By Tom Horvath, PhD This weekend SMART Recovery is celebrating (a few months early) its 30th anniversary by holding a conference in Salt Lake City. What has SMART achieved? How well is it functioning? What might its future hold? What follows is my personal perspective on some highlights of SMART’s first 30 years (from someone who has been part of that process), and my hopes for the years ahead. Growth and influence The good news is that in 2018 SMART Recovery expanded into SMART Recovery International, which has a world-wide presence. The US based organization is now an affiliate of the international organization, which operates approximately 2,500 weekly meetings in 38 countries and has printed materials in 18 languages. The less-than-good news is that SMART in many parts of t...

By A. Tom Horvath, PhD Is this question sacrilegious? It should not be. AA has done much good in the world, and I expect it will continue to do so, for those who freely choose to attend it. In this article I point out what harm AA can do and might continue to do. Any activity has a cost benefit analysis, and it is generally reasonable to consider that analysis. The question this article asks has been discussed many times before. You can conduct an internet search for this title and get numerous hits. You might even find this one: https://www.practicalrecovery.com/prblog/aa-harmful/ (posted 10 years ago on 3/25/14). For AA not to be harmful it might need to have more control over its discussions and what its members say (as SMART Recovery aims to do). AA members should NO...

By Kenneth Anderson, MA Alcohol treatment wasn't always divorced from alcohol science; the divorce between the two can be largely laid at the feet of Hazelden CEO Daniel John "Dan" Anderson, PhD (Mar 30, 1921 - Feb 19, 2003). Anderson's attitude towards science was one of hubris and arrogance. The History of Alcohol Treatment in the United States Treatment for alcohol problems in the United States occurred in two major waves: The first was prior to Prohibition (January 17, 1920), and the second followed Repeal (December 5, 1933). Demand for alcohol treatment dried up almost completely during the period from 1915 to 1920 due to state and local prohibition laws, the so-called Wartime Prohibition Act, and other factors, and all but a handful of alcohol treatment facilities had shut do...

By John de Miranda Innovation does not come quickly or easily to the addiction treatment sector. For example, harm reduction strategies had been employed in the public health sector for decades before their recent adoption by the federal government as a latecomer to fighting our nation’s opioid epidemic. Similarly, the Minnesota Model of addiction treatment, which emerged in the 1950s, still accounts for the model preferred by the majority of treatment programs. At its core, this approach draws heavily from 12-step ideology and requires a commitment to abstinence as the key focus of treatment goals. “If you have had enough and are ready to quit, then we can help you,” is the metamessage sent to potential clients by most addiction treatment programs. The problem with this approa...

By Kenneth Anderson, MA The Wegscheider-Cruse Family Roles Theory is one example of how “chemical dependency” treatment does not have the firm scientific foundation that it is suggested to have. Despite this lack of foundation, to become a certified addiction counselor today one must study Wegscheider-Cruse's theory. Below I present the history of the development of this theory, and some of the specific problems with it. Sharon Wegscheider-Cruse Behind the Wegscheider-Cruse Family Roles Theory was Sharon Wegscheider-Cruse (Nov 16, 1938 - living), born Sharon Rae Roelandt in Jasper, Minnesota, the daughter of Emil Leonard Roelandt (Jan 19, 1915 - Dec 24, 1961) and Marjorie Annadell Roelandt nee Olson (Aug 7, 1919 - Aug 11, 1986). The Roelandts were Catholic, and Sharon attended Cath...

By Tom Horvath, PhD This month the Substance Abuse and Mental Health Services Administration (SAMHSA) of the federal government released a 15-page document entitled Advisory: Low Barrier Models of Care for Substance Use Disorders. The document summarizes the difficulties associated with reaching and providing care for individuals with substance use disorders. Less than 10% of individuals who might benefit from treatment participate in it. A “low barrier” approach to treatment attempts to reduce the difficulties that might reduce treatment attendance. Although not primarily intended as a list of the shortcomings of the current US addiction treatment system, the document can be understood that way. What’s wrong with US addiction treatment? Too many requirements for entry. The insu...

By Tom Horvath, PhD, ABPP One of the simplest but most powerful ways to reduce stress is to focus on breathing. Although books have been written on this subject, the following ideas may be a sufficient guide for you. Because we breathe continuously, you will have lots of opportunity to practice! Less is More Perhaps the most important single step to reduce stress is to breathe less, while breathing regularly, through your nose. A deep breath or two can get you started on “breath work,” but after those initial breaths, focus on breathing regularly but more slowly, and with lower volume of air. You are not going to reduce your rate of breathing instantly. However, over the course of many breaths your rate will (probably not entirely smoothly) reduce. With practice you might breathe a...

by Tom Horvath, Ph.D. Would the term “preaddiction” be helpful? The National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) jointly issued a Request for Information on this term. The details of the Request are at the very bottom. Below is what I sent them (slightly edited): ** What would a better term be? Addiction (and thereby, preaddiction) is an undesirable term because it is used by many in an all-or-none fashion, or to denote a state of disease (leaving out those who view these disorders as primarily behavioral). Consequently, preaddiction is also undesirable. I believe that eliminating the terms addiction and preaddiction will greatly reduce stigma, because these terms are used to divide people into two groups (addicted, n...

By Tom Horvath, PhD, ABPP Transforming the US Addiction Treatment Workforce, Part 1, argued that the US needs to follow other nations, which have substantially lowered overdose rates and rates of addictive problems by adopting harm reduction. To offer this approach we need providers who work with the client not against the client’s disease, accept that there are as many pathways for change as there are individuals, work with the client to discover their individual pathway (and not assume that the provider knows what it is), empathize with the value experienced from the addictive behavior, and not confront the client about the desirability of change. Part 2 reviews specific examples of how the US addiction treatment workforce (the providers and systems) would operate having made this ...

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...