Healing From the Inside Out

[Upbeat Guitar Music]

Mike: Welcome everybody. This is Avoiding the Addiction Affliction, brought to you by Westwords Consulting. I'm Mike McGowan.

Mike: We've talked with quite a few medical professionals on this podcast, and every one of them who works with and around substance use disorders came to that work in a slightly different way and have different perspectives.

Mike: We're gonna talk about that work and those perspectives today with our guest, Dr. Sarah Nasir. Dr. Nasir is a board certified addiction medicine physician, life coach, and entrepreneur, specializing in holistic addiction recovery, and empowering individuals through actionable healing strategies.

Mike: Welcome Dr. Nasir.

Sarah: Thank you so much, Mike, for having me on the show. I'm so excited to be here today.

Mike: Well, me too. And part of that goes to what we were talking about before this is putting some of what we do into language that everybody can understand. So, but start us out. Tell, tell me how you got into working with addiction medicine.

Mike: 'cause that's not the norm for most physicians.

Sarah: I think when life wants you to do something, it becomes the norm for you. So my journey in addiction medicine, I would say, looking back, it started in medical school. I was doing rotation and during my third year, those are like right after you finished the knowledge absorption.

Sarah: You go and you start to rotate through different fields and see, and this is before residency, so I was in rural West Virginia. This is a coal mine town and there was a lot of addiction, but at that time I didn't know about it. 'cause you know, it's like a fresh chick coming out of a hatching, out of an egg.

Sarah: I felt like looking back, that's how I think I was. I was just a hatchling and I was on OB rotation and my first experience, I think, like officially was when there was this baby withdrawing from opioids in the nursery. The baby's mom was someone who was using while she was pregnant with the baby.

Sarah: And so when the baby comes out after exposure in the womb with exposure to opioids and other drugs. The babies have withdrawal symptom as well, and that medical terminology for that is called neonatal abstinence syndrome. And just like what adults go through, babies go through it as well.

Sarah: That jitteriness, discomfort, high-pitched crying. But we weren't at that time giving morphine to the babies. What the nurses were doing, and I engaged in, was basically having a hate fest on the mom, which is like, how horrible is she to do this to the baby. Without really understanding what went on.

Sarah: And I didn't know, and I trusted the nurse. And as I was holding this screaming baby in my hand, trying to like give it whatever love I could, and the baby was kept away from the mom, which now we actually recommend that moms continue to breastfeed the baby. Unless there's like HIV or other transmittable disease that can be transmitted through breast milk.

Sarah: The best thing to do, once again for mom and baby is skin to skin and stay with each other. We deprived that and then keep moving forward. In residency, I was in New York and we were on the line, or the highway that went from Mexico to Canada for fentanyl delivery system by the cartels.

Sarah: As well as apparently our town was a pill mill, so we had the prescribers who would try to make the patients happy and just give them that easy prescription so they had a good review, et cetera. And one of those doctors were actually my attending and thinking back, he was a very kindhearted man, is what he came across to me as somebody who doesn't want to ruffle feathers or get into a negative situation with others. So I wonder if it kind of came from like a, not knowing how to say no. And then, as you know, as you get more positive reinforcement, you tend to do more of that, whether it's right or wrong, especially if you don't have your own sense of conscience of this is right or this is wrong.

Sarah: So that was my experience with this attending. However, when he was fired and his patients were just like, cut off the opioids and I witnessed that. I was part of that situation where everybody in the program was rallying together to give the patients a 30 day prescription and said like, go, good luck. Go find somebody who's gonna take care of you.

Sarah: And it was a small town once again. So my experience in America has been very rural suburban, like fully urban. I've been in, like, all across East Coast, West Coast. So I was fortunate enough to see that. And during that time in residency, one of my attendings was very big about going into addiction.

Sarah: 'cause there was nobody else who was taking care of that as well. And so what happened was I was talking with my attending after I saw a patient with him that, here's this adult man who is suffering from opioid addiction and he has an elderly father who's still worrying about him.

Sarah: He's in his twenties, the gentleman and his father's like in his fifties, and you can see the amount of stress on the father's face. And for me, like my personal bias came back up again. Is that here's this dad who should be worrying about like, you know, how to go and retire. Instead, he's constantly checking on his son, making sure he's not overdosing, and it felt very selfish.

Sarah: It felt very inappropriate. It took me back to a time when my dad would joke, I don't know if it was joke or not, maybe he was serious. He would be like, I'll give you guys up, but I will not stop smoking cigarettes, you know? And so we didn't like that. And so I could see a little bit of that in this father son dynamics.

