The Transformed Minds Pod

Paying for Recovery: Contingency Management, Stimulant Use Disorder, & Survival w/Dr. Park

Stimulant overdose deaths are rising rapidly and one of the most effective treatments remains widely misunderstood. In this episode of Transform Minds Podcast, Dr. O sits down with addiction psychiatrist Dr. Dong Chan Park to explore contingency management (CM), an evidence-based treatment for stimulant use disorder that uses immediate rewards to reinforce recovery behaviors. Drawing on a 2025 American Journal of Psychiatry cohort study, this conversation examines how contingency management may significantly reduce all-cause mortality while addressing the ethical, clinical, and policy barriers limiting broader adoption. WHAT YOU’LL LEARN: * Why stimulant-involved overdose deaths continue to rise * How contingency management works in real-world addiction treatment * Why CM is often criticized as “bribery” * The evidence linking CM to lower mortality * Trauma-informed approaches to stimulant treatment * The role of ADHD, housing instability, and relapse triggers in recovery * How CBT, IOP, and multidisciplinary care support long-term outcomes FEATURED ARTICLES & RESOURCES: * Coughlin LN et al. Contingency Management for Stimulant Use Disorder and Association With Mortality. Am J Psychiatry. 2025. https://doi.org/10.1176/appi.ajp.20250053 [https://doi.org/10.1176/appi.ajp.20250053] * National Academies of Sciences: Medications and Behavioral Treatments for Substance Use Disorders * SAMHSA: Treatment of Stimulant Use Disorders Recovery is possible. Evidence-based treatment saves lives. #ContingencyManagement #StimulantUseDisorder #AddictionPsychiatry #MentalHealthPodcast #AddictionRecovery

Youth Self-Harm, Substance Use, and Suicide Risk: What the Data Actually Show | Epi 6

In this episode, Dr. O examines how self-harm, substance use, and emotional dysregulation interact to increase risk in adolescents and young adults. Drawing on the Global Burden of Disease Study 2025, this discussion highlights how mental disorders, substance use, and self-harm are leading contributors to disability in ages 10–24. Key topics include: * Substance use as a major risk factor for suicidal thoughts and behaviors * Emotional dysregulation and impulsivity * Social media and behavioral risk patterns * Clinical implications for screening and early intervention Featured research includes: * Xu et al., Translational Psychiatry 2025 * Jones et al., Substance Abuse 2023 * López-Martínez et al., Behavioral Sciences 2025 RESOURCES:If you or someone you know is in immediate danger, call emergency services (911 in the U.S.) right away. *U.S.: Call or text 988 (Suicide and Crisis Lifeline) OR Chat via 988lifeline.org *International: Visit findahelpline.com to find local resourcesYou are not alone. Help is available.

When Policy Lags Behind Science: Buprenorphine Dosing Reconsidered with Dr. Drits | Ep 5

Are dose caps on buprenorphine costing lives? In this episode of the Transform Mind Podcast, Dr. O and Dr. Drits dig into the evidence and the gaps around buprenorphine dosing for opioid use disorder In the fentanyl era, drawing on a 2023 narrative review by Grande and colleagues published in the Journal of Addiction Medicine. Higher doses are consistently linked to better treatment retention. Yet dose caps persist in clinical practice and insurance policy, even as the opioid supply has fundamentally shifted. Dr. O and Dr. Drits break down why, and what clinicians and patients can do about it.In this episode: → Why the "ceiling effect" applies to respiratory depression not to craving or withdrawal relief → What the evidence says about retention, fentanyl, and dosing → How to advocate for patients within institutional and insurance constraints → Common myths about diversion and high-dose buprenorphine → Shared decision-making in practice Learning Objectives By the end of this episode, listeners will be able to: 1. Describe the evidence base regarding buprenorphine dose limits and clinical outcomes. 2. Explain how buprenorphine pharmacology informs safety at higher doses. 3. Identify policy and systemic factors that influence dosing practices. Apply evidence-based reasoning to clinical and systems-level decision-making in opioid use disorder care. Chapters: 00:00 High Dose Benefits 01:23 Podcast Intro Format 02:34 Why Dose Caps Matter 07:48 Guest Perspective Policy Lag 11:27 Dose Limits Today 14:44 Buprenorphine Pharmacology 18:07 Retention Saves Lives 20:31 Fentanyl Needs Higher Doses 22:25 Advocacy Under Limits 24:53 Training And Myths 28:38 Case Dosing Decisions 34:38 Shared Decision Making 37:34 Ceiling Effect Explained 39:24 Key Takeaways Reference: Grande LA et al. "High-dose buprenorphine for the treatment of opioid use disorder in the context of fentanyl exposure." Journal of Addiction Medicine, 2023. ⚠️ This podcast is for educational purposes only and does not constitute medical advice. Clinical decisions should be made in consultation with a qualified healthcare provider. #BuprenorphineTreatment #OpioidUseDisorder #MOUD #FentanylCrisis #AddictionMedicine #HarmReduction #TransformMindPodcast

