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: [e-mail]

Episode Transcript

Speaker 1 (00:00):
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.

(00:22):
For 14 years I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
Today's episode is onpost-traumatic stress disorder,

(00:44):
also known as PTSD, specificallythe link between PTSD and
addiction.
It's a joint episode between mypodcast and the Kratom Sobriety
Podcast.
If you haven't heard of theKratom Sobriety Podcast, they
are awesome.
The Kratom Sobriety Podcast isfocused on helping people learn

(01:05):
about Kratom and get help whenthey get addicted to Kratom, and
they've hosted me on theirpodcast several times now to
share my perspective as anaddiction medicine doctor on
Kratom for their audience.
And so they did anotherinterview with me recently with
a focus on how life traumaaffects addiction, and the

(01:26):
conversation was so awesome thatwe decided to make it a joint
episode on both podcasts.
And with that, here we go.

Speaker 2 (01:36):
Hi, Dr Grover, how are you?
Hello, how are you?
It's so good to catch up withyou.
We just figured you know.
Because trauma is such arecurrent predominant theme in
the addiction world and DrGrover is very knowledgeable
about trauma and PTSD from bothlived experience and his
clinical experience, why not doa trauma dump in the form of a

(01:58):
Q&A on trauma in the context ofaddiction and more?

Speaker 1 (02:06):
in the context of addiction and more.
I'm right here.
I'm very excited about thisepisode.
My niche in addiction medicine,in addition to Kratom, is
becoming the intersectionbetween addiction and PTSD.

Speaker 2 (02:12):
Perfect, yeah, so you mentioned you were diagnosed
with PTSD last year from yourtime as an emergency medicine
physician.
Do you want to tell your storya little bit more, or just
briefly?
It was very compelling and Ithink the listeners will enjoy
having that lived experienceperspective, in addition to all
the clinical knowledge bombs youwill be dropping.

Speaker 1 (02:33):
Yeah, in medical school we didn't get a lot of
education about post-traumaticstress disorder and it was
largely felt to be somethingthat people got when they
returned from war zonesSignificant conflict, gunshots,
explosives.
It was really something thatpeople got when they returned
from war zones Significantconflict, gunshots, explosives.
It was really something that Iwas taught.
You had to have just incrediblybig, huge, life-changing

(02:54):
traumas to really cause PTSD.
And I remember hearing the termtrauma-informed early in my
training as a doctor and I waslike what is that Trauma is when
you fall off of a building andyou have to go to the operating
room to fix your shoulder?
I was thinking and I was taughtabout trauma in the physical
sense only.
And so I started, as I lookback, developing some symptoms

(03:19):
of post-traumatic stressdisorder as early on as my
residency that's the trainingtime after medical school and I
just thought it was normal.
Oh sure, I have a nightmareabout working in the emergency
department, that's normal.
Or, yeah, I get a littlenervous before an ER shift.
Or yeah, I get a flashbackabout a bad case, or I can't get

(03:41):
this one case out of my mind.
That's part of the job and Iassumed everyone else felt the
same way and I was actuallydoing fairly well as an
emergency physician.
I graduated my training fromStanford in 2013 and I was the
director of the department andgoing into 2020, life was good,
except there was somethinghappening.

(04:02):
We all know that was COVID andit was really intense.
And I was something happeningwe all know that was COVID and
it was really intense and I wasthe medical director of the
department.
Through COVID and we justrallied in my department.
We all were selfless, we knewthat the health of the community
mattered and we just threwourselves into our work.

(04:23):
And starting about 2022, I wasdifferent.
On shift, it was harder to beempathetic, I felt overwhelmed
more easily and I was like youknow, it's just a pandemic thing
, we're still recovering.
And getting into 2023,something was wrong.

(04:43):
I was a different person.
My personality changed.
I was less empathetic and Ipride myself on kindness and
respect and honesty and I washaving trouble bringing kindness
and respect to work and I felt,for the first time, resentful

(05:05):
towards a patient for checkinginto the emergency department
and I just had this moment ofjust whoa, what is that?
I did not sign up to everresent anyone for needing
medical care and I thought itwas just hey, I'm chief of staff
, I've got a new leadership role, it is the stress and at the

(05:26):
end of 2023, I got somephysician coaching.
There's a physician out there,quick shout out to Dr Rob Orman.
He coaches physicians who arestruggling.
And I was in a new leadershiprole, chief of staff.
That's like being student bodypresident for the doctors and I
wanted to do my best, and so Igot a little education money in

(05:46):
my new leadership role to bettermyself.
And I said, hey, I want to dosome physician coaching and I'm
going to learn how to be abetter leader.
And the first session I didwith him was what's burnout?
Do I have it and how do I helpmy colleagues?
And he unearthed some stuffthat we realized was a lot more.

(06:08):
And around that same time, thehospital thank you, montage
Health started offering freetherapy and counseling for
doctors, and there's a lot ofshame and stigma, particularly
among physicians, about mentalhealth.
And I said, well, hey, I'm thehead honcho when it comes to the
doctors.
I want to lead by example.
And so I signed up for therapy.

(06:28):
My first therapist was not agreat fit, and as I worked with
my therapist, she said do youget nightmares?
And I said yeah, and she goesdo you get nightmares about work
?
And I was like, yeah, prettyregularly.
And she's like, how often doyou get flashbacks about bad
cases at work?
And I said, well, I don't know,like a couple of times a day

(06:50):
why this is all normal.
And she pointed out to me thatI had post-traumatic stress
disorder.
I was having flashbacks,negative experiences.
It was affecting my mood.
I was having consequences in mywork.
And I'll never forget one ofthe shifts.
The nurses asked me hey, drGrover, how are you?
And all I could say was I amphysically present and I got a

(07:14):
couple of looks from the nurseslike uh-oh, something's wrong
with Grover.
So I continued to work with mytherapist she's an awesome human
being and I realized I neededto leave the emergency
department and I was soembarrassed.
I told my colleagues I had amedical issue.
I was super cryptic about it.
I tried switching to a lowacuity area of the emergency

(07:38):
department where people aren'tas sick, it's not as complicated
, and that was still causing mesymptoms.
I mean, the minute I walkedthrough those doors I was just a
different person and finally Irealized I had to say goodbye to
all of it, and I have a lot ofsocial capital.
I'm a successful physician, I'mrespected in my community and I
felt it was my duty to bevulnerable on behalf of those
who can't.
And so I just told everyone, Itold the board of trustees at my

(08:03):
hospital and highlighted theneed to support the mental
health of medical providers.
I wrote an article that waspublished nationally for
emergency physicians and I hadto own it and I tell anyone who
wants to talk about it.
I have nothing to hide and Igot to be honest.
Ptsd has been a roller coasterand I have the utmost respect

(08:25):
for the diagnosis, given whatI've been through.
Sorry for the long answer, butthat's my story.

Speaker 2 (08:30):
You definitely don't have to apologize.
I appreciate it and I think thelisteners will as well.
Yeah, there really is a lot ofstigma in the medical community,
and even for people likecreative users seeking help.
There's a lot of stigma theretoo, which I guess we can get
into a little bit more, but I dorelate.
I too was diagnosed with PTSD,and so, for reasons that are

(08:54):
related to childhood adverseexperiences actually which we'll
get to but could you give thelisteners an idea of what is the
definition of PTSD?

