History of SMART Recovery

SMART Recovery, a non-profit corporation, was originally named the Rational Recovery Self-Help Network, and was affiliated with Rational Recovery Systems, a for-profit corporation owned by Jack Trimpey.

In 1994, the non-profit changed its name to SMART Recovery, and ended all affiliation with Trimpey. This change occurred because of disagreements between Trimpey and the non-profit's board of directors about the program of recovery to be offered in the self-help groups.

SMART Recovery is comprised almost entirely of volunteers and available in many countries around the world. Its ideas are based on scientific research drawn from outcome research on addiction treatments and observational studies of “natural recovery”. The program is designed to help people recover from all types of addictive behaviors, including: alcoholism, drug abuse, drug addiction, substance abuse, alcohol abuse, gambling addiction, cocaine addiction, and addiction to other substances and activities.

Definition of SMART Recovery

The objectives behind SMART Recovery’s methods is to assist people to take control of addictive behaviors, attain sobriety, have a well-adjusted lifestyle and lead meaningful and fulfilling lives. SMART Recovery uses a 4 point program, building and maintaining motivation, coping with urges, problem solving, and achieving a more balanced lifestyle. Through these 4 points they provide the tools needed for and sustaining change using techniques based on Rational Emotive Behavior Therapy (REBT), Cognitive Behavioral Therapy (CBT) and Motivation Enhancement Therapy (MET). These techniques along with attending meetings help in gaining control over addiction.

Theory Behind SMART Recovery

Is based on Science, Secularity & Sobriety.

• SCIENCE – The SMART Recovery® program originates in science and embraces techniques shown to work relatively better in rigorous research, through an international panel of experts. Ongoing research allows the program to adopt new ideas that reflect new discoveries.
• SECULARITY - The SMART Recovery® program is not based on spiritual or religious beliefs, nor does it teach them. It is not required to belong to a religious organization or other affiliation to be a part of the program, this is left up to the individual, and their own beliefs.
  
• SOBRIETY – The SMART Recovery® program based on abstinence where alcohol, drugs and many other addictive behaviors are concerned. Each individual must decide what their addictive behaviors are and must be certain about the aspect of the problem behavior from which they will abstain. With commitment and the practice of the program, abstinence can be a safer, easier and more effective goal.

Difference between 12-Step Programs

• They are not based on religion and do not rely on a higher power or religious belief;
• They do not use or require a sponsor;
• They do not label people as alcoholics and addicts;
• They do not emphasize past mistakes, they teach to learn from them and move on;
  
• They do not believe the need for a life-long program. Instead they give members the tools and skills they need to live an addiction free life without falling back in to old routines and behaviors.
  

SMART Recovery How it works

SMART Recovery® combines meetings (available in person or online) with a science based 4-point program. Where each of the 4 points gives you different techniques that are needed to change addictive thinking patterns, and gives the tools to maintain that change in recovery.

What is the importance of going to meetings (either in person or online)

• Meetings allow for a system of mutual support between people going through the same type of situations in life who are wanting to, or considering change of destructive habits and improve their lifestyle.
• Meetings allow for a discussion among those in the program of the different tools and theories they’ve learned, and helping to dismiss and misgivings.
  
• Meetings allow those who have changed and succeeded in their lives to share their experiences with those wanting change. Providing them with hope and allowing them to realize they are not alone, nor the only one dealing with addiction or addictive behaviors, and that change is possible.
  

SMART Recovery and the 4 point Program

1. Building and maintaining motivation
   - Improving and continuing motivation to refrain from addictive behavior
2. Coping with urges
   - Learning how to cope with urges and cravings
3. Problem Solving : Managing thoughts, feelings, and behaviors
   - Teaching different techniques to control harmful thoughts, feelings and behaviors
4. Achieving a more balanced lifestyle
   – Balancing short-term and long-term desires and needs to live a satisfying life.

Point 1: Building and Maintaing Motivation

- Improving and continuing motivation to refrain from addictive behavior

This point covers tools and tips for abstaining from your addiction, things to help those in early stages of recovery get through this period and how to move on, by looking at the good and bad of using, what you gain by abstaining, assessing your values, defining what you want to change and how, and several other useful tools. Not to mention what they offer online through message boards, chat rooms, meeting rooms and their online library.

