The High Functioning Patient with Addiction

Thanks for tuning in . Let's get started . This is a really special episode for me . Today I will be talking with Dr Samantha Hart , who is a physical therapist , and for me , today I will be talking with Dr Samantha Hart , who is a physical therapist and recovery coach in Southern California .

She is the author of the book Breaking the Circuit , and today we're going to be talking about what it's like being a very highly functional person with addiction and how to heal when everything looks good on the outside but actually isn't good on the inside . And I really , as you will hear during this episode , can relate to this .

Sam was in active addiction as she was completing a doctoral degree in physical therapy , and I can relate because I was suffering from major depression , self-harm and an eating disorder when I was graduating from UCLA with straight A's and getting into medical school .

For the person who is highly functioning , who is struggling , it becomes easy to say nothing is wrong because everything looks good on the outside . Control and perfectionism become addictive , as it's how to believe that you are successful without actually having to face being vulnerable .

This was a fantastic episode to record , and I am really grateful to have met Dr Hart . As you listen to her speak , you can tell how intelligent she is , and yet she's had some real struggles . This episode is a great reminder that addiction can happen to anyone , even if their life looks good on the outside .

One quick warning this episode does contain some salty language . And with that here we go . Well , good morning , sam . It is so nice to meet you . I'm so looking forward to hearing your story today . Let's start by just telling us who you are and what you do .

If you had asked me that question even two years ago , I would just be Dr Hart which is not small , it's not nothing and I would tell you that I help people correct faulty movement patterns and prevent injury . And so what's changed ? What's changed ? What's changed ?

And I would say that when I got out of grad school and I saw the landscape of the healthcare climate , I was newly sober and I thought this is it , this is what I got into , all this debt for you want me to see four or five patients at a time and at best , before insurance discharges them , give them a set of straight leg raises to do when they get

home . Is this a joke ? And so I remember one of the exciting things about becoming a PT was that I could have my own business one day . So it was always in the back of my mind , but I didn't want to start my career that way . I needed to get my clinical feet underneath me , so to speak .

So I worked for a woman who truly only saw one patient at a time , and I did that very intentionally so I could become a good practitioner . And I did that very intentionally so I could become a good practitioner . And then within three years , I was% better . And so I started to ask them and their answer was oh , I go to a trainer .

I bought a package of Pilates sessions and all of a sudden I'm thinking , wait a minute , these people who are so much less qualified are getting three times as much money to do the thing that I would love to be doing with these patients . I should offer it .

So I did , and that's how my business was born and I ran a cash-based PT clinic in Santa Monica for 10 years and the thing is on a parallel track . I was in sobriety and we'll get into that .

You know one of those high-functioning addicts who , on the evening of getting accepted into a doctoral program , overdosed on cocaine , very begrudgingly entered the rooms of AA and didn't go back for a year and a half until I begrudgingly went back because the guy I was dating caught me with this prescription pill bottle that was not prescribed to me , that I was

totally abusing , and I felt like , uh-oh , he was probably going to leave me if I didn't get sober , but not because I really wanted to do any of the work that the steps were

suggesting I ought to do , because that work threatened my entire identity . That work meant that this high-achieving perfectionist who was able to control , curate the world around her , was going to have to relinquish control over people , places , things and situations . And I didn't see a reason to do that at all . I just knew I had to stop using cocaine .

And so , as I'm trudging through sobriety very reluctantly and having to do the work Now , I did the work for a long time without a power greater than myself . My husband , the guy who found the pill bottle , who was my boyfriend , who became my fiance , who became my husband . He was my higher power .

I didn't know that until he pulled away from me , but he was . His love for me was what kept me safe and whole in the world , and until he pulled that away , I didn't understand how much I was relying on it . So I did the steps the best I could . I worked through my fourth step . I unpacked my anger .

I had made amends to him and to a lot of people I had hurt , and I'm starting to gather some evidence that these patients in the clinic , who are not addicts , seem to also be suffering from a spiritual malady . What do I mean ? Well , I'd have the wife who had seen every in-network practitioner for plantar fasciitis and nobody could fix it .