Speaker 1 (09:03):
So we, as doctors, use diagnostic criteria, and the
one we use for mental healthdiagnosis is called the DSM-5,
or Diagnostic and StatisticalManual, version 5.
And there's criteria foreverything ADHD, which is
attention deficit, hyperactivitydisorder, ocd, obsessive

(09:24):
compulsive disorder, and PTSDhas very specific criteria and I
will give them to you now.
Number one you had to have somesort of stressor.
That could have been that ithappened to you.
You witnessed it.
It happened to a very closecontact, like a very close loved
one or, like me, you got itthrough work.

(09:46):
The second criteria is symptomsare intrusive.
You get re-experiencing of thetrauma through nightmares,
memories, flashbacks, and youget reactive after you have one
of those.
The next thing is it has to beso unpleasant that you try to
avoid it, so you try to avoidmemories of the trauma or
feelings related to the trauma.

(10:07):
The next is is it harms you?
You have, let's say, you can'trecall details of what happened,
or you feel overly negative, oryour mood goes down.
You feel depressed.
You might blame yourself.
You don't feel like life isenjoyable.
You have trouble feeling happy.
The next is that it changes howyou interact with the world.

(10:29):
You might be more irritable,you might engage in risky or
destructive behavior, likeaddiction.
You might be hypervigilant orbe easily startled, and this one
is so common.
You might have difficultysleeping, have difficulty
sleeping.
And then the last three is thatit has to last longer than a
month, it has to causesignificant impairment in your

(10:51):
life and it can't be that thisis caused by something else.
I go through these criteriawith my patients all day long in
clinic, but the basic thing issomething bad happened.
You get a lot of bad memoriesand it's hurting you.

Speaker 2 (11:02):
So why do some people who experience traumas develop
PTSD clinically and some peoplecan seem more resilient and do
not develop the disorder?

Speaker 1 (11:12):
It's a great question and I can tell you in my
emergency department some of mycolleagues do not have PTSD and
practice longer than I did.
There's a couple of factors.
So the first is some of us aremore sensitive to our emotions
than others.
So I would identify as anempathic and emotional person

(11:35):
and some of the experiences Ihad had a much more profound
effect on me because I am wiredto feel more emotion than, let's
say, my colleague next door.
The other is the magnitude ofthe trauma.
We'll talk about big T's andlittle t's in just a little bit.
And then it's how much trauma,how much it's repeated, and then

(11:59):
is the person able to removethemselves from the environment.
So let's go through this right.
Let's say a 35-year-old personhas a near-fatal car accident.
That's one big T trauma, onebig big event.
Now let's say another personwas repeatedly sexual assaulted,
going back to age 5, all theway to 25.

(12:22):
That is early, long durationand very intense.
That's going to be a greatertrauma response on the brain.
They also talk about, I said,big T's and little t's.
A big T are these big eventsFor me as a doctor.
One of my patients hung herself.
One of my patients walked intothe ER and died in front of me.

(12:43):
I've taken care of too manycases of brutal sexual assault.
Those are big T's.
The little T's are the smallnegative experiences that add up
over time and it's almost ifyou have a bucket the big T's
fill it up faster, but a lot oflittle T's will fill it up too.
The little T's are one of mycolleagues yelling at me at 2 am

(13:07):
when I'm just trying to help apatient.
A little t might be a notverbally abusive but highly
critical parent.
So essentially it's the overallcumulative magnitude of the
trauma combined with a person'semotional sensitivity and
therefore vulnerability with aperson's emotional sensitivity
and therefore vulnerability.

Speaker 2 (13:26):
Thank you so much, and I know you mentioned on the
prior episode of your ownpodcast what is it?

Speaker 1 (13:35):
Addiction Medicine Made Easy.
Thank you for the shout out itis Addiction Medicine Made.

Speaker 2 (13:37):
Easy.
That is my podcast.
Yeah, check it out.
We'll put a link to it in theshow notes.
But yeah, in a really goodlecture you published on that
podcast about trauma, youmentioned the adverse childhood
experiences, and one thing thatreally struck me as compelling
was, and something I couldrelate to too, is that the more
adverse childhood experiencesyou have, the more likely you

(13:58):
are to develop certain physicalillnesses.
And you also mentioned Dr GaborMate, and I'd love to pick your

(14:20):
brain a little bit about himbecause, 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 todevelop physical, actual like
real physiological illnesses.
Do you want to talk a littlebit more about that, because
it's fascinating, I like how yougave me an entire PhD's worth
of work into a single question.

Speaker 1 (14:36):
Okay, so let's talk first about adverse childhood
experiences.
So there's history here, andplease realize I am not trying
to criticize anyone, I'm justtrying to give the history.
So the literature on adversechildhood events, abbreviated as
ACE or ACEs, comes from Kaiser,and, if anyone doesn't know,
kaiser is a large hospitalsystem that's in various places

(14:59):
in the United States.
It's very big here inCalifornia.
They tend to operate in regionsStates.
It's very big here inCalifornia.
They tend to operate in regions, and Kaiser is a closed system,
meaning that they only takeKaiser patients.
Somebody can walk into theemergency department and they'll
get taken care of, but Kaiseronly takes care of Kaiser
patients and Kaiser as a closedsystem.
If they keep people healthy, thesystem saves money, and so they

(15:23):
were thinking from a financialstandpoint well gosh, what if we
prevented illness?
And so they asked the questionwhy do people get sick?
Why do people get high bloodpressure?
Why do people get diabetes?
Why do people develop analcohol addiction?
Why do people get depression?
And so the cool thing aboutKaiser is they have millions and

(15:43):
millions of members and anextremely robust electronic help
system that allows them to dohuge studies on populations, and
one of the things that theyfound that was correlated with
the development of illness notmental illness or addiction.
Any illness, including mentalhealth and addiction, was

(16:05):
adverse childhood experiences,and essentially the idea was
this is probably complicated,but increased childhood stress
is an inflammatory state.
Families where there are theseadverse childhood experiences
are less likely to prioritizegood nutrition, education and
healthy physical activity.

(16:26):
And then there tends to be thisintergenerational trauma effect
.
So let me read you someexamples of adverse childhood
experiences.
Parents in the household sworeat you, insulted you, put you
down, humiliated you or made youfeel that you would be
physically hurt.
Did an adult in the householdpush, grab, slap or throw
something at you or hit you sohard that you had marks?

(16:47):
Did an adult or person at leastfive years older than you touch
or fondle you in a sexual way?
Did you often feel like no oneloved you?
Did you often feel like you didnot have enough to eat?
Were your parents everseparated or divorced?
Was someone in your familypushed, grabbed, slabbed or hit,
or even in front of you?
Was someone in your familypushed, grabbed, slabbed or hit,
or even in front of you, wasanyone in your family ever

(17:09):
repeatedly threatened with a gunor a knife?
Did a family member haveaddiction?
Was there mental illness in thefamily?
Or did a family member commitsuicide and did a family member
go to prison?
You get the idea that these areaddiction, trauma,
interpersonal violence, sexualviolence, physical violence,
verbal violence, mental illness.
These are things that aredestabilizing to a child and
affects the childhood, and thoseare the things that we found

(17:32):
were associated with all formsof illness, but there's a
particular association withmental health and addiction.
Now there's a website that I usecalled MDCalc and it's
basically got a number ofmedical calculators on it, and
so I I use called MDCalc andit's basically got a number of
medical calculators on it, andso I just went on MDCalc.
I have no affiliation with them, except it's useful and I
actually went through.

