152. An Insider’s Look at Addiction Medicine

What if addiction isn’t about drugs, but about pain? Beneath compulsive behaviors often lie histories of trauma, anxiety, and unmet emotional needs, hidden behind layers of stigma and misunderstanding. In medicine, addiction is still often mischaracterized as a moral failing rather than a treatable illness with deep psychological roots. In this episode, we explore the personal and professional evolution of Dr. Casey Grover, an addiction medicine physician who reframed both his own struggles and the way he cares for patients. Finally, we uncover how shifting mindset and language can transform both clinical outcomes and clinician well-being.

Guest bio:  Dr. Casey Grover is a board-certified physician in Addiction Medicine and Emergency Medicine at Montage Health, where he also serves as Chief of Staff. He is the Physician Champion for the Monterey County Prescribe Safe Initiative, a program focused on reducing opioid misuse through education, safe prescribing, and improved treatment access. In addition to his clinical and leadership roles, Dr. Grover hosts the podcast Addiction Medicine Made Easy, where he breaks down complex topics to make addiction care more approachable for both providers and the public.

We Discuss:

The Role of Trauma in Addiction 

• Addiction is not simply about repeated use. It’s defined by behaviors that lead to significant impairment or distress in a person’s life. 
• With addiction, there is some sort of negative feeling (e.g., pain or anxiety) and the brain gets tricked into thinking that the substance is the solution.
• Food and substance addiction have commonalities. Highly processed foods are deliberately engineered to hit a precise “bliss point” of salt, sugar, and fat, triggering powerful dopamine responses that mimic the neurochemical patterns of substance addiction.
• Addiction is often the brain’s misguided attempt to solve an emotional problem using a chemical solution.
• Childhood trauma – including abuse, neglect, or household dysfunction – is a near-universal theme in addiction stories, with adverse childhood experiences strongly linked to adult mental and physical health issues.

Personal Journey From Depression to Eating Disorders

• Dr. Grover shared his personal history of anorexia, bulimia, self-harm, and anxiety which developed during college after his father’s terminal diagnosis. Food was his way of coping with deep emotional pain, and recovery meant facing those feelings rather than numbing them.
• Eating disorders are an attempt to soothe overwhelming emotional discomfort through restrictive or compulsive eating behaviors. They are anxiety-driven behaviors where food becomes a tool for emotional regulation, mirroring the compulsive relief-seeking found in drug use.
• Grover’s experiences have cultivated a profound compassion for patients struggling with addiction, particularly those whose behaviors stem from unprocessed emotional trauma.

The Stigma of Addiction

• The term “addict” is a label and is stigmatizing. Person-first language (such as a “person with addiction”) is preferred.
• Judgment-laden terms like “dirty urine” perpetuate stigma and deter patients from seeking care.
• Labels shape perception, and medical terminology must honor humanity to be truly therapeutic.
• Some patients may reclaim the word “addict” in empowering ways, and their language choices should be respected.

Understanding the Neurology of Addiction

• Addiction causes a functional disconnect: the prefrontal cortex underperforms while the fight-or-flight system is overactive.
• The prefrontal cortex governs hope, executive thinking, and planning; addiction weakens this part of the brain.
• The limbic system, or “lizard brain,” becomes dominant in addiction, driving impulsive, survival-based behaviors.
• People with addiction may appear normal but are neurologically impaired in decision-making.
• “Addiction is one of the few diseases that tries to convince you that you’re not sick.” — Macklemore

The Divided Views on Sobriety

• There’s a “conservative” sobriety definition tied to abstinence and 12-step programs. The “liberal” view includes harm reduction, even supervised use, as a legitimate path.
• Functional sobriety may include people still using substances but who’ve regained stability in life.
• Sobriety should be viewed as progressive improvement rather than perfection. It can be evaluated by: family engagement, work participation, eating habits, and emotional regulation.
• “If you’re functioning in your family, personal, and work lives, that’s pretty good. I’ll take that as sober.”

Why Some People Recover and Others Relapse

• Success in recovery hinges on two key factors: the ability to tolerate discomfort and having strong social support.
• Recovery depends heavily on a genuine willingness to tolerate discomfort and be vulnerable. Sobriety requires facing trauma without the crutch of substances. This is often deeply painful.
• Emotional vulnerability in therapy or groups is a key predictor of progress.
• The level of social support – family, friends, and healthy coping mechanisms – makes a significant difference. Isolation and lack of resources dramatically reduce the chances of recovery.

Stigma as a Deadly Force

• Stigma leads to delayed care, misdiagnosis, and even death—as illustrated by a patient who refused to go to the ER and died of sepsis.
• Personal experience with judgmental psychiatric care led Grover to avoid mental health services for 20 years.
• Health professionals must use stigma-free language and see patients as whole people, not their conditions.
• “Stigma kills” is not a metaphor—it directly leads to avoidable deaths and worsened health outcomes.
• Reducing stigma starts with humility and listening.
  

Trauma, PTSD, and Personal Reckoning

• Grover’s PTSD includes visual flashbacks of traumatic emergency department cases and nightmares of forgotten patients.
• His deepest wounds came not from catastrophic events but from repeated emotional helplessness.
• “Little t” traumas accumulated from feeling inadequate or unable to help patients.
• Identifying his anxiety disorder and learning to journal brought clarity and healing.
• Integrating trauma requires intentional reflection, support, and vulnerability.
  

Processing Pain Through Connection

• Grover coped with stress through excessive exercise, which he now balances with community and moderation.
• Journaling each morning helps identify emotions, name discomfort, and process trauma.
• He now shares workouts with patients as a therapeutic community activity.
• Substituting harmful behaviors with meaningful connections and habits can be a powerful treatment strategy.
• “I would absolutely take exercise addiction over meth and heroin any day.”
  

The Practice of Addiction Medicine

• To become certified in addiction medicine without a fellowship, clinicians must document extensive relevant experience (through 2025).
• Grover now practices full-time in addiction medicine, offering 30-minute intakes and 20-minute follow-ups.
• The most important tools are listening without judgment and approaching patients with genuine curiosity.
• He builds rapport through low-stakes questions before exploring trauma.
• “When they trust you, they are willing to be honest.”