Addiction Medicine Made Easy | Fighting back against addiction
Addiction is killing us. Over 100,000 Americans died of drug overdose in the last year, and over 100,000 Americans died from alcohol use in the last year. We need to include addiction medicine as a part of everyone's practice! We take topics in addiction medicine and break them down into digestible nuggets and clinical pearls that you can use at the bedside. We are trying to create an army of health care providers all over the world who want to fight back against addiction - and we hope you will join us.*This podcast was previously the Addiction in Emergency Medicine and Acute Care podcast*
Addiction Medicine Made Easy | Fighting back against addiction
When your brain can't let go: Understanding the PTSD-addiction connection
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: ammadeeasy@fastmail.com
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. Today's episode is on post-traumatic stress disorder, also known as PTSD, specifically the link between PTSD and addiction. It's a joint episode between my podcast and the Kratom Sobriety Podcast. If you haven't heard of the Kratom Sobriety Podcast, they are awesome. The Kratom Sobriety Podcast is focused on helping people learn about Kratom and get help when they get addicted to Kratom, and they've hosted me on their podcast several times now to share my perspective as an addiction medicine doctor on Kratom for their audience. And so they did another interview with me recently with a focus on how life trauma affects addiction, and the conversation was so awesome that we decided to make it a joint episode on both podcasts. And with that, here we go.
Speaker 2:Hi, Dr Grover, how are you? Hello, how are you? It's so good to catch up with you. We just figured you know. Because trauma is such a recurrent predominant theme in the addiction world and Dr Grover is very knowledgeable about trauma and PTSD from both lived experience and his clinical experience, why not do a trauma dump in the form of a Q&A on trauma in the context of addiction and more?
Speaker 1:in the context of addiction and more. I'm right here. I'm very excited about this episode. My niche in addiction medicine, in addition to Kratom, is becoming the intersection between addiction and PTSD.
Speaker 2:Perfect, yeah, so you mentioned you were diagnosed with PTSD last year from your time as an emergency medicine physician. Do you want to tell your story a little bit more, or just briefly? It was very compelling and I think the listeners will enjoy having that lived experience perspective, in addition to all the clinical knowledge bombs you will be dropping.
Speaker 1:Yeah, in medical school we didn't get a lot of education about post-traumatic stress disorder and it was largely felt to be something that people got when they returned from war zones Significant conflict, gunshots, explosives. It was really something that people got when they returned from war zones Significant conflict, gunshots, explosives. It was really something that I was taught. You had to have just incredibly big, huge, life-changing traumas to really cause PTSD. And I remember hearing the term trauma-informed early in my training as a doctor and I was like what is that Trauma is when you fall off of a building and you have to go to the operating room to fix your shoulder? I was thinking and I was taught about trauma in the physical sense only. And so I started, as I look back, developing some symptoms of post-traumatic stress disorder as early on as my residency that's the training time after medical school and I just thought it was normal. Oh sure, I have a nightmare about working in the emergency department, that's normal. Or, yeah, I get a little nervous before an ER shift. Or yeah, I get a flashback about a bad case, or I can't get this one case out of my mind. That's part of the job and I assumed everyone else felt the same way and I was actually doing fairly well as an emergency physician. I graduated my training from Stanford in 2013 and I was the director of the department and going into 2020, life was good, except there was something happening. We all know that was COVID and it was really intense. And I was something happening we all know that was COVID and it was really intense and I was the medical director of the department. Through COVID and we just rallied in my department. We all were selfless, we knew that the health of the community mattered and we just threw ourselves into our work.
Speaker 1:And starting about 2022, I was different. On shift, it was harder to be empathetic, I felt overwhelmed more easily and I was like you know, it's just a pandemic thing, we're still recovering. And getting into 2023, something was wrong. I was a different person. My personality changed. I was less empathetic and I pride myself on kindness and respect and honesty and I was having trouble bringing kindness and respect to work and I felt, for the first time, resentful towards a patient for checking into the emergency department and I just had this moment of just whoa, what is that? I did not sign up to ever resent anyone for needing medical care and I thought it was just hey, I'm chief of staff, I've got a new leadership role, it is the stress and at the end of 2023, I got some physician coaching. There's a physician out there, quick shout out to Dr Rob Orman. He coaches physicians who are struggling. And I was in a new leadership role, chief of staff. That's like being student body president for the doctors and I wanted to do my best, and so I got a little education money in my new leadership role to better myself. And I said, hey, I want to do some physician coaching and I'm going to learn how to be a better leader. And the first session I did with him was what's burnout? Do I have it and how do I help my colleagues? And he unearthed some stuff that we realized was a lot more.
Speaker 1:And around that same time, the hospital thank you, montage Health started offering free therapy and counseling for doctors, and there's a lot of shame and stigma, particularly among physicians, about mental health. And I said, well, hey, I'm the head honcho when it comes to the doctors. I want to lead by example. And so I signed up for therapy. My first therapist was not a great fit, and as I worked with my therapist, she said do you get nightmares? And I said yeah, and she goes do you get nightmares about work? And I was like, yeah, pretty regularly. And she's like, how often do you get flashbacks about bad cases at work? And I said, well, I don't know, like a couple of times a day why this is all normal. And she pointed out to me that I had post-traumatic stress disorder. I was having flashbacks, negative experiences. It was affecting my mood. I was having consequences in my work. And I'll never forget one of the shifts. The nurses asked me hey, dr Grover, how are you? And all I could say was I am physically present and I got a couple of looks from the nurses like uh-oh, something's wrong with Grover.
Speaker 1:So I continued to work with my therapist she's an awesome human being and I realized I needed to leave the emergency department and I was so embarrassed. I told my colleagues I had a medical issue. I was super cryptic about it. I tried switching to a low acuity area of the emergency department where people aren't as sick, it's not as complicated, and that was still causing me symptoms.
Speaker 1:I mean, the minute I walked through those doors I was just a different person and finally I realized I had to say goodbye to all of it, and I have a lot of social capital. I'm a successful physician, I'm respected in my community and I felt it was my duty to be vulnerable on behalf of those who can't. And so I just told everyone, I told the board of trustees at my hospital and highlighted the need to support the mental health of medical providers. I wrote an article that was published nationally for emergency physicians and I had to own it and I tell anyone who wants to talk about it. I have nothing to hide and I got to be honest. Ptsd has been a roller coaster and I have the utmost respect for the diagnosis, given what I've been through. Sorry for the long answer, but that's my story.
Speaker 2:You definitely don't have to apologize. I appreciate it and I think the listeners will as well. Yeah, there really is a lot of stigma in the medical community, and even for people like creative users seeking help. There's a lot of stigma there too, which I guess we can get into a little bit more, but I do relate. I too was diagnosed with PTSD, and so, for reasons that are related to childhood adverse experiences actually which we'll get to but could you give the listeners an idea of what is the definition of PTSD?
