The Addicted Mind Podcast

Maybe someone you love is starting treatment for opioid use disorder and their doctor mentioned buprenorphine, or a monthly shot, and you're thinking, Wait... isn't that swapping one opioid for another? Or maybe you're the one struggling, and the idea of withdrawal feels so terrifying that treatment doesn't feel possible. Those fears make so much sense. And a lot of what we've been told about these medications is confusing, outdated or wrapped up in stigma.In this episode I sit down with Nick Casale, a pharmacist who has spent the last 15 years in addiction medicine, focused on opioid use disorder. Nick started out in a Pennsylvania Medicaid health plan in the early 2010s, right as the opioid crisis was exploding, and watched firsthand how inconsistent, and sometimes punishing, treatment coverage was. Today he works in medical affairs for a pharmaceutical company, talking with clinicians, researchers, and even sheriffs and jail medical directors about what the evidence shows.Nick breaks down how buprenorphine works in the brain (there's a great musical-chairs metaphor in here), why fentanyl has made opioid use disorder so much harder to treat, and what long-acting injections are changing, especially for people leaving jail. And we talk about the part medication can't do alone: counseling, support, peers who've been there. It's a hard topic. The numbers are heavy. But there's real hope here. Treatment works, access is better than it's ever been, and reaching out is a brave first step.In This EpisodeNick's path from retail pharmacy to a Medicaid health plan to addiction medicine, and why he fell in love with this workWhy insurance coverage for opioid use disorder treatment was "all over the board," and how kicking people off treatment for a failed drug screen made things worseWhat buprenorphine is, in plain language: a partial opioid agonist that holds the receptor, eases withdrawal and cravings, and blocks other opioidsThe three waves of the opioid crisis: prescription opioids, then heroin, then fentanyl and other synthetic opioidsHow fentanyl changes the brain by creating more opioid receptors, and why that makes withdrawal so brutalTablets and films vs. long-acting weekly and monthly injections, and why steady levels matter nowMedication for opioid use disorder in jails and prisons, and why the days after release are so dangerousHow buprenorphine can be misused, and why naloxone was added to some formsWhat real-world research is showing beyond clinical trials: fewer non-fatal overdoses, fewer serious infections, people getting their lives backAccess and cost today, and why so many people still aren't getting treatment.Key TakeawaysMost people who need treatment aren't getting it. Nick shares that roughly 4.8 million U.S. adults live with opioid use disorder, and only about 1 in 5 receive medication for it. He describes the overdose toll as the equivalent of a Boeing 737 crashing every day.Buprenorphine works differently from other opioids. Nick's metaphor: heroin plays musical chairs, jumping on and off the receptor. Buprenorphine sits down and stays. That steadiness helps keep people out of withdrawal and blocks other opioids from taking the seat.Fentanyl has changed the game. According to Nick, the street supply is now dominated by fentanyl and other synthetic opioids. They're so potent the brain grows more opioid receptors, which makes withdrawal harder and treatment more complex.There's no set timeline for treatment. ASAM (the American Society of Addiction Medicine) recommends at least three months, and longer treatment is linked to better outcomes. How long to stay on medication is a decision between you and your provider, much like blood pressure medication.Relapse isn't a reason to be punished. Nick and I agree that setbacks are part of many people's recovery journeys, and treatment should keep the door open.Medication is one piece, not the whole picture. Buprenorphine works "exponentially better," as Nick puts it, alongside counseling, behavioral support and peer mentors."Just be brave, seek out the treatment... just make that first step." — Nick CasaleTIME STAMPS00:15 Nick introduces himself and his work in addiction medicine01:40 From retail pharmacy to a Medicaid health plan in the middle of the opioid crisis08:06 What "transmucosal" means and how buprenorphine treatment has evolved10:47 How buprenorphine works in the brain, and the musical-chairs metaphor16:05 The numbers: 4.8 million adults with opioid use disorder, and 1 in 5 treated17:01 The three waves of the opioid crisis20:02 How fentanyl "upregulates" opioid receptors21:58 How long should treatment last?25:42 Long-acting injections and steady protection28:57 What the research shows, and why abstinence isn't the only measure30:52 Treatment in jails and prisons, and the risk after release33:40 Stigma and pushback in correctional settings36:40 Can buprenorphine be misused?39:36 Why medication works best with therapy and support44:29 Access, insurance and cost47:48 Nick's one message for anyone strugglingAbout Nick Casale, PharmDNick Casale