A Growing Alternative To 12-Step Programs
Dee Cloward’s recovery from addiction mirrors a path taken by millions of people worldwide. She began working the 12 steps, attending meetings in church basements, clubhouses and office buildings with the New York City fellowship of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).
“I attended a variety of AA and NA meetings for maybe six months or so and found them comforting and safe,” Cloward says. “I related to the stories and the courage and strength of those who had gotten clean and sober.”
But Cloward’s shyness kept her from socializing with her 12-step peers, and she felt wary about a faith-based approach to addiction recovery. “I felt that my religion and spiritual surrenderings were between me and my god, and possibly my church,” Cloward says. “I was very intimidated by the whole sponsorship concept, and I was reluctant to approach people for that.”
After slipping back into problem drinking – this time with young children at home – Cloward decided that daily 12-step meetings were not a good fit. She turned to the Internet for help and found a lifeline at SMART Recovery,® the leading secular self-help alternative.
“I felt as though I’d come home. Everything they said made sense to me,” Cloward recalls. “It was based on psychological principles – Cognitive Behavioral Therapy – that I had some familiarity with, and the people sounded so nice and hopeful and authentic and compassionate – without being pushy or overly-invasive. I definitely resonated right away.”
Now six years sober, Cloward embodies the growing movement of people seeking alternatives to 12-step recovery programs. They work on self-empowerment and practice techniques based on modern science to change their addictive behaviors. They find fellowship in organizations such as SMART Recovery,® LifeRing, Women for Sobriety, Moderation Management and HAMS (Harm reduction, Abstinence & Moderation Support).
The most popular of the non-12-step groups is SMART Recovery® (the acronym stands for Self Management and Recovery Training), a nonprofit launched in 1994. SMART serves an active online community – there are virtual meetings, recovery forums, podcasts and chat rooms – and also conducts free, in-person mutual support meetings.
“Twenty years ago we had about 150 meetings. Now we have 10 times that number, and in quite a few countries,” says Tom Horvath, Ph.D., President of SMART Recovery.®
It’s still a tiny fraction of the dominant 12-step approach, whose doctrine is deeply ingrained in recovery culture (AA estimates it had 2 million members and 115,326 groups worldwide in 2014).
But there’s growing enthusiasm for a pro-science, religion-neutral option to overcome drug and alcohol addiction.
SMART Recovery® attracts an estimated 95,000 visits each month to its main website, according to the organization. More than 1,800 people register monthly for SMART online services (such as virtual meetings) and an average of 500 people participate on the website daily. SMART’s face-to-face meetings are now held in churches, prisons, universities, treatment centers, veterans’ facilities and other U.S. locations – in addition to meetings in 13 other countries.
Empowered, Not Powerless
While SMART Recovery® shares elements with 12-step programs – such as peer support and a goal of abstinence – the organization rejects the 12-step view that a person is powerless over drugs and alcohol.
“In the powerless approach, it is assumed that outside support will always be needed – the higher power, the group, the sponsor,” Horvath says. “In SMART Recovery, we assume that in time, the individual can gain self-control.”
SMART’s emphasis on self-directed change is outlined in its 4-point program that covers Building and Maintaining Motivation; Coping with Urges; Managing Thoughts, Feelings and Behaviors; and Living a Balanced Life.
Each of the four stages include actions for managing thoughts and behaviors and preventing addiction relapse.
For example, a primary discipline used by SMART participants is Rational Emotive Behavior Therapy (REBT), which has been shown to promote abstinence and was more effective than AA in clinical studies of court-mandated recovery programs. REBT espouses that we can change how we feel and how we act by changing our beliefs (“bad things do not make you feel sad or depressed. You make yourself feel sad or depressed”).
“I think there is a really nice cognitive behavioral basis for SMART Recovery® that aids people in choosing their direction,” says Nicole Kosanke, Director of Family Services for the Center for Motivation & Change in New York.
“AA has a certain way of facilitating change through having a sponsor, working the steps, participating in meetings, “Kosanke says. “But with SMART Recovery,® what I’ve seen is that people are drawn to it and benefiting from it when they need help with skills – concrete strategies around, for instance, how to manage a craving or relationship.”
Some people find it’s easier to sustain recovery with “dual citizenship” – attending both SMART Recovery® and 12-step meetings, Horvath says. “There are individuals who benefit from both. 12-step can complement SMART or vice versa.”
The reasons are varied, but include attending 12-step programs for the fellowship, and joining SMART Recovery® for the behavior-change tools. In fact, 32.5 percent of SMART Recovery® participants also attend a group such as AA or NA, according to the 2014 SMART Recovery® Participant Survey.
