Episode 183: Purpose Over Addiction (featuring Dr. Sarah Nasir) の全文書き起こし

system. 00:05:02.399 --> 00:05:17.839 So this is for individuals who struggle with relapses, and they want to have that holistic approach where it's we're not addressing just their addiction, but the other health conditions and other dimensions of them. 00:05:18.240 --> 00:05:22.079 So that's one that's available in California at this time. 00:05:22.480 --> 00:05:29.839 And a lot of exciting things I'm part of basically what I like to say is live your purpose. 00:05:30.000 --> 00:05:31.920 It is the sun in the horizon. 00:05:32.720 --> 00:05:35.680 How did you get involved in addiction work in particular? 00:05:35.839 --> 00:05:42.800 Because when you get into family aspects of things, you get into doctor medicine. 00:05:42.959 --> 00:05:48.319 I imagine there's a multitude of different pathways that you could take. 00:05:48.480 --> 00:05:52.639 What what drove you or got you interested in addiction in particular? 00:05:53.600 --> 00:05:54.800 Yeah, great question. 00:05:54.879 --> 00:05:59.759 Um, the short answer is I think life guided me to it, you know. 00:05:59.920 --> 00:06:10.160 Um, but in talking about my arc of how I went from a family medicine doctor to now being a full-time addiction uh specialist. 00:06:10.399 --> 00:06:15.279 So in family medicine, our motto is we take care of patients from cradle to the grave. 00:06:15.439 --> 00:06:23.600 We see from babies as soon as they're born, and sometimes, like, you know, some family medicine docs, they actually help deliver the babies too. 00:06:23.759 --> 00:06:30.480 Um, I don't do that, but I have the skill set to take care of birth to uh cradle to the grave, right? 00:06:30.639 --> 00:06:35.040 And so that means we see everything in between as the primary care provider. 00:06:35.360 --> 00:06:42.240 And as I was training for this specialty, I came across the impact that addiction had. 00:06:42.480 --> 00:06:48.160 A lot of times a patient will walk in and the silent thing will be addiction. 00:06:48.319 --> 00:07:02.800 And unless we know how to ask about it, how to see it, um, then the patient is, you know, like the other care of them are struggling, surviving, um, you know, struggling hard to get done properly. 00:07:03.040 --> 00:07:05.680 It impacts their community. 00:07:05.839 --> 00:07:09.120 Before it impacts the community, it impacts the family. 00:07:09.360 --> 00:07:11.759 Um, and the it's devastating. 00:07:12.000 --> 00:07:21.199 I saw addiction for the first time in my life as a medical student when I was um doing my rotations in the rural West Virginia. 00:07:21.279 --> 00:07:22.800 That's where I went to school. 00:07:22.959 --> 00:07:36.160 It was in a nursery, mom had just delivered the baby was going through neonatal abstinence syndrome, which is where the baby was exposed to um opioids in pregnancy. 00:07:36.720 --> 00:07:42.800 And so when the baby came out, it's no longer getting that opioids from mom's bloodstream. 00:07:42.879 --> 00:07:45.120 And so the baby goes into withdrawal. 00:07:45.279 --> 00:07:52.879 Um, and the nurses were, you know, having a very big um, what's the word I'm looking for? 00:07:53.120 --> 00:08:00.160 Hate fest is not the right word, but for the lack of better words, you know, lots of judgment, lots of commentary happening. 00:08:00.399 --> 00:08:18.720 And at that time, I also held the similar mentality that if you love us, you should be able to easily just quit the drugs, you know, like taking it to that unrealistic expectation, forgetting or not being aware at that time of what addiction really is. 00:08:19.040 --> 00:08:22.160 Fast forward to my residency years. 00:08:22.319 --> 00:08:38.639 This is in Elmira, New York, a rural New York uh city, and apparently it was part of the drug belt that went from the um Southern uh sorry, Central South America all the way up to Canada. 00:08:38.879 --> 00:08:47.279 So we were sitting in the middle of that um uh belt, and we had a huge heroin uh epidemic in that area. 00:08:47.440 --> 00:08:58.080 Um, also we had patients who were um, you know, going to doctors locally and getting plenty of prescription opioids and using it in a wrong way. 00:08:58.320 --> 00:09:05.679 Yes, so we were sitting in a Bible belt, not a Bible belt, the drug belt going from the South America to Canada. 00:09:05.840 --> 00:09:11.679 We had doctors who were prescribing a lot of opioid prescription, contributing to the opioid epidemic. 00:09:11.840 --> 00:09:17.360 So this is when the pendulum is swinging the other way, DEA is taking a lot of actions. 00:09:17.600 --> 00:09:23.600 Um, and I saw the impact of it firsthand of what was happening in our community. 00:09:23.840 --> 00:09:46.000 Um, so this is where I moved from, you know, having the similar stigma against addiction like the rest of the world, to, you know, telling um my attending why can't they stop just stop using like their families, uh the stress level on their family is so so um significant. 00:09:46.480 --> 00:09:52.080 The family members are aging, worried and everything, and yet they love each other, you know. 00:09:52.240 --> 00:09:57.840 Uh, why can't love be more powerful than this substance that they're using? 00:09:57.919 --> 00:09:59.120 Like, how could they? 00:09:59.279 --> 00:10:08.960 And my attending told me that, Sarah, you do realize that addiction is a chronic disease, that the brain actually changes significantly. 00:10:09.120 --> 00:10:12.720 Like, even if they want to quit, it's not easy to quit. 00:10:12.879 --> 00:10:14.879 You have to approach it that way. 00:10:15.200 --> 00:10:30.559 Um, that statement really just made like shook me, and it like really made me feel bad for all the prejudice I held against the patient population before people around me, because you know, tobacco is an addiction too. 00:10:30.639 --> 00:10:41.120 Nicotine is very addicting, and it is one of the legal and most commonly um abused drugs or substances, along with alcohol. 00:10:41.279 -->

00:10:48.720 Um, and so I held a lot of negative feelings against those family members or relatives as well. 00:10:48.960 --> 00:10:53.919 But this statement just really made me feel like I need to rethink this. 00:10:54.159 --> 00:11:26.720 And, you know, when I approached it that way, I started to also see the difference it makes to be able to take somebody who is actively in addiction, and then in a year or so, just the big change that happens in that person going from you know, fragile, frail, their life all over the place, to being somebody who is now healthy, um, looks, you know, they have proper weight on them, they're smiling, they're showing up, their family is also um doing well. 00:11:27.440 --> 00:11:29.919 That night it's like a night and day difference. 00:11:30.080 --> 00:11:34.159 And I like to say it may feel like curing cancer in many ways. 00:11:34.480 --> 00:11:43.200 Because when I have patients who have diabetes, high blood pressure, it's it's hard to convince them um that you know you need to change. 00:11:43.519 --> 00:11:59.120 The visibility of the impact is not as prominent versus when you are able to save somebody, guide them out of addiction, and put them back in control of their own lives, it is so satisfying. 