By Tom Horvath, Ph.D., ABPP Wondering whether you should moderate or abstain? You're not the only one. Read on for some things to consider as you determine which approach is best for you. Practical Recovery's policy is not to give advice about whether to moderate or abstain. Unfortunately, this approach has sometimes been interpreted to mean that we “advocate” moderation. We neither advocate nor oppose any specific level of addictive activity, including cutting back (to something short of moderation) or focusing on safety without reducing quantity and/or frequency (e.g., “I won’t cut back my drinking, but I’ll stop drinking and driving”). Harm Reduction The term for this broad position, which follows the client’s lead on what changes to make, is harm reduction. Harm reduct...

By Dan Galant, PhD "The Abstinence Violation Approach" - This ominous sounding term from the relapse prevention literature is perhaps one of the most useful concepts to understand in addiction treatment. I often have clients tell me years after our last therapy session that this was the singular most helpful idea to keep them on track! So what’s it all about – and how can it help you? The Abstinence Violation Effect (AVE – think the abbreviation for avenue to help you remember it) is what happens when an individual deviates from his/her plan – and then continues to remain off that path due to frustration, shame, guilt, etc. Think of the problem drinker who has chosen to abstain from alcohol. When that person takes even one drink (”violating” their abstinence), the tendency is to t...

Ashley Adams, MFTI does much of the couple and family work at Reunion and below, she discusses the practice of Emotionally Focused Therapy. At Practical Recovery, our goal is to give clients the necessary tools that empower them to make healthy choices. One such choice is the option to participate in couples therapy and family therapy. Although this work is highly recommended (in most cases), clients have the option to decline. We may also offer their loved one individual therapy with another provider who is not working with the resident, as a way to provide additional support in conjunction with the couples/family therapy. Before the first session occurs, the family or partner will fill out a number of brief questionnaires and have some basic understanding of what emotionally focuse...

by Kevin Murphy, Psy.D. Exposure Therapy emerged in the 1950s as an intervention to treat panic-phobic disorders. Owing to the abundance of empirical support behind the intervention, Exposure Therapy (ET) has become a staple in the treatment of anxiety disorders. Building on that long track record, Cue Exposure Therapy (CET) borrows heavily from the format used in ET, but is specifically designed to treat the cravings that perpetuate substance use disorders. CET acts to de-sensitize the effect of triggers (the feel of a cold bottle, the sight of a sandwich baggie, etc.) that tend to prompt cravings. Research into CET is not nearly as robust as the literature that supports the efficacy of ET. Eventually, it’s predicted, CET will become as mainstream a practice in the field of chemical...

by Tom Horvath, Ph.D., ABPP Motivational Interviewing and Harm Reduction compared: In this article I compare these two important contemporary recovery concepts. From my perspective they are mostly similar, but have dramatically different rates of acceptance in the addiction treatment industry. You might also be interested in: Addiction Treatment: Motivational Enhancement Therapy Motivational Interviewing (MI) Motivational interviewing (MI) is a psychotherapeutic approach for promoting any healthy behavior change. MI was created for work with addiction, then extended to any behavior change about which someone is ambivalent. Ambivalence is a crucial aspect of MI. The person who is completely committed to change is actually changing, and not sitting in front of you discussing the pos...

by Tom Horvath, Ph.D. “Everyone is entitled to his own opinion, but not his own facts.” Ironically, I have not been able to confirm (the fact of) who first expressed this idea. It is widely attributed to Daniel Patrick Moynihan, four-time US Senator from Massachusetts (1927-2003). What are the primary “facts” or findings about addiction and recovery, of which any theory of them, and any approach to treatment and recovery, would need to take into account? I will propose a few facts (and opinions too). Of course, even our selection of “facts” can be biased. However, only by making the effort to understand the foundations of one’s own opinions can these opinions be improved. 1) Prohibition will be of limited effectiveness in preventing addiction. Alcohol prohibition in the US (...

How could believing addiction is a disease be bad? There are now several studies suggesting that individuals who believe their behavioral problems (either addiction or mental health) are a disease may have more trouble recovering from them. The most recent study found that individuals who believe obesity is a disease are less focused on weight loss. If someone views himself or herself as having an addictive disease, there seems little benefit in trying to change that view (and possibly much to lose). However, if someone does not view addiction as a disease, is attempting to instill that view worthwhile? Given that viewing addiction as a disease may be a high-risk belief, promoting that belief is inconsistent with promoting recovery. Unfortunately, many US addiction treatment faci...

Author: Tom Horvath, PhD, ABPP Is AA (Alcoholics Anonymous) potentially harmful to 90% of over-drinkers? The best way to determine whether AA might be helpful or harmful to you is to attend one or more meetings. Keep an open mind. You might be surprised by what you experience. Remember to try several meetings if you are uncertain, as meetings can vary considerably. If you find AA (or any other 12-step group, such as Narcotics Anonymous) helpful, then I encourage you to continue for as long as it is helpful, a lifetime if you want. If you find AA less than helpful, you already know there are alternatives. You might also be interested in: From AA to AfA - What Works? That 90% estimate comes from a recent book by Lance Dodes, MD, The Sober Truth: Debunking the Bad Science Behind 12...

Natural recovery should be seen as the primary process of addiction recovery. Treatment needs to be seen as an adjunct to natural recovery, not as the essential element of recovery. In physical health, the self-healing capacity of the body is ultimately the source of healing. A physician can intervene, but the body heals. As the 16th century French surgeon Ambroise Pare remarked, “I dressed, and God healed.” When the body is too ill to heal, no physician’s work can be effective. Although surgery today is a highly successful enterprise, we might fail to consider that many patients are refused surgery because the surgeon decides they are not well enough to benefit from it. In psychological health, the capacity to benefit from an intervention appears to be based on the mind’s willingnes...