And finally I'm going . Well , you have a hip issue . Nobody's looked at your hip and because you have no stability there , you're dropping into excessive pronation and your plantar fascia is getting yanked over and over again . So here's what we're going to do about it .

I create this amazing program and then she comes in the next day and says I'm so sorry , I didn't get a chance to do it . Oh , what happened ? Well , my husband was supposed to do this and that and the other , and then he didn't , and so I obviously had to get it done .

And by the time I did all the things , I was exhausted , and in order for me to have any time to myself at all , I stayed up late and blah , blah , blah , blah , blah , blah , blah .

Or you know , I know you said I should be using at least five pound weights to really build strength , but I just , every time I do that , it makes me feel bulky and I feel I feel big , and I just I don't , I don't want to do that , I don't , I don that .

And so these people are suffering from hypervigilance , taking on the invisible mental load in their household , chronic people-pleasing , perfectionism , obsession with the beauty and body standard , and all of it is getting in the way of their plantar fasciitis getting better , and so it was like an itch that I couldn't scratch , you know , and when you ask me , who am I

? The second part of what I said is that I'm a personal development coach . I could also say I'm a life coach . I could also say I'm a mindset coach . I could also say I'm an executive coach . I could also say I'm a sober life coach . Kind of depends on who I'm speaking to , of course . But why is that part of my description today ?

Because on March the 13th of 2022 , I lost my big sister , jessica , to a drug overdose and in that moment , I decided I was going to write a book and the book was going to be about the spiritual side of wellness and that I was going to put that at the epicenter of what I do in the world , whether it's talking on a podcast , speaking on a stage or

treating a patient in the clinic . So today , I don't just treat the body , I treat the body and the spirit , because I don't believe we should separate the two .

I was an ER doc before I was an addiction doctor and people come in and it's been like 45 years of poor nutrition , no access to exercise , family didn't prioritize education and now we need three back surgeries and we're dependent on pain meds . I was like man , this didn't start this week and I can't do much in the ER .

So I 100% relate to your sentiment of I actually want to help all of the person and it takes attention to more than just what they tell you is wrong . And then I also hear you saying that about yourself is you want to work on all of Sam to be the best Sam you can be . Do I have that right ?

about that day , other than wailing on the floor of the airport . But my husband said that on the flight back I turned to him and said I'm writing a fucking book . So apparently I knew that day . Now , I think what I knew in that moment was this was a story among a sea of stories , it being the most painful and dramatic .

That finally gave me permission to say I am not recovering in silence anymore . I am sharing my story because our secrets are keeping us sick and there are people in and out of the rooms of recovery , addicted to substance and other things , that are suffering in silence , and I will be the lighthouse . And so the book started as the stories of my life .

You know , when I sat down , I took a note from James Clear in Atomic Habits , who said we don't rise to the level of our goals , we fall to the level of our systems , and I thought what is a system I can put into place that would actually hold me accountable to writing this book , which is a huge goal , a goal that so many people have by the way for

their lives . And I thought I'm going to write for 30 minutes a day for 30 days . I'm going to start with that . No pressure , this does not have to go in order , I do not have to start at chapter one , I do not have to know the structure .

I'm just going to pick a story and write , and so I'm writing , and I'm writing , and I'm writing , and eventually I work with someone who's a published author and I create a book proposal and then I start submitting and submitting , and submitting , and eventually I work with this hybrid publishing company , and a hybrid publisher , if you pick a good one , gives you

all the process for a certain fee monthly , which I was okay doing in exchange for a much higher royalty split . And as I got my team assembled , the question became what is this book for ? Well , it's to help as many people as possible . Great , then , what helped you ?

Helped you when I worked the 12 steps in my marital crisis in a more modern and trauma-informed way . My healing actually began . That's what this book is going to be . This book is going to be a modern reinvention of the 12 steps of recovery . So I didn't know when I started that the memoir was not just a movement , but it is .

I am trying to become known now as the girl who 12-stepped the world . We talk about it in the rooms all the time . Man , this is like the best kept secret . The whole goddamn world needs these steps . Well , who's bringing them to the world then ? If we're all anonymous , who's going to be the cycle breaker ?

