June 18, 2025 • 31 mins
Working with people with substance use disorders means working with the person’s whole self, body, mind, spirit, and environment. Dr. Sarah Nasir talks about her holistic approach to addiction medicine and the challenges that underserved populations face in getting the help they need to discover their whole selves. Dr. Nasir is a dual board-certified family medicine physician with a sub-specialty in addiction medicine. An alumna of UC Davis, she majored in Biological Systems Engineering and later pursued her passion for medicine at the West Virginia School of Osteopathic Medicine. Currently, as the medical director at a methadone clinic, Dr. Nasir specializes in treating patients with opioid use disorders. She founded several holistic wellbeing-focused startups, including Tripti-v, Transcendant You, and the nonprofit Pacific Oasis Foundation. Dr. Nasir’s work and links can be found at https://www.facebook.com/sarahnasirdo/
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:12):
Welcome everybody.
This is Avoiding the Addiction Affliction,brought to you by Westwords Consulting.
I'm Mike McGowan.
We've talked with quite a few medicalprofessionals on this podcast, and
every one of them who works with andaround substance use disorders came
to that work in a slightly differentway and have different perspectives.
We're gonna talk about that workand those perspectives today
(00:32):
with our guest, Dr. Sarah Nasir.
Dr. Nasir is a board certifiedaddiction medicine physician, life
coach, and entrepreneur, specializingin holistic addiction recovery,
and empowering individuals throughactionable healing strategies.
Welcome Dr. Nasir.
Thank you so much, Mike,for having me on the show.
I'm so excited to be here today.
(00:53):
Well, me too.
And part of that goes to what we weretalking about before this is putting
some of what we do into languagethat everybody can understand.
So, but start us out.
Tell, tell me how you got intoworking with addiction medicine.
'cause that's not thenorm for most physicians.
I think when life wants you to dosomething, it becomes the norm for you.
(01:13):
So my journey in addictionmedicine, I would say, looking
back, it started in medical school.
I was doing rotation and during mythird year, those are like right after
you finished the knowledge absorption.
You go and you start to rotatethrough different fields and see,
and this is before residency,so I was in rural West Virginia.
(01:36):
This is a coal mine town and therewas a lot of addiction, but at
that time I didn't know about it.
'cause you know, it's like a fresh chickcoming out of a hatching, out of an egg.
I felt like looking back,that's how I think I was.
I was just a hatchling and I was onOB rotation and my first experience,
(01:57):
I think, like officially was whenthere was this baby withdrawing
from opioids in the nursery.
The baby's mom was someone who was usingwhile she was pregnant with the baby.
And so when the baby comes outafter exposure in the womb with
exposure to opioids and other drugs.
(02:18):
The babies have withdrawalsymptom as well, and that medical
terminology for that is calledneonatal abstinence syndrome.
And just like what adults go through,babies go through it as well.
That jitteriness, discomfort,high-pitched crying.
But we weren't at that timegiving morphine to the babies.
What the nurses were doing, and Iengaged in, was basically having a hate
(02:42):
fest on the mom, which is like, howhorrible is she to do this to the baby.
Without really understanding what went on.
And I didn't know, andI trusted the nurse.
And as I was holding this screamingbaby in my hand, trying to like give
it whatever love I could, and thebaby was kept away from the mom,
which now we actually recommend thatmoms continue to breastfeed the baby.
(03:06):
Unless there's like HIV or othertransmittable disease that can be
transmitted through breast milk.
The best thing to do, once againfor mom and baby is skin to
skin and stay with each other.
We deprived that andthen keep moving forward.
In residency, I was in New York andwe were on the line, or the highway
(03:26):
that went from Mexico to Canada forfentanyl delivery system by the cartels.
As well as apparently our town was apill mill, so we had the prescribers who
would try to make the patients happy andjust give them that easy prescription
so they had a good review, et cetera.
(03:47):
And one of those doctors were actuallymy attending and thinking back, he
was a very kindhearted man, is whathe came across to me as somebody who
doesn't want to ruffle feathers or getinto a negative situation with others.
So I wonder if it kind of came fromlike a, not knowing how to say no.
(04:09):
And then, as you know, as you get morepositive reinforcement, you tend to
do more of that, whether it's rightor wrong, especially if you don't
have your own sense of conscienceof this is right or this is wrong.
So that was my experiencewith this attending.
However, when he was fired and hispatients were just like, cut off
(04:31):
the opioids and I witnessed that.
I was part of that situation whereeverybody in the program was rallying
together to give the patients a 30 dayprescription and said like, go, good luck.
Go find somebody who'sgonna take care of you.
And it was a small town once again.
So my experience in America has beenvery rural suburban, like fully urban.
(04:53):
I've been in, like, allacross 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.
'cause there was nobody else whowas taking care of that as well.
And so what happened was I wastalking with my attending after I
saw a patient with him that, here'sthis adult man who is suffering from
(05:18):
opioid addiction and he has an elderlyfather who's still worrying about him.
He's in his twenties, the gentlemanand his father's like in his
fifties, and you can see the amountof stress on the father's face.
And for me, like my personalbias came back up again.
Is that here's this dad whoshould be worrying about like,
(05:40):
you know, how to go and retire.
Instead, he's constantly checkingon his son, making sure he's not
overdosing, and it felt very selfish.
It felt very inappropriate.
It took me back to a time when my dadwould joke, I don't know if it was
joke or not, maybe he was serious.
He would be like, I'll give youguys up, but I will not stop
smoking cigarettes, you know?
(06:00):
And so we didn't like that.
And so I could see a little bit ofthat in this father son dynamics.
And so I went to my attending andI mentioned that, how horrible
is it that he's addicted?
How can somebody choosedrugs over their loved ones?
