December 19, 2025 • 28 mins
Dr. Smita Das is a board-certified psychiatrist specializing in addiction psychiatry and addiction medicine, and Clinical Associate Professor of Psychiatry and Behavioral Sciences at Stanford.
With over 20 years of experience in clinical care, research, and leadership—including her role as VP of Psychiatry & Complex Care at Lyra Health—she’s known for bringing nuance and compassion to how we talk about trauma and addiction.
What sets her apart is how she addresses overlooked trauma, especially among high-functioning populations. She’s been a leading voice in reframing motherhood—not just as joy, but as a potential mental health breaking point. Dr. Das explores how sleep deprivation, identity rupture, hormonal shifts, and the invisibility of caregiving pain can mirror complex trauma, challenging the notion that maternal crises are rare.
In This Episode
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With over 20 years of experience in clinical care, research, and leadership—including her role as VP of Psychiatry & Complex Care at Lyra Health—she’s known for bringing nuance and compassion to how we talk about trauma and addiction.
What sets her apart is how she addresses overlooked trauma, especially among high-functioning populations. She’s been a leading voice in reframing motherhood—not just as joy, but as a potential mental health breaking point. Dr. Das explores how sleep deprivation, identity rupture, hormonal shifts, and the invisibility of caregiving pain can mirror complex trauma, challenging the notion that maternal crises are rare.
In This Episode
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-trauma-therapist--5739761/support.
You can learn more about what I do here:
The Trauma Therapist Newsletter: celebrates the people and voices in the mental health profession. And it's free! Check it out here: https://bit.ly/4jGBeSa
———
If you’d like to support The Trauma Therapist Podcast and the work I do you can do that here with a monthly donation of $5, $7, or $10: Donate to The Trauma Therapist Podcast.
Click here to join my email list and receive podcast updates and other news.
Thank you to our Sponsors:
Incogni - Use code [traumatherapist] and get 60% off annual plans: https://incogni.com/traumatherapist
Jane App - use code GUY1MO at https://jane.app/book_a_demo
Journey Clinical - visit https://join.journeyclinical/trauma for 1 month off your membership
Therapy Wisdom - https://therapywisdom.com/jan/
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the Trauma Theriver's podcast. My name is Gamiferson
and I interview incredible people who share the story of
how trauma has shaped their lives. And a big thank
you for sponsoring today's episode goes to my guest and
our sponsors. So five, four, three, two and one, our folks,
(00:24):
welcome back to the podcast. Very excited to have with
my guest today, Doctor Smita Das Smita, Welcome.
Speaker 2 (00:30):
Thank you so much for having me today.
Speaker 1 (00:33):
Doctor Smita is a board certified psychiatrist specializing in addiction
psychiatry and addiction medicine, and clinical Associate Professor of Psychiatry
and Behavioral Sciences at Stanford with over twenty years of
experience in clinical care, research, and leadership, including her role
as VP of Psychiatry and Complex Care at LIRA Health.
She's known for bringing nuance and compassion to how we
(00:56):
talk about trauma and addiction. What sets her apart is
how she addresses overlooked trauma, especially among high functioning populations.
She's been leading voice and reframing motherhood not just as joy,
but as potential mental health breaking point. Doctor Dos explores
how sleep deprivation identity rupture, promoto shifts, and the invisibility
(01:16):
of caregiving pain can mirror complex trauma, challenging the notion
that maternal crises are rare. All right, Samita, just a
little bit about you, obviously, but before you go and
share with the listeners where you're from originally and where
you are currently.
Speaker 2 (01:35):
That's a great question.
Speaker 3 (01:37):
I am somebody who originally came from a background of
wanting to just do research in the area of public health,
and where I've ended up is in being a psychiatrist,
an addiction psychiatrist who actually works with very complex populations.
(01:59):
And I think that journey was very much influenced by
the people and the stories that I learned about along
the way. During my research journey, it just became so
clear that that this was an area that's underserved and
uh and really needs needs more hands on deck.
Speaker 1 (02:18):
Okay, where are you from originally?
Speaker 3 (02:22):
I'm sorry, I'm from I'm from San Jose, California. I'm
from the California base.
Speaker 1 (02:27):
Okay, yeah, okay, and you're still there. I'm guessing around there.
Speaker 3 (02:31):
I actually I I went around the country for my
education and training, and then I ended up back here.
Speaker 2 (02:36):
It's hard to it's hard to leave this place.
Speaker 1 (02:41):
Yes, I know very well, all too well. All right,
so you said you started out interested in public health.
What as a young kid that happens or what?
Speaker 2 (02:55):
That's a good question.
Speaker 3 (02:56):
Actually, the funny thing is, I so I went to schools.
I was just having this conversation with some parent friends
at my daughter's school, and because we were all local,
we were comparing notes about about high schools and who
went where, and I think I firmly established that I
(03:17):
probably went to one of the more troubled high schools
in East San Jose.
Speaker 2 (03:23):
And there, in part.
Speaker 3 (03:26):
Because we we were a high school that had a
lot of at risk students, there was a lot of
interest in helping the students there. And so for example,
Stanford University would come and do our local local university
would come and do research studies with our student populations.
Speaker 2 (03:45):
And so one of.
Speaker 3 (03:46):
Them was to help prevent at you know, students in
high schools that are are traditionally underserved and at risk
not go down paths so for example, addiction and and
gain violence, A lot of things that were present present
at my high school. So as part of one of
those studies, I joined as a student participant, and our
(04:08):
task was to look at tobacco and tobacco anything having
to do with tobacco, and so we actually the students
as part of this project.
