By Tom Horvath, PhD
In the state of California, a licensed residential substance use treatment facility (a “rehab”) needs to provide 20 hours of treatment per week. Typically, this treatment is provided in groups. In many rehabs there is only one individual session per week, the minimum required by law.
The groups in a rehab have significant similarities with SMART Recovery meetings, particularly if a SMART participant talks about their specific goals and challenges. If someone were primarily interested in the treatment aspect of being in a rehab, 20 SMART meetings per week would be a reasonable alternative to residential treatment.
To make the best use of SMART meetings the participant would benefit from having an individual session a week, just like in the rehab. The individual (outpatient) session could occur with a psychotherapist, a recovery coach, a peer mentor, or someone similar.
There are other reasons to attend a rehab, not just the groups, but everyone has different needs. The biggest advantage of rehab for many is the break in using that almost always occurs there. That period of abstinence enhances brain functioning, and can lead to clearer thinking, better problem-solving, and more attention to one’s values and long-term goals. The rehab might offer spa-type experiences. Being there could be a break from stressful circumstances. The family might appreciate the sense of relief that comes from knowing their loved one is being taken care of by others.
If someone attends SMART meetings, rather than checking into a rehab, they could still be engaging in substance use. However, for several groups of people that possibility may not be problematic. Some are confident of their ability to abstain for a few weeks. If someone is concerned only about alcohol, the medication disulfiram (Antabuse) could keep them from drinking (by making them sick if they do). Naltrexone would prevent an opiate high, but I recommend against it early in the change process because so many people die from an overdose after the naltrexone wears off or is discontinued. If naltrexone is ever used for opiates, I recommend that it be considered only much later in the change process, if at all.
A third group is individuals who are confident they could abstain or dramatically reduce consumption for a briefer period, long enough to learn whether this course of action was helpful. A fourth group might be highly motivated to avoid the typical 12-step, powerlessness-based, disease-model oriented approach that still appears to dominate the US rehab industry (and their insurance coverage or budget does not allow for attending a rehab with a self-empowering approach).
If you’re looking for a free alternative to residential treatment, remember, there are as many approaches to change as there are individuals. Perhaps more SMART meetings, even if only one per day, would be a major or significant addition to your change process.
Liked this article? You might also be interested in: How SMART Recovery Works.