And basically passing on my prejudiceand judgment on those patients.
(06:21):
And at that time thatattending, he actually told me.
Sarah, you do realize that addictionis a disease, that it changes the body.
That maybe it might have startedout as a moment of weakness
in judgment, but over time.
(06:41):
It becomes like something that youcan't just turn the switch off on.
So you have to be kind to themand you have to nurture them.
And that just, I feel likethat was a defining moment.
When you get like hit by thunder.
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 Ifelt ashamed for these moments that
(07:06):
I've mentioned where I was engagedin looking at the patients negatively
and not being a proponent and a kindperson to them, even though they
weren't there, they weren't seeing it.
But just in my heart, the factthat I harbored those feelings
made me feel like I need to do.
I need to look into this more.
I need to reevaluate this.
(07:27):
What is it that I needto do to understand?
And so I dived a little bit moreinto it, and then I started to
find a joy for treating addiction.
Because when you're trying to take careof diabetes and high blood pressure and
obesity, and you're telling somebody stopeating sweets, go out and break a sweat.
You know, just exercise.
(07:49):
These lifestyle changes thatare not hurting them, like.
Pain is a powerful motivator.
Like it pushes you away.
Diabetes, high bloodpressure, stroke, et cetera.
These things don't start hurtingyou until it really hurts.
So it's hard for people to be like, well,I'm not seeing any issues with that.
So sometimes it feels like pullingtooth and nail in that population.
(08:11):
However, when you're taking care of apatient 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 ascuring cancer maybe, or, I don't know.
I'll let an oncologist weigh in on that...
(08:31):
(laughs)
But it feels (laughs), it feels amazing tosee somebody go from disheveled homeless.
Yep.
Without a relationship to somebodybecoming like a CEO of their own company,
having their own children, havingtheir own house, having their own car.
It's so gratifying.
(08:52):
And so that's what I do now.
That's just delightful all the way around.
But it's interesting that you justhappened 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 numberone health issue in the United States.
(09:12):
And that's addiction.
So good thing you had that person.
Yeah.
And it's funny you mentioned that becauseI think maybe now it's picking up more
of a, I feel like it has more attentionnow than just even when I started,
right when I started the, I started atime when the government was putting
(09:32):
out a little bit of money and SAMHSAwas putting out a little bit of money
to get primary care providers certifiedto prescribe buprenorphine and stuff.
And because of my residency, I knew Ihad to get in on that boat, like free
training, free certification, sign me up.
(laughs)
(laughs)
But I'm so glad they did that becauseI think it really allowed me to do
(09:54):
what they intended for us to do.
Yeah.
Because at that time I was workingin DC and I was working with the
underserved population because I workedwith National Health Service Corps.
And one of their criteria was thatafter you finish, you give service back.
And it was an honor to be able todo that, to serve, you know, that's
why we go into medicine and try tohelp people and it was a largely
(10:17):
disenfranchised black population in DC.
I didn't realize DC was gonna besuch a large black population.
I thought it was gonna be probablymajority white, just like it was in
New York or at least upstate New York.
And I got to see that systemic inequalityand the impact, the generational
impact of it firsthand and I wasgrateful to have that opportunity to
(10:42):
provide that full care in the patientswithin the time that I was able to.
That's awesome.
You've also worked with otherunserved population or underserved
populations, including Muslim women.
More so than Muslim women.
I think for me, they're everywhere.
When they see me, they come to me.
(11:03):
I think...
I bet.
The other group that reallystands out to me additionally
is the undocumented population.
Sure.
Right.
And in California, that's apopulation that I worked a lot with.
That's where you are now, right?
California?
Yes.
Yes.
I'm in California and withthe Muslim women I think this
is another, how do I say it?
(11:25):
I think it's a challenge that I'mtrying to address now in the Muslim
population, not just the Muslim women.
The concept of mental healthis very, very minimal.
People believe that depression, like evenlike in my own family growing up, right?
I'm, I'm coming from anecdotesas well as seeing around me
(11:48):
that depression doesn't exist.
If you believe in God, youshouldn't be depressed.
If you have God in your life, youshouldn't have anxiety, you know?
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 Muslimfamilies that are suffering from
(12:09):
addiction in a silent, in a silent manner.
Yeah.
I think there's so much stigma, notjust like the typical stigma I see
amongst my patients with addiction.
But particularly in the Muslim community,I haven't met too many who have come forth
to seek help, surprisingly, and maybeit's because they don't know it exists.
(12:30):
Maybe they don't know that there'ssomebody out there who understands
and can deal with it and compassion.
But I do hope that this is one categorywhere I can make a bigger impact.
It's not just the publicthat carries the stigma.
Sometimes our culture carries the stigma.
Patients carry the stigma andfamily passes the stigma on.
(12:53):
Very true.
Yeah, I have a addiction in my familyand my uncle (laughs) Sarah used
to say, well, my business McGowanAssociates, that's a law firm.
I'm like, I'm not a lawyer!
He goes, well, you could have been!
He didn't wanna tell peopleeven what I did for a living.
Right.
So interesting.
Yeah.
When you do this, you decided atsome point to branch out right?
(13:19):
And take a more holisticapproach, which is terrific 'cause
addiction affects everything.
It does.
It does.
And, you know, i'm a doctor of osteopathy.
That's another type of training you canget, or another pathway to becoming a
medically licensed doctor in the US whotakes care of humans and this medicine,
(13:44):
prescription surgery, et cetera.
The other branch is the allopathic.
That is the one that everybody knows.
That's the MD. My alphabet soupis DO, and that's for osteopathy.
So I think my foundation in osteopathyis what makes it easier for me.
(14:05):
Yeah.
And more receptive for the approachof holistic because of the four
tenets of osteopathic principle.
