SMART Recovery at 30
By Tom Horvath, PhD
This weekend SMART Recovery is celebrating (a few months early) its 30th anniversary by holding a conference in Salt Lake City. What has SMART achieved? How well is it functioning? What might its future hold? What follows is my personal perspective on some highlights of SMART’s first 30 years (from someone who has been part of that process), and my hopes for the years ahead.
Growth and influence
The good news is that in 2018 SMART Recovery expanded into SMART Recovery International, which has a world-wide presence. The US based organization is now an affiliate of the international organization, which operates approximately 2,500 weekly meetings in 38 countries and has printed materials in 18 languages. The less-than-good news is that SMART in many parts of the US is more of an idea than a reality. Although anyone with an internet connection can attend an online meeting, SMART’s in person mutual help experience needs to be much more available.
Fortunately, when mutual help for addictive problems is mentioned, many perhaps most behavioral health organizations mention SMART Recovery alongside 12-step groups. However, the public remains largely unaware of SMART (presumably most have heard of AA), and many treatment organizations fail to inform their clients about SMART. How long it will take to improve this situation is anyone’s guess, but progress does seem to be accelerating. Also fortunate is the fact that even as an idea SMART is a powerful addition to the current system. Once someone has heard of SMART (even if they have not attended a meeting), the idea that they have choices about how to change becomes more believable.
Evolution in approach
SMART promised to “evolve as the science evolves.” The two most substantial evolutions so far have been to give up the view that addiction is not a disease, and to embrace the goal of progress rather than the goal of abstinence.
Within about a decade we realized that our meetings could be helpful regardless of someone’s view about addiction as a disease. Perhaps a third of participants viewed their problems as diseases, and the remainder viewed it otherwise, or were unsure. We realized that there was little value in having a position on this issue, or on debating the issue in meetings. Now we state: “SMART Recovery tools can help you regardless of whether or not you believe addiction is a disease.”
The transition to a harm reduction perspective began almost at SMART’s founding, and was finalized in 2022, when SMART adopted the following policy on goals: “We support progress with reducing addictive problems and building a better life. Participants choose their own specific goals.” We were always ready to accept participants at any stage of change, and now clearly state that you need not be considering abstinence. For all participants the over-riding goal, since the beginning of SMART, is building a better life.
This policy fits with recent developments in society, and with SMART’s own experience. With the dramatic rise in overdose deaths harm reduction has become more acceptable in society (although it is far from universally accepted). Within SMART we have observed that 1) many participants are choosing, for instance, to abstain from alcohol but moderate cannabis, or to moderate all their substance use, 2) some participants attend because of problems that align with moderation (e.g., food, or sex), and 3) meeting participants appear to be supportive of the goals of other participants, even if those goals are different than their own; “abstinence only” is not necessary for having a meaningful interaction in meetings. We can say that everyone in SMART is “learning to stop” but deciding for themselves “where to stop.”
In the run-up to this policy change SMART’s language about abstinence softened, but printed publications may continue to contain “abstinence only” language until they are updated. We can recognize that a small, underfunded non-profit does not have the resources to instantly reprint all its publications. Helping SMART hire more staff is an excellent reason to consider contributing (and it’s tax deductible)!
SMART in the scientific literature
There is a growing list of publications about many aspects of SMART. There is emerging evidence that SMART is as effective as any approach for addictive problems. Additional studies are underway. We expect that in about two years there will be sufficient evidence to state that SMART appears to be as effective as AA and as effective as professional treatment.
One aspect I hope to see change is information about who attends SMART and who finds it appealing. SMART participants so far are significantly white and well-educated, and the literature reports this fact. However, as SMART takes its place in other communities, I expect to see SMART participants reflect the US population. SMART already operates within a few minority communities, where it is well received.