Speaker 2 (04:18):
Again, it really wasn't for the content.
Speaker 3 (04:19):
It was more to get us going in a in
a very positive direction and be a positive influence for
our school. We studied how much retailers in the San
Jose San Jose area were advertising tobacco and alcohol illegally
to minors, and then put together a study and then
went to San Jose City Council.
Speaker 2 (04:39):
And presented the results.
Speaker 3 (04:41):
And so actually, yeah, kind of as a kid, I
was introduced to the area of public health, and many
years later I got to actually meet the lead researcher
at Stanford who who had done that research study when
I was.
Speaker 2 (04:56):
Coo, when I was just a kid.
Speaker 1 (04:58):
Oh cool, So you're impacted by this? You what? What?
What does the path look like? You go? You go
to Stanford? Did you get?
Speaker 2 (05:09):
I ended up going to Stanford for college.
Speaker 3 (05:12):
Uh, and then I am actually to to just make
some money on the side as a student going to a.
Speaker 2 (05:19):
Very expensive private school.
Speaker 3 (05:21):
I joined as a research a research assistant in a lab.
But this lab happened to be led by doctor C.
Bar Taylor Emeritus, who's now passed away, but he was
a leading researcher in behavioral treatments for for all sorts
of things, so everything from using cognitive behavioral therapy to
(05:44):
treat smoking use tobacco use disorder, to how to use
behavioral treatments to treat people who are in cancer or
cardiovascular UH programs. And then he also was doing some
research on UH digital treatment. So using technologies is in
early two thousands, if I'm going to date myself looking
(06:05):
at digital treatments for high school students on eating disorders.
And so I just happened to work start working there
and then found a love for this type of research
and statistics, and then that led me to go to
graduate school and then eventually to go to medical school.
Speaker 1 (06:25):
And how did your interest in addiction come about? That
and more specifically and more specifically psychiatry.
Speaker 3 (06:36):
Yeah, so I was definitely going down this path of
One of the main studies that I was working on
had to do with doing an intervention with people who
were smoking and hospitalized. And what I didn't know at
the time is that I was actually delivering cognitive behavioral therapy,
one of the gold standard treatments in psychiatry and psychology,
(07:00):
to people at the bedside to help them quit smoking.
And I was sure that you know, this population people
with cardiac disease and lung diseases, that that was the
path that I was going to go down. But then
I realized the common thread between all of them was
one that this is an addiction that they're struggling with
(07:21):
that's probably impacting their life more than anything else. And
then two that behavioral treatments were really effective, and so
could we could look at the leading preventable cause of
death in this country, which is tobacco use disorder, and
we could work with it with a behavioral intervention. And
that was really eye opening that, you know, I could
(07:45):
sit there and study a lot, and I still had
to study a lot to end up becoming a physician,
but go down a path of looking at disease processes
when the answer is actually already there in front of
me that these behavioral interventions are very very effective.
Speaker 1 (08:04):
Does your or did your belief a utilization of these
behavioral interventions? Does that presuppose that you had a feeling
one way or the other in terms of the disease
model or you know, another model for addiction.
Speaker 3 (08:27):
I interestingly have always had a viewpoint on addiction being
a disease model, and it's probably just because I got
introduced to addiction through kind of experts who who really
dive into evidence based.
Speaker 2 (08:44):
Theories and ideas, and so the.
Speaker 3 (08:46):
Idea that that addiction is a brain disease, as a
National Institute of Drug Abuse helps us learn about through
their resources, That's that's been with me for a very
long time. It's not a choice, a moral failing. It
is a brain disease and we need to treat it
as such and give it the same importance as well
(09:08):
as parity with treatments and access as we give to
any medical condition.
Speaker 1 (09:17):
So in the bio, I think we talked about your
focus on what challenged, challenging populations or difficult populations. What
does that mean to you? How do you define that
and why that population?
Speaker 2 (09:35):
It's a really great question. So I think we're coming.
Speaker 3 (09:39):
We've come a long way, especially through the pandemic, in
terms of reaching people with a lot of general mental
health needs, things like anxiety and depression of more of
a mild moderate.
Speaker 2 (09:52):
Sort of nature.
Speaker 3 (09:53):
I think where we're failing still in mental health and
as a system has to do with people who are
struggling with more than that. Maybe it is anxiety and depression,
but it's also a level of severity that may be
considered more treatment resistant, or they're struggling with with those
(10:16):
plus a substance use disorder which can't be treated independently
and you can't do one and then the other, you need.
Speaker 2 (10:22):
To really do both.
Speaker 3 (10:24):
Or they're struggling with with trauma and another one of
these diagnoses, or they are social circumstances that really make
it hard for them to engage in care. And so
for these populations, oftentimes the one who ones who are
who are having to manage complex conditions there there there
(10:44):
haven't been great solutions in public health to date, and
so that was those These are the individuals, the patients
that I see that that come into my office and
and are trying everything, or or the ones that aren't
even able to make it into my office because the
complexity of what they're dealing with is just so high.
(11:04):
These are the individuals that really need somebody in their corner.
Speaker 1 (11:09):
It sounds mind boggling to how do you approach with
the understanding that every person's different, every case is different.
But how do you approach working with someone who's got
the weight of, you know, many challenges and problems beneath them?
(11:30):
How do you start working with someone like that? And
there's a part two to the question, which is why
do you think you're able to do that? That's the
second part?
Speaker 3 (11:48):
All right, Well, I'll start with another question that I
get often asked, which is why isn't it hard to
be an addiction psychiatrist managing these very complex cases?