is a pharmacist who has worked in addiction medicine for about 15 years, with a focus on opioid use disorder. He began his career in retail pharmacy before joining a Pennsylvania Medicaid health plan as a clinical pharmacist, where he led the plan's opioid overutilization program and its addiction medicine benefit during the height of the opioid crisis. He then moved into the pharmaceutical industry, first working with Medicaid programs across the country and now leading a medical affairs team. His team shares scientific information with physicians, nurse practitioners and physician assistants, works with leaders in addiction research, and helps jails and prisons understand the evidence for treating opioid use disorder.Connect with NickLinkedIn: search Nick Casale, PharmD Resources MentionedBuprenorphine and buprenorphine/naloxone (tablets and films taken under the tongue)Long-acting injectable buprenorphine (weekly and monthly)Methadone and naltrexone, other medications for opioid use disorderAmerican Society of Addiction Medicine (ASAM)National Commission on Correctional Health Care (NCCHC)SAMHSA National Helpline: 1-800-662-4357, free and confidential, 24/7FindTreatment.gov: find treatment providers near you, including medication for opioid use disorderSupporting ResourcesLooking for a therapist? Medication works best with support around it. Novus Mindful Life offers therapy for addiction, betrayal trauma, anxiety and depression, in person in Garden Grove, CA, and by telehealth in California, Idaho, Virginia, Florida and Texas. → NovusMindfulLife.comHealing after betrayal? Addiction can break trust in a relationship. Shame to Resilience is a guided program for both the betrayed partner and the person who caused the harm. → ShameToResilience.comStay close to the work. Get new episodes, tools you can actually use, and a little hope for the hard days in your inbox. → Subscribe at TheAddictedMind.comListen, Follow and ReviewIf this conversation helped you, or helped you understand someone you love a little better, please follow The Addicted Mind and leave a rating or review. It helps someone else who's struggling find the show.Apple PodcastsSpotifyInstagram: @addictedmindpodcastFacebook: The Addicted Mind Podcast community groupYouTubeLeave Duane a voice messageIf you're struggling with opioids, or loving someone who is, keep reaching out. Help is out there, and you're not alone.Find more episodes and resources at TheAddictedMind.com.Follow and Review: We’d love it even more if you could drop a review or 5-star rating over on Apple Podcasts. Simply select “Ratings and Reviews” and “Write a Review” then a quick line with your favorite part of the episode. It only takes a second and it helps spread the word about the podcast.Supporting Resources:If you live in California and are looking for counseling or therapy please check out Novus Mindful Life Counseling and Recovery CenterNovusMindfulLife.comWe want to hear from you. Leave us a message or ask us a question: https://www.speakpipe.com/addictedmindDisclaimerSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode of The Addicted Mind, host Duane Osterlind is joined by Joanna Conti, founder of Conquer Addiction and the Vista Research Group. Driven by her personal journey navigating her daughter’s severe alcohol addiction, Joanna set out to solve a major gap in the addiction treatment industry: the lack of hard, verifiable outcome data.Joanna shares how her background in software and engineering led her to launch Vista Research Group to track patient progress during and after rehab, as well as Conquer Addiction, a non-profit helping families find evidence-based care. They discuss what the data reveals about long-term recovery, why the 90-day care benchmark is critical, and how real-time patient monitoring can save lives.Key Topics CoveredA Personal Catalyst: Joanna’s harrowing experience with her daughter’s severe alcohol addiction, six years of navigating rehabs, and her daughter's eventual 13-year recovery.Marketing vs. Hard Data: The frustration of encountering unverified success claims (such as "98% success rates") and discovering in 2015 that only five treatment centers nationwide were scientifically tracking and publicly sharing post-treatment outcomes.Launching Vista Research Group: How tracking patient progress during treatment—including cravings, depression, and therapeutic alliance—improves patient outcomes in real time.What the Data Reveals: Insights gathered from monitoring over 100,000 patients in treatment and following up with over 50,000 post-treatment.Factors Influencing Success: How primary substance choice (alcohol vs. fentanyl or meth), age, peer culture, and ongoing support impact recovery rates.Why Industry Data Has Stagnated: Why nationwide 1-year recovery rates have remained around 36% to 37% since 1993, and how systematic measurement can drive outcome leaps similar to those in cancer research.Key Takeaways & Data InsightsThe 90-Day Benchmark: Patients who stay engaged in care across various levels (residential, IOP, outpatient) for at least 90 days are twice