Speaker 1:So we, as doctors, use diagnostic criteria, and the one we use for mental health diagnosis is called the DSM-5, or Diagnostic and Statistical Manual, version 5. And there's criteria for everything ADHD, which is attention deficit, hyperactivity disorder, ocd, obsessive compulsive disorder, and PTSD has very specific criteria and I will give them to you now. Number one you had to have some sort of stressor. That could have been that it happened to you. You witnessed it. It happened to a very close contact, like a very close loved one or, like me, you got it through work.
Speaker 1:The second criteria is symptoms are intrusive. You get re-experiencing of the trauma through nightmares, memories, flashbacks, and you get reactive after you have one of those. The next thing is it has to be so unpleasant that you try to avoid it, so you try to avoid memories of the trauma or feelings related to the trauma. The next is is it harms you? You have, let's say, you can't recall details of what happened, or you feel overly negative, or your mood goes down. You feel depressed. You might blame yourself. You don't feel like life is enjoyable. You have trouble feeling happy.
Speaker 1:The next is that it changes how you interact with the world. You might be more irritable, you might engage in risky or destructive behavior, like addiction. You might be hypervigilant or be easily startled, and this one is so common. You might have difficulty sleeping, have difficulty sleeping. And then the last three is that it has to last longer than a month, it has to cause significant impairment in your life and it can't be that this is caused by something else. I go through these criteria with my patients all day long in clinic, but the basic thing is something bad happened. You get a lot of bad memories and it's hurting you.
Speaker 2:So why do some people who experience traumas develop PTSD clinically and some people can seem more resilient and do not develop the disorder?
Speaker 1:It's a great question and I can tell you in my emergency department some of my colleagues do not have PTSD and practice longer than I did. There's a couple of factors. So the first is some of us are more sensitive to our emotions than others. So I would identify as an empathic and emotional person and some of the experiences I had had a much more profound effect on me because I am wired to feel more emotion than, let's say, my colleague next door. The other is the magnitude of the trauma. We'll talk about big T's and little t's in just a little bit. And then it's how much trauma, how much it's repeated, and then is the person able to remove themselves from the environment. So let's go through this right. Let's say a 35-year-old person has a near-fatal car accident. That's one big T trauma, one big big event. Now let's say another person was repeatedly sexual assaulted, going back to age 5, all the way to 25. That is early, long duration and very intense. That's going to be a greater trauma response on the brain. They also talk about, I said, big T's and little t's. A big T are these big events For me as a doctor.
Speaker 1:One of my patients hung herself. One of my patients walked into the ER and died in front of me. I've taken care of too many cases of brutal sexual assault. Those are big T's. The little T's are the small negative experiences that add up over time and it's almost if you have a bucket the big T's fill it up faster, but a lot of little T's will fill it up too. The little T's are one of my colleagues yelling at me at 2 am when I'm just trying to help a patient. A little t might be a not verbally abusive but highly critical parent. So essentially it's the overall cumulative magnitude of the trauma combined with a person's emotional sensitivity and therefore vulnerability with a person's emotional sensitivity and therefore vulnerability.
Speaker 2:Thank you so much, and I know you mentioned on the prior episode of your own podcast what is it?
Speaker 1:Addiction Medicine Made Easy. Thank you for the shout out it is Addiction Medicine Made.
Speaker 2:Easy. That is my podcast. Yeah, check it out. We'll put a link to it in the show notes. But yeah, in a really good lecture you published on that podcast about trauma, you mentioned the adverse childhood experiences, and one thing that really struck me as compelling was, and something I could relate to too, is that the more adverse childhood experiences you have, the more likely you are to develop certain physical illnesses. And you also mentioned Dr Gabor Mate, and I'd love to pick your brain a little bit about him because, yeah, my very first exposure to you on this podcast, I think you mentioned him and I was thinking like, oh yeah, that's what I wish more people, the more likely you are to develop physical, actual like real physiological illnesses. Do you want to talk a little bit more about that, because it's fascinating, I like how you gave me an entire PhD's worth of work into a single question.
Speaker 1:Okay, so let's talk first about adverse childhood experiences. So there's history here, and please realize I am not trying to criticize anyone, I'm just trying to give the history. So the literature on adverse childhood events, abbreviated as ACE or ACEs, comes from Kaiser, and, if anyone doesn't know, kaiser is a large hospital system that's in various places in the United States. It's very big here in California. They tend to operate in regions States. It's very big here in California. They tend to operate in regions, and Kaiser is a closed system, meaning that they only take Kaiser patients. Somebody can walk into the emergency department and they'll get taken care of, but Kaiser only takes care of Kaiser patients and Kaiser as a closed system.
Speaker 1:If they keep people healthy, the system saves money, and so they were thinking from a financial standpoint well gosh, what if we prevented illness? And so they asked the question why do people get sick? Why do people get high blood pressure? Why do people get diabetes? Why do people develop an alcohol addiction? Why do people get depression? And so the cool thing about Kaiser is they have millions and millions of members and an extremely robust electronic help system that allows them to do huge studies on populations, and one of the things that they found that was correlated with the development of illness not mental illness or addiction.
Speaker 1:Any illness, including mental health and addiction, was adverse childhood experiences, and essentially the idea was this is probably complicated, but increased childhood stress is an inflammatory state. Families where there are these adverse childhood experiences are less likely to prioritize good nutrition, education and healthy physical activity. And then there tends to be this intergenerational trauma effect. So let me read you some examples of adverse childhood experiences. Parents in the household swore at you, insulted you, put you down, humiliated you or made you feel that you would be physically hurt. Did an adult in the household push, grab, slap or throw something at you or hit you so hard that you had marks? Did an adult or person at least five years older than you touch or fondle you in a sexual way? Did you often feel like no one loved you? Did you often feel like you did not have enough to eat? Were your parents ever separated or divorced? Was someone in your family pushed, grabbed, slabbed or hit, or even in front of you? Was someone in your family pushed, grabbed, slabbed or hit, or even in front of you, was anyone in your family ever repeatedly threatened with a gun or a knife? Did a family member have addiction? Was there mental illness in the family? Or did a family member commit suicide and did a family member go to prison? You get the idea that these are addiction, trauma, interpersonal violence, sexual violence, physical violence, verbal violence, mental illness. These are things that are destabilizing to a child and affects the childhood, and those are the things that we found were associated with all forms of illness, but there's a particular association with mental health and addiction.