(17:53):
They have what's called anadverse childhood experiences
score and when my patients arenot doing well, I will actually
go through the score with themto 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 youwant to go the withdrawal
management route or you want togo to the suboxone route and

(18:14):
then if they keep relapsing,it's like what am I missing?
And it's usually trauma.
So most of my patients have anaverage childhood event score
using this score on MDCalc andagain, that's mdcalccom.
Most of them have a scoresomewhere between about four and
eight.
I have a few nines and I havetwo tens and my two tens have

(18:37):
lived through the mostunbelievable trauma and one of
them just had a relapse traumaand one of them just had a
relapse.
This person was in a socialsituation.
A member of the opposite sexcame towards them.
Every bell and whistle in theirbrain went off.
Trauma response leads torelapse and we're working on it

(18:58):
Now.
Dr Gabor Mate is really thefather of the link between
addiction and trauma.
Not that he discovered it, buthe is the one that realized how
pervasive it is.
In his words, not everyone whois traumatized has addiction,
but everyone who has addictionhas been traumatized and it

(19:21):
shows up in different ways.
Two siblings might live in thesame household growing up and
sibling A develops addiction,the other does not, and they
look at each other and it waslike it was the same mom and dad
.
What are you talking about thesibling with addiction had a
different experience.
They had a differentrelationship with the parents.
Perhaps the parents were moreverbally abusive.
Perhaps the other sibling wastreated better.

(19:43):
Perhaps the sibling withaddiction was more emotionally
sensitive.
Unless you've lived in someoneelse's shoes, which we know is
not possible, it's really hardto know what was traumatic to
someone else, and that's hismessage is let's honor the
trauma that people have livedthrough because developing

(20:04):
addiction wasn't on yeah,exactly, I remember you said you
went to speak to all these kidsand nobody will say oh, when I
grow up I want to be an addictor I want to be in jail.

Speaker 2 (20:18):
You know, you want to be an astronaut.
You could have a sibling and itcould be like everything else
is the same.
But if the mother is under morestress when you're in the
uterus, then that's going toaffect you too.

(20:39):
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 canthat be traumatic too and also
predict?
Or what do you think?
Natal?

Speaker 1 (20:53):
environment.
Can that be traumatic too, andalso predict?
Or what do you think?
I can't speak to the humanresearch, but there is some
research in mice where they hadadult mice and they would
electrocute their cage so theirfeet would hurt and then they
would release the smell ofcherry blossoms.
And then the mice got pregnantand they exposed the offspring
to the smell of cherry blossomsand they exhibited a stress

(21:14):
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 forestthat they are, rather than the
tree of addiction and see theperson for the forest that they
are, rather than the tree ofaddiction.

Speaker 2 (21:36):
Yeah, that's a fascinating study.
The epigenetics of addictionand trauma is fascinating.
So I guess there is a lot ofresearch on intergenerational
trauma and how their descendantswill have a gene that might not
have been turned on but becauseof that trauma of their
ancestors it turned on.

Speaker 1 (21:51):
That is epigenetics.

Speaker 2 (21:52):
Ah, cool Okay.

Speaker 1 (21:53):
It's basically the environment activates certain
genes.

Speaker 2 (21:56):
Yeah, and so, yeah, you've discussed the very
profound link between trauma andaddiction, and one thing that
comes up often in this littlecomplex set of circles is ADHD
too.
There seems to be an interplaybetween, among ADHD, addiction
and trauma.
And this is where I want tojust ask something about Dr

(22:20):
Gabor Mate, because a lot of itseems likea lot of fellow
clinicians criticize him becauseof his thoughts about ADHD.
He said in a lot of casespeople with ADHD have developed
a habitual dissociation.
If you go through trauma as achild, you will tend to
dissociate as a coping mechanism, and that is true, definitely

(22:41):
true for me, and as such I feellike I do have more dissociative
tendencies as an adult and thataffects my concentration.
But there's such a stronggenetic link to that a lot of
like his fellow medical doctorscriticize him for that and then
think, oh, everything else hesaid is must be bunk, because
why is he just disregarding thegenetic link in ADHD?

(23:05):
So it seems like ADHD is justit's a very complex disease or
disorder and a very complexinterplay.

Speaker 1 (23:15):
Yeah, I'm going to take what you said about you
know, dr Gabor Mate, not beingrespected by colleagues and I'm
waiting for my colleagues here,where I practice medicine on the
Central Coast, to accuse me ofoverdiagnosing PTSD.
And so, essentially, if youcome to my practice and you're
doing great, we put you on someSuboxone.

(23:36):
We don't necessarily need toexplore what else is going on.
But if you keep relapsing and Ican't figure it out, I'm going
to go down the trauma rabbithole with you and I'm going to
find something.
We've all been throughsomething.
We've all been throughsomething and the reason I

(23:59):
mention that in my own practiceis it's very easy to attribute
things to PTSD because aperson's not doing well, they're
emotionally reactive and, gosh,there's a trauma.
Let's link them.
But bipolar disorder can makepeople impulsive.
Adhd can make people impulsive.
Adhd can make people impulsive.
Ptsd can make patientsimpulsive and it's really
nuanced and there's no bloodtest, there's no CAT scan.

(24:22):
It's all these diagnosticcriteria and a lot of the
syndromes overlap.
I think what I would say aboutADHD and PTSD and addiction is
ADHD in and of itself is a riskfactor for addiction.
Ptsd in and of itself is a riskfactor for addiction.
If you have two risk factors,your risk of addiction is higher

(24:45):
than if you have one alone.
And I think for me, when itcomes to trying to get sober,
being able to focus on youremotions, to regulate them,
focus on therapy, focus onmeetings, focus on your support
If you can't do that, it's veryhard to get and stay sober.

(25:13):
Who's super smart and was on mypodcast about ADHD was really
the person that opened my eyesto the fact that I was
under-treating ADHD in mypractice and I needed to be more
aggressive, and my patients allvalidate what he said Doc, my
ADHD is better.
I can finally pay attention tomy therapy sessions and so in
some ways and this sounds reallysilly, but if a person has
diabetes, we would treat it.

(25:34):
Person has high blood pressurewe would treat it.
Why would we leave one of theirmental disorders untreated and
wonder why they're not doingbetter?

Speaker 2 (25:46):
So if somebody walks into your practice with not the
dual diagnosis but like a triplediagnosis of ADHD, ptsd and
addiction, it's like athree-pronged kind of issue.
Like where would you start withone of your patients?
Would you try to address theADHD first, or all together?
Or if you're using medicationas like an adjunct to

(26:08):
psychotherapy, like, yeah, ifsomebody walks into your
practice with all of that goingon, what would the process be
like to figure out how to get tothe heart of the pain and how
to treat them going forward?

Speaker 1 (26:21):
The first thing I would do is thank them for
coming to see me and remind themthat they're in a safe
environment and they're not tobe judged.
So much stigma for eachindividual diagnosis and even
more altogether.
Essentially, what we have tofigure out is what's the primary
driving issue?
Is it that alcohol is intenselyeuphoric for that person,

(26:42):
beyond the average person?
Is it that their PTSD is so badthat they cannot sleep and
therefore they drink alcohol?
Is their ADHD so bad that theycannot stop using
methamphetamine?
So, essentially, I, as aphysician, I create a problem
list.
Okay, problem one hyperbloodpressure.

