Moving From 12 Steps to SMART Recovery
Tom Horvath & Alan Marlatt, Ph.D.
Although Albert Ellis was only slightly involved with substance abuse treatment or research, a significant part of his legacy may turn out to be his impact on US and international addiction treatment, and in particular, addiction self-help groups.
In the mid1980s a California social worker named Jack Trimpey was upset about the typical insistence that the 12-step approach was the only way to recover from addiction. Trimpey wrote "The Small Book," titled to place its contents as an alternative to the AA Big Book. He also started Rational Recovery, a network of free self-help groups. The groups were just like AA: free, open to all, and supporting abstinence, except that the program of recovery was quite different. Both his book and his groups were based on a combination of REBT, and Trimpey's ideas about coping with craving.
In 1991 Trimpey gathered a volunteer board of advisors, who met in Dallas. This group evolved, with Trimpey's blessing, into a non-profit organization, incorporated in 1993. The non-pr oft was to run the Rational Recovery groups, while Trimpey provided his for profit services near Sacramento. By 1994 differences of opinion about the proper direction for Rational Recovery resulted in the non-profit changing it's name to SMART Recovery. By Jan 1, 2000, Rational Recovery stopped operating any free support groups as a matter of policy.
SMART Recovery has emerged as the leading alternative support group. Other notable groups are Women for Sobriety, Moderation Management, Secular Organizations for Sobriety, and Life-Ring Secular Recovery.
When SMART Recovery changed its name in 1994 it also explicitly stated that it would keep modifying its recovery program in the light of empirical findings. The original program was based on CBT and relapse prevention as applied in a self-help format. Since 1994 SMART Recovery has incorporated more motivational components, based on the success of motivational interviewing. Mindfulness components are currently under review.
Despite SMART Recovery's foundation in empirical findings, if there is a patron saint of SMART Recovery, it is Albert Ellis.(One might wonder how Al would take up the role of a patron saint...).Even though REBT itself is not widely used in addiction treatment, Ellis is widely viewed in SMART Recovery as the foundation on which the cognitive-behavioral treatment of addiction is based. For the average non-psychologist, CBT is about thinking rationally in order to feel better and to behave better. For most SMART Recovery members distinctions between the schools of Ellis, Beck, Michenbaum, Seligman or others are not worth bothering with. Albert Ellis is Dr. Rationality. The accessibility of Al's many books, not to mention their often colorful language, has made him the natural choice to read for many SMART Recovery participants. Furthermore his concepts are also presented as components of the SMART Recovery Handbook.
So at a typical SMART Recovery meeting, in addition to members doing their CBAs (cost benefit analysis), they are also doing their ABCs (Activating event, Belief, emotional and/or behavioral Consequence). They are watching out for musturbation, awfulizing, and catastrophizing. When a new idea emerges, they wonder what Dr. Ellis would think of it.
SMART Recovery now offers online meetings, at smartrecovery.org, 7 days a week. There are about 300 face to face meetings, mostly in the US, but also in Vietnam, Australia, the UK, and Uzbekistan, and emerging in other countries. Like the British empire of old, the sun never sets on SMART Recovery. There is a rapidly growing number of meetings in prisons and other correctional settings. In the US this increase has been based on court rulings in effect in nearly 20 states, that the government cannot order someone to attend a 12-step meeting because of its religious content.
Dr. Ellis supported SMART Recovery in a number of ways. He reviewed books for the SMART Recovery newsletter. His Institute in NYC was the site of SMART Recovery trainings. He was a member of the International Advisory Council.
Severe addictive behavior is an excellent example of irrationality. It is fitting that Al's work would have found a lasting place SMART Recovery. There participants not only learn to overcome addictive behavior, but also how to lead more functional and happier lives. It's what Al wanted for all of us.
About the Authors
Tom Horvath, Ph.D., is president of SMART Recovery (smartrecovery.org), president of Practical Recovery Services (practicalrecovery.com), past president of the American Psychological Association's Division on Addictions, and author of Sex, Drugs, Gambling & Chocolate: A Workbook for Overcoming Addictions (Impact, 2003, 2nd ed.).
G. Alan Marlatt, is Professor of Psychology and Director of the Addictive Behaviors Research Center at the University of Washington. His most recent book is: A Therapist's Guide to Evidence-Based Relapse Prevention (Witkiewitz & Marlatt, 2007, Academic Press).