By John Lavitt.
Since being founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio, Alcoholics Anonymous has proven to be the primary recovery fellowship worldwide. Combined with the many other 12-step programs that have followed in its footsteps, AA is the first open door usually offered to help people with alcoholism and addiction find the path to sustainable sobriety. AA also provides the theoretical backbone for the majority of treatment programs in the recovery industry while also being an essential part of sentencing mandates in the judicial system (in the US, not so in the UK).
The actual long-term success of 12-step programs, however, remains controversial. A big part of this controversy is the debate over how effective 12-step programs are. For example, the percentage estimates of how many people manage to stay sober for one continuous year after their first 12-step meeting range substantially from 5% to 26%. Given this meager success, many new organizations and groups have popped up in the past quarter century hoping to offer an effective alternative.
Although none of these programs has gained enough traction to compete with the 12-step juggernaut, some of them, such as SMART Recovery (Self Management and Recovery Training), have experienced a definite modicum of success. Originally incorporated in 1992 as the Alcohol and Drug Abuse Self-Help Network (ADASHN), the organization soon switched gears and started operating under the SMART Recovery name in 1994.
As an international non-profit organization, SMART Recovery provides support to people seeking abstinence from addictive behaviors. The organization’s approach emphasizes a secular and scientifically-based modality which is attractive for people who do not connect with the spiritual aspect of 12-step. However, if the individual wants to include the spiritual component into their recovery, they are welcome just the same. The core of this approach employs non-confrontational motivational, behavioral and cognitive methods of treatment based on therapeutic principles.
As a Licensed Marriage and Family Therapist in private practice at Pacific MFT Network in Santa Monica, California, Matianna Baldassari is studying to become a facilitator at SMART Recovery meetings. Explaining her motivation to take this step, she says, “Given that many of my clients do not connect to the spiritual aspect of the 12-step programs, I wanted to be able to provide them with a real alternative. In SMART Recovery, they are given a choice. For me, it’s not about supporting this program or that program, but rather finding a way to help people with addictive disorders see the benefits of being sober and taking action.”
The positive work of SMART Recovery has been recognized by both the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). After being embraced by many doctors, SMART Recovery also was endorsed by the American Academy of Physicians. None of these endorsements favor SMART Recovery over traditional 12-step programs. Instead, the endorsements are commendations or encouragements, signing off on SMART Recovery as a viable alternative to the 12-step programs.
Given the recent success and the appeal of SMART Recovery, those considering the program may be interested in how this program differs from the 12 steps. Full disclosure: I got sober in a 12-step program, and I still attend meetings on a regular basis. I am not, however, a 12-Step Big Book or Basic Text thumper, and I respect whatever sound choices a person chooses to make that lead to a recovery that works for them. After all, no two people are the same.
Although I have enjoyed my experiences at SMART Recovery meetings and I recognize their value, I choose to stick with what has worked for me for almost a decade. Moreover, given the simple fact that there are over 3,000 12-step meetings in Los Angeles County every week compared to 20 or so SMART Recovery meetings, easy access plays a major role in my decision.
As a writer that focuses on recovery, however, I wanted to explore how SMART Recovery differs from traditional 12-step programs. As opposed to planting flags and declaring one better than the other, I hope to provide insight into the SMART Recovery program through a compare and contrast. Ultimately, the choice of what program to embrace is at the liberty of each person. Finally, this compare and contrast analysis is far from definitive, comprehensive, or perfect. Rather than being a judge’s gavel banging on a bench, it’s meant to be a door opening that will inspire further investigation.
How SMART Recovery Is Different from 12-Step Programs:
1) Six Stages of Change vs. 12 Steps
As opposed to using the 12 steps as a guide to the progression of a person’s recovery, SMART Recovery highlights what they define as the six stages of change. Since participants tend to be in one or more of various stages of change, SMART Recovery believes that a different approach can be helpful at each stage of the recovery process.
The six stages of change are as follows:
Precontemplation – The addictive behavior being faced may still be subconscious and not fully realized or acknowledged by the participant in the recovery process.
Contemplation – Through a cost/benefit analysis, a participant evaluates the advantages and disadvantages of the addiction.