Stages of Change

Recognizing that members might be in different stages of change helps to identify different exercises that may be helpful at different stages

• Precontemplation Stage
  Not yet acknowledging that there is a problem behavior that needs to be changed.
  -These people are not thinking seriously about changing and are not interested in any kind of help. People in this stage tend to defend their current bad habit(s) and do not feel it is a problem. They may be defensive in the face of other people’s efforts to pressure them to quit.
• Contemplation Stage
  Acknowledging that there is a problem, but not yet ready or sure of wanting to make a change.
  -These people are more aware of the personal consequences of their bad habit and they spend time thinking about their problem. Although they are able to consider the possibility of changing, they tend to be ambivalent about it
• Preparation Stage
  Getting ready to change.
  -These people have made a commitment to make a change. Their motivation for changing is reflected by statements such as: “I’ve got to do something about this — this is serious. Something has to change. What can I do?”
• Action Stage
  Changing behavior.
  -This is the stage where people believe they have the ability to change their behavior and are actively involved in taking steps to change their bad behavior by using a variety of different techniques.
• Maintenance Stage
  Maintaining the behavior change.
  -This involves being able to successfully avoid any temptations to return to the bad habit. The goal is to maintain the new changes. People in this stage tend to remind themselves of how much progress they have made.

Cost/Benefit Analysis (CBA)

CBA Worksheet

This tool is designed to help with building and maintaining motivation by identifying the good and the bad of using, of not using, and how could the person’s life change if they didn’t use anymore. It uses 4 basic questions to

• What is it about your addiction that you enjoy, and what it does for you?
  
• What is it about your addiction that you dislike, and what it does to you?
  
• What is it about giving up your addiction that you will like?
  
• What is it about giving up your addiction that you’re not going to like?
  

By using advantages (benefits and rewards) against disadvantages (costs and risks) listed out this helps the addict to see on paper short term and long term effects that using and not using will have, up against each other. Which in turn helps remind them of their motivations for quitting. This is an ongoing project. For most people as time goes on they remember more about the positive and negative parts of addiction and recovery and continually add to this worksheet. This worksheet can be done alone or used as a tool during meetings.

Hierarchy of Values Worksheet

HOV Worksheet

With this tool the person decides those things that are most important to them in life. Staring off with writing down those things in life they find to be important to them. Then they select the top 5 of those that are MOST important to them. By doing this it points out that their addiction isn’t a part of that list, and when they let their addictive behaviors take over it puts those things they value the most in jeopardy. Constant review of this is another tool to help the addict to stay motivated in their quest for change.

Change Plan Worksheet

Change Plan Worksheet

A tool to help with Building and maintaining motivation actually writing down a plan of action for the changes they want to make.
Questions include

• What changes the person wants to make
• What are the most important reasons for making these changes?
  
• What steps does the person intend on making this change?
  
• How can others help in making this change?
• What are signs that show the plan is working?
• What could interfere with this plan to change?
• The importance of change
• A person’s level of confidence that they can actually make these changes?

This also is an ongoing worksheet as ones ideals and situations change through recovery, to be used alone or with the help of others in meetings.

Motivational Interviewing

Motivational interviewing is a tool used to help people resolve their indecision about changing addictive behaviors without instilling resistance to change.

Motivational Interview is based on the stages of change, is goal oriented, and focused.
The basic skills for motivational interviewing follow 4 basic steps called OARS

1. Open-Ended Questions: These types of questions cannot be answered by a simple yes or no, and require the person to explore one’s own thinking.
   
2. Affirmations: The use of affirming or encouraging types of declarations help the person to recognize their own positive behaviors, thoughts, and strengths building confidence that change is possible. They express respect, acceptance, and care and must be both honest and appropriate.
   
3. Reflective Listening: This is repeating back the comments a person has just make, allowing them to hear it for themselves, and ensuring you heard them correctly. It helps to intensify the conversation by letting that person hear back what they said, leading to a better understanding of their own thoughts.
   