I also expect the scientific literature will make clearer statements about how much there is for us to learn about how mutual help groups work. I expect that SMART, AA, and other mutual help groups will be found to have similar mechanisms of action. Like psychotherapy, I view the effectiveness of mutual help groups as based on common factors rather than unique mechanisms, despite surface differences. If these findings solidify, training about how to conduct any mutual help group will need to accommodate it.
Self-description
In its early days SMART described itself as a non-12-step approach. Perhaps that was sufficient at the very beginning, but we quickly realized that we needed to describe what we are, not what we are not! We now have much to say about our guiding principles, and how our meetings operate.
Our current guiding principles
Participants establish their own specific goals (or none at all).
We support individuals who consider, act on, or maintain a process of change from the addictive behaviors they consider problematic. The goal of the change process could be to abstain, moderate, reduce use, or reduce problems.
Our approach is self-empowering, science-based, progress-oriented, and holistic.
Progress occurs by learning, which includes practice. Participants learn from one another. They also learn from SMART, via our publications and our facilitators. Our content is primarily accurate psychological information (to correct the misinformed ideas some participants have) and how to use psychological tools (so that they can be applied well in the participant’s life).
Participants are encouraged to develop their own unique pathways for change (self-empowering):
- We support the use of legally prescribed medications for addictive and psychiatric problems
- Belief in a higher power is not part of our approach (although participants may choose to incorporate religion or spirituality into their change process).
- Participants are encouraged to make use of other forms of support, as needed
SMART’s language, tools, and information will change as scientific evidence changes (science-based).
SMART occurs in public. We do not have sponsors (an individual to meet with someone privately).
Our meetings now operate according to the following rules:
SMART meetings are confidential and free (donations requested).
Participation by all is encouraged, but no one is required to participate. In online meetings cameras may be on or off.
Perhaps the primary rule is that no one can be disruptive.
Meetings are conversational. No one should talk too long or too often.
Participants and facilitators do not give advice, but they do share their own experiences when appropriate. Participants are encouraged to be thoughtful about the language they use.
Our meeting discussions focus on
- Any level of current or past addictive problems
- Making progress with reducing or resolving addictive problems (progress-oriented)
- The ultimate goal of building better lives (holistic)
- Changing our situations when we can
- Revising our interpretations of these situations when we cannot
Meetings are open to the public unless otherwise indicated.
Meetings with a specific focus or for a specific population may be established.
Facilitators are expected to be humble about what they and SMART know, confident about how to facilitate a meeting, and empathic with participants. During their training they learn a range of information and tools for use in meetings. They are granted significant authority about how to conduct some aspects of their meetings. Meetings use the format chosen by the facilitator.
Our nationally oriented online meetings, which may have hundreds in attendance, are more instructional, while the smaller meetings, typically oriented to a specific locality (either in person or online) are more interactive.
SMART’s future
We continue to work towards the time when a SMART meeting is easily accessible to anyone who could benefit from it, when SMART is as widely known as AA and NA, and when there is no argument that SMART is a valuable resource for anyone who chooses to attend. I also hope SMART makes the four following changes (these changes already appear to be emerging).
Using inclusive language: The first change is the use of inclusive language. In my view many of the terms used in the field of addictive problems (including recovery, in recovery, sobriety, disease, higher power, alcoholic, addict, chemical dependency, hit bottom, rock bottom, enabling, enabler, co-dependent, relapse, slip, lapse, addiction, etc.) are potential sources of conflict. For instance, would someone who attends SMART Recovery with mild to moderate eating problems, or minor alcohol problems, or very intermittent over-use of cannabis, want to think of themselves as seeking recovery or sobriety, as having hit bottom, or as having an addiction? Maybe not. Further, evidence from scientific surveys indicates that some individuals even with severe problems do not use some of these terms.
SMART has a history of rising above possible conflict. For instance, disease or not, higher power or not, abstinence or not, you are welcome in SMART Recovery. Further, we do not debate these issues. You are free to think about them as you choose. I believe we need to take the additional step of encouraging our participants to use whatever language they want about themselves, and to use the language that someone else uses when talking about them.
