Spontaneous Remission from Addiction: Definitions and Implications for Treatment

Spontaneous remission from addiction, when people recover from substance use disorders without treatment, is the ardent wish of people with addiction and of those who love them, particularly if remission occurs readily, speedily, and without complications. Yet, what exactly defines spontaneous remission, what causes it, and how often it occurs are mostly unknown. Estimates of the rate of spontaneous remission from addiction have ranged from 4% to nearly 60%.

Poppy in the setting sun

Why do some people spontaneously recover and others don’t? Does it mean there is hope for people who are addicted that they will one day be able to “just say no”? (Should we be angry with them if they don’t?) And what about those difficult cases treatment providers see, that never seem to improve despite the provider’s best efforts? And if someone claims a treatment cured them, might they have just “spontaneously remitted” and not know it?

Unfortunately, precise estimates of spontaneous remission are notoriously difficult to obtain because of the limits of the data available. Very little is actually known about spontaneous remission.

For one thing, different researchers use different terms to describe the phenomenon: “spontaneous remission,” “spontaneous recovery,” “aging out,” “maturing out,” “natural recovery,” “selfremitting,” “unassisted recovery,” “recovery without treatment,” and “selfchange.” Each term has slightly different connotations, and definitions may differ as to specifying complete abstinence or some moderation of use. In general, researchers seem to agree that the terms refer to people who are achieving abstinence or moderation on their own.

The definition of addiction itself is a moving target. Which people are most susceptible to which drugs with what severity changes, perhaps based on economic and social conditions. (In the 80s and 90s in the U.S., the primary concern was crack cocaine in inner cities, and in 2017 the primary concern is prescription opioids and heroin laced with fentanyl in rural areas.) Some of the older epidemiological surveys available use outdated diagnostic criteria (e.g., DSM-III or DSM-IV) to diagnose addiction, such that heavy use and physiological dependence may have qualified as addiction. Now, with DSM-Vwe distinguish between simple dependence and more complex addiction. People who are dependent but not addicted to a substance are probably more likely to remit on their own, without treatment, than people who are heavily addicted.

To determine whether remission was spontaneous, researchers also need to be able to pin down what is considered treatment, and what isn’t. For example, some researchers consider 12-step approaches to be treatment, while others don’t, accordingly influencing estimates of people who recover without treatment.

As if all of this isn’t enough of a puzzle, researchers don’t follow up with study subjects after the same amount of time. Some researchers follow up after a year, while others try to find people every five or ten years. Depending on the length of time, some subjects might have remitted and relapsed, while others might have remitted for good; the percent of subjects in remission is likely to change over time. Some subjects cannot be found again at all, and their data is typically removed from consideration, thus influencing estimates of spontaneous remission rates.

The information that is available comes mainly from three different kinds of evidence, each of which has strengths and drawbacks: individual case studies, nationwide epidemiological surveys, and meta-analyses of smaller-scale studies.

1. Individual Case Studies

Spontaneous remission is a known phenomenon in part because of the people who have stepped forward and told their stories. Maia Szalavitz wrote about one of the most famous examples, Oliver Sacks, who, “found in writing an alternative source of pleasure and purpose. His ability to take joy in this work—even when it was not his primary source of income—replaced the ‘vapid mania of amphetamines’; more critically, writing was more meaningful than taking drugs.”

Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, has done extensive journalistic research into the phenomenon of spontaneous recovery. In an interview, she speculated on why and how spontaneous remission from addiction happens:

“I think in some cases, a lot of times, it’s life events, like you fall in love with somebody and because you’re just in love with somebody at that moment, you are able to give it up for them, whereas if you fell in love at another time, it wouldn’t work. Or you just got the job you’ve always wanted. Or the structure of your life changes. For a lot of people, you can’t really party the way you did in college [at age] 30. And that structurally helps a lot of people to recover, just the fact that in order to earn a living, you have to show up somewhere at 9 or 10 in the morning. And maybe those people have less severe addictions.”
Maia Szalavitz

Individual case studies and anecdotes are helpful for observing that a phenomenon sometimes occurs, but we cannot draw conclusions on how often it usually happens.  As Szalavitz notes, no generalizations can be drawn from individual anecdotes.

2. Nationwide Epidemiological Surveys

National epidemiological surveys are typically designed to estimate the prevalence of various disorders and/or diseases in the population. They are not well-suited to describing the course of a disease or disorder over a person’s life, or how often people get better from the disease or disorder (whether on their own or through treatment).

Four epidemiological surveys have been analyzed related to spontaneous remission from addiction: the Epidemiological Catchment Area survey (ECA, 1980-84), the National Comorbidity Survey (NCS-1, 1990-92), the National Comorbidity Survey Replication (NCS-R, 2001-03), and the National Epidemiological Survey on Alcohol and Related Conditions (NESARC, 2001-02). The first three were generally performed to determine the predominance of various mental health illnesses in the United States. Only the fourth was aimed at people with addiction, and it was focused on alcohol-related problems.

In-depth analysis or review of these four surveys is beyond the scope of this article, but one researcher, Gene Heyman, performed an analysis of all four in 2013, in order to try to answer questions about spontaneous remission. Based on his analysis of these four nationwide surveys, Heyman concluded that a consistent percent of people with addiction remit over time, and that most people do so by age 30. He estimated lifetime recovery rates to be around 80%.

Unfortunately, his conclusions are limited by the nature of the data he examined. Large-scale surveys are notoriously fickle when one tries to conclude anything from them beyond what they were designed to estimate.

  • They are observational, and therefore often unable to distinguish between lurking variables. For example, these surveys did not adequately answer whether people were in treatment or not when they remitted. Heyman’s estimate of 80% is not an estimate of spontaneous recovery, only lifetime remission. From these surveys, we can only say that people remitted, not why or how they did so.
  • They are a snapshot in time, not longitudinal. Therefore, the surveys are unable to show how long addiction persisted for individuals. His conclusion that a consistent number of people remit every year is based on a snapshot of people in different generations, not based on a longitudinal study following a group of people over time.
  • Surveys are also prone to misrepresenting populations. In the case of the four examined by Heyman, the people who are most severely addicted, living in impoverished neighborhoods, homeless, or in prison, were less likely to be sampled. He noted that the ECA survey attempted to compensate for this by over-sampling prison populations, but the other three did not. None of the surveys accounted for people who may have died in the course of their addictions. Heyman’s 80% statistic is only valid if the surveys adequately represent the total population of people with addiction in the U.S.