Sarah: And so I went to my attending and I mentioned that, how horrible is it that he's addicted? How can somebody choose drugs over their loved ones? And basically passing on my prejudice and judgment on those patients. And at that time that attending, he actually told me. Sarah, you do realize that addiction is a disease, that it changes the body.

Sarah: That maybe it might have started out as a moment of weakness in judgment, but over time. It becomes like something that you can't just turn the switch off on. So you have to be kind to them and you have to nurture them. And that just, I feel like that was a defining moment. When you get like hit by thunder.

Sarah: Not, or lightning. Not that I've been hit by lightning, but I feel like it was that like. Just like clarity that came and I felt ashamed for these moments that I've mentioned where I was engaged in looking at the patients negatively and not being a proponent and a kind person to them, even though they weren't there, they weren't seeing it.

Sarah: But just in my heart, the fact that I harbored those feelings made me feel like I need to do. I need to look into this more. I need to reevaluate this. What is it that I need to do to understand? And so I dived a little bit more into it, and then I started to find a joy for treating addiction. Because when you're trying to take care of diabetes and high blood pressure and obesity, and you're telling somebody stop eating sweets, go out and break a sweat.

Sarah: You know, just exercise. These lifestyle changes that are not hurting them, like. Pain is a powerful motivator. Like it pushes you away. Diabetes, high blood pressure, stroke, et cetera. These things don't start hurting you until it really hurts. So it's hard for people to be like, well, I'm not seeing any issues with that.

Sarah: So sometimes it feels like pulling tooth and nail in that population. However, when you're taking care of a patient with addiction and the medicines are working, the patient is realizing, and then it becomes a collaboration. And the outcome. It feels like probably as gratifying as curing cancer maybe, or, I don't know.

Sarah: I'll let an oncologist weigh in on that...

Mike: (laughs)

Sarah: But it feels (laughs), it feels amazing to see somebody go from disheveled homeless.

Mike: Yep.

Sarah: Without a relationship to somebody becoming like a CEO of their own company, having their own children, having their own house, having their own car. It's so gratifying.

Sarah: And so that's what I do now.

Mike: That's just delightful all the way around. But it's interesting that you just happened to have a supervisor who gave you that little bolt of lightning. I had a friend of mine, who's a physician, who said in four years of medical school, he got two weeks of training on the number one health issue in the United States.

Mike: And that's addiction. So good thing you had that person.

Sarah: Yeah. And it's funny you mentioned that because I think maybe now it's picking up more of a, I feel like it has more attention now than just even when I started, right when I started the, I started a time when the government was putting out a little bit of money and SAMHSA was putting out a little bit of money to get primary care providers certified to prescribe buprenorphine and stuff.

Sarah: And because of my residency, I knew I had to get in on that boat, like free training, free certification, sign me up. (laughs)

Mike: (laughs)

Sarah: But I'm so glad they did that because I think it really allowed me to do what they intended for us to do.

Mike: Yeah.

Sarah: Because at that time I was working in DC and I was working with the underserved population because I worked with National Health Service Corps.

Sarah: And one of their criteria was that after you finish, you give service back. And it was an honor to be able to do that, to serve, you know, that's why we go into medicine and try to help people and it was a largely disenfranchised black population in DC. I didn't realize DC was gonna be such a large black population.

Sarah: I thought it was gonna be probably majority white, just like it was in New York or at least upstate New York. And I got to see that systemic inequality and the impact, the generational impact of it firsthand and I was grateful to have that opportunity to provide that full care in the patients within the time that I was able to.

Mike: That's awesome. You've also worked with other unserved population or underserved populations, including Muslim women.

Sarah: More so than Muslim women. I think for me, they're everywhere. When they see me, they come to me. I think...

Mike: I bet.

Sarah: The other group that really stands out to me additionally is the undocumented population.

Mike: Sure. Right.

Sarah: And in California, that's a population that I worked a lot with.

Mike: That's where you are now, right? California?

Sarah: Yes. Yes. I'm in California and with the Muslim women I think this is another, how do I say it? I think it's a challenge that I'm trying to address now in the Muslim population, not just the Muslim women.

Sarah: The concept of mental health is very, very minimal. People believe that depression, like even like in my own family growing up, right? I'm, I'm coming from anecdotes as well as seeing around me that depression doesn't exist. If you believe in God, you shouldn't be depressed. If you have God in your life, you shouldn't have anxiety, you know?

Sarah: So to then talk about addiction, that like is like something, it's like the white elephant in the room. I believe there are so many Muslim families that are suffering from addiction in a silent, in a silent manner.

