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 When we experience anguish (despair, heartache, melancholy, sorrow) after a significant loss, the depth of the anguish reminds us of the depth of the loss. Usually, the anguish does not surprise us, but we may be surprised at how powerful it is. Even our bodies can hurt. We feel anxious and confused. We ruminate about the past and imagine “if only” over and over. We neglect ourselves, and possibly others. We fear for the future. We think we need to talk about how we feel, but we don’t know where to start. Most often we think of grief as arising from the loss of a person or a relationship, but grief can arise from any significant loss. Like other aspects of human life, grief is an experience we will likely have several or more times. We will somehow get th...

By Tom Horvath, PhD I recommend the term “addictive problems” to replace several other similar terms, and no longer using the term “recovery,” which has several better alternatives depending on context. In this two-part series on improving the language about addictive problems, part 1 will focus on addictive problems, and part 2 will focus on “recovery.” The diagnostic manual, DSM5-TR, identifies 10 categories of substance problems. The substances are alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedative/hypnotics/anxiolytics, stimulants, tobacco, and “other.” There is also one category of activity problems (gambling). There are 11 criteria (9 for gambling) which identify common consequences which can arise from substance use. The consequences manifest themselve...

by Thaddeus Camlin, Psy.D. An underemphasized area in the disease model of addiction is the role of environmental factors.  Genetics and sensationalized hijackings of the midbrain are certainly factors in the development of problematic addictive behaviors, but they are overemphasized at the expense of family and social factors.  The disease model paints addiction as an individual problem and gives family dynamics and societal norms a get out of jail free card, so no wonder it maintains its stronghold as the dominant theory - everybody other than the identified addict gets to point their finger from a holier than thou position of moral superiority and save themselves from the discomfort of identifying and addressing their own issues. Addiction and Family Systems Family roles (e.g. t...

Addicted in Film: Movies We Love About the Habits We Hate, by Ted Perkins A review by Tom Horvath, PhD www.addictedinfilm.com I have already provided advance praise for this book, and I am pleased to repeat it: [Addicted in Film: Movies We Love About the Habits We Hate] is a must-have if you or anyone you know has been touched by addictive problems. It's filled with enlightening stories about powerful films that could become a turning point for people. You might also be interested in: 14 Addiction and Recovery Movies to Add to Your Queue Perkins** reviews over two dozen addiction-related films (culled from over 100 that he considered including). The reviews are thorough and cover the main components of each film. He selected films that might help someone change. He exc...

"You Need Help." Everyone knows that if someone has addictive problems, they need help, right? “Treatment works.” There is an alternative perspective. If there is an individual with problems (IWP), concerned significant others (CSO’s) may start a conversation. Perhaps there is smoldering resentment and withdrawal by the CSO, and the IWP starts the conversation. If as CSO you initiate such a conversation, I suggest that the best message is a combination of concern about the problems that the IWP has experienced, hope that the IWP will focus on solving these problems, and a description of any changes the CSO will make.  Such changes might be, for instance, “if you are intoxicated… I will depart for the evening; I will ask you to sleep in the other room; I will take the kids and g...

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...