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 And a lot of what we've been told about these medications is confusing, outdated or wrapped up in stigma.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 Episode
Nick's path from retail pharmacy to a Medicaid health plan to addiction medicine, and why he fell in love with this work
Why 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 worse
What buprenorphine is, in plain language: a partial opioid agonist that holds the receptor, eases withdrawal and cravings, and blocks other opioids
The three waves of the opioid crisis: prescription opioids, then heroin, then fentanyl and other synthetic opioids
How fentanyl changes the brain by creating more opioid receptors, and why that makes withdrawal so brutal
Tablets and films vs. long-acting weekly and monthly injections, and why steady levels matter now
Medication for opioid use disorder in jails and prisons, and why the days after release are so dangerous
How buprenorphine can be misused, and why naloxone was added to some forms
What real-world research is showing beyond clinical trials: fewer non-fatal overdoses, fewer serious infections, people getting their lives back
Access and cost today, and why so many people still aren't getting treatment.

Key Takeaways
Most 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 Casale

TIME STAMPS
00:15 Nick introduces himself and his work in addiction medicine
01:40 From retail pharmacy to a Medicaid health plan in the middle of the opioid crisis
08:06 What "transmucosal" means and how buprenorphine treatment has evolved
10:47 How buprenorphine works in the brain, and the musical-chairs metaphor
16:05 The numbers: 4.8 million adults with opioid use disorder, and 1 in 5 treated
17:01 The three waves of the opioid crisis
20:02 How fentanyl "upregulates" opioid receptors
21:58 How long should treatment last?
25:42 Long-acting injections and steady protection
28:57 What the research shows, and why abstinence isn't the only measure
30:52 Treatment in jails and prisons, and the risk after release
33:40 Stigma and pushback in correctional settings
36:40 Can buprenorphine be misused?
39:36 Why medication works best with therapy and support
44:29 Access, insurance and cost
47:48 Nick's one message for anyone struggling

About Nick Casale, PharmD
Nick 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 Nick
LinkedIn: search Nick Casale, PharmD
Resources Mentioned
Buprenorphine 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 disorder
American Society of Addiction Medicine (ASAM)
National Commission on Correctional Health Care (NCCHC)
SAMHSA National Helpline: 1-800-662-4357, free and confidential, 24/7
FindTreatment.gov: find treatment providers near you, including medication for opioid use disorder
Supporting Resources
Looking 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.com
Healing 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.com
Stay 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.com
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Leave Duane a voice message
If 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.

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Supporting Resources:
If you live in California and are looking for counseling or therapy please check out Novus Mindful Life Counseling and Recovery Center
NovusMindfulLife.com
We want to hear from you. Leave us a message or ask us a question: https://www.speakpipe.com/addictedmind
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Maybe you've watched someone you love do something that makes no sense, something that's clearly hurting them and everyone around them, and you've asked, "Why would anyone choose this?" Or maybe you've asked that question about yourself. It's such a human question. And the answers we come up with, the stories we tell about addiction, end up shaping how we treat people who are struggling... including ourselves.
In this episode I sit down with Dr. Maria Cichosz, a writer, critical drug studies scholar and professor of literature and creative writing at Victoria College, University of Toronto. Maria isn't coming from a medical or therapy background. She has a PhD in literary and cultural studies, and she brings her own story: growing up as the child of Polish immigrant parents in a home marked by generational trauma and addiction, and her own relationship with substances over the years. Together we look at how our ideas about addiction have changed over time, from a choice, to a weakness of the will, to a disease of the brain, and what each of those stories gets right and what it misses.
It's a big conversation, and Maria doesn't pretend there are easy answers. But there's a lot of hope in it. When you can see that our ideas about addiction haven't always been this way, you can start to imagine they could be different. More compassionate. More human.

Key Takeaways
Our ideas about addiction have a history. The idea that addiction is a disease of the brain is only a few decades old. Before that it was seen as a weakness of the will or the soul, and before that, a behavior some people chose. Those stories affect how people get treated today.
The brain disease model helps, and it's still only part of the picture. It takes blame out of the equation. But a brain scan is "a brain in a vat," as Maria puts it. It doesn't show poverty, trauma, isolation, overprescribing or punitive drug policy.
Environment matters, a lot. In Rat Park, rats who had community, play and stimulation mostly chose not to take the drug. Rats aren't people, but we're social creatures too.
Compassion and responsibility can live together. Duane and Maria sit with the hard question of how we hold people accountable for the harm they cause while also understanding the forces that brought them there. Neither of them has a clean answer, and that's okay.
Stories can build empathy. Fiction lets us step inside someone else's head and see that they think, feel and struggle much like we do.

