November 10, 2025 • 32 mins
Your brain is ancient, but your world is not. We unpack how a hunter-gatherer reward system runs into modern dopamine superstimuli—engineered foods, infinite feeds, one-click buys, and potent drugs—and why that mismatch can spiral into addiction. Using clear language and vivid examples, we explain cravings, compulsion, and consequences through the lens of dopamine: how normal rewards help us survive, how substances hijack that circuitry, and how constant notifications keep the throttle stuck open.
We go deeper into the factors that raise or lower risk. Genetics account for roughly half of vulnerability and often determine a “drug of choice,” where one person feels sick from alcohol while another feels energized and social. Then we connect the dots between mental health and substance use. Depression, anxiety, ADHD, and PTSD frequently overlap with addiction, and treating one without the other rarely works. The ACEs research shows how chronic childhood stress reshapes the brain and the body, setting the stage for later disease. PTSD flips fight-or-flight on at the wrong time, and many people reach for alcohol or cannabis to blunt nightmares and panic, only to worsen the cycle.
Timing is pivotal. Teen brains run on lower baseline dopamine yet respond fiercely to novelty, making early use more rewarding and more dangerous. We share practical insights about delaying use, protecting brain development, and building real skills for stress, sleep, and conflict. A candid case study ties it together: a young adult mixing alcohol and cocaine, a missed PTSD diagnosis, and a turning point when care shifts to trauma therapy and targeted medications. The takeaway is hopeful and clear—when we treat the pain beneath the substance and rebuild healthy rewards, recovery becomes possible and durable.
If this conversation helped you see addiction more clearly, subscribe, share the episode with someone who needs it, and leave a review with your biggest takeaway. Your support helps more people find science-based care and hope.
To contact Dr. Grover: ammadeeasy@fastmail.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr.
Casey Grover, an addictionmedicine doctor based on
(00:20):
California's Central Coast.
For 14 years, I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side of thefight, helping people rebuild
their lives when drugs andalcohol take control.
Thanks for tuning in.
Let's get started.
Today's episode is on the brainscience behind addiction.
(00:45):
My daughter's school asked me tospeak to the students about this
topic, and I actually had theprivilege of speaking to my
daughter's class with mydaughter Kai in attendance.
The reason I mention her is whenI asked the group questions, I
had to make sure she didn'tanswer because she knows all the
answers.
(01:05):
She helped my wife and colleagueDr.
Reb Close and I study for ouraddiction medicine board exam.
So I gave this lecture on thebrain science behind addiction
to high school students, and Irecorded it to share with all of
you.
One quick clarification.
(01:34):
And to keep the kids interested,I brought quite a few of them to
the presentation and tossed theminto the audience.
I hope you find this topichelpful.
And with that, here we go.
So today we're going to talkabout the brain science behind
addiction.
And to start off, does anyonewant to give me a definition of
(01:55):
what addiction is?
I know Kaino's because shehelped me pass my board.
100%.
That's as simple as it is.
You like something, it hurtsyou, and you can't stop.
Okay, so there's an officialdefinition.
So as doctors, we haveprofessional societies, and we
have one called the AmericanSociety of Addiction Medicine.
(02:17):
And this is the definition thatthey give.
I don't necessarily know if it'shelpful to read it, except that
it is a treatable condition andit is a chronic medical
condition.
So once it develops, it's likeasthma.
You have it, it has to bemanaged.
And the simplest way to thinkabout addiction is there are
three things that happen.
(02:37):
You do something, whether it'sgambling, whether it's looking
at pornography, whether it'scannabis, whether it's alcohol,
whatever it is, you do it.
You have cravings to do it,meaning you have this intense
desire to do it.
You do it compulsively, meaningyou can't control it.
And then you have consequences.
So one of my patients right nowis in jail because she relapsed.
(03:01):
One of my patients I sawyesterday will face two years in
prison if he uses any drugs oralcohol.
One of my patients just lostcustody of two of her kids
because of her addiction.
So that's the consequences.
So that's really what addictionis.
Okay.
Now we are going to talk aboutthe why, why this happens.
Does anyone know what dopamineis?
(03:22):
And I know Kai knows because shehelped me pass my boards.
So I'm going to give my daughtera high five.
That is dopamine.
We're going to talk exactly whywe have it and what it does, but
we will come back to dopaminemultiple times as we talk about
this.
Okay.
So just a level set, dopamine isthe chemical in our brain that
makes us feel good.
(03:42):
Now, how long do you think we ashuman beings it takes for us to
meaningfully change in responseto our environment?
So, in other words, how longdoes it take for us to evolve?
Any guesses?
21 years.
I need it's much higher.
Go ahead.
Any guesses?
Yeah.
unknown (04:03):
Like a thousand.
SPEAKER_00 (04:04):
Like a thousand years.
Yeah.
So probably it's somewherebetween a thousand and five
thousand years for us toactually meaningfully change.
And the reason I bring this upis we are still wired to be
hunter-gatherers.
So our brains do not understandcars, social media, technology,
addictive food, alcohol,cannabis.
(04:25):
We're still wired to decidetoday who's going to go pick
fruit and who's going to go huntdeer.
So we will talk about thathunter-gatherer brain, but
that's actually how we're wired.
Now, as hunter-gatherers, ourfirst issue was we had to not
die.
Forgive me for being blunt.
(04:46):
We are not apex predators.
So right now, if a mountain lioncame in and chased one of us and
got one of us, that would be theend of our life.
Or if we are a small tribe andthere was a neighboring tribe
that was hostile, they mightcome attack us.
So we are wired, number one, tolook around and say, Am I safe?
(05:06):
Is anything gonna hurt me?
We'll talk about the brainchemistry of that in just a sec.
Once we look around and werealize we're not gonna die,
then we are our brain shifts andit starts focusing on how do we
live as long as we can.
So I apologize for the reallybad graphics.
(05:27):
I'm old and boring.
I use ChatGPT to make imagesbecause I couldn't find anything
on Google.
So I said a man being chased bya bear, and this is what ChatGPT
gave us.
Okay, so the way the brainchemistry works is when we are
in danger, we get a stressresponse.
So people talk about like reallyliking adrenaline.
That is what adrenaline is thereto do.
(05:49):
If you are in danger, your brainmakes all these stress chemicals
so you can run faster, bestronger, and fight back.
Now, we'll talk about whatthat's like in the modern world,
but that's what we're meant tohave in this hunter-gatherer
brain that we have.
Okay.
The next thing is once we aresafe, our brain looks around and
(06:13):
says, What do I need to survive?
And there are three basicthings.
Okay.
We need human connection becausewe have to have a tribe to
protect ourselves.
We have to eat.
Why does food taste good?
Dopamine.
And we need to make more humans.
We have to have babies.
(06:34):
And obviously, the act thatmakes a baby is pleasurable, and
that's what gives us thedopamine.
Okay?