Speaker 1:Now there's a website that I use called MDCalc and it's basically got a number of medical calculators on it, and so I I use called MDCalc and it's basically got a number of medical calculators on it, and so I just went on MDCalc. I have no affiliation with them, except it's useful and I actually went through. They have what's called an adverse childhood experiences score and when my patients are not doing well, I will actually go through the score with them to help them understand how their trauma is affecting them, because usually what happens is people come to me, they're like, hey, doc, it's the kratom, and I'm like, okay, well, do you want to go the withdrawal management route or you want to go to the suboxone route and then if they keep relapsing, it's like what am I missing? And it's usually trauma. So most of my patients have an average childhood event score using this score on MDCalc and again, that's mdcalccom. Most of them have a score somewhere between about four and eight. I have a few nines and I have two tens and my two tens have lived through the most unbelievable trauma and one of them just had a relapse trauma and one of them just had a relapse.
Speaker 1:This person was in a social situation. A member of the opposite sex came towards them. Every bell and whistle in their brain went off. Trauma response leads to relapse and we're working on it Now.
Speaker 1:Dr Gabor Mate is really the father of the link between addiction and trauma. Not that he discovered it, but he is the one that realized how pervasive it is. In his words, not everyone who is traumatized has addiction, but everyone who has addiction has been traumatized and it shows up in different ways. Two siblings might live in the same household growing up and sibling A develops addiction, the other does not, and they look at each other and it was like it was the same mom and dad.
Speaker 1:What are you talking about the sibling with addiction had a different experience. They had a different relationship with the parents. Perhaps the parents were more verbally abusive. Perhaps the other sibling was treated better. Perhaps the sibling with addiction was more emotionally sensitive. Unless you've lived in someone else's shoes, which we know is not possible, it's really hard to know what was traumatic to someone else, and that's his message is let's honor the trauma that people have lived through because developing addiction wasn't on yeah, exactly, I remember you said you went to speak to all these kids and nobody will say oh, when I grow up I want to be an addict or I want to be in jail.
Speaker 2:You know, you want to be an astronaut. You could have a sibling and it could be like everything else is the same. But if the mother is under more stress when you're in the uterus, then that's going to affect you too. Like the prenatal environment, prenatal stress and then the trauma of the childbirth too, like things like that. Do you see that? Does that make sense? The prenatal environment can that be traumatic too and also predict? Or what do you think? Natal?
Speaker 1:environment. Can that be traumatic too, and also predict? Or what do you think? I can't speak to the human research, but there is some research in mice where they had adult mice and they would electrocute their cage so their feet would hurt and then they would release the smell of cherry blossoms. And then the mice got pregnant and they exposed the offspring to the smell of cherry blossoms and they exhibited a stress response. That's called epigenetics. So I am not an expert in this, but what I can tell you is to really do trauma-informed care, you have to really step back and see the person for the forest that they are, rather than the tree of addiction and see the person for the forest that they are, rather than the tree of addiction.
Speaker 2:Yeah, that's a fascinating study. The epigenetics of addiction and trauma is fascinating. So I guess there is a lot of research on intergenerational trauma and how their descendants will have a gene that might not have been turned on but because of that trauma of their ancestors it turned on.
Speaker 1:That is epigenetics.
Speaker 2:Ah, cool Okay.
Speaker 1:It's basically the environment activates certain genes.
Speaker 2:Yeah, and so, yeah, you've discussed the very profound link between trauma and addiction, and one thing that comes up often in this little complex set of circles is ADHD too. There seems to be an interplay between, among ADHD, addiction and trauma. And this is where I want to just ask something about Dr Gabor Mate, because a lot of it seems likea lot of fellow clinicians criticize him because of his thoughts about ADHD. He said in a lot of cases people with ADHD have developed a habitual dissociation. If you go through trauma as a child, you will tend to dissociate as a coping mechanism, and that is true, definitely true for me, and as such I feel like I do have more dissociative tendencies as an adult and that affects my concentration. But there's such a strong genetic link to that a lot of like his fellow medical doctors criticize him for that and then think, oh, everything else he said is must be bunk, because why is he just disregarding the genetic link in ADHD? So it seems like ADHD is just it's a very complex disease or disorder and a very complex interplay.
Speaker 1:Yeah, I'm going to take what you said about you know, dr Gabor Mate, not being respected by colleagues and I'm waiting for my colleagues here, where I practice medicine on the Central Coast, to accuse me of overdiagnosing PTSD. And so, essentially, if you come to my practice and you're doing great, we put you on some Suboxone. We don't necessarily need to explore what else is going on. But if you keep relapsing and I can't figure it out, I'm going to go down the trauma rabbit hole with you and I'm going to find something. We've all been through something. We've all been through something and the reason I mention that in my own practice is it's very easy to attribute things to PTSD because a person's not doing well, they're emotionally reactive and, gosh, there's a trauma. Let's link them.
Speaker 1:But bipolar disorder can make people impulsive. Adhd can make people impulsive. Adhd can make people impulsive. Ptsd can make patients impulsive and it's really nuanced and there's no blood test, there's no CAT scan. It's all these diagnostic criteria and a lot of the syndromes overlap.
Speaker 1:I think what I would say about ADHD and PTSD and addiction is ADHD in and of itself is a risk factor for addiction. Ptsd in and of itself is a risk factor for addiction. If you have two risk factors, your risk of addiction is higher than if you have one alone. And I think for me, when it comes to trying to get sober, being able to focus on your emotions, to regulate them, focus on therapy, focus on meetings, focus on your support If you can't do that, it's very hard to get and stay sober.
Speaker 1:Who's super smart and was on my podcast about ADHD was really the person that opened my eyes to the fact that I was under-treating ADHD in my practice and I needed to be more aggressive, and my patients all validate what he said Doc, my ADHD is better. I can finally pay attention to my therapy sessions and so in some ways and this sounds really silly, but if a person has diabetes, we would treat it. Person has high blood pressure we would treat it. Why would we leave one of their mental disorders untreated and wonder why they're not doing better?
Speaker 2:So if somebody walks into your practice with not the dual diagnosis but like a triple diagnosis of ADHD, ptsd and addiction, it's like a three-pronged kind of issue. Like where would you start with one of your patients? Would you try to address the ADHD first, or all together? Or if you're using medication as like an adjunct to psychotherapy, like, yeah, if somebody walks into your practice with all of that going on, what would the process be like to figure out how to get to the heart of the pain and how to treat them going forward?
