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 In September 2021, Netflix released a seven-episode miniseries that mentions Rational Recovery (RR) as an alternative to Alcoholics Anonymous (AA) in episode II (starting in minute 46). Ironically, the mention of RR occurs in a very small (two-person) AA meeting. The pro-RR speaker is required to attend AA as part of parole, but he objects to AA’s powerlessness and God-centered approach. He prefers RR’s addictive voice recognition technique and the idea that he could take charge of his own behavior. In that AA meeting, he takes an extended moment to explain RR concepts and what he likes about them. Miniseries Mentions Rational Recovery - The Significance The significance of RR’s presence in Midnight Mass is that self-empowering approaches to resolving addictive ...

Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, by Maia Szalavitz Review by A. Tom Horvath, PhD The harm reduction approach to addressing addictive problems has until recently been highly controversial, at least in the US. Treatment and other change efforts in the US have been primarily guided by the views that addiction is a disease and that the 12 steps are the primary (or only) method for change. Harm reduction accepts and encourages small steps toward change. The US approach has typically required an immediate and large change, often involving a completely new perspective: “I’m an addict, I have a disease, I will abstain from everything forever.” The small steps approach of harm reduction, even though it describes how most human change occurs, has ...

By Tom Horvath, PhD Addiction professionals say they're working toward ending stigma surrounding addiction, but they also tend to promote addiction as a disease. These activities are contradictory. By promoting addiction as a disease they play into the general tendency to perceive in-groups (“normies”) and out-groups (those with the disease). Instead of emphasizing that “addiction is a chronic brain disease” or “treatment works,” the following ideas, depending on the context, would make much more helpful and less stigmatizing messages: You might also be interested in: The Stigma of Addiction and the Inadvertent Contribution of the Recovery Community 1. Addictive problems range from very mild to very severe. 2. Most addictive problems are not in the severe or very severe range. ...

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 Thaddeus Camlin, PsyD Let’s call a spade a spade.  The war on drugs is a euphemism for a war on personal freedom.  The hypocrisy inherent in a war on personal freedom in the self-proclaimed land of the free is more than a tad embarrassing (insert cringe emoji here).  The number of lives ruined with criminal scarlet letters and families torn apart because someone dared possess psychoactive compounds is beyond measure.  Even on the very day of writing this article a U.S. Olympian was kicked off the track and field team because she tested positive, not for a performance-enhancing drug, but for cannabis detected in her bodily fluids after she inhaled the plant’s smoke to ease the pain of the death of her mother.  This Independence Day, as America celebrates the passing of the drug war...

by Tom Horvath, PhD, ABPP Interpersonal boundaries are part of the rules we establish about how we interact with other people. In this blog we focus on protecting ourselves from the outside. In a parallel blog we focused on keeping inside what needs to stay there. In both cases we can compare interpersonal boundaries to a house, which protects us from the outside, and keeps inside what needs to be there. We prevent violations to ourselves by establishing and managing boundaries. For instance, who can touch us and how, who can enter our living space and how far, whom we respond to online and whom we do not, whom we will accept advice from and whom we won’t, and so forth. The challenge often is that these boundaries need to be communicated and enforced, and communication and enforce...

by Thaddeus Camlin, PsyD The ‘us & them,’ ‘normies and addicts’ mentality continues to lose its stronghold in addiction theory.  The more addictive behaviors are recognized as a manifestation of normal human learning rather than diseased character defects and spiritual maladies, the better.  New Year’s resolutions, and their reputation for failure that often precedes them, offer yet another opportunity to highlight the universality of addictive behaviors.  New Year’s resolutions often fail because of a phenomenon of all-or-nothing thinking frequently referred to in the world of addiction as the ‘abstinence violation effect,’ where a single breach of a vow to change is viewed as failure and justifies absconding from the entire change attempt. Old habits die hard, new habits for...

by Thaddeus Camlin, PsyD Sparks do not burst from a vacuum, they are incandescent blasts from intense heat and friction.  The famous Christmas Carol ‘Feliz Navidad’ was back in the headlines recently celebrating its 50th anniversary.  Most stories talked about the song-writing process of its creator, José Feliciano, as one of magical ease, a spark of hope and inspiration.  The magical spark storyline fits, given that 'Feliz Navidad' contains only 19 words, was written in ten minutes, and recorded in one take.  What is missed in the magical story of Feliz Navidad’s inception is the backdrop of toil, perseverance, sacrifice, and hardship in the life of the songwriter that constituted the rich soil from which the Christmas Carol gem burst forth. Feliciano was born in Puerto Rico in 1...