by Tom Horvath, PhD There are many occupations considered to be safety-sensitive. The industries from which they are drawn include healthcare, transportation, and construction. Specific occupations include physicians, airline pilots, and heavy equipment operators. When these individuals have their substance use monitored (often because of recent substance problems), what principles should guide the creation of the monitoring plan? Let us focus on alcohol, because it may be the most common substance monitored. There are many methods to monitor alcohol use. They differ according to the timeframe they observe, their accuracy (will they miss use that occurred?), whether they assess the substance itself or a metabolite, the convenience of use (e.g., including how far one must go to get...

By Tom Horvath, PhD In the state of California, a licensed residential substance use treatment facility (a “rehab”) needs to provide 20 hours of treatment per week. Typically, this treatment is provided in groups. In many rehabs there is only one individual session per week, the minimum required by law. The groups in a rehab have significant similarities with SMART Recovery meetings, particularly if a SMART participant talks about their specific goals and challenges. If someone were primarily interested in the treatment aspect of being in a rehab, 20 SMART meetings per week would be a reasonable alternative to residential treatment. To make the best use of SMART meetings the participant would benefit from having an individual session a week, just like in the rehab. The individu...

By Tom Horvath, PhD This article focuses on physicians with substance problems (and by extension all licensed professionals). However, the underlying idea, that those wanting to assist someone with substance problems should focus on ends not means, applies widely. In most US states there is a state-recognized Physician Health Plan (PHP) which often controls how physicians who have substance problems are dealt with. Similar plans exist for other licensed professionals. These organizations do much beneficial work. No one wants a licensed professional with substance problems. The national organization for PHPs is: https://www.fsphp.org, the Federation of State Physician Health Plans. In this article I focus on some major problems with PHPs (and the parallel organizations). The ide...

By Tom Horvath, PhD Mutual help groups for addictive problems have been in existence for centuries. No one knows exactly how they work. What follows is my best estimate of what happens in SMART Recovery meetings, and how they help. How SMART Recovery Works SMART offers an approach that will appeal to many (for either substance problems, activity problems, or both) because it is self-empowering, science based, progress-oriented, and holistic. Other mutual help approaches will appeal to other people. Some people may use multiple approaches. In 1994, when SMART Recovery began operating under that name, SMART elected to move beyond specific tools (which had been prominent in its pre-history) by identifying 4 common tasks for the process of addressing an addictive problem, the 4 Poin...

Neuronal Plasticity, Mindfulness Meditation, and Addiction Recovery by Nicholas A. Nelson, Ph.D. Part 1 of 2 It is not uncommon during active addiction or early in recovery for people to feel that their brain is working somehow differently than before, or to feel like it is going to be impossible to break out of harmful habits and thought patterns. It can feel like the mind is damaged, or operating out of our control. This lack of control, and feeling that something is broken, can lead to a sense of hopelessness. When we look at the brain there is some truth to this feeling - during engagement with problematic addictive behaviors and during early recovery, our brains are not wired in the same way as before these problems took root. Through months, years, or decades of repetiti...

By Tom Horvath, PhD Even if you do not have a specific partner this Valentine's Day, and especially if you do, it’s a great day to engage in relationship enhancing behaviors. You might do something special just for today. In addition to your partner, you could also reach out to someone who is not at all expecting to hear from you (a parent, relative, mentor, friend, etc.): “I know you may not be expecting to hear from me on Valentine’s Day, but when I thought about all the people who mean a lot to me, I realized that thanking you for being you was a great idea. So, I want you to know I appreciate you and am thankful for the role you have played in my life.” Too sappy? Keep in mind that a psychologist wrote it! Any variation that works for you can get the job done. Further, love...

by Lesley Wirth, MA I’m just going to say it: The self-help world needs to reconsider the phrase, “Take responsibility for your life.” Why? It rarely works. It is usually the wrong medicine, offered at the wrong time, to the wrong person. When someone has suffered from loss, injustice, or trauma, telling them to “Take personal responsibility for their reality,” is not helpful. It is damaging. Maybe you've been there: you lay your heart bare to a spiritual coach you believed you could trust, only to have them dismiss your experience by telling you to let go of your "victim consciousness." If you are really lucky, they will ask you what part of you attracted your situation so you could learn from it. I understand people mean well, but words like these can feel like...

by John de Miranda Early in my recovery from an alcohol use disorder I discovered that memoirs and first-person accounts of people struggling with addiction were a useful method to help me deal with the challenges of a life without alcohol. Many of these accounts were uplifting. Some were scary. I remember one in particular A Sensitive Passionate Man published in 1974 by Barbara Mahoney. Her account chronicles life with her husband Sean who died at the age of 45 from cirrhosis of the liver. Despite a life of material and personal success Sean rebutted all attempts from family and friends to intervene in his alcoholism and literally drank himself to death. In my pink cloud naivete I was taken by surprise that not all stories of addiction had a happy ending. I am an instructor in...

By Tom Horvath, PhD Although the following information is very basic, I hope it is a useful reminder for you. You are breathing all the time. With a few minor adjustments breathing can become a powerful tool to support yourself. Start by closing your mouth and breathing through your nose. Probably this step can happen immediately. You can also if you wish focus on the sensation of the air coming in and out of your nose. That focus can also be a helpful distraction technique. Begin to slow down your breathing. It may take many breaths to achieve a significantly slower pace. However, if you can get down to 6 breaths per minute (one every 10 seconds) you have a strong likelihood of lowering your stress level. If you are not sure how to accomplish slowing down, start counting you...

By Tom Horvath, PhD With 2025 now over a week old, we may already be falling short of some of our New Year’s resolutions. Nevertheless, take heart! It is easy to fall into all-or-none thinking about positive change. Please consider the following ideas. Even if you did not make any New Year’s resolutions, you may have thought about self-improvement changes you want to make. The beginning of the year is an obvious time to do so. To the extent you did such thinking (or do it now!), you have acted on step one: identifying a desired change. What actions now make sense? This part is often complicated, but the principle of “small steps” can be very helpful. This may be a time to investigate, experiment, inquire, consult, and otherwise gather information. Keeping mental notes of what y...