"I wish I could tell you it gets better… We can't always see among the murkiness of where we are in the moment, but there is certainly something on the other side, even if it's a twisting path to get there." — Dr. Maria Cichosz
Timestamps"
00:36 Maria introduces herself and how she became "the drug person" in her academic work
06:18 Growing up in a home shaped by generational trauma and addiction
12:48 Addiction has a history: why the brain disease model isn't the whole story
13:54 From Roman law to "a disease of the will": how our ideas about addiction changed
24:01 What the brain disease model gets right, and what it can miss
30:37 The Rat Park study and the power of environment
33:42 The other side: psychedelics, harm reduction and moving past "good vs. bad"
38:54 Set and setting
41:30 Maria's novel Middlemen
45:35 One thing Maria wants you to know
About Dr. Maria Cichosz
Maria Cichosz is a writer, critical drug studies scholar and professor of literature and creative writing at Victoria College in the University of Toronto, where she also directs the Victoria College Writing Centre. She holds a PhD in Modern Thought & Literature from Stanford University, and her research focuses on post-1945 literature, art and theory, with a particular interest in drug histories and cultures. Her writing has appeared in Critique, the Los Angeles Review of Books, the Literary Review of Canada and American Literature. She's the author of the novels Cam & Beau (2020) and Middlemen (NoN Publishing, fall 2026). On Drugs, part of Biblioasis's Field Notes series, is forthcoming.

Connect with Maria
Website: mariacichosz.com
University of Toronto faculty page: vic.utoronto.ca/cichosz
Academia.edu: utoronto.academia.edu/MariaCichosz
Middlemen from NoN Publishing: nonpublishing.com/middlemen
Toronto launch of Middlemen: Thursday, October 22, 2026, 6:30 PM at Queen Books, 914 Queen Street East
Resources Mentioned
Middlemen by Maria Cichosz
Cam & Beau by Maria Cichosz (2020)
Dr. Bruce Alexander's Rat Park study
Eve Kosofsky Sedgwick, "Epidemics of the Will"
Jacques Derrida, "The Rhetoric of Drugs"

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 Center
NovusMindfulLife.com
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.com
Healing after betrayal? Shame to Resilience is a guided program for both the betrayed partner and the person who caused the harm. → ShameToResilience.com
Stay 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.com

We want to hear from you. Leave us a message or ask us a question: https://www.speakpipe.com/addictedmind
Disclaimer

See 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 Covered
A 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 Insights
The 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 Conti
Resources & Links
Conquer 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.

