By Tom Horvath, PhD We continue the theme of “how to change my mind.” We have all experienced changing our minds (it is part of how we grow up), but we are here looking at deliberate efforts we might use when we feel stuck in a problematic perspective, a perspective that seems true but does not seem to be helping us (perhaps because of the distress it leads to). In Part 1 we mentioned psychedelics, stating the problem out loud, and stating it to others. These last two, talking out loud to oneself, and especially with others, helps any of the techniques we will consider in this series. In this Part we will focus on shifting and broadening our attention to help us reconsider aspects of a problem we may have not given enough attention to. Let’s focus on a specific situation (which...

Beyond the Twelve-User’s Guide: A Workbook for Navigating the Intersection of Addiction and Change (without the Twelve-Step programs), by Ryan Paul Carruthers A Review by Tom Horvath, PhD I stopped years ago attempting to keep up with new books about how to address addictive problems without using the 12 steps. There seemed to be so many! Unfortunately, it has taken more than books to sufficiently penetrate US awareness about the existence of the multiple pathways, “beyond the 12,” available to us. Much work remains to be done before “everyone seeking recovery from addictive behavior [is] informed about the full diversity of recovery options available and allowed to choose freely amongst them (p 5).” Nevertheless, progress is being made. Carruthers has made a worthy contributio...

By Tom Horvath, PhD "An intimate look inside the billion-dollar addiction treatment industry where young people are bought and sold for their insurance policies and ushered into a system designed to keep them sick.” From www.StopTheShuffle.com Practical Recovery will host a free screening of this award-winning documentary on Thursday, 11/13/25, at 7:00PM, in the conference room of our building in La Jolla (just off I-5). Seating is limited. RSVPs are required, by emailing Susie.Lee@practicalrecovery.com. A brief discussion period with the producer and Dr. Horvath will occur at the conclusion of the 81-minute screening. In 2013 Practical Recovery organized a screening of The Business of Recovery. That film focused on how poorly addiction treatment can be provided, and how ...

The Value of Advocating for Safer (But Not Reduced) Substance Use By Tom Horvath, PhD In a study recently published online, researchers at Brown University (a major US addiction research site) compared an intervention to reduce the drinking of heavy drinking college students (without focusing on the consequences of drinking), with an intervention to reduce the negative consequences from drinking (without focusing on the amount of drinking). Both interventions worked as predicted. The first group (PNF; Personalized Normative Feedback) reduced drinking (without reducing consequences) and the second group (CAA; Counter-Attitudinal Advocacy) reduced consequences (without reducing drinking). The subjects were 585 students who by self-report engaged in episodes of heavy drinking and ...

By Tom Horvath, PhD SMART’s 3rd edition Handbook lasted about 12 years. Because SMART is committed to staying current with scientific advances, it was time for an update. The first update is the title: SMART Recovery 4-Point Program Handbook.  SMART now considers itself to offer three programs (or services): 4-Point Program meetings (for individuals with addictive problems), Family and Friends meetings (for their loved ones), and the Multiple Pathways Partnership (for organizations that want to support SMART and the concept of “multiple pathways for change”). The Handbook simplifies the language of the 3rd edition, removes some acronyms by renaming some tools (also in service of simplifying the language), adds some tools (particularly ones that reflect third wave CBT), emphasiz...

Neuronal Plasticity, Mindfulness Meditation, and Addiction Recovery by Nicholas A. Nelson, Ph.D. Part 2 of 2 In Part 1, we visited the motivations for leveraging mindfulness as a tool for overcoming problematic addictive behaviors. We discussed the concept of neuroplasticity and took a theoretical look at how mindfulness meditation can aid in reshaping our brain and behavior during addiction recovery. In Part 2 we’ll take a look at a few specific scientific studies that have put these theories to the test, then wrap up with a discussion of what mindfulness meditation can feel like in practice. Let’s dive in. The Frontal Lobe Because the neuroscience of addiction and neuroscience of meditation are rather complex and relatively new topics, they are still undergoing rapid...

The SMART Recovery 2025 Annual Conference, Charlotte, NC, April 2-4 By Tom Horvath, PhD In summary: SMART is thriving, and recognition of SMART in the recovery and wider world seems to be accelerating. Entire systems of services (e.g., state prison systems, national prison systems, treatment systems) are adopting SMART Recovery meetings. Part of the purpose of this conference was to celebrate SMART’s growth and to thank the volunteers (our “champions”) who have grown it. SMART Recovery now has approximately 1800 meetings in the US and Canada. The main presentation room only had space on its walls for 20 flags (of the 32) of SMART’s other countries. Worldwide there are nearly 3000 meetings. SMART now has printed materials in 18 languages. There were about 220 attendees (up...

by Tom Horvath, PhD There are many occupations considered to be safety-sensitive. The industries from which they are drawn include healthcare, transportation, and construction. Specific occupations include physicians, airline pilots, and heavy equipment operators. When these individuals have their substance use monitored (often because of recent substance problems), what principles should guide the creation of the monitoring plan? Let us focus on alcohol, because it may be the most common substance monitored. There are many methods to monitor alcohol use. They differ according to the timeframe they observe, their accuracy (will they miss use that occurred?), whether they assess the substance itself or a metabolite, the convenience of use (e.g., including how far one must go to get...

By Tom Horvath, PhD In the state of California, a licensed residential substance use treatment facility (a “rehab”) needs to provide 20 hours of treatment per week. Typically, this treatment is provided in groups. In many rehabs there is only one individual session per week, the minimum required by law. The groups in a rehab have significant similarities with SMART Recovery meetings, particularly if a SMART participant talks about their specific goals and challenges. If someone were primarily interested in the treatment aspect of being in a rehab, 20 SMART meetings per week would be a reasonable alternative to residential treatment. To make the best use of SMART meetings the participant would benefit from having an individual session a week, just like in the rehab. The individu...

By Tom Horvath, PhD Mutual help groups for addictive problems have been in existence for centuries. No one knows exactly how they work. What follows is my best estimate of what happens in SMART Recovery meetings, and how they help. How SMART Recovery Works SMART offers an approach that will appeal to many (for either substance problems, activity problems, or both) because it is self-empowering, science based, progress-oriented, and holistic. Other mutual help approaches will appeal to other people. Some people may use multiple approaches. In 1994, when SMART Recovery began operating under that name, SMART elected to move beyond specific tools (which had been prominent in its pre-history) by identifying 4 common tasks for the process of addressing an addictive problem, the 4 Poin...