The big ones are for me, is that thebody is a unit of mind, body, and spirit.
And the other one is that the bodyhas the ability to heal itself.
These two are the ones that, you know,I operate on a daily basis, not just
(14:26):
in the medical aspect realm, but alsoI feel like in personal realm also.
And so in the process of workingwith patients with addiction, I've
added three more dimensions to that.
And I call this the sixdimensions of a transcendent.
And allow me to describe transcendenta little bit really quick.
Please.
So this is part of where I do mycoaching and also not just with
(14:50):
personal development, but alsowith addiction, because I think it
just captures that concept so well.
It just branches into the other aspects.
So transcendence are inspired souls.
People who are transcending theirlimits, connecting with their limitless
soul, harnessing the power of theirpurpose, and living a fulfilling
(15:14):
and thrilling life of design.
And the way to do that, the way I workwith my patients and my clients on that
is to balance their six dimensions.
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 thesedimensions are in balance, then
(15:37):
the person thrives and transcends.
And so that's how I now approach onevery aspect of when I'm interacting
with a patient or a coachee.
And I find that life, the secretof life is that everything
wants to move towards balance.
Nothing likes to be in the extreme, andthat is what's happening in our body
(16:00):
with addiction and other disease as well.
Disease happens when our bodymoves away from that homeostasis.
The balance where it is supposedto operate at the optimal range.
And whenever it's not within that setting,it starts to malfunction or dysfunction,
which goes back to the osteopathicconcept of somatic dysfunction.
(16:23):
So I feel like as I'm living life, justso many things are falling into place and
I'm just seeing things in different ways.
So that's where my concept andprinciple of making sure that we're
approaching this holistically,because as you said, addiction
is not a one dimensional disease.
You don't just throw chemicalsat it and poof, it goes away.
(16:44):
Right.
Well for those of you who listenregularly, you know that I'm gonna
put links to Dr. Nasir's informationand socials and all of her videos
online for you, and she goes into muchmore depth with all of these there.
You've talked about addressing thechemical gap, and when you're with
addiction, there is a chemical gapthat you put your own body into
(17:05):
or it is already in and you'retrying to compensate for it.
Yes.
Chemical gap is terminology that I'musing 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 startto put these external chemicals in your
(17:27):
body at a concentration that isn't normal.
And actually a lot of the opioids andalcohol and stuff that we put in our
body, these are not normal chemicals thatadd to the functionality of our body.
But our body has its own system.
And so when we put these other chemicalsin, what the body does is in order to
(17:49):
protect the person and save their life,the body starts to change how it operates.
So it moves it away fromwhere the baseline is.
So for example, when we're talkingabout opioid and someone's introducing
fentanyl, heroin, or prescriptionopioid pills for a chronic period of
time, so daily, on a regular basis fora long time, what happens is the body
(18:14):
does what I found one of three things.
Two of them are for sure, and the thirdone, I think it probably has an epigenetic
factor into it, not just a geneticexpression, but I'll get into that.
So the first one it does is itmakes less of your natural hormones.
So like the endorphins, enkephalins,it makes less of those natural hormones
(18:35):
in the first place because of thisinflux of this outside chemical.
Second thing it can do is it pulls awayreceptors where the opioids bind to, so
you're not getting stimulated as much.
So that's what builds up tolerance, whereyou need more of the fentanyl or the
heroin or the pills to get that same high.
(18:55):
And same with alcoholand other drugs as well.
And then the third thing.
Some bodies do is increase the rateat which clearance of that medicine
or chemical happens in the body.
And some people are rapid metabolizersbecause of existing genes in their body.
And the other one that I'm thinking.
(19:16):
I don't know if there's enough researchon 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.
And so that's why you can havepeople using four to five grams of
fentanyl and still walk around becausetheir body's in just hyper mode.
(19:37):
And so when the body does oneof these three things, your
body then is stuck in this.
What I like to visualize as a whole.
You know, versus somebody whohas a normal biochemistry,
they're like on flat surface.
And so when you don't have theseother external chemicals in your
body, your body has lost disabilityto climb back up to the normal level.
(20:01):
And that difference between beingon that baseline to where your
body is now is the chemical gap.
And yes, anybody can give up thesubstances, but just because a person
is ready to quit yesterday doesn'tmean that their body is at that
same stage, and this is where thatholistic approach comes in again.
(20:25):
What I tell my patients is thatyou 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 mewhat your body is telling you.
Because the signals that your bodygives you in withdrawal symptoms and
the cravings your body gives you toget yourself out of that dangerous
(20:46):
situation because this is suboptimalliving condition for your body.
These are your body'scommunication mechanism to you.
You have to tell me.
And then my experience, my expertiseis in understanding the law of how the
human body works, how these medicineswork, and how to make them work together.
(21:07):
And together we will do this treatmentprocess where we will go through
chemically stabilizing you and I'mgonna go ahead and give you the help.
If you want my coachinghelp, there's that.
And definitely include your counselor,your therapist, your other healthcare
practitioners, your family, your churchgroup, or other faith group, 12 steps.
(21:32):
Whatever it is that feeds your souland keeps propelling you forward.
You lean into that, you feed more energyinto that, and you cut ties with the
negative sources in your life, like yourdealers, like the quote unquote friends
who are trying to apparently help youby giving you pills laced with ecstasy.
(21:55):
I see so much ecstasy in my patient'surine and they don't even know
where it's coming from, right.
So those people are notreally your friends.
I don't know who needs to hear this,but (laughs) you know somebody who's
giving you something so you keep comingback to them at the cost of your life.
(22:16):
That is not a friend,that is an opportunist.
And although I like people takingadvantage of opportunities.
You have to have a limit on whoyou trust and who you don't.
Well, and you need a strong supportsystem, right, Dr. Nasir, because
sometimes those people who aren'tyour friends are also your family.
