“Is MAT swapping one drug for another?”
About the episode:
What if everything you’ve been taught about recovery is wrong?
What if the thing your family fears —medication—might actually be the one thing that could help save your loved one’s life?
You might recognize names like methadone, suboxone, sublocade, buprenorphine, and others.
In this episode, we talk honestly about what MAT is, how and why it works, and why so many families still judge it. We dig into the hard truths—how detox alone sets people up to fail, how shame keeps loved ones stuck, and how MAT creates the chemical stability that recovery literally cannot happen without.
Guest: Dr. Sarah Nasir, DO, Addiction Medicine & Osteopathic Family Medicine
A dual board-certified physician in Addiction Medicine and Family Medicine, and founder of Zenara Care and Transcendant You, Dr. Sarah Nasir blends medical science with human-centered insight to help people find their true strength in recovery. She reframes healing as more than sobriety—it’s about thriving with clarity, purpose, and joy.
This episode will help you:
Understand the real science behind MAT and why it stabilizes the brain when nothing else does
Break free from the biggest stigmas, including why the “one drug for another” myth does more harm than good
See what recovery actually requires beyond detox, tough love, or willpower
Find clear ways to support your loved one without shame, judgment, or outdated beliefs
Episode links
MORE FROM DR. SARAH NASIR
Understand the 3 phases of treatment: https://youtu.be/9gxEYpeJN0g
Download the Opioid Recovery Guide at https://getformly.app/L12BzT
Resources
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[00:00:00] Sarah: They're trying to go into a rehab which doesn't believe in methadone. That becomes an extra level of struggle because the patient already has a lot of inner doubt, everybody around them saying that you should be coming off of it. It is so easy to break something takes shorter amount of time. You'll drop a cup and shatter it then to pick up all the pieces and put it back together.
[00:00:34] Dominique: Welcome to FLOR For Love of Recovery, where I'm your host, Dominique Dajer. Sibling relationships can be so unique, but they can become more complex when there's drug or alcohol use involved. If you find yourself questioning how to help, you're not alone. Every month we bring together stories that empower you to navigate your sibling's addiction and offer a sense of connection.
[00:00:51] Dominique: We also provide fresh perspectives on understanding substance use and how to protect your peace. Join me on this journey in restoring hope and healing.
[00:01:09] Dominique: If you have a family member who has sought out addiction treatment, or you've been a resource to help them get into treatment, you know how challenging it can be to get them the right help from insurance concerns to medication stigma, to getting the right care after the 30 day mark, supporting them along the way and everything in between.
[00:01:25] Dominique: Today we have Dr. Sarah Nasir to talk about what's possible when the system works, and why families deserve access to evidence-based stigma free care. Dr. Nasir is a dual based certified physician in addiction and family medicine and blends medical science with human centered insight to help people find their true strength and recovery.
[00:01:43] Dominique: Thank you so much for being on the show today. I am super excited to have this conversation with you.
[00:01:49] Sarah: Thank you so much, Dominique, for having me on the show.
[00:01:51] Sarah: It's a topic that's very close to my heart and this is my opportunity to give back to the world in my way. I'm thankful to be able to share it.
[00:02:01] Dominique: Absolutely. Of course. Thank you for being here. Before we jump in, I'd love to get the audience more acquainted with who you are. And what exactly got you into the work that you're doing today?
[00:02:12] Sarah: Great question. I think I just really resonate with the human struggle, the human story that is in the story of recovery. For me, the story started back in medical school when I was in my. Third year I was doing an OB rotation and there was this baby who was born to a mom who was using opioids while she was pregnant.
[00:02:32] Sarah: And this one baby was in the nursery going through withdrawal symptoms. And at that time we definitely didn't have a neonatal abstinence syndrome protocol in place. The nurses in charge cares. So much about the babies. So they were standing there trying to cajole it, but at the same time, you know, the common thought is that how could this person be so selfish that she would use to cause this to her baby?
[00:02:59] Sarah: So the blame was [00:03:00] being put on the mom and me having the. Same type of understanding and thought process as the rest of the society, that if you are using, then there's something wrong with you. If you love drugs, that means you don't love me, and you know, there's that fight between the substance versus the.
[00:03:20] Sarah: Family, the society, you know, this person that is put in the middle. I used to think it was the person's fault, and so I was participating in this hate fest with the nurses and thinking that the mom was the bad person. Fast forward to residency. I was fortunate to have a doctor doing the buprenorphine, the Vivitrol treatment in our clinic.
