Clinical Trial of SMART Recovery’s Effectiveness
There have been many success stories during the 19-year history of SMART Recovery. The most recent of these is scientific evidence that supports SMART’s effectiveness in dealing with alcohol problems.
Like AA, SMART Recovery provides free mutual help for anyone desiring to abstain from alcohol. However, SMART Recovery’s approach, based on cognitive-behavior therapy tools, is quite different from that of AA. Many have questioned whether this type of addiction recovery alternative is helpful.
To answer this question, a randomized clinical trial, funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recruited 189 heavy drinkers who were new to SMART Recovery. A web app, Overcoming Addictions (OA), based on the SMART Recovery 4-Point Program®, was created and the 189 heavy drinkers who were new to SMART were randomly assigned to one of three conditions: 1) use the OA web app alone; 2) use the OA web app, plus attend SMART Recovery meetings, or 3) attend SMART Recovery meetings only. “Significant others” were interviewed to verify the participant’s self-report at baseline and at follow-up.
Researchers assessed the percentage of days abstinent and the amount of negative alcohol/drug consequences in the three months prior to enrollment in the study and at follow-up. After three months, participants in all groups increased their percentage of days abstinent from 44% to 72%, and significantly reduced their negative alcohol/drug consequences. There were no significant differences between groups. Based on the results obtained with other recovery approaches, these results are clinically significant. Individuals who find the SMART Recovery approach appealing can try it with confidence.
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“I am feeling all kinds of freedom that I had not experienced in the past. I feel like I am growing and stretching and learning. There has been a lot of internal progress, and I am so grateful for my time at SMART Recovery. SMART Recovery Online really is a home base for me — my touchstone. Community meetings have been beneficial to me, as well. I had some good long lapses in the past, but I have always stayed in touch online. And I’ve had some darn good successes, too — I’m now almost 4 years sober and continuing to grow.” Dee, SMART Volunteer
The report of the clinical trial has just been published online at the open access Journal of Medical Internet Research.
The Overcoming Addictions web app will be available to the public in the fall of 2013, via the SMART Recovery website.
About the study: The study was conducted by the Research Division of Behavior Therapy Associates, LLC.
What’s the success rate of smart recovery concerning alcohol and marijuana use?
Hello,
Thanks for your interest in the SMART Recovery Program, which is accessible for any type of addiction, substance or behavioral.
Whether a specific program works for an individual depends mainly on 2 factors: the individual’s level of motivation to change and whether the program resonates with and engages the individual, intellectually and temperamentally.
With more than 3,500 free SMART Recovery meetings weekly in 27 countries (over 2,200 in the US, including 36 weekly online via smartrecovery.org) almost all run by volunteer trained facilitators, mostly peers who have experienced success with the program, the program is obviously successful for tens of thousands of people.
Its scientific credibility is attested to by its bibliography of over 100 articles (see link below). I call your attention specifically to the studies by Reid Hester, et al. and Sarah Zemore, et al., which refer specifically to alcohol use disorder. You can access an abstract of these studies at pubmed.gov.
A massive study of the efficacy of the SMART Recovery group program in Alcohol Use Disorder, funded by the National Institute of Alcoholism and Alcohol Abuse, is currently underway under the supervision of Assoc. Prof. of Addiction Medicine John F. Kelly of Harvard Medical School. However, the results will not be available for 4 years.
The SMART Recovery 4-Point Program has been endorsed as evidence-based by NIDA, NIAAA, SAMHSA, NADCP, ONDCP, EAPA, Federal Prison System, the Surgeon General and similar agencies in Ireland, UK, Denmark, Canada and Australia.
The easiest way to familiarize yourself with the SMART Recovery Program and the meeting format to see whether it might be of interest to you is to attend a few meetings. Since they are free and available locally (smartrecovery.org/meetings) or online, this should serve your purposes in assessing whether this program might be something you wish to pursue.
http://www.williamwhitepapers.com/pr/dlm_uploads/SMART-Recovery-Bibliography.pdf
Question: when the term evidence-based is used, what precisely does that mean? What I see here is that a group of researchers followed x-number of SMART-recovery adherents, then tallied how many remained abstinent for y-number of days. Then published what was discovered. If that’s correct, then the only thing keeping AA from being described as evidence-based is that researchers have not developed a cohort of would-be participants, then applied the same protocol and tallied results. Is that correct? If that is the case, then I think “evidence-based is a rather thin endorsement of efficacy.
Hello Bill,
Problematic alcohol use can be divided into two categories: heavy or risky drinking and Alcohol Use Disorder. Of course, there will be a few cases which are in the murky zone between the two.
Risky drinking falls into mild, moderate or severe, as does AUD. These are rigid categories, but necessary when considering research methodology.
A study by Hester, et al. on 180 SMART participants demonstrated about 70% reduction in number of drinking days, drinks per drinking day and social dislocations due to drinking alcohol as compared to the month previous to the start of the study. Results were stable over 3 and 6 months. This was compared to other studies with other variables and represented a best result obtainable in similar studies with other techniques and was comparable between those who attended mainly face-to-face meetings or mainly online meetings. Although a control group was planned, almost no potential participants were willing to be randomized into this group, so it had to be cut from the study. All participants had been non-abstinent during the month previous to the study.
Obviously, trying to study efficacy and comparability of anonymous voluntary support groups is very complicated. Chad Emrich, a Professor at U of Colorado/Denver spent 10 years trying to prove the efficacy of AA. His final conclusion was: “AA works for those for whom it works!”
The MATCH study, [Matching Alcoholism Treatment to Client Heterogeneity] the largest MH study ever done, [1,200 participants,1,000 from OP Rx and 200 from IP treatment] in the 90s, tried to use a 4-meeting Motivational Enhancement approach as a control for 12-meeting CBT or 12-Step Facilitation, all individually-administered, and failed miserably. [It was felt that a “no treatment category was not ethical]All groups did about the same: 40% achieved virtual abstinence. Also, a significant number of prospective participants who had been screened, ultimately refused randomization, most of them because they didn’t want to be allocated to the 12-Step Facilitation limb. Unfortunately, there was no option of a secular mutual-aid group, whereas the 12-Step Facilitation group specifically was referred to AA meetings.
I don’t think there is much to quibble about with a 70% reduction of drinking days and drinks per drinking day as being efficacious, but the issue revolves around the perennial question of the role of motivation when joining a study and here is where a control group or comparable group becomes critical, but very difficult to implement.
The study from Australia on 6,000 inmates with an addiction history was propensity-controlled. All inmates, on entry to prison, are given an exhaustive assessment with 21 rated parameters [age, sex, type of addiction, type of crime, previous crime history, etc.). Each prospective participant who had attended SMART meetings [3,000] was matched on these 21 parameters with an inmate who attended one of 6 other programs. 123 inmates in the SMART group could not be matched within acceptable parameters (+/- 20%) and were excluded. The major result was a 42% reduction in reconvictions or violent crimes within 2 years of release, -21% for any type of crime, among those attending at least 10 SMART meetings.
Also, significant delay in time to offence for SMART attendees. Note: this is not recidivism, which can occur from missing a probation appointment. but conviction in a court. The results were similar for the 7 demographic groups studies, including Aboriginals, who had a low average education level. The article reporting these results was listed as the Leading Article and an Invited Article (with Editorial), in the Journal of Forensic Practice in 2016.
Joe Gerstein, MD. Co-Found of SMART Recovery