(27:02):
You're going to see yourcardiologist.
Problem two PTSD mild.
Problem three ADHD severe.
Problem four creatinine usedisorder secondary to untreated
ADHD.
So, in other words, my job is to, by talking to the patient,
understand their diagnoses, theseverity of each, and then
therefore come up with a plan toprioritize what's the primary

(27:26):
issue, and it could be any ofthe three, right?
Some people, when they drinkalcohol, have an intense
euphoric response, others do not.
So a person who has an intenseeuphoric response to alcohol
might benefit from themedication naltrexone that makes
alcohol less euphoric, and wemight find that they're able to
stop drinking just withnaltrexone and we can pause and

(27:48):
take a deep breath and then workon the PTSD or ADHD.
We might find on the flip sidethat their PTSD is horrible and
they can't sleep and they'reconstantly in fight or flight
mode and they're so easilystartled and they're just trying
to use kratom to calm downbecause they want that
opioid-like effect.
So what I do as a doctor is tounderstand each diagnosis, how

(28:13):
severe it is, and thereforeprioritize treatment, to come up
with a treatment plan way tothe substance, and then you have

(28:34):
the environmental and thesocial and all the social
determinants of health that gointo this too.

Speaker 2 (28:36):
And so I'm wondering this is going to be such a weird
question, but do you becauseit's so interdisciplinary do you
use like a chat GPT type systemto put all this information
together, and do you encourageyour patients to use ChatGPT to
sometimes make sense ofeverything that's going on?

Speaker 1 (29:13):
ChatGPT to give me my first draft.
Or let's say we need to createa memorandum of understanding
with a therapy program that wewant to easily refer patients
back and forth.
I'll use ChatGPT for that.
I don't know if we're evergoing to get to the point that
machines will replace humandoctors when it comes to
medicine, and I may be totallywrong, but essentially it's

(29:35):
almost like picking flavors outof a food.
So let's say, you eat ablueberry muffin, you can taste
the blueberries, you can tastethe starch of the muffin, you
can taste the cinnamon.
It's pulling out the nuancedflavors.
And ChatGPT is what's calledthe large language language
model.
All it's good at is reallypredicting the next word in a
sentence.

(29:55):
Now some of my patients in factI actually have one who uses
kratom and uses chat gbt some ofmy patients will basically
journal the chat gbt and thenask chat gbt to summarize, and
chat gbt basically looks atwhat's been written into it,
stops and reflects and then usesagain that large language model

(30:18):
to predict what potentiallycould be said.
I can tell you when we looked atGoogle, if you Google your
symptoms, you had about a 50%chance of getting the right
diagnosis.
I don't know if we have thedata on artificial intelligence
yet, but how many hours is it?

(30:38):
Let me get you the number here.
So for me to become a doctor inthe emergency department, the
average emergency doctor'straining is anywhere from 15,000
to 20,000 hours.
That's a lot of time, right.
And then to train in addictionmedicine, it was 40 times 48.
It was 1920 hours.
So it's a lot of hours and alot of it is pattern recognition

(31:03):
and, granted, you could arguethat that's really what large
language models are good at isrecognizing patterns and
predicting.
And we may get to where AI iseffective in medicine, but
really not around diagnoses yet,because there are subtleties.
Artificial intelligence is beingused in radiology to make

(31:23):
reading x-rays faster and as abackup against misfindings, but
I'm not aware of any physiciansusing ChatGPT to make diagnoses
yet.
That being said, there are somephysicians 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 makea prediction.
So I don't know, we may getthere, but certainly around

(31:46):
surgery, I don't think we'llever have AI replace medicine,
just because if somethingunexpected happens, which does,
I don't know how the algorithmwould respond, and in the world
of behavioral medicine andaddiction medicine there are
things that are very unusual.
So one of my patients takesdrug A and gets a super weird

(32:08):
reaction that no one's everheard of.
I review the literature.
It's never been out there.
I'll publish it as a casereport.
That was the first one.
So I don't know, maybe I'm justclueless.
On ChachiBT, I do use it fairlyfrequently, but no long answer.
I'm not using it in my practiceto make any diagnoses.

Speaker 2 (32:24):
Yeah, that's really important too, because I think
there are also biases built intothe system too.
You know, like how pulse ox wasnot tested on people with
darker skin and the melaninaffects the oxygen delivery, so
it wasn't accurate.
So I think they're findingsimilar issues with bias of the
chat GPT algorithms.
So it's good that you guysaren't totally relying on that.

(32:46):
I know I read on Reddit peoplewill post oh, my doctor didn't
know what was going on with meand after 12 years chat GPT
finally figured it out and it'sjust whoa.
But getting back to Kratomspecifically, I'm curious does
the number of childhood adverseexperiences that you endorse, or

(33:06):
the severity of the trauma orthe duration, does that affect
the type of kratom that peopleuse, whether it's a stronger
extract or 7-OH, or theirtendency to relapse or just the
progression of the addiction?
Or is there not really acorrelation there?

Speaker 1 (33:24):
I think what's hard about that question is kratom is
not kratom.
Is not kratom meaning a 7-OHproduct acts more like morphine,
whereas leaf Kratom has lessopioid effects and more
stimulant effects.
So it's a little bit likesaying tell me about a car, well

(33:46):
, do you mean like a ToyotaTundra, or do you mean like a
Mercedes SUV, or do you meanlike a Porsche or a Honda Civic?
My understanding is Kratom ischanging.
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 knowbecause the Kratom products are
so heterogeneous.

(34:07):
Here's what I tend to see in mypractice 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 Kratomnot realizing what it is.
They're like hey, I'm soberfrom alcohol and I don't want to
drink and I don't want to usedrugs.

(34:28):
But hey, this is a supplement,how bad could it be?
Or hey, I'm really havingtrouble being productive at work
and I need something.
I'm not going to go buy drugsand energy drinks aren't working
.
Let me see if there's asupplement.
Oh, kratom, it helps your mood,it helps with energy.
And then what ends up happeningis because of how kratom works.

(34:50):
It activates the opioidreceptor.
People develop tolerance, andthat happens with anything that
activates the opiate receptor.
They need more over time to getthe same effects.
And then, unfortunately, peopledevelop dependence, and that's
with anything that activates theopiate receptor.
They change in their brain towhere, when they stop they feel

(35:13):
horrible, they get kratomwithdrawal.
So we think if somebody is asavvy kratom user and they
started out using some of thelighter stuff and then had a
traumatic life experience andwanted to numb those PTSD
feelings, they might jump from,say, like a leaf product or a
tea to a 70H because they knowit and want more intense

(35:37):
feelings.
But the vast majority of mypatients find Kratom almost
accidentally, not knowing whatit is, and it's more the
dependence that keeps them stuckon it.
What has your experience been?