Speaker 1:The first thing I would do is thank them for coming to see me and remind them that they're in a safe environment and they're not to be judged. So much stigma for each individual diagnosis and even more altogether. Essentially, what we have to figure out is what's the primary driving issue? Is it that alcohol is intensely euphoric for that person, beyond the average person? Is it that their PTSD is so bad that they cannot sleep and therefore they drink alcohol? Is their ADHD so bad that they cannot stop using methamphetamine? So, essentially, I, as a physician, I create a problem list. Okay, problem one hyperblood pressure. You're going to see your cardiologist. Problem two PTSD mild. Problem three ADHD severe. Problem four creatinine use disorder secondary to untreated ADHD.
Speaker 1:So, in other words, my job is to, by talking to the patient, understand their diagnoses, the severity of each, and then therefore come up with a plan to prioritize what's the primary issue, and it could be any of the three, right?
Speaker 1:Some people, when they drink alcohol, have an intense euphoric response, others do not. So a person who has an intense euphoric response to alcohol might benefit from the medication naltrexone that makes alcohol less euphoric, and we might find that they're able to stop drinking just with naltrexone and we can pause and take a deep breath and then work on the PTSD or ADHD. We might find on the flip side that their PTSD is horrible and they can't sleep and they're constantly in fight or flight mode and they're so easily startled and they're just trying to use kratom to calm down because they want that opioid-like effect. So what I do as a doctor is to understand each diagnosis, how severe it is, and therefore prioritize treatment, to come up with a treatment plan way to the substance, and then you have the environmental and the social and all the social determinants of health that go into this too.
Speaker 2:And so I'm wondering this is going to be such a weird question, but do you because it's so interdisciplinary do you use like a chat GPT type system to put all this information together, and do you encourage your patients to use ChatGPT to sometimes make sense of everything that's going on?
Speaker 1:ChatGPT to give me my first draft. Or let's say we need to create a memorandum of understanding with a therapy program that we want to easily refer patients back and forth. I'll use ChatGPT for that. I don't know if we're ever going to get to the point that machines will replace human doctors when it comes to medicine, and I may be totally wrong, but essentially it's almost like picking flavors out of a food. So let's say, you eat a blueberry muffin, you can taste the blueberries, you can taste the starch of the muffin, you can taste the cinnamon. It's pulling out the nuanced flavors. And ChatGPT is what's called the large language language model. All it's good at is really predicting the next word in a sentence. Now some of my patients in fact I actually have one who uses kratom and uses chat gbt some of my patients will basically journal the chat gbt and then ask chat gbt to summarize, and chat gbt basically looks at what's been written into it, stops and reflects and then uses again that large language model to predict what potentially could be said.
Speaker 1:I can tell you when we looked at Google, if you Google your symptoms, you had about a 50% chance of getting the right diagnosis. I don't know if we have the data on artificial intelligence yet, but how many hours is it? Let me get you the number here. So for me to become a doctor in the emergency department, the average emergency doctor's training is anywhere from 15,000 to 20,000 hours. That's a lot of time, right. And then to train in addiction medicine, it was 40 times 48. It was 1920 hours. So it's a lot of hours and a lot of it is pattern recognition and, granted, you could argue that that's really what large language models are good at is recognizing patterns and predicting. And we may get to where AI is effective in medicine, but really not around diagnoses yet, because there are subtleties.
Speaker 1:Artificial intelligence is being used in radiology to make reading x-rays faster and as a backup against misfindings, but I'm not aware of any physicians using ChatGPT to make diagnoses yet. That being said, there are some physicians who are saying to ChatGPT I am doing this, this, this, this and this, what do you think the patient has? And it can go through and make a prediction. So I don't know, we may get there, but certainly around surgery, I don't think we'll ever have AI replace medicine, just because if something unexpected happens, which does, I don't know how the algorithm would respond, and in the world of behavioral medicine and addiction medicine there are things that are very unusual. So one of my patients takes drug A and gets a super weird reaction that no one's ever heard of. I review the literature. It's never been out there. I'll publish it as a case report. That was the first one. So I don't know, maybe I'm just clueless. On ChachiBT, I do use it fairly frequently, but no long answer. I'm not using it in my practice to make any diagnoses.
Speaker 2:Yeah, that's really important too, because I think there are also biases built into the system too. You know, like how pulse ox was not tested on people with darker skin and the melanin affects the oxygen delivery, so it wasn't accurate. So I think they're finding similar issues with bias of the chat GPT algorithms. So it's good that you guys aren't totally relying on that. I know I read on Reddit people will post oh, my doctor didn't know what was going on with me and after 12 years chat GPT finally figured it out and it's just whoa. But getting back to Kratom specifically, I'm curious does the number of childhood adverse experiences that you endorse, or the severity of the trauma or the duration, does that affect the type of kratom that people use, whether it's a stronger extract or 7-OH, or their tendency to relapse or just the progression of the addiction? Or is there not really a correlation there?
Speaker 1:I think what's hard about that question is kratom is not kratom. Is not kratom meaning a 7-OH product acts more like morphine, whereas leaf Kratom has less opioid effects and more stimulant effects. So it's a little bit like saying tell me about a car, well, do you mean like a Toyota Tundra, or do you mean like a Mercedes SUV, or do you mean like a Porsche or a Honda Civic? My understanding is Kratom is changing. Is it a Kratom Kava Mix? Is it an extract? Is it a 70H? Is it Leaf Kratom? So it's a little hard to know because the Kratom products are so heterogeneous.
Speaker 1:Here's what I tend to see in my practice and I will defer to you as the Kratom Sobriety Podcast, having interviewed way more people about Kratom than I have. But people usually go to Kratom not realizing what it is. They're like hey, I'm sober from alcohol and I don't want to drink and I don't want to use drugs. But hey, this is a supplement, how bad could it be? Or hey, I'm really having trouble being productive at work and I need something. I'm not going to go buy drugs and energy drinks aren't working. Let me see if there's a supplement. Oh, kratom, it helps your mood, it helps with energy.
Speaker 1:And then what ends up happening is because of how kratom works. It activates the opioid receptor. People develop tolerance, and that happens with anything that activates the opiate receptor. They need more over time to get the same effects. And then, unfortunately, people develop dependence, and that's with anything that activates the opiate receptor. They change in their brain to where, when they stop they feel horrible, they get kratom withdrawal. So we think if somebody is a savvy kratom user and they started out using some of the lighter stuff and then had a traumatic life experience and wanted to numb those PTSD feelings, they might jump from, say, like a leaf product or a tea to a 70H because they know it and want more intense feelings. But the vast majority of my patients find Kratom almost accidentally, not knowing what it is, and it's more the dependence that keeps them stuck on it. What has your experience been?