Heyman was aware of all of these limitations, and adjusted his estimate to 64% based on the critique of researchers who estimated that these surveys missed about 25% of all people with addiction. He tried to then assume that, if the missing people remitted by age 30, the rate would jump back up to 74%, but the “age 30” estimate was based on the same data that is biased by missing people. He claimed that to adjust the statistic below 64% to account for missing people, “would imply that approximately one in ten adult Americans had become addicted to an illicit drug and that most were currently addicted.” In fact, 1 in 10 was the estimate for the number of Americans over the age of 12 who were currently addicted in 2007, and about 1 in 13 (7.8%) Americans over the age of 12 were currently addicted in 2015.

While Heyman establishes a hopeful picture for overall remission rates for people with addiction, caution is warranted in trusting his conclusions. The estimates for lifetime remission, whether 64%, 74%, or 80%, are cause to be optimistic about the ability of people to recover from addiction. They are not, however, reason to become impatient with people who suffer from addiction. His statistics are also not applicable to the question of spontaneous remission, given that the surveys did not examine whether the people who remitted were in treatment or not.

Heyman’s results are potentially grounds for someone to apply for grants to do a large-scale longitudinal study. If remission rates without treatment can be known, researchers may be better able to evaluate treatment effectiveness. A longitudinal study could help determine which treatments are effective above and beyond spontaneous remission.

3. Meta-Studies

Where the nationwide surveys lack the power to describe how addiction progresses in an individual or why spontaneous recovery happens, individual studies typically lack the large sample sizes needed to generalize for all of America. For this reason, some researchers choose to use complex statistical analyses to compare results across studies and draw conclusions from their combined data, a process called meta-analysis.

In 2009, Glenn Walters did a quantitative review of the literature to determine the extent of spontaneous remission, and whether people who spontaneously remit are different in any obvious way from people who don’t. Walters included 12-step approaches under the umbrella of “formal intervention,” or treatment. He also performed the analysis for a broad definition of spontaneous remission, that the subjects had reduced the amount and/or frequency of drug intake and were free of negative consequences for 6 months, and a narrow definition of spontaneous remission, that the subjects were entirely abstinent from the substance of choice for 6 months.

Walters found that the average prevalence of spontaneous remission from alcohol, tobacco, or other drugs was 26.2% using a broad definition of remission, and 18.2% using a narrow definition of remission. Walters also managed to evaluate the principal reasons people who spontaneously remitted reported for why they quit using.

The top four reasons people reported for stopping alcohol/drugs and staying stopped were:

  1. “support from family/friends”
  2. “find new relationships/avoid old relations”
  3. “transform identity/reject addict identity”
  4. “willpower/resist the urge to use”

The top four reasons people reported for stopping tobacco and staying stopped were:

  1. “willpower/resist the urge to use”
  2. “substitute activities/dependencies”
  3. “self-confidence”
  4. tied: “change in recreational/leisure activities” and “exercise/physical fitness”

In Walters’ review, people who were able to remit (spontaneously or otherwise) were not less severely addicted or otherwise meaningfully different from those who did not remit. The exception is that, for tobacco, there is some evidence that those who had been smoking longer/more intensively were less likely to remit.

To draw conclusions with greater confidence, however, one would need to look into the sampling methodology of the studies Walters reviewed, to see whether sampling bias occurred. For instance, Walters’ estimates of spontaneous remission are much lower than those that come from the nationwide surveys. Aside from the fact that his estimates are of spontaneous remission rather than total lifetime remission, Walters’ estimates may also be more accurate due to better/more representative sampling or less accurate due to more biased sampling.

Walters himself noted that, to really understand how and why spontaneous remission occurs, and at what specific rates, a study with more rigorous methodology is needed.

“A longitudinally designed investigation of a large unselected group of untreated substance abusers would go a long way toward filling many of the gaps in our current knowledge of spontaneous remission. This group of individuals could be followed and periodically reinterviewed to determine changes in their use of substances. Such a study would allow more precise calculation of patterns of spontaneous remission, treatment remission, and relapse.”
Glenn Walters

In fact, while such a longitudinal study would be extremely expensive, it would be cost-effective in the long run, both in terms of dollars and relieving human suffering. Researchers need to know natural remission rates if they are to adequately determine the effectiveness of various treatments that surpass those natural rates. Furthermore, if spontaneous remission rates are indeed as high as 50%, then treatment funds can be used to potentially accelerate the process of spontaneous remission, or to focus on people who are unlikely to remit without help.

For now, we can only estimate spontaneous remission rates to range between 4% and 60%, and speculate about the reasons why people spontaneously remit. We can say, confidently, that spontaneous remission does happen, and possibly at fairly high frequencies. That alone has hopeful implications for the treatment of addiction.

Jennifer West from Virginia Tech’s Laboratory for Interdisciplinary Statistical Analysis contributed to this post.

A Brief Guide to Evidence-Based Self-Care for Recovery from Addiction

Intended to supplement medical and professional care for substance use disorders, this guide offers a brief, straightforward distillation of the latest information and research on addictions recovery self-care.

Organized in a series of three handouts, the guide offers compassionate, supportive assistance to individuals with substance use issues who are already receiving medical and professional care. Professionals and concerned others may want to offer it as a link or printed packet. Passages are stated simply, but link to authoritative sources for corroboration and further exploration.

Self-help does not equal treatment. Substance use disorders are complex conditions requiring medical and professional care.

The handouts were originally written by the author as personal guidance after extensive reviews of the research on addiction, hence the use of the pronoun “you,” but they are for informational purposes only and are not a substitute for individualized medical or professional advice. Individuals are urged to consult with qualified health care professionals for personalized medical and professional advice.