Who's going to be the one that has the courage to say you know ? Much like yoga , these principles are beautiful . They're sacred . There's something ancient about them that many people believe we shouldn't touch . But it's also 2025 . And we know a lot more now about addiction , childhood trauma and psychology .

We know a lot more now about addiction , childhood trauma and psychology . So how can we take this beautiful set of principles if it's an accordion that's squished together , best kept secret and widen and open it up and bust through the framework so that anyone can have access to a spiritual blueprint for how to get through life's hardest things .

Anyone can have access to a spiritual blueprint for how to get through life's hardest things . So my book is called Breaking the Circuit how to Rewire your Mind for Hope , resilience and Joy in the Face of Trauma . I purposely did not put the 12 steps on the title . I didn't want to scare people away .

I wanted them to crack it open and give it a whirl right . And for me you know , speaking about high achievers and how , in some ways , how much more difficult it is to really concede to your innermost self that you need help and that you actually are an addict .

When I think about who I was when I got into the 12-step rooms , I was just a woman who came into , came into a childhood that was wildly volatile , with a mentally unstable mom who was popping prescription pills , an emotionally absent father and a very , very angry sister who was acting out sexually and with drugs , and control was my drug of choice .

So if I could make my body perfect and my grades perfect watch out world , here I come . Then everything was okay , and so I was hardwired as a type A perfectionist genetically , but then it was so unbelievably reinforced by the unstable environment and those set of skills really worked for me . Culturally , you get rewarded for being perfect .

How did you get that job ? Wow , you're summa cum laude . How are you so fit , crowd ? How are you so fit ?

Just patting , patting on the back again and again , and so , all of a sudden , aa's going hey , by the way , even though your mom told you that there's no such thing as God and the greatest thing about you is your intellect , and the only person you can count on is yourself . You're going to have to get down with God .

So you're going to have to come to believe that some power in the sky , some dude with a white beard , is going to wave a wand and strike you sane because you're acting fucking crazy . To that step I said fuck you . Show me , I'm crazy , show me , I'm about to be a doctor . For God's sakes , I'm living in Manhattan in my 20s and I'm surviving .

I have a job . I have a boyfriend . What about me exactly is crazy . I just have a cocaine problem . I didn't understand that the steps were butting up against childhood beliefs that kept me safe in a very traumatic home , and nobody said that to me . It was just get down with God or good luck to you .

So when my marriage was falling apart and this man's love for me that was my higher power was taken away , I was truly insane . In recovery , I was filled with rage , I was filled with anxiety .

I was so sure that something I could say or do was going to change this man's mind and make him love and forgive me again , because I had been able to do it every other time in my life and it didn't work .

And so what started as I'm going to sleep on a friend's couch because we're fighting so much and I had enough sobriety to go this isn't healthy turned into a month in a sponsor's apartment , turned into three months on another friend's air mattress , until finally a sober friend said you can't live like this .

If you don't want to leave your marriage , you need to find a place that's yours , you need to sign a lease and you need to heal . The idea of doing that meant , in my mind at the time , failure , complete failure meant , in my mind at the time , failure , complete failure , perfectionism Collapsing Before my very eyes .

But I didn't know what choice I had , because I couldn't live in that house under those circumstances , with the fighting .

I didn't want to get down with God and I didn't want to relapse , because my first sponsor who saved my life , who had 22 years sober from heroin addiction , he relapsed at the end of my first year and he killed himself and I knew if I relapsed I was going to die .

So I sign a lease and I go into this empty apartment that needed to be furnished and I'm sobbing so , absolutely depressed . That was rock bottom . That was spiritual rock bottom , a place where I didn't want to die but I could no longer go on living with the coping patterns I had been using and in walks , a woman

who has worked the steps many times in many programs , who says what if we do the steps on your marriage ? What do you mean ? Well , I'm not saying you can't call the drug dealer and that it's not a possibility , but I don't think you're about to do that . I think you know you're powerless over that .

What you don't really know is your powerlessness over this man , the situation , the history of you cheating on him before you got married and the way it's plaguing the marriage today .