[00:03:40] Sarah: So I got a chance to watch him and we had this one patient, young man with an elderly father. Just as soon as you walk into the room, lots of tension is present. This gentleman is trying to stop using however. Really struggling. And at that time we weren't using buprenorphine as [00:04:00] much yet. We were using the Vivitrol, the Naltrexone.
[00:04:03] Sarah: And to go on that treatment, you have to be sober for about seven days without any opioid in your system. And then you can start, and this guy just couldn't do it. And he would come back, like just the day before he was supposed to start the medicine, he would've relapsed. Or something. And so I went and I asked Dr.
[00:04:23] Sarah: Alvis, just frustrated. 'cause I could see his dad would come with him every time and he, like, every time the dad came, he looked more aged than the last time. Right? So I was asking my attending, you know, Dr. Alvis, I just don't get this. Like, why can't he just do it? Like, what's wrong with him? Like why doesn't he see how much his.
[00:04:41] Sarah: Father is suffering. How could he be so selfish? How could he be so cruel? And what Dr. Alves told me at that time was the epiphany moment where he said, Sarah, you do know that addiction actually changes the brain. This is not just a moral injury. [00:05:00] After a while, the brain itself changes and it starts to look like a chronic disease.
[00:05:04] Sarah: So it's not just easy to just switch it off like a light switch, turn on, turn off, and that's it. You're done using. I felt very guilty. For the thoughts that I was having. I had a lot of flashbacks and spaces where I was not kind to the patient who was coming in with substance use disorder. I didn't give them the compassion they needed 'cause I didn't have that insight, that knowledge.
[00:05:34] Sarah: And so I think. A little bit of that guilt. What if there was another, me giving me that opinion? How would have I felt about it? I found myself like really sympathizing and standing in the shoe of a person who's using, 'cause you know, every single one of these people who are using every single soul has a story.
[00:05:55] Sarah: They're not just their addiction, they're not just the problem. [00:06:00] There's a lot that goes into them reaching that point to where they're coming to see me. And it's not just their story. There's family story behind it. There is a societal story behind it. There's a justice system story behind. So it's not as simple as we would like to chalk it up to be.
[00:06:19] Sarah: It's much easier to blame and to escape instead of to actually like come in hands on and fix things. So that's my story. I think that's what brought me to it.
[00:06:30] Dominique: Well, one, it's a beautiful story that there's so much complexity that goes into addiction and treatment, whether it's understanding the family story, understanding the options around medication.
[00:06:42] Dominique: There's a lot of layers to it. So I'm really excited to unpack it today. And I think the other topic you already started to touch on and did a great job at it. Is talking about the stigma and misconceptions that are in addiction treatment. Based on your years of experience, what [00:07:00] stigma or what stereotype around addiction or addiction treatment have you found causes the most harm today?
[00:07:07] Sarah: I've found that there was this journal published where it was looking at this categorization of stigma. There was this internal stigma. Which is the patient has a stigma within themselves. The person who is suffering from addiction. Second one is an external stigma, which is their loved ones, their community, you know, the society, et cetera.
[00:07:30] Sarah: That's a stigma that's being put on them. And then there's a systemic stigma that is actually in the healthcare system itself. Where the article that I was looking at, it was showing that if a doctor knew that a patient had substance use disorder, they were less likely to, one, refer them to the support that they needed, and then number two, they were also less likely to.
[00:07:59] Sarah: You know, take [00:08:00] them as seriously. So which one of these is the most harmful? I don't think we have really measured that. Where I found a lot of struggle is when I'm talking with a patient, let's start with that. The patient comes in, they believe that. They can do it themselves. They just need to detox and then they're ready to run and go.
[00:08:21] Sarah: So for dependence on things like opioids, alcohol, benzodiazepines, these are really hard to quit without like using a bridge to get. Through over the rift to say, right. And so when the patient is refusing that support, that bridge and they're like, I can cross this big cavern like all on my own, I don't need any help.
[00:08:46] Sarah: I think that's a place where I find time to, it's as an opportunity to address what is the patient's actual beliefs. System, where is it limiting them? And then using some of my coaching techniques to help [00:09:00] them see what the reality is in a language that makes sense. Because when we learn about what's happening in the body, we're learning like really difficult jargon that even I have to like pause and think sometimes, like is this the right word or not?
[00:09:15] Sarah: And then to expect another person to understand that and to talk with another person that way really limits it and inhibits it. So that's an opportunity for me to sit and talk with the patient, help them understand that this is a chemical instability. Your body is a bag of chemicals. Everything that we do is chemical reaction.
[00:09:36] Sarah: When we're talking, when we're hearing, when we're seeing, when we're breathing. There's chemical reaction happening at every moment, every cellular level. So when you start to put in these chemicals that are not natural in presence or in concentration, you start to mess with those chemical reactions and the body needs an optimal range.
