The SMART Recovery 2025 Annual Conference, Charlotte, NC, April 2-4 By Tom Horvath, PhD In summary: SMART is thriving, and recognition of SMART in the recovery and wider world seems to be accelerating. Entire systems of services (e.g., state prison systems, national prison systems, treatment systems) are adopting SMART Recovery meetings. Part of the purpose of this conference was to celebrate SMART’s growth and to thank the volunteers (our “champions”) who have grown it. SMART Recovery now has approximately 1800 meetings in the US and Canada. The main presentation room only had space on its walls for 20 flags (of the 32) of SMART’s other countries. Worldwide there are nearly 3000 meetings. SMART now has printed materials in 18 languages. There were about 220 attendees (up...

by Tom Horvath, PhD There are many occupations considered to be safety-sensitive. The industries from which they are drawn include healthcare, transportation, and construction. Specific occupations include physicians, airline pilots, and heavy equipment operators. When these individuals have their substance use monitored (often because of recent substance problems), what principles should guide the creation of the monitoring plan? Let us focus on alcohol, because it may be the most common substance monitored. There are many methods to monitor alcohol use. They differ according to the timeframe they observe, their accuracy (will they miss use that occurred?), whether they assess the substance itself or a metabolite, the convenience of use (e.g., including how far one must go to get...

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 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, ABPP Although many of us have warm memories about Thanksgiving spent with family and friends, there may be some painful memories as well. If you're looking for tips on coping with Thanksgiving, and the problems that might arise, consider the following goals: If avoiding squabbles is your goal, can you sit on your own opinions for one day? Say nothing, or say “I don’t agree with these ideas, but this isn’t the time or place to discuss them.” Repeat “this isn’t the time or place” as needed. If your goal is not drinking, or drinking less, you might need some preparation. Will a family member or two be “in the know” and support you? If you are likely to be asked questions (“why are you not drinking?”) do you have an honest but not necessarily revealing ans...

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 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...

What are your sources of pleasure? By Tom Horvath, PhD If you’ve had addictive problems, you may easily recall experiences (with substances or activities) that you found intensely pleasurable. Addictive behavior can provide that! However, regardless of how much you are still having that type of experience, you can understand and appreciate yourself much better by examining the other sources of pleasure in your life. A daily review of them is useful. That review could happen at any time, but doing so as you fall asleep is a good way to end the day with a sense of pride and gratitude. What experiences from your day stand out to you? You may be surprised at what you discover. Here are some questions to consider in that review. How much did you enjoy sensory experience today? S...

By Tom Horvath, PhD A recent scientific paper analyzed the responses from nearly 10K individuals who identify themselves as “in recovery” from substance problems. In recent years the addiction recovery field has been considering how to define “recovery.” Five major organizations have offered definitions or attempts at definitions. However, there is not much data on this issue. Two previous studies have looked at how individuals in recovery define it. The present study is an advance because it identified 30 sub-groups, based on socio-demographics, substance use problems, and help-seeking history. Each sub-group was analyzed for which components of a recovery definition might be common for that sub-group. The second study had averaged all subjects together, thus losing some of the diff...