What if you were powerless over him Whether he is cheating on you , because it seems like it , but you don't have no evidence and he's denying it over the future of the relationship , and that when you try to exert power over this man and every other person , place , thing and situation of the relationship , and that when you try to exert power over this man and

every other person , place , thing and situation , by the way , your life becomes unmanageable in the following way . Well , that's pretty easy to see You're full of rage , you're depressed , you're anxious , you have no sense of self-worth and you're only okay if he loves you . So if all of that is true , then what do you have power over ?

By the way , I find it fascinating that Mel Robbins' new book called the Let them Theory , has caught fire culturally . Because what is the let them theory ? It is step one , modernized . That's what it is . Let them let your child be upset that you took away their screen time . You're powerless over their upsetness . Let them let them be who they are .

Let them feel how they want to feel . Let them be who they are . Let them feel how they want to feel . Let them think what they want to think and let me do what I can do . I'm powerless over him , him , him . I'm not powerless over me .

So that's the work we started to do , and we repurposed the steps in this way around the marital crisis and the breakthrough that literally not just changed my life , but saved . It was the ninth step , because here I am , I'm five years sober and I'm thinking oh God , amends , you know how many times do I have to apologize to this man for all the cheating .

I did seven years ago when I was in active addiction , and she looked at me and she said have you ever made an amends to yourself ?

Okay , because this is the difference between the land of positive affirmation and spiritual bypass and doing the work . Once this woman gave me permission , which , at that time in my life , I needed someone to give me , because it wasn't even in the realm of possibility , as a professional self lacerator , that I could let myself off the hook .

Plus , my identity was so wrapped around beating myself up , which gave me the edge that I had that . Who would I be without it ? I needed this woman to open that door for me so that I could consider whether or not I could be a woman who , despite cheating on her then-boyfriend-now-husband , is worthy of love and forgiveness .

Because if that was true , what did that mean ? Well , that meant that in the days and weeks that followed , every single time , which was constant , my critical voice showed up and said this is what you fucking get for what you did , sam . You get a shitty marriage , and I guess you'll just have to wait and see .

If your husband forgives you or if you're dissatisfied at some point , maybe you'll leave . But I can't imagine that , because then I'd be nothing and no one . If that way of speaking to myself is reflective of a person who doesn't love and Shit , now I have to think about that . Now I have to think about shifting my critical self-talk to a compassionate self-talk .

You know what , sam ? Those things did happen and it really sucks , and your husband's definitely still angry about it . But those behaviors are not who you are . They are separate from your identity . And even though you did those things and he's not over it you actually deserve a big , beautiful life and a happy marriage .

I had to practice coming up with what sounded real and true to me , not something I read off the internet . And once I came up with what that was , I'd had to double down on saying it and interrupting the feedback loop of self-criticism that was so unbelievably reinforced for decades .

And so , as I did that work and , by the way , I was depressed every day in that apartment , I mean I woke up and it literally felt like a gray cloud was over my head , following me everywhere . But I didn't want to die . I just didn't know how to live differently . And this was the beginning of learning how to live differently .

And in that six to eight month period , the miracle , after doing the amends on myself , was that I could hear the whisper of my intuition . She told me what my favorite color was . I didn't know , so I decorated my whole apartment with splashes of teal . It made me feel good in a really dark time .

She also said , because I was working for someone else at the time , I hadn't started strong Heart Fitness yet . You know , sam , I think you'd be really good as a business owner and I think you could make a lot more money than what you're doing and help people way more than the way you're helping them .

She just started nudging me , she started speaking to me and she sounded so different than my critical voice that's how I knew . She was clear , calm , curious and compassionate every time , versus the critical voice , which was just cerebral . Just cerebral , obsessive , mean , constrictive , gave me anxiety .

There's a physiologic presentation of a critical part versus a compassionate part , and the compassionate part always seemed to rise up , and I love that .

There's some research being done right now about , you know , our gut being like a second brain , you bet , and I really feel like my intuitive downloads come from there , and since there's trillions of bacteria inside of there , I don't think that's outside of the realm of possibility inside of there .