Speaker 2 (12:00):
Is like, how is it that you go to work
every day?
Speaker 3 (12:03):
And the truth is I go to work every day
and I am just excited to see the patients and
the individuals that I'm working with because they have taken
an incredibly brave step to seek help. There is so
there are so many reasons why they may not show
(12:24):
up on my screen or in my office, so many
reasons everything from stigma to barriers, to lack of access
to not having resources, to just managing the complexity and
the severity of those symptoms of all of the conditions
that they're trying to work with here, and the fact
that even with all of that going on, I will
(12:49):
have somebody pop up on my screen for their first visit.
The fact that they can do that is just so
humbling and so impressive and so inspire hiring that it
makes me excited to be working with them. And I figure,
if they are putting in a million percent, because that's
(13:10):
what it's taking, then I can put in everything that
I have to help them along along their journey.
Speaker 1 (13:22):
Specifically, when you're is it a matter of triaging. Okay,
they're homeless, they've got mental health issues, there is trauma,
there's addiction, they can't pay their rent, their stress. How
do you literally begin approaching working with them?
Speaker 3 (13:40):
Yeah, So the first thing is to really build engagement
and alliance. And so whether I'm working with an individual
or im I'm working with my team and they're they're
in touch with somebody who's struggling, we first need to
get that hook, create that alliance, create that so that
(14:01):
even if this isn't the call or this isn't the
visit where they are going to make X y Z changes,
at least they feel comfortable coming back to us and
continuing that conversation because it is again very hard to
take those steps to to start to engage in care.
And then we take it one step at a time.
What's the thing that's that's most difficult right now? What
(14:24):
what are you? What is what is getting in the
way most or what is most important to you? It's
very important to have a client centered approach. I may
I may want them to do five things for their health,
but if what they're really worried about is how they're
going to get their kid to an appointment next week,
They're not going to want to talk about their five
(14:47):
things that I have on my list for their health.
I need to take their lead in terms of what's
important to them. And again that's still that still helps
build that alliance and that relationship to help keep them
coming back.
Speaker 1 (15:01):
Are you working with a team of people? I e.
Do you you offering groups, et cetera? Or how or
how are you working with clients?
Speaker 2 (15:11):
Yeah?
Speaker 3 (15:11):
So I have two main roles in my academic role.
I work with a multidisciplinary team. And so, for example,
earlier this week, I was in a room with an
addiction fellow, a patient, and a social worker on our team,
and we were just really brainstorming how to get somebody
(15:33):
to and from our clinic and to and from an.
Speaker 2 (15:36):
A social activity.
Speaker 3 (15:38):
So that's a team in my academic setting, and then
on the LIRA health side, I work with a team
of master's level clinicians primarily composed comprised of social work
as well as psychiatry and psychiatrists who are are there
for the again, the patients who are presenting with the
(15:59):
most complex needs.
Speaker 1 (16:02):
Is there kind of an understanding in addiction treatment that
again with the understanding that everyone's different, but is there
an understanding that it's important for people to be involved
in groups? Is this that most.
Speaker 3 (16:18):
Often help groups are very important. I never I never
kind of make an absolute requirement for my patients that
you have to do X, Y Z, because I want
them to do some amount of treatment. However, we know
that groups are very important because in addition to the
(16:38):
content and the processing that can happen through groups, there
is also the opportunity to have more structure in ondnesday
whether it's depression or substance use disorder, alcohol use disorder,
so on. Structure is very important, as is that sense
of community and peer support. So with so much isolation.
I think the Surgeon General UH a few years ago
(17:02):
had done a couple of years ago, rather had done
a report on on loneliness in the US with the
amount of isolation that there is having that that group,
even if it's a zoom group, and I, for example,
I run zoom groups and I hold groups both at
both of my roles. There there's a place for people
(17:24):
to go to have some accountability, to feel some camaraderie.
So very important, and we know from the evidence that
that groups and peer support can actually be just as
effective and in fact, for some for some populations, more
effective than treatments like CBT, which I talked about earlier.
Speaker 1 (17:42):
M hmmm, all right, let's let's let me just remind
every when I'm speaking with doctor Sumita das we're talking
about addiction, I also want to kind of shift gears
a little here and talk about motherhood. How does that
whole track come into play with you and your interest.
Speaker 3 (18:03):
Yes, so I started my career before myself personally becoming
a mother, and so I didn't I didn't yet have
an appreciation until I went through the journey of being pregnant,
having probably one of the most traumatic or difficult times
in my life during that time period, and then and
(18:27):
then coming out of it now you know, a decade.
Speaker 2 (18:30):
Later, and.
Speaker 3 (18:33):
The idea that I was talking about earlier about where
when when somebody either shows up in my office or
on my screen to see me for treatment, they have
they have had to face so many barriers and reasons.
Speaker 2 (18:46):
To not come.
Speaker 3 (18:48):
I think that's very very true with with with with
women and with mothers in particular. There's there's so many
burdens and so much pressure, and so many reasons that
they they they may not seek treatment, and and so
I just I have so much, so much more respect
(19:09):
and admiration for those who are managing that. In addition
to whatever other disease processes, do.
Speaker 1 (19:17):
You work with women specifically or mothers specifically.
Speaker 3 (19:22):
In my practices, I've since especially since I've left the VA,
which is whereas director of Addiction Treatment Services prior to
these two roles, I have had a lot more experience
and opportunity to work with women. In fact, it became
such an important part of what we're doing at LIRA
that we built a Center of Excellence for women's mental health.