[00:09:57] Sarah: The body naturally has its balance, [00:10:00] homeostasis, and when you start to mess with it. Outside chemicals, food, liquid smoking, temperature, pressure, altitude, your body starts to shift. That's called adaptation. That's part of the evolutionary process, right? So basically when the high dies down, you know, that pushes you to like a spike.
[00:10:22] Sarah: Then the crash happens because the body has all this chemical gap left that it can't close on its own. And so the problem with, you know, substance use disorder is that these are hits you, it's like quick interval introductions, and so you go high, and that means what happens after is a crash. So the goal with the treatments that we do is to stabilize that chemical gap by.
[00:10:47] Sarah: Filling in an artificial amount. 'cause here's another stigma that patients have, is that they don't want to take the support for the medicines because they believe it's switching one drug [00:11:00] for another.
[00:11:00] Dominique: I wanna pause you there for a second because I feel like you're unpacking. So many interesting topics and so many misconceptions that are ever present in the addiction and recovery communities.
[00:11:13] Dominique: You had mentioned patients often believe that they don't need any kind of additional support after they go through the detox or the withdrawal process, and that of course is, you know, depending on the substance that they're using, can be anywhere from a couple of days to several weeks. But I think it goes back to understanding that addiction is more than just a physical dependence.
[00:11:35] Dominique: It's really rewiring your behavior in terms of how you're thinking. You know, where you're getting that dopamine, which I think you're starting to get to where you're getting that sense of pleasure. And I love that you brought up this normal range that your body should be in and all these different elements, right?
[00:11:54] Dominique: Whether it's your oxygen, your food, whatever chemicals are in your body. I recently came [00:12:00] across a video, and I'll link it in the bio, but I forgot who said it. And he talks about the science of addiction as well, and he says, when you're using marijuana, your dopamine goes from. Zero to a hundred, let's say, and your body is only meant to be in a SERP in dopamine range.
[00:12:20] Dominique: When you introduce opiates, that number skyrockets even more. When you introduce methamphetamine, that number skyrockets to numbers that your body should never even really be in. So it's almost like your brain doesn't know what to do with all this dopamine, and then of course it's gonna want it, and it craves it again and again and again.
[00:12:40] Dominique: So I think the fact that you brought that up is like a perfect analogy and a perfect segue into understanding just how potent. Not just substances are, but the dopamine hit that people are craving and then that crash when that high is no longer active.
[00:12:55] Sarah: Yeah. Very well summarized there because you know our [00:13:00] bodies, it has, its.
[00:13:01] Sarah: Own production system because it knows what our demands are and our body only likes to use the resources it needs for survival. So there's that survival mechanism kicking in. And so dopamine is very important in our body. It's our motivation reward system. This is what allows us to pursue that delayed gratification.
[00:13:24] Sarah: This is what allows us to. Keep trooping through the struggles of life, having to wake up in the middle of the night, change your baby's diaper because when that baby kisses you after they grow up, like that oxytocin, that serotonin, that dopamine, that is the reward for all of our hard work and to deprive ourselves of it completely is not good neither.
[00:13:46] Sarah: So we need to live in that range, that optimal range. And what I've found, like after I started to learn more about coaching, is that the best state to be in is that peak performance state when we're [00:14:00] using and trying to replace that with like drugs, activities that take away from our morale. That's where it starts to become a negative consequence.
[00:14:10] Sarah: So yeah, hope, I feel like we went on a tangent. No, these
[00:14:14] Dominique: were all really helpful and I think everything that you've spoken about so far is connected. So I think it's important to understand about how everything plays a role and feeds into each other. You started to allude to the different types of treatment and the way different substances can be treated in the medical community.
[00:14:32] Dominique: Could you break down what exactly those things are and what the different treatment phases are for some of those recovery processes?
[00:14:41] Sarah: Sure. I'll be happy to. I'm gonna start with the recovery phases you want to go through. The first phase is the induction phase. That is where you go from no medicine and full blown substance use to.
[00:14:55] Sarah: The therapeutic dose and the therapeutic dose is the medicine dose that [00:15:00] holds your body and gives it stability for 24 hours from dose to dose without any withdrawal symptoms or cravings. It introduces stability into your system by bringing you back into that homeostasis.
[00:15:14] Dominique: So it's not about removing the substance, it's about giving you the stability. That way you can continue with the treatment and recovery process.
[00:15:22] Sarah: It's closing a gap. That chemical gap needs to be closed, either illicitly or prescriptively. Okay? Because your body, if it was able to close it on its own, it wouldn't have that issue. This is the three phases that I'm talking about, and this one is more for opioid use.