(22:37):
If you're struggling with stuff andit's your family that wants you to
continue the same behavior or give yousomething after a period of time where
you're trying to bring your life around.
Ah, we may have to make some toughchoices about who we hang around with.
Yes.
I'm so glad you bring that upbecause not only that, that they're
(22:59):
enabling you in disabling you, butalso sometimes family ends up being
the first source of the trauma.
Yep.
That pushes one into, this abyss.
And it might be becausethat's what they grew up with.
(23:19):
They just never learned how to stopthe cycle of destruction because
they grew up seeing trauma in theirhouse and that's how they saw the
adults in their lives cope with theirinability to change their condition.
You know, versus, there's a lot ofrape stories in my patient population.
(23:41):
So somebody abusing the right, thesanctity and the shame and the frustration
that comes from being a kid and not beingable to protect yourself when somebody
that should have been protecting you.
So there's a lot of trigger in that.
So no, you can't do it alone.
Are you worried at all about the funding,slashing, the difficulty in accessing
(24:07):
help, the number of resources available.
You mentioned a couple of programsthat you had access to early in
your professional career thathave taken hits financially.
Yeah, definitely.
I think we use the public fund inthings that should not be used and we
(24:29):
don't allocate the funds to resourceswhere they actually need to go.
There's definitely, thatis, how do I say it?
That is a dilemma and a harm of oursociety that we are not bolstering
ourselves in the foundation.
(24:51):
And so whenever you have a weak foundationand you try to raise whatever our
politicians are trying to do making ourcountry look great and stuff, but if
you do it in the process of just harmingyourself, 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
(25:20):
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 showingup and doing what we need to do?
(25:41):
I don't think so.
We're gonna keep doing.
Yeah.
And I've heard you talk about thetime it takes to actually listen
to the patient, to your clients.
That's critical in making sure thatyou're addressing their whole self.
It is, and I think it's more of amedical system problem rather than just
(26:06):
the government problem (laughs) wherepeople who don't work behind closed
doors are the ones who are makingthe calls of how the flow happens.
And so what I found, and one of themost frustrating things for me has been.
Until recently, I think I'm finally at ajob that I just absolutely love and adore.
(26:27):
It allows me to do all theseother 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 forcebenefit on anybody, right?
(laughs)
So, in the past, my frustrationwas that the triaging, the time
(26:51):
allocation, the burden of work wasjust so disproportionately allocated.
And then the compensation, I guessthat's where the government and
insurance stuff comes in, is thatthey're also the folks who are not
actually seeing what's happening.
They're not in the trenches.
And so, (laughs) you know, theexpectations are unrealistic.
(27:14):
Things that even they couldn't doif they had our training and, you
know, intellectual capacity andto be able to do what we do, they
would go home frustrated and crying.
I mean, there have been timeswhen I'm like, I need a manager.
Where are they?
It's 4:00 PM.
Oh, they went home.
I mean, I mean, the day ends at 5:00 PMthey come in at 9:00 AM they're gone at
(27:37):
4:00 PM and our day started at like sevenor 8:00 AM and then the, we're not done
until the patient is served and gone.
And sometimes that meant that I wasthe only one there with other doctors.
MA's gone.
The security's coming and checking,doc, how much longer are you gonna take?
Because they gotta close up.
(27:57):
(laughs) And I'm like.
You know, so there's, thereare those frustrating things.
Who's gonna deal with it?
It has to be doctors.
I think we have to be the ones who endup empowering ourselves to take ownership
of the leadership that is put on us.
I think at this point we have becomevery docile very, what do you call it?
(28:20):
Just like.
Just, what is it?
Very robotic.
The humanity gets taken out of us.
It's like just follow order and then ifsomebody needs to be called to the court
to be half off with their heads, it endsup being the doctor, which kind of reminds
me of that attending I was talking aboutinitially, the one who was the pill mill.
Right.
(28:41):
You know, I don't know if he hadaccess to adequate support, that
I, I can't imagine what type of.
What the aftermath of what hewent through could have been.
Because if that happened tome, I would be devastated.
Mm-hmm.
I would be devastated to be labeledthat and ostracized and just be banned
(29:01):
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.
You know, here's a fine and justleave state and uproot and go
see where you can feed yourself.
So yeah, I, I think, anyways, Ithink that can, we can keep going
(29:22):
on that for maybe what's wrong.
(laughs)
Yeah.
I was just thinking as you weredoing that, that was so articulate,
I was thinking we should just doanother half an hour sometime on.
On that topic alone, because we'reat that place when we're slashing.
I'm looking out, my window over hereis looking out over my backyard where I
had somebody trim the trees last summer.
(29:43):
I have no expertise in how to trim thetrees, but they didn't just lop 'em down.
They took the time to cut thebranches that were not healthy away.
And now that spring is here as they'regrowing back, they look spectacular.
And that's maybe a decent metaphorfor what we're talking about.
(30:04):
Yeah, that pruning, that guidance, that'swhat 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 wouldbe evidence-based because now I feel
like I'm just going into opinion.
(laughs)
Well, that's okay.
This is a podcast.
We don't always have to be evidence-basedbecause I think a lot of the anecdotal
(30:26):
stuff is where we're at, where people are,these are real issues for real people.
Yeah.
For those of you listening...
We forget that we are real people.
(laughs)
Yeah.
Right.
Yeah.
We're not just innumbers somewhere, right.
Dr. Nasir and I were talking listenersbefore we started about all of
this, and she made the comment, Ijust need to find a place some more
(30:48):
people can hear this stuff in a waythat they can hear it, and I think
you've gone a long way in doing that.
I would encourage all of you to followthe link that I'm gonna put on the end
of this podcast where she has otherpodcasts that she's been a part of.
