Podcast Summary: "The Truth About Addiction: Dr. Ben Shapiro & Dr. Brett Sherman Break It Down"

We're Out of Time Podcast
Host: Richard Taite
Guests: Dr. Ben Shapiro, Dr. Brett Sherman
Date: December 2, 2025

Main Theme & Purpose

This episode dives deep into the realities and raw truths of addiction, discussing its psychological and neurological underpinnings, the fentanyl crisis, and modern treatment innovations. Host Richard Taite—an addiction recovery expert—tackles essential but under-discussed aspects of addiction care with two renowned psychiatrists, Dr. Ben Shapiro and Dr. Brett Sherman. The conversation moves from cutting-edge neuromodulation with TMS (Transcranial Magnetic Stimulation), to family heartbreak, misdiagnosis, boundaries in treatment, trauma roots, and the promise (and pitfalls) of emerging psychedelic therapies.

Key Discussion Points & Insights

1. Reframing Addiction: More Than a Chemical Dependency

• Addiction as Relationship to Self:
  • "Addiction isn't just a relationship with a drug. It's a relationship with yourself." — Dr. Ben Shapiro [00:00]
  • The core of addiction lies in trauma, individual experiences, and self-knowledge.
• Chemistry vs. Experience:
  • "You're not just a bunch of chemistry. You're a bunch of your experiences and your traumas." — Dr. Ben Shapiro [00:06]
  • Both doctors stress that understanding one’s story and trauma is essential—not just biochemistry.

2. Innovations in Treatment: TMS and Neuromodulation

• Introduction to TMS:
  • Explained as a "powerful magnetic field to either stimulate or inhibit brain circuits" — Dr. Sherman [01:33].
  • Used increasingly for trauma, depression, OCD, and now, addiction [01:49–07:12].
• Efficacy & Protocols:
  • "Crazy effective, especially with new accelerated protocols—the Saint Protocol from Stanford had remission rates over 90% for depression." — Dr. Sherman [04:22, 05:21].
  • Limitations include insurance coverage and high costs (about $100K/machine, $20–30K/year to maintain) [16:52–17:08].
• Beyond Depression:
  • TMS now FDA-approved for OCD, anxious depression, adolescent depression, migraine, nicotine dependence—and being studied widely for addiction [07:12].
  • Multi-site TMS (stimulating various brain regions) may offer promise, especially as science catches up with real-world practice [10:03–10:59].

3. The Fentanyl Crisis: Death, Grief, and Systemic Issues

• Testimonies from the Trenches:
  • "I have so many fentanyl deaths, I've lost count. I don't want to count." — Dr. Sherman [11:47]
  • Many deaths are accidental overdoses: "None of them are suicide. They're accidental overdose or being unaware that there's fentanyl." — Dr. Sherman [12:04]
• Families in Crisis:
  • "It rips them apart... it's unbelievable grief to lose a family member, particularly a child." — Dr. Sherman [12:33]
  • The randomness and lethality—"It's not if, it's when you’re going to die"—is more severe than past heroin waves [15:28]
  • "Even weed gets laced with it. It's crazy." [15:52]
  • "You gotta get a script from a doctor... that’s it, the end." — Host [16:12]

4. Barriers to Treatment & Underutilization of Effective Tools

• Insurance, Cost, and Public Awareness:
  • Insurance restrictions and high cost make TMS underused [16:40, 17:29].
  • Even most clinicians know only of TMS for depression, not its broader uses or latest protocols [17:29–18:13].
  • The default is still "diagnose as depression" to get TMS covered, since "nobody gets to treatment on a winning streak." — Host [18:13]

5. Addiction and Psychiatric Illness: Overlapping Pathways

• "Addiction’s a psychiatric illness, no question." — Dr. Shapiro [18:48]
• Treatment isn’t about a strict division: "It all has to be treated the same; if you can't treat it the same, the roots don't take hold." — Host [19:14–19:17]
• Trauma, childhood attachment, and the family system play central roles in both addiction and mood disorders [20:47–26:34].
• "A lot of it's trauma." — Dr. Sherman [21:50]

6. Therapeutic Alliance: Empathy, Detachment, and Outcomes

• Burnout and Empathy:
  • Host describes being re-injured by client stories; doctors share how their training taught them detachment, but real caring remains crucial [27:20–29:50].
• Therapeutic Relationship Predicts Success:
  • "The biggest variable that predicts outcome in any therapeutic experience is the relationship with the patient, the level of empathy the patient feels from the therapist." — Dr. Sherman [30:00]
  • Even medication “works better” when the alliance is strong [32:25].

7. Misdiagnosis & Prescription Pitfalls

• Misdiagnosis Is Common:
  • Host: "How often are people misdiagnosed, given antidepressants or stimulants when what they really need is addiction treatment?"
  • "High." — Dr. Sherman [35:12]
  • Overuse/misuse of meds like Adderall, benzos, and opioids often comes from inadequate addiction training in psychiatry [35:44–46:55].
• Systemic Training Gaps:
  • "In medical school you get one week of addiction." — Host [47:00]
  • Only 1,500 addiction psychiatrists in the entire country; a massive shortfall [47:36].