[00:15:39] Sarah: Imagine that the ground is your baseline optimal range, and when you start to use your body compensate and it starts to basically go into the hole. So to treat whatever medicine you give has to come to that back up. Yeah. To baseline. Correct To a normal baseline. And that's where you want to be for the treatment [00:16:00] process.
[00:16:00] Sarah: 'cause that's where your body wants to be. That's functionality. This is the induction phase. And then maintenance phase is to hold at this steady state. And a lot of magic starts to happen in that phase. When you're in that stable phase, your body starts to move from a. Survival mode to a healing and rebuilding mode.
[00:16:20] Sarah: And I like to use the example of a forest fire here. So when you have a forest fire, you've put in all the water to stabilize, right? So you put the fire out and then you recruit and rebuild right here. That's the maintenance space. The last phase is the taper phase where you come down slowly, little by little, train your body to acclimate as you go back up towards the normal surface.
[00:16:44] Sarah: For alcohol and benzo, I think it's more of a seesaw picture, not like a up and down picture,
[00:16:50] Dominique: right? If the person's using illicit substances anyway. Using regulated substances that are prescribed by a doctor to help aid the recovery process is a win. Like you [00:17:00] said, it's really about like reframing that perspective.
[00:17:03] Dominique: So I love that you had this visual aid because I think it's super helpful to really understand what people can expect when either they or their loved one is going through this transition. Something that you and I have talked about, and I wanna make it a little bit more real for people who are going through it, is.
[00:17:19] Dominique: An example of this induction stage was when my brother was in active addiction and he just wanted to start the recovery process. He was put on methadone to help stabilize him. I'll let you talk about more about what methadone and Suboxone are, but just that way people understand how it's working. He was put on methadone, which was swapping out the opioids in his body for some stability to get him to like, like you said, that baseline when.
[00:17:46] Dominique: Methadone was suddenly removed from him. He was back on like that Seesaw, like trying to reach that baseline dopamine and wanting to get high again. When the methadone was reintroduced, it was able to continue giving him that stability while he was working on the recovery [00:18:00] process on that methadone for, I don't know, like six months or so, he was able to transition down to Suboxone.
[00:18:08] Dominique: That way he can relearn what it's like to. Be a person in recovery. Relearn what it's like to live his life and give him that stability to develop healthier behavioral habits and he and healthier mental habits. He's slowly beginning that tapering off process and he's been in recovery for about six or seven months.
[00:18:31] Dominique: And while there are differences in how methadone and Suboxone are used, the important thing to note, I think, is the stability that it provides the person who's accustomed to using substances, and it also gives some stability to the family so they can figure out what their treatment or recovery plan will be for their brother, sister, parent, spouse, whomever.
[00:18:53] Sarah: Very well explained. I think the key word is stability from family level to [00:19:00] cellular level. Yeah. So going to the next question about describing the difference between buprenorphine and the methadone. I think you did a great job explaining that these are medicines we use to treat opioid use disorder, and so opioids are your heroin.
[00:19:16] Sarah: Fentanyl, methadone, oxycodone, Percocets, poppy seed, opium, et cetera. A lot of these names may ring a bell because they do have medicinal use, like the oxycodone, the fentanyl, morphine, et cetera, and there are ones that doesn't have any medical use like the heroin. Fentanyl is everywhere because it's a lot easier to make and sell.
[00:19:40] Sarah: It is so much more potent. A hundred times more potent than morphine and 50 times more potent than heroin, A lot easier to overdose on. We use these in the operating rooms. We use this in the ERs when somebody comes in immense pain and they need support. So to have [00:20:00] things like this in the hands of unwary individuals and even kids, you know, like 14 year olds, 11 year olds, there.
[00:20:09] Sarah: Being given it by their friends who don't know what they're grabbing, and they use it for the first time. There's no tolerance, so it's like kissing a nuclear. That's why they overdose. They have no protection. Their body hasn't had a chance to acclimate. Normally what happens is if you have something smaller like the prescription oxycodone, Percocet.
[00:20:32] Sarah: And then you build tolerance, and then you go into heroin, which is a little bit more potent, and then you keep using it and your tolerance also, like that hole gets deeper chemical gap, bigger. And then now you bring in fentanyl. So it's like if you were diving off the cliff, if there isn't a big enough hole, you're gonna go and hit this.
[00:20:52] Dominique: Right. It's interesting that you bring that up because. Something that I've talked about too, about the opioid epidemic is the rise of fentanyl [00:21:00] and something that was apparent for my brother. You know, my family being ignorant. At the time we didn't really understand the gravity of how Fentanyl was in the illicit drug supply.
