SMART Recovery®: Self-Empowering Support for

Abstaining from Addictive Behavior

A. Thomas Horvath, Ph.D., ABPP

Practical Recovery Services

La Jolla (San Diego), CA www.practicalrecovery.com

SMART Recovery®

(Self Management And Recovery Training)

www.smartrecovery.orgwww.smartrecovery.co.uk

SMART RecoveryOrganizational Overview

• Non-profit

• Primarily volunteer operated (in US)

• Primarily US (but spans the globe)

• Over 300 groups– community, correctional, online– related services (training, publications)

• Promotes choice in recovery

SMART Recovery® Program Overview

• Abstinence groups for any addictive behavior

• Scientific (vs. spiritual) approach

• Biopsychosocial disorder (vs. disease)

• Learning self-reliance (vs. higher power)

• Discussion meetings (vs. no crosstalk)

• Months to years (vs. lifetime) attendance

• No sponsors, labels

SMART Recovery® Program Overview, cont.

• The intersection of – Self-empowerment– Empirically supported treatment– What will work in a support group

vs. SMART Recovery Therapy

Context for the Emergence of SMART Recovery®

• Diversity• Other support groups• Scientific findings• Legal decisions

Diversity

Race, color, gender, religion, age, national origin, veteran status, sexual

orientation, physical disability

Diversity, 2

Diagnosis, SES, personality, temperament, motivation, core

beliefs, social support, life situation, etc.

Diversity in Addiction Recovery and Treatment

• Degree of natural recovery

• Involvement goal (abstinence, near abstinence, moderation, reduction, greater safety)

• Treatment approach (12-step/disease, other religious, CBT, energy methods)

• Motivation enhancement vs. skill building vs. passive change

Diversity (continued)

• Motivation (avoid pain, seek pleasure)

• Levels of problems, other disorders

• Level of life transformation needed

• Social support received

• Support group attendance

• Speed of change

• Medical/Complementary assistance

Alcoholics Anonymous® (AA)

• Acceptance of powerlessness

• Belief in a higher power

• Acceptance of label “alcoholic”

• Lifelong group attendance

• Aimed at severe problems

Alcoholics Anonymous® (AA)

• Established 1935

• Largest of 200+ 12-step groups

• Effectiveness unknown

• Most don’t attend, or follow through

• 93% of US treatment 12-step based

• First evidence supporting treatment, 1996

Alternative Support Groups

• Women for Sobriety

• Secular Organizations for Sobriety®

• (Rational Recovery®)

• SMART Recovery®

• Moderation Management®

• Life-Ring Secular Recovery

San Diego Treatment Provider Survey, Fall 1998 (N=38)

45%

47%

8%

Only 12-Step Exists Others Exist-Don't Work Others May Help

Scientific findings

Addiction is a choice

Co-occurring disorders

Efficacious treatment

Natural recovery

Empirically support treatment

Handbook of Alcoholism Treatment Approaches: Effective Alternatives (3rd. ed.)

edited by Hester, RK. & Miller, WR

Boston: Allyn & Bacon, 2003

Principles of Drug Addiction Treatment: A Research-based

Guide

National Institute on Drug Abuse

October, 199913 principles or 54 page document available at

www.nida.nih.gov

NIDA Principles

• 1. No single treatment is effective for all individuals.

• 3. Effective treatment attends to the multiple needs of the individual, not just his or her drug use.

• 6. Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction.

NIDA Principles, continued

• 7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

• 8. Addicted or drug-abusing individuals with co-existing mental disorders should have both disorders treated in an integrated way.

SMART vs. 12-step day tx

• SAMI population

• NIDA funded, 5 years

• 12-step needs to be client centered

• “12-step program might not have survived”

• few main effects

• no matching found

Stages of Change

Preparation

Action

Maintenance

Contemplation

Relapse

Precontemplation

Permanent exit

Legal Decisions Overturning Government Mandated 12-step

Attendance, Since 1996

• 5 (of 11) US Circuit Courts of Appeal rulings (2nd, 3rd, 7th, 8th and 9th)

• 9/07 ruling removed qualified immunity

Implications of current context

Diversity

Other support groups

Scientific findings

Legal decisions

SMART Recovery®

Purposes and Methods

1. We help individuals gain independence from addictive

behavior.

2. We teach how to

-enhance and maintain motivation

to abstain

-cope with urges

-manage thoughts, feelings, and behavior

-balance momentary and enduring satisfactions

3. Our efforts are based on scientific knowledge, and evolve as scientific knowledge evolves.

4. Individuals who have gained independence from addictive behavior are invited to stay

involved with us, to enhance their gains and help others.

