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Not 12-step or SMART; 12-step AND SMART

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ChimpsmileWhat value could there possibly be in getting people with social and brain impairment together to help each other without any sort of professional involvement? John F Kelly and Bill White suggest this could be interpreted as ‘the blind leading the blind.’As it turns out, there’s quite a bit of merit in mutual aid with members getting the same kind of outcomes that they might get if they were engaged with professionals. Kelly and White quote the oft heard recovery phrase:We may be sick, but we’re not all sick on the same day.’

 In this 2012 paper the background to mutual aid is explored and the authors point out that although AA dominates, there are plenty of mutual aid organisations around. The problem is that they haven’t been researched to the same degree as AA even though ‘due to their similar social orientation and group format, they may confer benefits comparable to those of AA.’

In the UK, SMART Recovery has grown significantly in just a few years. A search on their meetings finder comes back with ten meetings in the central belt in Scotland (compared with hundreds for 12-step), though I think that’s an underestimate. Although the philosophies are different, there is a significant crossover with some folk in recovery attending both. In a SMART member survey, 60.7% of members reported believing in some kind of god or higher power, and 85.2% reported attending AA or other 12-step organisations in addition to SMART Recovery, which kind of bursts some of the myths out there. SMART Recovery is recommended in the latest NICE guidelines alongside 12-step approaches.

Kelly and White call for greater diversity in mutual aid and encourage professionals to overcome barriers to refer to smaller organisations. They conclude: ‘Providing and supporting greater choice and more options will broaden the base of addiction mutual help. This, in turn, is very likely to enhance the chances of recovery for more individuals.’

[This post was first published on the pistach.io Recovery Review site where there were also comments. These are published below.]

SMART Recovery UK: Couldn’t agree more! We find that there are quite a lot of people attending SMART Recovery meetings attend the Fellowships as well. Some prefer one, others prefer both – and we should all celebrate choice. The research paper you quote is from the USA but is still really interesting. The UK is a lot less religious than the USA so I think we will find less higher power belief here – but I strongly suspect the proportion who also go to fellowships might be similar.

Thank you for posting this – it is a terrific anecdote to some of the divisive ‘my way works best for everyone’ nonsense out there..

DJ Mac: Thanks for the comment. You are right – fewer people have a god belief here than in the USA; I think about a third of us are atheists. Mind you some of them are in the Fellowships! And of course, choice is good, though I think sadly that rivalry, narrow-mindedness and black and white thinking will remain with us. That’s not a reason to put up with it though.

I was going to do a separate blog on SMART at some point. Do you have any studies or evaluations that might be of interest?

SMART Recovery UK: 
There are not many evaluations of SMART Recovery – there are a few bits of research but MOSTLY the evidence for mutual aid is about AA in the USA, so you are extrapolating from there. You might be interested in this paper – published this weekend – it would be great to see your thoughts / review of this on your excellent site: http://cdn.smartrecovery.org.u…
Further comment on your post – and some of this is covered in the evidence review: In the USA, 60% of SMART Recovery attendees believe in God or a higher power (I think that is right, but haven’t gone back and checked) and I think a majority go to Church. So certainly religious belief is no barrier to participation. That said, ~90% of US citizens report believe in god or higher power – so the 30% difference seems very significant. This suggests to me that in the USA, religiosity is a factor for many people who choose SMART Recovery (or presumably, Lifering etc). It seems likely however that atheists behave differently in a highly religious society (where they may feel themselves to be a beleaguered minority!) to a more pluralist and secular country such as in Northern Europe.
So we should not assume that this pattern will repeat in the UK. I personally don’t think it will, or not to that degree. This is touched on in the evidence review.

We were at a great conference in Chester yesterday – it was fairly 12 step focused but a great sense of agreement that it really is 12 step AND SMART Recovery rather than one vs the other. Lots of people at the event use both kinds of meetings, which is great.
One of the speakers argued strongly that evidence suggested it was not which ‘recovery club’ you were in, but that you were in a club! So we can say with confidence that mutual aid is a good idea, but for any individual we are not likely to be able to predict which approach will work best – better that they try lots of things and use what works for them..
Thanks for great site..
Richard

DJ Mac: Thanks for the feedback. I took a brief look at your paper earlier in the week and made a mental note to review, so will get round to this. I think the research on why 12-step works is likely to be confluent with processes in SMART, perhaps with one difference around the accumulating evidence on ‘spirituality’ which does also seem to predict good outcomes. Who knows what spirituality studies in SMART might yield; we may find SMART members rate spirituality important in their recoveries too. In any case, as you say, many do both meetings and everyone should have a choice of what’s on offer

    2 Responses to "Not 12-step or SMART; 12-step AND SMART"
    1. Anon says:

      10 meetings in central Scotland is definately an underestimate. There were 14 in Edinburgh alone as of last April and it is growing apace.

      SMART – excellent at enabling recovery, less good at IT

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