April 4, 2014

Review of a SMART Recovery Meeting

I heard of SMART Recovery several years ago, and lately I’ve been hearing more and more about the program.  Based on what I’ve learned about their philosophy, I have mentioned it to some people who have inquired about non-12-step options, but I figured I ought to go check out a meeting so I can give a less ambiguous recommendation.  So here’s my review of a SMART meeting, and a bit of info about their philosophy.

For those who don’t know, SMART is an alternative support group to AA – and it is a real alternative to treatment programs which operate on the disease model of addiction.  When I stepped into the meeting I was given a handout with anti-disease messages appearing twice on the first page:

What you believe about addiction is important, and there are many ideas being tossed around about addiction and recovery.  You may believe for example, that you have an incurable disease, that you have a genetic defect, that you are powerless, or that after the first drink or use or act you have to lose all control.  These beliefs may actually be damaging you.

That right there was a great sign to me.  It falls exactly in line with what I believe about addiction – the belief that you have an incurable disease which causes you to be addicted – actually causes you to behave like an addict.  There’s more:

We’re not trying to cure an imaginary disease.  We’re concerned with changing human behavior.

And that’s what it’s all about.  The disease stuff sends you on a wild goose chase, when you should be focusing on changing your behavior.  This is why I tell people to stay as far away from treatment and 12-step programs as possible.  Reading this first page while waiting for the meeting to start truly was a breath of fresh air for me.  Beyond that, the facilitator of the meeting mentioned several times that they do not view addiction as a disease, and that they see people as responsible for their own choices and behavior.

I should also mention here that I returned to check out some 12-step meetings a few years back because an AA friend was trying to convince me that the disease stuff is never really mentioned and it’s only used figuratively etc, and I thought to myself that I hadn’t been to a 12-step meeting in 6-7 years, maybe she’s right, and I’m just remembering it wrong.  Nope, she was wrong, I couldn’t even begin to count how many times that disease was mentioned, literally, not figuratively.  So on this count, and it’s an important one, SMART is a true alternative to 12-step programs in that they are clear about saying that addiction is not a disease and they will not approach it on those terms.  This is important because there are some other programs out there who claim to reject the disease model, but end up using the model under different terms and different ways – such as those who tell you that nutritional factors cause addiction and that you need supplements to quit your addiction.  There is none of this in SMART, it truly is an alternative on the disease front.  I do however have one nit-picky problem with the fact that the term “relapse” is used in SMART.  It’s a word I like to stay away from, because it implies that there is a disease state to relapse into.  One person used the term at the meeting, but it was clear to me when he said it that he took responsibility for the act of using.  So it seems that the term may be used simply to refer to a freely chosen episode of substance use, rather than the common usage which implies that it’s something which happens uncontrollably.  Even so, in a perfect world, if I were running SMART, I would strike the word from their vocabulary because it’s too mixed up with the disease model of addiction.

The meeting kicked off with a quick statement read by the facilitator about SMART’s philosophy and goals, then moved on to a 30 minute open discussion period where attendees were asked to introduce themselves, and speak about what they’re working on changing.  Crosstalk was encouraged, and the discussion was great.  First of all, no one identified themselves as an addict or alcoholic (a harmful practice of negative self-labeling which turns many people off of 12-step groups for good reason).  Second, the discussion was very rational for the most part.  These were people discussing how they related to substance use, trying to understand why they chose to do it, and working out how to change their behavior and move on with life.  Although this meeting was small (only 5 people in attendance), everyone was really taking responsibility at the level of thought and behavior for their own problems.  Not one person talked about how they relapsed because of something ridiculous like their cat died, or their mother asked them to do something, or they walked past a bar and couldn’t resist walking in, or whatever silly things you hear in other support groups.  One guy who was trying to quit a crystal meth habit had used 4 days prior to the meeting, and when he discussed it, he didn’t blame anyone or anything other than his own pattern of thought, and he was working to find a way to make a different choice.  Again, truly refreshing.

There is no illusion in SMART that you need to wait for god to change your behavior, and the facilitator made clear that spirituality of any kind is an outside issue on which SMART doesn’t really take a stance.  The focus is clearly on beliefs, motivation, emotions, and behavior – and how we can modify these to end our substance use problems.  Mysticism is “avoided like the plague”, and instead, SMART seems to get you focused on the here and now with things you can directly do to change.  I didn’t hear one mention of god in the discussions at the meeting – this is something which would also be a breath of fresh air for someone looking for an alternative to the conventional recovery culture.