00:11:59.360 --> 00:12:03.759 So I get that pleasure of taking care of patients and guiding them. 00:12:03.840 --> 00:12:06.960 Um, so that's my trajectory into addiction. 00:12:07.440 --> 00:12:12.399 So there's a there's a couple things I want to ask about based on your description of that. 00:12:12.559 --> 00:12:27.600 One thing that came up is the the stigma, and not just stigma, but stigma among medical professionals, which is not anything new that's that's been talked about quite a bit, even research and study about the stigma among medical professionals. 00:12:27.759 --> 00:12:42.879 And but you shared a really great story of how someone in the profession helped change that and said something that really became such a a shift in how you perceived people who use drugs. 00:12:43.200 --> 00:12:54.480 So, my my question to you is why do we see such stigma in the medical profession when we would think that's the opposite of where we would see stigma? 00:12:54.960 --> 00:13:15.519 And then what are ways that you've seen help change that or make it where more people have experiences like you where they hear kind, compassionate things versus stigmatizing or judgmental statements about the very same people we are caring for? 00:13:15.840 --> 00:13:22.480 Yeah, no, it is it is really sad that amount of stigma that we have as medical professionals. 00:13:22.639 --> 00:13:31.360 I mean, it's rampant and in every level of care, from nurses to doctors to higher-ups, you know, every level. 00:13:31.519 --> 00:13:42.559 Um, even I think I felt impacted by like after I had C-section, my nurse, like one of the nurses, not all of the nurses, they were like holding, withholding the pain medicine. 00:13:42.639 --> 00:13:48.480 And this is like after I delivered a human child being after being cut open in two, right? 00:13:48.720 --> 00:13:53.279 And I'm in pain, and she didn't give me the pain medicine. 00:13:53.440 --> 00:14:02.879 I've of course I didn't tell her that I'm a doctor who also takes care of addiction, so I know when I'm asking for something, like I know how to like navigate it. 00:14:03.039 --> 00:14:18.720 Um, I didn't want to throw that title around, but yeah, I saw the stigma firsthand myself, and it made me think if I'm experiencing this where I'm not being um given the medicine, even though I've like asked for it like third time uh and more. 00:14:19.200 --> 00:14:24.799 Uh, the I'm I'm I'm somebody who now knows how to advocate for myself in the healthcare system. 00:14:24.960 --> 00:14:33.120 What's happening to my other patients, especially if we're talking socioeconomic um and you know, equity and healthcare. 00:14:33.200 --> 00:14:40.080 Uh, women of color are commonly not given medicine, um, they're not believed, etc. 00:14:40.799 --> 00:14:46.320 So I knew that if she like pushed my button one more time, I knew how to escalate it, right? 00:14:46.639 --> 00:14:49.360 But most patients don't, they're not believed. 00:14:49.519 --> 00:15:00.240 And and that stigma was because they want to like be like hyper-vigilant, hyper uh defensive of even starting this. 00:15:00.320 --> 00:15:02.639 Now the pendulum has swung the other way. 00:15:02.879 --> 00:15:10.639 Um, so it's there, and I've I've witnessed it, I believe I've also taken part in it. 00:15:10.879 --> 00:15:16.720 Um, so this exists, I believe, to go go to go back to your question. 00:15:16.960 --> 00:15:26.080 Um, I think it's because number one, ignorance, I believe, is the root cause of all intolerance and prejudice. 00:15:26.320 --> 00:15:29.600 Okay, uh, no matter which topic you pick up. 00:15:29.679 --> 00:15:40.799 If you find somebody is being judgmental, that means their capacity to think diversely from different angles is limited. 00:15:40.960 --> 00:15:43.919 Um, so lack of information is number one. 00:15:44.159 --> 00:15:52.080 Number two, being set that your way of perceiving things is the only way is number two. 00:15:52.320 --> 00:15:55.919 And then number three, I think societal approach. 00:15:56.080 --> 00:16:13.039 I mean, obviously, as a society, we establish our norm that stealing is bad, killing is bad, raping is bad, and we have decided also that addiction is bad, which I can see a benefit of it to prevent the entry into it. 00:16:13.279 --> 00:16:28.480 But once somebody has fallen prey to these um diseases of the mind and body, um we need to now be able to switch gear, and I think society does not have that flexibility. 00:16:28.720 --> 00:16:33.840 We society likes black and white because it's easy to just categorize. 00:16:34.080 --> 00:16:38.639 Um I think that's why one of the reasons that happens. 00:16:38.960 --> 00:16:42.720 Now, how to um

tackle it, how to solve it. 00:16:42.799 --> 00:17:22.559 Um, once again, the first one is education awareness, to be able to learn about it, um, implementing it in medical education, showing it up in residency is a way to train the medical um call our medical colleagues and future doctors, nurses, counselors, just everybody across the spectrum on what it is for what it is, how to navigate it, and then equipping the tools to communicate with the people who are afflicted with this disease to be able to transition it because that's the other thing. 00:17:22.720 --> 00:17:33.119 Like when we don't know how something is gonna play out, how to be in control of it, fear, hatred, stigma, then start to reign supreme. 00:17:33.359 --> 00:17:55.920 Next step, I think what you're doing is very, very important is to educate the public via podcasts, via TV shows, um, news outlets, etc., to put destigmatizing, compassionate language out there that educates prevention as well as treatment. 00:17:56.160 --> 00:18:10.880 One of my biggest frustrations taking care of the patient population with addiction is the stigma that is in the different fields, different levels of treatment, um, especially in the recovery homes. 00:18:11.119 --> 00:18:26.319 When patients are trying to get into the you know sober living facilities, oftentimes they're still operating on that Oxford model where it's like you can't be on anything if you're gonna truly recover. 00:18:26.480 --> 00:18:30.319 And so oftentimes they will even decline treatment. 00:18:30.480 --> 00:18:50.319 Um, thankfully, Suboxone or buprenorphine is one of the treatment medicines that's the newer kid on the block and has a better face rep versus methadone, which is a really good treatment opportunity as well for those who it's a good fit for, um, has a really bad rep. 00:18:50.640 --> 00:18:55.599 Like before I started uh working at the methadone clinic, I didn't know enough about it. 00:18:55.839 --> 00:19:03.440 Even my colleagues who are board certified in addiction medicine uh don't know how the methadone clinics work. 00:19:03.599 --> 00:19:07.359 And so there's a lot of stigma when they're getting these medicines. 00:19:07.519 --> 00:19:10.720 My colleagues are calling it like they're getting their candy. 00:19:10.799 --> 00:19:12.720 So of course they're gonna listen to you. 00:19:12.880 --> 00:19:15.119 And I'm like, that's not the right way to think. 00:19:15.359 --> 00:19:24.160 So I come on these shows and I try to raise awareness, not only in the patient population, also in the medical professions. 00:19:24.480 --> 00:19:47.039 Yeah, it's good to hear when I talk with younger, newer clinicians, you know, I ask them about their college experience or their academics or their internships practicums, you know, whether it's like nurses, counselors, and I get excited when I hear them learning about like harm reduction in school now, or they're learning about MOUD. 00:19:47.680 --> 00:19:52.079 And I'm like,