4. Summary Statements or Self-motivational statements: This statement pulls everything together already said. This allows for the person to recognize and say out loud the issue they have been dealing with. Pointing out observations made and getting further input, this also helps transition into the next topic.

Point 2: Coping With Urges

- Learning how to cope with urges and cravings

Learning how to cope with urges you must first have an understanding of what urges are and the strategies to deal with them.

-Understanding your urges
It starts with a trigger, someplace, something, someone associated with using. If thought continues on it gets stronger and becomes cravings (the desire for the effects of what was given up). If the person allows the thought of cravings to continue they become urges, the strong feeling that they need to have what they crave. The best way to avoid this is by avoiding people, places and things that are triggers. But that is not always possible, so it’s necessary to learn ways to dismantle cravings and urges.

Many myths and misconceptions about urges and cravings have been spread that make it more difficult in managing those behaviors. When learning more about them, the fear of them subsides, and cravings and urges can be used to initiate coping strategies instead of negative behavior. Best thing to remember is that a person can accept the feeling of cravings and urges without automatically going back to addictive behavior.

--Coping Strategies
There are many ways to cope with urges and cravings, most people find what works the best for them and stick with those. The more common, and easiest are avoidance, escape, and distraction, but are not always effective, it helps to also learn behavioral modification skills also.
Strategies learned give way to tools to help reduce the difficulty of cravings and urges, but these take practice before they will come automatically, without thinking so hard about them. As long as the individual stays motivated and is willing to put forth the effort, the strategies will come more naturally in time.

Basic Strategies for Coping with Urges

• Escape: Leave the situation
  
• Avoid people, places or things that you associate with that type of behavior
• Distraction: Pay attention to something else.
  
• Put the things in perspective, rate it on a scale of 1 to 10 and notice if it’s exaggerated, compare to other uncomfortable things
  
• Thought Stopping: Yell out loud or in your head a firm statement to break your chain of thought such as “STOP”
  
• Remind yourself of the problems using caused.
• Think of what the negative consequences would be if you gave into the craving
• Visualize how good you will feel about resisting the urge
• Review Counter Arguments: Refer to CBA
  
• Come up with Coping Statements that counter urge triggering ideas
• Waiting It Out: This too shall pass just be strong, don’t use, and let it pass
• Observe the urge, notice it and pay attention despite its discomfort, and use imagery to push it away, this will help to lessen fear and discomfort in the future
  

Record Urges in a journal

Keep a log of your urges in a recovery journal, when they happen, what was the trigger, how uncomfortable it was, how long it lasted, and what strategy you used to get through it. This helps to enhance your awareness of the urges, triggers, and what strategies worked. This helps to transition to acceptance when you are able to accept the urge and notice it’s just a little uncomfortable, and not something you can’t handle. Soon you’ll learn to recognize it, acknowledge it, and then let it pass as you would any other thought.

Destructive Self-talk Awareness and Refusal Method (DiSARM)

This tool teaches how to challenge the negative thoughts brought on by urges and unveils them as lies, excuses, and rationalizations, by answer a few main questions. This is a good tool to use when having strong urges.
By answering these questions it puts the cravings in perspective and understand the urges better, helping in reducing them in the future.

• Do you have to give into the urge, even though it’s really strong and hard not to?
• Is it awful, am I denying myself if I don’t give in?
• Is the urge really that unbearable?
• Is it within my rights, or am I entitled to give up using without having strong urges?

Another exercise used with this tool is called Disarming the Enemy. In which the person detaches themselves from the destructive thoughts or voice in their head.

• First you need to recognize exactly which thoughts if allowed to continue would lead you back to your addictive behaviors. Recognize these thoughts as your enemy, and give them a name, as if they were their own person.
• Very firmly refuse to go along with this thinking, and attack your enemy with counter statements, yell at him by name even.
• Quickly change your focus to something esle which coincide with the lifestyle you’re trying to achieve now, opposite of what your enemy is saying, this takes away his power and allows for it leave you alone.

By taking these statements and using ABC’s (discussed in next section) you can dispute them and develop stronger counter statements for next time.

Role-playing and Rehearsing

Role play involves acting out situations playing alternately you and those you may face in some situations, to better prepare what you would do if faced with a triggering event. Rehearsal is better if you have someone else to help play the part of those people you think you might run into.