After the initial 30 minute discussion period, the facilitator moved on to the decisional balance exercise – a key component in SMART.  I was first introduced to this exercise as part of a management training program I went through years back, eventually I saw that it was something used to help people with addictions in some literature from some of my favorite researchers, Mark and Linda Sobell, and I began to use it myself with my coaching clients.  The exercise is a cost/benefit analysis.  You quite simply look at the costs and benefits of the behavior and measure whether it points you towards quitting.  The facilitator drew four quadrants on a whiteboard and began to question the group about the costs and benefits of substance use and enter the answers on the board.  The twist on how I’ve usually seen it done, is that this one only focused on the costs and benefits of substance use, and broke them both into subcategories of short and long term costs and benefits – in lieu of sections on the costs and benefits of quitting.  This was quite a genius way of doing the exercise because the long-term benefits of substance use section was ultimately left empty.  No on could really think of a long-term benefit, and that makes a poignant point about what’s going on in addiction – you’re trading your future for some cheap of-the-moment thrills.  I think this point really sunk in with everyone in attendance.

During the decisional balance exercise, there was a lot of discussion and it took up the last hour of the meeting.  It felt good, like everyone was really pushing their minds in a positive rational direction.  In the recovery culture, thinking is frowned upon.  You’re considered arrogant if you believe that you could reason your way to better choices about substance use.  When you express any ideas about how to control your own behavior in 12-step forums, you’re often told to “take the cotton out of your ears, and stick it in your mouth.”  That was not the case at this meeting.  People were encouraged to think, express their honest ideas and feelings, and to build confidence to make their own informed choices about substances use.  On this front, SMART is an incredible alternative to the conventional recovery culture.

When the meeting was done, I felt like I could whole-heartedly recommend SMART Recovery to others, and I do.  With that said, I have one warning.  There is something about all support groups which can be dangerous, and that is that people may use the group as a means to ride the fence and feel like they’re doing something to change, when they really aren’t.  People may use the groups as a dose of medicine, or to diffuse responsibility for change on others.  This potential exists no matter the philosophical content of the support group.  So beware that if you choose to use SMART, you don’t do it in this way.  SMART, seems to want people to come get what they need and move on.  They’re not looking for lifetime members, and the last thing they want is for people to be dependent on the group.  It looks like there may be some safe-walls in place in order to prevent this though.  For example, when we did the decisional balance exercise the facilitator was sure to let us know by the end, that we couldn’t rely only on the content of the exercise we did together in the meeting, and reminded us that we have to do our own decisional balance which reflects our own thoughts, beliefs, feelings, and values.  This is smart, because it reminds us that we’re individuals making our own choices, and that we can’t depend on the group to make our choices for us.  Small touches like this, will go a long way towards effecting individual work to change rather than dependence on the group or attendance at the meetings while spinning your wheels.

I have one other nit-picky problem with SMART, and that is that it is an abstinence only program.  At this point, with all the research I’ve seen, and living in the real world where people tell me about how they quit an addiction and moved on to moderate use all the time, I feel it’s unrealistic and wrong for a program to be focused only on abstinence.  With that said, SMART doesn’t seem to push abstinence on anyone, they leave it up to the individual to choose, and they say that they’re there to help people with abstinence.  Also, I think abstinence is probably the best choice for a lot of people, but I’d just personally like to encourage and support any goal of substance use reduction that people choose, whether it be abstinence or moderation.

Having taken the path I took, through the Jude Thaddeus Program, I wouldn’t choose a support group myself.  I liked our approach which is to deal with the problem quickly and move on with life, and support groups seem to naturally stand in the way of that.  With that said, there’s no reason you can’t go get what you need in SMART and move on with your life.  Many people want the social support of such groups though, so in spite of my concerns about support groups, I recommend SMART to people who want that – it’s a billion times better than any 12-step group.

Here is a link to SMART Recovery’s website, where you can find a meeting in your area.  If you’re struggling “in recovery” by conventional methods, I encourage you to pull the trigger on trying something different and go check out SMART.  It won’t hurt, and you’ll leave with some important insight into your problems.