Anyone is welcome to use this information and a printable packet in .pdf form – 2,700 words, 6 pages – is available here. Original segments of this post were first published by The Fix here, here and here. The .pdf was last updated 5/3/17 and this post was last updated 5/3/17.

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A Brief Guide to Evidence-Based Self-Care for Recovery from Addiction

Handout 1

“Love, evidence & respect.”
– Maia Szalavitz’s answer via Twitter to the question, “What fights addiction?”

1.  Who you are does not cause addiction.

2. Nothing bad you have done, nor good you failed to do, caused addiction.

3. You do not deserve addiction, nor do you deserve not to have addiction. It’s just an unfortunate condition having no moral value one way or the other.

4. You are not the problem. Addiction is the problem. Let’s see what we can do to solve or improve this for your unique, individual situation. And we’ll do this with compassion. As Maia Szalavitz writes, “To return our brains to normal then, we need more love, not more pain.”

We need more love, not more pain

“…we need more love, not more pain.” – Maia Szalavitz

5. Get medical care for the medical condition of addiction. Forced abstinence can result in dangerous withdrawal symptoms, decreased tolerance and increased craving, an intolerable emotional and mental state, and risk of a dangerous, potentially deadly, return to use.

6. Symptoms of addiction can appear as thoughts, words, and actions perceived as irrational, anti-social, and immoral. Addiction is not, in and of itself, a thought problem, a moral problem, a spiritual problem, a mental illness, or a behavior problem. Addiction is not a personality type. It’s a brain condition, contentiously defined, uncertainly located, and uncertainly targeted for treatment, but detectable in the brain at the minutest level.

7. Unfortunately, at this time, we know of nothing you can specifically do on your own to immediately and directly treat, cure, or reverse malfunctions in brain structures associated with addiction. Until we can identify exactly which brain structures and circuits to treat with medications, stimulation or probes, and what beneficially modifies them, for now, other than directly through the medications we know of, we’ll have to use indirect means.

8. However, what can directly administer care to brain structures is protecting them from problematic substances. That’s why obtaining medical care and professional help to assist with abstinence or harm reduction is critical. Over time, helpful changes may occur in the brain in the absence of overwhelming or damaging substances.

9. Focus maximum effort on becoming aware, very specifically, of what helps you stay abstinent and what does not. If you’re practicing harm reduction, discover what helps you use less, less often, or use less problematic substances. Acute awareness takes painstaking attention, but the logic is simple. If you can become aware of inner and outer conditions that precede use, you may be able to do something about them. If you don’t know, you can’t.

10. Needing or wanting to abstain, and firmly deciding and being resolved to quit, unfortunately – as you know from former heroically determined efforts to quit followed by heartbreaking returns to use, all explained by the brain science of addiction – aren’t sufficient to achieve abstinence.

11. You must learn what each substance did for you or meant to you, how you related to it, how it worked for you, and how it eased or enhanced your experience or your life. Discovering this, and finding alternate ways to get your needs met, is difficult but worthy, essential work. Again, the logic is simple. If you can learn what substances did for you, and find alternate ways to get most of that done – regrettably, possibly never again to the extent substances did – you’re more likely to be able to do without them.

12. Repeat: Go to a doctor. Although medical treatments for directly treating the brain for most substance use disorders are currently unknown (however, methadone and buprenorphine directly affect brain areas involved in opioid use disorder), several medications can be helpful with creating the stability necessary for intensive self-learning. In addition to being assessed for medication-assisted treatment (MAT), ask to be screened for mental illnesses and physical illnesses that might be causing conscious and unconscious stress and distress, the primary precursors to a return to use. (If you don’t have health insurance and can’t afford to self-pay, try to find local organizations that will help you get health insurance or help you with costs for medical care.)

13. Abstain from self-judgment. Become aware of a learned pattern of self-harshness, now nearly automatic. It feeds shame, a primary source of inner distress. Self-discernment is a compassionate process of discovering one’s strengths. In contrast, self-judgment cruelly weakens, reduces and demoralizes. As Maia Szalavitz urges, treat yourself for addiction by loving yourself, getting evidence-based care, and respecting the gravity of this illness and the heroic effort required to overcome it.

Turn towards reality and truth

Turn towards reality and truth, not away from them.

Handout 2

“Addictive disorders are a major public health concern, associated with high relapse rates, significant disability and substantial mortality. Unfortunately, current interventions are only modestly effective. Preclinical studies as well as human neuroimaging studies have provided strong evidence that the observable behaviours that characterize the addiction phenotype, such as compulsive drug consumption, impaired self-control, and behavioural inflexibility, reflect underlying dysregulation and malfunction in specific neural circuits.”
– Spagnolo and Goldman, 2017

“[W]hat if the negative thinking patterns, feelings, and behaviors that keep them stuck have powerful, unconscious advantages serving vital, even life-preserving purposes?”
David Burns, 2017

“People may not have caused all of their own problems, but they have to solve them anyway.”
Marsha Linehan , 2012

1. Expect to feel shock, grief, rage and other strong emotions over the before-and-after states addiction brings to your life. Practice self-kindness and self-compassion and find others who can support you when you experience these.

2. Seek stability. Become aware of how you define stability, what individually helps you achieve and maintain stability (emotionally, mentally, physically, occupationally, relationally, situationally), and try to make these happen for yourself. Suppression, repression, avoidance and obfuscation can backfire and destabilize. Turn towards reality and truth, not away from them. (If you have concerns about whether or not what you’re thinking is real or true, see #5 below.)

3. Get counseling. At this time, it is not known if counseling directly treats the brain in an efficient, targeted way for addiction. (For opioid use disorder, for example, multiple studies fail to prove that counseling with medication increases abstinence rates over medication alone). But counseling can help people maintain abstinence, often by assisting with awareness. The main precursors to a return to use are stress, distress, and environmental cues. Environmental cues include being around substances, in situations, and with people associated with use. Make sure the counselor offers an evidence-based therapeutic approach. The Surgeon General’s report, Facing Addiction in America, lists cognitive behavior therapy, CBT, as the top evidence-based counseling approach for assisting people with addiction maintain abstinence or harm reduction. Dialectical behavior therapy, DBT, also included in the report, is increasingly proving effective as well.

