By Tom Horvath, PhD We know how to estimate levels of alcohol moderation and intoxication. For instance, we can estimate that a 180 pound male, without a history of alcohol dependence, drinking over two hours, might hardly feel one drink, would be mildly buzzed at two or three drinks, would be substantially buzzed (and over the legal driving limit) at 4 to 6 drinks, and intoxicated to heavily intoxicated at 10 drinks. Almost anyone can make these estimates because blood alcohol level (BAL) calculators are widely available. They are based on a “standard drink,” the differences between how men and women on average metabolize alcohol, time drinking, and body weight. We can interpret the BAL because we understand the average expectable behavior at different BAL’s. In the example above, 1...

By Tom Horvath, PhD Psychedelic experiences have apparently been an aspect of Western life for a long time. It is hypothesized that the Eleusinian Mysteries, a religious rite in the ancient Greek world starting circa 1500 BCE, involved the use of an LSD-like substance. Since the synthesis of LSD in 1943, there have been waves of interest in several psychedelics (also known as hallucinogens and entheogens). The most recent wave appears to be about 20 years old, based in part on scientific investigations at prestigious universities of the positive aspects of these substances. Recently (1/13/26) Nora Volkow, MD, the Director of the National Institute on Drug Abuse, released a blog arguing that: The potential use of psychedelics in the treatment of various mental health conditions ...

Dr. Horvath's Contrarian View About Recipes (but encouragement to prepare food at home) By Tom Horvath, PhD I was raised by a father from a family in the catering business, and a mother who was a dietitian and highly accomplished cook (one of the best I have experienced). In our home we had dozens of recipe books, and there are many in my current home. Nevertheless, I rarely use a recipe, and even if I do, I may never have followed one precisely. When there is a particular kind of dish I want to make, and I'm not sure about ingredients, I will jump to a recipe book or online, but that information is just a launching pad. I understand that baking is an entirely different business, but when it comes to cooking food, I love the creativity and playfulness of it. Even when I come...

By Tom Horvath, PhD By traditional addiction treatment I mean expecting the client to agree that addiction is a disease, abstain for life, engage deeply in 12-step meetings, and attend them for life. This approach probably continues as the dominant US approach, although there may be much variation in how firmly it is applied. This approach can work well for someone who agrees to it. Or enough of it. Because we do not understand exactly how addiction treatment works, it seems likely that even variations in the approach can be effective. This variation is a positive sign, because a strict approach would likely violate much of what we have come to know about how psychotherapy works. Although there are many forms of psychotherapy, successful psychotherapy appears to involve what are k...

By Tom Horvath, PhD “We are disturbed not by events but by our views about them.” - Epictetus, 50-135 CE The cognitive behavioral therapy (CBT) tool known as cognitive reappraisal uses a fancy term for what is perhaps the fundamental idea of Stoicism: We can control our lives by controlling our “views” (or our “thoughts,” in the broad sense of that term). There are many terms for view or thought, including: perspective viewpoint perception belief interpretation model map cognitive structure cognitive schema internal representation construct knowledge structure life script personal mythology interpretive framework mindset inner theory of reality assumed context I’ll use the term “interpretation.”  We experience an almost...

By Tom Horvath, PhD One of the most basic principles of self-control is not to rely on it! Although our motivation (willpower, sense of purpose) can be very strong, there are times when it falls short of what is needed. An alternative approach to self-control is to control our environment. Then self-control is not needed. We can do this for ourselves, such as when we keep ourselves from not eating cookies at home by not purchasing them, or avoid drinking by not going to the holiday party, or avoid scoring by not going to that part of town. What is typically called “relapse prevention” mostly consists of finding ways to manage high risk situations, primarily by avoiding them. A relapse prevention plan is based on a thorough review of where, when, and with whom one has engaged in...

By Tom Horvath, PhD In 2022, the National Institute of Alcohol Abuse and Alcoholism (NIAAA) proposed a definition of recovery that begins: Recovery is a process through which an individual pursues both remission from alcohol use disorder (AUD) and cessation from heavy drinking. An individual may be considered “recovered” if both remission from AUD and cessation from heavy drinking are achieved and maintained over time. In case you missed it, note that unlike other definitions of recovery, this definition does not require abstinence. For decades the diagnostic manual, the DSM, has not required abstinence for a diagnosis of sustained remission, but this fact is often overlooked. NIAAA includes the following language later in the definition: Cessation from heavy drinking is def...

By Tom Horvath, PhD Thanksgiving is a few days away. The day after Thanksgiving (or Christmas, New Year’s Day, the Super Bowl, etc.), we often get calls about a substance binge the day before. The binge was so bad, is it time to go to rehab (residential treatment)? Below are some issues to consider when making that decision. I typically recommend AGAINST going to rehab, as I will explain. Every case is unique. In addition to the following considerations there may be many others. For many substances you need to taper off or get medical assistance (a detox). A brief admission lasting several days (up to a week or two) for detox is not the same as rehab, and it may be worthwhile. Would going to rehab please your family, rather than going because you need it? Do you have a family m...

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...

How effective is ketamine for depression? By Tom Horvath Depression often coincides with addictive problems, as a cause or effect, or some combination thereof. Addressing depression, whatever its causal role, is often one of our main focuses at Practical Recovery. Fortunately, there are a wide range of methods for addressing depression, and we expect to be successful, in time, with nearly everyone. In recent years many clinicians have been interested in the possibility that ketamine is an effective antidepressant. (There is also interest in ketamine as a direct treatment for addictive problems, but for now we focus on depression). Any large urban area is now likely to have multiple ketamine clinics. A recently published study raises significant concern about whether, as with othe...