Comments

  1. Steven,
    Great article, and thank you for taking the time to attend the meeting so you could give us such a thorough and informative article. I, too, have the same reservations about support groups but agree wholeheartedly that SMART is a good alternative option for people who want that kind of help. However, I definitely recommend attending these meetings with the ultimate goal to be to effect lasting lifestyle changes and move on. Thank you again!

    • What Michelle said:0) This was really cool to read, Steven. Thanks for sharing your thoughts/insights about SMART meetings!

  2. kim oppy says:

    Great to know about. Thanks for spreading the word.

  3. Your review of a face to face SMART meeting pretty much jibes with the two meetings I attended in my area a year or so ago. I found the silence which followed saying my first name quite refreshing… no “and I’m an …”

    Ultimately, I’m through with meetings of all kinds, which makes online SMART resources a great fit for DIY alcohol abuse support. Only it’s not support, but more like a handy tool kit.

  4. Have ever had a drinking/drug addiction yourself? Just asking.

    • It depends on how you define addiction. If your concept of addiction includes powerlessness, then no, I never had an addiction myself, because I don’t believe such a thing exists. However, at one point in my life I did choose to engage in a pattern of substance use which was the source of countless problems in my life. I chose to use copious amounts of various drugs for a total of 8 years, for the last five of those years I chose to shoot up heroin and cocaine on a daily basis. There were some dark times when I “felt” powerless, but when I finally chose to see through that illusion, it was easy to subsequently choose to stop my destructive choices about substance use and move on with my life. That was 10 years ago.

      • From your review, I too wondered if you had a personal drug/alcohol problem. According to your theory, you should now be able to use heroin and cocaine in moderation — empowered through choice to just use occasionally… as in, no I don’t have a problem, I just use it socially.

        • This is a really great question!

          Why would anybody who is moving forward in life, want to use an illegal drug in moderation? But of course they can! I am proof it is possible. I used to freebase and progressed to IV use with cocaine, a very long time ago. About 10 or 15 years after I stopped, I used some cocaine with a relative, and I did this probably a half dozen times over several years. The amount I used was ridiculously small compared to the past. The other times I saw this person, I never asked to do it, even though she was constantly going in the bathroom to do it, and this was every time I saw her. So yes, it was definitely a choice.

          I decided it was not something to go back to. The drug is way too strong, I don’t like the side effects even in small doses, I didn’t like hiding that we did it from my husband, and most of all it is illegal and I am all about being legal.

  5. rational_sista_nyc says:

    hi steven ~ i really liked your article. i attend SMART in NYC and it’s the best thing available…for me, it’s my “treatment” program, not really a support group.

    i also agree with your statement on possible moderation and i was saying last night that i don’t have any “beliefs” as a result of my using the SMART tools, just that it made the most sense to me and is the first thing that helped me see why i was choosing to drink and that i could choose not to.

    and the CBA you speak of – there is another part of it that had the biggest impact on me. the short term benefits i “thought” i was getting weren’t really benefits they were just avoidance behaviors and substitute tacticts…i realized i had true needs i actually needed to get met that i did not know how at the time…not just feeling better with alcohol. that was an eye opener.

    • rational_sista, Thanks for that insight. Love how you take responsibility and discovered yourself. That’s my story too.

      • rational_sista_nyc says:

        :)

        • Maybe we could generalize and say everyone who goes back to a substance habit (“relapse” in 12 step terminology) does so because they never bothered to figure out why they did it, and why they gave themselves permission to do it.

          So once you figure it out, you no longer have to fear drinking in moderation or taking pain meds after surgery. You no longer have to live in fear of yourself and what you might do or what habits you might go back to.

          In 12 step, there is no discussion EVER of why they did it. I shared in meetings often about why I did it, and I have heard others say they don’t know why, it doesn’t matter why, or if they knew why it would give them an excuse to do it again. And that is probably their biggest downfall, the lack of self awareness and taking responsibility.

          Thoughts?

          • rational_sista_nyc says:

            my thoughts are people have to decide these things through their own rational thought and recovery.
            the biggy for me is that people in treatment should be made aware of all options for self-help recovery, not just AA. and treatment professionals should learn about the options.

            i feel a deep sense of injustice about this. so, i am doing something about it. i’m becoming a SMART facilitator next month and getting involved.