4. The more you can 1) learn to become aware of, and regulate, your inner experience of feelings, thoughts and physical sensations – optimally for you individually, not by someone else’s methods or criteria, 2) discover what needs you personally have and what uniquely and healthily meets them, and 3) help yourself avoid environmental cues or manage exposure to them, the more likely you are to be stable and, therefore, the less likely you will be to use.

5. Run even your simplest ideas by others before taking action. Your thinking may not be as clear as it will be in the future.Consulting others will help protect you from error.

6. Seek contact with people who help you clarify your feeling and thinking, who are non-judgmental, and with whom you feel safe and supported. Become aware of how you feel about yourself when you’re talking with anyone and everyone. If you don’t feel good, however you might define “good,” that’s stressful and potentially destabilizing. Find a way to have limited or no contact with those with whom you feel unsafe and unsupported, at least in the short-term.

7. Listen for fact vs. opinion when people talk with you about addiction. Are they sharing the latest science  and research reports on addiction or are they sharing opinions based on beliefs, personal experiences or outdated information? If they’re sharing an opinion, do they acknowledge it as such and explain how they derived it? Or are they stating opinions as facts? Practice caution and care with what you let into your tender, vulnerable mind and heart.

8. Practice engaging, disengaging, and shifting your attention. Discover and focus your attention on what is preferable to you, rather than attempting to force your mind to think what you believe will please or protect, or letting it grind in patterns that have simply become habitual rather than helpful. This power over your attention can give you enormous power to enjoy your life, to assist yourself with enjoying the company of others, and to increase others’ pleasure in your company. Impossible as it sounds, exercising your power to focus your attention may exercise brain functions atrophied from substance use. Many people with substance use disorders have experienced trauma and find using the mind for meditation distressing. Meditation, therefore, may not be advised. Marsha Linehan, inventor of dialectical behavior therapy, DBT, recommends what she terms “mindfulness” instead. A simple, DBT-based mindfulness practice involves using your attention to observe what’s going on within and without and to describe those to yourself. (Here’s a brief YouTube video of Marsha Linehan explaining mindfulness, part of a series of videos on the core principles of DBT.)

9. Become aware of what helps you feel better. Whether it’s just for a few moments or for longer, become aware of what uniquely helps you via your senses – sight, hearing, smell, touch, taste – to ease, reassure, and comfort yourself. Google the term “self-soothing” and you’ll find lots of ideas to try.

10. Believe that you, yourself, can do this. In addictions recovery circles, you may hear about admitting powerlessness, surrendering, relinquishing control, and the dangers of “self-will.” The opposite is true. The more self-aware you are and the more self-power you see yourself as having – the more “self-efficacy” you possess – the more likely you are to stay abstinent. You be you.

11. Practice “love love”  not “tough love” with yourself and others. “Tough love” is a euphemism for smiling while wielding a 2″ x 4″ of hostile methods to exert psychological control. Practice self-kindness and other-kindness. And distance yourself from those who profess to be treating you with the “tough love” they think you “need” or “deserve.” In fact, with the whole concept of “tough love,” practice hostility. But briefly. Then compassionately self-regulate and return yourself to recovery-enhancing stability.

Seek out supportive others

Seek out supportive others.

Handout 3

“…but seven years is long enough and all of us
deserve a visit now and then
to the house where we were born
before everything got written so far wrong”
– Peter Meinke, “Liquid Paper”

“The most natural way for human beings to calm themselves when they are upset is by clinging to another person.”
– Bessel van Der Kolk, M.D., The Body Keeps the Score

“Do not attempt to take away a person’s main means of trying to cope with pain and suffering until you have another effective coping strategy in place.”
Alan Marlatt

“I don’t believe in getting ‘in the moment’ and then exercising will-power. I believe in avoiding ‘the moment.’ I believe in being absolutely clear with myself about why I am having a second drink, and why I am not; why I am going to a party, and why I am not. I believe that the battle is lost at Happy Hour, not at the hotel. I am not a ‘good man.’  But I am prepared to be an honorable one.”
Ta-Nehesi Coates

“It’s my life. Don’t you forget.”
Talk, Talk

1. Attach to yourself. Discover the curl within you of your truest self, “before everything got written so far wrong.” Gently begin to view yourself as someone with whom the vulnerable essence of you can feel safe. Many people with addiction have experienced abuse and neglect from caregivers  and have attachment challenges. What shouldn’t have happened did, and what should have happened didn’t. They may feel undeserving and unqualified to care for themselves. They may believe they can’t be entrusted with themselves and fear the piece-of-shit messages they’ve heard all their lives might be true. Given what many people have been through, having these beliefs is sadly understandable. Still. Kindly and protectively begin to identify yourself more by who you are, and less and less by what you’ve done or what has happened to you.

2. Take care of yourself. Try to imagine finding the truth of who you are showing up as a foster child on your doorstep right now. What do you need?! What do you want?! Remember the best of what you’ve learned, experienced and observed. Start with basic needs. Do you need to be invited in or given some time to adjust? Do you need something to eat, a nap, something interesting to do, a hug? Experiment and see what seems to work. What a huge responsibility! But what a relief! Finally, finally, after all that’s gone down, you can have your own consistent, kind, reliable, present, attentive caregiver who knows you better than anyone else on the planet and who wants the best for you, no matter what. And you don’t have to be a perfect self-caregiver. Good enough will do. Addiction – like life – is a 24-7 condition and others aren’t always available. But you can be there for yourself. Whenever you need or want to, you can cling to your own good-enough self.

3. Seek out supportive others. Social connection can assist with abstinence. Stress and distress are part of human relationships, but the benefits of de-stressing need to outweigh the costs of stressing. No gathering with others will leave you stress-free. The goal is to find people with whom – enough of the time – you can feel good enough and safe enough to feel stable.

