SMART Recovery is a nationwide network of support groups for people struggling with addiction. It’s the second-largest community support system in the world, rivaled only by 12-Step programs like Alcoholics Anonymous.
“SMART” is an acronym that stands for Self-Management and Recovery Training. It is secular in nature and rooted in science, using Rational-Emotive Behavioral Therapy (REBT) and non-confrontational motivational methods to help its members make positive changes in their lives.
And my guess is you didn’t even know it existed.
That’s a bit odd if you think about it, given the sheer number of people who struggle with drug and alcohol addiction. The opioid epidemic killed more than 70,000 people last year, a number that has almost doubled in the past five years. You’d think that someone would have declared a national emergency by now, that advertisements for support groups and treatment centers would be commonplace on television and social media.
But no, substance abuse treatment remains shrouded in mystery, despite the fact that more than 20 million Americans struggle with it every year.
This is baffling because addiction is a disease and so it makes sense to inform the public about treatment options. And SMART Recovery is a logical treatment option, as its approach is rooted in actual science.
But what happens instead is that hospitals and lawyers and community centers and social workers all tend to point people towards Alcoholics Anonymous, despite the fact that AA, by definition, offers a faith-based approach to the disease of addiction.
Isn’t that strange?
No other disease is treated in this manner. No serious doctor would refer a cancer patient or a diabetic to a spiritual program for formal treatment, but this is precisely what happens when addicts and alcoholics seek help for their problem.
Alcoholics Anonymous has saved the lives of hundreds of thousands. So has Narcotics Anonymous. And if they work for you, then keep going. But this phenomenon is truly bizarre if you think about it.
Every other disease gets treated like, you know, a disease.
Why should addiction be any different?
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Furthermore, several peer-reviewed studies like this one and this one and this one have shown that 12-Step Programs are only successful for 10–15% of the people who have tried them, which begs the question: why do they only seem to work for a fraction of the people who try them?
Logic dictates that we try to understand what it is that works about them and what it is that does not. Addiction is, after all, a condition that is chronic, progressive, and incurable.
12-Step programs treat the spiritual components of addiction, but they fail to address critical things that impact our ability to recover, like co-occurring mental illness. And the culture of these Programs is such that even talking about mental illness is frowned upon. The prevalent belief is that a spiritual deficit exists, which is what one should be focusing on.
Maybe that’s why 12-Step Programs are only successful a fraction of the time. Perhaps the treatment of mental illness is a bit more complicated than remaining abstinent. Most drug addicts self-medicate. Should we not be treating the conditions that keep so many in active addiction?
It is true that 12-Step Programs get the lion’s share of press, but they aren’t the only game in town. SMART Recovery® has been growing in popularity for years. These are four good reasons to check it out.
The National Institute on Drug Abuse (NIDA) and The Substance Abuse and Mental Health Services Administration (SAMHSA) report that 20 million adults in this country have a substance use disorder. And of those 20 million, about half have a co-occurring mental health disorder, which means that they are also dealing with some form of depressive, anxiety, mood, or psychotic disorder.
Frank discussions about mental health tend to be frowned upon in 12-Step meetings. It has something to do with the 12-Step belief in a Higher Power and the power of The Program. The idea is, if you’re working the program the way you should, your sanity should be restored and you get to be a productive member of society. Frankly, overt discussions about mental illness disrupt that narrative.
Zealots in those groups will often claim that you are not working the program to the best of your ability if you were still depressed or manic or any of the other things that come with mental illness. This is from AA’s Big Book:
“Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.”
Alcoholics Anonymous
And from NA’s Basic Text:
“We have never seen a person relapse who lives the Narcotics Anonymous program.”
The Basic Text, Narcotics Anonymous
SMART Recovery®, on the other hand, recognizes mental illness is separate from addiction. It acknowledges that psychiatric distress often keeps people using and endorses the use of therapeutic interventions such as Rational Emotive Behavior Therapy (REBT) to address the symptoms.
This might be the single biggest difference between SMART Recovery® and 12-Step Programs, which make a point of separating themselves from “professional services.” It’s even against their guidelines to have trained clinicians involved in meetings. NA, for example, believes that “the therapeutic benefit of one addict helping another is without parallel.” That sounds great, and for many it’s true.
But what if you need more?
12-Step Programs are populated by sick people, with no training, helping other sick people. This works for some, but why is it a bad idea to use evidence-based therapies or even prescribed medications in the fight against addiction and co-occurring mental illness?
Many members of NA and AA despise the very mention of medication. Some would go as far as to say you are not working an honest program if you are using any drug, prescribed or otherwise.
