by Tom Horvath, Ph.D., ABPP How can the United States improve addiction treatment? The ultimate goal of support for overcoming problematic addictive behavior is to improve individual health and well-being while reducing societal costs associated with the behavior.  Several countries (e.g., Portugal, Switzerland, the Netherlands) are much more effective than the US in providing this support, which can include professional services (treatment) as well as a variety of non-professional and informal support. Calling for Change in US Addiction Treatment In the US a rational, medical and psychological approach would improve a system that has been overly influenced by the punitive aspects of drug prohibition and the diversity-suppressing dominance of the 12-step spiritual approach (which ha...

by Tom Horvath, PhD, ABPP Why individual sessions in addiction treatment are important One of the most frequent complaints I hear from clients who have attended other treatment facilities is “I almost never had an individual session.” Why are frequent individual sessions unusual in US addiction treatment, and why are they important? Groups led by drug and alcohol counselors save money A business reason to provide treatment primarily in groups is to lower costs. All businesses want to save on labor costs. In many cases groups are oriented around a well-established curriculum, designed to help clients “get the program.” Getting the program typically involves accepting the perspective that “I have a disease, I need to go to meetings for the rest of my life, I can never drink again, my ...

by Tom Horvath, Ph.D., ABPP Practical Recovery’s IIOP The Individualized Intensive Outpatient Program To be clear: An Individualized Intensive Outpatient Program (IIOP) is not an Intensive Outpatient Program (IOP). An IOP is a group that typically meets three hours per day, three days per week. In addition, there may be one individual session per week. The IOP is the backbone of many outpatient addiction treatment approaches, and indeed, Practical Recovery offers one (which includes one individual session per week). One of the advantages of an IOP is that insurance companies are familiar with it, and tend to reimburse this service at a reasonable level. Nearly 20 years ago Practical Recovery introduced the concept of the Individualized Intensive Outpatient Program. This year we ar...

It can be challenging to stay sober when you're coping with tragedy. This last year has been full of grief, tragedy, and challenge. We continue to grieve together and are finding that many people are experiencing anger, sadness, confusion, grief and anxiety.  With a surge of emotions that arise in response to tragic events, it is understandable that some of us may experience temptations to return to our addictive behaviors in order to cope with stress and loss.  It is important to understand that this is a normal reaction and a part of recovery. It is also important to know that while the urge may be there, we do not need to give in. Now is the time to call on those new coping tools we've been working on! Some common reactions to tragic events: Increased fear, anxiety and worry i...

Have you noticed the stigma that exists when it comes to men and addiction? It is no secret that the stigma of males in relation to addiction exists in our society today. While it’s widely understood that this is a complex issue, it’s often oversimplified and overlooked.  The stigma may include anything from negative attitudes towards those who may be overindulging in addictive substances or behaviors, to critical beliefs about who specifically is affected by addiction.  The idea that men who are affected by addiction are weak, deserving of their fate and less worthy of care is so inextricably tied to our current societal views that it’s challenging to attempt the separation of addiction from shame and guilt. Most of us who are struggling with addictive behaviors find that the stigm...

Just how do Prince and the opioid epidemic come together? The death of Prince has left many wondering what really happened and whether circumstances could have been different.  Prince’s use of pain killers came as a surprise and many found it hard to believe he had been struggling with prescription drugs for quite some time. On April 20, two of Prince’s representatives, in hopes to intervene and find treatment for the artist, contacted Dr. Howard Kornfeld, a California based doctor who specializes in pain management and opioid addiction. According to CNN, Dr. Kornfeld sent his son, Andrew, a consultant from the pain management practice, to Prince’s estate, purportedly to take buprenorphine to the performer. It was Andrew Kornfeld and two of Prince’s representatives who found the sing...

Too Much of a Good Thing: How Four Key Survival Traits Are Now Killing Us by Lee Goldman, MD A review by Tom Horvath, PhD Too Much of a Good Thing is packed with well-referenced scientific information to support the author’s suggestion that hunger, thirst and desire for salt, fear and anxiety, and ease of blood clotting, all originally crucial to human survival, have in the modern era turned against us and become significant causes of illness and death. Of course he is not proposing we give up any of these abilities and behaviors. However, unless we take more control of how they operate, or ameliorate their effects, we will increasingly suffer from them. The author is dean of the faculties of health sciences and medicine at Columbia University Medical Center, the author of 450 sci...

In a unique move toward reducing opioid overuse, the emergency room of New Jersey’s St. Joseph’s Regional Medical Center, the busiest in the state, has decided to eliminate the use of opioids as the first defense against mild to moderate cases of pain. In an effort that has spanned a period of two months, the hospital’s Alternative to Opioids, or “ALTO,” program has managed to control the pain of 300 patients (that’s 75%) without the use of opioids. Through use of acetaminophen, ibuprofen and non-opioid pain blocking medications such as lidocaine injections, doctors and nurses have successfully been able to treat a number of different ailments such as kidney stones, chronic pain and other mild to moderate ailments. While the staff at St. Joseph’s still value the power of opioid...

Addictions typically develop to substances or activities that make us feel good. For instance, alcohol can relax us and cocaine can make us feel energized and happy. Substances that influence emotion because of their biochemical effects are called psychoactive. Even substances which are not “biochemically psychoactive” can become “psychologically psychoactive” because of learned associations to them. For instance, someone who drinks water after every workout might associate water and relaxation. Or an herbal tea (which has no caffeine) might be associated with peacefulness or relaxation. To help clarify the significance of substances or activities making us feel good, let’s make a comparison to something that makes us feel bad: phobias. Most of us are exposed to elevators, freeway dr...

Expanded from original article published Jan. 30, 2015 Problem Gambling With the recent PowerBall win and the upcoming Super Bowl, we thought it was a good time to take a closer look at problem gambling. It doesn't matter if it's sports betting, casino gambling, lotteries, friendly wagers or even illegal street bets, all forms of gambling have the potential to become problematic and addictive in nature. Let’s be honest – the thrill of gambling (and winning) gets us pumped. For most people, gambling on the Super Bowl or participating in the office sports pool is just a source of entertainment and fun. But for some, gambling can become problematic and can even turn into a full-blown addiction. In fact, some estimates suggest that about 2 million Americans meet the criteria for gambli...