Today we highlight treatment resources for substance abuse and addictions. While Twelve Step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) may be familiar to the general public, there are other alternatives. SMART Recovery® is one such organization that is gaining popularity.
This is taken directly from their website:
SMART Recovery® is the leading self-empowerment addiction recovery support group. Our participants learn addiction recovery tools based on the latest scientific research and participate in a worldwide community that includes free, self-empowerment, and science-based mutual help groups.
The SMART Recovery® 4-Point Program® helps people recover from all types of addictions and addictive behaviors, including: drug abuse, drug addiction, substance abuse, alcohol abuse, gambling addiction, addiction to cocaine, prescription drug abuse, sexual addiction and addiction problems to other substances and activities. SMART Recovery® sponsors face-to-face meetings around the world and daily online meetings. Plus, our online message board and 24/7 chat room are great forums to learn about SMART Recovery® and get addiction recovery support. If you’re new to SMART Recovery®, start with our introduction here.”
As someone who has attended literally hundreds of NA meetings in the last ten years, but who is also a trained mental health counselor, SMART Recovery® appeals to me in ways that NA doesn’t. For the record, if NA or AA works for you, then keep doing it. But for me, some of the ideals that NA holds sacred are the ones I find the hardest to accept as a practicing physician. Here are 4 ways SMART Recovery® is different:
1. It is okay to have a mental illness.
When I was new to recovery, I just assumed that everyone in recovery also had a mental illness. This is called a dual diagnosis: basically, you are an addict AND you have something like depression, anxiety, or bipolar disorder. I was surprised to learn that this was not the case. It’s probably up for debate, but I knew several recovering addicts who claimed they had never experienced any mental health problems, aside from the addiction, of course, which had invariably ruined their lives. Also, I soon discovered that those addicts who suffered from mental illness were reluctant to admit it to the rooms. He would certainly discuss it with his sponsor, but these kinds of topics were considered controversial in a general meeting.
I could never understand why that seemed to be the case. I suspect it has something to do with NA’s belief in a Higher Power and the power of the Program. The idea is that if he’s working on the show the way he’s supposed to, his sanity should come back and he’ll become a productive member of society. Extremists in groups would inevitably claim that you weren’t working the show to the best of your ability if you were still depressed or manic from any of the other things that come with mental illness. I guess this is true for some, but it certainly wasn’t the case for me.
SMART Recovery®, on the other hand, fully acknowledges mental illness as something real, sometimes separate from addiction but often linked. They recognize “possible psychological factors” and members are treated accordingly. This makes sense to me.
2. They support the evidence-based use of psychological treatments and the legal use of prescription psychiatric medications.
This might be the biggest difference between SMART Recovery® and NA. Both NA and AA insist on separating themselves from “professional services.” It is even against their guidelines to have trained doctors involved in the meetings. NA, for example, believes that “the therapeutic benefit of one addict helping another is unparalleled.” That sounds great, and for many it is true. Except when you think about it, you’re talking about a sick person, with no training, helping another sick person. Admittedly, this works for many, but why is it a bad idea to use evidence-based therapy or even prescription medication in the fight against addiction and co-occurring mental illness? Many NA members scorn the very idea of medication, for whatever reason. Some would go so far as to say that you are not working on an honest program if you are using any medication, prescription or not. total abstinence from everything.
While it might not be a good idea for a recovering heroin user to take narcotic painkillers when Advil would, this belief gets a little more murky when you start looking at mental illnesses like schizophrenia and bipolar disorder. These are conditions that can absolutely be managed with medication and therapy, but the bottom line is that some schizophrenics are completely unable to function without their medication. In an example like this, abstinence from all substances seems like a horrible idea. I attended NA meetings for years and was under a doctor’s care all the time for both severe anxiety and depression. I was prescribed medication for both. I told exactly zero people in NA about that part of my life. Not because I was embarrassed, but because I didn’t want to be accused of “relapse” when all I did was take legally prescribed medication. This ended up being one of the main reasons I eventually stopped attending meetings. Even as a licensed counselor, I am hesitant to talk to people about psychotropic medications, as I am not a medical doctor. I just don’t think it’s a good idea for completely untrained people to give medical advice on anything. But sadly, that’s what sometimes happens in NA rooms.