SMART Recovery “Tools”- Stages of Change- Change Plan Worksheet- Cost/Benefit Analysis (Decision Making

Worksheet)- ABCs of REBT for Urge Coping- ABCs of REBT for Emotional Upsets- DISARM (Destructive Irrational Self-talk

Awareness & Refusal Method)- Brainstorming- Role-playing and Rehearsing- USA

Basic Meeting Outline (60 minutes)

• Welcome………….…………………...5 min

• Quick check-in..…...…………….…….5 min

• Extended check-in…...………………35 min

• Pass the hat…………………………....5 min

• Checkout……………………………..10 min

Facilitating Made Simple

• Flowing discussion (from member to member) but...

• Focus on addictive behavior issues;

• Accept everything (thoughts, feelings, beliefs) offered, but encourage a...

• Rational and scientific perspective

SMART Recovery® History

• Initial groups• First Board meeting, 1991• Incorporation, 1992• Name change, 1994• National training conferences, 1996• International Advisory Council,1998• Outreach for non-recovering Fs, 2000• InsideOut, 2002

SMART Recovery® Structure & Operations

• Participants (meetings, internet, pubs)

• Facilitators

• Volunteer Advisors

• Board of Directors– Central Office in US (Mentor, Ohio)

• International Advisory Council

SMART Recovery®Board of Directors, 2007

• Elaine Appel• F. Michler Bishop,

Ph.D., Vice President• John Boren, Ph.D.,

Secretary• Joseph Gerstein, M.D.,

Treasurer

• Barry Grant• Tom Horvath, Ph.D.,

President• Tom Litwicki• Fraser Ross• Henry Steinberger,

Ph.D.

SMART Recovery® International Advisory Council

• Aaron Beck, M.D.

• Carlo DiClemente, Ph.D.

• Albert Ellis, Ph.D.*

• Frederick B. Glaser, M.D.

• Nick Heather, Ph.D.

• Reid Hester, Ph.D.

• Keith Humphreys, Ph.D.

• Harald Klingemann, Ph.D. • Richard Longabaugh,

Ed.D.

• Alan Marlatt, Ph.D.

• Maxie C. Maultsby, Jr., M.D.

• Barbara McCrady, Ph.D.

• Peter Monti, Ph.D.

• Stanton Peele, Ph.D.

• James Prochaska, Ph.D.

• Linda Sobell, Ph.D.

• Mark Sobell, Ph.D., ABPP

• William White, M.A.*deceased

SMART Recovery® Publications

• SMART Recovery Handbook

• Facilitator’s Manual

• News and Views (quarterly newsletter)

• Recommended reading list

• Smartrecovery.org

SMART Recovery® Recommended Reading List

• Alcohol: How to Give it Up and Be Glad You Did, A Sensible Approach ‑ Philip Tate, Ph.D.

• Addiction, Change & Choice: The New View of Alcoholism ‑ Vincent Fox, M.Ed.

• When AA Doesn’t Work for You: Rational Steps to Quitting Alcohol ‑ Albert Ellis, Ph.D. & Emmett Velten, Ph.D.

• Changing for Good ‑ James Prochaska, Ph.D., John Norcross, Ph.D. & Carlo DiClemente, Ph.D.

SMART Recovery® Recommended Reading List(continued)

• The Truth About Addiction and Recovery ‑ Stanton Peele, Ph.D. & Archie Brodsky with Mary Arnold

• The Small Book ‑ Jack Trimpey, LCSW

• Sex, Drugs, Gambling and Chocolate: A Workbook of Overcoming Addictions - A. Thomas Horvath, Ph.D.

• Three Minute Therapy: Change Your Thinking, Change Your Life - Michael R. Edelstein, Ph.D., with David R. Steele, Ph.D.

SMART Recovery®:The Organization’s Future

• Internet groups 24/7• Specialized groups (teens, family, specific

addictions, etc.)• Research• Continued growth• Facilitators as leadership trainees• International presence

SMART Recovery®:The Program’s Future

Mindfulness

Emotion

Willpower training

Developmental level

Addictive Behavior:Survival and pleasure

• Food, Sex, Attention (attachment)

• Status (prestige), power, stimulation

• Is addictive behavior increasing?– food, pharmaceuticals, news and entertainment

media– public health concerns vs. individual freedom

SMART Recovery®and public policy

• Cost savings

• Need for a strong UK Central Office

• Finding facilitators– Encouraging partnerships?

SMART Recovery® Central Office7537 Mentor Avenue, Suite #306

Mentor, OH 44060

440-951-5357

Fax 951-5358

SRMail1@aol.com

www.smartrecovery.org

SMART Recovery®  UKThe Gateway

1A Millburn RdInverness IV2 3PX

Tel: 0845 603 9830 Charity no: SC 037968

Company Registration no: 318729

(registered in Scotland)www.smartrecovery.co.uk