I I didn't learn about any of this in in my academics. 00:19:52.240 --> 00:20:11.599 So part of that education early, and now it's I think almost it's there's gonna be a shift, I think, where it's almost gonna be weird if it's not covered in in early on, but like that's so important because I sometimes think like, where would where would I have been if I was taught that when I was young? 00:20:11.680 --> 00:20:30.640 Because I got into OTP work very similarly when I was offered a job and I had a lot of people telling me people on methadona are they just want to use their they just dose and go, they don't do counseling, and I'm a counselor being like I love counseling, so you mean I'm gonna go work there and I'm not gonna do counseling. 00:20:30.720 --> 00:20:37.200 So like I faced a lot of stigma, but at the same time, I'm like, how is this like the gold standard of treatment? 00:20:37.279 --> 00:20:42.400 How does this have so much benefits, and yet there is so much stigma behind it? 00:20:42.480 --> 00:20:58.079 I was like, this isn't my Columbo style of like not making sense drove me to say I need to learn this for myself because I wasn't getting a congruent answer between what the science was saying and what the very same people who do this work was saying. 00:20:58.319 --> 00:21:03.839 So I was like, all right, I'm gonna go find out and learn and if and find out what I know. 00:21:04.000 --> 00:21:15.440 So it's it's great to hear those experiences and and how we challenge the stigma because I think we need to play a part in it some way. 00:21:15.599 --> 00:21:26.480 I don't think we can take a backseat to the stigma that happens within our own profession, that we can't expect someone else to come in and address that. 00:21:26.559 --> 00:21:37.440 Like this is among our own professionals, our own colleagues, people who hold similar licenses, where part of us is to advocate on behalf of those who can't for themselves. 00:21:37.759 --> 00:21:40.640 So I really appreciate that that discussion. 00:21:40.880 --> 00:21:53.359 The other part of your story I wanted to ask about, which may seem like it's really way off in an ultimate direction, was the whole part about family practice and lens and the lifespan. 00:21:53.440 --> 00:22:06.240 You mentioned the lifespan, which I'm really curious about because in addiction work, whether it's drugs, whether Whether it's gambling, we always seem to talk about different parts of the life. 00:22:06.319 --> 00:22:11.440 You know, we look at prevention as being like early kids, teens, adolescents. 00:22:11.759 --> 00:22:30.079 And then we then we look at um ages in which people are you know either struggling the most or having some most difficulty, and then all of a sudden sometimes we forget about people as they age, even though some things I'm seeing is like drinking among older populations is is growing. 00:22:30.160 --> 00:22:42.960 Uh there's always been a concern with like gambling, not just with older ages, but also now younger with like sports betting, that addiction doesn't care how old you are. 00:22:43.599 --> 00:22:56.640 You know, like it doesn't matter what age you are, but it sometimes seems like we forget how it impacts and presents itself across the lifespan. 00:22:56.880 --> 00:23:09.279 It seems like we we tend to have this idea to become more targeted because then we think like if we have better approaches for this age group, then we're gonna have a better effect. 00:23:09.440 --> 00:23:14.640 But also we still need to be able to like take a step back, I think, and look at the lifespan. 00:23:14.720 --> 00:23:19.359 But we don't we don't really talk that way, or we don't really have discussions that way. 00:23:19.440 --> 00:23:37.759 So I'm very curious from your experience and really with that family, like why is it in why is that important to consider addiction and and other things across the lifespan versus thinking we can just address it at this age and then boom, we can take care of it? 00:23:38.240 --> 00:23:40.160 You know, that's a really great question. 00:23:40.319 --> 00:23:41.759 Nobody has asked me that. 00:23:41.920 --> 00:23:45.279 So I really appreciate you opening up this like fascinating. 00:23:45.440 --> 00:23:56.160 So I'm gonna be making up the answers as I go because I haven't had to uh like answer this really beautiful question before, but it's very profound. 00:23:56.240 --> 00:24:07.039 And as you were asking me, I'm thinking, like, you know, as I was mentioning like how my journey into the world of addiction treatment started and my awareness started. 00:24:07.200 --> 00:24:21.599 I was sharing the story about the baby who was going through neonatal abstinence syndrome, and this is something that started to happen from birth, and I'm gonna take a step back and say that it happens even before we're born. 00:24:21.759 --> 00:24:26.160 When we're like first being made, the Lego pieces are being put together. 00:24:26.559 --> 00:24:34.799 Genetics contributes 60% of the um the susceptibility to addiction. 00:24:35.039 --> 00:25:04.559 So there has been like twin studies done that showed if you have a set of twins with certain genetic um mutations that predisposes them to addiction versus twins who don't have it, and they took the twins and they put it in different homes where you know once uh one set of like the twins were in a house with substances and the other set was in homes without substances. 00:25:04.720 --> 00:25:22.640 And what they found is that you know, the foot the twins that didn't have the genes for addiction, they even though like in the the you know, the nurture, the environment was heavy with drug use, they you know, they were able to escape it. 00:25:22.799 --> 00:25:46.720 And and and opposite, the it was very interesting that even the twin who with the genes for addiction, uh, when they were in the environment where there was no substances, when they came across substance, like they had

