SMART Recovery: A thoughtful alternative to Alcoholics Anonymous

Any recovery from an addiction to alcohol can be a long and difficult road for many.     Alcoholics Anonymous, (AA), and it’s child, the 12 Step Recovery model seem to have a firm hold on many of the hearts and minds in the recovery world.  The AA/12 step culture permeates the language and “business” of recovery.    If we think of alcoholism and recovery…. the AA/12 Step Model is often what we think about.

This popularity and recognition anecdotally supports the idea that the 12 Step model is the only “proper” way to “recover” from an addiction. We hear many statements of faith from those who say AA has “saved their life”… so many personal testimonies that we take it as a given that the program works for many who try it. But what if that is not the case?   What if AA’s self-promoted success may be a bit of an exaggeration?

AA claims a success rate of 75%!    So why would you do anything else to recover from an alcohol addiction?   However, given the difficulty in recovering from an alcohol addiction, this 75% seems highly unlikely and a number that should be examined.

Peer-reviewed studies over the past 50 years or so have put the success rate of AA at about 5 to 10 percent.  So at best, only 10% of people who enter these types of 12 step programs are able to become and stay sober long term.

Evidence of this is the 2006 Cochrane Collaboration, who conducted a review of the many studies of AA “success” conducted between 1966 and 2005 and reached the conclusion that:

“No experimental studies unequivocally demonstrated the effectiveness of AA” in treating alcoholism”.

Disheartening statistics for sure, considering that the vast majority of professional recovery treatment programs and centres, have at their their core, the 12-step AA model.

But to present a balanced view many put forward that AA does work well for many.

An article in Scientific American looking at whether “AA works” puts forward that:

Other research suggests that AA is quite a bit better than receiving no help. In 2006 psychologist Rudolf H. Moos of the Department of Veterans Affairs and Stanford University and Bernice S. Moos published results from a 16-year study of problem drinkers who had tried to quit on their own or who had sought help from AA, professional therapists or, in some cases, both. Of those who attended at least 27 weeks of AA meetings during the first year, 67 percent were abstinent at the 16-year follow-up, compared with 34 percent of those who did not participate in AA. Of the subjects who got therapy for the same time period, 56 percent were abstinent versus 39 percent of those who did not see a therapist—an indication that seeing a professional is also beneficial.

http://www.scientificamerican.com/article/does-alcoholics-anonymous-work/

Many proponents of the AA/12-step model have tried to question the methodology of the Cochrane Collaboration — but really, in the end?   The results are still mixed and there really is a shortage of peer reviewed scientific evidence supporting AA as the best or only approach to recovering from alcohol addiction.

Another limitiation and complaint often heard about the AA model is that a “belief in a higher power” is a central principle of working the system and is encouraged as a fundamental recovery strategy.

But what about people who have world views and philosophies that do not include any such belief in a higher power? What about die-hard athiests and humanists who do not believe any such higher power exists?

So what about those people for whom the 12-step treatment or AA style program doesn’t work or for people who don’t see the 12-step AA as an approach as isn’t a “fit for them” personally.   Do they have any other good choices?

 According to addictions and recovery expert Stanton Peele:

Rather than convincing people that they have a lifelong disease and that recovery is all about abstinence, treatment needs to encourage and train people toward belief in themselves and the ability for independent living. This involves therapies that encourage self-control through skills training, emotional self-maintenance (for example, learning how to avoid and escape depression), community integration (called community reinforcement therapy), relapse prevention (not allowing a bad experience or patch of substance use to explode into full resumption of the addiction) and empowerment. (2011) http://www.peele.net/blog/110608.html

The name for this type of approach is called Harm Reduction.     Peele defines Harm Reduction as consisting of the following four principles:

1. While absolute abstinence may be preferable for many or most substance abusers, very few will achieve it, and even that small group will take time to do so and may relapse periodically;
2. Ordinary medical treatment readily accepts and practices ameliorative therapies, which preserve health and well-being even when people fail to observe all recommended health behaviors;
3. Therapists should present accurate information to clients and may even express their own beliefs, but they cannot make judgments for clients;
4. There are many shades of improvement in every kind of therapy—this improvement may be all that people are capable of and should be encouraged and nurtured.

One such alternative that recognizes the key strategies of Harm Reduction and is backed by good solid psychological principles is called SMART Recovery.  (SMART = Self-Management and Recovery Training).

SMART Recovery is designed to help people:

…recover from all types of addictive behaviours, including: alcoholism, drug abuse, substance abuse, drug addiction, alcohol abuse, gambling addiction, cocaine addiction, and addiction to other substances and activities.

SMART Recovery states their purpose as:

To support individuals who have chosen to abstain, or are considering abstinence from any type of addictive behaviors (substances or activities), by teaching how to change self-defeating thinking, emotions, and actions; and to work towards long-term satisfactions and quality of life.

