A Personal and Professional Look at the Evidence for SMART Recovery

SMART Recovery’s statement of purpose is to “help individuals gain independence from addictive behavior and lead meaningful and satisfying lives’ and “to support the availability of choices in recovery.” Its stated mission is to “offer no-fee, self-empowering, science-based, face-to-face and online support groups for abstaining from any substance or activity addiction.”

SMART Recovery group protocols, tools and activities are based primarily on cognitive behavior therapy (CBT), rational emotive behavior therapy (REBT), which is a form of CBT, and motivational interviewing (MI).

While earning a master’s degree in counseling and subsequent work in the field, I was trained in CBT. As one of the many people hit with addiction who has also been hit with mental illness and trauma, I have been treated with CBT. CBT is an evidence-based practice for treating addiction. Reports like this one and this one question the primacy of CBT over medication-assisted treatment (MAT). However, I am a counselor, not a medical professional. To help people with addictions, I can offer CBT and the increasingly promising dialectical behavior therapy (DBT). That SMART Recovery employs CBT works for me personally and professionally.

I had the remarkable experience of serving as a “client” for Albert Ellis himself, founder of REBT, at a conference in Tampa, Florida in 2003. My name was selected from a fish bowl and I proceeded to the front of the room and learned first-hand from him, directly but gently, about my awfulizing and catastrophizing. What I remember most is not what he said, but the fully involved and kind look in his eyes when he said it.

While the tie between REBT and measures of addictions treatment efficacy – such as days abstinent, for example – hasn’t been studied extensively, REBT is well-documented as a useful therapy for emotional, mental and psychological problems. As with CBT, the inclusion of REBT as a basis of SMART Recovery is a fit for me.

Since I discovered in the late 80s I would be unable to conceive a child, I have frequently received individual counseling, weekly in the hard years since 2007. If my counselors used motivational interviewing with me, I didn’t notice. That’s the beauty of this extensively studied, powerful therapeutic method – it helps the client discover herself, rather than conform to some kind of “rightness” with a particular methodology’s paradigm. I have been trained in motivational interviewing and treasure the counselor’s paradoxical imperative to, as my latest instructor Gerard Lawson put it, “Be like water.”

SMART Recovery does not claim to be a treatment, nor does it claim to be an evidence-based treatment. Rather, it claims its components are evidence-based which, according to my careful, informed assessment, seems true. Further, it welcomes study of its efficacy, stating on its home page, “Our approach…evolves as scientific knowledge in addiction recovery evolves.” While reports on SMART Recovery like this one and this one are primarily descriptive, a meta analysis was begun this year and this study moves closer to measuring the efficacy of the program as a whole. A study published in 2016 found that patients participating in SMART Recovery showed “highly significant” improvements in percent days abstinent and a reduction in drinks per drinking day.

2017 study by Zemore et al. found that participants of SMART Recovery and other 12-step alternatives were more satisfied, with more group cohesion than the participants of 12-step groups. Zemore et al.’s findings mean that, despite the prevalence and cultural emphasis on 12-step groups, alternative groups are equally or more effective than 12-step groups at providing social support for people in recovery. Given that 12-step approaches have been studied for decades, with no causal link emerging between 12-steps and abstinence, a support group that is informed by and responsive to latest science is a welcome addition to the field of addictions treatment.

SMART Recovery was named as a recovery support service (RSS) in Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, released in November, 2016.

I feel personally and professionally confident in both participating in, and serving as a volunteer in, SMART Recovery.

Laurel Sindewald contributed to researching this post.

Last updated 4/4/17.

The content of this post is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

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