Determination/Preparation – A participant decides to pursue personal change. In the process, a key part of this change can be the use of the SMART Recovery Change Plan Worksheet.
Action – Once the decision is made, a participant seeks out new ways of handling the addictive behavior that plagues them. Such approaches include self-help, group support, and professional guidance. The purpose is to find what works to engender sustainable action that promotes continuous abstinence.
Maintenance – After a period that varies from several weeks to several months, the change within and the movement away from the negative addictive behavior leads to positive gains. A participant then seeks to maintain such gains over time.
Graduation/Exit – Once sustainable change has been achieved, a participant can choose to “graduate” from SMART Recovery.
2) Graduating vs. Never Graduating
The sixth part of the stages of change highlights a fundamental difference between SMART Recovery and 12-step programs. Unlike 12-step programs, SMART Recovery opens the door to leaving the addictive behavior behind. A participant can be “recovered” and not “in recovery.” In contrast, many people in 12-step programs identify as “alcoholics” or “addicts” in perpetuity, seeing recovery as an ongoing process that never ends. A favorite anecdote in 12-step rooms is the story of the person in long-term sobriety (usually 20 years or more) who relapses because they had “too many years and not enough days.” Thus, they stopped treating their disease on a daily basis. SMART Recovery believes such an approach perpetuates the stigma of addiction, not allowing the participant to be truly free of the negative implications of the addictive behavior.
3) 4-Point Program vs. the 12 Steps
In contrast to the 12 steps, SMART Recovery highlights a 4-Point program that helps a participant in the process of recovery. The 4-Point program covers a lot of the same ground that is covered in the 12 steps and helps the participant through the application of scientific principles:
Building motivation and maintaining it over time
Coping with urges
Managing thoughts and feelings through problem-solving
Learning how to live a balanced life
4) Being Active Despite Not Being Abstinent
Although the only requirement for attending a 12-step program is a desire to stop drinking or using, you are discouraged from taking an active part in a meeting if you have used drugs or alcohol in the past 24 hours. Although SMART Recovery is abstinence based, they take a different approach. A participant does not have to be abstinent to attend and take part in their meetings as long as the person is not disruptive. Even if you are unsure about the value of abstinence and you are not willing to admit that your addictive behavior is problematic, you are still welcome to attend and engage at SMART Recovery meetings.
5) Locus of Control vs. A Higher Power
SMART Recovery teaches self-empowerment and self-reliance as being the long-term keys to sustainable sobriety. The philosophical and psychological framework of SMART Recovery encourages participants to discover and map out their path to recovery. As a result, the “locus of control” of each participant is shifted to an internal position within the individual. The goal is to help participants shape their destiny. SMART Recovery firmly believes that healing from addictive behaviors works best through the empowerment of the individual; they need to develop the will to heal themselves through techniques such as motivational interviewing.
In contrast, 12-step programs insist that you cannot do it alone, and a person needs to surrender. You need to turn your will and your life over to a “Higher Power” that could be anything from God to the group itself to the waves of the ocean to a particularly influential doorknob. Although your Higher Power can be anything, the Christianity lurking behind the Big Book’s conception of spirituality is apparent. However, there is a strong argument that the self-empowerment that SMART Recovery brings forth happens in a similar manner as the process of surrendering by working the 12 steps. There is a great saying in the 12-step rooms that surrender means, in essence, the deciding to join the winning side. The winning side is the side of your Higher Power.
6) No Cross-Talk vs. Ample Cross-Talk at Meetings
In the vast majority of 12-step meetings, cross-talk is not allowed. You can comment on what was shared by the speaker or on the literature read, but you cannot talk about what another participant has said. In contrast, cross-talk is promoted at SMART Recovery meetings and becomes an essential part of the process. SMART Recovery facilitators do not have to be peers in recovery, and they also can be professionals like therapists or counselors.
7) Addiction as Temporary vs. Addiction as a Disease
Going back to the point about graduation, SMART Recovery sees addiction as a disease that can be overcome through modern scientific approaches. Rather than seeing addiction or alcoholism as a chronic disease and a participant as an addict or alcoholic, SMART Recovery believes in fighting the stigma of labels. Each participant is on their journey, and they have the ability to overcome the challenges they face. Although SMART Recovery is willing to accept the disease model, they do not emphasize it in their meetings or literature.