Her own stuff where she finally learnsto hit the on button as well as some
of the visuals she was talking about.
(31:10):
Dr. Nasir, thank you for yourdedication, but also for your
risk taking and for your work.
I really appreciate it.
Appreciate you being here.
Thank you.
For those of you listening, Ihope you find hope, courage,
support, wherever you are.
Thanks for listening.
Be safe and keep going and keep listening.
Welcome everybody.
This is Avoiding the Addiction Affliction,brought to you by Westwords Consulting.
I'm Mike McGowan.
We've talked with quite a few medicalprofessionals on this podcast, and
every one of them who works with andaround substance use disorders came
to that work in a slightly differentway and have different perspectives.
We're gonna talk about that workand those perspectives today
(00:32):
with our guest, Dr. Sarah Nasir.
Dr. Nasir is a board certifiedaddiction medicine physician, life
coach, and entrepreneur, specializingin holistic addiction recovery,
and empowering individuals throughactionable healing strategies.
Welcome Dr. Nasir.
Thank you so much, Mike,for having me on the show.
I'm so excited to be here today.
(00:53):
Well, me too.
And part of that goes to what we weretalking about before this is putting
some of what we do into languagethat everybody can understand.
So, but start us out.
Tell, tell me how you got intoworking with addiction medicine.
'cause that's not thenorm for most physicians.
I think when life wants you to dosomething, it becomes the norm for you.
(01:13):
So my journey in addictionmedicine, I would say, looking
back, it started in medical school.
I was doing rotation and during mythird year, those are like right after
you finished the knowledge absorption.
You go and you start to rotatethrough different fields and see,
and this is before residency,so I was in rural West Virginia.
(01:36):
This is a coal mine town and therewas a lot of addiction, but at
that time I didn't know about it.
'cause you know, it's like a fresh chickcoming out of a hatching, out of an egg.
I felt like looking back,that's how I think I was.
I was just a hatchling and I was onOB rotation and my first experience,
(01:57):
I think, like officially was whenthere was this baby withdrawing
from opioids in the nursery.
The baby's mom was someone who was usingwhile she was pregnant with the baby.
And so when the baby comes outafter exposure in the womb with
exposure to opioids and other drugs.
(02:18):
The babies have withdrawalsymptom as well, and that medical
terminology for that is calledneonatal abstinence syndrome.
And just like what adults go through,babies go through it as well.
That jitteriness, discomfort,high-pitched crying.
But we weren't at that timegiving morphine to the babies.
What the nurses were doing, and Iengaged in, was basically having a hate
(02:42):
fest on the mom, which is like, howhorrible is she to do this to the baby.
Without really understanding what went on.
And I didn't know, andI trusted the nurse.
And as I was holding this screamingbaby in my hand, trying to like give
it whatever love I could, and thebaby was kept away from the mom,
which now we actually recommend thatmoms continue to breastfeed the baby.
(03:06):
Unless there's like HIV or othertransmittable disease that can be
transmitted through breast milk.
The best thing to do, once againfor mom and baby is skin to
skin and stay with each other.
We deprived that andthen keep moving forward.
In residency, I was in New York andwe were on the line, or the highway
(03:26):
that went from Mexico to Canada forfentanyl delivery system by the cartels.
As well as apparently our town was apill mill, so we had the prescribers who
would try to make the patients happy andjust give them that easy prescription
so they had a good review, et cetera.
(03:47):
And one of those doctors were actuallymy attending and thinking back, he
was a very kindhearted man, is whathe came across to me as somebody who
doesn't want to ruffle feathers or getinto a negative situation with others.
So I wonder if it kind of came fromlike a, not knowing how to say no.
(04:09):
And then, as you know, as you get morepositive reinforcement, you tend to
do more of that, whether it's rightor wrong, especially if you don't
have your own sense of conscienceof this is right or this is wrong.
So that was my experiencewith this attending.
However, when he was fired and hispatients were just like, cut off
(04:31):
the opioids and I witnessed that.
I was part of that situation whereeverybody in the program was rallying
together to give the patients a 30 dayprescription and said like, go, good luck.
Go find somebody who'sgonna take care of you.
And it was a small town once again.
So my experience in America has beenvery rural suburban, like fully urban.
(04:53):
I've been in, like, allacross 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.
'cause there was nobody else whowas taking care of that as well.
And so what happened was I wastalking with my attending after I
saw a patient with him that, here'sthis adult man who is suffering from
(05:18):
opioid addiction and he has an elderlyfather who's still worrying about him.
He's in his twenties, the gentlemanand his father's like in his
fifties, and you can see the amountof stress on the father's face.
And for me, like my personalbias came back up again.
Is that here's this dad whoshould be worrying about like,
(05:40):
you know, how to go and retire.
Instead, he's constantly checkingon his son, making sure he's not
overdosing, and it felt very selfish.
It felt very inappropriate.
It took me back to a time when my dadwould joke, I don't know if it was
joke or not, maybe he was serious.
He would be like, I'll give youguys up, but I will not stop
smoking cigarettes, you know?
(06:00):
And so we didn't like that.
And so I could see a little bit ofthat in this father son dynamics.
And so I went to my attending andI mentioned that, how horrible
is it that he's addicted?
How can somebody choosedrugs over their loved ones?
And basically passing on my prejudiceand judgment on those patients.
(06:21):
And at that time thatattending, he actually told me.
Sarah, you do realize that addictionis a disease, that it changes the body.
That maybe it might have startedout as a moment of weakness
in judgment, but over time.
(06:41):
It becomes like something that youcan't just turn the switch off on.
So you have to be kind to themand you have to nurture them.
And that just, I feel likethat was a defining moment.
When you get like hit by thunder.