  6. Congrats on your involvement with SMART! That’s awesome. The SMART folks, and those meeting goers you will share your time/energy/dedication with are fortunate. I agree whole heartedly with your comments that people should be made aware of all options for recovery. Menu of evidense based options! That’s what will inspire self efficacy and creative problem solving. I get really frstrated with the ‘AA/Al Anon -’one size fits all’ attitude of many of the peeps I work with in advocacy.

    Best wishes to you as you embark on your journey as a SMART facilitator!

  7. rational_sista_nyc says:

    hey you guys might be interested in another conversation i’m participating in on pyschcentral.com with Dr. Sacks of Promises Treatment Center and commenters on both sides of the 12 step -evidence based recovery issue http://blogs.psychcentral.com/addiction-recovery/discuss/386/

  8. Very encouraging to read, and thank you, Mr. or Dr. Slate.

    I found SMART Recovery on the web while specifically Googling the search string “non 12 step support”.

    Overeaters Anonymous helped me enormously for at least 11 of the 16 years I attended meetings. However, I must have changed. By the time I left OA (on doctor’s orders, no less), each meeting felt to me like being wrapped in a blanket that’s been left in the washer a little too long and as a result, has that stagnant water smell. In two words, clammy and stifling.

    Haven’t been to a SMART meeting yet, due to vacation plans, but thank God (oh, the irony!) there are two near me. It’s on my schedule in 12 days. I’m truly a believer in God, but if I was open to the kind of surrender and self-deflation practiced in the Anonymous programs, I’d have kept going to synagogue!

    (Really–no intent to offend, but I thought this joke was too good to pass up, plus it really does capture my feelings about the 12-Step technology.)

    • Joye Billionaire says:

      I agree with you. I went to OA about three times a few years ago. It made me feel like I was closed in a room with no outlet. For years, I have not gone anywhere. A couple of days ago, the thought entered my mind to seriously do something. I started researching online. But, i found more of the same 12 step protocol. I went to see my counselor, and she suggested “SMART” to me. I read everything I could find about “SMART” and I was impressed. I will be attending a “SMART” meeting this weekend. I am very excited. I want to learn all I can, so, i can help myself, and help someone else to be successful at overcoming their addiction. I do not believe an addiction is a disease. I believe as painful, as it may be to say it, “it is a choice”. Best of luck to you, and myself. I thank everyone that shared. The readings were very inspirational.

  9. Not Powerless says:

    I have found SMART to be really helpful, I downloaded the help sheets off their website and practiced using the tools a few times. It really helped me to realise addiction is a choice and that other aspects of my behaviour were a choice too i.e. getting myself all wound up because the check out line is too long or being stuck in a traffic jam. i learned to stop blaming other people for my drinking and learned to stop self – downing. I don’t label myself ‘an alcoholic’ , i’m just myself and I used to be physically dependent on alcohol. Mostly I am self recovered, I don’t buy into recovery culture, I hang out with regular people, enjoy playing guitar and doing gigs, there might even be alcohol in these venues – but it doesn’t bother me, my friends know that I choose to not drink and not being heavy drinkers themselves they wouldn’t dream of forcing a drink on me.

    • i’ve been facilitating for a year now. I drink moderately now. Not Powerless that is awesome you used the tools! They really work! LOVE IT and i LOVE SMART.

      • I though SMART was an abstinence based program. How can you be a facilitator and still drink?

        • Jenny I was abstinent for a year while in the program then I graduated myself from the program and became a facilitator. Facilitators are not required to be abstinent and some have never been in recovery themselves. I no longer go to meetings but I get A LOT from facilitating. I began my foray into social drinking with the drug BACLOFEN and complete lifestyle change. Drinking is just not a big part of my life now. I’ve had beer sitting in the fridge for 2 weeks.

        • Hi Soul Sista..

          Thanks for answering. I thought that people who had drug/alcohol abuse issues in the past were required to remain abstinent to be facilitators in Smart. I guess I misunderstood that. I’m glad that it works for you and you are doing well. I’ve heard of that drug but am not very familiar with it. Is it an old drug with a new use? My experience and that of everyone I know is that moderation often at best works temporarily and often a minor life setback is enough to bring the abuse pattern right back if it doesn’t creep up itself. Most people with addiction issues are not able to moderate, at least that was the message I got from the book “Sober for Good”, which includes talk about moderation. And from reading many long term stories from a well known quit drinking forum where every quit method is used the consensus is moderation does not work (though often tried). I know i have seen that so many times.

