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...

Neuronal Plasticity, Mindfulness Meditation, and Addiction Recovery by Nicholas A. Nelson, Ph.D. Part 1 of 2 It is not uncommon during active addiction or early in recovery for people to feel that their brain is working somehow differently than before, or to feel like it is going to be impossible to break out of harmful habits and thought patterns. It can feel like the mind is damaged, or operating out of our control. This lack of control, and feeling that something is broken, can lead to a sense of hopelessness. When we look at the brain there is some truth to this feeling - during engagement with problematic addictive behaviors and during early recovery, our brains are not wired in the same way as before these problems took root. Through months, years, or decades of repetiti...

by John de Miranda Early in my recovery from an alcohol use disorder I discovered that memoirs and first-person accounts of people struggling with addiction were a useful method to help me deal with the challenges of a life without alcohol. Many of these accounts were uplifting. Some were scary. I remember one in particular A Sensitive Passionate Man published in 1974 by Barbara Mahoney. Her account chronicles life with her husband Sean who died at the age of 45 from cirrhosis of the liver. Despite a life of material and personal success Sean rebutted all attempts from family and friends to intervene in his alcoholism and literally drank himself to death. In my pink cloud naivete I was taken by surprise that not all stories of addiction had a happy ending. I am an instructor in...

By Tom Horvath, PhD With 2025 now over a week old, we may already be falling short of some of our New Year’s resolutions. Nevertheless, take heart! It is easy to fall into all-or-none thinking about positive change. Please consider the following ideas. Even if you did not make any New Year’s resolutions, you may have thought about self-improvement changes you want to make. The beginning of the year is an obvious time to do so. To the extent you did such thinking (or do it now!), you have acted on step one: identifying a desired change. What actions now make sense? This part is often complicated, but the principle of “small steps” can be very helpful. This may be a time to investigate, experiment, inquire, consult, and otherwise gather information. Keeping mental notes of what y...

By Tom Horvath, PhD This blog will publicize a recent blog post on syringe services from Nora Volkow, MD, the Director of the National Institute on Drug Abuse (NIDA). She states that: Nearly 30 years of research show that providing testing, counseling, and sterile injection supplies to people who inject opioids and other drugs helps prevent transmission of infectious diseases, without increasing drug-related or other crimes in the vicinity. Contrary to worries that syringe services programs (SSPs) will encourage or promote drug use, evidence shows that they more often do the opposite, linking people with addiction to effective treatment and even helping prevent overdose deaths. There is no scientist or professional who is more credible on this subject than Dr. Volkow. Her stanc...