By Tom Horvath, PhD This month the Substance Abuse and Mental Health Services Administration (SAMHSA) of the federal government released a 15-page document entitled Advisory: Low Barrier Models of Care for Substance Use Disorders. The document summarizes the difficulties associated with reaching and providing care for individuals with substance use disorders. Less than 10% of individuals who might benefit from treatment participate in it. A “low barrier” approach to treatment attempts to reduce the difficulties that might reduce treatment attendance. Although not primarily intended as a list of the shortcomings of the current US addiction treatment system, the document can be understood that way. What’s wrong with US addiction treatment? Too many requirements for entry. The insu...

By Tom Horvath, PhD Boredom is the perception of being under-stimulated. We all have optimal levels of stimulation (some generally want more, some generally less). Whatever your level, when you are not getting enough, you are bored (and when over-stimulated, you may be stressed). Boredom is often considered an undesirable state. However, let’s start with its advantages. If not much is going on in your immediate world, you have time to consider the larger context of your life. It is easy to lose track of what is more important than day-to-day and moment-to-moment issues. If bored you have a moment to consider what is important, rather than just immediate or urgent. When feeling bored you might say, “I’m glad nothing is pressing on me at the moment; I can think about the bigger p...

By Tom Horvath, PhD A recent scientific paper analyzed the responses from nearly 10K individuals who identify themselves as “in recovery” from substance problems. In recent years the addiction recovery field has been considering how to define “recovery.” Five major organizations have offered definitions or attempts at definitions. However, there is not much data on this issue. Two previous studies have looked at how individuals in recovery define it. The present study is an advance because it identified 30 sub-groups, based on socio-demographics, substance use problems, and help-seeking history. Each sub-group was analyzed for which components of a recovery definition might be common for that sub-group. The second study had averaged all subjects together, thus losing some of the diff...

By Kenneth Anderson, MA Two people of the same weight, height, and sex can drink the same amount of alcohol over the same period of time, and when they stop, one will have few if any symptoms of alcohol withdrawal, while the other will go through severe alcohol withdrawal. Why is this? Although environmental factors (e.g., kindling) may have some influence, the primary reason for this difference appears to be genetics. One of Several Studies on Genetics of Alcohol Withdrawal A 2005 study conducted at a detoxification unit in Germany by Martin Driessen et al. gives us an idea of what percentage of people will develop alcohol withdrawal. There were 217 patients in this study, and they had drunk an average of 15.6 US standard drinks per day during the 30 days prior to the study. The r...

By Tom Horvath, PhD, ABPP One of the simplest but most powerful ways to reduce stress is to focus on breathing. Although books have been written on this subject, the following ideas may be a sufficient guide for you. Because we breathe continuously, you will have lots of opportunity to practice! Less is More Perhaps the most important single step to reduce stress is to breathe less, while breathing regularly, through your nose. A deep breath or two can get you started on “breath work,” but after those initial breaths, focus on breathing regularly but more slowly, and with lower volume of air. You are not going to reduce your rate of breathing instantly. However, over the course of many breaths your rate will (probably not entirely smoothly) reduce. With practice you might breathe a...

by Tom Horvath, PhD It seems that almost everyone worries at times. We can think about a problem over and over and not make any progress. Ineffective strategies for worry include telling ourselves to “just stop,” and looking for guarantees or certainty when they are not available. Very little is guaranteed in life, and yet somehow we keep moving forward. Worry can be considered a problem-solving effort that is not working well because we are focused on the wrong parts of the problem. Most problems have aspects that 1) can be dealt with now or cannot be dealt with until later; 2) are under our control or not under our control; and 3) are more important or less important. If you focus your thinking on aspects of a problem that can only be dealt with later, are out of your control, o...

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, ABPP   Am I an “alcoholic” or “addict?” Do I “need help?” If so, what kind? If you are asking one or more of these questions, this blog is for you!   A somewhat out-of-date but nevertheless helpful federal publication considers these questions. Although this NIAAA (National Institute Alcohol Abuse and Alcoholism) document is focused on alcohol problems, many of its ideas can also be applied to other addictive problems. In this blog I will attempt to improve upon and expand their ideas. In my opinion NIAAA 1) focuses too much on treatment and not enough on the individual choosing or considering change, 2) does not alert the reader about the serious problems that can arise in treatment, and 3) is not up-to-date on the finding that AA specifica...

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...