Speaker 1 (19:48):
Because in the in the bio, I thought it was
very interesting, you know, it said something to the fact
that you're kind of shining a light on the nuance
reframing motherhood not just as coifold experience, but as as
a potential breaking point. Say more about that.
Speaker 3 (20:06):
Yeah, I think sometimes motherhood it's it's it's idealized in
this way of of everything looks like as it is
on TV or in a movie, and it's really so
much more than that. Everything from just the purely biological
process of the changes in the hormones and what's going on,
(20:26):
to the social expectations and you know, and that can
also overlap with cultural expectations and then and then even
to just how somebody is living within their own body.
I remember before I was pregnant, several years before, a
(20:48):
colleague we were in a process group, uh for for psychiatrists,
and and she was postpartum. And I remember her saying
this distinctly because it came back to me later after
I gave birth. She said, you know, we were we
were all passing around her baby and helping her take
care of the baby while we were doing this this
psychiatry group, and and she said that her her body
(21:11):
doesn't necessarily feel like hers anymore.
Speaker 2 (21:13):
And I didn't. I didn't understand what that meant, uh And and.
Speaker 3 (21:17):
I remember being like, that's an interesting thing to say,
and then and then after giving birth, I definitely understood,
uh what that meant, uh, and had had an appreciation
for it. And so I think, I think there's just
so many aspects of motherhood and that's just you know
that that's just really the beginning. And then as time
(21:38):
goes on. We saw this, especially in COVID, and I
experienced this personally, the.
Speaker 2 (21:44):
The the mental load. Uh, it's just it's it's.
Speaker 3 (21:49):
I don't even know how to describe it because it
is so heavy. And and during that time with all
the schools and preschools and so on closed and trying
to do it all, it was for me personally it
almost became a breaking point of do I keep working
or do I do I do I mom full time?
Speaker 1 (22:08):
It seems to me, you know, from from someone who's
had kids, that motherhood is often, certainly the importance of
it is to a certain degree dismissed. And when issues arise,
when you know, just as you're talking about, when physical
or mental emotional issues arise, there just not you know,
(22:34):
it's just motherhood. You know, it's just not taken. It's
gone of dismissed to a certain degree, to a certain
degree not taken. It seriously, But do you feel things
are changing the cultural view of motherhood and what mothers,
what it means to be a mother, Is that changing?
(22:55):
And where does this focus and interest that you have,
does this come into play? How is it going to manifest?
Speaker 3 (23:04):
I think it is changing, but very glacially. I I
know that we're we're giving more attention to the importance
of motherhood, the impact of motherhood, that the toll of motherhood.
And yet there's still i think an underlying cultural, any
(23:27):
cultural even within Western culture, cultural expectation of well.
Speaker 2 (23:31):
That's just what you do.
Speaker 3 (23:33):
Uh and and and and in these interviews, for example,
when you see an executive on stage, if if it's
a woman, it's always you know, how do you balance
having a family and being a business person? And then
uh and then you see like a male sitting next
to her who has the same role in same same
(23:53):
family situation, but.
Speaker 2 (23:54):
Nobody asks him that.
Speaker 3 (23:57):
And so I think that there's still a lot of
progress to be made to really and I'm saying two
things here. I'm saying, on one hand, be more fair
about checking in about how it is to be a parent,
But with that also needs to come the fairness of
how those responsibilities are divvied up in society, and we
(24:21):
still know from the numbers, for example, that women are
paid less for the same roles, that they have less
leadership roles, that they have less of.
Speaker 2 (24:30):
A chance to advance.
Speaker 3 (24:32):
And so if there's somebody an individual who's struggling with
mental health concerns and they're also in their own life
and their own professional development having to face even more barriers, gosh,
they're just they're really not set up for success. And
so in my own work, trying to at least do
what I can to address the mental health part of it,
(24:55):
to really help women live their best life and feel
common but so that they don't have to feel like
as much that it's an uneven playing field. It still
is an uneven playing field for sure.
Speaker 1 (25:09):
All Right. So as we as we wind down here,
what's the best way for people to learn more about
you and what you're doing possibly reach out to you?
Speaker 3 (25:20):
Yeah, I think that a really easy way to find
me is through my Psychology Today blog which is the
Science behind Recovery, or on my LinkedIn there I can
learn more about the work that I'm doing. Both at
Lerohealth at learhealth dot Com are also my work on
faculty at Stanford, and so those are probably the best
(25:41):
ways to reach out to me. And I'd encourage folks
to to you know, quote unquote do their research and
learn more, especially if they're struggling with any of the
things that I talked about. There's, especially in addiction, a
lot of a lot of people are unaware of treatment
and evidence based ways to start to feel better. And
(26:04):
so so I'm hopeful for folks to learn more about
about what we've talked about and learn for themselves.
Speaker 1 (26:13):
What, just quickly, what are some of those ways that
people might not be aware of.
Speaker 3 (26:19):
I think oftentimes the misconception in addiction, for example, comes
from just thinking that they need to tough it out
and bite the bullet and just you know, take care
of it on their own. And so really the evidence
based ways that are available and are super underutilized include therapy, therapy,
(26:40):
treatments like we've discussed, things like cognitive behavioral therapy, or
even just talking to a clinician and engaging in motivational
interviewing all the way to medications. Medications to treat substance
use disorders, but also medications to treat of the overlap
that often occurs between other mental health concerns like depression, anxiety, trauma,
and substance use disorders.
Speaker 2 (27:01):
So there's there's.