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 Ifelt ashamed for these moments that
(07:06):
I've mentioned where I was engagedin looking at the patients negatively
and not being a proponent and a kindperson to them, even though they
weren't there, they weren't seeing it.
But just in my heart, the factthat I harbored those feelings
made me feel like I need to do.
I need to look into this more.
I need to reevaluate this.
(07:27):
What is it that I needto do to understand?
And so I dived a little bit moreinto it, and then I started to
find a joy for treating addiction.
Because when you're trying to take careof diabetes and high blood pressure and
obesity, and you're telling somebody stopeating sweets, go out and break a sweat.
You know, just exercise.
(07:49):
These lifestyle changes thatare not hurting them, like.
Pain is a powerful motivator.
Like it pushes you away.
Diabetes, high bloodpressure, stroke, et cetera.
These things don't start hurtingyou until it really hurts.
So it's hard for people to be like, well,I'm not seeing any issues with that.
So sometimes it feels like pullingtooth and nail in that population.
(08:11):
However, when you're taking care of apatient 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 ascuring cancer maybe, or, I don't know.
I'll let an oncologist weigh in on that...
(08:31):
(laughs)
But it feels (laughs), it feels amazing tosee somebody go from disheveled homeless.
Yep.
Without a relationship to somebodybecoming like a CEO of their own company,
having their own children, havingtheir own house, having their own car.
It's so gratifying.
(08:52):
And so that's what I do now.
That's just delightful all the way around.
But it's interesting that you justhappened 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 numberone health issue in the United States.
(09:12):
And that's addiction.
So good thing you had that person.
Yeah.
And it's funny you mentioned that becauseI think maybe now it's picking up more
of a, I feel like it has more attentionnow than just even when I started,
right when I started the, I started atime when the government was putting
(09:32):
out a little bit of money and SAMHSAwas putting out a little bit of money
to get primary care providers certifiedto prescribe buprenorphine and stuff.
And because of my residency, I knew Ihad to get in on that boat, like free
training, free certification, sign me up.
(laughs)
(laughs)
But I'm so glad they did that becauseI think it really allowed me to do
(09:54):
what they intended for us to do.
Yeah.
Because at that time I was workingin DC and I was working with the
underserved population because I workedwith National Health Service Corps.
And one of their criteria was thatafter you finish, you give service back.
And it was an honor to be able todo that, to serve, you know, that's
why we go into medicine and try tohelp people and it was a largely
(10:17):
disenfranchised black population in DC.
I didn't realize DC was gonna besuch a large black population.
I thought it was gonna be probablymajority white, just like it was in
New York or at least upstate New York.
And I got to see that systemic inequalityand the impact, the generational
impact of it firsthand and I wasgrateful to have that opportunity to
(10:42):
provide that full care in the patientswithin the time that I was able to.
That's awesome.
You've also worked with otherunserved population or underserved
populations, including Muslim women.
More so than Muslim women.
I think for me, they're everywhere.
When they see me, they come to me.
(11:03):
I think...
I bet.
The other group that reallystands out to me additionally
is the undocumented population.
Sure.
Right.
And in California, that's apopulation that I worked a lot with.
That's where you are now, right?
California?
Yes.
Yes.
I'm in California and withthe Muslim women I think this
is another, how do I say it?
(11:25):
I think it's a challenge that I'mtrying to address now in the Muslim
population, not just the Muslim women.
The concept of mental healthis very, very minimal.
People believe that depression, like evenlike in my own family growing up, right?
I'm, I'm coming from anecdotesas well as seeing around me
(11:48):
that depression doesn't exist.
If you believe in God, youshouldn't be depressed.
If you have God in your life, youshouldn't have anxiety, you know?
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 Muslimfamilies that are suffering from
(12:09):
addiction in a silent, in a silent manner.
Yeah.
I think there's so much stigma, notjust like the typical stigma I see
amongst my patients with addiction.
But particularly in the Muslim community,I haven't met too many who have come forth
to seek help, surprisingly, and maybeit's because they don't know it exists.
(12:30):
Maybe they don't know that there'ssomebody out there who understands
and can deal with it and compassion.
But I do hope that this is one categorywhere I can make a bigger impact.
It's not just the publicthat carries the stigma.
Sometimes our culture carries the stigma.
Patients carry the stigma andfamily passes the stigma on.
(12:53):
Very true.
Yeah, I have a addiction in my familyand my uncle (laughs) Sarah used
to say, well, my business McGowanAssociates, that's a law firm.
I'm like, I'm not a lawyer!
He goes, well, you could have been!
He didn't wanna tell peopleeven what I did for a living.
Right.
So interesting.
Yeah.
When you do this, you decided atsome point to branch out right?
(13:19):
And take a more holisticapproach, which is terrific 'cause
addiction affects everything.
It does.
It does.
And, you know, i'm a doctor of osteopathy.
That's another type of training you canget, or another pathway to becoming a
medically licensed doctor in the US whotakes care of humans and this medicine,
(13:44):
prescription surgery, et cetera.
The other branch is the allopathic.
That is the one that everybody knows.
That's the MD. My alphabet soupis DO, and that's for osteopathy.
So I think my foundation in osteopathyis what makes it easier for me.
(14:05):
Yeah.
And more receptive for the approachof holistic because of the four
tenets of osteopathic principle.
The big ones are for me, is that thebody is a unit of mind, body, and spirit.
And the other one is that the bodyhas the ability to heal itself.
These two are the ones that, you know,I operate on a daily basis, not just
(14:26):
in the medical aspect realm, but alsoI feel like in personal realm also.
And so in the process of workingwith patients with addiction, I've
added three more dimensions to that.
And I call this the sixdimensions of a transcendent.
And allow me to describe transcendenta little bit really quick.
Please.