So now in 2025, our brains arewired like hunter-gatherers, and
yet we have Snapchat andelectric cars and all sorts of
stuff that our brain justdoesn't know what to do with.
(06:54):
So we are not in danger anymoreof being eaten by whatever
predator or being attacked byother neighboring tribes.
So essentially, that turns intoanxiety.
We are looking for threat.
We are afraid of somethinghappening, and yet our brain
doesn't understand that we'renot in danger the way we used to
(07:17):
be.
So what's actually interestingis anxiety can be viewed as
protective, right?
If we were hunter-gatherers5,000 years ago and one of you
is really anxious, looking forsomething to hurt us, and I'm
off picking daffodils, and abear comes in, who's bear food
first?
Right?
(07:38):
So we're actually wired to lookfor danger.
And in this modern world, itfeels really weird because
worrying about Facebook likesisn't actually putting us in
danger.
So it's almost there's amismatch between our world and
how our brain works.
Now, the one we're going to talkabout today is the dopamine
(08:01):
system.
Okay.
So again, we are wired for food,intimacy, and positive human
connection.
And that also really looksdifferent.
Okay.
We've discovered all sorts ofthings that give us more
dopamine than we were ever meantto naturally happen.
(08:21):
I have a whole lecture onaddictive foods and how the
industry has made food reallyaddictive.
But this is an example ofsomething that makes a lot of
dopamine.
This is a Reese's peanut buttercup.
Do they grow on trees?
No.
It's engineered to have as muchsalt, fat, and sugar as our
(08:44):
brains can tolerate to releasethe maximum amount of dopamine.
Does anyone need any dopamine?
I got a couple.
Here we go.
So literally, as you eat these,as you eat these, your brain is
releasing more dopamine thanblueberries in the back.
Here we go, up in front.
(09:04):
Right here.
I got one more.
Way in the back.
Yes.
Right there.
So as you eat your Reese'speanut butter cup, I guess I
should bring more next time.
That is not how food is meant totaste for our hunter-gatherer
brains, right?
(09:25):
We are meant to eat basicallyraw fruits and vegetables, nuts
and meat.
And so the industry has figuredout how to make us do things
because it uses our dopaminesystem against us.
So let's take a look.
So on a normal day, our brainmakes dopamine throughout the
(09:46):
day, right?
If you get an A plus on a testand you feel good, that's
dopamine.
Okay.
Normally it goes from about 40nanograms per deciliter to 100
nanograms per deciliter in yourbrain.
Don't worry about the numbers,but that's the reference.
Okay, we mentioned food.
(10:07):
Do cheeseburgers grow on trees?
No, they are engineered to beaddictive.
Okay.
So a cheeseburger releases oneand a half times the normal
maximum dopamine.
Okay.
Sex in 2025 is different, right?
We have pornography, sex toys,people get all sorts of bodily
(10:27):
surgeries.
Like even sex itself in 2025 ismore stimulating than it was for
us as hunter-gatherers.
So that now releases moredopamine than we used to get.
Nicotine is an addictivechemical.
Why is it addictive?
Because it releases moredopamine than we were meant to
have.
Now, cocaine is interesting.
Cocaine's an upper, it's a drugthat people use when they want
(10:50):
to be like up and party and stayup all night.
The way it works is it takes thedopamine in your brain.
And normally your brain makesdopamine, and then when it's
done, it reabsorbs it.
What cocaine does is it actuallyprevents your brain from
reabsorbing the dopamine.
So when you use it, you get thisintense flood of dopamine, which
is why it's really addictive.
(11:12):
And methamphetamine, which isalso an upper, does double duty.
It causes the brain to releasemore dopamine than normal and it
blocks the reuptake.
So you get these incredibly highlevels of dopamine.
There is nothing else that I'maware of on planet Earth that
releases this much dopamine.
How hard do you think it is toquit meth?
(11:34):
It's one of the harder ones.
Because what ends up happeningis basically what happens is
once you hammer on your dopaminesystem to release more and more
and more, your brain runs out.
And so my patients who use methwhen they're off meth and they
have no dopamine, they're bored,they're anxious, they're
depressed, they're flat, theycan't feel good.
(11:57):
Like literally giving someone ahigh five or a hug or eating
something when you're coming offof meth, none of it feels good
because your brain is out ofdopamine.
Here's another thing, justlooking at how much dopamine
gets released.
You can see that dotted line isjust the kind of the maximum
normal dopamine that we release.
Alcohol makes us release morenicotine, morphine, cocaine,
(12:20):
amphetamine.
This is why these substancesfeel good to the human brain and
why we do more of them.
Okay.
Now there's one other thingthat's interesting about
dopamine in 2025 is that we areconstantly stimulated for our
brains to release more.
(12:40):
Has anyone gotten a text messagetoday?
Has anyone be on social mediatoday?
Has anyone bought anything onAmazon this week?
All of those things areunnatural to our brains and they
release more dopamine.
So what ends up happening is ashunter-gatherers, again, human
connection, intimacy, and food,and then the rest of the day you
(13:03):
were just cruising.
Today it's like text messageafter DM, after Amazon purchase,
after all this intensestimulation, our dopamine system
is getting hit all day long.
And we're in this chronic stateof our dopamine system being
overstimulated.
So if you get really bored whenyour phone's not with you,
that's what this is.
(13:23):
Okay.
This is if anyone likes to reador likes audiobooks, this is a
book by a Stanford psychiatristabout all of this with our
relationship to dopamine.
And she called it a dopaminenation, meaning that as
Americans, we are wired toconstantly be looking for more
dopamine.
Okay.
Now, the next question is we'vetalked about how the brain
(13:47):
chemistry around that pleasureresponse, how that happens.
Now let's talk about the geneticside of addiction.
So I asked the question doesaddiction run in families?
The answer is yes.
Our estimates as doctors suggestthat about half of our risk for
addiction comes from ourfamilies.
Why does that happen?
(14:08):
Remember, I mentioned we'd betalking about dopamine a lot?
Okay.
My patients usually have a drugof choice.
Okay.
So some of my patients drinkalcohol and they're like, that's
the dumbest thing ever.
It makes me nauseated and tired.
Some people drink alcohol andthey love it, and that's the
genetic piece.
Truly, some people drink a beerand their dopamine goes off the
(14:32):
charts from alcohol.
Some people drink a beer andthey feel tired and sick to
their stomach.
And that is the geneticcomponent.
One of my patients, in regardsto opioids, like fentanyl, she's
really interesting.
So I saw her three weeks ago,and she uses opioids to wake up,
(14:53):
feel more productive.
It helps her mood, it helps heranxiety.
And you guys probably rememberopioids are downers.
They're supposed to do theopposite.
And yet she literally is, oh mygosh, when I take fentanyl, I
can clean my house and I can getmy chores done.
It's an opposite effect.
So her brain geneticallyreleases more dopamine when she
(15:15):
gets an opioid.
And she doesn't like alcohol.
