In this episode of 60 Plus Uncensored, host Seb Frey sits down with Dr. Tom Horvath, a clinical psychologist whose long career has shaped how many people think about addiction and recovery. Tom lives and works in San Diego, and he has spent more than 40 years specializing in addictive problems, starting in 1985. He founded Practical Recovery to offer science-based, self-empowering alternatives for people who don’t connect with a traditional 12-step or disease-model approach. He is also a founding figure of SMART Recovery and spent 20 years as its president, which gives him a rare, long-view perspective on what actually helps people change and why.
Dr. Tom Horvath’s Early Career and the Start of Practical Recovery
Tom introduces himself plainly: he’s a psychologist with a PhD, not an MD, and he has focused on addictive problems since the mid-1980s. The beginning of his story matters because it explains why his approach has stayed consistent over time. Even early on, he saw that people struggling with addiction were not one uniform group, and that a single model of recovery wasn’t going to meet everyone’s needs. That observation became the foundation for the work he’s still doing today.
A key turning point for him came in the fall of 1984, when he recognized something many providers missed at the time. There were plenty of people who could admit they had a problem and could even say change was needed, yet they did not want to be treated through the disease model of addiction or through Alcoholics Anonymous and other 12-step groups. Tom understood that these were not “unmotivated” people, and they weren’t people who were denying the seriousness of their situation. They simply didn’t want the particular framing of powerlessness and the spiritual structure that came with the most familiar programs.
That realization led directly to Practical Recovery, which he founded in 1985 in San Diego. He describes the approach as non-12-step, non–disease model, and self-empowering, with an emphasis on helping clients recognize their own capacities. The goal is not to force a single outcome or a single philosophy, but to help people resolve addictive problems “in whatever way works for them.” For Tom, the value is practical: if a person can see what they’re capable of, they can start using those abilities immediately rather than waiting to feel “ready.”
To explore how purpose and perspective can evolve with age, you may also want to read… Living Your Best Life After 60 Through Gerotranscendence.
Why He’s Still Doing This Work More Than 40 Years Later
Seb asks an obvious question that many listeners in their 60s and beyond are quietly asking themselves, too: why keep working? A lot of people with 40+ years in a field are calling it a day, yet Tom is still practicing and still building. Tom answers with humor first. He’s signed a lease that keeps him in the game until at least spring of 2030, but his real answer goes deeper than logistics. He keeps doing the work because he believes it is a genuine public service and because he finds meaning in watching people change.
He describes his work as a mix of job and passion, which feels honest for anyone who has worked for decades. There are parts of any job that aren’t thrilling, and he doesn’t pretend otherwise. But he talks about having “meaningful sessions” and running a meaningful group, and he’s clear that those moments still satisfy him. He also makes a point that many older adults will recognize immediately: it takes a long time to learn something well, and once you do, there’s a particular satisfaction in helping others with it. That kind of satisfaction can become even more important in life after 60, when people begin to prioritize usefulness and contribution over status or competition.
Tom also describes how he volunteers about ten hours a week for SMART Recovery, and he has done that since 1990. That volunteer role matters because it shows this isn’t only about a private practice or professional identity. He sees the availability of free, mutual-help support as part of the solution, especially for people who want a self-empowering approach and don’t want 12-step framing. For him, it’s not too soon to stop helping, and he says plainly that seeing people change “indirectly” because of his efforts is deeply satisfying.
When Experience Meets Cultural Assumptions About Addiction
As the conversation turns, Tom speaks to a belief many people over 60 have carried for a long time: that addiction is definitely a disease. He doesn’t mock that view, and he doesn’t try to win a debate. Instead, he explains that there is now much more diversity of opinion, and that it is not necessary to view addictive problems as diseases in order to address them effectively. That distinction matters because it shifts the focus from labeling to doing something helpful.
