By Tom Horvath, PhD, ABPP Transforming the US Addiction Treatment Workforce, Part 1, argued that the US needs to follow other nations, which have substantially lowered overdose rates and rates of addictive problems by adopting harm reduction. To offer this approach we need providers who work with the client not against the client’s disease, accept that there are as many pathways for change as there are individuals, work with the client to discover their individual pathway (and not assume that the provider knows what it is), empathize with the value experienced from the addictive behavior, and not confront the client about the desirability of change. Part 2 reviews specific examples of how the US addiction treatment workforce (the providers and systems) would operate having made this ...

By Tom Horvath, PhD, ABPP The rapid increase in US overdose deaths in recent years has resulted in increased attention to our drug policies and treatment system. In other developed countries drug policy has increasingly oriented toward harm reduction. Harm reduction approaches emphasize working with individuals who use drugs to increase safe use in the short term, and improved well-being and the resolution of addictive problems in the longer term. Transforming the US Addiction Treatment Workforce -  It's Needed This approach has been controversial in the US, on the assumption that any approach that does not insist on immediate abstinence encourages drug use and is therefore counterproductive. This controversy overlooks the reality that in the countries that have embraced a harm red...

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   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...

By Tom Horvath, PhD Not exactly: I’m reporting about a presentation by Professor Bruce Alexander, the creator of “rat park,” given on 4/19/22, for the Addiction Theory Network, based in the UK. The webinar was: Retiring the Brain Disease Model of Addiction. And Then What? Rat Park Recap Rat Park, if you are not familiar with it, was his groundbreaking research showing that when rats are given a stimulating environment they will NOT die from self-administering various substances (e.g., cocaine, heroin). However, they will die from self-administration in a barren cage where the only choices are food/water and substances. Further, if you take rats stuck in those barren cages and then place them in rat park, they will again engage in normal rat activities and no longer have substance p...

Psychedelic Diaries, Episode 3: Interview with Tom Horvath, PhD, ABPP "Psychedelic Diaries," a podcast hosted by Ray Christian, has nearly 30 episodes (each an interview). Dr. Horvath was the third interviewee. The podcast describes itself as offering: "Experts from the world of medicine talk about mental health, mystical experiences, and the psychedelic renaissance. The show features news and discussion on how psychedelics affect our mind and the world around us." This 3 minute video has excerpts from each of the five initial experts interviewed. Dr. Horvath, in the excerpt, speaks about the value of a psychedelic experience as a "pattern interrupter." In the full interview he elaborates on that concept and his own (unfortunately disappointing) experience doing ayahuasca fou...

by Tom Horvath, PhD There is no more important person to the addiction treatment and recovery field than Nora D. Volkow, MD. Dr. Volkow is the Director of the National Institute on Drug Abuse (NIDA). In the US government’s fiscal year 2021 NIDA spent about $1.4 billion, primarily on research. By comparison, the budget for the National Institute on Alcohol Abuse and Alcoholism is only about $500 million. A substantial portion (if not the majority) of the world’s addiction research is funded under Volkow. The Statement from Dr. Volkow: Consequently, when Volkow speaks, people listen. Maybe more so than ever now: “Making Addiction Treatment More Realistic And Pragmatic: The Perfect Should Not Be The Enemy Of The Good” https://www.healthaffairs.org/do/10.1377/forefront.20211221.6918...

by Tom Horvath, PhD In September 2021, Netflix released a seven-episode miniseries that mentions Rational Recovery (RR) as an alternative to Alcoholics Anonymous (AA) in episode II (starting in minute 46). Ironically, the mention of RR occurs in a very small (two-person) AA meeting. The pro-RR speaker is required to attend AA as part of parole, but he objects to AA’s powerlessness and God-centered approach. He prefers RR’s addictive voice recognition technique and the idea that he could take charge of his own behavior. In that AA meeting, he takes an extended moment to explain RR concepts and what he likes about them. Miniseries Mentions Rational Recovery - The Significance The significance of RR’s presence in Midnight Mass is that self-empowering approaches to resolving addictive ...

Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, by Maia Szalavitz Review by A. Tom Horvath, PhD The harm reduction approach to addressing addictive problems has until recently been highly controversial, at least in the US. Treatment and other change efforts in the US have been primarily guided by the views that addiction is a disease and that the 12 steps are the primary (or only) method for change. Harm reduction accepts and encourages small steps toward change. The US approach has typically required an immediate and large change, often involving a completely new perspective: “I’m an addict, I have a disease, I will abstain from everything forever.” The small steps approach of harm reduction, even though it describes how most human change occurs, has ...

By Tom Horvath, PhD Addiction professionals say they're working toward ending stigma surrounding addiction, but they also tend to promote addiction as a disease. These activities are contradictory. By promoting addiction as a disease they play into the general tendency to perceive in-groups (“normies”) and out-groups (those with the disease). Instead of emphasizing that “addiction is a chronic brain disease” or “treatment works,” the following ideas, depending on the context, would make much more helpful and less stigmatizing messages: You might also be interested in: The Stigma of Addiction and the Inadvertent Contribution of the Recovery Community 1. Addictive problems range from very mild to very severe. 2. Most addictive problems are not in the severe or very severe range. ...