By Kenneth Anderson, MA Normal and Retrograde Neurotransmission Delta-9 THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol) are the two most commonly found cannabinoids in the cannabis plant. The plant contains over 100 other cannabinoids as well. THC and CBD both affect the endocannabinoid system. "Endo-" is a Greek prefix meaning "inside." "Endocannabinoid system" refers to all the systems of the body which contain cannabinoid receptors and are affected by cannabinoids. We will be primarily focused on the effects of cannabinoids in the central nervous system, and on the CB1 receptor, which is the main cannabinoid receptor there. Drugs like THC can affect the central nervous system because there are also naturally occurring cannabinoids in the central nervous system, the endo...

By Tom Horvath, PhD This weekend SMART Recovery is celebrating (a few months early) its 30th anniversary by holding a conference in Salt Lake City. What has SMART achieved? How well is it functioning? What might its future hold? What follows is my personal perspective on some highlights of SMART’s first 30 years (from someone who has been part of that process), and my hopes for the years ahead. Growth and influence The good news is that in 2018 SMART Recovery expanded into SMART Recovery International, which has a world-wide presence. The US based organization is now an affiliate of the international organization, which operates approximately 2,500 weekly meetings in 38 countries and has printed materials in 18 languages. The less-than-good news is that SMART in many parts of t...

By Tom Horvath, PhD How can we explain the widespread expressed concern about US overdose deaths, coupled with our rather ineffective response to them? US overdose deaths may be the highest in the world. I will limit the following discussion to opiates, but alcohol, meth and multiple substance use are also of concern. I suggest that harsh and inaccurate beliefs about substance use and substance users have led many of the parts of our “system” for addressing substance problems into actions that increase overdose deaths rather than reduce them. In the remainder of this blog, I provide some details to support that idea. Buprenorphine and methadone: The medications most helpful for opiates are buprenorphine and methadone.  As it stands much less than half of the US individuals who cou...

By Tom Horvath, PhD I expect that you know everything I am about to write about. However, I hope this blog will be a useful reminder about life and values. A well-lived life is based on values. We act on values we are not even aware of. However, we know many of them. Becoming even clearer about them is worth the effort. Some ways to accomplish that effort is what I am proposing here. If you find yourself, in some part of your life, uncertain about what to do next, it’s time to think ahead. What is a value you want to be acting on? To help identify this value, ask yourself “big picture” questions. What would I ultimately like to accomplish? How would I like to be remembered? What change seems most important to make? If I could be completely in charge, what would I do? What I ...

By A. Tom Horvath, PhD Is this question sacrilegious? It should not be. AA has done much good in the world, and I expect it will continue to do so, for those who freely choose to attend it. In this article I point out what harm AA can do and might continue to do. Any activity has a cost benefit analysis, and it is generally reasonable to consider that analysis. The question this article asks has been discussed many times before. You can conduct an internet search for this title and get numerous hits. You might even find this one: https://www.practicalrecovery.com/prblog/aa-harmful/ (posted 10 years ago on 3/25/14). For AA not to be harmful it might need to have more control over its discussions and what its members say (as SMART Recovery aims to do). AA members should NO...

By Kenneth Anderson, MA Alcohol treatment wasn't always divorced from alcohol science; the divorce between the two can be largely laid at the feet of Hazelden CEO Daniel John "Dan" Anderson, PhD (Mar 30, 1921 - Feb 19, 2003). Anderson's attitude towards science was one of hubris and arrogance. The History of Alcohol Treatment in the United States Treatment for alcohol problems in the United States occurred in two major waves: The first was prior to Prohibition (January 17, 1920), and the second followed Repeal (December 5, 1933). Demand for alcohol treatment dried up almost completely during the period from 1915 to 1920 due to state and local prohibition laws, the so-called Wartime Prohibition Act, and other factors, and all but a handful of alcohol treatment facilities had shut do...

By John de Miranda Innovation does not come quickly or easily to the addiction treatment sector. For example, harm reduction strategies had been employed in the public health sector for decades before their recent adoption by the federal government as a latecomer to fighting our nation’s opioid epidemic. Similarly, the Minnesota Model of addiction treatment, which emerged in the 1950s, still accounts for the model preferred by the majority of treatment programs. At its core, this approach draws heavily from 12-step ideology and requires a commitment to abstinence as the key focus of treatment goals. “If you have had enough and are ready to quit, then we can help you,” is the metamessage sent to potential clients by most addiction treatment programs. The problem with this approa...

By Tom Horvath, PhD Stanton Peele suggested this idea in one of his recent blogs. As we await Super Bowl Sunday (2/11/24) the question seems worth re-visiting. It would require a careful analysis of outcomes from pro football and substance use to provide an accurate comparison. The data about substance problems is easy to find. Pro football’s data is harder to find, but generally we know that playing football can result in concussions, broken bones, chronic traumatic encephalopathy (CTE), and other injuries. For further details search for the NFL concussion settlement. However, it seems unlikely than an accurate comparison between pro football and substance use will occur because professional football is popular, and substance use seems to be unpopular. We often condemn substance ...

By Tom Horvath, PhD How well can I calm myself or energize myself using my own abilities? How much do I need to use a substance for help? Although at times a mild sedative (one drink) or mild stimulant (a cup of coffee) can be a helpful tool, the more we rely on such tools the more our internal abilities diminish (atrophy). Daily low doses of sedatives or stimulants can be helpful. As the doses get higher, problems can emerge. In cases of substantial addictive problems, it is common to see someone bouncing between “downers” and “uppers,” sometimes even multiple times per day. At that level of substance use we can lose all sense that self-regulation can be accomplished by ourselves. None of us may reach the ideal of regulating ourselves entirely from our own resources. However, ...

By Kenneth Anderson, MA The history of alcohol treatment since the 1960s has been a history of practitioners ignoring science and the scientific method and forming conclusions based on observations of clinical populations without testing hypotheses, then self-publishing these hypotheses or publishing them in the popular press rather than in peer-reviewed scientific journals. Some of the most notorious examples of this are Hazelden and the Johnson Institute, which will be discussed in later blog posts. Another notorious example is Lakeside Milam, founded by James Robert Milam (Mar 3, 1922 - May 6, 2016). This is a far cry from Shadel Sanitarium, which meticulously published its data in peer-reviewed journals in the 1940s and 50s. James Robert Milam Milam was born in the state of Was...