[00:21:10] Dominique: We knew about it 'cause we heard about it on the news and whatnot, but we didn't really, we didn't really understand this at what scale. So when my brother was about, I think he was about 16 or so, and we found out that he was using pills and. Obviously ones that he was getting from, like whoever, random friends or people that he knew, and he convinced us, not that it's okay, but he had convinced us that they were prescription and that the person who was giving it to him was sure that there was no fentanyl in it.
[00:21:42] Dominique: And then a little while later, after my brother overdosed, we found out that he was using fentanyl and he was going from marijuana to fentanyl. And like you said, there's this gap where that person is not being acclimated to using Percocets, [00:22:00] Oxy, or any other opioid. They're just going straight to the heroin or the fentanyl.
[00:22:05] Dominique: Nowadays, I feel like there's no heroin even on the street anymore.
[00:22:08] Sarah: Very rare to do pure heroin. It's so expensive and it is so scary. 'cause the fentanyl is just oof. It drops you like flies. Absolutely.
[00:22:16] Dominique: But to your point too, it's when used correctly in medicinal use, it can be a powerful tool for recovery and support in healthcare setting.
[00:22:26] Dominique: So I think it's about understanding the fine line between how you're using things, like you said, where you're using it for. Being educated in those substances and the different treatments is what's gonna be really important to either help you or your loved one who is going through the recovery process.
[00:22:43] Dominique: We started to talk about like the healthcare industry and really focusing like the hospital system and like how medical practitioners are working and prescribing these substances. I wanna shift gears a little bit to talk about the rehab industry because I think. Yes, [00:23:00] they go hand in hand the hospital industry and rehab, but I think they operate in very different ways, and I think they can also impact how people receive treatment.
[00:23:10] Dominique: So I'm not sure if you're familiar with Brandi Mack. She is a nurse. She's a mother to a daughter who's in recovery, and she's also a harm reduction advocate. I got her newsletter in my inbox this morning, and one of the things that she said is, if rehabs want to bill like hospitals, they should operate like healthcare.
[00:23:32] Dominique: Accountability isn't punishment. It's basic safety. And I think there's a lot to unpack there because there's a lot of. Challenging the status quo when it comes to the medical industry and the rehab industry. But I wanna know from you, like why do you think this type of call to action around the rehab industry is so powerful?
[00:23:51] Sarah: I mainly have operated in the outpatient setting. I am a medical director at a methadone clinic, and I've [00:24:00] seen the hospital aspect of it during residency. I'm not affiliated with the hospital at this time, but as somebody who's trying to advocate the patient mm-hmm. To take the medicine they need. In the way that it should be taken.
[00:24:14] Sarah: I have found sometimes it becomes very, it feels like I'm fighting two battles instead of just one. Where, you know, I'm trying to convince the patient that they need this, and now I have the patient on board and we finally have a regimen that's working beautifully and all we need to do is just give time.
[00:24:35] Sarah: The time it needs to do its thing. But now because they're trying to go into a rehab which doesn't believe in methadone. Mm-hmm. Or there are still rehabs, which doesn't even want Suboxone, that now that fortunately is dying out, that becomes an extra level of. Struggle because the patient already has a lot of inner doubt.
[00:24:56] Sarah: There's everybody around them saying that you should be coming off of it. [00:25:00] I'm like, that is too fast. It is so easy to break something takes shorter amount of time to like drop a cup and shatter it into pieces than to pick up all the pieces and put it back together. That can take hours to weeks to month.
[00:25:15] Sarah: Right, and here we are after using opioids for five years, six years. Some people, 35, 50 years, they're coming in and they're like trying to use the methadone or the buprenorphine, like a course of antibiotics where it's like seven to 14 days and you're done with the course. It doesn't work like that. I like to tell my patients that if they have been using.
[00:25:38] Sarah: For over three years. I say give yourself at least two years worth of time. Give. I
[00:25:43] Dominique: hear that number all the time. It's so interesting, like people that I know that are, that are in recovery, they always say, forget about the one year mark. Forget about six months, one year, 18 months. They said the real change, at least for them, has happened at two years.
[00:25:59] Dominique: Where they can [00:26:00] see the real substantial change. So I think it's really interesting that you brought that up.
[00:26:04] Sarah: It goes very hand in hand with the three phases that I like to talk about, because to go from, you know, where you are to the therapeutic dose that takes a. Few months. That takes about two to three months to complete that step and the maintenance phase.
