Desks and Chairs in Classroom

Chances are, the vast majority of Americans struggling with a drug problem have never heard of SMART Recovery. And that's a shame, because this modern, evidence-based alternative to Alcoholics Anonymous and Narcotics Anonymous might help many of them.

There are over 1,000 SMART groups worldwide, and in any given month, between 20,000 and 30,000 people attend meetings. These figures are climbing, although they're still dwarfed by AA.

What is SMART Recovery?

SMART Recovery (Self-Management and Recovery Training; we'll call it SR) is a self-empowering addiction recovery support group offering practical tools, techniques and strategies. Founded in 1996, the non-profit organization doesn't base its work on any spiritual component, or on the idea that addiction is a lifelong, incurable disease. Tom Horvath, Ph.D., one of the founders, says, "For many of our participants, addiction is not a disease. They want an alternative approach to both the disease concept and the 12 steps."

So what is addiction? According to SR literature:

"Addictive behavior is over-involvement with substance use, e.g., alcohol, nicotine, cocaine, food, etc., or activities, e.g., gambling, sexual behavior, spending, etc. We assume there are degrees of addictive behavior and that all individuals to some degree experience it. For some individuals the negative consequences of addictive behavior become so great that change becomes highly desirable."

SR encourages members to think about the benefits and the costs of their drug use and fill out a "decisional balance," stating: 1. Benefits for me of continuing, and 2. Benefits for me of stopping.

That the program accepts that there are benefits to using drugs is significant; although many recovery support groups do not acknowledge it, drugs of course have numerous powerful and pleasurable paybacks.

I observed one SR group in San Diego where members discussed the benefits they got from drinking. The facilitator wrote them on a whiteboard:

less shy at bars and parties

relaxation after a horrible day at work

tune out the kids

my partner is more interesting (that got a huge laugh)

helps me sleep

sex is better

helps me forget my problems

It felt liberating to discuss the pleasurable and rewarding aspects of alcohol, and it gave participants permission to be honest. Recognizing the positive facets of drug use could help a person to learn how to manage painful emotions, awkward situations and unfulfilling relationships without drugs. Denying these benefits could block people from understanding why they continue to use.

The group also eagerly recorded the benefits of stopping drinking:

save money

I won't need a liver transplant

no divorce

no DUIs

no blackouts

I won't get fired

Looking at the list, Leia* remarked: "It helps me remember why I quit drinking -- and helps when I have a craving to knock back two bottles of chardonnay."

The decisional balance maps out in a visual way the role that addictive behaviors play, builds motivation for change and points out potential relapse triggers. Coping with urges is one of the points in SMART Recovery's 4-Point Program:

Building and Maintaining Motivation Coping with Urges Managing Thoughts, Feelings and Behaviors Living a Balanced Life

Teaching people how to manage urges and cravings is valuable, because both are inevitable when trying to quit addictive substances or activities and can lead to relapse.

What is a SR meeting like?

In several SR groups that I attended across the country, members discussed lots of practical ways to resist urges to use -- and unlike in AA, "crosstalk" is encouraged. At one meeting in New York City, Sari recommended staying out of bars for a couple of months because "the temptation is overwhelming." Another participant suggested waiting 10 minutes to see if the craving passed; a young man proposed having nonalcoholic beer, like O'Douls, on hand.

SMART Recovery includes no requirement to believe in a higher power, identify as an addict or make a lifelong commitment to attend meetings. The goal is to solve the problem and move on.

The idea of drinking nonalcoholic beer set off a debate about whether that was "cheating" (O'Douls is about 0.4 percent alcohol). Eventually, most group members agreed that drinking an O'Douls was better than having a Budweiser, but one person cautioned it could kick off a craving for the real thing. The attitude toward abstinence was notably more relaxed than in an AA meeting. SR groups aim to allow participants to explore and process a full range of emotions and experiences without being judged or confronted.

During a morning meeting at a community center on Manhattan's Lower East Side, a dozen people sat around a large table in a sunny room, sharing personal struggles and empathic support and suggestions. David, a genial man who'd been an SR member for five years, facilitated. It began with each member "checking in." Holding back tears, Samantha described how during a drinking binge she blacked out and cheated on her fiancé. It wasn't clear whether the wedding was on or off. She wondered out loud, "Why did I do it?"

Samantha described how the trust in her relationship was gone and started to cry. Liam, a computer programmer, told her, "It takes time to rebuild trust." He recounted how he'd been in a similar situation: "Over and over I'd tell my wife that I was only going out to have a few drinks and I'd come home wasted. After a while she no longer trusted me. I haven't had a drink for two years and now the trust is back."