Speaker 2 (35:49):
Yeah, my experience is I didn't know what it was and
it's interesting because I'musually very well researched and
I will check everything beforeI put it in my body but I was
going through a traumaticexperience actually a few at the
same time.
So I was particularlyvulnerable and I didn't do my
due diligence because, almostbecause I was in a bit of denial

(36:10):
, I'm like this actually totallynumbs my depression and my
anxiety.
I don't have a chipmunk in mybrain anymore and I can actually
sleep, because PTSD affected mysleep and yeah, so I think a
lot of people use the languagelike it sank its teeth into me.
So it felt like that for me.
But this brings me to anotherquestion, because there are a

(36:33):
lot of different treatments forPTSD and then trauma, like in
the context of addiction, and Iwill say that for myself.
One thing that really helped mewith my trauma and that then in
turn, helped get rid of allthose cravings for Kratom is I
had tried in my life I've triedso many different

(36:54):
antidepressants.
Never really had any lastingsuccess.
So I just thought, oh, I havetreatment resistant depression,
and I finally sought, likeprofessional help from somebody
who works where psilocybintherapy is legal, and so you
know it's not exactly legalright where I am, but I remotely
did the training and learnedhow to you know all of the

(37:18):
therapy that goes into it, theintegration and having that
experience it was just like.
It was like reliving all thetrauma I went through as a kid
but it took away its power.
And then it took away the powerfrom Kratom and I'm just like,

(37:38):
oh yeah, it's a leaf.
I don't know why it had so muchpower over me.
So I'm wondering, because inyour previous podcast you talked
about using like a two-prongedapproach of you know, the
psychotherapy, the behavioraltherapy, and medication like as
an adjunct, and then youhighlighted maybe EMDR, and then
there's some medications likeprazosin is that how you say it?
And SSRIs.
But I'm wondering aboutactually let me let you talk
about those conventionaltherapies first and then we'll

(37:59):
dive into some of the newertherapies.

Speaker 1 (38:00):
Once again, an entire PhD in a single question.
I love it, okay.
So let's start with.
The first question was whatabout psychedelics and PTSD?
Well, we can thank RichardNixon for this, because when he
declared the war on drugs, a lotof research on these sorts of
substances and compounds wasjust totally wiped out.

(38:22):
So hallucinogens, in my opinion,will likely have a place as
therapeutics in the future, butwe 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 theyare used to using substances to

(38:44):
feel better, and so the answeris not I'm going to do a bunch
of shrooms and get better.
The answer is I'm going to workwith a therapist.
I'm going to continue in thattherapy.
I'm going to have 10 sessionsof therapy, and then we will
bring in the psilocybin in avery specific setting when the

(39:05):
time is right, with someonethere to guide me through it,
and then I do 10 more sessions,and then I do 10 more sessions.
The hallucinogens and ketaminefalls under this.
They augmented the effect ofthe therapy.
They don't replace the therapy.
I just want to be really clearright now.
If, yeah, if you are gettingthis, you're essentially getting

(39:29):
it in a research institution asa part of a, a research study,
and granted, depending on whereyou 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 togo into a program that has a
specific way of doing it, andthe 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

(39:50):
we'll probably learn more Now.
Standard therapy for PTSD.
The first issue is if you'restill in the trauma, it's really
hard to start the process.
If a woman is being beaten upby her domestic partner and that
is the source of the trauma,until she leaves the environment
, it's going to be really hardto get better.

(40:12):
So for me, I had to leave theemergency department.
I had to leave all aspects ofthe emergency department and at
some point, if I'm really stillstruggling, I may actually need
to leave medicine.
I have to get out of thetraumatizing environment.
The next issue is we need tocome up with some sort of

(40:32):
therapeutic modality that allowsthe person to process the
trauma.
That may be talk therapy, thatmay be equine therapy, where you
work with horses, that may beart therapy.
There are so many differentways.
But the person has toexperience some of the trauma
again in a safe environment toget it out of their system, if
you will.

(40:52):
That's obviously anoversimplification and it might
take months, it might take years, but when that trauma is just
stuck inside and festering, thePTSD is really hard to manage.
Now we do have medications, andhere's how I explain this to my
patients.
Addiction at its simplest isusing substances to feel

(41:14):
different.
Sobriety is learning how toself-regulate and not needing
substances, including medication.
I believe that if somebody isoff 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 mypatients is the ultimate goal is

(41:35):
sobriety without needingmedications, but medications are
a bridge to getting there.
So if somebody is reallystruggling with PTSD triggering
and can't stop drinking and weget them on some meds and they
stop drinking, that is a win andthey will not likely need to be

(41:55):
on those psych meds forever.
But while they work on thetrauma and get their support and
get their coping skills anddevelop all their emotional
tools.
The medicine is helpful.
So there are a couple that Iuse.
There are medicines fortriggering and hypervigilance
and there's two of them there'sclonidine and there's
propranolol, and they basicallyreduce the physical anxiety

(42:16):
reaction building up in your gutand taking over your body.
I have one of my patients whocalls propranolol trigger.
She can't remember themedication name, but she's a
doctor.
The trigger medicine.
That one works really well whenI'm triggered.
Then there is prazosin, andprazosin is a medication that
suppresses nightmares.
It doesn't work for everyone.

(42:39):
It works fairly quickly if itdoes, and everyone has a
different experience.
Some people don't dream at all.
Sometimes the dreams are morevivid, but not frightening.
One of my patients was like DrGrover.
This is amazing.
Now in all my nightmares I'mlike saving babies and they're
doing parades for me.
Some of my patients have sideeffects like dry mouth or low
blood pressure that they can'ttolerate it, but prazosin can be

(43:01):
very effective.
My patient who calls herpropranolol trigger calls the
prazosin nightmare because itmakes sense in her mind.
It's my fault.
She was really struggling withalcohol.
I couldn't figure out why.
She kept relapsing and I waslike tell me about your trauma.
She said that was no big deal.
She had a near fatal caraccident and was repeatedly
verbally abused as a child andwhen we pivoted to focusing on

(43:22):
PTSD, not the addiction, that'swhen we had the breakthrough.
So she takes trigger and shetakes nightmare.
The other thing is we can useantidepressants, most
specifically the SSRIs, orselective serotonin reuptake
inhibitors, like Lexapro, alsoknown as escitalopram, or
fluoxetine, also known as Prozac, and the SNRIs serotonin and

(43:46):
norepinephrine reuptakeinhibitors like Effexor, which
is venlafaxine, or Cymbalta,which is duloxetine, or Pristik,
which is venlafaxine, andessentially, the antidepressants
artificially increase youremotional resilience.
It takes more to feeloverwhelmed.
So usually when somebody comesto me and they've got PTSD, I

(44:08):
put them on some combination ofthose meds and then I usually
add in a non-addictive sleepingmed.
So if you are wondering whatwas my experience I have not
shared this before, but I'm anopen book I was a bad doctor and
I treated myself.
I was completely miserable.
It was going to be four monthsto see my PCP, so I put myself

(44:30):
on some escitalopram, also knownas Lexapro, and I put myself on
some clonidine and I put myselfon some trazodone.
That's a non-addictive sleepaid and I was actually fairly
functional and combining thatwith the therapy I did so much
better.
And then I went to see mydoctor and I love my doctor.
He's amazing, super nice guy,super smart.

(44:51):
And I love my doctor.
He's amazing, super nice guy,super smart.
And he said you know, casey, Idon't like you being on the
escitalopram, the Lexapro.
We're going to switch you toSertraline or Zoloft.
And the wheels fell off the bus.
I was a hot mess.
I was in fight or flight.
I had some really dark thoughts.

(45:11):
I was going to quit medicine.
My wife and daughter were likewhere is our husband and dad?
And I thought it was just.
My PTSD was getting worse.
And I remember one Saturdaymorning I was almost like rock
bottom.
I took my dog for a walk andcame home just tears streaming
down my face and I just told mywife I'm just, I can't do this.

(45:32):
And they went down and laid inbed and she curled up behind me
and we cried together and so Iput myself back on escitalopram,
also known as Lexapro, and sixweeks later I was myself again.

