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...

by Tom Horvath, PhD If guilt is the bad feeling I get after doing “something wrong,” then shame is the bad feeling I get about being myself. Shame might arise along with guilt (“I’m not good enough, and a bad person, for doing something that terrible”). However, shame might arise by itself. In the extreme I might think “I do not even have the right to exist. I’m so bad and foul and awful that I don’t deserve to belong to the human race. I should not be allowed to have the air I breathe, the food I eat, and the time and attention I get from others.” Understanding Shame vs. Guilt Simply stated, guilt is about what I did. Shame is about who I am. When I behave wrongly or badly, and feel guilt or regret, there are often ways I can resolve these feelings: Make it up to someone, apologiz...

by Tom Horvath, PhD When we talk about having boundaries, we can talk about managing external boundaries and we can talk about managing internal boundaries. This blog will discuss the management of external boundaries. To better understand external boundaries, it helps to understand the concept of interpersonal boundaries. Interpersonal boundaries are the rules we establish for ourselves about how we interact with other people. We can compare interpersonal boundaries to having a house. The house, with roof and walls, protects us from the outside, and keeps our possessions together. But there are also doors, windows, window coverings, pipes, wires, vents, and so forth, which allow us to be flexible about what comes in and what goes out. In this blog we focus on protecting ourselves fr...

by Tom Horvath, PhD A well-lived life needs to have significant and possibly considerable amounts of discomfort in it. For instance, do you want to exercise well, maintain a certain weight, get up early, work hard at something, or hold your tongue in an intense discussion? You are likely to feel uncomfortable! The key, then, is to learn skills for managing discomfort that will inevitably come. You might also be interested in: Coping with Stress in Addiction Recovery In particular, if you want to stop an addictive problem, you are likely to have a transition period as you change how you live. Cravings might die off almost entirely after 90 days (although there is no guarantee they will completely), but other challenges might last much longer. Maybe you should just give up now? Fortu...

by Thaddeus Camlin, PsyD As cannabis crawls toward federal legalization, the 11th hour panic push is in on.  Last week saw the introduction of the Cannabis Administration and Opportunity Act, which seeks to federally legalize cannabis in the U.S.  For those opposed to legalizing cannabis, ‘cannabis-induced psychosis’ and ‘ultra-high potency THC products’ are the buzz words working most effectively to enliven the embers of cultural pot fears.  Cannabis-induced psychosis is something to take seriously, as are ultra-high potency THC products, but neither is a reason to keep pot illegal. You might also be interested in: Drugs Don't Cause Addiction Cannabis-induced psychosis (CIP) refers to an individual experiencing delusions, hallucinations, disorganized speech, or grossly abnorma...

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 Dialectical Behavior Therapy (DBT) places a primary focus on improving distress tolerance. One of several tools DBT offers for tolerating distress is radical acceptance. The context of using any of the distress tolerance tools is the recognition that life will have distress, and that we need to learn how to bear up under it. Life is worth living even if it can be painful. DBT distress tolerance skills are designed to help us get through a crisis, but these tools benefit from practice in advance. These skills can help us accept the discomfort or pain that occur in a crisis, while preventing that discomfort or pain from rising to the level of suffering. Radical = “going to the root,” like a radish. Radical acceptance does not mean we approve of reality. ...

by Tom Horvath, PhD, ABPP Dialectical Behavior Therapy (DBT) is an approach to psychotherapy designed for individuals who are highly emotionally sensitive, who struggle with depression and anxiety, and who may at times become suicidal. DBT tools, which focus on distress tolerance, interpersonal effectiveness, emotion regulation, and mindfulness, can be helpful to anyone. You can remember these 4 categories as DIEM, as in carpe diem (seize the day). DBT is part of the larger family of CBT (cognitive behavior therapy). Marsha Linehan, a psychology professor emeritus at the University of Washington, Seattle, developed DBT as a result of coping with her own emotional problems. Linehan, born in 1943, revealed in her late 60’s the personal connection to her professional work. Distres...