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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®
(Self Management And Recovery Training)
www.smartrecovery.orgwww.smartrecovery.co.uk
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
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
SMART Recovery® Program Overview, cont.
• The intersection of – Self-empowerment– Empirically supported treatment– What will work in a support group
vs. SMART Recovery Therapy
Context for the Emergence of SMART Recovery®
• Diversity• Other support groups• Scientific findings• Legal decisions
Diversity
Race, color, gender, religion, age, national origin, veteran status, sexual
orientation, physical disability
Diversity, 2
Diagnosis, SES, personality, temperament, motivation, core
beliefs, social support, life situation, etc.
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
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
Alcoholics Anonymous® (AA)
• Acceptance of powerlessness
• Belief in a higher power
• Acceptance of label “alcoholic”
• Lifelong group attendance
• Aimed at severe problems
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
Alternative Support Groups
• Women for Sobriety
• Secular Organizations for Sobriety®
• (Rational Recovery®)
• SMART Recovery®
• Moderation Management®
• Life-Ring Secular Recovery
San Diego Treatment Provider Survey, Fall 1998 (N=38)
45%
47%
8%
Only 12-Step Exists Others Exist-Don't Work Others May Help
Scientific findings
Addiction is a choice
Co-occurring disorders
Efficacious treatment
Natural recovery
Empirically support treatment
Handbook of Alcoholism Treatment Approaches: Effective Alternatives (3rd. ed.)
edited by Hester, RK. & Miller, WR
Boston: Allyn & Bacon, 2003
Principles of Drug Addiction Treatment: A Research-based
Guide
National Institute on Drug Abuse
October, 199913 principles or 54 page document available at
www.nida.nih.gov
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.
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.
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
Stages of Change
Preparation
Action
Maintenance
Contemplation
Relapse
Precontemplation
Permanent exit
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
4. Individuals who have gained independence from addictive behavior are invited to stay
involved with us, to enhance their gains and help others.
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
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
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
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
SMART Recovery® Structure & Operations
• Participants (meetings, internet, pubs)
• Facilitators
• Volunteer Advisors
• Board of Directors– Central Office in US (Mentor, Ohio)
• International Advisory Council
SMART Recovery®Board of Directors, 2007
• 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® International Advisory Council
• Aaron Beck, M.D.
• Carlo DiClemente, Ph.D.
• Albert Ellis, Ph.D.*
• Frederick B. Glaser, M.D.
• Nick Heather, Ph.D.
• Reid Hester, Ph.D.
• Keith Humphreys, Ph.D.
• Harald Klingemann, Ph.D. • Richard Longabaugh,
Ed.D.
• Alan Marlatt, Ph.D.
• Maxie C. Maultsby, Jr., M.D.
• Barbara McCrady, Ph.D.
• Peter Monti, Ph.D.
• Stanton Peele, Ph.D.
• James Prochaska, Ph.D.
• Linda Sobell, Ph.D.
• Mark Sobell, Ph.D., ABPP
• William White, M.A.*deceased
SMART Recovery® Publications
• SMART Recovery Handbook
• Facilitator’s Manual
• News and Views (quarterly newsletter)
• Recommended reading list
• Smartrecovery.org
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.
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.
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
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
SMART Recovery®and public policy
• Cost savings
• Need for a strong UK Central Office
• Finding facilitators– Encouraging partnerships?
SMART Recovery® Central Office7537 Mentor Avenue, Suite #306
Mentor, OH 44060
440-951-5357
Fax 951-5358
SRMail1@aol.com
www.smartrecovery.org
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