8) Having a Sponsor vs. Not Having A Sponsor
There are no sponsors to guide a newcomer through the process of working a program in SMART Recovery. Although there is support in the meetings and participants can ask for help from more experienced members, each person is essentially on their own. In contrast, the 12-step programs recommend working the 12 steps with a sponsor. A sponsor helps guide newer members through the steps and assists them in their recovery. Sponsorship is at the very heart of the 12-step program because it allows members to pass the message of the program along and share their experience, strength, and hope.
In a sense, sponsorship is the ultimate realization of the first part of the 12th step — “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.” Through sponsorship, people in 12-step programs can carry the message. From a personal perspective, my sponsor has been a lifesaver. For over a decade, he has taken my phone calls and guided me in the right direction. When I have a problem that’s running circles in my head, and I am trying to think my way out of self-created misery, he has always said the same phrase time and time again: “How’s that working for you?” Almost always, I seem to reply, “Not so well.” Such a moment of admitting the truth is like a mini-surrender, and it provides me with the freedom to try a different approach. I am so grateful for the gift of sponsorship in the 12-step programs. Still, I can see how what has worked for me very well might not work for others.
9) SMART Recovery is Based in Scientific Tools that Continue to Evolve
The 12-step programs, particularly Alcoholics Anonymous, are based on a book that was published in 1939 and has remained virtually unchanged for over 75 years. In contrast, SMART Recovery is based on a combination of three relatively contemporary scientific methodologies: Motivational Enhancement Therapy (MET), Cognitive Behavior Therapy (CBT), and Rational Emotive Behavior Therapy (REBT).
Overall, the main ongoing inspiration behind the scientific and philosophical framework of SMART Recovery is Albert Ellis’ Rational-Emotive Behavior Therapy. Albert Ellis (1913-2007) was a well-regarded American therapist who helped to champion CBT and REBT in the therapeutic community. As the philosophical heart of the SMART Recovery approach, REBT’s focus is on changing negative thoughts and unhealthy behaviors into positive alternatives. This method is based equally on both the stoicism of the Greek philosopher Epictetus as it is on the psychoanalytical roots of Sigmund Freud. As Albert Ellis once proclaimed, “There is virtually nothing in which I delight more than throwing myself into a good and difficult problem… I love my work and work at my loving.”
10) SMART Recovery Treats All Addictive Behaviors as One Problem
Unlike the 12-step groups that tend to have different meetings for different substances (Narcotics Anonymous, Cocaine Anonymous) and different behaviors (Gamblers Anonymous, Debtors Anonymous), this is not true in SMART Recovery. All of the different addictions are treated as one. In the Frequently Asked Questions section of the SMART Recovery website, the decision to create the overarching category of addictive behavior is detailed:
“Addictive behavior is over-involvement with substance use (e.g., psychoactive substances of all kinds, including alcohol, nicotine, caffeine, food, illicit drugs, and prescribed medications), or over-involvement with activities (e.g., gambling, sexual behavior, eating, spending, relationships, exercise, etc.). We assume that there are degrees of addictive behavior, and that all individuals to some degree experience it. For some individuals, the negative consequences of addictive behavior (which can involve several substances or activities) become so great that change becomes highly desirable.”
As stated in the beginning of this article, this examination of the two programs is far from comprehensive. From my perspective, there are positive aspects to both programs, and I hope SMART Recovery continues to expand and find success as a sustainable alternative to 12-step programs.
As the San Francisco street poet Lord Buckley once said, “There is a great power within. / And when you use it, / it spreads like a living garden. / And when you do not use it, / it recedes from you.” I choose to see that power within as a window to God consciousness, and this is why I choose the 12-step programs for myself. My goal in my sober journey is to slowly open that window, getting rid of my ego and selfishness. I might not know what that power within is, and I might not be able to define it, but I have found that by surrendering to a Higher Power and embracing a different path, I was able to discover the almost clichéd realization of a life beyond my wildest dreams. Whatever path you choose, I hope you discover the same for yourself.
The above article was written by John Lavitt, who is the Treatment Professional News Editor for The Fix. It was originally posted on thefix.com