Speaker 2 (45:46):
Thank you so much for sharing that story.
Yeah, Do you think I know thatthere are some people who
endorse using companies likeGenesight to test how people
will respond to differentantidepressants, like
particularly SSRIs?
Self was interested in that atfirst, but then the more I dug

(46:12):
into it, it seems like there'snot a lot of evidence for that
actually being accurate.
Is that.

Speaker 1 (46:15):
So I use Genesight regularly in my practice.
So what is Genesight?
Genesight is a company thatdoes pharmacogenomic testing
which describes the interactionbetween your genes and your
medication.
So it's a cheek swab and I haveno financial connection to the
company except that I ordertheir.
So it's a cheek swab and I haveno financial connection to the
company, except that I ordertheir tests.
It's a cheek swab.
You swab your cheek and you getcheek cells, send it off to the

(46:37):
company, they extract the DNAand they actually tell me, as a
doctor, which of the enzymes inyour liver are underactive,
normally active or overactive.
Here's how I think about it.
They're not telling you whichmedication is going to work and
which medication is not going towork, but they give you an

(46:58):
expectation about how you'llmetabolize the med.
So if I'm going to put you onMed A and you over-metabolize it
, the drug levels aren't goingto come up very high because
you're so busy metabolizing it.
So I will start at a higherdose, or I'm going to choose a
medication that you metabolizemore predictably.
I think the issue is thatpeople say this test tells you

(47:22):
which medicine works.
That is not what the test means.
The test lets you know how youmetabolize different psychiatric
medications.
And the issue is there's not alot of evidence on how to use it
, meaning we don't have arandomized controlled trial.
That's the gold standard, besttest in medicine.
A blinded study means we don'tknow when we're in the study

(47:44):
which group is which.
It removes bias.
We don't have any data likethat on this sort of testing,
but my patients like it because,let's say, there's 25
antidepressants, most doctorsuse the ones that they're the
most familiar with and they haveabout a repertoire of, say,
three to five meds.
I am the same way.
I use a lot of Prostique.
That's Desvenlafaxine.

(48:04):
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'ssertraline.
I use a decent amount ofEffexor, that's venlafaxine.
I use Cymbalta, that'sduloxetine for pain patients,
and I use Welbutrin, also knownas bupropion.
So I said maybe that's whatlike eight.
Those are my go-to.
And patients feel like guineapigs.

(48:26):
What do you mean?
We have to try a newantidepressant?
Why can't you just run a test?
And the answer is I tell themthis gives me my first tier of
meds I'm going to pick frombecause we know you're going to
metabolize them the mostcorrectly.
Now let's just explore all thepotential options as to why this

(48:46):
test is useful.
Number one if I told you thismedicine is awful, you will get
horrible side effects from thismedicine.
How much do you want to take it?

Speaker 2 (48:59):
Not so much.
No, you run in the otherdirection.

Speaker 1 (49:02):
That is called the Noxibo effect, where you get
side effects because youanticipate them.
On the flip side, let's say Isaid, oh my gosh, this medicine,
this is like the best one.
Oh my gosh, people get to rideunicorns when they take this
medicine.
They can literally fly overrainbows on their unicorn when
they're on medicine.
A how much do you want to takethat?

Speaker 2 (49:22):
That's the placebo effect.

Speaker 1 (49:23):
I love unicorns, right?
Yes, that is the placebo effect.
So there is probably someplacebo-noxibo to tests like
GeneSight.
But it also informs me as adoctor to know if I have to use
medicine A and theyunder-metabolize it, I'm going
to drop the dose, or theopposite if they over-metabolize
, but I use the test all thetime.

Speaker 2 (49:46):
Thank you so much.
Yeah, now I'm actuallyintrigued to take it after all
and just see how I metabolizedifferent drugs.
I will say that there is a lotto be said for the placebo
effect, like I read this onestudy years ago about how taking
ibuprofen, it was like therewas a certain regimen and it's
that can actually help emotionalpain too.
And so I was going through areally depressed stage, and so I

(50:09):
looked on Reddit for commentswhere people said, oh, I took
ibuprofen and made my depressionbetter and I think it helped a
little bit.
Just who knows.
But yeah, so I hadn't been onthe medications that you had you
were on for years.
But I had a similar experiencewhere I was on Cymbalta at first
and I wasn't a pain patient butI had some anxiety too, and the

(50:31):
psychiatrist said, oh, thiswill help your anxiety and your
depression, and it seemed towork for maybe a year and a half
.
Now I will say I went away on atrip and I did not remember to
take my Cymbalta with me.
I had no idea that thewithdrawal I think they call it
discontinuation syndrome fromSSRIs it was miserable.
It was so terrible.

(50:51):
I thought I was jumping out ofmy skin it might have been just
as bad as kratom withdrawal.
So yeah, I was going to askabout the side effects and the
discontinuation.
How easy is it to wean peopleoff of these medications after
they've processed their traumaand they want to come off?

Speaker 1 (51:10):
I can get almost anyone off an antidepressant in
about two weeks.

Speaker 2 (51:14):
Oh, wow, it's fast.
Now, what about after?
I went through a period whereCymbalta just stopped working
and I have always struggled withlike suicidal thoughts and the
Cymbalta kind of it didn't mutethem, but it turned the volume
down a little bit and then allof a sudden I just I had, you
know, active suicidal ideationand the psychiatrist said, oh,

(51:36):
sometimes it just stops workingfor no apparent reason and it
can happen anytime.
Does that happen to any of yourpatients?

Speaker 1 (51:45):
Yeah, anecdotally.
I don't know if there's anyscience behind it and we can
certainly research it, butpeople get some weird
interactions with medications.
There's a class of bloodpressure medicines called ACE
inhibitors and people canrandomly develop this side
effect with their lips and faceswell at any point on it.
Second, just because so yes,the discontinuation syndrome is

(52:12):
a thing, and what I mean by thatis most people were not told
that there was some precautionthat needed to be taken, weaning
off of it.
But if you consider how long ittakes to wean off of kratom
compared to how long it takes towean off of an antidepressant,
it's so much faster to get offan antidepressant.
Let's say, somebody's on 20milligrams of fluoxetine, also
known as Prozac.
I'll do 20 for three days, 10for three days, five for three

(52:33):
days and they're done.
It's fairly fast.
Sometimes people get longer.
I think the longest it's takenme is maybe three weeks.
One of my patients just told mehe had a horrible withdrawal
from escitalopram.
So we're doing 30, 25, 20, 15,10, five, stop over about 18
days, I think something likethat.
So it's there, but it's mucheasier to get off of them than,

(52:56):
say, kratom or gosh.
Even worse, benzos,benzodiazepines.
It's six plus months to get offof those.
So yeah, I think the answer isyou know, ask your doctor if you
need to be worried about a newmedicine as you start it, and
can you stop it suddenly.
And if not, then you need tocome up with a plan to be able
to get off of it safely.

Speaker 2 (53:14):
Yeah, I don't really have experience with
benzodiazepines, but I will sayfor Kratom it took me like a
year to taper off of it.
So another medication wasLamictal that I took for a
little while, and I guess ithelped somewhat, but I don't
know if it's, if it's reallyused in PTSD, no.
So another question I wanted toask you, though, because this

(53:35):
is another controversial therapythat's used particularly in
trauma, and I too tried it for10 minutes with my psychologist
at the time EMDR, eye movement,depro, sensitization and
reproitization, and reprocessing, reprocessing, okay.

