The most dangerous phrase in senior health might be “I’ve always handled it fine.” We dive into how aging reshapes the risks of alcohol, benzodiazepines, opioids, nicotine, and today’s ultra‑potent cannabis—and why familiar habits can turn hazardous after 65. Drawing on frontline cases and recent research, we unpack the baby boomer lived experience, from “mother’s little helper” to daily cocktail hours in senior communities, then connect it to the biology of aging: slower metabolism, reduced kidney and liver function, impaired balance, and sharper sensitivity to side effects.

You’ll hear why DSM‑5 criteria still apply but require age‑aware interpretation, what “code cannabis” looks like in the ER when edibles or high‑THC products masquerade as stroke, and how subtle red flags—poor sleep, irritability, shakiness, forgetfulness, falls—signal a brewing problem. We get practical about safer detox for older adults, the reality of kindling with alcohol withdrawal, and the medication decisions that matter: when to taper sedatives, how to avoid dangerous interactions, and why nutrition and B‑vitamins can’t be an afterthought. Two real-world cases ground the lessons—titrating decades‑long benzodiazepine and Z‑drug use while reducing fall risk, and using naltrexone strategically for late‑onset alcohol use without tipping a patient into instability.

If you care for an older adult—or you are one—this conversation offers clear steps to lower risk and raise quality of life: rethink sleep meds, reduce alcohol use, check cannabis potency, simplify regimens, and choose therapy and support groups that fit your season of life. Subscribe, share this with a friend or colleague, and leave a review with your biggest takeaway so we can keep building smart, stigma‑free care for older adults.

To contact Dr. Grover: ammadeeasy@fastmail.com

Food isn’t just fuel and obesity isn’t just willpower. We sat down with bariatric surgeon Dr. Mark Vierra to unpack what weight-loss surgery really changes, why genetics and hormones can overpower the best intentions, and how a careful program decides who needs a scalpel and who needs a different plan. From GLP‑1 surges and ghrelin drops to PYY’s “brake,” we walk through how surgery reshapes appetite signals and why even modest weight loss can dramatically improve diabetes and cardiovascular risk.

The conversation goes beyond the operating room. Dr. Vierra explains why five of six referrals don’t get surgery, how he and his partner analyze food diaries, depression, and daily constraints, and when medications like bupropion or GLP‑1s make more sense. We explore binge patterns, the messy reality of predicting who will do well after weight loss surgery, and the tough calls around patients who’ve been told their BMI is destiny when their labs and function say otherwise. The story shifts sharply when we talk alcohol: after gastric bypass, blood alcohol rises faster and stays higher, which raises the risk of alcohol use disorder over time. We share practical ways to screen motives for drinking, plan safeguards with families, and use craving meds thoughtfully.

What ties it all together is respect for biology and the person in front of us. Genetics like MC4R variants and syndromes such as Prader–Willi can drive lifelong hyperphagia; ultra‑processed foods and liquid calories amplify the problem; stigma keeps people from care. We push for a different bias—against soda and engineered foods, not against people—and for care that follows patients long after the incisions heal. If you want a grounded, humane guide to obesity treatment, this conversation delivers clarity without blame.

If this resonated, follow the show, share it with a friend, and leave a review so others can find it. Your support helps us keep building informed, stigma‑free conversations about health.

To contact Dr. Grover: ammadeeasy@fastmail.com

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

A brightly colored box at a smoke shop should not hit like an opioid, yet that’s the business model behind “gas station heroin.” We dive into how tianeptine—a foreign antidepressant with mu‑opioid activity—landed on American countertops as a “dietary supplement,” and why that mirrors a broader playbook: repackage potent psychoactives, exploit loopholes, pivot fast when bans arrive, and let consumers pay the price. Joined by Matthew Lowe, executive director of the Global Kratom Coalition, we trace the supply chain from warehouses to wallets and separate leaf kratom from the synthetic isolates hijacking its name.

We break down the risk gradient inside the kratom category: natural leaf with fiber and mixed pharmacology, concentrated extracts that raise potency, and seven‑hydroxymitragynine products that function like a novel opioid. Matthew explains why the FDA’s percentage‑based scheduling of 7‑OH is a smart, surgical fix that preserves traditional use while ejecting synthetic opioids from the “supplement” aisle. We also tackle hemp’s loophole economy—Delta‑8 and Delta‑10 THC derived from hemp yet delivering marijuana‑like effects with far less oversight—plus contamination, cross‑stocking, and the handful of distributors fueling multiple “legal high” trends at once.

Beyond policy, we talk people. When regulators finally pull a dangerous product, dependent users are often left stranded. We outline a practical path: better labeling that discloses opioid activity and dependence risk, age gates, potency caps, and targeted enforcement against unapproved drugs sold as supplements. Just as crucial, clinicians need straightforward guidance to assess what patients took, why they took it, and how to transition them to safer, evidence‑based care without stigma.