Mike: Yeah.

Sarah: I think there's so much stigma, not just like the typical stigma I see amongst my patients with addiction.

Sarah: But particularly in the Muslim community, I haven't met too many who have come forth to seek help, surprisingly, and maybe it's because they don't know it exists. Maybe they don't know that there's somebody out there who understands and can deal with it and compassion. But I do hope that this is one category where I can make a bigger impact.

Mike: It's not just the public that carries the stigma. Sometimes our culture carries the stigma. Patients carry the stigma and family passes the stigma on.

Sarah: Very true.

Mike: Yeah, I have a addiction in my family and my uncle (laughs) Sarah used to say, well, my business McGowan Associates, that's a law firm.

Mike: I'm like, I'm not a lawyer! He goes, well, you could have been! He didn't wanna tell people even what I did for a living. Right.

Sarah: So interesting.

Mike: Yeah. When you do this, you decided at some point to branch out right? And take a more holistic approach, which is terrific 'cause addiction affects everything.

Sarah: It does. It does. And, you know, i'm a doctor of osteopathy. That's another type of training you can get, or another pathway to becoming a medically licensed doctor in the US who takes care of humans and this medicine, prescription surgery, et cetera. The other branch is the allopathic. That is the one that everybody knows.

Sarah: That's the MD. My alphabet soup is DO, and that's for osteopathy. So I think my foundation in osteopathy is what makes it easier for me.

Mike: Yeah.

Sarah: And more receptive for the approach of holistic because of the four tenets of osteopathic principle. The big ones are for me, is that the body is a unit of mind, body, and spirit.

Sarah: And the other one is that the body has the ability to heal itself. These two are the ones that, you know, I operate on a daily basis, not just in the medical aspect realm, but also I feel like in personal realm also. And so in the process of working with patients with addiction, I've added three more dimensions to that.

Sarah: And I call this the six dimensions of a transcendent. And allow me to describe transcendent a little bit really quick.

Mike: Please.

Sarah: So this is part of where I do my coaching and also not just with personal development, but also with addiction, because I think it just captures that concept so well. It just branches into the other aspects.

Sarah: So transcendence are inspired souls. People who are transcending their limits, connecting with their limitless soul, harnessing the power of their purpose, and living a fulfilling and thrilling life of design. And the way to do that, the way I work with my patients and my clients on that is to balance their six dimensions.

Sarah: The first one is from osteopathy, the mind, body, and spirit. And then the next ones are social, financial, and aspirational. So I find that when these dimensions are in balance, then the person thrives and transcends. And so that's how I now approach on every aspect of when I'm interacting with a patient or a coachee.

Sarah: And I find that life, the secret of life is that everything wants to move towards balance. Nothing likes to be in the extreme, and that is what's happening in our body with addiction and other disease as well. Disease happens when our body moves away from that homeostasis. The balance where it is supposed to operate at the optimal range.

Sarah: And whenever it's not within that setting, it starts to malfunction or dysfunction, which goes back to the osteopathic concept of somatic dysfunction. So I feel like as I'm living life, just so many things are falling into place and I'm just seeing things in different ways. So that's where my concept and principle of making sure that we're approaching this holistically, because as you said, addiction is not a one dimensional disease.

Sarah: You don't just throw chemicals at it and poof, it goes away.

Mike: Right.

Mike: Well for those of you who listen regularly, you know that I'm gonna put links to Dr. Nasir's information and socials and all of her videos online for you, and she goes into much more depth with all of these there. You've talked about addressing the chemical gap, and when you're with addiction, there is a chemical gap that you put your own body into or it is already in and you're trying to compensate for it.

Sarah: Yes. Chemical gap is terminology that I'm using to help people understand it because everybody understands where the gap is. And the video that you were mentioning, it goes exactly into that with a little bit more visual, is that when you start to put these external chemicals in your body at a concentration that isn't normal. And actually a lot of the opioids and alcohol and stuff that we put in our body, these are not normal chemicals that add to the functionality of our body. But our body has its own system. And so when we put these other chemicals in, what the body does is in order to protect the person and save their life, the body starts to change how it operates.

Sarah: So it moves it away from where the baseline is. So for example, when we're talking about opioid and someone's introducing fentanyl, heroin, or prescription opioid pills for a chronic period of time, so daily, on a regular basis for a long time, what happens is the body does what I found one of three things.