as likely to be in recovery one year later compared to those who leave in 20 days or less.Support Networks: Active involvement in recovery communities (such as AA or SMART Recovery) or living in sober housing doubles the likelihood of maintaining long-term recovery.Real-Time Feedback: Self-reported patient surveys often surface critical mental health warning signs—such as hidden suicidal ideation or rising cravings—that patients might hesitate to share face-to-face with clinicians.Hope for Chronic Relapse: Data confirms that individuals with 10 to 15 prior treatment episodes for severe substance use disorders are still fully capable of achieving lasting recovery.Guest Message"Love them and help them find effective treatment. Don't give up." — Joanna ContiResources & LinksConquer Addiction: conquer-addiction.org — Treatment centers with verified, above-average outcome data.Vista Research Group: Data-driven patient progress monitoring and outcome tracking for addiction treatment providers.Follow and Review: We’d love it even more if you could drop a review or 5-star rating over on Apple Podcasts. Simply select “Ratings and Reviews” and “Write a Review” then a quick line with your favorite part of the episode. It only takes a second and it helps spread the word about the podcast.Supporting Resources:If you live in California and are looking for counseling or therapy please check out Novus Mindful Life Counseling and Recovery CenterNovusMindfulLife.comWe want to hear from you. Leave us a message or ask us a question: https://www.speakpipe.com/addictedmindDisclaimerSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode of The Addicted Mind, host Duane Osterlind sits down with author, veteran, and off-grid farmer Robert "Bob" Stark. Bob shares his powerful journey of overcoming an 18-year battle with substance abuse, transitioning back to civilian life after parachuting into Iraq during the initial invasion, and deconstructing the rigid constraints of hyper-masculinity.Bob opens up about how he used writing to process unaddressed childhood and combat traumas, moving from anger and blame to deep internal healing. Today, Bob celebrates 11 years of clean and sober living on a 40-acre off-grid farm in the Kenai Peninsula of Alaska, where he is learning to balance strength with the gentleness his family deserves. Tune in to hear an inspiring conversation about resilience, the power of putting pen to paper, and the continuous journey of transformation.Key Takeaways & HighlightsThe Reality of Post-Combat Transition: Bob shares the stark contrast of sleeping with a rifle by his side in Iraq to sleeping in his car just two weeks later, highlighting the hyper-vigilance and isolation many veterans face.Breaking Out of the "Man Box": A deep dive into the societal expectations of male stoicism. Bob discusses the challenge of moving away from the "power through it alone" mentality to embrace emotional vulnerability and gentleness as a father.Writing as a Catalyst for Healing: Bob reveals why he is his most honest self when putting pen to paper. He shares how writing his two books allowed him to reframe his life experiences and process deep traumas without finger-pointing or resentment.Manifesting Dreams Off-Grid: From living with candles, oil lanterns, and no refrigeration to building a thriving 40-acre solar-powered farm with his family, Bob talks about the power of vision boards and relentless action.Action Beats Stagnation: Why thriving in recovery requires a willingness to keep trying new therapies, habits, and paths until something finally sticks.Bob’s One Piece of Advice: If you are feeling lost or stuck, start with the smallest foundational pieces: look at your lifestyle, your routine, your diet, and your sleep habits.Robert Stark (Bob) is an Army veteran who served four and a half years in the military, including a deployment as a paratrooper during the invasion of Iraq. He is the author of two deeply personal books, War Flower and Just Like a Soldier, which chronicle his experiences with trauma, military life, and long-term recovery. Bob has been clean and sober for 11 years and lives off-grid in Alaska with his wife, Savannah, and their four children, where they run their family farm, Secret Garden Alaska.Resources & Links MentionedRobert's Website & Farm: Secret Garden Alaska (Find his books, blog, and products here)Books by Robert Stark: * War FlowerJust Like a SoldierYouTube Channel: Secret Garden Alaska Follow and Review: We’d love it even more if you could drop a review or 5-star rating over on Apple Podcasts. Simply select “Ratings and Reviews” and “Write a Review” then a quick line with your favorite part of the episode. It only takes a second and it helps spread the word about the podcast.Supporting Resources:If you live in California and are looking for counseling or therapy please check out Novus Mindful Life Counseling and Recovery CenterNovusMindfulLife.comWe want to hear from you. Leave us a message or ask us a question: https://www.speakpipe.com/addictedmindDisclaimerSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.