Advanced Urge-Coping Strategies

• Give yourself the opportunity to refusing that First Drink, pill, line, smoke etc.
• Deliberately expose yourself to old triggers, or do something that brings on urges so you can practice your coping skills.
• Instead of avoidance, practice going around people or places that remind you of old behaviors.
  

Point 3: Problem Solving: Managing thoughts, feelings, and behaviors

Using rational ways to manage thoughts, feelings and behaviors

This point teaches behavioral therapy techniques involving challenging your negative thoughts and changing them to rational ones.

Rational Emotive Behavior Therapy (REBT)

REBT is one type of Cognitive behavioral therapy (CBT), in which a person is taught how to identify, challenge, a change self-defeating, self-harming thoughts and beliefs to ones that are more productive and healthier ones. This helps increase emotional well-being, and to achieve short and long term goals. This is done through a tool known as ABC’s.

Through this tool it helps with behavioral modification from old addictive thinking, motivation, and relapse prevention. With emphasis on self-discipline, self-motivation, and self-responsibility as the primary resources for ending addictive behaviors.

The “ABCs” of REBT

ABC’s Worksheet
ABC’s start with an Activating event that triggers a response based on dysfunctional Beliefs leading to an unwanted Consequence, and enables the person to choose a better, less harmful belief and behavior.[*]

• Activating event:What is the Activating event?—what happened to evoke these feelings or beliefs? Was it something you did? Was it some thing someone else did? Was it a thought or idea that come to you?
  IE: You’re hanging out with friends who are drinking
  
• Beliefs: dysfunctional beliefs, what do you believe about this event? What are you telling yourself? Are these beliefs helpful or self-defeating?
  IE: You MUST have a drink to have fun and fit in.
  
• Consequence: How does this make you feel, and what actions do you take? Are you feeling anger, anxiety, frustration? Does this cause a negative behavior?
  IE: you feel anxiety, and have a drink
  
• Disputing Irrational Beliefs
  Dispute the Beliefs to find which are dysfunctional— identify if the belief you have is helpful or self-defeating? Is this belief realistic and logical? Is the event really as bad as my beliefs lead me to believe?
  
  IE: Must I really have a drink to have fun with my friends, does this fit in with my long term goals, why is this so awful, etc.
  
  -Distinguish between irrational and rational beliefs. Irrational thoughts lead to irrational beliefs causing negative or self-harming behaviors. Whereas rational beliefs are reasonable, goal-oriented, objective and productive, which lead to healthy, positive behaviors.
  
• New Effect or Rational Belief [/h]
  - What rational new belief can I use to replace each irrational belief? What are my new feelings?
  
  IE: This is difficult but I can handle it, I don’t have to drink to have fun with my friends.

ABCs of REBT for Urge Coping & Emotional Upsets

ABC’s are not as easy as it may seem, changing long-term dysfunctional beliefs takes time and practice. Along with the basic ABC worksheet there is also many worksheets to help work through each step. Including positive coping statements, identifying irrational beliefs, tools assisting in changing one’s self-talk, and assisting in analyzing and redirecting irrational beliefs that cause a negative effect.

Using ABC’s when resisting urges is a very helpful tool to identify triggering events and the irrational belief it causes. Brainstorming to anticipate urges and preparing an ABC before they happen, and practicing this will make it easier to remember what to do when you’re overcome with the distorted thoughts and feelings brought on by cravings and urges.

With time and practice applying these techniques will become second nature and you’ll barely notice you are doing them, and the urges will weaken over time.

The use of this technique isn’t just for cravings and urges but can be applied to any situation that causes you to have negative thoughts, feelings and actions. This can help to challenge your thoughts in emotional upsets as well. With the help of this tool eventually unconditional self-acceptance will develop, where you realize that instead of believing that everyone else’s thinking needs to change, you come to realize you can just change yours.

Point 4: Achieving a more balanced lifestyle

-This takes everything you’ve learned and applying it to short-term and long-term goals to help balance the things you want out of life. Achieving balance between all aspects of your life, such as work, relationships, relaxation, and pleasures in life.

