SMART Recovery Can be Good Alternative or Addition to AA: Researcher

For some people in recovery, SMART Recovery groups are a valuable alternative or addition to traditional 12-step groups, according to a researcher at Penn State University.

SMART Recovery groups are facilitator-led, structured discussion groups that are closely aligned with counseling techniques. Unlike Alcoholics Anonymous and other traditional 12-step groups, SMART Recovery focuses on self-empowerment instead of surrendering to a higher power, says Deirdre O’Sullivan, PhD, Professor in the Department of Educational Psychology, Counseling and Special Education at Penn State.

Dr. O’Sullivan discussed results from a recent study she conducted on SMART Recovery group members and facilitators, at the National Conference on Addiction Disorders annual meeting on September 22.

Of the 3.8 million people who received treatment for substance abuse in the United States in 2011, 2.1 million received treatment exclusively at a peer support group, according to the Substance Abuse and Mental Health Services Administration.

Dr. O’Sullivan said receiving help from a peer support group is more important than which support group a person attends. “Extensive and rigorous research findings indicate peer support group attendance enhances remission rates,” she said.

There are currently about 300 SMART Recovery groups nationwide, Dr. O’Sullivan noted. The sessions are centered on building and maintaining motivation, coping with urges, managing thoughts feelings and behaviors, and teaching members to live a balanced life. Members are invited to stay involved with the group after gaining independence from addiction.

Alcoholics Anonymous (AA) is much more widely accessible, with more than 59,000 groups in the United States. It is led by non-professional members and centers on storytelling. Basic beliefs include that in order to stop drinking, a person must surrender to a higher power.

Dr. O’Sullivan’s study included 81 SMART Recovery members who had been attending an average of one meeting a week for at least three months, as well as 42 facilitators. The facilitators said their top three recovery goals were abstinence, correcting irrational beliefs and behaviors, and learning to cope with urges. Members listed changing thoughts and behaviors, feeling better about themselves and connecting past events to current use and abuse as their goals. Members ranked belief in a higher power last, while facilitators ranked spirituality last.

“It’s important for people attending peer support recovery groups to know what’s being discussed, and explore their comfort level with that,” Dr. O’Sullivan said.

She found 65 percent of SMART members said they had a psychiatric or physical disability, or both. “People with disabilities have an increased risk of substance abuse and dependence,” she said. “It doesn’t tend to be the primary focus of the meeting, but if you have a disability, it may be helpful to know you’re probably not going to be one of the only ones in the room.”

Although AA does not take an official position on medication, Dr. O’Sullivan said some AA members with physical disabilities who take pain medication say they find it is frowned upon at meetings as interfering with recovery.

SMART Recovery members in the study were similar to AA members in race, age and marital status, she noted. Members said they liked that the groups were led by facilitators who had training, and they appreciated that the meetings had a clear structure and format. They also said they liked being self-empowered to manage their addiction, and had difficulties with surrendering to religious affiliations, such as a higher power, and adopting a powerless identity.

She found about one-third of members attended both SMART Recovery and AA meetings. “It’s something to consider—you don’t have to choose one or another,” she observed.

Dr. O’Sullivan advises substance abuse counselors to discuss the format, structure, availability and accessibility of the different peer support groups with clients when considering referrals. They should also take into account recovery goals when making referrals, she recommended.

18 Responses to SMART Recovery Can be Good Alternative or Addition to AA: Researcher

  1. David Macmaster | October 1, 2013 at 1:40 pm

    I wish these researchers and writers were more accurate in their knowledge of 12 Step programs and their nature. No, a person does not have to “submit” to a Higher Power as a “must.” The 12 step programs make it clear all their ideas and activities are suggestions and completely voluntary. It is true that powerlessness as a description of the circumstances a person is in with alcohol and other drugs including nicotine. However, as I understand it that is a recognition of the irreversible brain disorder a person has. It is like me knowing I am powerless to demand injuries from a car/train accident I was in years ago no longer exist because I am going to will them away.

    My understanding of a Higher Power is not dogmatic. As a result of accepting my “substance dependence disorders” I am now EMPOWERED to address this reality and make the changes I select. I try to greet these reports with an open mind, and do believe Smart Recovery has its benefits. It just is not a good idea to make these available programs competitors for credibility in my opinion. They do suggest a person may benefit from being involved in both programs, and that is fine with me.

    Mac

  2. Deborah Kirk | October 1, 2013 at 2:43 pm

    I think your description of AA as “storytelling” is grossly misleading. AA meetings focus on each individual talking abouta their “experience, strength, and hope ( Big Book) “. More specifically we relate “what is was like, what happened, and what it is like now.” This is far from random “storytelling”.

  3. Romeo B. | October 1, 2013 at 4:01 pm

    In the book A.A.one chapter is clearly marked “To the Atheist” which addresses the individuals who have no religious beliefs. In fact the best definitions of an atheist and agnostic are found in the Big Book. Even those who hold no religious beliefs are able to recover in A.A. Not everyone believes in a Higher Power in the rooms and shares their own personal story of “experience, strength and hope.”

  4. D. Mizer | October 1, 2013 at 7:14 pm

    SMART Recovery are entirely different approaches to recovery. 12 step programs are support groups which supports and “describes”.

    SMART is an educational program. It teaches tools to help the person to leave their past in their past.