She doesn't have that geneticpredisposition with alcohol.
We had a family friend havesurgery, and I got a text
message of oxycodone is stupid.
I'm tired and I feel reallyunsmart.
That person does not have thatgenetic predisposition to
releasing a lot of dopamine withopioids, which is great because
(15:37):
she's really not likely to beaddicted to it.
So it is a very reasonablequestion for you as young adults
to ask your family (15:43):
does addiction run in our family?
And if so, to what substances?
You all will go off to collegeand there's alcohol and drugs
everywhere in college.
That's actually what I talkabout the seniors with.
And yeah, it's reasonable toknow how your family responds
when people use drugs andalcohol.
(16:04):
Okay.
The next question is how doesour lived experience affect
addiction?
Okay, and there's a couple ofparts to this.
The first is we're gonna talkabout, and this gets really
dark, traumatic experiences.
We're also gonna talk aboutmental illness and how they
intersect.
Okay.
(16:25):
So in my world as a doctor,there's what's called dual
diagnosis, which is basicallywhere a person has a mental
illness and an addiction.
And as a doctor, I cannotsuccessfully treat either one
unless I treat both.
Let's imagine you're depressedand you drink alcohol to feel
better.
(16:46):
I have to treat both.
I have to get you off of alcoholand treat your depression.
So you guys all remember frommath a Venn diagram of what
overlaps.
And you can see in this graphic,the overlap between addiction
and mental health is prettysmall.
Okay.
And given what I doprofessionally, this is
incorrect.
And it actually looks a lot morelike that.
(17:07):
Meaning, almost all of mypatients have addiction and a
mental health condition.
Okay.
I have maybe, let me think, Ithink I maybe have four or five
patients who are the exceptionand do not have a mental health
condition and addiction.
And a lot of what addiction is,is like people don't like how
(17:29):
they feel and they use asubstance and they temporarily
feel better.
And so they do it again, notrealizing that the substance
harms them in the long term.
This gets really dark, and Iapologize.
So we're going to talk aboutadverse childhood experiences,
which is abbreviated as ACE, andwe call them ACE, thus, the ACE
(17:54):
on the slide deck.
So you guys heard of KaiserPermanente?
Yeah, it's a big hospitalsystem.
They literally have millions ofpatients, and they have the data
to be able to find out like bigtrends in people's health by
say, we're going to look at twomillion people and see what
factors are associated with themdeveloping diabetes.
(18:15):
So Kaiser asked years ago, whydo people get sick?
Why do they get diabetes?
Why do they get heart disease?
Why do they get depression?
Why do they develop addiction?
And they found reliably thatdifficult circumstances in a
person's childhood leads them todevelop these illnesses as
adults.
(18:35):
So here are what are commonlythought of as adverse childhood
experiences.
So getting physically abused,emotionally abused, or sexually
abused as a child, beingphysically or emotionally
neglected as a child, and thenhaving a parent with a serious
mental illness, a parent orhousehold family member with
addiction, parental divorce,domestic violence in the home,
(18:55):
or a household memberincarcerated.
I literally sit down with mypatients and I actually score
their number of adversechildhood experiences with them.
I have two patients that haveall 10.
So one of my patients, she isthe nicest person, has all 10.
And she told me a story, andthis is what her life was like
(19:17):
as a child.
Her dad had addiction toalcohol.
So he was too intoxicated to doanything.
There was no food in the house.
And so she at age 11 had to getin the family car and drive to
the store to buy food.
So she started using drugs andalcohol around that same time
because she was so overwhelmedas a child, she didn't know what
(19:37):
to do.
And the best way we can think ofthis is these are all stressful
conditions.
And our stress hormones arefantastic when it comes to
running away from danger.
But when our stress hormones arealways active and always in our
systems, that chronic stresschanges how our brain grows and
(19:59):
develops.
And it also puts an extra stresson our organs.
That's why we see it leading tothings like heart disease.
For context, my ACE score basedon this is zero.
And then the last part of it ispost-traumatic stress disorder.
So I'm assuming you guys haveheard of PTSD.
Yeah.
So when I was a kid, it wassomething that we thought really
(20:21):
only happened in soldiers.
Like you went off to Vietnam andyou were shot at in the jungle
and you get nightmares and youcan't sleep.
It's actually more to the story.
So I will tell all of you, I gotdiagnosed with post-traumatic
stress disorder last year frommy work as a doctor in the ER.
I have seen stabbings,shootings, sexual assault, child
abuse, hangings, overdoses,people crushed by cars.
(20:45):
I still get flashbacks.
And I thought having nightmaresas a doctor was normal.
So thank you, communityhospital.
They offered therapy fordoctors.
And I start, I signed up.
I didn't know anything abouttherapy.
And I got diagnosed with PTSD.
And the reason I tell you thatis the best way to think about
PTSD is the I'm being chased bya bear response goes off at the
(21:12):
wrong time.
So again, if I'm being chased bya bear, I know that I will
respond to be ready to fight orrun to save my life.
But when people live through alot of traumas, it almost, you
can think of it like a scar intheir brain.
And when they live throughsomething that reminds them of
(21:33):
that, the fight or flightresponse goes off at the wrong
time.
So I will literally be inclinic.
I am safe.
No one's gonna hurt me.
And something will happen and Iam all spun up and I can't
figure out what's wrong.
It's really weird.
And a great number of mypatients have PTSD, and that's a
(21:55):
lot of why they use substances.
I can't sleep because ofnightmares, so I drink alcohol
because it's a downer.
And if I drink enough, I stopdreaming.
You can imagine if you livethrough getting abused as a
child, that's a really big riskfactor for PTSD.
(22:16):
Most of my patients that havethese adverse childhood
experiences, when I dig into itand I ask them, they have
nightmares, they haveflashbacks.
And a lot of them are reallyjust trying to figure out why I
feel so bad and what do I do?
And that's a lot of what I do asa doctor.
I help them stop whatever drugthey're using.
I help them get into therapy.
(22:37):
Literally, I sometimes buy booksfor art for my patients so they
can journal when they're reallystressed out.
They make like workbooks forpeople with PTSD.
And that's a lot of what I do asan addiction doctor is I help
people who've been throughreally difficult things
understand what they're feelingand stop using drugs and alcohol
(22:58):
to cope.
Okay.
Now the last bit, and how are weon time?
1040?
unknown (23:04):
Yeah.
SPEAKER_00 (23:05):
1040.
Okay.
The last thing is for you all tounderstand that your brain right
now is still growing, and I'llexplain how and why that
matters.
Okay.
So there's maybe what, a hundredand say 120 people in your
class?
Does that sound right?
unknown (23:22):
Yeah.
SPEAKER_00 (23:22):
120?
Okay.
So if we start using drugs andalcohol at a very young age, so
let's imagine we're all inseventh grade.
Okay.
If we decide as a group, all ofus as seventh graders are gonna
just try out a bunch of drugsand alcohol, which obviously we
wouldn't do, but two-thirds ofus will develop addiction.
