Medical school is traumatic at nearly every stage of training. The resulting wear and tear on medical students has lasting, detrimental effects. One of those is substance abuse. Does it have to be this way? What are the factors that contribute to substance abuse among medical students? From ineffective feedback to the stress of the residency Sorting Hat to the toxic, corrosive nature of the physician ego, Dr. Daniel Gouger--AMSA’s Education and Advocacy Fellow--walked ad lib’s Pete Thomson through some underlying causes.