[00:26:19] Sarah: I like to tell my patients, you want to be in this phase for one year, right? Give yourself one year. It's not just about that. I feel good, I'm doing good. It's also about lifestyle changes. Lifestyle changes take at least a year to become permanent. Okay. And so give yourself that time. And then the taper itself takes a little bit more.
[00:26:41] Sarah: So give or take two to three years for somebody who doesn't have many other complications, takes about two to three years to be done. And that's when I tell the patients is that if you wanna stop seeing me again and again in this setting.
[00:26:56] Dominique: Yeah, it's interesting when you think about time, because I think time is [00:27:00] subjective.
[00:27:00] Dominique: I think families especially can get really scared. When they hear how long the recovery process takes, it's important to remember, it's not a destination. It's really a journey. My brother is in a young adult long-term residential program, and the program, which we didn't know how long it is up until like a couple of weeks ago, young adults who were there from like six months, and it goes up to three years.
[00:27:26] Dominique: And I thought about like, that's insane. Like who's gonna be at a residential program for three years? And the more you learn about the science of addiction, you understand that three years is really like that sweet spot to make sure that someone is going through the process to build up the skills, build up time, having sobriety and in recovery.
[00:27:47] Dominique: And like you said, building some their own life skills and having long-term stability so that way they can go back out into the real world and rediscover themselves, rebuild new relationships. [00:28:00] People need to understand where they need to give themselves grace and also give their loved one who's in recovery some grace too, to understand that just because they might not be high or using substances.
[00:28:12] Dominique: There's a lot to learn in that process.
[00:28:14] Sarah: I wanna add a little bit to that. I think it's very, very important that we talk about the concept of time. If you don't do it right the first time, it's gonna keep happening. Mm. So if you don't give yourself that solid two to three years that your body needs, no matter which part of stage of your recovery journey you're in, and you're ready to be done with it.
[00:28:36] Sarah: That thing is gonna keep going. Like recently I was telling my patient another analogy. 'cause I think analogies are like great for making things stick. Mm-hmm. It's like if you are going from point A to point B. Point B is your destination, new place. You've never been there before. You know the map GPS is guiding you.
[00:28:54] Sarah: And to go there, you have to do right, left, et cetera. And if you miss your turn. You know, [00:29:00] sometimes the best thing to do is to make a U-turn. Mm-hmm. You don't wanna just like keep going
[00:29:05] Dominique: straight when, especially if you think about the analogy on a highway, right? Like if you're driving straight on a highway and you miss that exit, you might have to drive another five miles before you get to that exit to come back around, right?
[00:29:16] Dominique: But if you're driving on a local street, you can just make that U-turn real quick and get back in the direction you're going in.
[00:29:23] Sarah: But the thing is, if you're making a U-turn, don't feel bad about it. Mm-hmm. Because I have patients who are like, oh, I've all come down to like 20 milligrams. What do you mean I have to go up 10 milligrams, et cetera.
[00:29:34] Sarah: And, and it's like. No, my dear, you are struggling so much because the further you get from your exit that you missed, yeah. The worse it's gonna get. 'cause that's not your destination. And so that's another place I think where people lose hope and they think that the medicine doesn't work, but the reality is that they just didn't go down the right path.
[00:29:54] Sarah: So. You can keep going straight and what is it around the world in 80 days, [00:30:00] maybe eventually you'll get back on the on the thing, but I would rather add another 20 minutes than another 80 days to my journey. Yeah, that's totally fair.
[00:30:12] Dominique: Yeah. I love that you're bringing that up. In our last couple of minutes, we covered a lot of topics, things from addiction treatment, methadone, suboxone, you know, not being scared to, you know, make that U-turn and going back to care if there's a relapse or something.
[00:30:27] Dominique: What are some of the types of questions that. People in active addiction might wanna ask or people who are thinking about treatment might wanna ask, or families might wanna ask if they're thinking about helping their loved one get into either a treatment program or further into their recovery process.
[00:30:45] Dominique: Are there specific questions they should ask about medication or how would you recommend that they approach that when they're not really sure?
[00:30:54] Sarah: I think the best thing to do is 'cause it varies so much person to person. You know, [00:31:00] like different people are on a different part of the journey. I think it's very important to find somebody you trust, somebody who is willing to meet you where you are without making you feel either too low or too high if you're ever in doubt.
[00:31:16] Sarah: Always okay to get a second opinion, third opinion. There's doctor shopping and then there's getting opinions, but it's very important to get the opinion that is evidence-based. It's accurate, not just he says, she says they're doing this so I can try this, et cetera. The other thing that I feel really nervous about is when people start to use an alternative trying to self-medicate.
