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Self-Empowering Support Groups for Addiction Recovery: Smart Recovery

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

SMART Recovery

SMART (Self Management and Recovery Training) Recovery is the largest of the self-empowering support groups. It explicitly bases its program of recovery on evidence-based addiction treatments, applied in a support group setting. The organization is noted for its partnership between meeting participants and addiction professionals.

support groupSMART Recovery helps participants gain independence from addictive behavior with its 4-Point Program:

Point 1: Enhancing and Maintaining Motivation to Abstain
Point 2: Coping with Urges
Point 3: Problem Solving (Managing thoughts, feelings and behaviors)
Point 4: Lifestyle Balance (Balancing momentary and enduring satisfactions)

Under the 4-Point Program, there are 10 recovery tools:

1. Stages of Change
2. Change Plan Worksheet
3. Cost/Benefit Analysis (Decision Making Worksheet)
4. ABCs of Rational Emotive Behavioral Therapy (REBT) for Urge Coping
5. ABCs of REBT for Emotional Upsets
6. DISARM (Destructive Imagery and Self-talk Awareness & Refusal Method)
7. Brainstorming
8. Role-playing and Rehearsing
9. USA (Unconditional Self-Acceptance)
10. HOV (Hierarchy of Values)

Trained volunteer facilitators lead the meeting discussions. The facilitators are usually non-professionals, and usually in recovery themselves. However, some facilitators are professionals and/or non-recovering people who volunteer their time as a community service. Meetings are free of charge, donations requested. They are open to anyone unless a meeting is "closed." Closed meetings are reserved for individuals in recovery.

There are a number of fundamental differences between SMART Recovery and 12-step groups. Typically, people joining a 12-step group find a "sponsor." The sponsor serves as a sort of mentor and helps the newcomer learn the program. Contacts between a sponsor and the sponsored member are frequent. These contacts often take place outside of meetings, usually by phone. In contrast, SMART Recovery has no sponsor system. All official interactions between participants take place in meetings. The labels "addict" and "alcoholic" may be used but are discouraged. Meetings are discussions in which participants interact with one another. Under the guidance of the facilitator, the members work through one of the tools of recovery. Participants are free to believe in God or not. They may view addiction as a disease or not. Belief in God, and addiction as a disease, are not topics in meetings. The SMART Recovery tools are helpful regardless of one's individual beliefs about God or disease. Evidence-based addiction treatments and the recovery tools that arise from them (as used in SMART Recovery meetings) are compatible with almost any belief (or lack thereof).

SMART Recovery has an active and voluminous website. Program materials are available in eight languages. As of spring 2011, there are over 600 meetings worldwide. The organization supports itself by "pass-the-hat" contributions, publication sales, private donations, and website sponsorship. The organization began operating under the name SMART Recovery in 1994. It has received funding from private agencies such as the Robert Wood Johnson Foundation and governmental agencies such as Substance Abuse and Mental Health Services Administration (SAMHSA). It also receives indirect funding from the National Institutes of Health (NIH).

The National Institute on Drug Abuse (NIDA) funded a study that compared the effectiveness of 12-step and SMART Recovery approaches. The study participants were people who had both a serious mental illness and an addiction problem. They were attending a day treatment program. The authors of the study concluded:

"The 12-step intervention was more effective in decreasing alcohol use and increasing social interactions. However, a worsening of medical problems, health status, employment status, and psychiatric hospitalization were associated with the 12-step intervention. SMART was more effective in improving health and employment status, but marijuana use was greater for SMART participants. Improvements in alcohol use and life satisfaction occurred in both approaches (Brooks & Penn, 2003, pg. 359)."

The study appears to suggest that a SMART Recovery approach was effective in helping people in this difficult-to-treat population. The authors also noted that the SMART Recovery program retained participants better than the 12-step program.



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