So what is that like 90?
(23:42):
80, 90?
Okay.
Is anyone 15?
Okay.
So if we decide to start usingdrugs and alcohol around this
age, 14 to 15, that number dropsfrom two out of three to one out
of four.
So now we're looking at 30people in this room if we all
(24:02):
decide to try drugs and alcoholgetting addicted.
And if we wait till 21, thatnumber drops to less than one in
10.
So that's like maybe 10 or 11 ofus.
And the reason why this happens,there's two parts to it.
Okay.
The first is that when drugs andalcohol are in our brains, when
(24:23):
we're young, the brain doesn'tgrow the same way.
The brain does not reach itsfull potential.
We actually have some prettygood studies on cannabis
specifically.
For high school students thatuse cannabis, they are less
likely to get a B average, lesslikely to graduate high school,
less likely to graduate college.
(24:43):
The brain just does not grow toits full potential.
The second part is that yourbrains do different things with
dopamine than the adult brain.
Remember, we talked aboutdopamine, it was going to be
really important here.
The teenage brain makes moredopamine when new stuff happens.
(25:05):
So the first time you tryalcohol when you're 15, it's
actually more intense than ifyou wait till 21, because it
makes more dopamine.
And then the other thing aboutthe teenage brain is that you
actually have less dopamine onaverage than an adult.
So if you ever wonder why it'sso easy to get bored, it's
actually the teenage brain doesnot make as much dopamine.
(25:29):
So your brains are naturallygoing to look for new things to
do.
Again, whether it's socialmedia, whether it's sports,
whether it's bungee jumping,whether it's Reese's peanut
butter cups, whether it'scocaine, your brain is
constantly looking for moredopamine because as teenagers
you make less at baseline.
And then again, if you do trysomething new, you're gonna get
a bigger spike.
(25:50):
And then the last thing this isa man named Nick Chef, and he is
in recovery from addiction.
And his dad wrote about hisaddiction.
The book was called BeautifulBoy, it was made into a movie.
And this is actually one of hisbooks about what it was like
getting addicted.
And the way he describes it, andI see this all the time, is
(26:14):
drugs and alcohol offer ashort-term solution to a
problem.
Like I feel anxious.
If I use cannabis, I feel lessanxious.
And that's a lot of what mypatients tell me.
The problem is that I don'tprescribe drugs and alcohol to
patients because they causelong-term harm.
So a lot of what I do as adoctor is I help people to,
(26:35):
through therapy and medications,take those uncomfortable
feelings and we manage them in abetter way.
But essentially what happens ishis 13-year-old brain said, My
parents are going through adivorce and I don't feel good.
I'm anxious and I can't sleep.
I know I'll use cannabis.
And what happens is he startedto view cannabis as his solution
(26:56):
to everything.
Okay.
I feel bad, I'm gonna smoke.
I feel good, I'm gonna celebrateby smoking.
I'm really stressed out, I'mgonna smoke.
I can't sleep, I'm gonna smoke.
And so what we find is that whendrug and alcohol use becomes
regular, the brain stops growingsocially and emotionally.
So I literally get people whoare like 40 years old, and if
(27:19):
they started using drugs andalcohol at 18, when they get
sober, they're emotionally still18.
And it's really hard for thembecause they don't know how to
get a job, have a difficultconversation with a coworker,
because the only thing they knewfor all those years was drugs
and alcohol.
So literally, I'm gonna go backto work as a doctor.
(27:40):
If I have a difficult patientencounter, I can't go chug a
beer.
I have to cope and move on withmy day.
And this is where we find thatwhen people start using drugs
and alcohol regularly in theirteens, they don't get that full
social and emotional potential.
Okay.
I can go through a case of whatit actually looks like for one
of my patients, or we can stopand do questions.
(28:02):
What feels right?
Case study?
That's pretty good.
Okay.
All right.
So this is one of my patients.
I talked to her on Monday.
So the way we learn as doctorsis we do what are called case
studies.
So we literally describe a caseand then you can learn from it.
Okay.
So this is my patient.
She's 24 years old, and she wassent to me because she couldn't
(28:26):
stop drinking alcohol.
Okay.
And I go through my usual stuff,like where are you from?
What are your medicalconditions?
Do you have any allergies tomedications?
And so her only medicalcondition, because she's young,
is that she has an alcoholaddiction.
She doesn't have any medicationsthat she takes.
And then I asked her about heruse of drugs and alcohol.
(28:46):
And she says that she wouldusually binge on alcohol,
meaning drink a lot in a shortperiod of time.
And that alcohol would make herreally sleepy because it's a
downer.
So she would use cocaine to wakeup so she could drink more
alcohol.
So people sometimes mix uppersand downers to even out.
Okay.
And so as a doctor, I looked atwhat my options were and I
(29:07):
started some medication for herto make alcohol feel less
enjoyable.
If you are wondering, we do makemedications that make alcohol
less enjoyable.
And so I started her on the twomedications.
I saw her back in a month.
She was still drinking.
She'd maybe get a month whereshe wouldn't drink, and then
she'd go back to drinking.
And I just kept thinking, like,I feel like I'm missing
(29:30):
something.
So I about six months, you know,I said, let's talk about what we
could be missing here.
Why do you drink?
And she was like, oh, what well,you know, I sometimes get really
into it with my stepdad, and wefight and we argue and I don't
know what to do.
So and so we drink.
And I was like, okay, well,let's unpack that.
(29:52):
So I asked her, you know, didhave you had any traumatic
experiences?
And she literally told me, Dr.
Grover, no, I haven't.
Not.
And I was like, yeah, let's digin a little more here.
So I dug in deeper.
I literally went through andasked her about all of those
adverse childhood experiences.
And it turns out that she hadbeen verbally and physically
(30:12):
abused by this stepdad foryears.
And then she also had a nearfatal accident in a car when she
was 19 that left herhospitalized for almost three
weeks.
And so I started to ask her,like, do you get nightmares?
She was like, Dr.
Grover, how do you know?
I was like, Do you getflashbacks?
And she's Dr.
Grover, how do you know?
(30:33):
And it turns out that she hadpost-traumatic stress disorder
and I had missed it for thefirst six months of her care.
And so we stopped what we weredoing and we totally shifted.
And I got her a therapist and Iput her on medications
specifically for post-traumaticstress disorder.
And we started to make someprogress.
(30:55):
So I have her on threemedications.
She calls one of them triggerbecause she takes it when she's
really physically upset.
She calls one of them nightmarebecause she takes it to suppress
her nightmares.
And she all of a sudden had sometools, along with her therapist,
was giving her tools.
She had some tools to be able tosay, I'm really upset.
(31:17):
What am I gonna do?
And so I saw her on Monday.
She had been about six monthssober, and she and her
stepfather almost came to blows.
So she had a little relapse, butit was like a few hours of
drinking instead of a few daysof drinking.