Sarah: Two of them are for sure, and the third one, I think it probably has an epigenetic factor into it, not just a genetic expression, but I'll get into that. So the first one it does is it makes less of your natural hormones. So like the endorphins, enkephalins, it makes less of those natural hormones in the first place because of this influx of this outside chemical.

Sarah: Second thing it can do is it pulls away receptors where the opioids bind to, so you're not getting stimulated as much. So that's what builds up tolerance, where you need more of the fentanyl or the heroin or the pills to get that same high. And same with alcohol and other drugs as well.

Sarah: And then the third thing. Some bodies do is increase the rate at which clearance of that medicine or chemical happens in the body. And some people are rapid metabolizers because of existing genes in their body. And the other one that I'm thinking. I don't know if there's enough research on it is if there's an epigenetic factor where, because it's happening, now your body turns on those genes of enzymes that clear it out faster.

Sarah: And so that's why you can have people using four to five grams of fentanyl and still walk around because their body's in just hyper mode. And so when the body does one of these three things, your body then is stuck in this. What I like to visualize as a whole. You know, versus somebody who has a normal biochemistry, they're like on flat surface.

Sarah: And so when you don't have these other external chemicals in your body, your body has lost disability to climb back up to the normal level. And that difference between being on that baseline to where your body is now is the chemical gap. And yes, anybody can give up the substances, but just because a person is ready to quit yesterday doesn't mean that their body is at that same stage, and this is where that holistic approach comes in again.

Sarah: What I tell my patients is that you are the expert and what it feels like and living in your body. I have no experience in that. (laughs) So you have to tell me what your body is telling you. Because the signals that your body gives you in withdrawal symptoms and the cravings your body gives you to get yourself out of that dangerous situation because this is suboptimal living condition for your body.

Sarah: These are your body's communication mechanism to you. You have to tell me. And then my experience, my expertise is in understanding the law of how the human body works, how these medicines work, and how to make them work together. And together we will do this treatment process where we will go through chemically stabilizing you and I'm gonna go ahead and give you the help.

Sarah: If you want my coaching help, there's that. And definitely include your counselor, your therapist, your other healthcare practitioners, your family, your church group, or other faith group, 12 steps. Whatever it is that feeds your soul and keeps propelling you forward. You lean into that, you feed more energy into that, and you cut ties with the negative sources in your life, like your dealers, like the quote unquote friends who are trying to apparently help you by giving you pills laced with ecstasy.

Sarah: I see so much ecstasy in my patient's urine and they don't even know where it's coming from, right. So those people are not really your friends. I don't know who needs to hear this, but (laughs) you know somebody who's giving you something so you keep coming back to them at the cost of your life. That is not a friend, that is an opportunist.

Sarah: And although I like people taking advantage of opportunities. You have to have a limit on who you trust and who you don't.

Mike: Well, and you need a strong support system, right, Dr. Nasir, because sometimes those people who aren't your friends are also your family. If you're struggling with stuff and it's your family that wants you to continue the same behavior or give you something after a period of time where you're trying to bring your life around. Ah, we may have to make some tough choices about who we hang around with.

Sarah: Yes. I'm so glad you bring that up because not only that, that they're enabling you in disabling you, but also sometimes family ends up being the first source of the trauma.

Mike: Yep.

Sarah: That pushes one into, this abyss. And it might be because that's what they grew up with. They just never learned how to stop the cycle of destruction because they grew up seeing trauma in their house and that's how they saw the adults in their lives cope with their inability to change their condition.

Sarah: You know, versus, there's a lot of rape stories in my patient population. So somebody abusing the right, the sanctity and the shame and the frustration that comes from being a kid and not being able to protect yourself when somebody that should have been protecting you. So there's a lot of trigger in that.

Sarah: So no, you can't do it alone.

Mike: Are you worried at all about the funding, slashing, the difficulty in accessing help, the number of resources available. You mentioned a couple of programs that you had access to early in your professional career that have taken hits financially.

Sarah: Yeah, definitely. I think we use the public fund in things that should not be used and we don't allocate the funds to resources where they actually need to go. There's definitely, that is, how do I say it? That is a dilemma and a harm of our society that we are not bolstering ourselves in the foundation. And so whenever you have a weak foundation and you try to raise whatever our politicians are trying to do making our country look great and stuff, but if you do it in the process of just harming yourself, it becomes very hard for us to continue to be the leaders of in time and, and what are the words I'm looking for in progress, in innovation and growth? So if you cut your legs off, it's hard to go the distance. It's hard to stand up strong. And is that gonna impact what we do? Definitely. Is that gonna stop us from showing up and doing what we need to do?