Speaker 3 (27:03):
Both medication based and non medication based treatments for all
of these things that are just really underutilized.
Speaker 1 (27:11):
In your experience, do you find there's a predominant like
experience of trauma that's going on with people who are addicted?
Speaker 2 (27:23):
There is a lot of overlap.
Speaker 3 (27:25):
There isn't a specific predominant type of trauma that I
would say I would classify into addiction, but I will
say that there is a lot of overlap. And oftentimes
individuals who have experienced trauma may may turn to substances
to cope, and and so that's that's where we see
(27:47):
a lot of the overlap. And so it's very important
for someone who's struggling with both a substance use disorder
and a trauma related diagnosis that that they get both,
they work with both instead of just trying to do
one or the other, because of what we know from
the research is that treating both together results in better outcomes.
Speaker 1 (28:09):
Right right, Okay, all right, Samita, I appreciate you being here.
We'll have all those linked up here at the show
notes page at the Trauma Therapist podcast dot com. Very inspiring.
Appreciate it. Thank you so much, Thank you all right,
take care, take care,
Welcome to the Trauma Theriver's podcast. My name is Gamiferson
and I interview incredible people who share the story of
how trauma has shaped their lives. And a big thank
you for sponsoring today's episode goes to my guest and
our sponsors. So five, four, three, two and one, our folks,
(00:24):
welcome back to the podcast. Very excited to have with
my guest today, Doctor Smita Das Smita, Welcome.
Speaker 2 (00:30):
Thank you so much for having me today.
Speaker 1 (00:33):
Doctor Smita is a board certified psychiatrist specializing in addiction
psychiatry and addiction medicine, and clinical Associate Professor of Psychiatry
and Behavioral Sciences at Stanford with over twenty years of
experience in clinical care, research, and leadership, including her role
as VP of Psychiatry and Complex Care at LIRA Health.
She's known for bringing nuance and compassion to how we
(00:56):
talk about trauma and addiction. What sets her apart is
how she addresses overlooked trauma, especially among high functioning populations.
She's been leading voice and reframing motherhood not just as joy,
but as potential mental health breaking point. Doctor Dos explores
how sleep deprivation identity rupture, promoto shifts, and the invisibility
(01:16):
of caregiving pain can mirror complex trauma, challenging the notion
that maternal crises are rare. All right, Samita, just a
little bit about you, obviously, but before you go and
share with the listeners where you're from originally and where
you are currently.
Speaker 2 (01:35):
That's a great question.
Speaker 3 (01:37):
I am somebody who originally came from a background of
wanting to just do research in the area of public health,
and where I've ended up is in being a psychiatrist,
an addiction psychiatrist who actually works with very complex populations.
(01:59):
And I think that journey was very much influenced by
the people and the stories that I learned about along
the way. During my research journey, it just became so
clear that that this was an area that's underserved and
uh and really needs needs more hands on deck.
Speaker 1 (02:18):
Okay, where are you from originally?
Speaker 3 (02:22):
I'm sorry, I'm from I'm from San Jose, California. I'm
from the California base.
Speaker 1 (02:27):
Okay, yeah, okay, and you're still there. I'm guessing around there.
Speaker 3 (02:31):
I actually I I went around the country for my
education and training, and then I ended up back here.
Speaker 2 (02:36):
It's hard to it's hard to leave this place.
Speaker 1 (02:41):
Yes, I know very well, all too well. All right,
so you said you started out interested in public health.
What as a young kid that happens or what?
Speaker 2 (02:55):
That's a good question.
Speaker 3 (02:56):
Actually, the funny thing is, I so I went to schools.
I was just having this conversation with some parent friends
at my daughter's school, and because we were all local,
we were comparing notes about about high schools and who
went where, and I think I firmly established that I
(03:17):
probably went to one of the more troubled high schools
in East San Jose.
Speaker 2 (03:23):
And there, in part.
Speaker 3 (03:26):
Because we we were a high school that had a
lot of at risk students, there was a lot of
interest in helping the students there. And so for example,
Stanford University would come and do our local local university
would come and do research studies with our student populations.
Speaker 2 (03:45):
And so one of.
Speaker 3 (03:46):
Them was to help prevent at you know, students in
high schools that are are traditionally underserved and at risk
not go down paths so for example, addiction and and
gain violence, A lot of things that were present present
at my high school. So as part of one of
those studies, I joined as a student participant, and our
(04:08):
task was to look at tobacco and tobacco anything having
to do with tobacco, and so we actually the students
as part of this project.
Speaker 2 (04:18):
Again, it really wasn't for the content.
Speaker 3 (04:19):
It was more to get us going in a in
a very positive direction and be a positive influence for
our school. We studied how much retailers in the San
Jose San Jose area were advertising tobacco and alcohol illegally
to minors, and then put together a study and then
went to San Jose City Council.
Speaker 2 (04:39):
And presented the results.
Speaker 3 (04:41):
And so actually, yeah, kind of as a kid, I
was introduced to the area of public health, and many
years later I got to actually meet the lead researcher
at Stanford who who had done that research study when
I was.
Speaker 2 (04:56):
Coo, when I was just a kid.
Speaker 1 (04:58):
Oh cool, So you're impacted by this? You what? What?
What does the path look like? You go? You go
to Stanford? Did you get?
Speaker 2 (05:09):
I ended up going to Stanford for college.
Speaker 3 (05:12):
Uh, and then I am actually to to just make
some money on the side as a student going to a.
Speaker 2 (05:19):
Very expensive private school.