So this is part of where I do mycoaching and also not just with
(14:50):
personal development, but alsowith addiction, because I think it
just captures that concept so well.
It just branches into the other aspects.
So transcendence are inspired souls.
People who are transcending theirlimits, connecting with their limitless
soul, harnessing the power of theirpurpose, and living a fulfilling
(15:14):
and thrilling life of design.
And the way to do that, the way I workwith my patients and my clients on that
is to balance their six dimensions.
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 thesedimensions are in balance, then
(15:37):
the person thrives and transcends.
And so that's how I now approach onevery aspect of when I'm interacting
with a patient or a coachee.
And I find that life, the secretof life is that everything
wants to move towards balance.
Nothing likes to be in the extreme, andthat is what's happening in our body
(16:00):
with addiction and other disease as well.
Disease happens when our bodymoves away from that homeostasis.
The balance where it is supposedto operate at the optimal range.
And whenever it's not within that setting,it starts to malfunction or dysfunction,
which goes back to the osteopathicconcept of somatic dysfunction.
(16:23):
So I feel like as I'm living life, justso many things are falling into place and
I'm just seeing things in different ways.
So that's where my concept andprinciple of making sure that we're
approaching this holistically,because as you said, addiction
is not a one dimensional disease.
You don't just throw chemicalsat it and poof, it goes away.
(16:44):
Right.
Well for those of you who listenregularly, you know that I'm gonna
put links to Dr. Nasir's informationand socials and all of her videos
online for you, and she goes into muchmore depth with all of these there.
You've talked about addressing thechemical gap, and when you're with
addiction, there is a chemical gapthat you put your own body into
(17:05):
or it is already in and you'retrying to compensate for it.
Yes.
Chemical gap is terminology that I'musing 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 startto put these external chemicals in your
(17:27):
body at a concentration that isn't normal.
And actually a lot of the opioids andalcohol and stuff that we put in our
body, these are not normal chemicals thatadd to the functionality of our body.
But our body has its own system.
And so when we put these other chemicalsin, what the body does is in order to
(17:49):
protect the person and save their life,the body starts to change how it operates.
So it moves it away fromwhere the baseline is.
So for example, when we're talkingabout opioid and someone's introducing
fentanyl, heroin, or prescriptionopioid pills for a chronic period of
time, so daily, on a regular basis fora long time, what happens is the body
(18:14):
does what I found one of three things.
Two of them are for sure, and the thirdone, I think it probably has an epigenetic
factor into it, not just a geneticexpression, but I'll get into that.
So the first one it does is itmakes less of your natural hormones.
So like the endorphins, enkephalins,it makes less of those natural hormones
(18:35):
in the first place because of thisinflux of this outside chemical.
Second thing it can do is it pulls awayreceptors where the opioids bind to, so
you're not getting stimulated as much.
So that's what builds up tolerance, whereyou need more of the fentanyl or the
heroin or the pills to get that same high.
(18:55):
And same with alcoholand other drugs as well.
And then the third thing.
Some bodies do is increase the rateat which clearance of that medicine
or chemical happens in the body.
And some people are rapid metabolizersbecause of existing genes in their body.
And the other one that I'm thinking.
(19:16):
I don't know if there's enough researchon 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.
And so that's why you can havepeople using four to five grams of
fentanyl and still walk around becausetheir body's in just hyper mode.
(19:37):
And so when the body does oneof these three things, your
body then is stuck in this.
What I like to visualize as a whole.
You know, versus somebody whohas a normal biochemistry,
they're like on flat surface.
And so when you don't have theseother external chemicals in your
body, your body has lost disabilityto climb back up to the normal level.
(20:01):
And that difference between beingon that baseline to where your
body is now is the chemical gap.
And yes, anybody can give up thesubstances, but just because a person
is ready to quit yesterday doesn'tmean that their body is at that
same stage, and this is where thatholistic approach comes in again.
(20:25):
What I tell my patients is thatyou 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 mewhat your body is telling you.
Because the signals that your bodygives you in withdrawal symptoms and
the cravings your body gives you toget yourself out of that dangerous
(20:46):
situation because this is suboptimalliving condition for your body.
These are your body'scommunication mechanism to you.
You have to tell me.
And then my experience, my expertiseis in understanding the law of how the
human body works, how these medicineswork, and how to make them work together.
(21:07):
And together we will do this treatmentprocess where we will go through
chemically stabilizing you and I'mgonna go ahead and give you the help.
If you want my coachinghelp, there's that.
And definitely include your counselor,your therapist, your other healthcare
practitioners, your family, your churchgroup, or other faith group, 12 steps.
(21:32):
Whatever it is that feeds your souland keeps propelling you forward.
You lean into that, you feed more energyinto that, and you cut ties with the
negative sources in your life, like yourdealers, like the quote unquote friends
who are trying to apparently help youby giving you pills laced with ecstasy.
(21:55):
I see so much ecstasy in my patient'surine and they don't even know
where it's coming from, right.
So those people are notreally your friends.
I don't know who needs to hear this,but (laughs) you know somebody who's
giving you something so you keep comingback to them at the cost of your life.
(22:16):
That is not a friend,that is an opportunist.
And although I like people takingadvantage of opportunities.
You have to have a limit on whoyou trust and who you don't.
Well, and you need a strong supportsystem, right, Dr. Nasir, because
sometimes those people who aren'tyour friends are also your family.
(22:37):
If you're struggling with stuff andit's your family that wants you to
continue the same behavior or give yousomething after a period of time where
you're trying to bring your life around.
Ah, we may have to make some toughchoices about who we hang around with.
Yes.
I'm so glad you bring that upbecause not only that, that they're
(22:59):
enabling you in disabling you, butalso sometimes family ends up being
the first source of the trauma.