[00:31:41] Sarah: For example, one of the things that's. Pretty prominent right now. This rising is krato use, and this is something that I've seen patients, they're like, oh, I'm just gonna take care of it on my own. It started out as like, oh, it's a natural supplement, it's not an opioid. And then what ends up happening is they [00:32:00] end up becoming addicted to the kratom.
[00:32:02] Sarah: Because remember, opium is a natural product as well. It comes from the plant poppy, so all the chemicals that we use, they have some sort of natural origin, and then they go into the labs and then we refine it and become and becomes more concentrated, et cetera. We're doing that with all the illicit substances.
[00:32:22] Sarah: Also, I think it's very important to be informed. Mm-hmm. Ask intelligent questions, but definitely have a healthy. Range between trust and.
[00:32:34] Dominique: Mistrusting everybody, like it's not just about doctor shopping, it's about opinion shopping too. Getting all the facts that can inform your own opinion and you can make the best decision for yourself or help someone else make the best care decision for them.
[00:32:49] Sarah: I think as a society we have like a dichotomy of the way we approach medicine. We have a group that really loves medicine and we have a group that really hates. Anything [00:33:00] that's medicine. Yeah. The best place to be is in the middle. And that's not just medicine, but other chemicals like supplements that you buy over the counter.
[00:33:08] Sarah: I need this vitamin, that supplement for this and that. Those are chemicals too.
[00:33:15] Dominique: And I think, like you said, it's important to understand that all chemicals are bad just because it's a chemical and that we're all made up of naturally occurring chemicals. Right. People always hear the word chemical and they always assume that it's something negative and it's not necessarily.
[00:33:29] Dominique: Always the case. What's important to keep in mind is how you're improving that person quality of life, whether or not people disagree on the types of medication used. I like to bring in pets and I like to think about cats and dogs. I have a dog that's very anxious and when we go out in public, he's usually pretty fine, but he has very specific triggers.
[00:33:53] Dominique: For a long time I was always like, my dog doesn't need to be an anti-anxiety medication. Like he doesn't need to be medicated. He's totally [00:34:00] fine. These triggers will pass. And while those things are true, if I know I'm gonna be in a situation that is very triggering, which to him is like going to the groomer, going to the vet, being in long car rides, I'm gonna give him his medication because it'll improve his quality of life.
[00:34:15] Dominique: It'll reduce the stress that he's having and it'll reduce my stress too. But I think it's also important to remember I don't need to give him the medication every single day if he doesn't need it. Some people or some animals might, and I think this is where it's really coming down to, like you know yourself best, your loved one is gonna understand their treatment best.
[00:34:36] Dominique: My brother is at a point now where he feels comfortable tapering off the Suboxone and at the end of the day. I have to trust that he knows his body. He feels that he's ready to make that transition, and we have to give people grace in making those medical decisions and understanding that different environments, different situations, are gonna call for different levels of treatment.
[00:34:57] Sarah: For example, with your dog [00:35:00] example that you were saying, like animals, they start to feel anxious when you, when they don't feel safe. Mm-hmm. That's the animalistic basic, primal behavior, and we have that too. And a lot of times when people are using substances, it's because there's some sort of untreated trauma that.
[00:35:18] Sarah: Started somewhere. ACEs adverse childhood event, like huge, huge impact with correlation with substance use disorder as well. So these are the things that need to be addressed. And a lot of times patients are coming from environments where their loved ones don't get them, or they didn't protect them the way they should have.
[00:35:41] Sarah: And so if any of the listeners are in that boat where they're like, I could have done this better, I could have done that better focus on what you can do now because the future is still waiting. And you have decided that you're gonna do something about it. You want your loved one to be free of the substance use.
[00:35:59] Sarah: [00:36:00] Was there anything from your family dynamics that elicited and initiated this in the first place where they had to go seek and escape in these substances? You know, not everybody starts recreationally like because they just wanna have fun. Those are where the original injuries are, and oftentimes these substance use disorders.
[00:36:21] Sarah: The treatment of those symptoms. And it's like if you have cut your artery, you wanna go heal there. You don't wanna like fix things here at the scratch. If you're bleeding inside, then you can't just put a bandaid on it. And oftentimes I think people don't take care of that. There's
[00:36:37] Dominique: generational trauma.
[00:36:39] Dominique: You talked about the importance of understanding that FA family dynamic. We released an episode around family dynamics and understanding. The significance of blame and how parental experiences can really influence how children or siblings decide to use substances or not. So I'll put that [00:37:00] link in the show notes as well, but I think it's important to call that out that family dynamics can have a huge impact on how someone accesses the treatment they so desperately deserve.
