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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.’
More research needed 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.’

Spirituality

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.

Diversity is good

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

[A version of this blog appeared on an earlier iteration of Recovery Review and was published here in May 2014]

    4 Responses to "Not 12-step or SMART – 12-step AND SMART"
    1. It doesn’t surprise me to learn that 12 step programmes and SMART recovery have some ‘shared’ members. I don’t think a ‘one size fits all’ philosophy is a reasonable expectation for any recovery programme, as evidenced by the numbers who for instance try AA but don’t ‘keep coming back.’ I spend some time supporting people who are trying to get into recovery and the reason I hear quoted most often for resistance to AA is the perceived ‘requirement’ for a belief in God or a Higher Power and the The ‘God as we understand him’ clause apparently does little to help.

      I got into recovery with the help of AA and recommend it but frequently hear people with strong sobriety say that there are Steps that just don’t work for them. The point is that there’s enough in the programme as a whole and such is the sense of mutual aid and support, that what they do get from it is enough – enough in fact to allow for some ‘spare capacity’ to also help others. So perhaps the power of the group, sometimes suggested as a candidate for a Higher Power, is as important as the programme itself?

      At a point in life when we think all is lost, finding a group of people with a shared problem and a willingness to support each other is a wonderful thing so why wouldn’t we, having received empathy and help from one organisation, investigate what another has offer. It’s not against the law to cherry pick after all.

      Billie

      • djmac says:

        Although SMART has got some catching up to do in terms of the research, it’s very likely that the mechanisms by which it works will be similar to those of 12-step mutual aid, which, incidentally, seems to work as well for atheists and agnostics as it does for those who have some sort of faith.

    2. Detox Nurse says:

      Personally, I tend to find it easier to explain what SMART Recovery is to service users over AA. The fault is entirely mine, but when discussing mutual aid to treatment naive clients, there seems to be tendency for them to see SMART as more appealing. I not sure if this is anything to do with SMART or due to the negative stereotypes around AA.

      Our service holds an AA myth busting group that’s run by our mutual aid link worker and AA members. The uptake is frustratingly low and I know there’s talk of making it compulsory for client’s wishing to access the service. Not sure I’m 100% comfortable with this idea, but I do think people are more likely to try AA once they hear their message.

    3. The myth busting group sounds like a great idea but like you I’m not sure making it compulsory is the way to go. Offering service users an opportunity to question and engage with AA members outside of a formal meeting allows them to dip their toe in the water without feeling committed or press ganged. I wonder how many AA-averse service users have specific reasons for avoiding the fellowship and how many just don’t like the general look of it. It’s a shame because sometimes it only takes a couple of conversations to create a more open mind and challenge preconceptions.

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