And at the recommendation of hertherapist, she moved out.
And so she's away from thattrigger.
(31:39):
And so, yes, that that was myexperience with her.
I started focusing on thealcohol, but she's dual
diagnosis.
She has PTSD and alcoholaddiction, and I had to treat
both.
Before we wrap up, a huge thankyou to the Montage Health
Foundation for backing mymission to create fun, engaging
education on addiction.
(32:01):
And a shout out to the nonprofitCentral Coast Overdose
Prevention for teaming up withme on this podcast.
Our partnership helps me get theword out about how to treat
addiction and prevent overdoses.
To those healthcare providersout there treating patients with
addiction, you're doinglife-saving work and thank you
for what you do.
For everyone else tuning in,thank you for taking the time to
(32:23):
learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together, we can make it happen.
Thanks for listening.
And remember, treating addictionsaves lives.
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr.
Casey Grover, an addictionmedicine doctor based on
(00:20):
California's Central Coast.
For 14 years, I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side of thefight, helping people rebuild
their lives when drugs andalcohol take control.
Thanks for tuning in.
Let's get started.
Today's episode is on the brainscience behind addiction.
(00:45):
My daughter's school asked me tospeak to the students about this
topic, and I actually had theprivilege of speaking to my
daughter's class with mydaughter Kai in attendance.
The reason I mention her is whenI asked the group questions, I
had to make sure she didn'tanswer because she knows all the
answers.
(01:05):
She helped my wife and colleagueDr.
Reb Close and I study for ouraddiction medicine board exam.
So I gave this lecture on thebrain science behind addiction
to high school students, and Irecorded it to share with all of
you.
One quick clarification.
(01:34):
And to keep the kids interested,I brought quite a few of them to
the presentation and tossed theminto the audience.
I hope you find this topichelpful.
And with that, here we go.
So today we're going to talkabout the brain science behind
addiction.
And to start off, does anyonewant to give me a definition of
(01:55):
what addiction is?
I know Kaino's because shehelped me pass my board.
100%.
That's as simple as it is.
You like something, it hurtsyou, and you can't stop.
Okay, so there's an officialdefinition.
So as doctors, we haveprofessional societies, and we
have one called the AmericanSociety of Addiction Medicine.
(02:17):
And this is the definition thatthey give.
I don't necessarily know if it'shelpful to read it, except that
it is a treatable condition andit is a chronic medical
condition.
So once it develops, it's likeasthma.
You have it, it has to bemanaged.
And the simplest way to thinkabout addiction is there are
three things that happen.
(02:37):
You do something, whether it'sgambling, whether it's looking
at pornography, whether it'scannabis, whether it's alcohol,
whatever it is, you do it.
You have cravings to do it,meaning you have this intense
desire to do it.
You do it compulsively, meaningyou can't control it.
And then you have consequences.
So one of my patients right nowis in jail because she relapsed.
(03:01):
One of my patients I sawyesterday will face two years in
prison if he uses any drugs oralcohol.
One of my patients just lostcustody of two of her kids
because of her addiction.
So that's the consequences.
So that's really what addictionis.
Okay.
Now we are going to talk aboutthe why, why this happens.
Does anyone know what dopamineis?
(03:22):
And I know Kai knows because shehelped me pass my boards.
So I'm going to give my daughtera high five.
That is dopamine.
We're going to talk exactly whywe have it and what it does, but
we will come back to dopaminemultiple times as we talk about
this.
Okay.
So just a level set, dopamine isthe chemical in our brain that
makes us feel good.
(03:42):
Now, how long do you think we ashuman beings it takes for us to
meaningfully change in responseto our environment?
So, in other words, how longdoes it take for us to evolve?
Any guesses?
21 years.
I need it's much higher.
Go ahead.
Any guesses?
Yeah.
unknown (04:03):
Like a thousand.
SPEAKER_00 (04:04):
Like a thousand years.
Yeah.
So probably it's somewherebetween a thousand and five
thousand years for us toactually meaningfully change.
And the reason I bring this upis we are still wired to be
hunter-gatherers.
So our brains do not understandcars, social media, technology,
addictive food, alcohol,cannabis.
(04:25):
We're still wired to decidetoday who's going to go pick
fruit and who's going to go huntdeer.
So we will talk about thathunter-gatherer brain, but
that's actually how we're wired.
Now, as hunter-gatherers, ourfirst issue was we had to not
die.
Forgive me for being blunt.
(04:46):
We are not apex predators.
So right now, if a mountain lioncame in and chased one of us and
got one of us, that would be theend of our life.
Or if we are a small tribe andthere was a neighboring tribe
that was hostile, they mightcome attack us.
So we are wired, number one, tolook around and say, Am I safe?
(05:06):
Is anything gonna hurt me?
We'll talk about the brainchemistry of that in just a sec.
Once we look around and werealize we're not gonna die,
then we are our brain shifts andit starts focusing on how do we
live as long as we can.
So I apologize for the reallybad graphics.
(05:27):
I'm old and boring.
I use ChatGPT to make imagesbecause I couldn't find anything
on Google.
So I said a man being chased bya bear, and this is what ChatGPT
gave us.
Okay, so the way the brainchemistry works is when we are
in danger, we get a stressresponse.
So people talk about like reallyliking adrenaline.
That is what adrenaline is thereto do.
(05:49):
If you are in danger, your brainmakes all these stress chemicals
so you can run faster, bestronger, and fight back.
Now, we'll talk about whatthat's like in the modern world,
but that's what we're meant tohave in this hunter-gatherer
brain that we have.
Okay.
The next thing is once we aresafe, our brain looks around and
(06:13):
says, What do I need to survive?
And there are three basicthings.
Okay.
We need human connection becausewe have to have a tribe to
protect ourselves.
We have to eat.
Why does food taste good?
Dopamine.
And we need to make more humans.
We have to have babies.
(06:34):
And obviously, the act thatmakes a baby is pleasurable, and
that's what gives us thedopamine.
Okay?
So now in 2025, our brains arewired like hunter-gatherers, and
yet we have Snapchat andelectric cars and all sorts of
stuff that our brain justdoesn't know what to do with.
(06:54):
So we are not in danger anymoreof being eaten by whatever
predator or being attacked byother neighboring tribes.
So essentially, that turns intoanxiety.
We are looking for threat.
We are afraid of somethinghappening, and yet our brain
doesn't understand that we'renot in danger the way we used to
(07:17):
be.
So what's actually interestingis anxiety can be viewed as
protective, right?
If we were hunter-gatherers5,000 years ago and one of you
is really anxious, looking forsomething to hurt us, and I'm
off picking daffodils, and abear comes in, who's bear food
first?
Right?
(07:38):
So we're actually wired to lookfor danger.
And in this modern world, itfeels really weird because
worrying about Facebook likesisn't actually putting us in
danger.
So it's almost there's amismatch between our world and
how our brain works.