3. NA sees addiction as simple; SMART Recovery recognizes its complexity.
NA promotes its program as a simple program for complicated people. It sounds like a great idea. Except addiction is a complicated disease that gets even more complicated when you try to simplify it too much.
Consider the following: Not all addicts are built the same. I know many recovering addicts who claim they can get addicted to anything: heroin, crack, sex, soap operas, you name it. I know others who had their one drug of choice and never really had a problem with anything else. I was one of those types of addicts. He had what can best be described as a psychological addiction to marijuana. In my past, I have tried many other drugs. None of them really interested me. To this day, I have a beer every now and then, but I can’t remember the last time I got drunk. I have also never been arrested or been in trouble with the law, which for many addicts is the norm. All I’m saying is that we’re not all the same. SMART Recovery® recognizes this. SMART Recovery® accepts that this is a complicated and multifaceted disease. Some addicts require medication; some don’t. Some addicts require hospitalization; some don’t. Some addicts need therapy; others need responsibility, direction, structure, or all or none of these things.
4. SMART Recovery is based on science, not spirituality.
The following is taken from the SMART Recovery® FAQ: SMART Recovery® is scientifically based, not spiritually based. SMART Recovery® teaches how to increase self-sufficiency, instead of helplessness. SMART Recovery® meetings are discussion meetings where people talk to each other, rather than each other. SMART Recovery® encourages attendance for months or years, but probably not a lifetime. There are no sponsors in SMART Recovery®. SMART Recovery® discourages the use of labels such as “alcoholic” or “addict.”
If you’ve never been to a 12-step meeting, the differences may not be obvious to you. But the differences are profound. At an NA meeting, if I speak, I’m supposed to say “Hello, my name is Randy and I’m an addict.” It’s weird if you don’t. NA’s position is that we have to accept who we are, and I agree with that. But is it possible that we can change? I think it is. But if I go to an NA meeting and say “Hi, my name is Randy and I used to be an addict,” you can be sure there will be drama.
Also, the basic assumption with NA (and AA, for that matter) is that you attend those meetings FOR THE REST OF YOUR LIFE. Even if that is correct, how realistic do you think it is? Certainly some people end up doing this, since addicts have a bad habit of dying young. SMART Recovery®, on the other hand, recognizes that at some point treatment must stop. So are the things. Professional advice these days focuses on brief therapies that really shouldn’t last more than six months. If you’re seeing the same therapist five years later, you really have to ask yourself if any work is really being done. Wouldn’t the same thing happen with NA?
Finally, impotence was a problem I always had with NA. It’s also a HUGE part of his philosophy. We have to admit that we are powerless. Only then can we admit that we need help. That’s true, but the problem is that people tend to use impotence as an excuse for all sorts of things. SMART Recovery® advocates self-sufficiency, which is the cornerstone of any modern treatment modality. If we’re going to get better, we’ll need to lean on others at first, but eventually, we’ll have to lead our own lives. As well as being a more realistic way of looking at things, it also has the benefit of being killed.
If you’ve had success in the NA or AA rooms, then of course I want to encourage you to keep doing what you’re doing. It’s obviously working for you, so why change it? But if you’re like me, and parts of NA or AA just don’t sit well with you, or you prefer a more scientific approach to substance abuse treatment, check out SMART Recovery®. It’s free, they offer online and in-person meetings, and they even have an online chat feature if you have any questions or concerns. If you or someone you know is struggling with addiction, use the tools you have to fight back against this cunning and elusive disease. See SMART Recovery®.