Speaker 2:Yeah, my experience is I didn't know what it was and it's interesting because I'm usually very well researched and I will check everything before I put it in my body but I was going through a traumatic experience actually a few at the same time. So I was particularly vulnerable and I didn't do my due diligence because, almost because I was in a bit of denial, I'm like this actually totally numbs my depression and my anxiety. I don't have a chipmunk in my brain anymore and I can actually sleep, because PTSD affected my sleep and yeah, so I think a lot of people use the language like it sank its teeth into me. So it felt like that for me. But this brings me to another question, because there are a lot of different treatments for PTSD and then trauma, like in the context of addiction, and I will say that for myself.
Speaker 2:One thing that really helped me with my trauma and that then in turn, helped get rid of all those cravings for Kratom is I had tried in my life I've tried so many different antidepressants.
Speaker 2:Never really had any lasting success. So I just thought, oh, I have treatment resistant depression, and I finally sought, like professional help from somebody who works where psilocybin therapy is legal, and so you know it's not exactly legal right where I am, but I remotely did the training and learned how to you know all of the therapy that goes into it, the integration and having that experience it was just like. It was like reliving all the trauma I went through as a kid but it took away its power. And then it took away the power from Kratom and I'm just like, oh yeah, it's a leaf. I don't know why it had so much power over me. So I'm wondering, because in your previous podcast you talked about using like a two-pronged approach of you know, the psychotherapy, the behavioral therapy, and medication like as an adjunct, and then you highlighted maybe EMDR, and then there's some medications like prazosin is that how you say it? And SSRIs. But I'm wondering about actually let me let you talk about those conventional therapies first and then we'll dive into some of the newer therapies.
Speaker 1:Once again, an entire PhD in a single question. I love it, okay. So let's start with. The first question was what about psychedelics and PTSD? Well, we can thank Richard Nixon for this, because when he declared the war on drugs, a lot of research on these sorts of substances and compounds was just totally wiped out.
Speaker 1:So hallucinogens, in my opinion, will likely have a place as therapeutics in the future, but we don't fully know how to use them and how to dose them yet. So how does this work? I love my patients. I love my patients, but they are used to using substances to feel better, and so the answer is not I'm going to do a bunch of shrooms and get better. The answer is I'm going to work with a therapist. I'm going to continue in that therapy. I'm going to have 10 sessions of therapy, and then we will bring in the psilocybin in a very specific setting when the time is right, with someone there to guide me through it, and then I do 10 more sessions, and then I do 10 more sessions. The hallucinogens and ketamine falls under this. They augmented the effect of the therapy. They don't replace the therapy. I just want to be really clear right now. If, yeah, if you are getting this, you're essentially getting it in a research institution as a part of a, a research study, and granted, depending on where you are and if it's legal in that little area, sure. But my patients will be like, hey, doc, can I do shrooms to get off drugs? I'm like, well, no, you have to go into a program that has a specific way of doing it, and the best way to do it right now is to get into a research study. So let's put a pin in that, because five years down the road we'll probably learn more Now.
Speaker 1:Standard therapy for PTSD. The first issue is if you're still in the trauma, it's really hard to start the process. If a woman is being beaten up by her domestic partner and that is the source of the trauma, until she leaves the environment, it's going to be really hard to get better. So for me, I had to leave the emergency department. I had to leave all aspects of the emergency department and at some point, if I'm really still struggling, I may actually need to leave medicine. I have to get out of the traumatizing environment. The next issue is we need to come up with some sort of therapeutic modality that allows the person to process the trauma. That may be talk therapy, that may be equine therapy, where you work with horses, that may be art therapy. There are so many different ways. But the person has to experience some of the trauma again in a safe environment to get it out of their system, if you will. That's obviously an oversimplification and it might take months, it might take years, but when that trauma is just stuck inside and festering, the PTSD is really hard to manage.
Speaker 1:Now we do have medications, and here's how I explain this to my patients. Addiction at its simplest is using substances to feel different. Sobriety is learning how to self-regulate and not needing substances, including medication. I believe that if somebody is off of the substance and on medications, they are sober. But if you go to an AA meeting, they might disagree with that. So the way I describe it to my patients is the ultimate goal is sobriety without needing medications, but medications are a bridge to getting there. So if somebody is really struggling with PTSD triggering and can't stop drinking and we get them on some meds and they stop drinking, that is a win and they will not likely need to be on those psych meds forever. But while they work on the trauma and get their support and get their coping skills and develop all their emotional tools.
Speaker 1:The medicine is helpful. So there are a couple that I use. There are medicines for triggering and hypervigilance and there's two of them there's clonidine and there's propranolol, and they basically reduce the physical anxiety reaction building up in your gut and taking over your body. I have one of my patients who calls propranolol trigger. She can't remember the medication name, but she's a doctor. The trigger medicine. That one works really well when I'm triggered.
Speaker 1:Then there is prazosin, and prazosin is a medication that suppresses nightmares. It doesn't work for everyone. It works fairly quickly if it does, and everyone has a different experience. Some people don't dream at all. Sometimes the dreams are more vivid, but not frightening. One of my patients was like Dr Grover. This is amazing. Now in all my nightmares I'm like saving babies and they're doing parades for me. Some of my patients have side effects like dry mouth or low blood pressure that they can't tolerate it, but prazosin can be very effective. My patient who calls her propranolol trigger calls the prazosin nightmare because it makes sense in her mind. It's my fault. She was really struggling with alcohol. I couldn't figure out why. She kept relapsing and I was like tell me about your trauma. She said that was no big deal. She had a near fatal car accident and was repeatedly verbally abused as a child and when we pivoted to focusing on PTSD, not the addiction, that's when we had the breakthrough. So she takes trigger and she takes nightmare.
Speaker 1:The other thing is we can use antidepressants, most specifically the SSRIs, or selective serotonin reuptake inhibitors, like Lexapro, also known as escitalopram, or fluoxetine, also known as Prozac, and the SNRIs serotonin and norepinephrine reuptake inhibitors like Effexor, which is venlafaxine, or Cymbalta, which is duloxetine, or Pristik, which is venlafaxine, and essentially, the antidepressants artificially increase your emotional resilience. It takes more to feel overwhelmed. So usually when somebody comes to me and they've got PTSD, I put them on some combination of those meds and then I usually add in a non-addictive sleeping med. So if you are wondering what was my experience I have not shared this before, but I'm an open book I was a bad doctor and I treated myself.
Speaker 1:I was completely miserable. It was going to be four months to see my PCP, so I put myself on some escitalopram, also known as Lexapro, and I put myself on some clonidine and I put myself on some trazodone. That's a non-addictive sleep aid and I was actually fairly functional and combining that with the therapy I did so much better. And then I went to see my doctor and I love my doctor. He's amazing, super nice guy, super smart. And I love my doctor. He's amazing, super nice guy, super smart. And he said you know, casey, I don't like you being on the escitalopram, the Lexapro. We're going to switch you to Sertraline or Zoloft.
