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SMART Recovery®: Self-Empowering Support for Abstaining from Addictive Behavior

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®. ( S elf M anagement A nd R ecovery T raining) www.smartrecovery.org

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SMART Recovery®: Self-Empowering Support for Abstaining from Addictive Behavior

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  1. 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

  2. SMART Recovery® (Self Management And Recovery Training) www.smartrecovery.org www.smartrecovery.co.uk

  3. 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

  4. 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

  5. SMART Recovery® Program Overview, cont. • The intersection of • Self-empowerment • Empirically supported treatment • What will work in a support group vs. SMART Recovery Therapy

  6. Context for the Emergence of SMART Recovery® • Diversity • Other support groups • Scientific findings • Legal decisions

  7. Diversity Race, color, gender, religion, age, national origin, veteran status, sexual orientation, physical disability

  8. Diversity, 2 Diagnosis, SES, personality, temperament, motivation, core beliefs, social support, life situation, etc.

  9. 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

  10. 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

  11. Alcoholics Anonymous® (AA) • Acceptance of powerlessness • Belief in a higher power • Acceptance of label “alcoholic” • Lifelong group attendance • Aimed at severe problems

  12. 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

  13. Alternative Support Groups • Women for Sobriety • Secular Organizations for Sobriety® • (Rational Recovery®) • SMART Recovery® • Moderation Management® • Life-Ring Secular Recovery

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

  15. Scientific findings Addiction is a choice Co-occurring disorders Efficacious treatment Natural recovery

  16. Empirically support treatment Handbook of Alcoholism Treatment Approaches: Effective Alternatives (3rd. ed.) edited by Hester, RK. & Miller, WR Boston: Allyn & Bacon, 2003

  17. Principles of Drug Addiction Treatment: A Research-based Guide National Institute on Drug Abuse October, 1999 13 principles or 54 page document available at www.nida.nih.gov

  18. 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.

  19. 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.

  20. 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

  21. Stages of Change Permanent exit Precontemplation

  22. 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

  23. Implications of current context Diversity Other support groups Scientific findings Legal decisions

  24. SMART Recovery® Purposes and Methods

  25. 1. We help individuals gain independence from addictive behavior.

  26. 2. We teach how to -enhance and maintain motivation to abstain -cope with urges

  27. -manage thoughts, feelings, and behavior -balance momentary and enduring satisfactions

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

  29. 4. Individuals who have gained independence from addictive behavior are invited to stay involved with us, to enhance their gains and help others.

  30. 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

  31. 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

  32. 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

  33. 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

  34. SMART Recovery® Structure & Operations • Participants (meetings, internet, pubs) • Facilitators • Volunteer Advisors • Board of Directors • Central Office in US (Mentor, Ohio) • International Advisory Council

  35. 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®Board of Directors, 2007

  36. AaronBeck, M.D. CarloDiClemente, Ph.D. AlbertEllis, Ph.D.* Frederick B.Glaser, M.D. NickHeather, Ph.D. ReidHester, Ph.D. Keith Humphreys, Ph.D. Harald Klingemann, Ph.D. RichardLongabaugh, Ed.D. AlanMarlatt, Ph.D. Maxie C. Maultsby, Jr., M.D. BarbaraMcCrady, Ph.D. PeterMonti, Ph.D. StantonPeele, Ph.D. JamesProchaska, Ph.D. LindaSobell, Ph.D. MarkSobell, Ph.D., ABPP William White, M.A. *deceased SMART Recovery® International Advisory Council

  37. SMART Recovery® Publications • SMART Recovery Handbook • Facilitator’s Manual • News and Views (quarterly newsletter) • Recommended reading list • Smartrecovery.org

  38. 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.

  39. 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.

  40. 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

  41. SMART Recovery®:The Program’s Future Mindfulness Emotion Willpower training Developmental level

  42. 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

  43. SMART Recovery®and public policy • Cost savings • Need for a strong UK Central Office • Finding facilitators • Encouraging partnerships?

  44. SMART Recovery® Central Office 7537 Mentor Avenue, Suite #306 Mentor, OH 44060 440-951-5357 Fax 951-5358 SRMail1@aol.com www.smartrecovery.org

  45. SMART Recovery®  UKThe Gateway1A Millburn RdInverness IV2 3PXTel: 0845 603 9830 Charity no: SC 037968Company Registration no: 318729 (registered in Scotland)www.smartrecovery.co.uk

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