a much stronger um response to it and had a much harder time quitting and and not getting addicted. 00:25:46.960 --> 00:25:54.400 So that came to show there's like 60% chance, and this is something we learn in our board certification process. 00:25:54.480 --> 00:25:59.039 So this starts even before you come on earth, basically. 00:25:59.200 --> 00:26:02.880 You come out of your mom's body and then keep moving forward. 00:26:02.960 --> 00:26:04.079 You're so right. 00:26:04.319 --> 00:26:15.279 Um, addiction claims anybody and everybody, it doesn't have a particular face, it doesn't have a skin color, it doesn't have a socioeconomic standard. 00:26:15.680 --> 00:26:26.319 Actually, the uh drug dealers will will more likely be to go after kids of the rich people or rich people because they have the funds to finance it. 00:26:26.799 --> 00:26:29.839 Um, now keep moving forward into the adult days. 00:26:29.920 --> 00:26:32.160 I'm gonna stop in the middle age real quick. 00:26:32.400 --> 00:26:44.319 One of the things that I've seen why the individuals start using in the middle ages, I mean, we know the early ages, the earlier you can hook them, the longer you can keep him. 00:26:44.400 --> 00:26:48.160 So there's that financial incentive for the drug dealers. 00:26:48.400 --> 00:26:54.640 Um for the middle-aged, it ends up starting as iatrogenic or prescription-wise. 00:26:54.880 --> 00:27:07.759 They may suffer from um an injury or they have back pain or they may have undiagnosed other conditions like rheumatoid arthritis, and they're just going everywhere, they can't get the relief. 00:27:07.920 --> 00:27:32.799 They take either a prescription for a provider or their friend's medicine, and then all of a sudden, you now have this like, I need this to sustain my quality of life, and then it goes out of hand, and then they end up engaging in um you know illicit activities, buying medicines up the street, not knowing what it is. 00:27:32.960 --> 00:27:36.319 And right now, what's on the street is called M30s. 00:27:36.559 --> 00:27:41.839 These are sold as oxy pills, but then these are pure fentanyl, right? 00:27:42.000 --> 00:27:52.240 And so they're taking it, they don't know what it is, you have lots of overdoses, or it just basically damages the body's chemical balance so much. 00:27:52.480 --> 00:27:57.759 Um, disate the body disables a lot of its mechanisms to keep the person alive. 00:27:58.000 --> 00:28:02.640 And so when you don't have these chemicals there, the disease state sets in. 00:28:02.880 --> 00:28:08.720 Um, and so that's how the middle-aged population have seen they get hooked. 00:28:08.880 --> 00:28:23.599 Another thing that can happen is that after they have been exposed to the easy access to these substances, life events happen like divorce or infidelity, loss of job, death in the family, like some sort of trauma. 00:28:24.079 --> 00:28:26.559 And then they turn to these things to cope. 00:28:26.720 --> 00:28:28.559 So that's what I've seen in the middle age. 00:28:28.720 --> 00:28:31.519 And then fast forward to the elderly. 00:28:31.599 --> 00:28:34.160 Um, it's interesting you bring up the alcohol. 00:28:34.240 --> 00:28:42.720 So there's polypharmacy in the elderly, lots of prescriptions uh for a lot of uh problems that are happening in the body. 00:28:42.960 --> 00:28:47.200 One of the biggest problems for them is the lack of sleep, insomnia. 00:28:47.359 --> 00:28:59.200 I mean, naturally, as we age, our body has reduced ability to heal itself, our sleep cycle gets more shortened, um, so you don't get that restful sleep as much. 00:28:59.519 --> 00:29:03.440 Um, so individuals may turn to that. 00:29:03.680 --> 00:29:14.079 Um, insomnia can also happen because of other underlying conditions, like if somebody has obstructive sleep apnea, so their sleep is already disrupted, that impacts it. 00:29:14.400 --> 00:29:28.160 And oftentimes people don't realize that they already have been using alcohol socially, then they start to use it self-prescriptively to they drink, to sleep, to relax and sleep. 00:29:28.319 --> 00:29:37.599 And what happens is alcohol is not natural for the body, it's not something that's friendly to the body. 00:29:37.839 --> 00:29:46.160 Um, and so over time the the chemical balance in the body shifts again, and so then the disease starts to settle in. 00:29:46.240 --> 00:30:06.960 So you can have addiction to alcohol happening accidentally, um, and then also sleep medicines that are habit-forming, like the benzodiazepines, they may take it for anxiety because you know, loss of family members or stressful situations or untreated PTSD from the past. 00:30:07.119 --> 00:30:16.400 Our previous generations have a huge trauma history, they don't realize it because uh mental health didn't exist back then, basically. 00:30:16.559 --> 00:30:20.000 Um, and so they won't go, they won't get that help. 00:30:20.079 --> 00:30:27.039 But then all those years of trauma compound, and so they get on these um anxiolytics or anxiety medicines. 00:30:27.359 --> 00:30:44.400 Um, and benzodiazepines impact you the same way uh alcohol does, you know, lots of uh similar mechanisms in the body of how it works that impacts your body's sleeping skills when you don't have those substances in the body anymore. 00:30:44.559 --> 00:30:50.319 And so then the addiction starts, the um the dependence starts in that way. 00:30:51.440 --> 00:30:57.519 That's a great rundown of just some things that are happening and going on across the lifespan. 00:30:57.680 --> 00:31:36.480 I think it's just so important to realize like to step outside and see things from that lifespan perspective at point and and to like revisit it, not being stuck somewhere, but I I often think we forget about even how people are going to what's recovery gonna look like when they're in their 70s and eighties, you know, like sometimes someone's support network is gonna be entirely different, they're gonna go

through maybe a lot of loss um at that time, and we don't always play into factor just that lifespan and where they are. 00:31:36.720 --> 00:32:08.880 Because I remember like in academics, you know, I there was texts and courses on across the lifespan, uh, you know, we talked about psychosocial development and Erickson stages, and then it sometimes seems like then when we move into treatment and other things that we sometimes forget about some of those very important pieces that we learned about when it comes to someone's just development and as they as they age and go through life and how things change, even through addiction and mental health and other things. 00:32:09.039 --> 00:32:15.519 So, you having that family background, I was very curious about how to think more about that into the work that we do. 00:32:15.680 --> 00:32:22.000 So I appreciate the the insight and being willing to explore that question. 00:32:22.720 --> 00:32:23.440 No, of course. 00:32:23.599 --> 00:32:27.440 And once again, thank you for asking this very fascinating question. 00:32:27.599 --> 00:32:29.039 It was it was a deep question. 00:32:29.200 --> 00:32:30.400 I appreciate that. 00:32:31.119 --> 00:32:42.799 One thing you mentioned, which I'm also curious was um helping, I don't know how you put it, you might have to re-remind me, but it was like helping find purpose or identify purpose. 00:32:42.880 --> 00:32:46.960 And I'm I'm curious how do you do that when you're working with someone? 00:32:47.200 --> 00:32:53.839 Because it might be real easy to say to someone, here, here are some options as far as medications to give you. 00:32:54.000 --> 00:33:00.799 This is what it does, this is how long to take it, these are things to be um side effects to be aware of. 00:33:00.960 --> 00:33:16.079 Even for me as a counselor, it might be easy for me to be like, uh, we're gonna look at CBT to help you with something, or MI, you know, I can talk about a treatment modality, but then all of a sudden, I'm gonna talk to you about finding purpose. 00:33:16.319 --> 00:33:25.759 And that that might seem a little awkward, or like, how do we prescribe or introduce that into work that we're doing? 00:33:26.319 --> 00:33:37.279 And yet, I think most people would identify purpose and meaning is very important, like that is a vital thing. 00:33:37.680 --> 00:34:00.559 So I'm very curious with that being something that can you talk a little bit more about what that means to you or like how you use that with individuals in a way of how do you even begin to have that conversation, or how do you maybe anchor that in things that you're doing to sort of help drive what they are wanting to accomplish? 00:34:00.640 --> 00:34:02.880 Uh, anything you can share about that? 00:34:03.279 --> 00:34:04.240 Yeah, for sure. 00:34:04.319 --> 00:34:06.640 You're you're just asking like awesome questions. 00:34:06.720 --> 00:34:08.320 I'm loving this, by the way, Andrew. 00:34:08.400 --> 00:34:10.639 Thank