Speaker 1:And the wheels fell off the bus. I was a hot mess. I was in fight or flight. I had some really dark thoughts. I was going to quit medicine. My wife and daughter were like where is our husband and dad? And I thought it was just. My PTSD was getting worse. And I remember one Saturday morning I was almost like rock bottom. I took my dog for a walk and came home just tears streaming down my face and I just told my wife I'm just, I can't do this. And they went down and laid in bed and she curled up behind me and we cried together and so I put myself back on escitalopram, also known as Lexapro, and six weeks later I was myself again.
Speaker 2:Thank you so much for sharing that story. Yeah, Do you think I know that there are some people who endorse using companies like Genesight to test how people will respond to different antidepressants, like particularly SSRIs? Self was interested in that at first, but then the more I dug into it, it seems like there's not a lot of evidence for that actually being accurate. Is that.
Speaker 1:So I use Genesight regularly in my practice. So what is Genesight? Genesight is a company that does pharmacogenomic testing which describes the interaction between your genes and your medication. So it's a cheek swab and I have no financial connection to the company except that I order their. So it's a cheek swab and I have no financial connection to the company, except that I order their tests. It's a cheek swab.
Speaker 1:You swab your cheek and you get cheek cells, send it off to the company, they extract the DNA and they actually tell me, as a doctor, which of the enzymes in your liver are underactive, normally active or overactive. Here's how I think about it. They're not telling you which medication is going to work and which medication is not going to work, but they give you an expectation about how you'll metabolize the med. So if I'm going to put you on Med A and you over-metabolize it, the drug levels aren't going to come up very high because you're so busy metabolizing it. So I will start at a higher dose, or I'm going to choose a medication that you metabolize more predictably. I think the issue is that people say this test tells you which medicine works. That is not what the test means. The test lets you know how you metabolize different psychiatric medications. And the issue is there's not a lot of evidence on how to use it, meaning we don't have a randomized controlled trial. That's the gold standard, best test in medicine. A blinded study means we don't know when we're in the study which group is which. It removes bias. We don't have any data like that on this sort of testing, but my patients like it because, let's say, there's 25 antidepressants, most doctors use the ones that they're the most familiar with and they have about a repertoire of, say, three to five meds.
Speaker 1:I am the same way. I use a lot of Prostique. That's Desvenlafaxine. I use a lot of Lexapro. That's Acetalopram. I use a lot of Zoloft. That's escitalopram. I use a lot of Zoloft that's sertraline. I use a decent amount of Effexor, that's venlafaxine. I use Cymbalta, that's duloxetine for pain patients, and I use Welbutrin, also known as bupropion. So I said maybe that's what like eight. Those are my go-to. And patients feel like guinea pigs. What do you mean? We have to try a new antidepressant? Why can't you just run a test? And the answer is I tell them this gives me my first tier of meds I'm going to pick from because we know you're going to metabolize them the most correctly. Now let's just explore all the potential options as to why this test is useful. Number one if I told you this medicine is awful, you will get horrible side effects from this medicine. How much do you want to take it?
Speaker 2:Not so much. No, you run in the other direction.
Speaker 1:That is called the Noxibo effect, where you get side effects because you anticipate them. On the flip side, let's say I said, oh my gosh, this medicine, this is like the best one. Oh my gosh, people get to ride unicorns when they take this medicine. They can literally fly over rainbows on their unicorn when they're on medicine. A how much do you want to take that?
Speaker 2:That's the placebo effect.
Speaker 1:I love unicorns, right? Yes, that is the placebo effect. So there is probably some placebo-noxibo to tests like GeneSight. But it also informs me as a doctor to know if I have to use medicine A and they under-metabolize it, I'm going to drop the dose, or the opposite if they over-metabolize, but I use the test all the time.
Speaker 2:Thank you so much. Yeah, now I'm actually intrigued to take it after all and just see how I metabolize different drugs. I will say that there is a lot to be said for the placebo effect, like I read this one study years ago about how taking ibuprofen, it was like there was a certain regimen and it's that can actually help emotional pain too. And so I was going through a really depressed stage, and so I looked on Reddit for comments where people said, oh, I took ibuprofen and made my depression better and I think it helped a little bit. Just who knows.
Speaker 2:But yeah, so I hadn't been on the medications that you had you were on for years. But I had a similar experience where I was on Cymbalta at first and I wasn't a pain patient but I had some anxiety too, and the psychiatrist said, oh, this will help your anxiety and your depression, and it seemed to work for maybe a year and a half. Now I will say I went away on a trip and I did not remember to take my Cymbalta with me. I had no idea that the withdrawal I think they call it discontinuation syndrome from SSRIs it was miserable. It was so terrible. I thought I was jumping out of my skin it might have been just as bad as kratom withdrawal. So yeah, I was going to ask about the side effects and the discontinuation. How easy is it to wean people off of these medications after they've processed their trauma and they want to come off?
Speaker 1:I can get almost anyone off an antidepressant in about two weeks.
Speaker 2:Oh, wow, it's fast. Now, what about after? I went through a period where Cymbalta just stopped working and I have always struggled with like suicidal thoughts and the Cymbalta kind of it didn't mute them, but it turned the volume down a little bit and then all of a sudden I just I had, you know, active suicidal ideation and the psychiatrist said, oh, sometimes it just stops working for no apparent reason and it can happen anytime. Does that happen to any of your patients?
Speaker 1:Yeah, anecdotally. I don't know if there's any science behind it and we can certainly research it, but people get some weird interactions with medications. There's a class of blood pressure medicines called ACE inhibitors and people can randomly develop this side effect with their lips and face swell at any point on it. Second, just because so yes, the discontinuation syndrome is a thing, and what I mean by that is most people were not told that there was some precaution that needed to be taken, weaning off of it. But if you consider how long it takes to wean off of kratom compared to how long it takes to wean off of an antidepressant, it's so much faster to get off an antidepressant.
Speaker 1:Let's say, somebody's on 20 milligrams of fluoxetine, also known as Prozac. I'll do 20 for three days, 10 for three days, five for three days and they're done. It's fairly fast. Sometimes people get longer. I think the longest it's taken me is maybe three weeks. One of my patients just told me he had a horrible withdrawal from escitalopram. So we're doing 30, 25, 20, 15, 10, five, stop over about 18 days, I think something like that. So it's there, but it's much easier to get off of them than, say, kratom or gosh. Even worse, benzos, benzodiazepines. It's six plus months to get off of those. So yeah, I think the answer is you know, ask your doctor if you need to be worried about a new medicine as you start it, and can you stop it suddenly. And if not, then you need to come up with a plan to be able to get off of it safely.
