Beyond the Twelve-User’s Guide: A Workbook for Navigating the Intersection of Addiction and Change (without the Twelve-Step programs), by Ryan Paul Carruthers A Review by Tom Horvath, PhD I stopped years ago attempting to keep up with new books about how to address addictive problems without using the 12 steps. There seemed to be so many! Unfortunately, it has taken more than books to sufficiently penetrate US awareness about the existence of the multiple pathways, “beyond the 12,” available to us. Much work remains to be done before “everyone seeking recovery from addictive behavior [is] informed about the full diversity of recovery options available and allowed to choose freely amongst them (p 5).” Nevertheless, progress is being made. Carruthers has made a worthy contributio...

Substance use disorders slightly declined worldwide over the past 3 decades, but deaths increase 2.2 times. By Tom Horvath, PhD A recently published study (9/30/25) in the Frontiers in Psychiatry reported that although the presence of substance use disorders (both new cases—incidence, and existing cases--prevalence) has declined slightly around the world since 1990 (to 2021), substance-related deaths have increased 2.2 times. Increases in deaths were most prominent in North America, with an 11.2 times increase. The study was conducted with publicly available datasets from https://ghdx.healthdata.org. These datasets are collected and maintained by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle. [The IHME] provides rigorous and ...

By Tom Horvath, PhD For many of us a good life is a happy or a meaningful one (or some combination). However, in recent years a group of psychologists has proposed a third guideline: “psychological richness.”  On their deathbeds the happy might say “I had fun.” Those with meaningful lives might say “I made a difference in the world.”  Those pursuing psychological richness might say, ”what a journey I had” or “that was an adventure!” These three approaches can be and probably often are combined. You can pursue happiness by creating or finding satisfaction, well-being, and even joy. You can pursue meaning by looking for connection with others, purpose, and making the world a better place. If you add the dimension of pursuing personal growth, you can keep working to expand your persp...

By Tom Horvath, PhD Many of us are concerned about our weight. We might check the scale regularly, and not much else. I suggest that a food diary of everything you eat is a much more sensible approach. A simple version is a list of foods you eat at each meal, without listing how much you ate. There are apps, such as My Fitness Pal, which can streamline some aspects of this process. The apps also provide nutritional analysis of what you are eating. If you have food you tend to eat regularly (e.g., eggs at breakfast, bread at lunch), it is easy to copy them forward. There are free and paid versions, which means you have options when it comes to food diaries. This app was recommended to me by a registered dietitian (RD). I have found it useful. Be aware that there is no legal definit...

Crave: The Hidden Biology of Addiction and Cancer, by Raphael E. Cuomo, PhD A Book Review by Tom Horvath, PhD This compact and compelling book describes how our moment-to-moment actions regarding food, sleep and rest, physical activity level, electronic activities, relationships, and daily life in general contribute to increasing or decreasing our risk for developing cancer and other diseases. These actions often have the character of addictive behaviors, “the relentless cycle of stimulation and reward that defines ordinary life (pg. 1).” The impacts of these actions accumulate over time, altering “the internal landscape…the body’s terrain pg. 1).” This book could have been entitled The Body Keeps the Score, but that title was taken! “The term ‘addiction’ is reserved for beh...

By Tom Horvath, PhD In the US many individuals who might benefit from addiction treatment never attend. Although there are probably many reasons for this non-attendance, surely one of the primary reasons is the typical rigidity of US treatment programs. In a commentary published in the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine (ASAM), the committee overseeing the development of ASAM’s Engagement and Retention of Nonabstinent Patients in Substance Use Treatment presents a summary of the document. The California Department of Health Care Services funded this project, and it offers a path forward to get more people to seek addiction treatment. As this commentary states in its abstract: To improve population outcomes, it is im...

How Many Quit Attempts Are Needed to Be Successful? By Tom Horvath, PhD It is common knowledge that abstaining from a substance that has become problematic is difficult and may require multiple attempts to be successful. But how many attempts does it take to succeed in quitting addiction? One effort to answer this question, based on the International Quit & Recovery Registry, was recently published. Subjects were 344 individuals who have registered with this registry. The substances studied were pain meds, opioids, stimulants, alcohol, tranquilizers, inhaling, anesthetics, cocaine, cannabis, nicotine, and hallucinogens. They are listed here in the order of most attempts to fewest attempts. How many quit attempts is complicated not only by the specific substance, but also...

The CHIME Model for Addressing Addictive Problems (and Life) In many approaches to addressing addictive problems, eliminating or at least reducing the problematic substance or activity is the immediate priority. That priority makes sense, except when it does not. You might not be ready to make that level of change, even though you may recognize your addictive problem is indeed a problem. An alternative approach is to focus on what you could be adding into your life, rather than taking out of it. Various alternative approaches have been suggested. We covered some of them here and here. By adding positive aspects to your life, in time, you crowd out the need or desire for other (problematic) approaches to pleasure, satisfaction, and happiness. The CHIME framework arose from an im...

Early Research on LSD for Alcohol Problems: A Look at State Mental Hospitals and Elsewhere By Kenneth Anderson, MA In the 1950s, researchers such as Humphry Osmond and Abram Hoffer in Saskatchewan, Canada developed a unique therapy for alcoholism which entailed using a psychedelic experience to alter the beliefs and values of the alcoholic patients. Set and setting were essential variables in successfully inducing a psychedelic experience. The term "set" refers to the internal mindset of the person about to undergo the psychedelic experience. Patients were given weeks of psychological preparation by the researchers before they were given LSD, in order to ensure that they had the proper mindset for a positive and life-altering psychedelic experience. The term "setting" referred to th...

Negativity Bias: How Negative Are You? By Tom Horvath, PhD Almost 25 years ago two psychologists coined the term “negativity bias.” It refers to our tendency to focus on information, cues, or ideas that are negative, even when we have positive information around us. For instance, after a meeting in which our ideas are presented, we are more likely to remember and focus on the one criticism, rather than the five positive comments. Even animals have this bias, so it has a long history. The negativity bias has the advantage of promoting our survival, particularly in a hunter-gather environment. We were better off staying focused on the rustle in the bushes nearby (because it might be an animal seeking to eat us) than the good taste of what we ourselves were eating. We are descended ...