4. Try a variety of places and situations in which people gather in groups without use of problematic substances. Consider asking someone you trust to accompany you. Become aware of how you feel afterwards. If you feel neutral or better, you might return. If you feel worse, try another group, or, perhaps, try it a few more times and see. Keep visiting groups of any kind, whether recovery support groups, community groups, or hobby groups, until you find places that feel safe, supportive and helpful. If you don’t find established groups that are a fit for you, try to find individuals with whom you can meet one-on-one or in small, informal groups.

5. To further develop stability, establish priorities, schedules, routines and budgets. Figure out what you can do at the same time each day that’s helpful and do those things. Become aware of foods that fuel you and create a menu for yourself featuring those foods. Note which physical activities support your overall energy level throughout the day and do those. Figure out how much it costs to be you and find ways to supplement what’s missing and to modify spending for shortfalls. Discover the uniqueness that is you and set yourself up individually to thrive as only you would know, understand and be able to do.

6. Use “enough” vs. “all” as a standard. While you may want to examine your values, principles and beliefs more closely and decide what might work best for you individually going forward, for now, strive to get enough of your needs met enough of the time, to feel pretty good enough of the time, and to be with people with whom you usually feel safely supported. Since no one can deliver “all,” expecting all one’s needs to be met all of the time will result in disappointment which is stressful and destabilizing.

7. Stigma is real. Give yourself private time to take care of yourself and to feel better before you consider whether or not to share your condition with others. Keep your circle of confidantes thoughtfully selected and discuss your motivations and the pros and cons of self-disclosure with trusted others when you feel or think you might want to share your situation with others.

9. Do your homework, honey. Whether self-assigned or suggested by trusted sources, research reports that those who do therapeutic homework fare better than those who don’t.

10. You are a unique individual with an individual case of addiction. What helps you with your particular case will be unique to you. You are the expert on that and, ultimately, you are the decider. As you should be. Even if you have the regrettable condition of addiction, it’s still your life, your one precious life.

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Anne Giles, M.A., M.S., is the founder of Handshake Media, Incorporated. She is a counselor and writer and lives in Blacksburg, Virginia.

The opinions expressed here the author’s alone and do not necessarily reflect the positions of clients, employers, co-workers, family members or friends. This content 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.

Sound Sleep Makes for Sounder Addictions Recovery

Sleep disturbances are a sad fact of life for many people in recovery from substance use disorders. Sometimes sleep problems put people at risk for addiction, sometimes people develop sleep problems because of the drugs they take, and sometimes both. But causality aside, the correlation between disturbed sleep and substance use disorders is indisputably high.

Sound sleep aids addictions recoverySleep disturbances are known to occur across widely different substance use disorders, including nicotine, alcohol, opioids, and cocaine. Alhough sleep disturbance is a common experience, different substances affect sleep in different ways.

Alcohol helps people fall asleep faster and increases slow wave sleep in the first half of a sleep period. For this reason many people have turned to alcohol to cope with sleep problems, especially if they have a co-occurring mental disorder. Yet alcohol disrupts the second half of a sleep period, reducing overall REM sleep for the night and ultimately making sleep problems worse.

People dependent on cocaine and alcohol tend to have disturbed sleep architecture as they age, with increasing REM (Rapid Eye Movement) and accelerated age-related decreases in slow wave, stage 3 sleep. People trying to become abstinent from cocaine report better quality sleep, but one study reveals that even as their perception of sleep quality goes up, their actual quality and quantity of sleep goes down. People recovering from cocaine substance use disorders may therefore be at higher risk of relapse because of poor sleep without knowing it.

Opioids are notorious for detrimentally affecting sleep, but in a different way. Long-term opioid use causes sleep apnea (in 30-90% of long-term opioid users) and otherwise disrupted breathing, sometimes resulting in hypoxia, and contributing to fatal overdose. Unfortunately, though indefinite buprenorphine and methadone maintenance are most promising for treatment of opioid substance use disorders, methadone is documented to cause sleep problems and burpenorphine may as well.

Studies of alcohol substance use disorders have demonstrated that greater severity and frequency of sleep disturbances put people at greater risk of relapse. Researchers think this correlation may be generalized to all types of substance use disorders. Berro et al., in 2014, found that sleep deprivation affects the dopaminergic systems in the brain in a similar way to psychostimulants, like cocaine. They hypothesized that sleep deprivation could prolong recovery by extending the association of cocaine with environmental cues, and so cause people to relapse.

Poor quality sleep is known to cause other health problems, and to compromise immune function, an especially grim prospect for any person who contracted HIV or hepatitis while using. Improving sleep quality is thus an important goal for anyone in recovery to reduce risk of relapse and reduce craving, and also to improve quality of life overall.

Addictions treatment providers may help their patients tremendously by providing cognitive behavior therapy to encourage beliefs and behaviors that improve sleep, and to refer people in recovery to sleep specialists when possible.

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This post is one our series of reports on what the current science says about addictions and addictions treatment.

Partial list of reports, listed most recent first:

What I Would Do to Help a Loved One with an Addiction in the New River Valley

I live in Blacksburg, Virginia. Blacksburg is located within Montgomery County, and within a larger area generally termed the New River Valley (NRV) in Southwest Virginia. Blacksburg, Virginia, according to the U.S. Census Bureau, has over 46% of its population living in poverty. More than 16,000 people in my locale have problems with alcohol and other drugs. In terms of receiving or allocating funding for health care, Virginia is ranked poorly with other states. This means we have scarce health care resources and high demand for them.

Scarcity requires scrambling.

Disclosure and disclaimer: I am a counselor at New River Valley Community Services. The opinions expressed here are mine alone and do not necessarily reflect the positions of my employer.  This content 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.

Reaching out to help someone with addictionIn this post, I elaborate upon What You Can Do to Help Fight Addiction with specific details on what to do for a loved one with addiction in our area.