The SMART approach to recovery is based on teaching self-empowerment and skills based on good psychological science.  It really about changing habits, encouraging personal growth, and about learning how NOT to drink.

The SMART Approach:
* Teaches self-empowerment and self-reliance.
* Encourages individuals to recover and live satisfying lives.
* Teaches tools and techniques for self-directed change.
* Meetings are educational and include open discussions.
* Advocates the appropriate use of prescribed medications and psychological treatments.
* Evolves as scientific knowledge of addiction recovery evolves.

From: http://www.smartrecovery.org/intro/

How is SMART different than Twelve Step/AA?

SMART Recovery has a scientific foundation, not a spiritual one.
SMART Recovery teaches increasing self-reliance, rather than powerlessness. SMART Recovery meetings are discussion meetings in which individuals talk with one another, rather than to one another.
SMART Recover encourages attendance for months to years, but probably not a lifetime.
SMART Recovery has no “sponsors”
SMART Recovery discourages use of labels such as “alcoholic” or “addict”.

Especially note that SMART is based on using sound, proven psychological principles and with this comes as a willingness to be progressive and evolve and change with scientific knowledge.  Very different from what many people believe is rigid, conservative thinking in the AA/12 Step approach.

Here is a brief overview of the SMART Recovery 4-Point Program which includes the following components:

Point 1: Building and Maintaining Motivation
Point 2: Coping with Urges
Point 3: Managing Thoughts, Feelings, and Behaviors
Point 4: Living a Balanced Life

Another interesting part of SMART Recovery that can really help in recovery success….  is the inclusion of an online support forum that helps people in recovery to form a community of connection and mutual support:

Here is a link to this helpful tool: http://www.smartrecovery.org/community/

The research-proven REBT (Rational Emotive Behavioural Therapy) model of Albert Ellis is at the psychological core of SMART Recovery.

Ellis contends that addiction is not a disease, and the problem of alcohol addiction lies in the irrational thoughts and beliefs of the alcohol addict/user — this is very much divergent to the ideology of “powerlessness” taught by Alcoholics Anonymous (AA); where proponents admit they are powerless over alcohol because it is a “disease” (1992).

Ellis goes on and suggests that the AA strategy of admitting powerlessness over alcohol can even contribute greatly to maintaining alcoholism itself.   Feeling powerless can even encourage and lengthen relapses of using alcohol. Research also supports this contention.

Miller et al 1996 found that two main client characteristics were effective predictors  of resumed drinking and/or relapse:

1. lack of coping skills

2. belief in the disease model of alcoholism.

In other words, believing that alcohol is a disease that we are powerless over — may actually result in an increased likelihood and severity of relapse. (Miller et al 1996).

Realistically and pragmatically, we have to realize and accept that relapses in recovery happen often, regardless of the rehabilitation method or belief system —  a big advantage of the SMART method is that they:

view sobriety as a personal choice and relapse as a learning opportunity.

Relapse is not a personal or moral failing — it’s simply part of being addicted and it can be seen a learning experience to build on and move forward from.

SMART Recovery encourages the positive message that:

I’m not ‘powerless’ over alcohol, drugs or other addictive behavior. I can certainly use some help and I believe I can beat this problem like millions of other people have.

http://www.smartrecovery.ca/ideas.html

In my opinion and in my experience working with numerous people with addiction issues…   seems to be a much more productive, empowering and positive message than the powerlessness that may be caused in the AA “disease model.”

If an addiction has become an issue in your life and you’re looking for alternatives for help.  Or if you’ve tried AA/12 Step and it hasn’t been successful?

Maybe explore the SMART Recovery way to move forward?

Here is a link on how to get started with SMART:   http://www.smartrecovery.org/intro/

Photos from https://unsplash.com/

References

Scott O. Lilienfeld, Hal Arkowitz   Does Alcoholics Anonymous Work?   March 1, 2011.  http://www.scientificamerican.com/article/does-alcoholics-anonymous-work/

Ferri M, Amato L, Davoli M.  Cochrane Database Syst Rev. 2006 Jul 19;(3):CD005032.Alcoholics Anonymous and other 12-step programmes for alcohol dependence.

Albert Ellis, Ph.D., and Emmett Velten, Ph.D. 1992
When AA Doesn’t Work for You, Rational Steps to Quitting Alcohol Barricade Books, Inc., New York, NY,

http://www.peele.net/blog/110701.html
The Stanton Peele Addiction Website, July 1, 2011. This blog post also appeared on Stanton’s blog atThe Huffington Post website.

http://www.peele.net/blog/110608.html
The Stanton Peele Addiction Website, June 8, 2011. This blog post also appeared on Stanton’s blog atThe Huffington Post website.

Miller WR, Westerberg VS, Harris RJ, Tonigan JS. 1996 What predicts relapse? Prospective testing of antecedent models. Addiction. Dec;91 Suppl:S155-72.