Speaker 1 (53:53):
I'll let you say it EMDR.
Okay, all right.
So eye movement,desensitization and reprocessing
.
So essentially what this is isyou go through the traumatic
experiences and re-experiencethem with a therapist and then
they use eye movements to helpyour body process it.
It works.

(54:14):
I think the studies have notshown that it has a big effect
for everyone, but it can be veryhelpful.
It's best done in person and itcan be very intense if the
trauma is still fairly recent orfairly unprocessed.
Here's my take on this.
I'm going to try to be funny.
If you told me puttingmayonnaise on your left ear kept

(54:36):
you sober, I'd buy youmayonnaise.
So if you told me, dr Grover,the only thing that worked for
my trauma was EMDR, I'd say doEMDR.
And if you told me, dr Grover,the EMDR did not work for me,
you know what I would say let'stry something different.
But yes, I'm not an expert init.
At some point I'd like to tryit myself.
I have a couple of my staffthat have done it and swear by

(54:57):
it.
But the one thing that weshould talk about that actually
wasn't on your list was acervical sympathetic ganglion
block.

Speaker 2 (55:06):
I'd love to hear more about this.
Yes, I'm not familiar with itat all.

Speaker 1 (55:09):
So one of the physicians in my practice does
these.
He's from the military and whatthey found is that there's a
nerve ganglion in the neck, anda ganglion is basically a
cluster of nerve cells.
And what they found is, if theyblocked the nerve ganglion in
the neck, it changed how thestress response went up to the
brain and it made physicalreactivity and the intensity of

(55:30):
PTSD decreased.
I've had a number of mypatients swear by it and when I
got diagnosed with PTSD it wasrecommended to me that I should
get such a block myself and Ididn't know it existed until
about two years ago.
We have a new doctor in mypractice, Dr Chase Kisling, and
he casually walks by hey guys,just so you know I'm new, If you

(55:55):
need anyone to get a PTSD block, let me know and walks off.
And the other addiction doctorin the practice who's my spouse,
the beautiful and intelligentDr Reb Close.
She and I were like whatthere's a PTSD block?
Yes, A cervical sympatheticganglion block.
It's also called a stellateganglion block, that's it.
But yeah, for people who reallyhave tried multiple medications
and it doesn't work, Irecommend the block.

Speaker 2 (56:17):
That is fascinating.
I haven't heard of that and Iactually I think I could benefit
from that.
I feel like I've done so muchtrauma processing that I've
taken the power away from a lotof the experiences, but I still
get that reactivity.
I feel like I have that highcortisol all the time and then
the garbage truck will come andI'm jumping out of my skin and

(56:39):
it's like a physical reaction.
It actually hurts.

Speaker 1 (56:44):
Yes, when my medications were not right I
actually stopped being able toenjoy music were not right, I
actually stopped being able toenjoy music.
It was.
I was a really dark time andjust everything set me off and
the office would call and theworld was crumbling.
Man, it was brutal.
I'm just grateful that I havemy med straightened out.
I've actually come off theclonidine.

(57:04):
I might take trazodone here andthere if I can't sleep, but for
the most part acetalopram, andthat's all I need right now.

Speaker 2 (57:17):
Yeah, I did take prazosin.
I'm so bad at pronouncingthings.
I took that for a little bit.
It did lower my blood pressuretoo much and I wanted to get off
medications anyway, but I willsay it did work.
It helps me sleep and in thedreams it was interesting I
didn't have nightmares.
I still came in contact withperpetrators of abuse, but I
could see them, or like theywere looking me in the eye
instead of hiding their faces.

(57:38):
It was weird.
It was like oh, their power isgone, oh, you're hurting me, but
it doesn't matter.
Like you've taken away all ofthe emotional energy with it.
So it's interesting, but yeah.
So I wanted to ask youswitching gears a little bit,
unless there's anything else youwant to say about that.
I want to give some actionabletips to creative users or people

(58:00):
who are having trouble quittingand who want to visit an
addiction medicine doctor andtry to be heard and validated.
I remember I went to a dentistand I have severe dental phobia
because a lot of my traumarelated to hands over my mouth,
and so just even the nicestperson could be sticking drills

(58:21):
in my mouth and I will justliterally have a panic attack
and I would go to a couple ofdentists and they just seemed to
brush it off.
They wouldn't look me in theeye.
They're just like, okay, that'scool, we can give you nitrous
or oh, we can sedate you if youwant.
But I didn't feel validated andthen it's like my heart raced
and I was like okay.
Now I feel like it's beingminimized and I'm feeling more

(58:44):
anxious.
So it was just like thisterrible cycle and I feel like a
lot of people are afraid toadvocate for themselves when
they go to the doctor.
There's that statisticphysicians will interrupt you
within 18 seconds.
Let's say that I have thishorrible addiction to whatever
it is LEAF or 708.
And I just want my doctor torealize okay, it's not a

(59:07):
character flaw.
I have all of this pain, but Ionly have this amount of time.
So a lot of people feel likethey'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 tryingto tell you my life story.
It's because it affectseverything.

(59:29):
I'm lonely and I'm trying totell you my life story.
It's because it affectseverything.
It just it has so much powerover 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 (59:40):
So my mental health history is that in college I
developed anorexia, bulimia andself-harm and I met the nicest
psychiatrist.
He took such good care of me,started to get my life back
together and he decided tochange jobs and I was like all
right, cool, I figured everypsychiatrist was nice and great.
So he set me up for my nextfollow-up appointment with the

(01:00:03):
psychiatrist that was taking hispatients and I picked up
exactly where we left off andshe judged me.
She called me a narcissist Ican't remember what else she
called me and I literally shutmy mouth.
Tears welled up in my eyes.
I left the appointment and Irefused to get mental health
ever again.

(01:00:26):
And the way I look at it as adoctor is a first visit, as a
lot of it is about pleasantries.
Let's just get to know eachother.
I would say and I actuallycounseled one of my patients
that when he went to his firstpsychiatry appointment, let the
doctor ask the questions thedoctor needs to ask and if the
doctor needs more detail, letthe doctor ask the detail that

(01:00:48):
she or he needs.
Make a note with your doctor,after you've gotten through the
basic stuff, that you have ahistory of PTSD and you'd like
to talk to them about it at somepoint.
But we don't have to get to ittoday.
And when the doctor feels likethey've gotten what they need to
know, to get what they need foryou done, that's the time to

(01:01:09):
bring up the PTSD and I think,if you're willing because being
vulnerable is hard it's to saywhat you've been through and you
can say it as simply as youknow hey, doctor, okay, I'm
really glad we're going tomanage my blood pressure.
I'd just like you to know thatI had a very traumatic childhood
and I've been diagnosed withPTSD and I'll let you know if

(01:01:30):
I'm having trouble with my PTSD.
And you know.
Thanks for the visit, but it'sunfortunately a lot of doctors
don't understand it and if theymeet you, as you know, joey
patient who presents for amedical problem and the PTSD
comes up later, then it'ssomething that I think is easier

(01:01:51):
for physicians to wrap theirminds around.
And you know, with a dentist Iwould probably say for the first
visit, say, I just need to letyou know I had some serious
issues that happened to me in mylife around my mouth and I'm
very sensitive.
Can I ask you to explain thingsbefore you do them.
In fact we do this a lot withautistic children.
The family will say can youplease touch or tap just to warn

(01:02:12):
them and if someone doesn'ttreat you well, find a better
provider that fits better foryou.
But the term that I use istrauma-informed care.
So I'm a really huggy person.
I love to give hugs and ifyou've been a victim of sexual
assault, getting hugged by asix-foot-one male physician if
that was your aggressor is notgood.

