by Thaddeus Camlin, PsyD New England Journal of Medicine Article Says: Addiction is Learning, Not Disease One of the world’s most prestigious journals just published an article saying that addiction is not disease.  Not surprisingly, an uproar is underway.  Devotees to the disease model of addiction are not happy, but sometimes the truth hurts.  The article in the New England Journal of Medicine is a major step towards improving the standard of care in addiction treatment and deepening our understanding of the true nature of addictive behaviors. Including and Transcending the Disease Model of Addiction The article in the New England Journal of Medicine, written by Marc Lewis, Ph.D., does a masterful job of presenting the current state of the evidence about the etiology and maintenan...

The “tobacco settlement” was reached in 1998 after five years of litigation. Tobacco manufacturers agreed to change some business and marketing practices, and to pay over $200 billion spread over 25 years (with continued payments thereafter) to reimburse 46 states for their expenses in treating tobacco-related illnesses. Opiate Settlements There are now hundreds of opiate cases pending. The case against manufacturers is based on how opiates were marketed. Opiates can be more harmful than the marketing suggested. The case against drug distributors is based on the implausibly high numbers of pills that were made available to “patients” in specific localities, suggesting that massive amounts of medication were diverted from prescribed to other uses. Based on the tobacco settlement we cou...

by Tom Horvath, PhD, ABPP The US media often presents stories about substance problems. However, there are fewer stories about how individuals resolve these problems. The National Recovery Study (Kelly, Bergman, Hoeppner, Vilsaint, & White, 2017) was an effort to estimate how many in the US have resolved substance problems, and how they did so. This landmark study merits more attention. What We Already Knew 1) Many individuals who previously had substance problems resolved them on their own (“unassisted recovery”), without being involved in treatment, medication, mutual help or other recovery services (“assisted recovery”). Unassisted recovery is also termed natural recovery, or self-guided change (Bishop, 2018). 2) Many of the individuals in unassisted recovery do not consi...

by Tom Horvath, Ph.D., ABPP. Clients often attempt to choose addiction treatment carefully. Typically, they search for a “program” suitable to their problems, at least as they understand their problems. Unfortunately, most clients are uneducated about addiction. They are not professionals, and the addiction treatment industry and media often present inaccurate information. Consequently, clients can end up in facilities that harm them rather than help them, primarily because in these facilities substandard practices are common (U.S. Department of Health and Human Services, Office of the Surgeon General, 2016). Almost daily in our offices at Practical Recovery we hear about what goes wrong in addiction treatment. Here are some examples. Treatment sessions are not conducted by psychoth...

by Tom Horvath, Ph.D. According to a new ground-breaking study, individuals attending SMART, LifeRing and WFS now have scientific support for their choice to attend these groups. As with all new scientific findings, we have a reached a new vantage point from which to consider both next research efforts, and the clinical implications of what we now perceive more clearly. Before considering the clinical implications, let’s remind ourselves that any single finding is subject to re-interpretation in the light of new findings. However, this finding has many precedents, and therefore is not especially “single” or divergent. Although not a controlled trial, Atkins and Hawdon (2007) found individuals in multiple mutual help groups to obtain similar outcomes. In psychotherapy resear...

How to Solve the Opioid Crisis by Thaddeus Camlin, Psy.D. In an age when Americans agree on few things, an issue that unites us toward a common goal could be deeply and profoundly healing. On the costs of the opioid crisis in America, there is little disagreement. People from both sides of the aisle, all walks of life, and every socio-economic stratum are affected by the opioid epidemic. Even President Trump and former President Obama agree on this issue, with the former recently calling (but not officially declaring) the opioid crisis a national emergency and the latter recognizing it as an epidemic. While many agree the opioid crisis is a major problem, there is a need for increasing clarity and agreement on how to solve it. Officially Declare a National Emergency The first step...

The War on Drugs: History and Implications by Thaddeus Camlin, Psy.D. The Politics of Consciousness Few political issues today are sources of unity and shared vision.  Politics has become vehemently binary to the point that extremes on both sides see opposing views as subhuman.  In the current climate of ‘us and them,’ drugs may be one of the few remaining topics that many people from both sides of the aisle can agree upon.  Ending the drug war aligns with advocates for limited government, human rights, conservative economics, and liberal social policy.  However, as the war drums currently pound for a renewed call to arms in an impossible war, an in-depth analysis of the war on drugs is important for anyone who chooses to use  substances or knows someone who does. This article di...

State of the Addiction Treatment Field: Where We Are and Where We Need to Go by Tom Horvath, Ph.D., ABPP The following article is based on the presentation I gave at the Evolution of Addiction Treatment Conference in Los Angeles, February 2-5, in a Keynote Panel Presentation entitled “State of the field address: Where we are and where we need to go.” I was one of seven presenters. We each had up to 15 minutes. The entire presentation lasted two hours, including a brief discussion period at the end. The two presenters before me were not proposing the radical changes I was, so I began by addressing the fact that my presentation was likely to be an outlier in this group. In this piece on the State of the Addiction Treatment Field, I want to focus primarily on where we need to go. I...

Alcohol, Drugs, and Health: Highlights from The Surgeon General's Report Tom Horvath, Ph.D., and Thaddeus Camlin, Psy.D. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, released in November, has received considerable attention. The massive effort involved in creating this document is in itself worthy of respect. The opening pages list seven science editors, three managing editors, five contributing editors, 21 contributing authors, one science writer, 117 reviewers, and 10 other contributors (these individuals apparently being mostly involved in production). The professionals involved include many of the most important individuals in the fields of addiction and recovery. You may have heard the expression that a camel is a horse that was des...

Addiction as a Brain Disease? Cherry-Picking the Surgeon General’s Report by Thaddeus Camlin, Psy.D. The Surgeon General’s “landmark” report is generating a fair amount of media attention and discussion.  While it is valuable that substance use and related issues are receiving more attention, the aspects of the report receiving the lion’s share of the limelight are disappointing. Addiction as a Brain Disease? Yes it is true, as many media stories highlight, the report refers to addiction as a brain disease multiple times – 10 times in 428 pages by my count.  Unfortunately, the reporting stops there.  What is not covered in the media is that the Surgeon General’s report specifically states that addiction is a chronic brain disease, and the term addiction refers only to the most s...