This list is based on my experience in getting help for myself and others. Some readers may find themselves outraged by the workarounds needed to get addictions care. I have no time for outrage or debate. I may not want to be a do-it-yourself addictions treatment care coordinator, or may feel unqualified or ill-prepared to do so, but addiction is a critical illness and right-here, right-now, I need to get my loved one care.

“Love, evidence & respect.”
Maia Szalavitz’s answer via Twitter to the question, “What fights addiction?”

How to Help a Loved One with Addiction in the NRV

If I discovered my loved one had an addiction and I wanted to get him or her addictions treatment in my locale, this is what I would do to address immediate needs.

[A .pdf version of this guide – last updated 9/19/16 – is available here.]

0) SAFETY FIRST. Unfortunately, much addictions treatment in our area begins with a medical or legal emergency resulting from untreated addiction progressing to an acute stage. If my loved one, or I, or anyone present is in danger or is behaving dangerously, that must be addressed first. I may need to remove myself and vulnerable people immediately – even if I long to stay and help my loved one or fear his or her anger, even retribution – then call 911.

Important: The rest of this list is based on getting help for a loved in an urgent situation, not an emergency situation. The loved one is able to converse, perhaps unwillingly, but perhaps willingly enough to co-create next steps.

1) Lead with my heart to support my loved one.

Hug my loved one. Say, “I am so very sorry you have developed this health condition. It’s too bad but you are not bad. I love you and I am here for you.”

Realize I need to become my loved one’s care manager and advocate. My loved one is ill. Few can take effective action when they don’t feel good.

2) Lead with my head and prepare to take strategic action.

Recognize my loved one needs full physical and psychiatric evaluations to determine the dimensions of his or her particular case. Addiction is often accompanied by mental illness, physical illness, emotional and physical pain, and trauma. Issues of temperament and personality may need assessment. All of these factors need to be considered and evaluated by medical professionals to determine what principles of effective addictions treatment need to be activated for my loved one.

Blood work needs to be done to test for the presence of function and dysfunction, both to diagnose illness and to assess suitability for medications. Ideally, these assessments would be done by one specialist or a team of specialists, but I may need to cobble this together from multiple sources. From all this data, the first version of an individualized treatment plan can be devised.

Realize I need to get my loved one “in the system” ASAP. Wait lists exist for all services.

Realize that understanding addiction is a health condition needing health care – rather than believing it is a moral problem needing punishment – is new. I will need to listen carefully to what care providers advise. In 99% of my contact with local health care providers, I have experienced them as caring, determined, and resourceful. But if I hear disrespectful, shaming statements, or presentation of beliefs rather than science about addiction, I can’t walk away because I’ll just be put on another wait list. I’ll need to work with this care provider and his or her views in order to receive the piece of data this provider can offer. I must do what I can to protect my vulnerable loved one, but I may, at times, feel challenged to manage my own emotions.

Prepare to document. I’ll need to get copies of all previous medical reports for as many years back as I can find them, keep them organized in reverse chronological order in a binder, and take that binder to all appointments. I’ll need a list of all current and past medications. Our multiple health care providers have electronic health record software programs that don’t “talk” to each other so care providers may not be able to “see” data from other providers. Data from previous years may still be in paper file folders rather than available electronically. I’ll only have a few minutes with each care provider so I need to have a one-page summary at the front of the binder, then the medications list, so the care provider can be oriented to my loved one’s case quickly. I’ll need to update the summary after each appointment.

Consider the ER. If my loved one is in a state of emergency, I will call 911. If my loved one is not in a state of emergency, I need to know that it is through the emergency room that many people with addiction make first contact with our local health care system. ERs help stabilize patients briefly, but are limited in the length of care they can provide, sometimes under 24 hours. Local hospitals do not provide addiction treatment, medication-assisted treatment, or prescriptions for detox or pain meds. If my loved one is released without immediate follow-up care, relapse is probable.

Depending upon the system in which the ER operates,  referrals will be made to additional treatment through these emergency evaluation services. Referrals from those services are to local treatment providers. Many referrals are for treatment at in-patient facilities, few of which have beds available immediately, most of which require health insurance or a needs-based assessment prior to admission. If my loved one is considered a threat to himself or herself or others, a stay at a mental hospital is required. An ER visit may result in a range of outcomes, including release of my loved one into my care, to a stay at a mental hospital, possibly in another part of Virginia. When I/we leave, I will be sure to get a printout of lab reports and treatment notes, or return the next day for copies of them to add to my documentation binder. Again, in an emergency, I would call 911.

Consider urgent care. I have taken several people with health insurance coverage with illnesses or injuries that have resulted from addiction – not for addiction itself – to Velocity Care urgent care centers and have been impressed with how quickly the person is seen and how much attention each person is given by the care provider. Velocity Care also hands me a printout for my binder without asking. If my loved one is in a state of physical or mental emergency, however, they will refer us to the ER and it is a wasted trip.

Ask my loved one, “What help do you think you need first?” Although I’m nearly insane with worry and I see my loved one is in dire condition – but I have determined I do not need to call 911 for an ambulance and my loved one is not a child for whom it is my responsibility to make decisions – if my loved one’s answer to the question, is “I don’t want or need help,” then that is where the conversation must begin in hopes of mutually-deriving a plan of action.

In my experience, my view of what is the most important next step has never been what my loved ones have thought was important. I wanted to hurry them into shoes so I could get them into my car and race them to the ER faster than an ambulance could get there. They wanted a glass of orange juice. I need to continue to remind myself that this is a person, however ill or impaired, with needs, wants, preferences, priorities, and values. In my experience, co-creating next steps has been the most difficult, frustrating, and anguish-engendering part of helping someone with addiction. When is the person too ill to make a decision? Should I step in or not? Am I respecting this person’s autonomy and right to decide next steps on a life’s path? This is a realm of terrifying uncertainty, sometimes requiring life-and-death judgment calls, all made in the context of respect for human dignity.

3) Make appointments.