Speaker 3 (05:21):
I joined as a research a research assistant in a lab.
But this lab happened to be led by doctor C.
Bar Taylor Emeritus, who's now passed away, but he was
a leading researcher in behavioral treatments for for all sorts
of things, so everything from using cognitive behavioral therapy to
(05:44):
treat smoking use tobacco use disorder, to how to use
behavioral treatments to treat people who are in cancer or
cardiovascular UH programs. And then he also was doing some
research on UH digital treatment. So using technologies is in
early two thousands, if I'm going to date myself looking
(06:05):
at digital treatments for high school students on eating disorders.
And so I just happened to work start working there
and then found a love for this type of research
and statistics, and then that led me to go to
graduate school and then eventually to go to medical school.
Speaker 1 (06:25):
And how did your interest in addiction come about? That
and more specifically and more specifically psychiatry.
Speaker 3 (06:36):
Yeah, so I was definitely going down this path of
One of the main studies that I was working on
had to do with doing an intervention with people who
were smoking and hospitalized. And what I didn't know at
the time is that I was actually delivering cognitive behavioral therapy,
one of the gold standard treatments in psychiatry and psychology,
(07:00):
to people at the bedside to help them quit smoking.
And I was sure that you know, this population people
with cardiac disease and lung diseases, that that was the
path that I was going to go down. But then
I realized the common thread between all of them was
one that this is an addiction that they're struggling with
(07:21):
that's probably impacting their life more than anything else. And
then two that behavioral treatments were really effective, and so
could we could look at the leading preventable cause of
death in this country, which is tobacco use disorder, and
we could work with it with a behavioral intervention. And
that was really eye opening that, you know, I could
(07:45):
sit there and study a lot, and I still had
to study a lot to end up becoming a physician,
but go down a path of looking at disease processes
when the answer is actually already there in front of
me that these behavioral interventions are very very effective.
Speaker 1 (08:04):
Does your or did your belief a utilization of these
behavioral interventions? Does that presuppose that you had a feeling
one way or the other in terms of the disease
model or you know, another model for addiction.
Speaker 3 (08:27):
I interestingly have always had a viewpoint on addiction being
a disease model, and it's probably just because I got
introduced to addiction through kind of experts who who really
dive into evidence based.
Speaker 2 (08:44):
Theories and ideas, and so the.
Speaker 3 (08:46):
Idea that that addiction is a brain disease, as a
National Institute of Drug Abuse helps us learn about through
their resources, That's that's been with me for a very
long time. It's not a choice, a moral failing. It
is a brain disease and we need to treat it
as such and give it the same importance as well
(09:08):
as parity with treatments and access as we give to
any medical condition.
Speaker 1 (09:17):
So in the bio, I think we talked about your
focus on what challenged, challenging populations or difficult populations. What
does that mean to you? How do you define that
and why that population?
Speaker 2 (09:35):
It's a really great question. So I think we're coming.
Speaker 3 (09:39):
We've come a long way, especially through the pandemic, in
terms of reaching people with a lot of general mental
health needs, things like anxiety and depression of more of
a mild moderate.
Speaker 2 (09:52):
Sort of nature.
Speaker 3 (09:53):
I think where we're failing still in mental health and
as a system has to do with people who are
struggling with more than that. Maybe it is anxiety and depression,
but it's also a level of severity that may be
considered more treatment resistant, or they're struggling with with those
(10:16):
plus a substance use disorder which can't be treated independently
and you can't do one and then the other, you need.
Speaker 2 (10:22):
To really do both.
Speaker 3 (10:24):
Or they're struggling with with trauma and another one of
these diagnoses, or they are social circumstances that really make
it hard for them to engage in care. And so
for these populations, oftentimes the one who ones who are
who are having to manage complex conditions there there there
(10:44):
haven't been great solutions in public health to date, and
so that was those These are the individuals, the patients
that I see that that come into my office and
and are trying everything, or or the ones that aren't
even able to make it into my office because the
complexity of what they're dealing with is just so high.
(11:04):
These are the individuals that really need somebody in their corner.
Speaker 1 (11:09):
It sounds mind boggling to how do you approach with
the understanding that every person's different, every case is different.
But how do you approach working with someone who's got
the weight of, you know, many challenges and problems beneath them?
(11:30):
How do you start working with someone like that? And
there's a part two to the question, which is why
do you think you're able to do that? That's the
second part?
Speaker 3 (11:48):
All right, Well, I'll start with another question that I
get often asked, which is why isn't it hard to
be an addiction psychiatrist managing these very complex cases?
Speaker 2 (12:00):
Is like, how is it that you go to work
every day?
Speaker 3 (12:03):
And the truth is I go to work every day
and I am just excited to see the patients and
the individuals that I'm working with because they have taken
an incredibly brave step to seek help. There is so
there are so many reasons why they may not show
(12:24):
up on my screen or in my office, so many
reasons everything from stigma to barriers, to lack of access
to not having resources, to just managing the complexity and
the severity of those symptoms of all of the conditions
that they're trying to work with here, and the fact
that even with all of that going on, I will
(12:49):
have somebody pop up on my screen for their first visit.
The fact that they can do that is just so
humbling and so impressive and so inspire hiring that it
makes me excited to be working with them. And I figure,
if they are putting in a million percent, because that's
(13:10):
what it's taking, then I can put in everything that
I have to help them along along their journey.
Speaker 1 (13:22):
Specifically, when you're is it a matter of triaging. Okay,
they're homeless, they've got mental health issues, there is trauma,
there's addiction, they can't pay their rent, their stress. How
do you literally begin approaching working with them?