Cloward, who found her home at SMART Recovery® and became a volunteer leader for the national organization, says there are many paths to recovery.
“There are so many people out there who don’t have support at all,” she says. “There is way more than enough room for whatever people find helpful.”
A Closer Look: SMART Recovery® Tools
SMART Recovery® has a “toolbox” of research-based clinical strategies to help people overcome addiction and improve their lives. “The SMART tools honor the person’s ability to make his or her own choices, and to engage in a new adaptive effort, while providing initial guidance on how to do so,” Horvath says. “Eventually, the ways of thinking suggested by the tools can become positive mental habits as the participant moves beyond addictive behavior toward living a meaningful and purposeful life.”
Here’s an overview of some of the most widely used SMART Recovery® tools:
Cost Benefit Analysis
– This exercise builds motivation to change by helping people weigh the pros and cons of their addiction. They explore all the benefits and rewards of engaging in the addictive behavior, along with the harmful costs and negative consequences. The list serves as a relapse prevention tool, since it’s a constant reminder of the specific, undesirable costs of substance abuse. You might ask yourself, “If my addiction was a used car, would I pay this much for it?”
Using the Cost Benefit Analysis, people also consider what they’re going to hate or dislike about giving up their addiction. They learn what kinds of new coping skills and life changes are needed to sustain recovery.
ABCs of Rational Emotive Behavior Therapy
– Learning the fundamentals of this cognitive practice may help a person feel better in distressing situations – even when the external reality does not change. In a nutshell, the ABCs help people to stop being victimized by their own thoughts. They learn the danger of “should” and “must” thinking and how to identify underlying beliefs that are often irrational and self-defeating and can fuel addictive behaviors. The ABCs teach self-empowerment through healthier, more rational thought patterns.
Here’s an example of the ABCs in action (from SMART Recovery®):
- A. (Activating situation) I tried to do something and failed
- B. (Irrational Belief I have about A) I must always be successful
- C. (Consequences of believing B) I feel bad, depressed, etc.
- D. (Dispute the Irrational Belief in B) Where is it written in stone that I must I always be successful?
- E. (Effective new thinking to replace B) I would prefer always to be successful but let’s be realistic – that isn’t very likely, is it? – so when I’m not successful I don’t need to make myself feel bad.
CHANGE PLAN WORKSHEET
– This is a personalized plan of action for making positive life changes. Participants document their goals, and the steps and support they’ll need to gain independence from addiction.
An example of a Change Plan Worksheet can be found here:
– (Destructive Imagery and Self-talk Awareness and Refusal Method) – is a technique to “defeat the addiction salesman in your head.” When the voice inside says “let’s do something destructive,” DISARM challenges that self-talk. Participants learn to counter these self-defeating thoughts and expose the lies, excuses and rationalizations that often drive addictive behaviors.
Here are a few sample Q & A’s that teach people how to disarm the addiction salesman in their head (their alter ego) and re-direct their energy to a healthier behavior:
QUESTION: Do I have to give in to the urge because it is intense and hard to resist?
ANSWER: No, I don’t have to give in. Because the urge is strong, it would be easy to give in, but I don’t HAVE TO. I have had urges that I did not give in to, therefore it must be possible to resist.
QUESTION: Will it be awful to deny myself by not giving into the urge?
ANSWER: No, it won’t be awful. It may be quite unpleasant, but unpleasant is not awful, it’s just unpleasant. If I don’t give in to the urge, it will get weaker and come less frequently. If I do give in, the urge will stay strong, be harder to resist next time and show up more frequently.
Help For Family & Friends
To give strength to loved ones affected by addiction, SMART Recovery® incorporates a method known as Community Reinforcement and Family Therapy, or CRAFT. This behavior therapy approach uses positive reinforcement – as opposed to nagging, threats or punishment – to help a loved one change destructive behaviors and maintain abstinence.
CRAFT also aims to improve the lives of concerned family and friends. They learn self-care techniques and how to feel better about themselves, despite the burden of a loved one’s substance abuse.
“I have seen that almost universally, CRAFT is extremely helpful in directing family members to take better care of themselves – while also doing what they can to influence the motivation and change in their loved ones,” Kosanke says.
Research studies consistently show the effectiveness of the CRAFT approach. In a review of four randomized controlled trials, CRAFT was found to be superior to Al-Anon and Nar-Anon programs – producing three times more patient engagement in addicted individuals who were opposed to seeking formal treatment (Roozen, et. al., 2010 Society for the Study of Addiction).