How effective is ketamine for depression? By Tom Horvath Depression often coincides with addictive problems, as a cause or effect, or some combination thereof. Addressing depression, whatever its causal role, is often one of our main focuses at Practical Recovery. Fortunately, there are a wide range of methods for addressing depression, and we expect to be successful, in time, with nearly everyone. In recent years many clinicians have been interested in the possibility that ketamine is an effective antidepressant. (There is also interest in ketamine as a direct treatment for addictive problems, but for now we focus on depression). Any large urban area is now likely to have multiple ketamine clinics. A recently published study raises significant concern about whether, as with othe...

Substance use disorders slightly declined worldwide over the past 3 decades, but deaths increase 2.2 times. By Tom Horvath, PhD A recently published study (9/30/25) in the Frontiers in Psychiatry reported that although the presence of substance use disorders (both new cases—incidence, and existing cases--prevalence) has declined slightly around the world since 1990 (to 2021), substance-related deaths have increased 2.2 times. Increases in deaths were most prominent in North America, with an 11.2 times increase. The study was conducted with publicly available datasets from https://ghdx.healthdata.org. These datasets are collected and maintained by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle. [The IHME] provides rigorous and ...

By Tom Horvath, PhD For many of us a good life is a happy or a meaningful one (or some combination). However, in recent years a group of psychologists has proposed a third guideline: “psychological richness.”  On their deathbeds the happy might say “I had fun.” Those with meaningful lives might say “I made a difference in the world.”  Those pursuing psychological richness might say, ”what a journey I had” or “that was an adventure!” These three approaches can be and probably often are combined. You can pursue happiness by creating or finding satisfaction, well-being, and even joy. You can pursue meaning by looking for connection with others, purpose, and making the world a better place. If you add the dimension of pursuing personal growth, you can keep working to expand your persp...

Longterm: A Podcast on Recovery Interview with Tom Horvath, Ph.D. Episode: Understanding Recovery Beyond the Stereotype YouTube: https://youtu.be/c3wGl2If6o8?si=8HplQQxea6gMuG7c Spotify and all other podcast platforms: https://creators.spotify.com/pod/profile/tiking/ The host is Ti King. The podcast was described this way: Dr. Horvath explains that SMART Recovery is a free mutual-help group, similar to AA in its community-driven support. However, it stands apart with its self-empowering philosophy, contrasting with the "powerlessness" approach. SMART Recovery does not require belief in a higher power and supports individuals choosing to reduce harm, moderate, or abstain from substances, allowing for personalized goals. The program teaches a variety of coping and thin...

Tom Horvath, Ph.D. The second National Conference on Addiction Recovery Science was held online 4/23-24, 2025. The closing panel presentation was “Recovery Science: What Do We Know, and What Do We Need to Know?” The panel consisted of internationally recognized experts on this topic: David Best, Andrew Finch, Christine Grella, Keith Humphreys, and Sarah Zemore. The panel was skillfully moderated by Amy Mericle and Lourah Kelly. Here are my takeaways from the Addiction Recovery Science Conference: There was general support from the panel for the following ideas: Severe addictive problems are chronic disorders, but with many variations. Services for these problems need to be enduring. There is overwhelming evidence that AA (Alcoholic Anonymous) works (for those who will ...

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...

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...