Speaker 2:Yeah, I don't really have experience with benzodiazepines, but I will say for Kratom it took me like a year to taper off of it. So another medication was Lamictal that I took for a little while, and I guess it helped somewhat, but I don't know if it's, if it's really used in PTSD, no. So another question I wanted to ask you, though, because this is another controversial therapy that's used particularly in trauma, and I too tried it for 10 minutes with my psychologist at the time EMDR, eye movement, depro, sensitization and reproitization, and reprocessing, reprocessing, okay.
Speaker 1:I'll let you say it EMDR. Okay, all right. So eye movement, desensitization and reprocessing. So essentially what this is is you go through the traumatic experiences and re-experience them with a therapist and then they use eye movements to help your body process it. It works. I think the studies have not shown that it has a big effect for everyone, but it can be very helpful. It's best done in person and it can be very intense if the trauma is still fairly recent or fairly unprocessed.
Speaker 1:Here's my take on this. I'm going to try to be funny. If you told me putting mayonnaise on your left ear kept you sober, I'd buy you mayonnaise. So if you told me, dr Grover, the only thing that worked for my trauma was EMDR, I'd say do EMDR. And if you told me, dr Grover, the EMDR did not work for me, you know what I would say let's try something different. But yes, I'm not an expert in it. At some point I'd like to try it myself. I have a couple of my staff that have done it and swear by it. But the one thing that we should talk about that actually wasn't on your list was a cervical sympathetic ganglion block.
Speaker 2:I'd love to hear more about this. Yes, I'm not familiar with it at all.
Speaker 1:So one of the physicians in my practice does these. He's from the military and what they found is that there's a nerve ganglion in the neck, and a ganglion is basically a cluster of nerve cells. And what they found is, if they blocked the nerve ganglion in the neck, it changed how the stress response went up to the brain and it made physical reactivity and the intensity of PTSD decreased. I've had a number of my patients swear by it and when I got diagnosed with PTSD it was recommended to me that I should get such a block myself and I didn't know it existed until about two years ago. We have a new doctor in my practice, Dr Chase Kisling, and he casually walks by hey guys, just so you know I'm new, If you need anyone to get a PTSD block, let me know and walks off.
Speaker 1:And the other addiction doctor in the practice who's my spouse, the beautiful and intelligent Dr Reb Close. She and I were like what there's a PTSD block? Yes, A cervical sympathetic ganglion block. It's also called a stellate ganglion block, that's it. But yeah, for people who really have tried multiple medications and it doesn't work, I recommend the block.
Speaker 2:That is fascinating. I haven't heard of that and I actually I think I could benefit from that. I feel like I've done so much trauma processing that I've taken the power away from a lot of the experiences, but I still get that reactivity. I feel like I have that high cortisol all the time and then the garbage truck will come and I'm jumping out of my skin and it's like a physical reaction. It actually hurts.
Speaker 1:Yes, when my medications were not right I actually stopped being able to enjoy music were not right, I actually stopped being able to enjoy music. It was. I was a really dark time and just everything set me off and the office would call and the world was crumbling. Man, it was brutal. I'm just grateful that I have my med straightened out. I've actually come off the clonidine. I might take trazodone here and there if I can't sleep, but for the most part acetalopram, and that's all I need right now.
Speaker 2:Yeah, I did take prazosin. I'm so bad at pronouncing things. I took that for a little bit. It did lower my blood pressure too much and I wanted to get off medications anyway, but I will say it did work. It helps me sleep and in the dreams it was interesting I didn't have nightmares. I still came in contact with perpetrators of abuse, but I could see them, or like they were looking me in the eye instead of hiding their faces. It was weird. It was like oh, their power is gone, oh, you're hurting me, but it doesn't matter. Like you've taken away all of the emotional energy with it. So it's interesting, but yeah. So I wanted to ask you switching gears a little bit, unless there's anything else you want to say about that.
Speaker 2:I want to give some actionable tips to creative users or people who are having trouble quitting and who want to visit an addiction medicine doctor and try to be heard and validated. I remember I went to a dentist and I have severe dental phobia because a lot of my trauma related to hands over my mouth, and so just even the nicest person could be sticking drills in my mouth and I will just literally have a panic attack and I would go to a couple of dentists and they just seemed to brush it off. They wouldn't look me in the eye. They're just like, okay, that's cool, we can give you nitrous or oh, we can sedate you if you want. But I didn't feel validated and then it's like my heart raced and I was like okay. Now I feel like it's being minimized and I'm feeling more anxious. So it was just like this terrible cycle and I feel like a lot of people are afraid to advocate for themselves when they go to the doctor. There's that statistic physicians will interrupt you within 18 seconds.
Speaker 2:Let's say that I have this horrible addiction to whatever it is LEAF or 708. And I just want my doctor to realize okay, it's not a character flaw. I have all of this pain, but I only have this amount of time. So a lot of people feel like they're going to be shut down and I have that too. How much do I want to bring up, but it's not irrelevant If I got hurt as a child, it's not? Oh, I'm lonely and I'm trying to tell you my life story. It's because it affects everything. I'm lonely and I'm trying to tell you my life story. It's because it affects everything. It just it has so much power over like physically and and mentally, and yeah, like what, what can a person do to be heard and let me tell you a story.
Speaker 1:So my mental health history is that in college I developed anorexia, bulimia and self-harm and I met the nicest psychiatrist. He took such good care of me, started to get my life back together and he decided to change jobs and I was like all right, cool, I figured every psychiatrist was nice and great. So he set me up for my next follow-up appointment with the psychiatrist that was taking his patients and I picked up exactly where we left off and she judged me. She called me a narcissist I can't remember what else she called me and I literally shut my mouth. Tears welled up in my eyes. I left the appointment and I refused to get mental health ever again.
Speaker 1:And the way I look at it as a doctor is a first visit, as a lot of it is about pleasantries. Let's just get to know each other. I would say and I actually counseled one of my patients that when he went to his first psychiatry appointment, let the doctor ask the questions the doctor needs to ask and if the doctor needs more detail, let the doctor ask the detail that she or he needs. Make a note with your doctor, after you've gotten through the basic stuff, that you have a history of PTSD and you'd like to talk to them about it at some point. But we don't have to get to it today. And when the doctor feels like they've gotten what they need to know, to get what they need for you done, that's the time to bring up the PTSD and I think, if you're willing because being vulnerable is hard it's to say what you've been through and you can say it as simply as you know hey, doctor, okay, I'm really glad we're going to manage my blood pressure. I'd just like you to know that I had a very traumatic childhood and I've been diagnosed with PTSD and I'll let you know if I'm having trouble with my PTSD. And you know. Thanks for the visit, but it's unfortunately a lot of doctors don't understand it and if they meet you, as you know, joey patient who presents for a medical problem and the PTSD comes up later, then it's something that I think is easier for physicians to wrap their minds around.