Now, the one we're going to talkabout today is the dopamine
(08:01):
system.
Okay.
So again, we are wired for food,intimacy, and positive human
connection.
And that also really looksdifferent.
Okay.
We've discovered all sorts ofthings that give us more
dopamine than we were ever meantto naturally happen.
(08:21):
I have a whole lecture onaddictive foods and how the
industry has made food reallyaddictive.
But this is an example ofsomething that makes a lot of
dopamine.
This is a Reese's peanut buttercup.
Do they grow on trees?
No.
It's engineered to have as muchsalt, fat, and sugar as our
(08:44):
brains can tolerate to releasethe maximum amount of dopamine.
Does anyone need any dopamine?
I got a couple.
Here we go.
So literally, as you eat these,as you eat these, your brain is
releasing more dopamine thanblueberries in the back.
Here we go, up in front.
(09:04):
Right here.
I got one more.
Way in the back.
Yes.
Right there.
So as you eat your Reese'speanut butter cup, I guess I
should bring more next time.
That is not how food is meant totaste for our hunter-gatherer
brains, right?
(09:25):
We are meant to eat basicallyraw fruits and vegetables, nuts
and meat.
And so the industry has figuredout how to make us do things
because it uses our dopaminesystem against us.
So let's take a look.
So on a normal day, our brainmakes dopamine throughout the
(09:46):
day, right?
If you get an A plus on a testand you feel good, that's
dopamine.
Okay.
Normally it goes from about 40nanograms per deciliter to 100
nanograms per deciliter in yourbrain.
Don't worry about the numbers,but that's the reference.
Okay, we mentioned food.
(10:07):
Do cheeseburgers grow on trees?
No, they are engineered to beaddictive.
Okay.
So a cheeseburger releases oneand a half times the normal
maximum dopamine.
Okay.
Sex in 2025 is different, right?
We have pornography, sex toys,people get all sorts of bodily
(10:27):
surgeries.
Like even sex itself in 2025 ismore stimulating than it was for
us as hunter-gatherers.
So that now releases moredopamine than we used to get.
Nicotine is an addictivechemical.
Why is it addictive?
Because it releases moredopamine than we were meant to
have.
Now, cocaine is interesting.
Cocaine's an upper, it's a drugthat people use when they want
(10:50):
to be like up and party and stayup all night.
The way it works is it takes thedopamine in your brain.
And normally your brain makesdopamine, and then when it's
done, it reabsorbs it.
What cocaine does is it actuallyprevents your brain from
reabsorbing the dopamine.
So when you use it, you get thisintense flood of dopamine, which
is why it's really addictive.
(11:12):
And methamphetamine, which isalso an upper, does double duty.
It causes the brain to releasemore dopamine than normal and it
blocks the reuptake.
So you get these incredibly highlevels of dopamine.
There is nothing else that I'maware of on planet Earth that
releases this much dopamine.
How hard do you think it is toquit meth?
(11:34):
It's one of the harder ones.
Because what ends up happeningis basically what happens is
once you hammer on your dopaminesystem to release more and more
and more, your brain runs out.
And so my patients who use methwhen they're off meth and they
have no dopamine, they're bored,they're anxious, they're
depressed, they're flat, theycan't feel good.
(11:57):
Like literally giving someone ahigh five or a hug or eating
something when you're coming offof meth, none of it feels good
because your brain is out ofdopamine.
Here's another thing, justlooking at how much dopamine
gets released.
You can see that dotted line isjust the kind of the maximum
normal dopamine that we release.
Alcohol makes us release morenicotine, morphine, cocaine,
(12:20):
amphetamine.
This is why these substancesfeel good to the human brain and
why we do more of them.
Okay.
Now there's one other thingthat's interesting about
dopamine in 2025 is that we areconstantly stimulated for our
brains to release more.
(12:40):
Has anyone gotten a text messagetoday?
Has anyone be on social mediatoday?
Has anyone bought anything onAmazon this week?
All of those things areunnatural to our brains and they
release more dopamine.
So what ends up happening is ashunter-gatherers, again, human
connection, intimacy, and food,and then the rest of the day you
(13:03):
were just cruising.
Today it's like text messageafter DM, after Amazon purchase,
after all this intensestimulation, our dopamine system
is getting hit all day long.
And we're in this chronic stateof our dopamine system being
overstimulated.
So if you get really bored whenyour phone's not with you,
that's what this is.
(13:23):
Okay.
This is if anyone likes to reador likes audiobooks, this is a
book by a Stanford psychiatristabout all of this with our
relationship to dopamine.
And she called it a dopaminenation, meaning that as
Americans, we are wired toconstantly be looking for more
dopamine.
Okay.
Now, the next question is we'vetalked about how the brain
(13:47):
chemistry around that pleasureresponse, how that happens.
Now let's talk about the geneticside of addiction.
So I asked the question doesaddiction run in families?
The answer is yes.
Our estimates as doctors suggestthat about half of our risk for
addiction comes from ourfamilies.
Why does that happen?
(14:08):
Remember, I mentioned we'd betalking about dopamine a lot?
Okay.
My patients usually have a drugof choice.
Okay.
So some of my patients drinkalcohol and they're like, that's
the dumbest thing ever.
It makes me nauseated and tired.
Some people drink alcohol andthey love it, and that's the
genetic piece.
Truly, some people drink a beerand their dopamine goes off the
(14:32):
charts from alcohol.
Some people drink a beer andthey feel tired and sick to
their stomach.
And that is the geneticcomponent.
One of my patients, in regardsto opioids, like fentanyl, she's
really interesting.
So I saw her three weeks ago,and she uses opioids to wake up,
(14:53):
feel more productive.
It helps her mood, it helps heranxiety.
And you guys probably rememberopioids are downers.
They're supposed to do theopposite.
And yet she literally is, oh mygosh, when I take fentanyl, I
can clean my house and I can getmy chores done.
It's an opposite effect.
So her brain geneticallyreleases more dopamine when she
(15:15):
gets an opioid.
And she doesn't like alcohol.
She doesn't have that geneticpredisposition with alcohol.
We had a family friend havesurgery, and I got a text
message of oxycodone is stupid.
I'm tired and I feel reallyunsmart.
That person does not have thatgenetic predisposition to
releasing a lot of dopamine withopioids, which is great because
(15:37):
she's really not likely to beaddicted to it.
So it is a very reasonablequestion for you as young adults
to ask your family (15:43):
does addiction run in our family?
And if so, to what substances?
You all will go off to collegeand there's alcohol and drugs
everywhere in college.
That's actually what I talkabout the seniors with.
And yeah, it's reasonable toknow how your family responds
when people use drugs andalcohol.
(16:04):
Okay.
The next question is how doesour lived experience affect
addiction?
Okay, and there's a couple ofparts to this.
The first is we're gonna talkabout, and this gets really
dark, traumatic experiences.
We're also gonna talk aboutmental illness and how they
intersect.
