by A. Thomas Horvath, Ph.D., ABPP As part of my celebration of SMART Recovery’s 25th Anniversary, this blog is devoted to considering the recently released SMART Recovery USA Position on Goals: “SMART Recovery is abstinence oriented. Our meetings and tools are designed to help participants stop problematic addictive behavior.” I offer the following interpretation of this position.  Isn’t all addictive behavior problematic? Addictive behaviors are normal human behaviors, including eating, sexuality, and connecting with others. For some individuals these behaviors become problematic. Involvement with pleasurable psychoactive substances or activities is also common, including with alcohol, caffeine, gambling, video games, and many others. For some individuals these involvements becom...

by Thaddeus Camlin, Psy.D. The term ‘binge-drinking’ generally conjures up images of frat boys in pastel polos guzzling litres of PBR out of a homemade beer bong, or something along those lines.  The stereotype is that binge-drinking is a college thing, not a mature adult thing. The truth, according to the current dean at USC’s School of Social Work, is that binge-drinking is on the rise amongst adults in their 40’s, 50’s, and 60’s.  A 2017 survey conducted by the Center for Behavioral Health Statistics and Quality found that over 30% percent of men 26 years or older binge drink, and under 40% of men ages 18-25 binge drink – a difference in percentages pretty close to the margin of error in many surveys.  Based on recent findings, the stereotypical binge drinker may be about as l...

by Thaddeus Camlin, Psy.D. They said acid fries your brain and makes you jump off buildings.  They said shrooms make your brain bleed and that’s why they cause hallucinations.  They said pot makes people murder their families.  I don’t know exactly who ‘they’ are, but boy were they wrong.  The prestigious Johns Hopkins University just announced the opening of a nearly $20 million dollar research center to study psychedelic medicines.  The announcement from Johns Hopkins is arguably the single biggest acknowledgment that Western Society has been embarrassingly wrong about psychedelics all along.  Support for Psychedelic Therapy Research trials forthcoming from the new research center include the use of psychedelics to treat addiction, anorexia, Alzheimer’s related distress and cogni...

by Thaddeus Camlin, Psy.D. When it comes to addiction treatment, it is well-known that the United States is embarrassingly and shamefully behind the rest of the industrialized world.  It is no surprise then that evidence for MDMA-assisted psychotherapy reducing alcohol relapse is coming out of the UK. We know MDMA-assisted psychotherapy was designated breakthrough status as a treatment for PTSD, and we know that trauma is at the etiological heart of most addictive behaviors (see Atkins, 2014, p.195). So it would naturally follow that if MDMA-Assisted Psychotherapy helps treat the etiology of addiction, it will probably help treat addiction. Yet, the misinformed notion that all addicts are the same and can never touch mind-altering substances again (except of course for boat-loads...

by Thaddeus Camlin, Psy.D. HBO’s hit television series, Euphoria, pushed the envelope on many important topics, except one – addiction.  The show depicted a biracial romance between two women, one of whom was transgender. The show offered gritty, raw depictions of sexual assault, teenage substance use, physical and emotional abuse, and abortion.  When it comes to addiction, however, the show somehow missed the memo that there are no experimental studies that unequivocally demonstrate the effectiveness of traditional addiction treatment.  Euphoria pushed boundaries on a number of important social issues, but when it comes to addiction, the show succeeded only in being yet another example of mainstream media perpetuating the harmful messages that all addicts are the same and thus, all de...

by Thaddeus Camlin, Psy.D. Addiction treatment needs improvement.  Exploring new methods is essential to advancing the field.  To imagine the latest radical approach to treating addiction one might envision an amalgamation of electro-shock therapy and trepanning.  Brain surgery for addiction is not a futuristic concept at the dawn of its conception.  On the contrary, brain surgery for addiction is happening now in China and a clinical trial is scheduled in West Virginia this year.  Like any emerging treatment, brain surgery to treat addiction is worth a closer look to consider potential costs, benefits, risks, rewards, and ethical delivery of services. The Technique The brain surgery technique used to treat addiction is deep brain stimulation (DBS).  DBS is already an established t...

by Thaddeus Camlin, Psy.D. The concentration of misinformation in the world of addiction is as dense as osmium.  One of the most well-known misconceptions in addiction is the idea of an addictive personality.  I hear references to someone with an addictive personality all the time from professionals and lay folk alike.  The idea of an addictive personality is reminiscent of an availability cascade, in that people talked about it long enough that it became “true.”  The reality, however, is that scientific evidence does not support the concept of an addictive personality. A Closer Look at the "Addictive Personality" Anti-social and depressive behavior frequently accompany addictive problems, but the keyword is behavior.  Behavior is not personality.  According to research, no persona...

by Tom Horvath, PhD., ABPP This blog is addressed to psychotherapists who do not view themselves as capable of providing addiction treatment. Many (if not most) therapists have this perspective. However, as I have suggested for many years, individual therapy (possibly supplemented by couple’s and family therapy) is the setting of choice for most individuals with addictive problems, and therapists should learn to address these problems. Unfortunately, many therapists lack the confidence even to learn about addiction treatment. Therapists already know most of what they need to know for basic addiction treatment. They also need some basic information about addiction and recovery. In an effort to boost the confidence of these therapists, below are the principles they would keep in min...

by Thaddeus Camlin, PsyD New England Journal of Medicine Article Says: Addiction is Learning, Not Disease One of the world’s most prestigious journals just published an article saying that addiction is not disease.  Not surprisingly, an uproar is underway.  Devotees to the disease model of addiction are not happy, but sometimes the truth hurts.  The article in the New England Journal of Medicine is a major step towards improving the standard of care in addiction treatment and deepening our understanding of the true nature of addictive behaviors. Including and Transcending the Disease Model of Addiction The article in the New England Journal of Medicine, written by Marc Lewis, Ph.D., does a masterful job of presenting the current state of the evidence about the etiology and maintenan...

By Thaddeus Camlin, Psy.D. Mental health professions are big on person-first language, and rightly so.  Defining people by their problems is widely agreed upon to be below the standard of care.  People are much more than their diagnoses, and thus, mental health professions now routinely opt for descriptions like, ‘a person with schizophrenia’ rather than, ‘a schizophrenic,’ or ‘a person with borderline personality’ rather than ‘a borderline.’  As sensitivity to mental health issues grew in recent years and person-first language became the standard of care, one notable category of diagnoses was conspicuously left behind: substance use disorders. Why is language in addiction treatment failing to catch up? Addiction Treatment and Double Standards While the frequency of hearing a psych...