          Ironically, the creator of moderation management remained in denial for a long time that she had left the moderation level while still remaining in MM before she joined a bunch of programs and then killed people in a drunk driving incident. Of course, as well, people with abuse problems love to hear about moderation talk because it means that they may be able to continue to use. In any case, I liken it to smoking. Why would one want to continue moderating that? Drinking even at very low levels is cancer causing as alcohol is a potent carcinogen. It is not a healthy habit and it actually is the top killer of young people in the form of drunk driving. And if you can’t get the buzz what is the point?

          Anyway, I’m glad I read this blog because I have always gotten the impression that Smart sorta pays lip service to abstinence and really it appears to be more of an anything goes type of program while they talk about choice as if they invented choice. Allowing people in (I mean members) who are actively using and have just used I think is a bad idea. Also, at the end when the hat is passed, to say give what you would have spent on a drink (really?), I know has acted as an urge trigger for me a couple of times. Personally, I believe based on what I have seen with others and in myself that even talk about moderation is dangerous as is lack of commitment to abstinence for people who are trying to abstain and that is one thing that I agree about with AA though I think their program overall as outlined does not work for me. I am no longer going to participate in Smart, though I do find the Albert Ellis elements of it very helpful in various areas, and will keep some of that stuff. Thanks for listening and good luck to you.

  10. Another thing is, I don’t think anyone chooses to be addicted. Many people get addicted because many drugs are addictive by nature (almost everyone drinks caffeine and coffee addictively, and if you don’t think so, you are in denial) and some people have a genetic propensity and brain chemistry primed for addiction. No one says, I’m going get good and drunk so I can have a horrible life. They get drunk because they crave it and it feels good in the moment. Many people simply don’t experience that and don’t have a problem with alcohol for example.

    No one says, I am going to eat like a pig (like maybe my friend can) so I can get good and fat and suffer sleep apnea and type 2 diabetes (called a “disease” though often avoidable/reversible through portion control and limits).

    Fact is, alcohol abuse, even drinking just once a month at a binge drinking level of 5-10 beers (in fact, this is the most destructive from of drinking, occasional heavy drinking, because of neurotoxic effects of stopping), causes disease. It directly causes most “diseases” known.

    To say addiction is a choice ignores what we know about physiology. It ignores the fact that addiction to a substance causes disease through the substance which can also affect one’s ability to make any choices. It causes brain damage. To call addiction a choice is simplistic and not informed by science or even common sense. The way to fix or solve anything may involve choices, whether it is to take chemotherapy or abstain from drugs or do other things. But to call addiction a choice is not sane.

    I feel this whole “addiction is a choice, not a disease” thing is way overblown and may be flatly untrue in some cases. It is well known and commonly accepted for example that some people due to different brain chemistry and genetics may be far more susceptible to addiction than others. Just like with say type 2 diabetes… some people can eat sugar or saturated fat or relatively large amounts of food or carbs all day and are relatively fine or they may have no desire to eat like this at all. Others eat like this and because of genetic variance quickly begin having serious problems with insulin resistance, weight gain and type 2 diabetes, with devastating future consequences. We may call all of this a disease, though, in many cases, lifestyle adjustments may help and correct the issue all together.

    Alcohol abuse for some people is like this, but it is even worse in some ways. Some people when they drink experience a very different reaction compared to others. They may feel the neurotransmitter/blood sugar effects very strongly compared to another who would not as easily become addicted. They may also or not have background issues that contribute to enjoying this amped up high. So they drink heavily and cause themselves brain damage and other systems damage in the body causing various “disease”. Calling this a choice only makes sense if you call nearly all disease and illness a choice since much of it could have been prevented with exercising your choice not to partake in it the damaging environmental trigger.

    And alcohol abuse certainly is tied up with many diseases as it can cause cancer… uh, basically every disease under the sun. If alcohol abuse is not a disease because one could choose not to do it, then neither are most diseases which are brought on mainly by lifestyle choice and are triggered by the environment.

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