Yep.
That pushes one into, this abyss.
And it might be becausethat's what they grew up with.
(23:19):
They just never learned how to stopthe cycle of destruction because
they grew up seeing trauma in theirhouse and that's how they saw the
adults in their lives cope with theirinability to change their condition.
You know, versus, there's a lot ofrape stories in my patient population.
(23:41):
So somebody abusing the right, thesanctity and the shame and the frustration
that comes from being a kid and not beingable to protect yourself when somebody
that should have been protecting you.
So there's a lot of trigger in that.
So no, you can't do it alone.
Are you worried at all about the funding,slashing, the difficulty in accessing
(24:07):
help, the number of resources available.
You mentioned a couple of programsthat you had access to early in
your professional career thathave taken hits financially.
Yeah, definitely.
I think we use the public fund inthings that should not be used and we
(24:29):
don't allocate the funds to resourceswhere they actually need to go.
There's definitely, thatis, how do I say it?
That is a dilemma and a harm of oursociety that we are not bolstering
ourselves in the foundation.
(24:51):
And so whenever you have a weak foundationand you try to raise whatever our
politicians are trying to do making ourcountry look great and stuff, but if
you do it in the process of just harmingyourself, 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
(25:20):
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 showingup and doing what we need to do?
(25:41):
I don't think so.
We're gonna keep doing.
Yeah.
And I've heard you talk about thetime it takes to actually listen
to the patient, to your clients.
That's critical in making sure thatyou're addressing their whole self.
It is, and I think it's more of amedical system problem rather than just
(26:06):
the government problem (laughs) wherepeople who don't work behind closed
doors are the ones who are makingthe calls of how the flow happens.
And so what I found, and one of themost frustrating things for me has been.
Until recently, I think I'm finally at ajob that I just absolutely love and adore.
(26:27):
It allows me to do all theseother 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 forcebenefit on anybody, right?
(laughs)
So, in the past, my frustrationwas that the triaging, the time
(26:51):
allocation, the burden of work wasjust so disproportionately allocated.
And then the compensation, I guessthat's where the government and
insurance stuff comes in, is thatthey're also the folks who are not
actually seeing what's happening.
They're not in the trenches.
And so, (laughs) you know, theexpectations are unrealistic.
(27:14):
Things that even they couldn't doif they had our training and, you
know, intellectual capacity andto be able to do what we do, they
would go home frustrated and crying.
I mean, there have been timeswhen I'm like, I need a manager.
Where are they?
It's 4:00 PM.
Oh, they went home.
I mean, I mean, the day ends at 5:00 PMthey come in at 9:00 AM they're gone at
(27:37):
4:00 PM and our day started at like sevenor 8:00 AM and then the, we're not done
until the patient is served and gone.
And sometimes that meant that I wasthe only one there with other doctors.
MA's gone.
The security's coming and checking,doc, how much longer are you gonna take?
Because they gotta close up.
(27:57):
(laughs) And I'm like.
You know, so there's, thereare those frustrating things.
Who's gonna deal with it?
It has to be doctors.
I think we have to be the ones who endup empowering ourselves to take ownership
of the leadership that is put on us.
I think at this point we have becomevery docile very, what do you call it?
(28:20):
Just like.
Just, what is it?
Very robotic.
The humanity gets taken out of us.
It's like just follow order and then ifsomebody needs to be called to the court
to be half off with their heads, it endsup being the doctor, which kind of reminds
me of that attending I was talking aboutinitially, the one who was the pill mill.
Right.
(28:41):
You know, I don't know if he hadaccess to adequate support, that
I, I can't imagine what type of.
What the aftermath of what hewent through could have been.
Because if that happened tome, I would be devastated.
Mm-hmm.
I would be devastated to be labeledthat and ostracized and just be banned
(29:01):
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.
You know, here's a fine and justleave state and uproot and go
see where you can feed yourself.
So yeah, I, I think, anyways, Ithink that can, we can keep going
(29:22):
on that for maybe what's wrong.
(laughs)
Yeah.
I was just thinking as you weredoing that, that was so articulate,
I was thinking we should just doanother half an hour sometime on.
On that topic alone, because we'reat that place when we're slashing.
I'm looking out, my window over hereis looking out over my backyard where I
had somebody trim the trees last summer.
(29:43):
I have no expertise in how to trim thetrees, but they didn't just lop 'em down.
They took the time to cut thebranches that were not healthy away.
And now that spring is here as they'regrowing back, they look spectacular.
And that's maybe a decent metaphorfor what we're talking about.
(30:04):
Yeah, that pruning, that guidance, that'swhat 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 wouldbe evidence-based because now I feel
like I'm just going into opinion.
(laughs)
Well, that's okay.
This is a podcast.
We don't always have to be evidence-basedbecause I think a lot of the anecdotal
(30:26):
stuff is where we're at, where people are,these are real issues for real people.
Yeah.
For those of you listening...
We forget that we are real people.
(laughs)
Yeah.
Right.
Yeah.
We're not just innumbers somewhere, right.
Dr. Nasir and I were talking listenersbefore we started about all of
this, and she made the comment, Ijust need to find a place some more
(30:48):
people can hear this stuff in a waythat they can hear it, and I think
you've gone a long way in doing that.
I would encourage all of you to followthe link that I'm gonna put on the end
of this podcast where she has otherpodcasts that she's been a part of.
Her own stuff where she finally learnsto hit the on button as well as some
of the visuals she was talking about.
(31:10):
Dr. Nasir, thank you for yourdedication, but also for your
risk taking and for your work.
I really appreciate it.
Appreciate you being here.
Thank you.
For those of you listening, Ihope you find hope, courage,
support, wherever you are.
Thanks for listening.
Be safe and keep going and keep listening.
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