Start trying to get an appointment with a psychiatrist now. Most psychiatrists require a referral from a primary care physician (PCP) so an appointment with a PCP needs to be made ASAP. The PCP will make the appointment and can get back to me. Hearing back from the PCP, plus the wait to see the psychiatrist, and can take 6 months or more. Whether or not my loved one has insurance, whether or not I have a clue how we’re going to pay for it, whether or not my loved one may be able to make the appointment, I’m going to make an appointment now knowing I’ll have 6 months to figure out the money.

If I or we can self-pay, I would make an appointment for my loved one to see a physician at TASL, the one and only medical practice specializing in addictions medicine in our locale. Clients pay directly for services and the provider does not bill insurance. Payment in person by cash is required to make the first appointment and cash or credit cards are accepted after that. TASL explains its services clearly and specifically via phone recording. Select option 3 for new patient information, 540-443-0114.

If I can’t find a way to self-pay, and my loved one has health insurance, acknowledging the need to wait half a year for a psychiatric care appointment, I would immediately make an appointment with a primary care physician (PCP), ideally with my loved one’s current PCP or, if he or she doesn’t have one, with mine. An appointment with a Nurse Practitioner (NP) can be more readily available for immediate care if the PCP is booked. I would be sure to still keep the appointment with the PCP. The NP’s assessment will become part of the data that the PCP considers.

If my loved one doesn’t have health insurance, I would assist my loved one in calling  ACCESS at New River Valley Community Services, 540-961-8400, between 8:30 AM and 5:00 PM, and asking for a GAP insurance assessment appointment. (Appointments must be made by the individual requesting an appointment. Assessments are not done on Mondays). If my loved one is assessed as having a severe mental illness (SMI) he or she may qualify for coverage through the Virginia Governor’s Access Plan (GAP). If I can bring documentation of my loved one having been diagnosed with SMI to the GAP assessment appointment, that can expedite the process. (Although the National Institute on Drug Abuse (NIDA) itself defines addiction as a brain disease, addiction/substance use disorder is not considered an SMI.)

If we can’t self-pay, my loved one doesn’t have health insurance, and doesn’t qualify for GAP insurance, I would call the Community Health Care Center of the New River Valley, make an appointment to see a physician, prepare the application forms, and start calling churches and asking for help with co-pays.

(Community members, please help me expand this section. How would a person get cash in the NRV to pay for non-covered medical expenses for addictions treatment?)

For each appointment, I would make a list of the top questions, in priority order, for which answers are sought. To get the most out of my limited time with a care provider, I need to focus primarily on information, secondarily on getting reassurance for my loved one. I will talk with my loved one beforehand, take notes, and co-create a brief list. If I can accompany my loved one, I can bring the list, listen carefully, and ask for assistance with any questions not addressed. If I can’t go, I can provide the list for my loved one to take. After each appointment, I will cross off answered questions and note additional ones for the next appointment.

Contribute to my loved one’s documentation. I would hand write or type a timeline of what I know about my loved one’s life with all of these components in order as they happened. I would include years and ages if I can: 1) first use of cigarettes, alcohol, marijuana, other substances; 2) substance use history – what did they use, when did they use it, how much did they use, and how long did they use it, prescribed or otherwise, any incidents that seemed like just teenager stuff or just overdoing it at the time? 3) onset of physical illnesses or occurrence of physical injuries; 4) traumas – deaths in the family, losses, neglect, abuse, witnessing or experiencing emotional, physical, or sexual violence; 5) incidents I remember in which the person seemed to have a very strong reaction or surprisingly little reaction to an event, 6) anything else I think might be helpful for care providers to know.

4) Get my loved one to appointments.

Cover transportation. My loved one may not have a license or a vehicle. Ideally, I would transport and accompany my loved to all appointments to listen and to help as needed. If I can’t take the person myself, I need to help them find a ride, or find them a ride myself, perhaps from a friend or neighbor. If I have a credit card and a late model smartphone that can handle the Uber app, I could arrange for and pay for transportation through my local Uber service.

Cover dependent care. My loved ones may be parents of small children, and/or may provide care for a partner, ill or elderly friends or family members, or have pets. I need to find a way to arrange for coverage to ease my loved ones’ stress and concern about beings in their care.

Cover medication costs. Physical and mental stability is the top priority for my loved one and meds will likely be needed to achieve that. If my loved one can’t pay or doesn’t have insurance, I need to think about finding a way to cover this necessary expense.

5) Follow-up on recommendations received during health care appointments.

If out-patient treatment is recommendedNew River Valley Community Services (NRVCS) is the public provider of behavioral health services and the primary provider of addictions treatment services in our locale. To be screened for services, I would assist my loved one in personally calling ACCESS at New River Valley Community Services, 540-961-8400, between 8:30 AM and 5:00 PM, and asking for a Rapid Access intake appointment.

If in-patient residential treatment, i.e. “rehab,” and/or “detox” is recommended for my loved one, I would read carefully Maia Szalavitz’s article on the rehab industry, then call providers in this area and listen carefully to what they have to say about their services. Residential treatment can be helpful to some. For others, life is distressingly disrupted. An extended absence can compromise jobs, finances, relationships with children and partners, and subject one to addictions-related stigma. Many with addictions have trauma-related issues and find that in-patient treatment can exacerbate trauma symptoms. Rehab can be enormously expensive and is increasingly under scrutiny for ineffective treatment outcomes and high relapse rates upon release. This is a decision that needs to be made thoughtfully.

If my loved one did attend residential treatment, during visits, I would do my best to co-create with my loved one a life-in-recovery schedule for us to follow that would begin at the moment of discharge. Because I can’t do my life and theirs, too, I, would create a Doodle schedule, then ask for help from my friends. At my loved one’s discharge, I would be there to transport my loved one into our best efforts to create a new life in recovery.

If individual counseling is recommended, I know of two counselors in our area who specialize in substance use disorders and both are not taking new clients. I would ask physicians and friends for referrals, screen that list for counselors who specialize in cognitive behavior therapy, the top evidence-based counseling method for addressing substance use disorders, and take the first available appointment with the first available counselor. (Few specialize in Dialectical Behavior Therapy (DBT) which is showing increasing promise as an evidence-based counseling protocol for addictions treatment.)