I can call myself an alcoholic if I want, but I should not use that term about you unless you do. If the term alcoholic has come to be meaningful to me (it might have taken much work to reach that place) I also should not be criticized for using it. On the other hand, we need to educate our participants about how certain terms (addict, alcoholic, disease) may contribute to stigma. The guideline about talking only about oneself seems likely to be helpful here.
Ironically, even the traditional understanding of the term “recovery” can reinforce the idea that addictive problems are (hopeless) diseases, and that the individuals who have these diseases are quite different than others (“normies”). Although the traditional “recovery community” objects to stigma, I suggest that the language they use reinforces the existence of stigma. We would be much better off to recognize that addictive behavior is universal, and that addictive problems may be universal (at least at times). It’s hard to stigmatize a group when everyone is in it.
SMART itself should use only the most inclusive language: “The SMART community supports individuals who consider, act on, or maintain a process of change from the addictive behaviors they consider problematic. The goal of the change process could be to abstain, moderate, reduce use, or reduce problems.” By using only inclusive language we reduce possible conflict in meetings, we can be appealing to a wider range of people (“SMART welcomes you, because SMART is for everyone”), and we are being consistent with a self-empowering approach (in which you would choose your own language about yourself).
Identifying reinterpretation as the essence of change: As Epictetus said: “We are disturbed not by events but our views of them.” The second change I hope SMART makes is the recognition that re-interpretation is the essence of the change process (not only in SMART, but throughout behavioral health). This essence is captured well in one of our slogans: “Discover the Power of Choice.” The ABC tool, widely considered an essential tool in SMART, is essential because it reflects the importance of re-interpretation. Although we change our situations when we can (by communicating better, being more assertive, learning better how to relax, not acting on urges, etc.), our biggest challenges typically involve re-interpreting situations or aspects of situations we cannot change (I’m aging, I’m going to die, substances are very enjoyable for me, I need to make a living, etc.). In our meetings we help each other re-interpret our lives, making them more based on our deepest values, more productive and connected, and hopefully happier. Our re-interpretations may be basic (substance use is not worth it anymore) or more complex (in the years I have left I want make life better for my family).
Distinguishing tasks, tools, and information: The third change I hope SMART Recovery makes is to distinguish tasks (such as the 4 Points), psychological tools (such as the cost-benefit analysis), and information (such as the information that urges are time-limited, are not harmful, and do not force us to act on them). Why is this change important? We need to recognize that once we grasp information we are often immediately changed, but tools and tasks require ongoing effort. Learning ideas in a meeting can indeed be essential, but so is persistent practice.
Emphasizing openness and vulnerability over reasoning and evidence in meetings: The final change I hope to see is emphasizing the significance of creating a spirit of non-judgment in meetings. That spirit will lead to greater openness and vulnerability from participants. Reasoning and evidence will continue as a foundation of SMART (and of a good life). However, reasoning and evidence are only as helpful as the beliefs presented are significant. A meeting could work diligently on “my boss doesn’t like me” and not make much progress if the deeper belief is “my boss has figured out that I’m no good, and therefore does not like me.” That second, deeper belief is unlikely to come out if the participant does not feel safe enough to state it. Rather than focusing on the various surface manifestations of that deeper belief we could focus on the root itself. For many participants just stating the underlying belief out loud to others is a major advance. Reasoning and evidence can come later. Such vulnerable statements occur only in a meeting in which participants feel safe to express themselves.
Thank you!
SMART is reaching and supporting individuals who might not have found another pathway for change. Thank you to everyone who has contributed to the development and dissemination of SMART Recovery!
Thank you to Bill Greer, President, SMART Recovery USA, for his suggestions about this blog.
Liked this article? You might also be interested in: SMART Recovery’s First Systematic Scientific Review