A short time ago I asked Patricia Rosen, Publisher of The Sober World, if an article on SMART (self-management and recovery training) might be in order. An introduction was suggested. So, this is an opportunity for some people to get to know SMART, for others it could be a review or a refresher.
I will use Alcoholics Anonymous (AA) as the best example of the impact of 12-step recovery. AA has been a miracle for millions. It has had a profound impact on our culture. I was recently trying to help a person locate AA meetings in another country. Would you believe that there are eight weekly, English speaking AA meetings in the capital of Bulgaria? What more can be said? So, what’s the problem?
The problem is that “ half of all clients completing treatment do not participate in recovery support groups after discharge, and of those who do, 40-60% discontinue participation within a year of treatment discharge”
Experience tells me that the people who have their heels dug in the deepest against 12 step recovery have their heels dug in for one of two reasons, sometimes both:
1. 12-step recovery is religious (courts seem to agree)
2. labeling (my name is, “I’m an…….”
Many people will argue that AA is not religious and that labeling has a function, e.g. it develops humility.
But, that’s not the point.
The point is that it’s either unethical or immoral to toss away the enormous number of people who will not engage.
A number of non-12-step mutual support groups are emerging, e.g. Lifering, Refuge Recovery. SMART appears to be the one that is attracting the largest number of people. Presently, there are 1657 meetings in the United States, and 2,827 worldwide. Several treatment centers are offering in-house meetings.
Whether you are a person in recovery and/or a professional in the field, it makes sense to become familiar with SMART. The best way is to go to www.smartrecovery.com. There’s a lot of information there, an opportunity to ask questions, articles and books to read. You can even go to an on-line meeting.
What I can do is introduce SMART from the perspective of a person who has been friends with Bill and Bob for a long time. We remain friends. The perspective is also from a person who has been an addictions professional for a long time.
Perhaps, the most important differences between SMART and 12- step recovery is that SMART:
• is secular
• does not encourage labeling
• places an emphasis on being “empowered” rather than on being “powerless.”
When you stop and think about it, “empowered” and “powerless,” in this context, are not really that different. If you really felt “powerless,” why would you ever go to a meeting?
SMART is not anti-12-step. Negativity to other paths to recovery is not tolerated at SMART meetings. It’s not tolerated out of respect for those paths and for the people who have been helped by them.
SMART is an anonymous and confidential mutual support group that helps people establish and maintain abstinence from addictive behaviors. It is based on cognitive-behavioral principles coming from therapies such as Motivational Interviewing and Rational Emotive Behavior Therapy.
People who facilitate SMART groups participate in thirty hours of on-line training. On the one hand, thirty hours is not a lot, but it is continuously supported by ongoing education/participation. Personally, I was impressed with the quality of on-line training.
I often hear the criticism that a facilitator does not receive enough training or support given the impact that person can have on another.
Neither does a sponsor.
Tit for tat doesn’t make an issue go away.
It needs to be looked at.
SMART is not “an alternative to AA” nor is “AA an alternative to SMART.” A therapist does not have to wait until a patient threatens to leave treatment before recommending SMART (it happens).
It’s better to get to know a person’s belief system and then recommend a path. Can a person benefit from a spiritual and a cognitive-behavioral path? Of course, they can. “ …… accept the things I cannot change and the courage to change the things I can…” sounds pretty cognitive to me.
I also know that an organization that offers a SMART meeting is not necessarily an organization that is offering a SMART path. It’s not right to advertise a SMART path and continue to have the 12-steps on the walls or expect a person seeking a cognitive-behavioral path to work steps.
It seems likely that the SMART Handbook will become to a SMART path what the Big Book and the 12 x 12 has been to a spiritual path.
The Handbook emphasizes four areas to be addressed:
• Maintaining motivation to remain abstinent
• Coping with urges
• Managing thoughts, feelings and behaviors.
• Living a balanced life
There are exercises in each section that patients can do alone, with a therapist or a peer, in a group.
Personally, I find the exercises under “Managing Thoughts, Feelings, Behaviors” most helpful. I find that I feel much differently about doing something when I “choose” to do rather than “have to” do it.
“I can’t drink” feels different than “I choose not to drink.”
You may have guessed that in order to engage in exercises like the one described, people have to talk to each other. In SMART it’s referred to as “cross talk.” People who come to their first SMART meeting frequently find “cross talk” to be very different. The majority of most meetings is spent on people talking directly to each other. The job of the facilitator is to keep it manageable and on topic.
In order for this to happen, meetings have to remain relatively small. A couple of different things can happen if a group gets large.
1. Split the group in two. Often, there’s more than one facilitator available
2. Work on tools from the Handbook
The most recent research that I’m familiar with indicates that regular participation in AA, Lifering, SMART, or Women in Recovery are equally effective means toward maintaining abstinence.
Is Fellowship the secret?
References Provided Upon Request
Dr. Weiner is in private practice at Lifespan Recovery. Professional interests include treating addiction and the elimination of stigma. Dr. Weiner has written for various publications on these topics, and is very passionate about helping people who are struggling with addiction. www.lifespanrecovery.com firstname.lastname@example.org