they just don't know what else to do. So my patients don't crave drugs and alcohol, they crave feeling better, particularly when they're traumatized and can't sleep because they get flashbacks and nightmares all night. Why do they drink? To black out? Because they can't deal with the trauma.

Speaker 1:

I'll give you an example. One of my patients is a great young guy and I was chatting with him about two weeks ago and he was telling me he's got about a year sober from alcohol and we were talking about when he did drink and he said that he was the type of drinker that would just black out. And I never really asked him about his alcohol use, because he came to me about two or three months sober and I said why were you trying to black out? And he said I don't really know. And so the little light bulb went off in my head I wonder if there's some trauma. And so I asked him did you have any traumas as a kid? And he said yeah, yeah. And so we started talking about it and he got sexually assaulted in middle school by a bunch of older boys in his neighborhood. One day after school he couldn't actually finish the story. So I went through the PTSD criteria and he met all of them and I apologized to him. Him I said I'm so sorry I didn't ask about trauma sooner, because we need to address your trauma to really help you heal from your alcohol addiction. So what do we do once we diagnose someone with PTSD? Well, we need to give them trauma-focused psychotherapy so they can work on actually processing the trauma, and I'll talk about that in some detail.

Speaker 1:

We can often use medications to help a person feel better while the psychotherapy starts to work, and actually my recommendation is that we use both together. In terms of medications, the first-line treatment for PTSD are the selective serotonin reuptake inhibitors, and here are some common names Fluoxetine or Prozac, sertraline or Zoloft, citalopram or Celexa and S-Citalopram or Lexapro or Celexa and escitalopram or Lexapro. These are my go-to, my personal favorites. There's a little data that would suggest that maybe Zoloft is a little better in PTSD and, anecdotally, lexapro seems to help better for anxiety. Those are usually my go-to for trauma. You can also use their cousins, serotonin and norepinephrine reuptake inhibitors. There's not as much data on them, but they can still be used, and an example of that would be venlafaxine, also known as Effexor.

Speaker 1:

Now, if you didn't know, there is a very effective medication for nightmares and I started one of my patients on it today and that's Prazacin, which its brand name is Minipress, and Prazacin is interesting. So we all are probably pretty familiar with Klonidine, and Klonidine is a medication that suppresses the release of stress hormones from the brain. That's actually why it's used to treat either alcohol withdrawal or opioid withdrawal, because that's a high stress hormone state. Right, we're in a fight or flight response. We're hyper-stimulated as we're coming off of opiates or alcohol. So clonidine works by reducing the release of stress hormones from the brain and prazosin is its cousin, like Lexus and Toyota. Prazosin is its cousin, like Lexus and Toyota, and prazosin works by also decreasing the release of stress hormones from the brain. It's a little bit sedating and it suppresses nightmares, so it helps with sleep and then it helps reduce some of the traumatic nightmares that come out. I use it all the time in my practice, particularly when people are new in recovery and they're really struggling with sleep.

Speaker 1:

Now there are two other medications that we can also use with PTSD and for me personally, I feel my PTSD in my solar plexus. I get a lot of tightness right there and then I get a lot of tingling in my extrem, then I get a lot of tingling in my extremities and when I get tingling in my extremities I can feel my ptsd being triggered, as I can when I get that tightness in my solar plexus. So there are two other medicines that can be used To to blunt those physical reactive feelings, that hyper vigilance, that over stimulation that comes with ptsd. One of them is clonidine, like we just talked about. It reduces the amount of stress hormones coming out of the brain and so it actually blunts those physical symptoms. The other is propranolol, which is a blood pressure medicine which also suppresses those stress hormones as well. They can be very effective. Which also suppresses those stress hormones as well. They can be very effective. The only major issue is that they can drop the blood pressure. So I actually have one patient right now and I'll share her story in just a second who has PTSD and she is on sertraline or Zoloft, prazosin and propranolol.

Speaker 1:

Now you might be interested in learning more about trauma. There are some fairly famous books on the topic. This is one called the Body Keeps the Score and it's by a psychiatrist named Bessel van der Kolk, and if you ask around the trauma community, there's a lot of awareness of this book and it's a really wonderful journey that a psychiatrist details of how he went from working with World War II veterans to trauma in the modern era and how people's awareness and acceptance of the diagnosis of PTSD has changed. And basically this is his hypothesis when you are traumatized, the body keeps track. In other words to point out the title the body keeps the score. This is another one called Waking the Tiger by Peter Levine. Peter Levine is a psychotherapist who has created a style of trauma therapy called somatic therapy and what he does is he really focuses on the trauma and goes back to the traumatic time and tries to help people in the moment experience the trauma and focus on what they're feeling in their body to process the trauma. And he has some really interesting chapters in that book that describe how the animal brain processes trauma versus the human brain. It's a really enjoyable read.

Speaker 1:

So I have countless traumatized patients. I have so many female victims of sexual assault. It really can be very challenging some days. As I dig into this more, I see so much trauma in my practice. So here's my approach to trauma, putting this all together. Number one I have to actually be aware that a trauma has occurred and has made again that imprint on the patient's brain and their psyche and their body. So I am now asking routinely what sort of traumatic experiences have you had? Some of my patients are very forthcoming with me. One of my patients this week was very honest in the first minute of our encounter that she was sexually assaulted as a child.

Speaker 1:

Sometimes I have to pull it out of people. Step two people need to be in a place where they are safe to be able to process the trauma. So for me, I had to leave the ER. I had to get away of what was continuing to traumatize me. Some of my patients aren't there yet. I'm thinking of one patient who got assaulted this weekend and we're just trying to get her to a place where she can be physically safe. She has no safety in her life. She is not yet ready to process her trauma. So a person has to be away from the trauma to be able to process it.