Speaker 3 (13:40):
Yeah, So the first thing is to really build engagement
and alliance. And so whether I'm working with an individual
or im I'm working with my team and they're they're
in touch with somebody who's struggling, we first need to
get that hook, create that alliance, create that so that
(14:01):
even if this isn't the call or this isn't the
visit where they are going to make X y Z changes,
at least they feel comfortable coming back to us and
continuing that conversation because it is again very hard to
take those steps to to start to engage in care.
And then we take it one step at a time.
What's the thing that's that's most difficult right now? What
(14:24):
what are you? What is what is getting in the
way most or what is most important to you? It's
very important to have a client centered approach. I may
I may want them to do five things for their health,
but if what they're really worried about is how they're
going to get their kid to an appointment next week,
They're not going to want to talk about their five
(14:47):
things that I have on my list for their health.
I need to take their lead in terms of what's
important to them. And again that's still that still helps
build that alliance and that relationship to help keep them
coming back.
Speaker 1 (15:01):
Are you working with a team of people? I e.
Do you you offering groups, et cetera? Or how or
how are you working with clients?
Speaker 2 (15:11):
Yeah?
Speaker 3 (15:11):
So I have two main roles in my academic role.
I work with a multidisciplinary team. And so, for example,
earlier this week, I was in a room with an
addiction fellow, a patient, and a social worker on our team,
and we were just really brainstorming how to get somebody
(15:33):
to and from our clinic and to and from an.
Speaker 2 (15:36):
A social activity.
Speaker 3 (15:38):
So that's a team in my academic setting, and then
on the LIRA health side, I work with a team
of master's level clinicians primarily composed comprised of social work
as well as psychiatry and psychiatrists who are are there
for the again, the patients who are presenting with the
(15:59):
most complex needs.
Speaker 1 (16:02):
Is there kind of an understanding in addiction treatment that
again with the understanding that everyone's different, but is there
an understanding that it's important for people to be involved
in groups? Is this that most.
Speaker 3 (16:18):
Often help groups are very important. I never I never
kind of make an absolute requirement for my patients that
you have to do X, Y Z, because I want
them to do some amount of treatment. However, we know
that groups are very important because in addition to the
(16:38):
content and the processing that can happen through groups, there
is also the opportunity to have more structure in ondnesday
whether it's depression or substance use disorder, alcohol use disorder,
so on. Structure is very important, as is that sense
of community and peer support. So with so much isolation.
I think the Surgeon General UH a few years ago
(17:02):
had done a couple of years ago, rather had done
a report on on loneliness in the US with the
amount of isolation that there is having that that group,
even if it's a zoom group, and I, for example,
I run zoom groups and I hold groups both at
both of my roles. There there's a place for people
(17:24):
to go to have some accountability, to feel some camaraderie.
So very important, and we know from the evidence that
that groups and peer support can actually be just as
effective and in fact, for some for some populations, more
effective than treatments like CBT, which I talked about earlier.
Speaker 1 (17:42):
M hmmm, all right, let's let's let me just remind
every when I'm speaking with doctor Sumita das we're talking
about addiction, I also want to kind of shift gears
a little here and talk about motherhood. How does that
whole track come into play with you and your interest.
Speaker 3 (18:03):
Yes, so I started my career before myself personally becoming
a mother, and so I didn't I didn't yet have
an appreciation until I went through the journey of being pregnant,
having probably one of the most traumatic or difficult times
in my life during that time period, and then and
(18:27):
then coming out of it now you know, a decade.
Speaker 2 (18:30):
Later, and.
Speaker 3 (18:33):
The idea that I was talking about earlier about where
when when somebody either shows up in my office or
on my screen to see me for treatment, they have
they have had to face so many barriers and reasons.
Speaker 2 (18:46):
To not come.
Speaker 3 (18:48):
I think that's very very true with with with with
women and with mothers in particular. There's there's so many
burdens and so much pressure, and so many reasons that
they they they may not seek treatment, and and so
I just I have so much, so much more respect
(19:09):
and admiration for those who are managing that. In addition
to whatever other disease processes, do.
Speaker 1 (19:17):
You work with women specifically or mothers specifically.
Speaker 3 (19:22):
In my practices, I've since especially since I've left the VA,
which is whereas director of Addiction Treatment Services prior to
these two roles, I have had a lot more experience
and opportunity to work with women. In fact, it became
such an important part of what we're doing at LIRA
that we built a Center of Excellence for women's mental health.
Speaker 1 (19:48):
Because in the in the bio, I thought it was
very interesting, you know, it said something to the fact
that you're kind of shining a light on the nuance
reframing motherhood not just as coifold experience, but as as
a potential breaking point. Say more about that.
Speaker 3 (20:06):
Yeah, I think sometimes motherhood it's it's it's idealized in
this way of of everything looks like as it is
on TV or in a movie, and it's really so
much more than that. Everything from just the purely biological
process of the changes in the hormones and what's going on,
(20:26):
to the social expectations and you know, and that can
also overlap with cultural expectations and then and then even
to just how somebody is living within their own body.
I remember before I was pregnant, several years before, a
(20:48):
colleague we were in a process group, uh for for psychiatrists,
and and she was postpartum. And I remember her saying
this distinctly because it came back to me later after
I gave birth. She said, you know, we were we
were all passing around her baby and helping her take
care of the baby while we were doing this this
psychiatry group, and and she said that her her body
(21:11):
doesn't necessarily feel like hers anymore.
