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...

By Tom Horvath, PhD “If we have our own why, we shall get along with almost any how.” -Friedrich Nietzsche, Twilight of the Idols, Maxims and Arrows, #12, translated (1954) by Walter Kaufman, originally published 1889. Our Own Why There is a range of “whys” that explain how we behave. We have in-the-moment behaviors like eating (why? “I’m hungry”). As we mature, we also have much longer-term timeframes, such as multi-year educational plans (why? “I want to be an X”), and multi-decade parenting plans (why? “I want to give my children opportunities and an upbringing that I did not get to have”). You can probably recall many examples of how you tolerated discomfort or pain for the sake of a longer-term outcome. I suggest that it is helpful to make a list of these experiences in you...

By Tom Horvath, PhD “We are disturbed not by events, but by our views about them.” - Epictetus, 60-138 CE Bad events happen to all of us. To some of us, they happen to a great extent. Whether we have first-world problems, third-world problems, or something else, our problems focus our attention. We want to solve them. In some cases, solving problems means changing or exiting a situation. In many cases, however, there are no obvious changes or exits to make. What now? These types of problems require a change of “view.” Psychologists and others who help people change their “views” have used many terms to describe what needs to be changed to address these types of problems: perspective perception context viewpoint beliefs point of view interpretation *gui...

By Tom Horvath, PhD I was recently contacted by a website putting together a list of 50 very brief accounts, including before and after pictures, about individuals resolving addictive problems. I was pleased that they included a few quotes from me, about the process of change. https://www.boredpanda.com/best-all-times-before-after-addicts-transformation/ Perhaps the most important fact to know about significant addictive problems is that most individuals fully or mostly resolve them. So often the stories we see are focused on problems, not success. The process of change often takes more effort and more time than we would like, but nevertheless it happens! The results of the change process are quite different from individual to individual. The lengthy time needed to change ca...

By Tom Horvath, PhD Although occasionally we hear someone say “I’m addicted to everything,” it appears that most of us deeply enjoy only a few substances or activities. You would not have time for all of them! This fact means that there are many or at least some substances that you do not feel strongly drawn to, even though others may be. For instance, you might like gambling, but not be interested in any substances. Or you might very much like alcohol (or weed, or meth, or opiates, or coke, or ketamine, or various activities, etc.) but not especially be interested in MDMA (or alcohol, or weed, or meth, or opiates, or coke, or ketamine, or various activities, etc.). How do you do it? How do you NOT get carried away with substances or activities that others find so tempting? How...