Total abstinence from everything.
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When you consider that 47,000 die in this country every year from suicide, 90% of whom had a mental disorder, it is alarming to see a support group taking such a cynical attitude towards professional intervention.
While it is not a good idea for a recovering heroin user to take narcotic painkillers when Advil would do, this belief gets a bit murkier when you start looking at mental illnesses such as Schizophrenia and Bipolar Disorder. These conditions can absolutely be managed with medication and therapy, but schizophrenics and people diagnosed with Type 1 Bipolar are completely unable to function without medication.
Imagine that you struggle with psychosis, delusional thinking, and disorganized thought. How helpful do you think a dismissive attitude about medication would be for your mental health?
AA touts itself as a simple program for complicated people. That sounds great. Except that addiction is a complicated disease that gets further complicated when you try to oversimplify it.
Not all addicts are the same. Many addicts claim they can get addicted to anything — heroin, crack, sex, soap operas, you name it. Others have their one drug of choice and never had problems with anything else. Some addicts forego drugs and find themselves addicted to shopping, gambling, work, or sex.
The point is, we are not all alike. SMART Recovery® accepts that addiction is a complicated, multi-faceted disease. Some addicts require medication; some don’t. Some addicts require hospitalization; some don’t. Some addicts need therapy; others need accountability, direction, structure, or all of these things, or none.
Addiction is often a secondary issue, as I’ve discussed earlier with the concept of co-occurring disorders. Sometimes addiction is self-medication for depression. Sometimes it’s more on the Obsessive-Compulsive (OCD) spectrum. Sometimes people truly are physically addicted to a drug, as is often the case with opiates and heroin. Sometimes it’s more psychological. Often, it’s a combination of several factors.
Faith in a higher power is certainly helpful, but is it enough?
At 12-Step Meetings, you’re supposed to say “Hi my name is “X,” and I’m an addict.” It’s weird if you don’t. The idea is that we have to accept who we are. But is it possible that we can change? SMART Recovery says yes.
SMART Recovery® discourages the use of labels such as “alcoholic” or “addict.” It has a scientific foundation, not a spiritual one. It promotes self-reliance over powerlessness. Meetings are discussions where members talk with one another. Meeting attendance is encouraged for months, sometimes years, but not a lifetime.
The basic assumption with 12-Step groups is that you attend those meetings for the rest of your life. Even if that is the right thing to do, how realistic do you suppose that is?
SMART Recovery®, on the other hand, recognizes that at some point treatment has to stop. It’s just the way things are. Professional counseling these days is centered around brief therapies that are really not supposed to last for more than six months.
If you’re seeing the same therapist five years later, you really have to ask yourself if any work is actually being done. Wouldn’t the same thing be true with support groups?
Finally, the concept of “powerlessness” is problematic for many. It’s also a HUGE part of the 12–Step philosophy. We have to admit that we are powerless. Only then can we admit we need help. That’s true, but the problem is that people tend to use powerlessness as an excuse for all sorts of things, including relapse.
SMART Recovery® advocates self-reliance, which is the cornerstone of any modern treatment modality. If we are to get better, we will need to lean on others at first, but eventually, we are going to have to lead our own lives. In addition to this being a more realistic way of looking at things, it also has the benefit of being true.
In 2005, I went to rehab for drug addiction. I also started attending Narcotics Anonymous. I’ve worked the 12 Steps. I’ve had a sponsor and I’ve sponsored others. These days I’m a licensed substance abuse counselor, so I have the benefit of both personal and professional experience. Here’s what I have learned:
Recovery is holistic in nature. It is far more complicated than just not using. It’s about mental and physical health. It’s about setting goals and achieving them. It’s about avoiding toxic people and relationships. It’s about diet. It’s about spirituality and service. It’s about finding a job that you love and a partner that you adore. It’s about prayer and sacrifice and education and practice.
But mostly, it’s about connection — connection to others, connection to our world, connection to ourselves. People who are connected to the world in which they live tend to be more mentally healthy than those who live in isolation. Those who are mentally healthy tend not to become addicted to drugs and alcohol.
If you struggle with addiction, take a long, hard look at how you relate to your world and have the courage to make changes where needed. We do recover, but only if we have the willingness to do what we must to make it happen.
To learn more about SMART Recovery, visit their website. If you’d like to learn how to give up drinking on your own, go here to learn more about Alcohol-Free Forever. And you can also get sober with the help of an online counselor if you’re looking for more a more convenient option. I recommend and use BetterHelp.
What do you think? Please leave a comment below.
Originally posted 2019-01-26 16:43:25.
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