you for asking these deep questions. 00:34:10.880 --> 00:34:14.400 Um, I'm gonna hit the pause button one second. 00:34:14.480 --> 00:34:17.280 I'm gonna fix this light thing so it doesn't show up. 00:34:17.440 --> 00:34:21.679 I'm sorry, when we started, it was like the sun was down, so I didn't even think about it. 00:34:24.000 --> 00:34:47.119 Yeah, so going back to your question uh or starting on the question of purpose, it is, I found one of the actually most powerful tools that helps me guide the patient from this abyss they're in and to not back on not only back onto like level floor, but it actually helps me help them transcend. 00:34:47.199 --> 00:34:52.639 Um, and this concept of purpose is actually, I have to give credit to my patients. 00:34:52.880 --> 00:34:54.960 Um, now where do we start? 00:34:55.199 --> 00:35:16.159 I think the first place to start is to see the patient across from us not only as a disease, you know, that's the way that allopathic models have taught us is that here's a 46-year-old male coming in with a list of diseases, and that's basically it. 00:35:16.320 --> 00:35:21.519 You know, that's how we round on the patients with each other. 00:35:21.840 --> 00:35:29.760 It's great for like conveying our doctor work messages to each other to get give each other context of what we're dealing with. 00:35:29.920 --> 00:35:38.960 Um, but in the process of becoming this really lean and efficient machine of being a doctor, having to work in the healthcare field. 00:35:39.119 --> 00:35:52.719 I'm talking as a doctor because that's my experience, but I'm sure it's something that our nurses, physicians, assistants, allied health professionals, they all deal with is that you have to like we get fixated on it. 00:35:52.880 --> 00:36:00.880 And then also as a self-protective mechanism, so we can keep moving like a machine, we get detached in emotion. 00:36:00.960 --> 00:36:05.360 So a little bit of dissociation happens for self-preservation. 00:36:05.599 --> 00:36:14.639 Um and I think over time that dissociation becomes such second nature, we don't even pause to see the person in front of us. 00:36:14.800 --> 00:36:22.239 That the person who's there with addiction, with back pain, with um whatever it is that they're dealing with. 00:36:22.559 --> 00:36:30.000 The you know, people normally come to the doctor when they're hurting, they don't come to the doctor when trouble is brewing. 00:36:30.320 --> 00:36:32.880 So it's up to us to catch them early. 00:36:32.960 --> 00:36:37.360 That's what the prevention part is about, and screening for other things come up. 00:36:37.679 --> 00:36:41.760 Once again, like we lose sight of that because I'm gonna blame. 00:36:41.840 --> 00:36:49.360 There's a lot of systematic things that prevents us from showing up as a human to support another human. 00:36:49.679 --> 00:37:05.920 We are so um overburdened with paperwork, administrative stuff, um, that we lose the ability to serve the human being

in front of us. 00:37:06.159 --> 00:37:11.920 Those other emotional, spiritual, social needs, we don't even think about it. 00:37:12.079 --> 00:37:16.960 Maybe this is capitalism, maybe it is the fast food medicine style. 00:37:17.199 --> 00:37:19.519 So that's a conversation for another day. 00:37:19.599 --> 00:37:27.440 I think I can go on and on about like where are all the things we're having issues and we need to figure out how to solve it. 00:37:27.679 --> 00:37:32.320 But coming back, step one is to recognize the person in front of you. 00:37:32.480 --> 00:37:42.000 And I think for me, it's a lot easier because I studied in the osteopathic model and it's a holistic principle to begin with. 00:37:42.400 --> 00:37:45.440 We have four tenets of osteopathy. 00:37:45.679 --> 00:37:56.239 It was uh designed by a doctor who was fed up and frustrated with the way that um, you know, the allopathic way of treatment was. 00:37:56.480 --> 00:37:56.800 Dr. 00:37:56.880 --> 00:38:09.519 Andrew Taylor still, he was a physician in the Civil War era, and he lost his son to pneumonia as a baby, and the doctors at that time like didn't support in any other way, you know. 00:38:09.760 --> 00:38:12.159 Infection happened, that's it, the baby is gone. 00:38:12.320 --> 00:38:18.880 And then when he's serving in the Civil War, um a soldier gets a bullet in the leg. 00:38:19.039 --> 00:38:23.039 Then the solution for that is amputation right there on the field. 00:38:23.280 --> 00:38:30.239 No um, you know, attention to how that impacts them mentally, physically, and beyond. 00:38:30.400 --> 00:38:32.880 What does being crippled feel like? 00:38:33.039 --> 00:38:34.800 No, there was no further attention to that. 00:38:34.960 --> 00:38:39.519 Here's a gunshot wound to the leg, chop it off, move on to the next patient. 00:38:39.840 --> 00:38:44.719 This led him to approach medicine and teach a new philosophy. 00:38:44.880 --> 00:38:48.480 And he said that the body is a mind, body, and spirit. 00:38:48.719 --> 00:38:54.960 The body has the ability to heal itself, and its job is to put things back in balance, basically. 00:38:55.199 --> 00:38:57.920 And our treatment process has to come from that. 00:38:58.159 --> 00:39:05.599 So, repetitively, in every part of our lecture in our school, everybody was saying you can't just focus on the numbers. 00:39:05.760 --> 00:39:08.559 You have to see the person who is in front of you. 00:39:08.719 --> 00:39:10.239 You have to treat the person. 00:39:10.800 --> 00:39:17.119 So I spend a lot of time in that because I think that is the number one thing we need to do. 00:39:17.280 --> 00:39:26.559 We all come into the healthcare because we want to serve others and make their lives better by the time we're done coming out of the system. 00:39:27.039 --> 00:39:34.159 Uh, we are amazing, but we also lose a lot of our um humanness, I think. 00:39:34.320 --> 00:39:38.559 Um, so I tried my best to hold on to that and revitalize that. 00:39:38.800 --> 00:39:42.480 So this led me to when I'm meeting the person in front of me. 00:39:42.719 --> 00:39:45.920 I like to pay attention to what is their story. 