Okay.
(16:25):
So in my world as a doctor,there's what's called dual
diagnosis, which is basicallywhere a person has a mental
illness and an addiction.
And as a doctor, I cannotsuccessfully treat either one
unless I treat both.
Let's imagine you're depressedand you drink alcohol to feel
better.
(16:46):
I have to treat both.
I have to get you off of alcoholand treat your depression.
So you guys all remember frommath a Venn diagram of what
overlaps.
And you can see in this graphic,the overlap between addiction
and mental health is prettysmall.
Okay.
And given what I doprofessionally, this is
incorrect.
And it actually looks a lot morelike that.
(17:07):
Meaning, almost all of mypatients have addiction and a
mental health condition.
Okay.
I have maybe, let me think, Ithink I maybe have four or five
patients who are the exceptionand do not have a mental health
condition and addiction.
And a lot of what addiction is,is like people don't like how
(17:29):
they feel and they use asubstance and they temporarily
feel better.
And so they do it again, notrealizing that the substance
harms them in the long term.
This gets really dark, and Iapologize.
So we're going to talk aboutadverse childhood experiences,
which is abbreviated as ACE, andwe call them ACE, thus, the ACE
(17:54):
on the slide deck.
So you guys heard of KaiserPermanente?
Yeah, it's a big hospitalsystem.
They literally have millions ofpatients, and they have the data
to be able to find out like bigtrends in people's health by
say, we're going to look at twomillion people and see what
factors are associated with themdeveloping diabetes.
(18:15):
So Kaiser asked years ago, whydo people get sick?
Why do they get diabetes?
Why do they get heart disease?
Why do they get depression?
Why do they develop addiction?
And they found reliably thatdifficult circumstances in a
person's childhood leads them todevelop these illnesses as
adults.
(18:35):
So here are what are commonlythought of as adverse childhood
experiences.
So getting physically abused,emotionally abused, or sexually
abused as a child, beingphysically or emotionally
neglected as a child, and thenhaving a parent with a serious
mental illness, a parent orhousehold family member with
addiction, parental divorce,domestic violence in the home,
(18:55):
or a household memberincarcerated.
I literally sit down with mypatients and I actually score
their number of adversechildhood experiences with them.
I have two patients that haveall 10.
So one of my patients, she isthe nicest person, has all 10.
And she told me a story, andthis is what her life was like
(19:17):
as a child.
Her dad had addiction toalcohol.
So he was too intoxicated to doanything.
There was no food in the house.
And so she at age 11 had to getin the family car and drive to
the store to buy food.
So she started using drugs andalcohol around that same time
because she was so overwhelmedas a child, she didn't know what
(19:37):
to do.
And the best way we can think ofthis is these are all stressful
conditions.
And our stress hormones arefantastic when it comes to
running away from danger.
But when our stress hormones arealways active and always in our
systems, that chronic stresschanges how our brain grows and
(19:59):
develops.
And it also puts an extra stresson our organs.
That's why we see it leading tothings like heart disease.
For context, my ACE score basedon this is zero.
And then the last part of it ispost-traumatic stress disorder.
So I'm assuming you guys haveheard of PTSD.
Yeah.
So when I was a kid, it wassomething that we thought really
(20:21):
only happened in soldiers.
Like you went off to Vietnam andyou were shot at in the jungle
and you get nightmares and youcan't sleep.
It's actually more to the story.
So I will tell all of you, I gotdiagnosed with post-traumatic
stress disorder last year frommy work as a doctor in the ER.
I have seen stabbings,shootings, sexual assault, child
abuse, hangings, overdoses,people crushed by cars.
(20:45):
I still get flashbacks.
And I thought having nightmaresas a doctor was normal.
So thank you, communityhospital.
They offered therapy fordoctors.
And I start, I signed up.
I didn't know anything abouttherapy.
And I got diagnosed with PTSD.
And the reason I tell you thatis the best way to think about
PTSD is the I'm being chased bya bear response goes off at the
(21:12):
wrong time.
So again, if I'm being chased bya bear, I know that I will
respond to be ready to fight orrun to save my life.
But when people live through alot of traumas, it almost, you
can think of it like a scar intheir brain.
And when they live throughsomething that reminds them of
(21:33):
that, the fight or flightresponse goes off at the wrong
time.
So I will literally be inclinic.
I am safe.
No one's gonna hurt me.
And something will happen and Iam all spun up and I can't
figure out what's wrong.
It's really weird.
And a great number of mypatients have PTSD, and that's a
(21:55):
lot of why they use substances.
I can't sleep because ofnightmares, so I drink alcohol
because it's a downer.
And if I drink enough, I stopdreaming.
You can imagine if you livethrough getting abused as a
child, that's a really big riskfactor for PTSD.
(22:16):
Most of my patients that havethese adverse childhood
experiences, when I dig into itand I ask them, they have
nightmares, they haveflashbacks.
And a lot of them are reallyjust trying to figure out why I
feel so bad and what do I do?
And that's a lot of what I do asa doctor.
I help them stop whatever drugthey're using.
I help them get into therapy.
(22:37):
Literally, I sometimes buy booksfor art for my patients so they
can journal when they're reallystressed out.
They make like workbooks forpeople with PTSD.
And that's a lot of what I do asan addiction doctor is I help
people who've been throughreally difficult things
understand what they're feelingand stop using drugs and alcohol
(22:58):
to cope.
Okay.
Now the last bit, and how are weon time?
1040?
unknown (23:04):
Yeah.
SPEAKER_00 (23:05):
1040.
Okay.
The last thing is for you all tounderstand that your brain right
now is still growing, and I'llexplain how and why that
matters.
Okay.
So there's maybe what, a hundredand say 120 people in your
class?
Does that sound right?
unknown (23:22):
Yeah.
SPEAKER_00 (23:22):
120?
Okay.
So if we start using drugs andalcohol at a very young age, so
let's imagine we're all inseventh grade.
Okay.
If we decide as a group, all ofus as seventh graders are gonna
just try out a bunch of drugsand alcohol, which obviously we
wouldn't do, but two-thirds ofus will develop addiction.
So what is that like 90?
(23:42):
80, 90?
Okay.
Is anyone 15?
Okay.
So if we decide to start usingdrugs and alcohol around this
age, 14 to 15, that number dropsfrom two out of three to one out
of four.
So now we're looking at 30people in this room if we all
(24:02):
decide to try drugs and alcoholgetting addicted.
And if we wait till 21, thatnumber drops to less than one in
10.
So that's like maybe 10 or 11 ofus.
And the reason why this happens,there's two parts to it.
Okay.
The first is that when drugs andalcohol are in our brains, when
(24:23):
we're young, the brain doesn'tgrow the same way.
The brain does not reach itsfull potential.
We actually have some prettygood studies on cannabis
specifically.
For high school students thatuse cannabis, they are less
likely to get a B average, lesslikely to graduate high school,
less likely to graduate college.