5 Things to consider:

1. Regaining one’s health
   -emphases on eating a well-balanced diet, improving sleep hygiene, and developing an exercise routine.
2. Relaxation
   -Learning to practice relaxation or mediation techniques to help reduce anxiety and better deal with urges.
   
3. Goal setting
   -Setting your short-term goals that you want to achieve, remembering it is important that they are specific, realistic, measurable, and include a time period.
   
4. Social and recreational activities
   -Getting involved in social activities you find enjoyable and rewarding and fit within the limits of your goals helps to show that a sober life can be rewarding, and you don’t have to participate in addictive behaviors to have fun.
   
5. Relapse prevention
   -Developing strategies to continue forward movement in your recovery and how to keep from slipping back into old habits and behaviors. Many of the activities mentioned already are also to help in relapse prevention. Additional strategies not covered in the other points can be found on the website. If you have a lapse, don’t dwell on it, accept it, go to a meeting, learn from it, and move on.

Components to a Happy and Healthy Living

• SELF-ACCEPTANCE: Accepting yourself and who you are unconditionally without the need to prove themselves to others.
  
• RISK-TAKING: Taking emotional risks, being adventurous in reaching goals, without being reckless or irrational.
  
• Being Realistic: It’s unrealistic to believe we will never face a difficult or painful situation. It’s best to recognize these situations and avoid wasting our time to attain the unattainable.
  
• HIGH FRUSTRATION TOLERANCE: There are only two types of problems you shall run into: ones you can do something about, and ones you cannot. Once we recognize this, we begin to accept the things we cannot change, and change the ones we can.
• SELF-RESPONSIBILITY FOR DISTURBANCE: When we stop blaming others for the bad things in our life and taking responsibility for our own actions, thoughts, feelings, and behavior. You are the only one that has control over these.
  
• SELF-INTEREST: Healthy people will naturally put themselves out there to help those they care about, but not in an unhealthy way, they still hold their own personal interests above those of others.
  
• SOCIAL INTEREST: It’s natural for people to live among social groups in harmonious way acting with high morals, and protecting the rights of others.
  
• SELF-DIRECTION: Accepting responsibility for our own lives and it’s direction is not dependent on support of others.
  
• TOLERANCE: Everybody is human and will make mistakes, and we need not oust a person for this.
  
• FLEXIBILITY: Healthy people are flexible in their thinking, free of strict, prejudiced expectations of people, decreasing the possibility for a happy life.
  
• ACCEPTANCE OF UNCERTAINTY: Healthy people look for a sense of order without demanding perfect certainty out of life and accept the fact the world is full of probability and chance.
  
• COMMITMENT: Finding structure in life through outside activates and getting involved with other people, help to provide for a happy daily life.
  

SMART Recovery See Also

Along with all the tools and tactics mentioned above the website offers still a lot more help. Through message boards, chat rooms, meeting rooms, and their library. It contains many more exercises to help master the tools mentioned here.

Visit SMART Recovery’s Tool chest for even more self-help tools:
http://www.smartrecovery.org/resources/toolchest.htm

SMARTRECOVERY.ORG

References

• SMARTRECOVERY.ORG
• SMART RECOVERY Members Handbook, SMART Recovery® UK
• Wikipedia SMART Recovery
• Understanding Drug Abuse and Addiction: What Science Says, NIDA retrieved February 4, 2014.
  
• Hester R., Lenberg K., Campbell W., and Delaney H., 2013, Overcoming Addictions, a Web-Based Application, and SMART Recovery, an Online and In-Person Mutual Help Group for Problem Drinkers, Part 1: Three-Month Outcomes of a Randomized Controlled Trial, Journal of Medical Internet Research 15(7): e134.
• Forman R., Nagy P., (2006) Substance Abuse: Clinical Issues in Intensive Outpatient Treatment, Rockville (MD): Substance Abuse and Mental Health Services Administration (US)
• Alcohol Research & Health, The Journal of the National Institute on Alcohol Abuse and Alcoholism Volume 33, Issue Number 4.
• "Alcohol and Drug Information". US Dept of Health and Human Services. Retrieved 2007-12-12.