00:39:46.320 --> 00:39:51.760 Because yes, they are, they have addiction, their body's hurting with withdrawal symptoms. 00:39:52.000 --> 00:39:56.079 I have the medicines that I can just prescribe and just let them go. 00:39:56.239 --> 00:39:58.239 And many of my colleagues do. 00:39:58.400 --> 00:40:12.000 Uh, however, I like to connect with the person because I think once we connect, that report builds, that trust develops, and now we can talk about other things and actually guide them through the process. 00:40:12.559 --> 00:40:20.159 And what I've found is that a lot of people they'll be saying, like, I'm just using because I was bored, you know. 00:40:20.400 --> 00:40:23.920 And what I realized is that how do you have time to be bored? 00:40:24.000 --> 00:40:28.880 There's so much to be done, you know, the world is waiting for you. 00:40:29.039 --> 00:40:36.719 You know, you can go volunteer in a soup kitchen, you can go volunteer in Habitat for Humanities and help other people build their home. 00:40:36.880 --> 00:40:38.239 Everybody has a gift. 00:40:38.400 --> 00:40:40.960 How are you sitting there not doing it? 00:40:41.039 --> 00:40:44.000 You can go wash the dishes, you don't have time to be bored. 00:40:44.079 --> 00:40:45.119 Do the laundry, right? 00:40:45.199 --> 00:40:46.400 I need help with laundry. 00:40:46.480 --> 00:40:49.599 I hate doing laundry, but it keeps you busy. 00:40:49.840 --> 00:41:01.840 Um, so then I started to realize that number one, they are sinking into this as an escape when they're using the substances, and that is sometimes to fight boredom. 00:41:02.239 --> 00:41:06.320 And then on the other hand, I see patients that are like, I'm ready to quit. 00:41:06.480 --> 00:41:10.000 I want to get my kids back because CPS took them away. 00:41:10.159 --> 00:41:11.840 I'm living on the street. 00:41:12.159 --> 00:41:17.840 I have a horrible relationship with everybody, and so that becomes their purpose. 00:41:17.920 --> 00:41:23.119 They want to get their little girl or their little boy back, and then that motivates them. 00:41:23.280 --> 00:41:31.599 I found like that is such a powerful magnet to suck them out of this um abyss and help them move up. 00:41:31.679 --> 00:41:34.800 And and so that really caught my attention. 00:41:35.119 --> 00:41:38.800 And so I like to ask my patients, like, why are you doing this? 00:41:38.960 --> 00:41:40.000 Why do you want to quit? 00:41:40.159 --> 00:41:40.719 What is it? 00:41:40.800 --> 00:41:44.400 Is it because the police, the the judge is telling you to quit? 00:41:44.559 --> 00:41:47.199 Is it because you're tired of your mom snagging? 00:41:47.360 --> 00:41:51.760 Those things they don't succeed when it's coming from outside. 00:41:52.159 --> 00:41:56.079 People have a really hard time sticking to it.

00:41:56.239 --> 00:42:03.519 Versus when it comes from inside with absolute conviction that there's no other way, they're the patients who succeed. 00:42:03.760 --> 00:42:06.079 So that's how I first noticed it. 00:42:06.320 --> 00:42:17.039 Um, and then over the years, I love being able to, you know, help patients by stabilizing their body with the medicines that I have access to and the knowledge. 00:42:17.119 --> 00:42:22.239 Um, and then I realized like when that stops, um, purpose is what takes over. 00:42:22.480 --> 00:42:29.280 So I went and I became a coach and I combine now my medical knowledge with my coaching skill set. 00:42:29.519 --> 00:42:37.599 And what we do is um I was running a group, we were doing um what I call six dimensions. 00:42:37.760 --> 00:42:43.440 We try to focus on six dimensions and set goals and practice having that purpose. 00:42:43.599 --> 00:42:55.119 So in the physical, mental, spiritual, social, financial, and aspirational, um, we try to set those goals 90 days at a time and hit them. 00:42:55.440 --> 00:43:02.960 And that way people build up not only like how to have their goals set, but how to work towards it. 00:43:03.039 --> 00:43:08.320 And all of this overall is you know, I ask them, what is it that you're trying to become? 00:43:08.480 --> 00:43:10.480 What version of you would be happy with? 00:43:10.559 --> 00:43:17.760 But sometimes you feel too nervous or like you need permission to believe that you can do that. 00:43:17.920 --> 00:43:33.920 So normally when people feel that rush of dopamine, when they think about a normal, healthy image, I find that is a great replacement for this addiction because I believe we were created to be addicted. 00:43:34.159 --> 00:43:36.880 That's the motivation to become somebody greater. 00:43:37.199 --> 00:43:50.559 And when you can make that objective, something healthy, something transcendent, then you know, your dopamine, your reward pathway is actually being used the way it should be used. 00:43:50.880 --> 00:43:52.880 Um yeah. 00:43:53.199 --> 00:43:59.599 So I I think the drugs, they don't only hijack our reward pathway. 00:44:00.000 --> 00:44:03.760 They hijack our ability to fulfill our purpose. 00:44:03.840 --> 00:44:12.960 And I believe everybody's created with a purpose, a good purpose, and um helping individuals figure out what that is and hone in on that. 00:44:13.119 --> 00:44:19.519 Then you just become tunnel vision from everything else and you just launch forward and keep working forward. 00:44:19.760 --> 00:44:21.599 I found it's very powerful. 00:44:22.000 --> 00:44:31.039 And I think one of the ways you introduced how to do that is in the questions we ask and even how powerful but yet different they can be. 00:44:31.199 --> 00:44:39.360 So instead of asking, you know, hey, what are you, what are your symptoms or what are you um what are you experiencing behavioral-wise? 00:44:39.519 --> 00:44:46.800 Like so many people can list similar things, and that's not always what makes someone unique and different. 00:44:47.039 --> 00:44:52.079 But when you use the question about, you know, I want to know about their story, what's your story? 00:44:52.320 --> 00:44:56.320 That is what's going to make it very unique and different about who they are. 00:44:56.400 --> 00:44:59.599 That's the difference between what you have and who you are, right? 00:44:59.760 --> 00:45:05.599 And then also when you talk about, you know, what is your what is your purpose? 00:45:06.159 --> 00:45:14.239 You're also asking more, not just about what are you looking for to feel better right now, but you're also looking at like meaning and deeper down. 00:45:14.320 --> 00:45:26.960 So I think even just the way you craft some of those questions that we don't normally ask, and those aren't usually, you know, those aren't on standard assessments and screening instruments. 00:45:27.119 --> 00:45:27.840 What's your story? 00:45:27.920 --> 00:45:48.960 You know, it's usually check off some boxes, and it's usually some standard questions that match to certain things, but uh rarely are they ones that ask and require more of that deeper insight, thought providing human human responses. 00:45:49.119 --> 00:45:56.719 It's normally, you know, like a checkbox, not a uh empty space to write down a narrative or something. 