    • Kelly Gleason | October 4, 2013 at 1:22 pm

      AA also provides tools to help you “leave your past in your past.” They are called the 12 Steps to Recovery.

  5. Dean | October 3, 2013 at 9:20 am

    The first two letters in the word SMART stand for Self Management and that is just what I loved about the SMART approach. I certainly did not feel ‘powerless’. Nor was I. Smart enabled me to find what my priorities were. Smart had actual Tools, common sense approaches to better enable me to reach those self identified goals.

    SMART, a rational way to change.

  6. Gail Chmielewski | October 4, 2013 at 10:19 am

    I completly agree with David, Deborah and Romeo. Those not very familiar with 12 step make assumptions stated in this article. I have nothing against Smart Recovery, it is probably a good program but obviously has not had the attendence record of AA/NA. There are over 300 AA meetings every week in Dayton, Ohio not including NA. Smart Recovery as stated has 300 meetings nationwide. There are none in Ohio. 12 step does address empowerment just maybe not in the same way.

  7. Bob Ackley | October 4, 2013 at 2:29 pm

    I have been transformed through God and Twelve-Step living. I have been in, been out of, and around recovery all my adult years. Beware of the person who tells you there is only one path to “recovered/recovery”. I thank God for alternative paths to get out of the quicksand of addiction. Peace out…

  8. Reid K Hester, Ph.D. | October 4, 2013 at 3:01 pm

    We also have evidence of the effectiveness of SMART Recovery and our Overcoming Addictions web app for SMART Recovery in a randomized clinical trial. The outcome paper is online at JMIR at http://www.jmir.org/2013/7

  9. WD Stacey | October 4, 2013 at 8:50 pm

    I have to agree that the characterization of twelve-step groups in this article are…I am not sure how to phrase it…deplorable? I, too, have nothing against SMART recovery and I agree with the paragraph that comments on the peer support value of self help groups. To characterize the 12-step programs as a program that relies on surrendering to a higher power rather than a program that focuses on self improvement is just wholly inaccurate. The first thing that became clear to me about the 12-step program was that it is a program of self improvement. Read the 12-steps; they are a guide to self improvement. I am disappointed with the author.

  10. Billy | October 5, 2013 at 8:36 am

    “Dr. O’Sullivan’s study included 81 SMART Recovery members who had been attending an average of one meeting a week for at least three months…”

    A total of twelve meetings? And the Dr. based a “study” on this? Review the same addicts/alcoholics two, five, ten years from now, and see how well they’re doing without a spiritual element in their recovery. My bet is, at best, you’ll end up talking to a bunch of highly rational dry drunks . . .

  11. Ross Fishman, Ph.D. | October 5, 2013 at 10:29 pm

    First, AA does take an official position on medication. Its brochure advises a person to follow an MD’s prescription. There are so many medications for so many disorders that one must not make a blanket statement about all medications. Second, I’m tired of people quoting the Big Book about how AA works or what its philosophy is because each AA meeting is run based on the people that run it. My patients report various outrageous statements made to them from “Don’t get involved in any activity that is not AA (meaning professional counseling)” to “If you are here you are alcoholic and you should say so when you identify yourself.” We should understand and perhaps tolerate that there are these individual differences between people and between meetings, but please don’t quote the Big Book to defend a position because many AA members don’t follow it and they do what they want to do.

  12. Denny A | October 6, 2013 at 11:00 am

    I agree with Mac. For example, the word “surrender” does not appear in the basic text section of Alcoholics Anonymous. It only appears in six of forty-two stories in this book. Surrender does not appear in Twelve Steps and Twelve Traditions, either. These two books are the core of the description of Alcoholics Anonymous. People might do well to read these before attempting to intelligently represent Alcoholics Anonymous.

    Secondly, I believe the SAMHSA graph was also misrepresented. I believe the 2.1 million who attend recovery groups is not exclusive of other forms of help, since the chart is inclusive.

  13. Paul | October 9, 2013 at 4:28 pm

    AA has no opinion on outside matters.

    • sub0xxed | October 11, 2013 at 2:29 pm

      “AA has no opinion on outside matters.”-
      HA! You wouldn’t know this by all of the SMART Recovery bashing that is going on here!

  14. Daniel D | October 12, 2013 at 7:20 pm

    This is a great post except for the Surrendering to a higher Power. There is a whole section in our literature about the atheist, as well as medications. It seems like this program of SMART is also helping those in need. I myself have been sober now for over 16 years, One Day at a Time

    Daniel D

  15. Earl | February 12, 2014 at 4:09 pm

    The article states there are 300 SMART Recovery meetings, but I believe there are actually over 1,000 at this point.

  16. Rick | February 13, 2014 at 11:01 am

    Been going to A.A. for several months. Never been to smart – planning to though. A.A. and working the steps has kept me sober but Ive also never been so depressed in my entire life and never wanted to drink more than after an A.A. as I find them to be so uncomfortable. For a program that demands rigorous honesty, its too bad I cant be honest and share my feelings about how I feel and where I am at in my recovery in meeting because A.A. people are pretty fanatical (at least the ones around here) and I will be told that its my fault that the program is not working, and that Im selfish, self-centered, dishonest, have defective character traits, maybe havent hit rock bottom yet, take the cotton out of my ears and put it in my mouth, blah, blah, blah. Besides I really don’t enjoy the company of angry old men, aging bikers and crazy cat ladies that fill the rooms in the area Im in. To each their own I guess.

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