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...

By Tom Horvath, PhD In Part 1 I recommended that the term “addictive problems” replace several similar terms. In Part 2 I recommend that the term “recovery” be replaced with several better alternatives, depending on context. To summarize Part 1, there is a continuum of addictive problems (abstinence, moderation, misuse, mild substance use disorder, moderate substance use disorder, severe substance use disorder). Over time someone can move up or down that continuum. They are not stuck forever at one level. This possibility of movement is the most radical aspect of viewing addictive problems as lying on a continuum (vs. the view that you are an “alcoholic” or “addict” forever, or that you are not). The lower the level of problems, the less likely someone is to address them because t...

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 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...

Psychedelic Diaries, Episode 3: Interview with Tom Horvath, PhD, ABPP "Psychedelic Diaries," a podcast hosted by Ray Christian, has nearly 30 episodes (each an interview). Dr. Horvath was the third interviewee. The podcast describes itself as offering: "Experts from the world of medicine talk about mental health, mystical experiences, and the psychedelic renaissance. The show features news and discussion on how psychedelics affect our mind and the world around us." This 3 minute video has excerpts from each of the five initial experts interviewed. Dr. Horvath, in the excerpt, speaks about the value of a psychedelic experience as a "pattern interrupter." In the full interview he elaborates on that concept and his own (unfortunately disappointing) experience doing ayahuasca fou...