Speaker 1:And you know, with a dentist I would probably say for the first visit, say, I just need to let you know I had some serious issues that happened to me in my life around my mouth and I'm very sensitive. Can I ask you to explain things before you do them. In fact we do this a lot with autistic children. The family will say can you please touch or tap just to warn them and if someone doesn't treat you well, find a better provider that fits better for you.
Speaker 1:But the term that I use is trauma-informed care. So I'm a really huggy person. I love to give hugs and if you've been a victim of sexual assault, getting hugged by a six-foot-one male physician if that was your aggressor is not good. I tell them I care about you. We may fist bump, we may high five, we may just say thank you and not even touch at all. But I need you to know they care and I try to be very careful with my body language and you can very easily ask on the first day. I have a history of PTSD. I do my best but I'm sometimes a little sensitive. Can you talk to me about how you're going to respect my trauma as you care for me? That's a very fair question to ask.
Speaker 2:Yeah, I luckily shopped around for a dentist and I needed an oral surgeon at some point. And I lucked out. I found an oral surgeon who looked me in the eyes very gently, put his hand on my shoulder and he said okay, you say you understand it, but let me just explain this and this and this. And it's okay, a lot of people are like that. You're not alone. I see this all the time and he actually talked to me. I know that in psychology or in mental health health counseling, I think the biggest predictor of treatment outcomes in that therapy is the therapeutic alliance. Like it, you can do whatever modality you want. You can be freudian and say have them lie down on a couch. You could say, oh, I'm doing the mayonnaise in the ear modality and and if you have that rapport that I mean, then you're gonna do pretty well. Or comparatively you might not, but Absolutely Quick time check.
Speaker 1:I've got to go get back to help my daughter at tennis practice. Can we do one more question and then wrap it up?
Speaker 2:Sure. Okay, I'll end this with sort of an existential question, because we've talked a lot about stigma and vulnerability and how a lot of people and physician it's it's like not okay to bring up your trauma and and you might be judged and it's really hard. So this is sort of like a societal question, like what do we do as a society about this, this perspective, this sort of like macho attitude where it's tough enough. I still feel like I I know so many people who think, oh, I've gone through this trauma but it's okay, because, I mean, think about all the other people, you just have to go through it. I don't know, it seems like this culture of masculinity, alpha male, that sort of pervades even other demographics, has a hook on people and I don't know what we can do about that to really get rid of the stigma and make people realize there is strength in vulnerability, as, like Brene Brown would say.
Speaker 1:So I'm going to go down the rabbit hole here and come back to it. So in the 1980s, only about 25% of Americans approved of gay marriage. 1980s, only about 25% of Americans approved of gay marriage. By the late 2010s, about 75% of Americans approved of gay marriage. How did that change so quickly? And the answer is is that many people who are gay don't outwardly look as such, and what happened is people would go to work and soccer games and parent-teacher conferences and make friends and acquaintances and then wait, you're gay, but like I wouldn't have known or I couldn't tell. In other words, the human connection came first and the label came second.
Speaker 1:So one of the things I do is I lecture professionally about stigma and I come into this meeting and I'm a successful physician and I'm fit and I'm over six feet tall and I, you know, I'm the hometown hero. I was born at the hospital I work at and I lecture, lecture, lecture, lecture, lecture, lecture, lecture, mr Smarty Pants. And then I dropped the bomb that I had anorexia and bulimia and I used to engage in self-harm and no one in that audience expects it and then when they look at me, they're like but you're so normal. I don't mean that, but that's the sentiment and then it makes them question what they know about a person based on their appearances. So my hope is is that my own honesty about my eating disorder has changed my colleague's perception of what an eating disorder is and what it's like or who gets it. And actually we're going to be doing a four-part episode on stigma on my podcast in a few weeks and the final episode is myself and some firefighters talking about our own mental health struggles. Talking about our own mental health struggles.
Speaker 1:And one of the firefighters he was on my podcast. His name is Evan, big burly guy, big old firefighter mustache suffered with addiction and PTSD. And what was really cool is the gentleman who runs the nonprofit I work with called Central Coast Overdose Prevention. He's our executive director. He's also a firefighter and he took Evan to a training for young firefighters. And there comes in Evan big tough guy fire captain. You can see the admiration for him. And then he drops the bomb. And I had PTSD and Suboxone saved my life and it's people willing to be vulnerable and, like I said, not everyone feels that they're in a place to be vulnerable, but I can be and so I feel it is my obligation to be vulnerable on behalf of those who can't be, and conversations like this, hopefully, will help us all realize that we all struggle in some way and that's part of being human. As I say to my patients all the time, it's not a you problem, it's a human problem.
Speaker 2:I love that and that's such a good place to end and, yeah, we'll definitely put your podcast in the show notes. I really appreciate how you not only share your lived experience but you also highlight different people who are susceptible to addiction on your own podcast. Like you had that high functioning person on your podcast and I myself I also self-harmed quite severely and I had anorexia and bulimia, so behaviorally I did have addictions that were triggered by a lot of trauma. But yeah, so I appreciate that so much. And do you have anything else you want to add before we close? Do you have any books or movies or any media you want to recommend for people who want to learn more about the trauma and addiction link?
Speaker 1:and life-changing. I had no idea until I got it. A couple of things. A shout out to my friend and colleague, stephanie Whittles-Wax. She has a podcast called Last Day and if you look up Last Day, dr Gabor Mate, she has the most unbelievably mind-blowing episode on trauma, where Dr Gabor Mate discovers her own trauma and her own addiction on the podcast. It's Addiction 17, trauma with Dr Gabor Mate Last day. It came out January 29th 2020. I send it to so many of my patients. I send it to so many of my patients. In terms of books, there's a couple that are really helpful.
Speaker 2:One is called what Happened to you by Oprah, and the other is called the Body Keeps the Score, and they just remind all of us that when we go through trauma, the problem is not us. It's a humanity problem that we all experience differently individually. Thank you so much. I'm very familiar with my body keeps the score and I have experience with that too. I don't remember consciously that there's a date that's important and then my body will tense up almost reflexively. So thank you so much again for being on the podcast. I really appreciate it and for just being you, with all of your empathy, compassion and amazing. Thank you for your brilliance. I really appreciate you, dr Casey Grover.
Speaker 1:I am honored, as always, to be here.
Speaker 2:Thanks, let's do it again, and I hope you have a great weekend.
Speaker 1: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 nonprofit 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. 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.