(01:02:32):
I tell them I care about you.
We may fist bump, we may highfive, we may just say thank you
and not even touch at all.
But I need you to know theycare and I try to be very
careful with my body languageand you can very easily ask on
the first day.
I have a history of PTSD.
I do my best but I'm sometimesa little sensitive.
Can you talk to me about howyou're going to respect my

(01:02:54):
trauma as you care for me?
That's a very fair question toask.

Speaker 2 (01:03:00):
Yeah, I luckily shopped around for a dentist and
I needed an oral surgeon atsome point.
And I lucked out.
I found an oral surgeon wholooked me in the eyes very
gently, put his hand on myshoulder and he said okay, you
say you understand it, but letme just explain this and this
and this.
And it's okay, a lot of peopleare like that.
You're not alone.

(01:03:27):
I see this all the time and heactually talked to me.
I know that in psychology or inmental health health counseling
, I think the biggest predictorof treatment outcomes in that
therapy is the therapeuticalliance.
Like it, you can do whatevermodality you want.
You can be freudian and sayhave them lie down on a couch.
You could say, oh, I'm doingthe mayonnaise in the ear
modality and and if you havethat rapport that I mean, then

(01:03:47):
you're gonna do pretty well.
Or comparatively you might not,but Absolutely Quick time check
.

Speaker 1 (01:03:54):
I've got to go get back to help my daughter at
tennis practice.
Can we do one more question andthen wrap it up?

Speaker 2 (01:04:00):
Sure.
Okay, I'll end this with sortof an existential question,
because we've talked a lot aboutstigma and vulnerability and
how a lot of people andphysician it's it's like not
okay to bring up your trauma andand you might be judged and
it's really hard.
So this is sort of like asocietal question, like what do
we do as a society about this,this perspective, this sort of

(01:04:23):
like macho attitude where it'stough enough.
I still feel like I I know somany people who think, oh, I've
gone through this trauma butit's okay, because, I mean,
think about all the other people, you just have to go through it
.
I don't know, it seems likethis culture of masculinity,
alpha male, that sort ofpervades even other demographics

(01:04:48):
, has a hook on people and Idon't know what we can do about
that to really get rid of thestigma and make people realize
there is strength invulnerability, as, like Brene
Brown would say.

Speaker 1 (01:04:59):
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% ofAmericans approved of gay
marriage.
By the late 2010s, about 75% ofAmericans approved of gay
marriage.
How did that change so quickly?
And the answer is is that manypeople who are gay don't

(01:05:22):
outwardly look as such, and whathappened is people would go to
work and soccer games andparent-teacher conferences and
make friends and acquaintancesand then wait, you're gay, but
like I wouldn't have known or Icouldn't tell.
In other words, the humanconnection came first and the

(01:05:42):
label came second.
So one of the things I do is Ilecture professionally about
stigma and I come into thismeeting and I'm a successful
physician and I'm fit and I'mover six feet tall and I, you
know, I'm the hometown hero.
I was born at the hospital Iwork at and I lecture, lecture,
lecture, lecture, lecture,lecture, lecture, mr Smarty
Pants.
And then I dropped the bombthat I had anorexia and bulimia

(01:06:06):
and I used to engage inself-harm and no one in that
audience expects it and thenwhen they look at me, they're
like but you're so normal.
I don't mean that, but that'sthe sentiment and then it makes
them question what they knowabout a person based on their
appearances.
So my hope is is that my ownhonesty about my eating disorder

(01:06:28):
has changed my colleague'sperception of what an eating
disorder is and what it's likeor who gets it.
And actually we're going to bedoing a four-part episode on
stigma on my podcast in a fewweeks and the final episode is
myself and some firefighterstalking about our own mental
health struggles.
Talking about our own mentalhealth struggles.

(01:06:49):
And one of the firefighters hewas 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 thegentleman who runs the
nonprofit I work with calledCentral Coast Overdose
Prevention.
He's our executive director.
He's also a firefighter and hetook Evan to a training for

(01:07:10):
young firefighters.
And there comes in Evan bigtough guy fire captain.
You can see the admiration forhim.
And then he drops the bomb.
And I had PTSD and Suboxonesaved my life and it's people
willing to be vulnerable and,like I said, not everyone feels
that they're in a place to bevulnerable, but I can be and so

(01:07:31):
I feel it is my obligation to bevulnerable on behalf of those
who can't be, and conversationslike this, hopefully, will help
us all realize that we allstruggle in some way and that's
part of being human.
As I say to my patients all thetime, it's not a you problem,
it's a human problem.

Speaker 2 (01:07:52):
I love that and that's such a good place to end
and, yeah, we'll definitely putyour podcast in the show notes.
I really appreciate how you notonly share your lived
experience but you alsohighlight different people who
are susceptible to addiction onyour own podcast.
Like you had that highfunctioning person on your
podcast and I myself I alsoself-harmed quite severely and I

(01:08:17):
had anorexia and bulimia, sobehaviorally I did have
addictions that were triggeredby a lot of trauma.
But yeah, so I appreciate thatso much.
And do you have anything elseyou want to add before we close?
Do you have any books or moviesor any media you want to
recommend for people who want tolearn more about the trauma and

(01:08:37):
addiction link?

Speaker 1 (01:08:53):
and life-changing.
I had no idea until I got it.
A couple of things.
A shout out to my friend andcolleague, stephanie
Whittles-Wax.
She has a podcast called LastDay and if you look up Last Day,
dr Gabor Mate, she has the mostunbelievably mind-blowing
episode on trauma, where DrGabor Mate discovers her own

(01:09:14):
trauma and her own addiction onthe podcast.
It's Addiction 17, trauma withDr Gabor Mate Last day.
It came out January 29th 2020.
I send it to so many of mypatients.
I send it to so many of mypatients.

(01:09:50):
In terms of books, there's acouple that are really helpful.

Speaker 2 (01:09:51):
One is called what Happened to you by Oprah, and
the other is called the BodyKeeps the Score, and they just
remind all of us that when we gothrough trauma, the problem is
not us.
It's a humanity problem that weall experience differently
individually.
Thank you so much.
I'm very familiar with my bodykeeps the score and I have
experience with that too.
I don't remember consciouslythat there's a date that's
important and then my body willtense up almost reflexively.
So thank you so much again forbeing on the podcast.
I really appreciate it and forjust being you, with all of your

(01:10:13):
empathy, compassion and amazing.
Thank you for your brilliance.
I really appreciate you, drCasey Grover.

Speaker 1 (01:10:20):
I am honored, as always, to be here.

Speaker 2 (01:10:22):
Thanks, let's do it again, and I hope you have a
great weekend.

Speaker 1 (01:10:27):
Before we wrap up, a huge thank you to the Montage
Health Foundation for backing mymission to create fun, engaging
education on addiction, and ashout out to the nonprofit
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdosesTo those healthcare providers

(01:10:50):
out there treating patients withaddiction.
You're doing life-saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto 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 andremember treating addiction

(01:11:13):
saves lives.