Curious how these products keep showing up, what “novel synthetic opioid” really means, and how we can protect choice where risk is low while acting decisively where harm is high? Press play, share this episode with a friend, and leave a review with the one reform you think would make the biggest difference. If this helped you learn something new, subscribe so you never miss an update.

To contact Dr. Grover: ammadeeasy@fastmail.com

Have you ever wondered what it's like to practice Addiction Medicine? In this episode I speak about what we do in Addiction Medicine - both generally as well as how we do things in our practice on the Central Coast of California.

I share how our clinic treats substance use with low‑barrier access, kind care, peer support, and long‑acting injectables while partnering with therapists to address trauma and ADHD that often drive relapse.

I also review two cases that reveal how PTSD and undiagnosed ADHD change the treatment plan and the outcome.

Topics Discussed:

• What an addiction medicine visit includes
• Medications for alcohol and opioid use disorder
• The "three‑legged stool" of meds, therapy, and groups to treat addiction
• Levels of care and smooth transitions
• Dual diagnosis as the rule, not the exception
• Low‑barrier access through walk‑ins and telemedicine
• Person‑first language to reduce stigma
• Peer support as lived‑experience expertise
• Long‑acting injectables to boost adherence
• Mobile street medicine and carceral care partnerships

To contact Dr. Grover: ammadeeasy@fastmail.com

Dr. Casey Grover welcomes Dr. Sarah Nasir, an addiction medicine specialist, for an insightful conversation about effectively communicating with patients and addressing common myths in addiction treatment.

• Personal journeys into addiction medicine that transformed both doctors' understanding of substance use disorders
• The science behind medication-assisted treatment and why it's not "trading one addiction for another"
• How the body adapts to chronic opioid use through three key mechanisms: reducing natural chemicals, decreasing receptors, and increasing metabolism
• Why recovery takes time: "It's easier to break something than to fix it"
• The critical connection between trauma, PTSD, and addiction
• Integration of life coaching principles into addiction treatment
• Creating authentic connection as a cornerstone of effective recovery
• Addressing stigma around medications in recovery communities and sober living facilities
• The difference between dependence and addiction in patient education

If you're a healthcare provider treating patients with addiction, thank you for your life-saving work. For everyone else, thank you for taking time to learn about addiction – it's a fight we cannot win without awareness and action.

To contact Dr. Grover: ammadeeasy@fastmail.com

Mental health conditions and addiction are deeply intertwined, creating complex treatment challenges that require addressing both simultaneously. Dr. Mark Hrymoc, an addiction psychiatrist, shares insights on effectively treating dual diagnosis patients through parallel treatment plans that address both substance use and underlying mental health conditions.

• Dual diagnosis (co-occurring disorders) describes patients with both mental health conditions and substance use disorders
• Many patients use substances to self-medicate underlying mental health conditions rather than for euphoria
• 50-80% of patients with addiction also have PTSD or significant trauma histories
• SSRIs like Zoloft and Lexapro are first-line treatments for anxiety disorders including PTSD
• Prazosin is effective for PTSD-related nightmares
• Propranolol, clonidine, and gabapentin offer non-addictive options for anxiety management
• ADHD is a major risk factor for developing substance use disorders
• Non-stimulant options like Strattera, Qelbree, and Wellbutrin should be tried first for ADHD with comorbid addiction
• Insomnia treatment options include trazodone, mirtazapine, quetiapine, and newer DORA medications
• Ketamine therapy shows promise for treatment-resistant depression and suicidality

Remember, treating addiction saves lives.

To contact Dr. Grover: ammadeeasy@fastmail.com

Dr. Casey Grover shares his personal struggle with food addiction and binge eating while exploring the science behind why certain foods trigger addictive behaviors in the brain. He examines how the food industry deliberately engineers products to maximize pleasure and consumption through carefully calibrated combinations of sugar, fat, and salt.

• Food addiction involves an intense dopamine response to certain foods that varies between individuals based on genetic predisposition
• The food industry uses "bliss point" science to make products as addictive as possible
• Ultra-processed foods make up over half the average American diet despite increasing risks of various diseases
• Eating disorders (anorexia, bulimia, binge eating) are mental health conditions where food behaviors are merely the symptoms
• Treatment options include SSRIs, topiramate, naltrexone/bupropion combinations, and potentially GLP-1 medications
• Weight loss surgery fails to address the underlying mental health aspects of food addiction
• Dr. Grover's personal experience with naltrexone showed how it made previously pleasurable foods taste "flat"

If you found this episode helpful, please consider supporting Central Coast Overdose Prevention (https://ccodp.org/) and the work we do to treat addiction and prevent overdoses. Together we can improve how addiction is treated and save lives.

To contact Dr. Grover: ammadeeasy@fastmail.com