00:45:56.880 --> 00:46:14.800 So I I think that's you you've taught me even in just the questions to ask in a way that can get people and myself to think more on that human level versus a behavior or a symptom type question that we're usually pros at. 00:46:14.880 --> 00:46:18.239 Like we know how to ask the questions and go through the checkboxes. 00:46:18.559 --> 00:46:25.039 As you said, the questions we ask, these are the questions to appease the insurance payers, right? 00:46:25.199 --> 00:46:27.679 All the check boxes are built around that. 00:46:27.840 --> 00:46:39.840 And instead of being able to just sit and connect with the human being in front of you, um, we are sitting there just trying to get through this list, the screening thing, etc. 00:46:40.239 --> 00:46:42.400 I mean, those have their places. 00:46:42.559 --> 00:46:46.559 I think they're very important, but we're not given the time. 00:46:46.719 --> 00:46:49.599 We're we're a fast food restaurant in many ways. 00:46:49.840 --> 00:46:57.840 You know, you don't come in there for the experience, you just come in there to just um shut up your hunger and keep moving forward. 00:46:58.000 --> 00:47:04.159 And in the process, what you put in is not something that's good for your body, good for your soul. 00:47:04.320 --> 00:47:16.079 Um, I think when we start to practice as the human improvers that we are, I think it becomes a lot more, much more powerful. 00:47:16.239 --> 00:47:29.199 This is why AI is never gonna replace humans, because that that aspect that we have, that need for social connection, that soul-to-soul connection, AI will never be able to

have that. 00:47:30.159 --> 00:47:39.199 Yeah, this is a fascinating conversation, and I know we're gonna need to wrap up, which is okay, because we just have so much great things to talk about. 00:47:39.440 --> 00:47:44.320 One thing before we do wrap up, I wanted to ask about is you you do a lot of things. 00:47:44.400 --> 00:47:52.800 You've you speak, you're a doctor, you you do a ton of different things, you balance many hats. 00:47:53.039 --> 00:48:03.760 I'm curious, and you even mentioned the coaching, like even you went in in coaching, and I don't know if I've ever heard of a lot of doctors who then went and did coaching after. 00:48:04.159 --> 00:48:27.199 Uh so I guess my question to you is when you've done all these different things, what is it that's pulled you to then say this is something else I need to learn, or something else I need to add to what I offer people versus thinking, you know, I've got this, so I'm I'm good. 00:48:27.360 --> 00:48:38.639 I can now but you you seem to have continued to find new or or different things to add to the service you provide for others. 00:48:38.880 --> 00:48:49.360 I'm curious what drives that versus someone who thinks I'm at I got to this degree or I got to this point and I'm good with that. 00:48:49.519 --> 00:48:57.840 You seem like you're always kind of maybe on the lookout for what you could do or what might you need to do in service of others. 00:48:58.000 --> 00:49:07.360 So can you answer that on what sort of drives you to continue to find ways to to help others? 00:49:07.519 --> 00:49:10.880 I guess is a easy way to ask that. 00:49:11.280 --> 00:49:21.039 Yeah, and and it's actually a very um like great way to segue from your last question because the answer is purpose. 00:49:21.840 --> 00:49:28.400 It's I'm I'm just like full-fledged um falling forward into purpose. 00:49:28.719 --> 00:49:43.920 And the reason is when you are doing that which you are uniquely built to do, the amount of dopamine that you get is like really, really insane. 00:49:44.559 --> 00:49:55.519 Um with the like I like to say, with the substances, you have like a quick hit, you have a quick high, but your body's not ready to sustain that amount of dopamine. 00:49:55.679 --> 00:49:59.199 So what follows it is a hard crash, right? 00:49:59.840 --> 00:50:13.840 And our bodies, if you look at the science behind our the laws of uh nature of our how of how our body works, it's really good at adapting over time if you give it time to acclimate. 00:50:14.159 --> 00:50:26.000 But if you do these rapid ups and downs, the body cannot keep up with it because I mean it has so many systems, it has to shift into another uh field, um, another gear. 00:50:26.159 --> 00:50:35.039 So this is why, like if you are climbing the Himalayas or you're coming up from diving, you know, if you come up too quick, it can hurt you. 00:50:35.199 --> 00:50:40.880 Or this is why, you know, the divers and the climbers they acclimate level by level. 00:50:40.960 --> 00:50:43.280 They they they take the time to come up. 00:50:43.519 --> 00:51:03.920 And so, similarly with purpose, what I've found is that uh when I started to lean more into it, um it not only helped me overcome my own depression, anxiety, PTSD, and etc., it helped me with next moving on to the next level. 00:51:04.079 --> 00:51:14.000 Um, and as I gave myself time, as I keep building on it, because having to become a doctor, it was one of the most intense things I went through in my life. 00:51:14.239 --> 00:51:17.599 For example, having to be in three places at the same time. 00:51:17.840 --> 00:51:21.119 I had to learn how to adapt to that really quickly. 00:51:21.280 --> 00:51:33.039 Um, there was this night in residency where I was doing an ER admission while I was uh attending to a code blue in the ICU. 00:51:33.360 --> 00:51:37.119 And then on the floor, the nurse is saying, My patient is sundowning. 00:51:37.360 --> 00:51:40.000 I need some Atavan prescription, right? 00:51:40.079 --> 00:51:45.280 I had to do all three at the same time because all of them were apparently equally important. 00:51:45.920 --> 00:51:52.719 Um, so I learned how to like reach a huge amount of my human potential. 00:51:52.880 --> 00:51:55.760 Um, so I didn't give that up after I left. 00:51:55.840 --> 00:52:04.239 And then I had to learn on the go as a doctor, you know, have to see patients and study for my boards and pass it at the same time. 00:52:04.480 --> 00:52:09.199 Um, so not everybody in the world gets to have that experience. 00:52:09.360 --> 00:52:18.079 I could have easily, like after I was done paying my student loans and had my baby, say, like, I've achieved everything, I can just now go on cruise control. 00:52:18.480 --> 00:52:24.480 I could have, you know, I could have enjoyed everything that I had and be good for the rest of my life. 00:52:24.800 --> 00:52:28.559 But something is that I think we all have it. 00:52:28.719 --> 00:52:33.280 We have a need to contribute because it makes us feel significant. 00:52:33.599 --> 00:52:36.800 Um, that's one of like Maslow's hierarchy of needs, right? 00:52:36.960 --> 00:52:39.039 The contribution aspect of it. 00:52:39.280 --> 00:52:48.639 Um so for me, that was that like I have to keep growing because now I was just stuck in this like constant learning and growing mode. 00:52:48.880 --> 00:52:51.199 Not doing that also made me feel anxious. 00:52:51.280 --> 00:52:57.760 So this was like my self-medication is that I have to keep knowing because there's so much to learn in the world. 00:52:57.920 --> 00:53:09.840 And once you dive into it, that acquisition of knowledge, that acquisition of a new skill makes you feel fuller, makes you feel bigger. 00:53:10.079 --> 00:53:15.840 And if we're not growing, the only thing that doesn't grow is the non-living. 00:53:17.920 --> 00:53:36.480 So for me, this was a way of experiencing being alive, which is sometimes that uh initial part of

