By Tom Horvath, PhD We regularly see criteria for evaluating our health, physical fitness, or financial well-being. If our relationships are the primary source of our emotional well-being (a statement apparently accurate for most people), then guidelines for evaluating our relationships would also be valuable. Having both one or a few intimates, and a wide range of other relationships, is conducive to well-being. We need to have one or a few people we know very well, and then many other relationships that could be meaningful in various ways. We can compare this situation to the specialist/generalist distinction. We need to be a specialist in one or a few areas (often to make a living), but we also need to have much general knowledge, to get along well in the world. The followin...

by Tom Horvath, PhD The Year of the Dog, a roughly 90-minute film, presents a fictional account of a mid-30s man and his early to middle change process out of alcohol problems. The story begins at the end of day 2. Matt has been released from jail, still experiencing withdrawal symptoms. Over the next several months he experiences various emotional setbacks, and several positive events he has worked to bring about. My interest in this film arose from the fact that the trailer showed Matt arguing forcefully with someone whom I suspected was his AA sponsor. Matt significantly ignores the sponsor’s advice. How open to alternative recovery approaches would this film be? This indie film, shot in Montana, impressively uses its resources to create a story I expect anyone dealing with alc...

By Tom Horvath, PhD, ABPP   “How do I love thee? Let me count the ways.” from How Do I Love Thee? (Sonnet 43) By Elizabeth Barrett Browning 1806-1861   [caption id="attachment_13904" align="alignright" width="281"] "I Love You" written in different languages.[/caption] This poem focuses on the writer’s experience of being in love. That experience could occur even if the love were not returned. We could have a “crush” on someone who does not know of our feelings. In this blog, I focus on the day-to-day experience of mutually expressing love and receiving it. The five “languages of love” have been popularized by Gary Chapman. Anyone not familiar with them would benefit from knowing them: kind and loving words, meaningful time together, physical affection, helpful...

By Tom Horvath, PhD, ABPP The rapid increase in US overdose deaths in recent years has resulted in increased attention to our drug policies and treatment system. In other developed countries drug policy has increasingly oriented toward harm reduction. Harm reduction approaches emphasize working with individuals who use drugs to increase safe use in the short term, and improved well-being and the resolution of addictive problems in the longer term. Transforming the US Addiction Treatment Workforce -  It's Needed This approach has been controversial in the US, on the assumption that any approach that does not insist on immediate abstinence encourages drug use and is therefore counterproductive. This controversy overlooks the reality that in the countries that have embraced a harm red...

By Tom Horvath, PhD In Part 1 I recommended that the term “addictive problems” replace several similar terms. In Part 2 I recommend that the term “recovery” be replaced with several better alternatives, depending on context. To summarize Part 1, there is a continuum of addictive problems (abstinence, moderation, misuse, mild substance use disorder, moderate substance use disorder, severe substance use disorder). Over time someone can move up or down that continuum. They are not stuck forever at one level. This possibility of movement is the most radical aspect of viewing addictive problems as lying on a continuum (vs. the view that you are an “alcoholic” or “addict” forever, or that you are not). The lower the level of problems, the less likely someone is to address them because t...

By Tom Horvath, PhD, ABPP When we experience anguish (despair, heartache, melancholy, sorrow) after a significant loss, the depth of the anguish reminds us of the depth of the loss. Usually, the anguish does not surprise us, but we may be surprised at how powerful it is. Even our bodies can hurt. We feel anxious and confused. We ruminate about the past and imagine “if only” over and over. We neglect ourselves, and possibly others. We fear for the future. We think we need to talk about how we feel, but we don’t know where to start. Most often we think of grief as arising from the loss of a person or a relationship, but grief can arise from any significant loss. Like other aspects of human life, grief is an experience we will likely have several or more times. We will somehow get th...

By Tom Horvath, PhD I recommend the term “addictive problems” to replace several other similar terms, and no longer using the term “recovery,” which has several better alternatives depending on context. In this two-part series on improving the language about addictive problems, part 1 will focus on addictive problems, and part 2 will focus on “recovery.” The diagnostic manual, DSM5-TR, identifies 10 categories of substance problems. The substances are alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedative/hypnotics/anxiolytics, stimulants, tobacco, and “other.” There is also one category of activity problems (gambling). There are 11 criteria (9 for gambling) which identify common consequences which can arise from substance use. The consequences manifest themselve...

Boundaries are difficult. Figuring out what your own wants, needs, and limits are can sometimes be hard enough. And then we must figure out a way to communicate our wants, needs and limits to someone else who may have a history of pushing them. Now add on top of that the stress, overwhelm, and sometimes chaotic nature of the holiday season, and it makes sense that this time of year is one of the hardest in terms of setting and maintaining boundaries.   If you have a family member, or loved one who is struggling with substance abuse, or additional mental health disorders that may be affecting the way that they show up- setting boundaries during the holidays is essential. Sometimes it can be difficult to hold space for the awareness of your loved one’s struggle with substance a...

By Tom Horvath, PhD, ABPP   Am I an “alcoholic” or “addict?” Do I “need help?” If so, what kind? If you are asking one or more of these questions, this blog is for you!   A somewhat out-of-date but nevertheless helpful federal publication considers these questions. Although this NIAAA (National Institute Alcohol Abuse and Alcoholism) document is focused on alcohol problems, many of its ideas can also be applied to other addictive problems. In this blog I will attempt to improve upon and expand their ideas. In my opinion NIAAA 1) focuses too much on treatment and not enough on the individual choosing or considering change, 2) does not alert the reader about the serious problems that can arise in treatment, and 3) is not up-to-date on the finding that AA specifica...

Stanton Peele Interviews Tom Horvath by Tom Horvath, ABPP, Ph.D. In an unexpected honor I was invited to be interviewed for one hour on video by Stanton Peele. I have admired Peele’s work since early in my days specializing in addictive problems. Along with the Sobell’s, Alan Marlatt (now deceased), and Bill Miller, he is one of the thinkers I have learned the most from. I view him as the most important theorist about addiction. As I wrote in my review of his latest book: Peele revolutionized our understanding of addiction. Love and Addiction, published in 1975 (and co-authored with Archie Brodsky), presented a new perspective on what addiction is, how it arises, and how it can be addressed. His insights are still far from being fully understood and acted upon, especially in th...