He also points out a practical issue with the disease framing, especially when people are still on the fence about whether they “qualify.” If the first question someone asks is, “Do I have the disease?” it becomes easy to talk yourself out of it. Most people can name someone who is “worse,” which becomes a reason not to act. Tom’s alternative is to focus on specific problems you are having and then decide what to do about them, because problems are harder to argue away. You may not want to claim a diagnosis, but you can usually see the real-life consequences in health, relationships, responsibilities, money, or self-respect.
What lands here is the way Tom keeps returning to nuance. He says the field has had a lot of all-or-none thinking, swinging from “it’s a moral problem” to “it’s a disease” and treating those as the only two options. His view is that addiction can have aspects of both, plus other elements like habit, learning, environment, and biology. For listeners thinking about reinvention after 60, that nuance can feel like relief, because it opens up more ways forward. It allows someone to take responsibility without drowning in shame, and to seek medical support when needed without surrendering agency.
To better understand how mental resilience evolves with age, explore The Science of Staying Sharp: How to Keep Your Brain Young After 60.
What We Know Today That Wasn’t Clear 40 Years Ago
Seb asks what we know now that we didn’t know then, especially for an audience that may have internalized older narratives. Tom offers several examples without turning the conversation into a lecture. One is that Alcoholics Anonymous appears to be as effective as professional treatment, which is a finding that the treatment community didn’t love hearing for obvious reasons. Tom isn’t dismissing treatment, but he’s emphasizing something useful for the public: free mutual-help groups can save money and still be effective.
He also says that other mutual-help groups appear to be equally effective, with additional studies still in progress, and he expects more solid evidence specifically about SMART Recovery. He’s careful about certainty while still giving listeners a grounded sense of where the field is headed. For an older audience, this matters because it means there are real options that don’t require an expensive program or a single belief system, and that choice can be part of aging with purpose rather than a sign of “doing it wrong.”
Another point he makes is that perhaps half of the people who resolve these problems do so primarily on their own. He clarifies that this doesn’t mean they do it in isolation or with no support, but that they may not go to formal treatment or even group meetings. They may arrange support in ways that feel right to them, while still making genuine changes. This challenges a common assumption that nearly everyone needs a program to recover, and it also honors the reality that people differ in what helps them.
Tom also highlights something he considers crucial for change: cravings pass. When a strong desire shows up, it doesn’t force action, and it won’t last forever. If you wait long enough, it tends to go away, especially if you engage in another activity while you wait. He adds an important caution about alcohol withdrawal and the need for medical awareness in certain situations, but the core message is empowering. A craving can be uncomfortable without being dangerous, and learning to wait it out can become a turning point.
The Emotional Challenges: Identity, Confidence, and the Fear of Being Stuck
Even though this conversation is about addiction and recovery, it’s also about identity and confidence, which are especially relevant in life after 60. Seb brings up a concern many people have about the disease model: that it can feel like it absolves people of responsibility. Tom doesn’t argue with Seb’s frustration, but he shifts it toward something more workable. Rather than focusing on whether someone should be “excused,” he encourages people to make a decision, address the problem, and think about it consistently in small, manageable ways.
For older adults, that approach can feel more respectful because it treats them like capable adults instead of helpless patients. It also avoids the trap of defining oneself by a label. Tom emphasizes that the key is not “Do I have a problem?” as a yes-or-no question. It’s “What problems do I have?” and how do I address them. That framing is practical, but it’s also emotionally supportive because it invites clarity without humiliation.
He also talks about how addictive behaviors can become part of a lifestyle and identity over time, especially when someone has been using something for decades. That reality can feel intimidating because changing can feel like losing a familiar version of yourself, even if that version is hurting you. Tom’s view is that you don’t need to solve every causal puzzle first; you need to start changing your patterns and then address other problems if they emerge. That step-by-step approach is often the only way confidence returns, because confidence is built through follow-through, not through perfect understanding.
What Causes Addiction, and Why the “Why” Isn’t Always the First Step
Seb asks directly what causes addiction if it isn’t simply a disease, and Tom answers with a balanced approach. He says genetics does influence risk, and a family history makes addictive problems more likely, but that doesn’t mean someone must develop them. He also frames genetics in a practical way: if you have a family history, you might like certain substances more, and that can make stopping harder. Still, he returns to the point that genetics aren’t something you can change, and worrying about them doesn’t help you change your behavior.
