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...

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...

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...

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 ...

A Scientific Life on the Edge: My Lonely Quest to Change How We See Addiction, by Stanton Peele, reviewed by Tom Horvath, PhD Peele’s latest book (#14) is a personal autobiography, an intellectual autobiography, and a detailed comparison of his work with that of many other authors and scientists, including Maia Szalavitz, Carl Hart, Marc Lewis, and Johann Hari. For those unfamiliar with Peele’s work, this book would be an excellent introduction. If you already appreciate him, the historical and comprehensive nature of this book (379 pages, plus 52 pages of online references) will likely be appealing. The references online are helpful, and save the reader from flipping pages back and forth. Peele revolutionized our understanding of addiction. Love and Addiction, published in 1975 (...

by Thaddeus Camlin, PsyD Let’s call a spade a spade.  The war on drugs is a euphemism for a war on personal freedom.  The hypocrisy inherent in a war on personal freedom in the self-proclaimed land of the free is more than a tad embarrassing (insert cringe emoji here).  The number of lives ruined with criminal scarlet letters and families torn apart because someone dared possess psychoactive compounds is beyond measure.  Even on the very day of writing this article a U.S. Olympian was kicked off the track and field team because she tested positive, not for a performance-enhancing drug, but for cannabis detected in her bodily fluids after she inhaled the plant’s smoke to ease the pain of the death of her mother.  This Independence Day, as America celebrates the passing of the drug war...

by Thaddeus Camlin, PsyD Labeling people who’ve been traumatized as sick, is sick. There’s nothing pathological about being severely affected by the worst of life’s horrors. There is something deeply pathological when natural reactions to unnatural situations are described as sickness and disease. There’s nothing sick or diseased about someone experiencing post-traumatic stress after catastrophic events then easing the aftershocks with substances that provide fast-acting relief. Substance use is an adaptive effort to cope with life problems, and until we figure out ways to effectively and reliably help people who suffer from post-traumatic stress people will continue to take matters into their own hands. The problem is not the people in addiction treatment, the problem is the woefull...

by Thaddeus Camlin, PsyD [caption id="attachment_12950" align="alignright" width="500"] HBO's Euphoria misses the mark when it comes to addiction, again[/caption] The latest installment of HBO’s Euphoria is chock-full of harmful addiction myths and contradicting information.  The show’s main character, Rue, is a young and intelligent woman with a history of severe trauma.  Her father died young from cancer, she was drugged and nearly raped, and she was cheated on and heartbroken by her first true love.  Like many who experience horrible trauma, Rue found solace in substances like MDMA and opiates.  Like many who find solace from trauma in substances, Rue got a bit carried away.  Like many who get a bit carried away with substances, Rue experienced some negative consequences becaus...