(24:43):
The brain just does not grow toits full potential.
The second part is that yourbrains do different things with
dopamine than the adult brain.
Remember, we talked aboutdopamine, it was going to be
really important here.
The teenage brain makes moredopamine when new stuff happens.
(25:05):
So the first time you tryalcohol when you're 15, it's
actually more intense than ifyou wait till 21, because it
makes more dopamine.
And then the other thing aboutthe teenage brain is that you
actually have less dopamine onaverage than an adult.
So if you ever wonder why it'sso easy to get bored, it's
actually the teenage brain doesnot make as much dopamine.
(25:29):
So your brains are naturallygoing to look for new things to
do.
Again, whether it's socialmedia, whether it's sports,
whether it's bungee jumping,whether it's Reese's peanut
butter cups, whether it'scocaine, your brain is
constantly looking for moredopamine because as teenagers
you make less at baseline.
And then again, if you do trysomething new, you're gonna get
a bigger spike.
(25:50):
And then the last thing this isa man named Nick Chef, and he is
in recovery from addiction.
And his dad wrote about hisaddiction.
The book was called BeautifulBoy, it was made into a movie.
And this is actually one of hisbooks about what it was like
getting addicted.
And the way he describes it, andI see this all the time, is
(26:14):
drugs and alcohol offer ashort-term solution to a
problem.
Like I feel anxious.
If I use cannabis, I feel lessanxious.
And that's a lot of what mypatients tell me.
The problem is that I don'tprescribe drugs and alcohol to
patients because they causelong-term harm.
So a lot of what I do as adoctor is I help people to,
(26:35):
through therapy and medications,take those uncomfortable
feelings and we manage them in abetter way.
But essentially what happens ishis 13-year-old brain said, My
parents are going through adivorce and I don't feel good.
I'm anxious and I can't sleep.
I know I'll use cannabis.
And what happens is he startedto view cannabis as his solution
(26:56):
to everything.
Okay.
I feel bad, I'm gonna smoke.
I feel good, I'm gonna celebrateby smoking.
I'm really stressed out, I'mgonna smoke.
I can't sleep, I'm gonna smoke.
And so what we find is that whendrug and alcohol use becomes
regular, the brain stops growingsocially and emotionally.
So I literally get people whoare like 40 years old, and if
(27:19):
they started using drugs andalcohol at 18, when they get
sober, they're emotionally still18.
And it's really hard for thembecause they don't know how to
get a job, have a difficultconversation with a coworker,
because the only thing they knewfor all those years was drugs
and alcohol.
So literally, I'm gonna go backto work as a doctor.
(27:40):
If I have a difficult patientencounter, I can't go chug a
beer.
I have to cope and move on withmy day.
And this is where we find thatwhen people start using drugs
and alcohol regularly in theirteens, they don't get that full
social and emotional potential.
Okay.
I can go through a case of whatit actually looks like for one
of my patients, or we can stopand do questions.
(28:02):
What feels right?
Case study?
That's pretty good.
Okay.
All right.
So this is one of my patients.
I talked to her on Monday.
So the way we learn as doctorsis we do what are called case
studies.
So we literally describe a caseand then you can learn from it.
Okay.
So this is my patient.
She's 24 years old, and she wassent to me because she couldn't
(28:26):
stop drinking alcohol.
Okay.
And I go through my usual stuff,like where are you from?
What are your medicalconditions?
Do you have any allergies tomedications?
And so her only medicalcondition, because she's young,
is that she has an alcoholaddiction.
She doesn't have any medicationsthat she takes.
And then I asked her about heruse of drugs and alcohol.
(28:46):
And she says that she wouldusually binge on alcohol,
meaning drink a lot in a shortperiod of time.
And that alcohol would make herreally sleepy because it's a
downer.
So she would use cocaine to wakeup so she could drink more
alcohol.
So people sometimes mix uppersand downers to even out.
Okay.
And so as a doctor, I looked atwhat my options were and I
(29:07):
started some medication for herto make alcohol feel less
enjoyable.
If you are wondering, we do makemedications that make alcohol
less enjoyable.
And so I started her on the twomedications.
I saw her back in a month.
She was still drinking.
She'd maybe get a month whereshe wouldn't drink, and then
she'd go back to drinking.
And I just kept thinking, like,I feel like I'm missing
(29:30):
something.
So I about six months, you know,I said, let's talk about what we
could be missing here.
Why do you drink?
And she was like, oh, what well,you know, I sometimes get really
into it with my stepdad, and wefight and we argue and I don't
know what to do.
So and so we drink.
And I was like, okay, well,let's unpack that.
(29:52):
So I asked her, you know, didhave you had any traumatic
experiences?
And she literally told me, Dr.
Grover, no, I haven't.
Not.
And I was like, yeah, let's digin a little more here.
So I dug in deeper.
I literally went through andasked her about all of those
adverse childhood experiences.
And it turns out that she hadbeen verbally and physically
(30:12):
abused by this stepdad foryears.
And then she also had a nearfatal accident in a car when she
was 19 that left herhospitalized for almost three
weeks.
And so I started to ask her,like, do you get nightmares?
She was like, Dr.
Grover, how do you know?
I was like, Do you getflashbacks?
And she's Dr.
Grover, how do you know?
(30:33):
And it turns out that she hadpost-traumatic stress disorder
and I had missed it for thefirst six months of her care.
And so we stopped what we weredoing and we totally shifted.
And I got her a therapist and Iput her on medications
specifically for post-traumaticstress disorder.
And we started to make someprogress.
(30:55):
So I have her on threemedications.
She calls one of them triggerbecause she takes it when she's
really physically upset.
She calls one of them nightmarebecause she takes it to suppress
her nightmares.
And she all of a sudden had sometools, along with her therapist,
was giving her tools.
She had some tools to be able tosay, I'm really upset.
(31:17):
What am I gonna do?
And so I saw her on Monday.
She had been about six monthssober, and she and her
stepfather almost came to blows.
So she had a little relapse, butit was like a few hours of
drinking instead of a few daysof drinking.
And at the recommendation of hertherapist, she moved out.
And so she's away from thattrigger.
(31:39):
And so, yes, that that was myexperience with her.
I started focusing on thealcohol, but she's dual
diagnosis.
She has PTSD and alcoholaddiction, and I had to treat
both.
Before we wrap up, a huge thankyou to the Montage Health
Foundation for backing mymission to create fun, engaging
education on addiction.
(32:01):
And a shout out to the nonprofitCentral Coast Overdose
Prevention for teaming up withme on this podcast.
Our partnership helps me get theword out about how to treat
addiction and prevent overdoses.
To those healthcare providersout there treating patients with
addiction, you're doinglife-saving work and thank you
for what you do.
For everyone else tuning in,thank you for taking the time to
(32:23):
learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together, we can make it happen.
Thanks for listening.
And remember, treating addictionsaves lives.
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