The Hidden Architecture: Rethinking Mental Health System Design | Ep 3

Why does mental health care stay fragmented when the evidence for effective treatment already exists? In this Host Rx episode, Dr. O argues that persistent treatment gaps are a structural problem, not a knowledge problem. Drawing on a 2023 Lancet Psychiatry paper, Dr. O breaks down what's actually driving fragmentation: * Insurance design and weak parity enforcement * Prior authorization delays blocking time-sensitive care * Scope-of-practice restrictions and workforce shortages * EHR silos and reimbursement models that don't support collaborative care She maps the problem across clinical, organizational, and policy levels, and makes the case for structural literacy as the foundation for reform. 00:00 Evidence Versus Architecture01:05 Podcast Welcome And Format02:19 Treatment Gaps Are System Design04:58 Why Care Stays Fragmented06:38 Insurance Shapes Clinical Care07:19 Why Pilots Fail To Scale08:14 Case Study OUD And Depression09:49 Clinician Reflection And Levers10:52 Warm Handoffs And Case Conferences13:45 Why Silos Persist In Practice15:18 What Integration Really Means15:54 Three Levels Of Architecture17:42 Advocacy And Closing MessageFeatured Studies- 2023 Article, The Lancet Psychiatry (ScienceDirect link provided)- Lagisetty PA et al., 2019. Racial disparities in buprenorphine treatment. JAMA Psychiatry.- Parity enforcement advocacy and policy statements from the American Medical Association Transformed Minds is hosted by Dr. O and covers addiction medicine, psychiatry, and the policy shaping mental health care delivery.

Alcohol Withdrawal in the Hospital: CIWA, Benzodiazepines & Phenobarbital Explained | S2 Ep.3

In this episode of Transformed Minds Season 2, Dr. O sits down with addiction medicine specialist Dr. Desai, a CATCH Team Lead Physician (Consult for Addiction Treatment and Care in Hospitals), for a deep clinical dive into alcohol withdrawal management in the hospital setting. Whether you're a hospitalist, internist, nurse, resident, addiction medicine clinician, or medical student, this episode gives you a practical, bedside framework you can use immediately. What You'll Learn: * A practical framework for risk-stratifying alcohol withdrawal at the bedside * When and how to use CIWA and what most clinicians get wrong * How to choose between benzodiazepine regimens based on patient profile * When phenobarbital enters the picture and how to use it safely * How an interdisciplinary consult model changes outcomes for hospitalized patients with alcohol use disorder Chapters * 00:00 Why Early Assessment Matters * 00:49 Welcome to Transformed Minds * 02:38 Meet Dr. Desai * 04:37 What Is the CATCH Team * 07:26 Alcohol Withdrawal Red Flags * 13:10 Bedside CIWA and Reassessment * 15:16 Symptom-Triggered Protocols * 18:10 High-Risk Withdrawal Timeline * 20:22 Front-Loading and Fixed Tapers * 25:58 Complicated Withdrawal and Phenobarbital * 36:54 Choosing the Right Benzo * 39:32 Key Takeaways and Wrap Up Subscribe to Transformed Minds for clinical education on psychiatric and addiction care, advocacy and tips.