"You Need Help." Everyone knows that if someone has addictive problems, they need help, right? “Treatment works.” There is an alternative perspective. If there is an individual with problems (IWP), concerned significant others (CSO’s) may start a conversation. Perhaps there is smoldering resentment and withdrawal by the CSO, and the IWP starts the conversation. If as CSO you initiate such a conversation, I suggest that the best message is a combination of concern about the problems that the IWP has experienced, hope that the IWP will focus on solving these problems, and a description of any changes the CSO will make.  Such changes might be, for instance, “if you are intoxicated… I will depart for the evening; I will ask you to sleep in the other room; I will take the kids and g...

By Tom Horvath, PhD, ABPP On 7/6/22 JAMA (the Journal of the American Medical Association) published “Preaddiction—A Missing Concept for Treating Substance Use Disorders.” Written by three of the most well-respected scientists in the field (McLellan, Koob, and Volkow), the article reminds us of the value of early detection and treatment of addictive problems, rather than waiting until these problems are severe. Because there is also a much larger number of individuals at lower levels of severity, there is substantial societal benefit from addressing that larger group. That group may generate more negative impact than the severe group. The article also reminds us that less than 20% of those who might benefit from treatment seek it, a situation that frustrates the authors. When ...

by A. Tom Horvath, Ph.D., ABPP Might you be looking for an up-to-date and thoroughly scientific “textbook” on alcohol, alcohol problems, and how to deal with them? In May, 2022, the US National Institute on Alcohol Abuse and Alcoholism (NIAAA), one of the 27 National Institutes of Health, published one online. Although this resource is written for healthcare professionals who address alcohol problems, motivated non-professionals will find answers to many of their questions, as well as links to resources for investigating further. NIAAA's Core resource provides 14 articles, which address: How much alcohol is too much? Risk factors for developing alcohol problems The neuroscience of alcohol Understanding and coping with stigma about alcohol problems Medical complic...

By Tom Horvath, PhD Not exactly: I’m reporting about a presentation by Professor Bruce Alexander, the creator of “rat park,” given on 4/19/22, for the Addiction Theory Network, based in the UK. The webinar was: Retiring the Brain Disease Model of Addiction. And Then What? Rat Park Recap Rat Park, if you are not familiar with it, was his groundbreaking research showing that when rats are given a stimulating environment they will NOT die from self-administering various substances (e.g., cocaine, heroin). However, they will die from self-administration in a barren cage where the only choices are food/water and substances. Further, if you take rats stuck in those barren cages and then place them in rat park, they will again engage in normal rat activities and no longer have substance p...

Addiction and Relationships: How Well Do I Engage in Relationships? by Tom Horvath, PhD, ABPP If I live just for myself I can do what I want when I want. If I do not mistreat others they probably will not mistreat me. However, if I have no connections with others no one is likely to help me or care for me. If I live just for myself I can do what I want but be alone. If I am connected with others, then I also live for them and for us, as well as for me. Now others will help me and care for me. However, at times I will need to act for them and for our relationship, even at my own expense. At times I will need to address relationship concerns, to keep the relationship growing, even if raising these concerns is uncomfortable. Addiction and Relationships: Questions to Consider Have...

Psychedelic Diaries, Episode 3: Interview with Tom Horvath, PhD, ABPP "Psychedelic Diaries," a podcast hosted by Ray Christian, has nearly 30 episodes (each an interview). Dr. Horvath was the third interviewee. The podcast describes itself as offering: "Experts from the world of medicine talk about mental health, mystical experiences, and the psychedelic renaissance. The show features news and discussion on how psychedelics affect our mind and the world around us." This 3 minute video has excerpts from each of the five initial experts interviewed. Dr. Horvath, in the excerpt, speaks about the value of a psychedelic experience as a "pattern interrupter." In the full interview he elaborates on that concept and his own (unfortunately disappointing) experience doing ayahuasca fou...

Sage Money Conversations with Barbara Norman, CFP® - Interview with Dr. Tom Horvath Episode 010: Dealing With Family Addiction Addiction can be financially devastating, it can destroy a life, and it can tear a family apart. It’s common for individuals with addictive problems to attend several expensive treatment programs, with little lasting progress. In this revealing episode, Dr. Tom Horvath reveals some of the problems with traditional approaches to treatment, and he offers alternative ways to treat addictive problems, talk with our loved ones, and create a happier home life. Dr. Horvath, author of Sex, Drugs, Gambling & Chocolate: A Workbook for Overcoming Addictions, has specialized in addictive problems since 1985.  He is a California licensed (PSY7732) and board-...

by Tom Horvath, PhD There is no more important person to the addiction treatment and recovery field than Nora D. Volkow, MD. Dr. Volkow is the Director of the National Institute on Drug Abuse (NIDA). In the US government’s fiscal year 2021 NIDA spent about $1.4 billion, primarily on research. By comparison, the budget for the National Institute on Alcohol Abuse and Alcoholism is only about $500 million. A substantial portion (if not the majority) of the world’s addiction research is funded under Volkow. The Statement from Dr. Volkow: Consequently, when Volkow speaks, people listen. Maybe more so than ever now: “Making Addiction Treatment More Realistic And Pragmatic: The Perfect Should Not Be The Enemy Of The Good” https://www.healthaffairs.org/do/10.1377/forefront.20211221.6918...

by Tom Horvath, PhD In September 2021, Netflix released a seven-episode miniseries that mentions Rational Recovery (RR) as an alternative to Alcoholics Anonymous (AA) in episode II (starting in minute 46). Ironically, the mention of RR occurs in a very small (two-person) AA meeting. The pro-RR speaker is required to attend AA as part of parole, but he objects to AA’s powerlessness and God-centered approach. He prefers RR’s addictive voice recognition technique and the idea that he could take charge of his own behavior. In that AA meeting, he takes an extended moment to explain RR concepts and what he likes about them. Miniseries Mentions Rational Recovery - The Significance The significance of RR’s presence in Midnight Mass is that self-empowering approaches to resolving addictive ...

Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, by Maia Szalavitz Review by A. Tom Horvath, PhD The harm reduction approach to addressing addictive problems has until recently been highly controversial, at least in the US. Treatment and other change efforts in the US have been primarily guided by the views that addiction is a disease and that the 12 steps are the primary (or only) method for change. Harm reduction accepts and encourages small steps toward change. The US approach has typically required an immediate and large change, often involving a completely new perspective: “I’m an addict, I have a disease, I will abstain from everything forever.” The small steps approach of harm reduction, even though it describes how most human change occurs, has ...