8. Why Therapy-First, Individual Care Works

• Carrera’s Approach Vs. 12-Step:
  • "Addiction isn't just a relationship with a drug. It's a relationship with yourself that comes first, like some kind of early trauma." — Dr. Shapiro [48:51]
  • "AA is great, but it's a support group... it is not specific to you and your problems." — Dr. Sherman [50:54, 50:57]
  • Therapy is about unpacking trauma, building insight, and replacing drugs—once a meaningful ‘attachment’—with something of equal or greater value [51:05–51:44].

9. Psychedelics, Promise & Caution

• On Psychedelic Therapies (Ibogaine, Psilocybin, MDMA, Ketamine):
  • These can be transformative short-term, but "if that's all you did... you're good for two months." — Dr. Sherman [40:35]
  • Lasting benefit depends on follow-up therapy; psychedelics can be risky or destabilizing in certain patients [39:34, 41:28].
  • "There's promise in psychedelics, but that's what it is—promise. It is not here." — Dr. Sherman [39:34]

10. Family Education: The Hardest Truths

• What Families Get Wrong:
  • "It's a disease that kind of takes over your will... They don't realize how deep it is, how it just controls their life." — Dr. Shapiro [36:39]
  • Support requires boundaries, not enabling: "With addiction, you set very strict limits—like, I can't help you unless you go to treatment." — Dr. Sherman [36:57]

11. Advice and Hope for the Next Generation

• What Would You Tell a 16-Year-Old About to Try Drugs?
  • "Don't do that, you're gonna die." — Dr. Sherman [52:06]
  • "What are you trying to get out of it?" — Dr. Shapiro [52:11]
• Holding Hope for the Hopeless:
  • Finding a reason to live, often by leveraging love for family, can be a critical anchor [54:00–54:34].

Notable Quotes & Memorable Moments

• "Addiction isn't just a relationship with a drug. It's a relationship with yourself."
  — Dr. Ben Shapiro [00:00 & 48:51]

• "You have to know yourself. You have to have somebody who can guide you through it."
  — Dr. Ben Shapiro [00:06]

• "I have so many fentanyl deaths, I've lost count. I don't want to count."
  — Dr. Brett Sherman [11:47]

• "It's not if, it's when you're going to die. I have no heroin overdose death in my practice... but fentanyl? I can't count."
  — Dr. Brett Sherman [15:28]

• "The biggest variable that predicts outcome in any therapeutic experience is the relationship with the patient—the level of empathy the patient feels from the therapist."
  — Dr. Brett Sherman [30:00]

• "If you can't treat [addiction and depression] the same, the roots don't take hold."
  — Host [19:17]

• "No medication management appointment because there's always a therapeutic element to it."
  — Dr. Brett Sherman [32:32]

• "You need to restructure... so other elements in your life bring meaning out. You replace it."
  — Dr. Ben Shapiro [51:05]

Important Segment Timestamps

• Defining Addiction & Trauma: [00:00–01:00]
• Explaining TMS & Company Details: [01:27–05:00]
• TMS for Addiction & Stanford Protocol: [05:12–07:12]
• Multi-site TMS & Future of AI in Psychiatry: [10:01–10:59]
• Reality of Fentanyl & Accidental Deaths: [11:43–16:12]
• Treatment Barriers—Insurance, Costs: [16:33–18:13]
• Overlap of Psychiatry and Addiction: [18:47–20:47]
• Therapeutic Alliance/Detachment: [27:20–32:25]
• Misdiagnosis, Overprescription: [34:41–36:39]
• Advice to Families: [36:39–37:51]
• Cutting-edge Therapies (TMS, Psychedelics): [38:08–43:51]
• Why Individual Therapy Beats Cookie-Cutter Approaches: [48:35–51:00]
• Role Play: Helping a Suicidal Teen: [52:06–54:34]

Tone & Style

The conversation is direct, compassionate, and often darkly humorous. The host mixes personal testimony with raw honesty and sometimes biting commentary. Both doctors balance scientific rigor with accessible explanation and practical wisdom, making the material relatable and urgent for families, clients, and clinicians alike.

For Listeners: Key Takeaways

• Addiction is deeply personal, rooted in relationships, trauma, and meaning—not just biochemistry.
• New neuromodulation tools like TMS offer real hope, especially when coupled with individual therapy and holistic, community support.
• The fentanyl crisis is rewriting the risk landscape: any street drug could be lethal; families and users must understand this.
• Strong, empathetic relationships—whether in medicine, therapy, or family—are at the heart of every lasting recovery.
• Systemic gaps in training, diagnosis, and insurance still leave far too many vulnerable—and innovation is needed, fast.
• No single tool, whether TMS or psychedelics, is a magic bullet—lasting change is always anchored in honest self-examination and supportive care.

"We're Out of Time" challenges listeners not just to understand addiction, but to act—demanding better from medicine, community, and ourselves.