by Tom Horvath, PhD It seems that almost everyone worries at times. We can think about a problem over and over and not make any progress. Ineffective strategies for worry include telling ourselves to “just stop,” and looking for guarantees or certainty when they are not available. Very little is guaranteed in life, and yet somehow we keep moving forward. Worry can be considered a problem-solving effort that is not working well because we are focused on the wrong parts of the problem. Most problems have aspects that 1) can be dealt with now or cannot be dealt with until later; 2) are under our control or not under our control; and 3) are more important or less important. If you focus your thinking on aspects of a problem that can only be dealt with later, are out of your control, o...

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...

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   A somewhat out-of-date but nevertheless helpful federal publication considers these questions.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...

by Thaddeus Camlin, Psy.D. An underemphasized area in the disease model of addiction is the role of environmental factors.  Genetics and sensationalized hijackings of the midbrain are certainly factors in the development of problematic addictive behaviors, but they are overemphasized at the expense of family and social factors.  The disease model paints addiction as an individual problem and gives family dynamics and societal norms a get out of jail free card, so no wonder it maintains its stronghold as the dominant theory - everybody other than the identified addict gets to point their finger from a holier than thou position of moral superiority and save themselves from the discomfort of identifying and addressing their own issues. Addiction and Family Systems Family roles (e.g. t...

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...

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 Practical Recovery and SMART Recovery both use the self-empowering approach for resolving addictive problems. This approach contrasts with the powerlessness-based approach of AA and other 12-step groups, at least on the surface. Both approaches begin with the person considering change, and then deciding to change (at least to some degree). Both approaches can be effective, but one may work better for specific individuals. The powerlessness-based approach is described in AA’s 12 steps. In the first step you admit you are “powerless over alcohol.” In the third step there is “a decision to turn our will and our lives over to the care of God as we understood Him.” This approach can be described as serenity (as used in the Serenity Prayer, and also as “letting go” o...

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 Tom Horvath, PhD, ABPP Dialectical Behavior Therapy (DBT) is an approach to psychotherapy designed for individuals who are highly emotionally sensitive, who struggle with depression and anxiety, and who may at times become suicidal. DBT tools, which focus on distress tolerance, interpersonal effectiveness, emotion regulation, and mindfulness, can be helpful to anyone. You can remember these 4 categories as DIEM, as in carpe diem (seize the day). DBT is part of the larger family of CBT (cognitive behavior therapy). Marsha Linehan, a psychology professor emeritus at the University of Washington, Seattle, developed DBT as a result of coping with her own emotional problems. Linehan, born in 1943, revealed in her late 60’s the personal connection to her professional work. Distres...