Tom describes addiction as a coping method for many people, including coping with depression, anxiety, social anxiety, or bipolar disorder. He also mentions chance and environment, offering a simple example: a socially anxious student may feel immediate belonging when drinking in a social setting, and that relief can become reinforcing. What starts as a tool becomes a habit, and over time, it can crowd out other coping skills. If the person never learns how to manage social anxiety without alcohol, the reliance deepens.
He also acknowledges that causality can run both directions. Sometimes emotional problems lead to addictive behavior, and other times addictive behavior leads to depression or anxiety. His practical message is that you often don’t need to perfectly untangle causality before you start changing. If new problems show up once you stop, like depression emerging after drinking stops, then you address that too. That approach is especially relevant for staying relevant later in life, because it keeps you in motion. It encourages learning and adjustment instead of getting stuck in analysis or self-blame.
Exercise as a Cornerstone of Recovery and Aging With Purpose
One of the most striking parts of Tom’s approach is how strongly he emphasizes exercise. He tells clients there is “nothing I can do for you that’s more helpful than having a regular, effective exercise program.” He doesn’t oversell it as a magical cure, and he admits he can’t fully explain the physiology. But he emphasizes outcomes, and he points out that evidence supports exercise helping many emotional and behavioral problems.
Tom practices what he recommends. During the conversation, he’s walking slowly on a treadmill or walking pad, moving at half a mile per hour, and he does it for hours a day to stay physically engaged. He also describes a home gym setup with a rowing machine, bands, a pull-up bar, adjustable dumbbells, and a bench. He talks about strength, balance, stretching, and cardiovascular fitness as distinct parts of staying well, especially as we age.
This section matters for a 50+ audience because it ties directly to aging with purpose. Exercise is not framed as vanity or performance. It’s framed as engagement. Tom says the goal is to “live well while we’re here,” and that physical vitality supports emotional resilience. In the context of recovery, exercise can also become a replacement for the role a substance used to play. If drinking were a mood regulator, movement could become part of a new regulation system, one that builds confidence instead of eroding it.
If you’re looking for practical ways to stay active safely, take a look at The Best Low-Impact Exercises for Adults Over 60.
SMART Recovery and the Choice to Be Self-Empowering
Seb asks about 12-step programs, and Tom explains them in plain language without judgment. He describes the first step as admitting powerlessness and life being unmanageable, and he explains that later steps include turning the problem over to a higher power, examining character defects, and making amends. Tom acknowledges that individual steps may benefit the right person, but he also explains why the framework doesn’t work for everyone. Some people are atheists, some have different religious beliefs, and some simply don’t want to start from powerlessness.
For people who want to say, “I want to learn how to manage this myself,” self-empowering approaches can feel like a better fit. Tom also points out something that never made sense to him early on: if addiction is a disease, why would a spiritual method be the primary solution? He draws a common-sense comparison that many listeners understand immediately. People may pray in hard times, but they also seek medical expertise for medical issues. In Tom’s view, addictive problems are often solvable through learning, behavior change, and support, and people should have choices in how they pursue that change.
This is where SMART Recovery comes in. Tom distinguishes Practical Recovery, his for-profit practice with a small team, from SMART Recovery, a nonprofit offering free mutual-help groups. He emphasizes that SMART meetings are available widely and online, often around the clock, and that meetings can vary, meaning it can be useful to try a few and find one that fits. For people navigating life after 60, this offers an important form of accessibility: support that isn’t limited by geography, finances, or licensing.
For insight into how continued learning supports independence and confidence, read How Lifelong Learning Keeps Your Brain Sharp After 60.
Practical Lessons: What to Focus on When You Want to Change
When Tom shifts to advice, he stays consistent with his overall philosophy: focus on the specific problems, then build a plan that matches your reality. One of his most practical suggestions is to ask a question people rarely ask honestly: “What do I like about it?” He uses alcohol as an example, but the idea applies broadly. If you drink because it helps you socialize, then the real task is learning to socialize without needing a drink. Until you understand what the behavior is doing for you, it’s easy to fight the wrong battle.