Understand that addiction, in early recovery, is a 24-7 condition that requires 24-7 care. Although I may assist my loved one, once stabilized, a person with addiction serves as his or her own primary care provider. I would point my loved one to these self-help suggestions:

Practice self-care. Although it’s last on the list and hard to practice in urgent moments, self-care is to what I have to continually return my attention. I need to be high-functioning to help anyone with anything. And this may well be one of the hardest fights of my life. I need food and rest. I may need counseling for myself and definitely need time with supportive friends. The self-care checklist for addictions recovery that I will suggest to my loved one can assist me with my self-care, too.

I need love, too.

. . . . .

If my loved one has an opioid addiction, I would:

Buy opioid overdose antidote Naloxone kits – available now without a prescription from the pharmacy at CVS on University City Boulevard in Blacksburg – for my loved one, myself, and others with whom my loved one has frequent contact in case of my loved one’s return to use. (See helpful discussion of Naloxone in NYT letters to the editor, 8/7/16.)

Study carefully and learn What Science Says to Do If Your Loved One Has an Opioid Addiction and the New England Journal of Medicine’s report on opioid addiction released 3/31/16.

Get my loved one assessed for medication-assisted treatment (MAT), the top evidence-based treatment for opioid use disorder. Unfortunately, my loved one has an immediate need for an MAT assessment and wait lists for assessments and treatment from local public providers and providers who take insurance are 6 months or more. (Here’s an explanation of why we have wait lists for opioid addiction treatment.) To bypass wait lists, I have to self-pay. The closest self-pay source of buprenorphine/Suboxone/Subutex to me in Blacksburg is TASL, 540-443-0114. Methadone is only available at highly regulated clinics in Salem and Roanoke.

. . . . .

I am so grateful to the many who have shared their lives and struggles with me so that I could write this post in hopes that we can help many more.

This post is a work in progress. If you have suggestions, pease leave them in the comments or email me at [email protected]

UPDATE: On my personal blog, I am writing a series of posts entitled DIY Addictions Recovery for people with addictions who are seeking help for themselves.

Last updated 10/11/16

If you or someone else is experiencing a substance use and/or mental health emergency, call 911 and/or ACCESS, 540-961-8400.

Disclosure and disclaimer: I am a counselor at New River Valley Community Services. The opinions expressed here are mine alone and do not necessarily reflect the positions of my employer.  This content 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.

What Happens at a SMART Recovery Meeting?

A SMART Recovery meeting offers people who want to stop doing something – but find themselves still doing it – an opportunity to meet together with others with similar challenges. The free meeting is chaired by a volunteer trained as either a host or as a facilitator.

A facilitator has completed a 30-hour training. A host has completed a self-paced, online training that takes 4-6 hours.

Circle of welcome at a SMART Recovery meeting

I am trained as a host, not as a facilitator. At the facilitated SMART Recovery meetings I have attended, the facilitator warmly and skillfully guides participants to deeper understanding using what’s termed SMART Recovery “tools.”

At a hosted discussion meeting – the type of SMART Recovery meeting available to the community in my hometown of Blacksburg, Virginia and for which I am trained – prior to the meeting, the host has chosen a SMART Recovery activity that the attendees might find helpful or meaningful. Given that people thrive when they feel safe, the host doesn’t divide his or her attention by participating but focuses on the needs of the group and its members. To foster safety and continutity, the meeting is held using a script and the meeting proceeds in this order: check-in, discussion, activity, discussion, check-out.

In the above description, I meticulously did not use any of these terms: support, group, support group, mutual aid, mutual aid group, addiction, recovery, illness, disease, disorder, science, evidence, or research. As, happily, discussions about addiction and recovery become more frequent and these terms are used variously in multiple contexts, without meticulous definitions, they’re pretty meaningless.

And none of those terms describes my primary experience of a SMART Recovery meeting: kindness.

Maybe it’s the hope-filled discussion topics: building and maintaining motivation, coping with urges, managing thoughts, feelings and behaviors, and living a balanced life.

Maybe it’s the guidelines for discussion read at the beginning of the meeting, including “We don’t give advice. SMART Recovery encourages participants to make their own choices,” and “We don’t debate issues about addiction and recovery. We are free to speak in the language we want to, and to view addiction and recovery however we want to.”

Maybe it’s the tools and the activities that primarily ask what’s working and what might work better, rather than pointing out how bad and wrong everything is – including the individual.

Maybe it’s the use of “I-statements” rather than boundary-violating “you-statements” or “we-statements.”

Maybe it’s the time and space to speak without being interrupted or corrected.

Whatever it is that results in prevailing kindness, I sense participants’ best wishes for themselves and for others. I sense an intentional effort to bring forth the best of their hearts and minds for the time we’re together.

In her letter to the New York Times, author Maia Szalavitz wrote, “Shame and stigma are the exact opposite of what fights addiction.” In response to my Twitter tweet asking her what does fight addiction, Maia Szalavitz replied, “Love, evidence & respect.”

At a SMART Recovery meeting, I give and receive love – as much as people who may not know each other or know each other well may offer – I work together with others in ways for which there is enough evidence to support it might be helpful, and I feel respected by, and I feel respect for, people who are willing to come together to talk. 

I chortle with joy thinking that, in our kind little well-intentioned circle, we’re “fighting” addiction.

  • A hosted SMART Recovery discussion meeting is held on Sundays, 4:00-5:00 PM,  at New River Valley Community Services, 700 University City Boulevard, in Blacksburg, Virginia. Directions
  • A facilitated SMART Recovery meeting for Virginia Tech students is held when classes are in session on Thursdays, 6:30 PM – 7:45 PM at Squires Student Center, Virginia Tech, Blacksburg, Virginia. For more information, please contact: [email protected] or call 540-231-2233.
  • Recovery resources in the Blacksburg and New River Valley areas
  • Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, will be speaking in Blacksburg, Virginia on August 3, 2016. Read more

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.

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.