Liam and other participants recommended that Samantha and her fiancé get into couples counseling. Samantha kept beating herself up and Liam interjected, "Cheating on your partner once isn't the worst thing in the world. It's not like murdering someone."

The group also suggested Samantha do an "ABC." Developed by Dr. Albert Ellis, the ABC process is a key component of Rational Emotive Behavior Therapy. "A" stands for the activating event -- the thing that happened. "B" is for beliefs -- the need to challenge irrational beliefs. "C" is for consequence -- the emotional response to the belief. It's a way to analyze negative emotions and self-defeating behaviors. During the group, many participants remarked how various SR tools and techniques were vital to their ability to abstain -- online surveys also suggest a high degree of satisfaction with the program.

A middle-aged woman named Joan shared that she'd relapsed after a year of sobriety. She hadn't drunk for a week and said, "I'm using the tools to manage my thoughts." In AA, if a person relapses they have to begin counting days from zero again. In SR, there's no starting over and the person is seen as continuing to build on what they've learned. Relapse is viewed as an opportunity to re-examine addiction-related thoughts and behaviors.

Ben started using heroin and cocaine in his twenties and was currently living in a halfway house after a stint in detox. He said, "I want to learn the tools because I'm not powerless." One of the most significant ways that SMART Recovery differs from AA is its view that addicted people have the power to change their own thinking and behavior. Another differing belief is that people can be "recoverED, rather than recoverING." SR includes no requirement to believe in a higher power, identify as an addict or make a lifelong commitment to attend meetings. The goal is to solve the problem and move on.

Another discussion at the Lower East Side meeting explored boundaries and learning how to say no. Naydia, a confident Puerto Rican woman, led the conversation, describing how in the past her inability to say no to family and friends brought feelings of resentment and anger. She gave an example of how she told her manipulative mother no, and convinced her siblings to do the same. Naydia said, to the group's approval, "We attract people who become co-dependent if we can't say no and if we don't have boundaries."

Alejandro said that in the past he had trouble telling friends no when they came to his apartment to use crystal meth. So he decided to practice for a whole week, telling every man who came over, no -- no matter how good looking he was. Everyone chuckled.

Several members expressed feeling "like a failure" for not being able to drink without getting intoxicated, for always having "too many." Rose asked, "Why can't I have a drink like everyone else?" There was a sense among some that they were missing out by not being able to drink. Other members noted that there were plenty of other things in life that they had to abstain from, and that didn't make them failures.

Although SR is abstinence-based, it accepts members who are only exploring the option of quitting. "Most of our participants are committed to abstinence, others are merely investigating it," Tom Horvath says. "Individuals who have decided not to abstain are encouraged to seek out Moderation Management [MM] or the Harm Reduction, Abstinence, and Moderation Support [HAMS] group."

At another SR meeting in Manhattan, four women and three men sat in a circle in a dim room with two ceiling fans. Each group member did a check-in and participants revealed struggles with addictions to Ambien, food and alcohol.

Claire talked about the challenges of warm weather and seeing people sitting at sidewalk cafes drinking cold cocktails. Summer holidays were hard, too, because celebrations always included lots of alcohol.

Francis, an intense and thoughtful middle-aged man from Long Island, had a history of binge drinking. He talked about the ways that abstaining from alcohol had positively impacted his life and said in a deadpan voice, "When you stop, time changes." For Francis, not drinking slowed time down and gave him a clear head to make decisions about his personal and work life.

Eva, who was facilitating the meeting, suggested doing an exercise from the SMART Handbook and handed out pen and paper. Everybody decided to do an exercise that involved making a pie chart of values that were important to them.

Family appeared as the most important value in all the participants' pie charts -- and a lively discussion ensued about how families react to addiction. The responses encountered ranged from shame to disappointment to anger. Only one member of the group said her family had been supportive as she grappled with her addiction to prescription medication. Participants noted that the idea that family always rallies around a loved one who uses drugs is a myth -- underscoring the need for nonjudgmental support groups.

The core ideas of SMART Recovery -- self-reliance, self-empowerment, building motivation and life balance -- appeal to many people who are turned off by the rigidity, religiosity and disease-model basis of AA or NA meetings.

SMART Recovery meetings are currently held in 36 U.S. states, at venues including community and correctional settings as well as hospitals and outpatient drug treatment centers. But with recognition increasing that a "one-size-fits-all" approach fails many people with substance problems, making SMART Recovery support groups available daily in every city and town would be a big step forward.

*All names have been changed.