SMART Recovery is a recovery program that helps people recover from all types of addiction. It is an alternative to “Anonymous” self-help groups, and its popularity has constantly grown over the last few years. SMART Recovery challenges participants to discover the power of choice.
What is SMART Recovery?
Self Management for Addiction Recovery training (SMART) is a recovery program based on scientific knowledge. SMART Recovery group protocols, tools, and activities are primarily based on cognitive behavior therapy (CBT), rational emotive behavior therapy (REBT, which is a form of CBT), and motivational interviewing (MI).
CBT is a therapy which relies on the concept that all thoughts, feelings, physical sensations and actions are connected. The goal is to help people to manage their problems by changing the way they think and behave. One of the individual features of CBT is that it does not focus on issues from one’s past. It helps to deal with current problems and anxieties instead.
REBT stands for Rational Emotive Behavior Therapy, the first form of CBT. It is a form of psychotherapy and a philosophy of living developed in the 1950’s by Albert Ellis, M.A. and Ph.D. in clinical psychology from Columbia University and American Board of Professional Psychology. According to his approach, it is not the occurring events that upset people, but their beliefs and views on these events. Changing those beliefs might help develop unconditional self-acceptance, other-acceptance, and life-acceptance.
Motivational interviewing is a goal-directed form of counseling. Its goal is to facilitate and engage intrinsic motivation within a person to trigger behavior change. MI has four general principles:
- expressing empathy: understanding the person and his/her experiences and past;
- developing discrepancy: understanding the differences between a person’s current behavior and its consequences and desirable future goals;
- “rolling” with resistance: accepting a person’s unwillingness to change rather than turning it argumentative;
- supporting life-efficacy: motivating a person to change rather than imposing a way to change.
Another method used in the SMART Recovery is Destructive Images and Self Talk Awareness Refusal Method (DISARM). It implies imagining the urge felt as something, or someone, who is attacking, and fight it back, block that something or someone, and then focusing on other thoughts, images, or activities. This should weaken the urge and it should fade away.
The SMART program is continuously developing, gaining experience with every single participant. Likewise, the program evolves together with the progress of the scientific knowledge.
Institutions that recognize the SMART Recovery Program are the National Institute on Drug Abuse (NIDA), American Academy of Family Physicians, US Department of Health and Human Services and SAMHSA’s National Clearinghouse for Alcohol and Drug Information, Center for Health Care Evaluation, and American Society of Addiction Medicine.
Sometimes, whether they do or do not recognize they need recovery, people cannot attend ordinary recovery programs, like the “Anonymous” groups or Twelve Steps programs, for various reasons. Some of them do not like “addicts” or “alcoholics” labels. Others cannot attend groups (one of the main Twelve Steps programs requirements) to keep their privacy. Still, others refuse this approach for religious purposes.
The principles of SMART recovery are different. First of all, the SMART Recovery suggests discovering the power of choice. Despite convincing people that they are powerless over their addiction, SMART encourages self-acceptance. One should be self-directed: make his or her own choices, instead of being told exactly what to do. SMART Recovery can be used as a stand-alone primary recovery or combined with any other recovery program.
SMART Recovery principles say NO to:
- Labels like “addict” or “alcoholic”;
- Considering oneself powerless;
- Obligatory group attendance (sometimes lifelong);
- Considering someone sick or as having a disease.
SMART purpose is 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, as well as to work towards long-term satisfactions and quality of life.
Building and Maintaining Motivation supports having a proper motivation and willingness to maintain sobriety. What is the way to clear one’s view on the problem? A solution could be drawing the Decision-Making Worksheet: Cost Benefit Analysis.
After completing this worksheet, the person should make his / her own conclusions on the listed facts, and decide whether it is or it is not worth it quitting on his / her addiction.
Coping With Urges is the second point of the SMART program. It suggests, that accepting urges as part of changes, rather than considering them a catastrophe and learning to change the way of thinking about urges will help cope with them.
Managing Thoughts, Feelings and Behaviors. Thoughts are powerful enough to stimulate intense emotions. Most thoughts are automatic (should, must, etc. or their negatives), and usually tend to be pessimistic, always expecting the worst. These are a major source of anxiety. Changing your vocabulary, and using the “Destructive Images and Self Talk Awareness Refusal Method (DISARM)” will help manage thoughts, feelings, and behaviors.
Living a Balanced Life point of SMART Recovery provides intrinsic and extrinsic recommendations for achieving a balanced life.
The intrinsic steps to achieve a balanced life are:
- Self-Acceptance: accepting yourself unconditionally, not rating, and not trying to prove yourself
- Risk Taking: trying adventures, taking risks, while staying rational
- Frustration tolerance: recognizing the difference between problems that can and cannot be solved
- Responsibility: recognizing your own responsibility, for all your thoughts, behaviors, and actions
- Non-Utopian: not striving for unrealistic perfection
- Self-Interest: not sacrificing yourself for others, completely or overwhelmingly
The perspectives to others can be guided by:
- Social Interest: acting morally, protecting the rights of others, and helping
- Self-Direction: assuming your own responsibility rather than relying on others’ support and nurturance
- Tolerance: accepting that humans can be both right and wrong (within moral limits)
- Accepting Uncertainty: being aware that there is no perfect certainty about anything
- Flexibility: thinking flexibly rather than following rigid rules
- Commitment: having at least one strong creative interest and/or human involvement.
The first Twelve Step program was Alcoholics Anonymous, founded in 1935. Since then, it adapted to other types of addictions’ and dependencies’ treatment. However, there are controversial opinions on this recovery program.
For example, if a person with some disease would visit a doctor and be advised to surrender to a “higher power” by accepting his / her powerlessness over the disease, that person would definitely visit another doctor.
The Twelve Step program promotes non-medical guidelines for recovery. The steps have a more religious and psychological foundation.
A Twelve Step slogan says, that the only alternatives to the program are “jail, institutions, and death”.
Dr. Lance Dodes, a recently retired professor of psychiatry at Harvard Medical School, estimates about 5 million individuals attend one or more meetings in a given year. But, according to him, the success rate at best is 31%, at worst – 5% to 10%, while the overall retention rate is 5%.
The National Survey of Substance Abuse Treatment Services (N-SSATS) for 2014 shows interesting results of the Twelve Steps program usage in rehabilitation facilities versus the usage of the SMART approaches, and namely CBT, REBT, and MI.
74% of the facilities, comprised in the survey results, use 12 Step Facilitation. Amazingly, 92% of these facilities use CBT, 91% use MI, and 48% use REBT.