He also recommends short daily reflection, just a few minutes, to keep the project active in your mind. Try abstaining for a day or two and notice what you learn, then adjust. He’s not pushing perfection or a single commitment level from day one. He’s pushing engagement, experimentation, and learning. That process-based mindset can be particularly helpful for older adults who may be tired of rigid systems or shame-based messaging.
Tom also highlights two resources he sees as especially helpful: relationships and exercise. Find people who will listen, ideally loved ones, and build a connection rather than secrecy. Add movement as a daily stabilizer. Beyond that, he mentions sleep and nutrition as part of the broader foundation. He does not pretend there is only one lever to pull, but he keeps returning to what is most actionable and sustainable.
Advice for Older Adults: The Next 10, 20, 30 Years Can Be Better
Near the end, Seb asks for one piece of advice for someone 65 or 70 who feels trapped by a lifelong struggle. Tom’s answer is hopeful without being naïve. He says addictive problems often diminish as we get older, and that older adults tend to have more resources and more experience to draw on. He also notes that retirement can create a challenge, filling time, so purposeful structure can become important. At the same time, the body may tolerate substances less well with age, making negative consequences appear sooner, which can motivate change.
He also recommends a full medical workup, not as a scare tactic, but as a way to know your baseline and track improvement. He does acknowledge serious risks that can happen, such as overdose, suicide, falls, and fatal accidents, because he has seen those outcomes. But he returns to the core message that most people will be successful if they work at it, even if it takes longer than expected. That is a practical kind of optimism, rooted in what he’s observed over decades.
This is also where the themes of reinvention after 60 and staying relevant later in life come into focus. For someone struggling, reinvention may not mean a new job or a new city. It may mean learning to live differently in your own body and mind, and learning to build days you don’t need to escape from. That kind of reinvention is quiet, but it changes everything.
If you’re focused on building momentum in this stage of life, you might appreciate How to Stay Positive and Motivated as You Age
Life Now: Purpose, Service, and a Long View of Change
Tom’s life today is not presented as a victory lap. It’s presented as ongoing engagement. He continues his practice, volunteers substantial time, writes regularly, and participates in talks, podcasts, and presentations. He even jokes that his team has built a YouTube presence he wasn’t fully tracking, which adds a human note: staying relevant later in life doesn’t require being perfectly on top of every platform. It requires showing up, contributing, and staying connected to real work that matters.
He also speaks openly about the satisfaction of teaching what you’ve learned, and that satisfaction is a core part of aging with purpose. After decades in a field, it would be easy to retreat into private life, but Tom keeps offering his skills to the public in both paid and free formats. In a culture that sometimes treats aging as withdrawal, his story shows another possibility: continued contribution with a steadier pace and clearer priorities.
To explore what purposeful living can look like after your primary career, see Creating a Fulfilling Lifestyle After Retirement.
Conclusion: A Grounded Way Forward for Life After 60
If there’s a single thread running through this conversation, it’s that change doesn’t require a single belief system, and it doesn’t require you to surrender your agency. Dr. Tom Horvath keeps returning to practical steps: identify the specific problems, understand what the addictive behavior is doing for you, and begin building alternative ways to meet those needs. He encourages people to lean on relationships, move their bodies regularly, and treat cravings as temporary experiences rather than commands. For older adults, especially, he offers hope rooted in reality: many people improve, resources often increase with age, and addictive problems can diminish over time.
For anyone thinking about life after 60, reinvention after 60, or simply what it means to keep aging with purpose, this episode is a reminder that your next chapter can be built deliberately. You don’t have to solve every debate about disease models or genetics before you act, and you don’t have to let a past pattern define the rest of your life. Start by focusing on what’s happening now, stay curious about what could work, and permit yourself to learn through small changes. Staying relevant later in life often begins the same way recovery does: with an honest look, a workable plan, and the quiet confidence that you can still choose differently.