Speaker 1:

Next, a person needs to start processing that trauma. We need to help the brain to get the negative energy to be able to be processed. So it's not constantly in that negative feedback loop and people can do this on their own. They can journal, they can do art, they can do music, they can also work with a therapist. They can do equine therapy, they can do EMDR, which is eye movement, desensitization and reprocessing. That's a particular type of therapy. There's lots of different ways to do this but, as I say to my patients all the time, the negative energy has to go somewhere, otherwise it's going to stay in that vicious, negative feedback loop of triggering trauma, processing, not being able to process, triggering trauma, trying to process. It's a vicious cycle. And then, while people are going through this, we start medication to reduce the symptoms of PTSD, while the therapeutic modality is taking time to work. So I'm going to share two patient stories to illustrate what I've been working on and this approach to addiction and hopefully this helps us understand the relationship between trauma and addiction.

Speaker 1:

So patient number one is a woman in her 30s and she came to me wanting to get off of alcohol. She had been about maybe three weeks sober. She was trying, she had recently slipped up and so I put her on standard addiction medications for alcohol. I put her on some naltrexone and I added in a little bit of gabapentin because she was anxious. So I kept seeing her. She was sober for about two months she relapsed. She came back to me about two months later, tried again, put her on standard medications focusing on her alcohol use. I put her on naltrexone and I put her on topamax to try to suppress her cravings. She did well again for about two months and she relapsed again and then she came back to me in November and so in my November visit with her I said you know, maybe we're barking up the wrong tree here. Have you had any traumatic experiences in your life? And she said well, not really.

Speaker 1:

So I started probing and I started asking targeted questions about common traumas and what came out is that she was repeatedly verbally and physically assaulted by her stepdad, starting at about age 12. And then she was in a horrific car accident, starting at about age 12. And then she was in a horrific car accident, I think around 19 or 20. That left her in the hospital for several weeks and then she had several years of court dates and legal proceedings related to the accident and we went through the DSM criteria for PTSD and I looked at her and I said you may have a problem with alcohol, but I think PTSD is a deeper issue. And she found this so empowering and again I apologized to her that I hadn't addressed PTSD sooner and so I stopped the naltrexone, I stopped the topamax. I put her on sertraline, also known as Zoloft. I put her on Prazacin she can never remember the names, she knows Zoloft, so she calls Prazacin Nightmare. And I put her on some propranolol and she calls that Trigger. And then she started changing her pivot with her therapist from alcohol to trauma and she's now about three months sober and is really, really empowered to realize that there's more to her addiction than she realized. And I actually just sent her, after I saw her last week, some podcasts on trauma and she's really been very interested in learning more and understanding herself more.

Speaker 1:

Here's a second case. A woman in her late 40s was referred to me by another addiction medicine physician for incurable alcohol use disorder. He'd been working with her for several years and had really been unable to make any progress around her alcohol addiction. She was also using benzodiazepines. So she came to me drinking and using clonazepam and asked me to get her off of alcohol and get her off of clonazepam. First visit. She cried the whole visit. She was intoxicated during the visit and my initial thoughts were just oh man, oh man, this is going to be. This is going to be really hard. This feels like a big mess. What am I going going to do? So I worked with her about six, eight months and we tried various medications for alcohol.

Speaker 1:

We tried some naltrexone, we tried some acamprosate, we tried to pyromate. We have her on gabapentin. We tried her on diazepam. Then she would relapse and then we'd have to wean her off of alcohol with diazepam. We tried clonazepam. Again she would relapse, we'd have to get her off of alcohol and get her on benzos again. We just weren't making any progress.

Speaker 1:

So again around the same time in the fall, I said you know, can we talk about some traumas? And she hit puberty early and she looked like a woman when she was 10, and her stepdad sexually assaulted her and then proceeded to repeatedly sexually assault her, and unfortunately she's had a lot of traumatic relationships. She cannot count the number of times she's been sexually assaulted. I don't know that alcohol is her primary problem or that benzos are her primary problem. She has been horribly traumatized too many times to count and her brain knows that benzos and alcohol make the pain not as bad from her multiple traumas, and so I'm really trying to help her understand what she's been feeling and to understand the why. I can get her sober for maybe about eight weeks at the most and then something happens Our relationship goes bad and she falls apart and she's been traumatized so many times to count.

Speaker 1:

Her brain is so full of these emotional scars that she's so full of triggers and I'm not able to get her to a point where she's stable to really process them. Yet the first patient is actually doing very well. She's away from her trauma, she's ready to start processing and she's really enjoying that with her therapist. The second patient is not. She got sexually assaulted within the last few months again, and what breaks my heart is she knows that alcohol numbs her emotional pain. She's been very honest with me that on several occasions after being sexually assaulted she will ask her abuser for a bottle of alcohol as they leave, because at least she can numb the pain and try to get some sleep and then figure out what to do next.

Speaker 1:

So, as I said, that was a potentially triggering topic and I apologize, but that is a lot of what I'm trying to work on right now with my patients, which is to understand that they've been very traumatized and a lot of what they're just trying to do is feel better. So I realize that drugs and alcohol are a significant part of what we're working on, but I always try to understand the why, and trauma is such a big part of that. So I want to stop here and see what questions people have and then discuss as a group Before we wrap up. A huge thank you to the Montage Health Foundation for backing my mission to create fun, engaging education on addiction, and a shout out to the non-profit Central Coast Overdose Prevention for teaming up with me on this podcast. Our partnership helps me get the word out about how to treat addiction and prevent overdoses To those healthcare providers out there treating patients with addiction.

Speaker 1:

You're doing life-saving work and thank you for what you do For everyone else tuning in. Thank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together we can make it happen. Thanks for listening and remember treating addiction saves lives. I'll see you next time.