You just shared so much about your life and it reminds me quite a bit of mine . So I

went through college , at UCLA , with an eating disorder . People always ask me what my addiction was . It was binge eating on food and I engaged in self-harm and too many relationships to count that were horribly unhealthy . And yet I got straight A pluses one year at UCLA .

I didn't know they gave A pluses , but I literally got 10 A pluses my sophomore year at UCLA and I went off to medical school and same thing at UCLA .

And I went off to medical school , and same thing self-harm , eating disorder , perfection , I agree with you , was my drug , and I just want to reflect back one successful person talking to another successful person , that I'm grateful that you and I have the social capital to be vulnerable with our own stories on behalf of those who can't , because when I listen to

you writing your book , sam has been through a lot and by Sam . Having been through a lot and having emerged on the other side , sam can empower those who haven't emerged yet , and that's how I share my own life professionally .

I got diagnosed with post-traumatic stress disorder from my time in the ER and I know there are thousands of healthcare workers nationally who feel that way but don't have a voice . So I am willing , as are you , to share my own dark secrets because it can help others . So I would love to read your book .

I love the idea of taking a trauma-informed approach to our deepest struggles , because as I heard you speak , I heard adverse childhood experiences Yep , and we know how that affects us and looping together what you do and what I do . I incorporate fitness into my addiction treatment program .

We're running a Spartan race with some of my patients this weekend and I incorporate trauma and a trauma-informed approach to everything I do . I actually have my personal CrossFit trainer and I send my traumatized patients to her because she has such an unbelievable understanding of trauma and how it affects the human body .

So I got to say I love what you do and if only you were not in Thousand Oaks but Monterey , we could refer patients back and forth .

So I have people on the East Coast that I'm doing physical fitness with over the computer , coupled with spiritual work , and they get all kinds of homework assignments . I mean , it's there's nothing like being in person , of course , and the level of care you can provide and connection you can make .

But oh , it's , it's possible , and there's so much crossover that I think it would be crazy for us not to have each other top of mind for potential referrals . And , by the way , something that I've been doing , I have a really cool story I don't know if we have time for it that I could share with you . That takes us to current day .

Having been diagnosed with it has really changed my understanding of how profound it is , and one of my patients was suicidal last week and I was super triggered and my staff in the office yesterday was great . They totally knew something was off . They checked in on me and , yeah , trauma is so profound physically , emotionally , spiritually .

I have so many of my patients that are my age I'm 41 , that live with chronic pain . I'm like we're missing something here and the trauma is so profound . So , as you go into your story , I'd love to just hear a little bit about how you are trauma-informed in your work .

And I already talked about all of my objections , and I think , for the high achiever , the high functioning addict , especially if they're atheist or agnostic , same objections Please show me where I'm acting crazy , please . So then , what's a trauma-informed reinterpretation of that step that can actually land safely in someone's nervous system ?

Can I come to believe , when I'm stuck in a perfectionistic loop and I just want to control the outcome so badly , can I come to believe that a different part of myself , a more loving , surrendered , compassionate , curious , open-minded part of me , can restore me to a feeling of safety ? Can I do that ? How different is that ?

Because if we're looking at our perfectionist part as just a part of us , it's not all of us , it's a strong part , really reinforced part , culturally rewarded part . But if we look at it and we go , huh hey , perfect voice , I see that you're really showing up right now . You really , really , really want to control things .

I'd love for you to tell me what you're afraid of and I'd love to just remind you that you've been working so hard trying to make me feel safe , and I get it and I thank you so much for your service .

But right now you're actually really affecting my peace of mind , and so I'm going to let you speak your mind and I'm going to let you have a seat at the table . That is the boardroom of my life , but I capital S self , intuitive self , higher self . I'm just going to slide into the seat of CEO .

I'm going to try to redirect this a little bit , because I really want to feel better than this Right , and so how different would my experience in recovery have

been if someone gave me language like that ?

And so , in the spirit of , I wish you weren't so far away , right ? I recently met a guy who has 13 years sober , who is part owner in an outpatient facility in Texas , and he said you got to come and talk to our clients . They're heavily movement-based , they're really progressive .