Speaker 2 (21:13):
And I didn't. I didn't understand what that meant, uh And and.
Speaker 3 (21:17):
I remember being like, that's an interesting thing to say,
and then and then after giving birth, I definitely understood,
uh what that meant, uh, and had had an appreciation
for it. And so I think, I think there's just
so many aspects of motherhood and that's just you know
that that's just really the beginning. And then as time
(21:38):
goes on. We saw this, especially in COVID, and I
experienced this personally, the.
Speaker 2 (21:44):
The the mental load. Uh, it's just it's it's.
Speaker 3 (21:49):
I don't even know how to describe it because it
is so heavy. And and during that time with all
the schools and preschools and so on closed and trying
to do it all, it was for me personally it
almost became a breaking point of do I keep working
or do I do I do I mom full time?
Speaker 1 (22:08):
It seems to me, you know, from from someone who's
had kids, that motherhood is often, certainly the importance of
it is to a certain degree dismissed. And when issues arise,
when you know, just as you're talking about, when physical
or mental emotional issues arise, there just not you know,
(22:34):
it's just motherhood. You know, it's just not taken. It's
gone of dismissed to a certain degree, to a certain
degree not taken. It seriously, But do you feel things
are changing the cultural view of motherhood and what mothers,
what it means to be a mother, Is that changing?
(22:55):
And where does this focus and interest that you have,
does this come into play? How is it going to manifest?
Speaker 3 (23:04):
I think it is changing, but very glacially. I I
know that we're we're giving more attention to the importance
of motherhood, the impact of motherhood, that the toll of motherhood.
And yet there's still i think an underlying cultural, any
(23:27):
cultural even within Western culture, cultural expectation of well.
Speaker 2 (23:31):
That's just what you do.
Speaker 3 (23:33):
Uh and and and and in these interviews, for example,
when you see an executive on stage, if if it's
a woman, it's always you know, how do you balance
having a family and being a business person? And then
uh and then you see like a male sitting next
to her who has the same role in same same
(23:53):
family situation, but.
Speaker 2 (23:54):
Nobody asks him that.
Speaker 3 (23:57):
And so I think that there's still a lot of
progress to be made to really and I'm saying two
things here. I'm saying, on one hand, be more fair
about checking in about how it is to be a parent,
But with that also needs to come the fairness of
how those responsibilities are divvied up in society, and we
(24:21):
still know from the numbers, for example, that women are
paid less for the same roles, that they have less
leadership roles, that they have less of.
Speaker 2 (24:30):
A chance to advance.
Speaker 3 (24:32):
And so if there's somebody an individual who's struggling with
mental health concerns and they're also in their own life
and their own professional development having to face even more barriers, gosh,
they're just they're really not set up for success. And
so in my own work, trying to at least do
what I can to address the mental health part of it,
(24:55):
to really help women live their best life and feel
common but so that they don't have to feel like
as much that it's an uneven playing field. It still
is an uneven playing field for sure.
Speaker 1 (25:09):
All Right. So as we as we wind down here,
what's the best way for people to learn more about
you and what you're doing possibly reach out to you?
Speaker 3 (25:20):
Yeah, I think that a really easy way to find
me is through my Psychology Today blog which is the
Science behind Recovery, or on my LinkedIn there I can
learn more about the work that I'm doing. Both at
Lerohealth at learhealth dot Com are also my work on
faculty at Stanford, and so those are probably the best
(25:41):
ways to reach out to me. And I'd encourage folks
to to you know, quote unquote do their research and
learn more, especially if they're struggling with any of the
things that I talked about. There's, especially in addiction, a
lot of a lot of people are unaware of treatment
and evidence based ways to start to feel better. And
(26:04):
so so I'm hopeful for folks to learn more about
about what we've talked about and learn for themselves.
Speaker 1 (26:13):
What, just quickly, what are some of those ways that
people might not be aware of.
Speaker 3 (26:19):
I think oftentimes the misconception in addiction, for example, comes
from just thinking that they need to tough it out
and bite the bullet and just you know, take care
of it on their own. And so really the evidence
based ways that are available and are super underutilized include therapy, therapy,
(26:40):
treatments like we've discussed, things like cognitive behavioral therapy, or
even just talking to a clinician and engaging in motivational
interviewing all the way to medications. Medications to treat substance
use disorders, but also medications to treat of the overlap
that often occurs between other mental health concerns like depression, anxiety, trauma,
and substance use disorders.
Speaker 2 (27:01):
So there's there's.
Speaker 3 (27:03):
Both medication based and non medication based treatments for all
of these things that are just really underutilized.
Speaker 1 (27:11):
In your experience, do you find there's a predominant like
experience of trauma that's going on with people who are addicted?
Speaker 2 (27:23):
There is a lot of overlap.
Speaker 3 (27:25):
There isn't a specific predominant type of trauma that I
would say I would classify into addiction, but I will
say that there is a lot of overlap. And oftentimes
individuals who have experienced trauma may may turn to substances
to cope, and and so that's that's where we see
(27:47):
a lot of the overlap. And so it's very important
for someone who's struggling with both a substance use disorder
and a trauma related diagnosis that that they get both,
they work with both instead of just trying to do
one or the other, because of what we know from
the research is that treating both together results in better outcomes.
Speaker 1 (28:09):
Right right, Okay, all right, Samita, I appreciate you being here.
We'll have all those linked up here at the show
notes page at the Trauma Therapist podcast dot com. Very inspiring.
Appreciate it. Thank you so much, Thank you all right,
take care, take care,
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