addiction is people are using to feel alive when they're just so submerged in trauma and negative things all around them. 00:53:36.639 --> 00:53:39.920 There's no escape, they feel helpless, hopeless. 00:53:40.239 --> 00:53:43.599 So to have a quick escape, people turn to drugs. 00:53:43.679 --> 00:53:45.519 That's what the people who are bored do. 00:53:45.679 --> 00:54:06.400 That's what the people who have, you know, war zones or extreme trauma, extreme poverty, uh, societal injustice, um, uh racial discrimination, you'll see like these things are very predominant in the population because they feel hopeless, helpless, they don't feel they can do anything with their lives. 00:54:06.480 --> 00:54:07.679 So this is an escape. 00:54:07.840 --> 00:54:10.960 Many people use initially to escape their situation. 00:54:11.199 --> 00:54:28.400 Kids, if they're seeing that their parents are getting divorced, constant fighting happening at home, these kids are more likely to become um, you know, fall prey to the uh the friends who are selling uh fun time to them in the guise of friends, right? 00:54:28.800 --> 00:54:35.280 So um, yeah, so I believe that I have a purpose as well. 00:54:35.440 --> 00:54:41.039 And if I have life has trained me to become what I have, it would be a shame to let it go. 00:54:41.199 --> 00:54:44.400 So the next thing for me to do is to just keep growing. 00:54:44.639 --> 00:54:50.159 And in the process, the dope, as I said, the dopamine hit I get is just keeps me going. 00:54:50.400 --> 00:54:58.320 Um, but because I'm doing this over time, you reach then the the peak performance state. 00:54:58.559 --> 00:55:09.039 So that's a state where your ground goes up with you basically, and you're just constantly living in that high life while your baseline has also shifted to higher. 00:55:09.280 --> 00:55:13.679 So if you fall, it's kind of like falling on a flat surface. 00:55:13.760 --> 00:55:15.760 You're not falling off a cliff. 00:55:16.719 --> 00:55:21.440 So yeah, this the purpose is the sun in my horizon, as I like to say. 00:55:21.599 --> 00:55:23.360 What is the sun in your horizon? 00:55:23.760 --> 00:55:36.719 But I think that's an important takeaway because of not only is that something to ask, inquire, and explore with the people we're serving, but also as providers ourselves. 00:55:36.960 --> 00:55:40.800 Like we're not we talk about all these things that make us human, yeah. 00:55:41.039 --> 00:55:49.599 That that doesn't that means us as well, that we're not immune or you know, like excused from any of this this stuff as well. 00:55:49.840 --> 00:56:04.800 So I really appreciate that your willingness to share that about yourself, and part of exactly what we need to do as as helpers is go through that process too, that we would want our the people we serve to go through too. 00:56:05.199 --> 00:56:07.440 So amazing conversation. 00:56:07.599 --> 00:56:10.559 Yeah, we could talk for a long time. 00:56:11.119 --> 00:56:20.079 After our based on our discussion and uh anything else you want to share, what would be your final takeaway for listeners? 00:56:21.039 --> 00:56:41.360 Um, you know, the takeaway that I like to leave folks with is if you determine or if you decide that you're gonna become a great greatness, you're gonna your destination is greatness, and you decide that you're gonna do it, you become greatness in progress. 00:56:41.760 --> 00:56:47.519 So at the beginning, you may feel like you're nothing, but don't give up hope in yourself. 00:56:47.679 --> 00:56:51.679 You have to be the first believer in your crazy inspiration. 00:56:51.920 --> 00:57:00.400 And who knows, maybe this is what's gonna, you know, be the next big thing that makes people's life um better. 00:57:00.639 --> 00:57:01.679 Don't give up. 00:57:01.760 --> 00:57:18.239 Uh, we healers need to remember that we're humans, and that means that we not only show up as human beings for the humans in front of us, but we also take care of our human needs, and that means we need connection, we need forgiveness, we need love. 00:57:19.039 --> 00:57:23.199 And one of the first people you need to get that from is yourself. 00:57:23.519 --> 00:57:27.760 Um, so I think that's a good place to wrap up. 00:57:28.159 --> 00:57:29.440 Yeah, that's amazing. 00:57:29.599 --> 00:57:30.480 Thank you so much. 00:57:30.639 --> 00:57:34.000 Uh the conversation was amazing. 00:57:34.159 --> 00:57:42.639 I I think we covered uh some areas around addiction and and recovery and humanness in ways that uh we don't always have those conversations. 00:57:42.719 --> 00:57:54.079 So I'm really thankful that we had this space to do that, and you were so willing and able to be able to shed light on those, those areas that we don't always get time to talk about. 00:57:54.400 --> 00:57:56.239 So I want to thank you again, Dr. 00:57:56.320 --> 00:57:58.079 Sarah Nasir, for being here. 00:57:58.159 --> 00:58:06.079 We're gonna have ways for people to learn more about you, links to connect with you in the podcast notes, but it was a pleasure having you on the podcast. 00:58:06.480 --> 00:58:07.199 Thank you, Andrew. 00:58:07.280 --> 00:58:08.960 It was a pleasure being on the show. 00:58:09.119 --> 00:58:16.320 Thank you for inviting me and giving me the time to share, you know, from what I've learned with the rest of the crew. 00:58:16.880 --> 00:58:18.480 Well, another great episode with Dr. 00:58:18.559 --> 00:58:19.519 Sarah Nasir. 00:58:19.760 --> 00:58:27.599 One quick thing before you go if you've gotten value from this show, the best thing you can do to support is to leave a review on Apple Podcasts. 00:58:27.920 --> 00:58:29.840 I'm not asking for anything elaborate. 00:58:30.079 --> 00:58:33.920 Tap the stars, write a few sentences about what this show means to you. 00:58:34.159 --> 00:58:37.920 Ratings helps more people in the behavior health and recovery space. 00:58:38.079 --> 00:58:38.880 Find us. 00:58:39.199 --> 00:58:39.760 Thank you. 00:58:39.920 --> 00:58:43.039 I appreciate you, and we'll talk to you in the next episode. 00:58:44.639 --> 00:58:48.079 You've been listening to Talking Addiction and Recovery with Andrew J. 00:58:48.239 --> 00:58:48.800 Tryer. 00:58:48.880 --> 00:58:57.360 We're so glad you've joined us and invite you to connect further with the show and these topics at www.andrewjdryer.com. 00:58:57.519 --> 00:59:02.559 That's andrewjsc r e-i-e R dot com. 00:59:02.960 --> 00:59:08.400 You can also email us directly at talkingaddictionandrecovery at female.com. 00:59:08.559 --> 00:59:19.440 And connect on social media Instagram at Talking Addiction and Recovery, Facebook, Talking Addiction and Recovery Podcast, and Twitter at talk AR underscore podcast. 00:59:19.599 --> 00:59:24.000 To stay connected and never miss an episode, be sure to like, rate, and subscribe. 00:59:24.239 --> 00:59:28.000 Until next time, friends, let's keep talking addiction and recovery.