They do a lot of IFS work , right , internal Family Systems work , which is an amazing therapeutic modality which , by the way , was so much of what was happening in that period of darkness where I did the steps in this new way . It was actually a very therapeutic approach that we were using .

I just didn't know it at the time , and so I'm thinking , wow , what an amazing opportunity .

I can go and I can use the fact that I'm a PT and take these clients through a workout that's professionally guided and backed by science out , that's professionally guided and backed by science , I can stretch them and take them through a meditation , and then I can have a heart-centered talk to them , give them a copy of my book , give them a fresh way to look

at the steps . But the last time I had been in Texas was when my sister died . The two places that I was in was Austin , and we also had visited San Antonio , my husband and I in that trip and so their treatment facility was in San Antonio and I thought , well , I can't think of a better reason to go back .

Talk about PTSD and rewriting our story and creating new neural networks , about how my brain associates the word Texas inside . You better believe I'm going to go back so that I don't just have this horrific , traumatic memory and I also have a beautiful one that is a full-blown example of what I've done with my pain . Okay , so talk about rewiring .

Right , it was intentional on that level for me to go , and here's what's so amazing . So he's giving me hotels to book . You know places to stay that are pretty close by and I had booked my flight . I was so sure I booked my hotel . My friend goes where are you staying ? Two days before the trip , I look it up , I never booked it . I'm like fuck .

So now I'm on Expedia like scouring , trying to find , and I book a hotel that gets good reviews . Not one of the checkout . One woman is busy . I go up to the other one . She takes all the information , asks me would I rather be on an upper level floor or a lower level floor ? I think one other person has asked me that .

Anytime I've stayed in a hotel I said I don't know , upper , thinking maybe there'll be a view G , gives me a key card , walks me to the elevator , which is also kind of rare . My sister passed away on March 13th of 2022 and her name was Jessica . This woman gives me the key card and she says you're on the 13th floor .

My name is Jessica , let me know if you need anything . The 13th floor . My name is Jessica , let me know if you need anything . And immediately I'm just shot with the presence of God , the presence of intuitively saying yes to this trip , saying yes to this hotel , looking everywhere for miracles , and I'm thinking I'm going to tell this woman .

I'm just going to tell her , even if she thinks I'm crazy , if I see her again right and later in the day she was still in the lobby . I went up to her and I said can I tell you something spiritual ?

And I explained what happened with my sister and that this was the first time back in Texas since then , sister , and that this was the first time back in Texas since then , the date that she died , her name and the key card she just gave me and the coincidence that her name is also Jessica and that I just wanted her to know that I'll never forget that

moment . And her face dropped and she said can I go on a walk with you for a moment ? So we go down the hall , she takes me into a corridor where the stairwell is to the hotel so we could be alone , and she starts crying and she says I can't stop drinking and I think God sent you here and I don't know how to stop and I don't know what to do .

And I give her a hug and I tell her there is hope and she's going to have to fight like hell and that I'm going to go upstairs and get a copy of my book and I'm going to give her my contact information . And that's what I did . And that happened before I even went to the outpatient facility no-transcript .

And I would have never had that moment if I wasn't brave enough to go back to the very place where the hardest thing in my life happened . And now I don't just have the memory of helping the clients in the clinic , I have that memory . I took a photo of the message I wrote to that woman . We took a picture together . I'll remember that on my deathbed .

That's fucking powerful . That's the power we get back when we're willing to heal .

That'll be our first book .

leave people with that to sit on and please , please , please , reach out to me . I am a person who responds to my DMs . I do not have a bot or someone else managing my social media , so please contact me at Dr Samantha Hart Book a free discovery call . Connect with me . If something I said is piercing , it's for a reason .

I'm here to wake you up and light your soul on fire , and I don't want you to ignore the call .

Our partnership helps me get the word out about how to treat addiction and prevent overdoses To those healthcare providers out there treating patients with addiction . You're doing life-saving work and thank you for what you do For everyone else tuning in . Thank you for taking the time to learn about addiction . It's a fight we cannot win without awareness and action .

There's still so much we can do to improve how addiction is treated . Together we can make it happen . Thanks for listening and remember treating addiction saves lives . Bye .