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Supporting Resources:
If you live in California and are looking for counseling or therapy please check out Novus Mindful Life Counseling and Recovery Center
NovusMindfulLife.com
We want to hear from you. Leave us a message or ask us a question: https://www.speakpipe.com/addictedmind
Disclaimer
See 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 Podcast, host Duane Osterlind speaks with actor, playwright, and recovery advocate Ned Van Zandt. Ned shares his life story—from an exotic childhood traveling the world to studying under Olympia Dukakis and working alongside high-profile actors and musicians in the 1970s. He candidly details his descent into hard drugs while living at New York's iconic Chelsea Hotel, his first 13-year stretch of surface-level sobriety, a sudden relapse that led to an arrest in Texas, and his eventual surrender to deep, service-driven recovery. Today, Ned is the managing director of a NYC sober living facility and the creator of the one-man show Lost in Del Valle.
Key Topics Covered
Roots and Early Career: Growing up in a prominent Fort Worth family, child acting in The Music Man and Oliver!, and studying acting at NYU under Olympia Dukakis.
The Chelsea Hotel Era (1978): Moving into the legendary hotel the same week as Sid Vicious and Nancy Spungen, accelerating a lifestyle of heavy drug use and rock-and-roll partying.
First Sobriety Attempt & Relapse: Getting sober in 1987 following legal pressure, putting together 13 years of continuous recovery, and landing roles on Broadway and Law & Order. Ned reflects on how skipping the deeper step work left him vulnerable to a sudden relapse on New Year's Eve 1999.
The Downward Spiral: Overdosing on cocaine, leaving New York to hide out in Texas, losing his life savings, and being arrested on a dirt road outside Austin for possession with intent to distribute.
Jail at Del Valle: Navigating time in jail, where the head of the local Texas Aryan Brotherhood gang recognized him from his role on the soap opera One Life to Live.
True Recovery in Hawaii: Entering treatment in Hawaii in 2007, embracing sponsorship and service work, and rebuilding his acting career with roles on Lost and film projects.
Creating Lost in Del Valle: Developing a raw, humorous one-man play directed by Amir Arrison (The Blacklist) recounting his wild history, rock-and-roll encounters, time in jail, and path to redemption.
Service as a Pillar of Sobriety: Working as managing director and partner at Transcend NYC, helping young men find direction and recovery.
Words of Wisdom for Anyone Struggling
Focus on the Single Frame: View life like a long roll of film. Instead of obsessing over the outcome or the end of the reel, focus exclusively on the single frame in front of you right now.
Move a Muscle, Change a Thought: Physical action shifts mental state. Go for a walk or change your environment to break negative thought patterns.
Get Out of Your Own Head: Engaging in service and helping others brings back the purpose and vitality that addiction strips away.
Mentioned in This Episode
Resources & Links for Ned:
Ned's Play Lost in Del Valley at the Soho Playhouse
Play Official Website: lostindelvalle.com
Sober Living Facility Transcend NYC (Upper West Side, Manhattan)
Podcast Websitetheaddictedmind.com
Supporting Resources: Duane Osterlind LMFT CSAT
If you live in California and are looking for counseling or therapy please check out Novus Mindful Life Counseling and Recovery Center
NovusMindfulLife.com
Shame to Resilience
We want to hear from you. Leave us a message or ask us a question: https://www.speakpipe.com/addictedmind
Disclaimer
See 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 speaks with orthopedic spine surgeon Dr. David Hanscom about his book, Calm Your Body, Heal Your Mind. They explore the deep physiological connection between chronic pain, anxiety, and addiction, outlining how regulating the nervous system can lead to genuine, lasting healing.
Key Takeaways
The Problem with Chronic Surgery: A vast majority of spine surgeries for non-structural chronic pain fail because they treat a symptom rather than the root cause. Chronic physical pain is frequently driven by an oversensitized nervous system rather than structural spinal flaws.
Threat Physiology vs. Psychology: Anxiety and anger are physical, chemical reactions—a "fight-or-flight" survival mechanism—rather than purely psychological issues. Because the unconscious brain processes roughly 1 billion bits of information per second compared to the conscious brain’s 20–30 bits, you cannot simply talk or willpower your way out of deep physiological threat states.
The Bridge to Addiction: When the body remains trapped in sustained threat physiology, mental and physical pain become unbearable. Without tools to down-regulate the nervous system, individuals often turn to substances or compulsive behaviors as a last-ditch effort to soothe the body's alarm system.
Reframing Trauma Work: Continuously discussing and re-analyzing past trauma can sometimes act as a "trauma anchor," reinforcing pain circuits in the brain. Long-term recovery requires shifting focus toward present-moment awareness and neuroplasticity.
The 4-Part Framework for Healing
Thought Separation: Using expressive writing and mindfulness to separate your identity from repetitive, negative thought patterns.
Calming the Physiology: Directly toning down fight-or-flight chemistry by engaging the vagus nerve and creating a felt sense of physical safety.
Softening the Ego: Cultivating self-awareness to spot cognitive distortions without needing to defend a rigid identity.
Neuroplasticity: Constructing new brain pathways by intentionally practicing gratitude, engaging with community, and pursuing purpose.
Resources & Links
Book: Calm Your Body, Heal Your Mind by Dr. David Hanscom
Website: Back in Control
Guided Healing Program: The DOC Journey

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 Center
NovusMindfulLife.com
We want to hear from you. Leave us a message or ask us a question: https://www.speakpipe.com/addictedmind
Disclaimer
See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.