[00:37:11] Sarah: I think that therapy needs to happen at the same time for all family members involved because it's a very stressful situation. Everybody loves everybody, but at the same time, everybody's on each other's nerves, so everybody needs like,
[00:37:26] Dominique: so it's so true. I'm thinking about like my own family, love them, but we all get on each other's nerves when families come into your office.
[00:37:35] Dominique: They're coming to you in a very vulnerable state. Maybe they're pissed off at their child or their sibling or their spouse, and they're not really sure how to navigate the situation. What message would you want families to receive when they feel defeated or they feel that treatments have failed 'em before?
[00:37:53] Sarah: The first thing you need to do is if you're a loved one and your person is not [00:38:00] ready to seek help, you need to take care of yourself first. You come first, okay? And then you can only do so much for the other person. But you have no power over anybody other than yourself. So give yourself grace. Make sure that you have the safety and the space for sanity.
[00:38:22] Sarah: In your life, continue to love that person, but make sure you give yourself the love even more. I think that's the first message I would give to the family is it's okay to have healthy boundaries because you gotta put on your own oxygen mask on first before you can help somebody else. That's the first advice.
[00:38:40] Sarah: Second advice is if the patient is not ready, it's not gonna work. It's not gonna work and, and life needs to happen. Everybody needs to travel their own journey to come to their own realization. So hold space for that. [00:39:00] It's not just about you. And when they're ready to change, you need to be ready to hook them up and give them the support they need all
[00:39:08] Dominique: the time.
[00:39:08] Dominique: I absolutely love that. I found that to be true for. My own family and my own experience trying to support my brother. What have you seen to be the most successful in families as they're learning to be true partners in a recovery system that often overlooks families? Learn how to
[00:39:27] Sarah: understand, number one, what you are feeling, what your needs are, and then number two, being able to translate it in a way that the other person understands.
[00:39:35] Sarah: You can both be speaking English, but you can be saying totally different things. Absolute, and it will not. Work on communication as a family. Most of the conflicts in the family and government arises from communication issues. Mm-hmm. Right. I think we need to become master communicators. Your job to understand what your body is telling you, and then translate it for somebody else to [00:40:00] understand.
[00:40:00] Sarah: Same with conflict. Get that help, make sure that you have the support system. If you haven't developed those skills yet, start learning it. And then when the loved one is ready, give them that safe space they need when the first part starts. Relapse is very common. Don't make them feel bad about it. Learn how to do positive reinforcement and less of negative reinforcement because the brain is already looking for that reward.
[00:40:28] Dominique: I think that's a great point right there. Is positive reinforcement in realizing that the substance that the person is using is not necessarily the problem. It's their solution to whatever emotional distress and feelings they're going through. And I think it helps families find a little bit more empathy and understanding how they can help their parent spouse.
[00:40:52] Sarah: That's a great point that they're using it to address some sort of emotional need or some physical need. [00:41:00] So create a list of other things that they can go to to fulfill those needs that are healthier. Mm-hmm. And oftentimes people end up relapsing because when they're hurting, there's no other options.
[00:41:11] Sarah: So where do they go? They go back in.
[00:41:13] Sarah: So create your emergency plan, right? If you see fire, what direction you're gonna go, you run those drills. You have your roads mapped out, so when you're ready to go, the person who's using, they also have those menus to choose from. Yeah,
[00:41:28] Dominique: it's like a recovery plan and having a support system in place.
[00:41:31] Dominique: I just wanna add on, there's this workbook for families called Beyond Addiction. That has helped me and my family do exactly what Dr. Nasir is explaining, which is reframing your thinking and improving your communication within your family. So that way whether the person is in active use or the person is in early recovery, or has been in recovery, it helps you set the foundation for rebuilding those relationships.
[00:41:56] Dominique: So I'll also link that in the show notes down below. [00:42:00] With that being said, doctor Nasir, I wanna thank you so much for coming onto the show today, being vulnerable, and sharing your experiences as to why you got into addiction medicine for being honest and candid about the strengths and the challenges of the medical industry.
[00:42:15] Dominique: There's a lot to unpack. We only touched the surface today, but I think it was a very hopeful conversation for families that might be looking to support their loved one through recovery.
[00:42:26] Sarah: And thank you once again, Dominique, for having me on the show, for giving me the opportunity to share that hope exists.
[00:42:32] Sarah: Struggle is part of our life. It's about how we respond to it, so keep going.
[00:42:41] Dominique: Thanks for listening to this episode of For Love of Recovery. If you enjoyed this episode or know somebody who might, please leave a comment and share it. You can also join our Facebook group, siblings for Love of Recovery. If you're looking to have deeper conversations around your siblings drug or alcohol addiction, and remember whether there's hope, there's healing.