Sarah: I don't think so. We're gonna keep doing.

Mike: Yeah. And I've heard you talk about the time it takes to actually listen to the patient, to your clients. That's critical in making sure that you're addressing their whole self.

Sarah: It is, and I think it's more of a medical system problem rather than just the government problem (laughs) where people who don't work behind closed doors are the ones who are making the calls of how the flow happens.

Sarah: And so what I found, and one of the most frustrating things for me has been. Until recently, I think I'm finally at a job that I just absolutely love and adore. It allows me to do all these other things I'm doing, grow and become more valuable myself. So whoever I show up for gets value, doesn't leave without benefiting from me in some way if they're willing to benefit. Because you can't force benefit on anybody, right? (laughs)

Sarah: So, in the past, my frustration was that the triaging, the time allocation, the burden of work was just so disproportionately allocated. And then the compensation, I guess that's where the government and insurance stuff comes in, is that they're also the folks who are not actually seeing what's happening.

Sarah: They're not in the trenches. And so, (laughs) you know, the expectations are unrealistic. Things that even they couldn't do if they had our training and, you know, intellectual capacity and to be able to do what we do, they would go home frustrated and crying. I mean, there have been times when I'm like, I need a manager.

Sarah: Where are they? It's 4:00 PM. Oh, they went home. I mean, I mean, the day ends at 5:00 PM they come in at 9:00 AM they're gone at 4:00 PM and our day started at like seven or 8:00 AM and then the, we're not done until the patient is served and gone. And sometimes that meant that I was the only one there with other doctors.

Sarah: MA's gone. The security's coming and checking, doc, how much longer are you gonna take? Because they gotta close up. (laughs) And I'm like. You know, so there's, there are those frustrating things. Who's gonna deal with it? It has to be doctors. I think we have to be the ones who end up empowering ourselves to take ownership of the leadership that is put on us.

Sarah: I think at this point we have become very docile very, what do you call it? Just like. Just, what is it? Very robotic. The humanity gets taken out of us. It's like just follow order and then if somebody needs to be called to the court to be half off with their heads, it ends up being the doctor, which kind of reminds me of that attending I was talking about initially, the one who was the pill mill.

Sarah: Right. You know, I don't know if he had access to adequate support, that I, I can't imagine what type of. What the aftermath of what he went through could have been. Because if that happened to me, I would be devastated.

Mike: Mm-hmm.

Sarah: I would be devastated to be labeled that and ostracized and just be banned from society (laughs) as you know, that I spent my whole life training to be the identity that's a part of me, to be like, now you're a bad doctor.

Sarah: You know, here's a fine and just leave state and uproot and go see where you can feed yourself. So yeah, I, I think, anyways, I think that can, we can keep going on that for maybe what's wrong. (laughs)

Mike: Yeah. I was just thinking as you were doing that, that was so articulate, I was thinking we should just do another half an hour sometime on.

Mike: On that topic alone, because we're at that place when we're slashing. I'm looking out, my window over here is looking out over my backyard where I had somebody trim the trees last summer. I have no expertise in how to trim the trees, but they didn't just lop 'em down. They took the time to cut the branches that were not healthy away.

Mike: And now that spring is here as they're growing back, they look spectacular. And that's maybe a decent metaphor for what we're talking about.

Sarah: Yeah, that pruning, that guidance, that's what they got with expertise, right? Just repetition. Yeah. That sounds fun. I would love to do that. I don't know how much of it would be evidence-based because now I feel like I'm just going into opinion. (laughs)

Mike: Well, that's okay. This is a podcast. We don't always have to be evidence-based because I think a lot of the anecdotal stuff is where we're at, where people are, these are real issues for real people.

Sarah: Yeah.

Mike: For those of you listening...

Sarah: We forget that we are real people. (laughs)

Mike: Yeah. Right. Yeah. We're not just in numbers somewhere, right.

Mike: Dr. Nasir and I were talking listeners before we started about all of this, and she made the comment, I just need to find a place some more people can hear this stuff in a way that they can hear it, and I think you've gone a long way in doing that. I would encourage all of you to follow the link that I'm gonna put on the end of this podcast where she has other podcasts that she's been a part of. Her own stuff where she finally learns to hit the on button as well as some of the visuals she was talking about.

Mike: Dr. Nasir, thank you for your dedication, but also for your risk taking and for your work. I really appreciate it. Appreciate you being here.

Sarah: Thank you.

Mike: For those of you listening, I hope you find hope, courage, support, wherever you are. Thanks for listening. Be safe and keep going and keep listening.