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. ...

by Tom Horvath, PhD Practical Recovery and SMART Recovery both use the self-empowering approach for resolving addictive problems. This approach contrasts with the powerlessness-based approach of AA and other 12-step groups, at least on the surface. Both approaches begin with the person considering change, and then deciding to change (at least to some degree). Both approaches can be effective, but one may work better for specific individuals. The powerlessness-based approach is described in AA’s 12 steps. In the first step you admit you are “powerless over alcohol.” In the third step there is “a decision to turn our will and our lives over to the care of God as we understood Him.” This approach can be described as serenity (as used in the Serenity Prayer, and also as “letting go” o...

by Tom Horvath, PhD A well-lived life needs to have significant and possibly considerable amounts of discomfort in it. For instance, do you want to exercise well, maintain a certain weight, get up early, work hard at something, or hold your tongue in an intense discussion? You are likely to feel uncomfortable! The key, then, is to learn skills for managing discomfort that will inevitably come. You might also be interested in: Coping with Stress in Addiction Recovery In particular, if you want to stop an addictive problem, you are likely to have a transition period as you change how you live. Cravings might die off almost entirely after 90 days (although there is no guarantee they will completely), but other challenges might last much longer. Maybe you should just give up now? Fortu...

by Thaddeus Camlin, Psy.D. Research chemicals are commonly associated with things like ‘the dark web,’ ‘silk road,’ ‘the amazon of drugs,’ and other, slightly shady and un-salubrious sectors of society.  However, research chemicals earn their family name because there are some actual scientific researchers investigating true therapeutic and clinical potential.  Recently, one such scientific researcher, Dr. Alan Kozilowski, a trained organic chemist from the University of Berkeley and Harvard, outlined his efforts to manufacture a compound that mirrors the effects of psilocybin.     Psilocybin is a compound best know for being the ‘magic’ in the mushroom.  Kozilowski was inspired by the significant, positive research findings for psilocybin and the treatment of various ...

by Thaddeus Camlin, PsyD The American Psychological Association (APA) recently published an article offering advice from leading professionals on effectively treating and preventing addictive problems during the COVID-19 pandemic.  Our own Dr. Horvath is quoted multiple times in the APA article, speaking about the value of telehealth during pandemic and the importance of fostering resilience through adversity.  The APA article’s endorsement of harm-reduction practices is also a subtle but revealing sign of the shifting landscape of addiction treatment.   For nearly a century the tyranny of abstinence dominated the zeitgeist of American thinking on treating addiction.  A major, national organization like the APA weaving in a concrete endorsement of harm-reduction as a v...

by A. Thomas Horvath, Ph.D., ABPP As part of my celebration of SMART Recovery’s 25th Anniversary, this blog is devoted to considering the recently released SMART Recovery USA Position on Goals: “SMART Recovery is abstinence oriented. Our meetings and tools are designed to help participants stop problematic addictive behavior.” I offer the following interpretation of this position.  Isn’t all addictive behavior problematic? Addictive behaviors are normal human behaviors, including eating, sexuality, and connecting with others. For some individuals these behaviors become problematic. Involvement with pleasurable psychoactive substances or activities is also common, including with alcohol, caffeine, gambling, video games, and many others. For some individuals these involvements becom...

by Thaddeus Camlin, Psy.D. When it comes to addiction treatment, it is well-known that the United States is embarrassingly and shamefully behind the rest of the industrialized world.  It is no surprise then that evidence for MDMA-assisted psychotherapy reducing alcohol relapse is coming out of the UK. We know MDMA-assisted psychotherapy was designated breakthrough status as a treatment for PTSD, and we know that trauma is at the etiological heart of most addictive behaviors (see Atkins, 2014, p.195). So it would naturally follow that if MDMA-Assisted Psychotherapy helps treat the etiology of addiction, it will probably help treat addiction. Yet, the misinformed notion that all addicts are the same and can never touch mind-altering substances again (except of course for boat-loads...

by Thaddeus Camlin, Psy.D. HBO’s hit television series, Euphoria, pushed the envelope on many important topics, except one – addiction.  The show depicted a biracial romance between two women, one of whom was transgender. The show offered gritty, raw depictions of sexual assault, teenage substance use, physical and emotional abuse, and abortion.  When it comes to addiction, however, the show somehow missed the memo that there are no experimental studies that unequivocally demonstrate the effectiveness of traditional addiction treatment.  Euphoria pushed boundaries on a number of important social issues, but when it comes to addiction, the show succeeded only in being yet another example of mainstream media perpetuating the harmful messages that all addicts are the same and thus, all de...

by Thaddeus Camlin, Psy.D. Despite unfounded resistance, Medication-Assisted Treatment (MAT) is increasingly considered the treatment of choice to combat what is commonly referred to as an opioid epidemic.  A report issued this week from the American Association for the Treatment of Opioid Dependence (AATOD) solidifies MAT as a frontline defense in the opioid crisis and makes important points about how to increase the accessibility and effectiveness of MAT addiction treatment in the United States. Unsupported Restrictions on MAT Services Many cumbersome, unsupported restrictions remain in place that hinder MAT services in the United States.  The AATOD report states that MAT regulations like waiver policies, patient limits, restrictions on settings where medications are available, a...