By Bill Greer, President, SMART Recovery USA
In addition to reading this formal announcement, we encourage you to listen to this interview with Board President Bill Greer to hear some additional context around this stance.
SMART: ‘Abstinence-Oriented’ Recovery Support
Recently, the SMART Recovery USA Board made a minor but important change by replacing the term “abstinence-based” with “abstinence-oriented” in describing our approach to helping people. This is because people with opioid addiction are dying from overdoses when their “abstinence-based” treatment and recovery support preclude the use of opioid agonist medications, such as methadone and buprenorphine. A large part of the U.S. treatment and recovery support world continues to regard the use of these medications as “substituting one drug for another.”
SMART strongly opposes this position because these agonists help maintain tolerance to protect people from deadly overdoses when they relapse, which is common in opioid use recovery. This position is shared by the National Institute on Drug Abuse, American Medical Association, American Society of Addiction Medicine, World Health Organization, and many other prominent authorities worldwide.
Using opioid agonists is widely regarded as part of the “gold standard” for treating opioid addiction. Elinore McCance-Katz, M.D., Ph.D., Assistant HHS Secretary for Mental Health and Substance Use and head of the Substance Abuse and Mental Health Services Administration, states:
Medication-assisted treatment (MAT) combined with psychosocial therapies and community-based recovery supports is the gold standard for treating opioid addiction. (Facing Addiction in America: Surgeon General’s Spotlight on Opioids, p. 2, update of June 2019)
SMART meetings provide key community-based recovery support, and we adopted the “abstinence-oriented” term to distance SMART from dangerous and misinformed views about the use of prescribed medications to support recovery from addiction.
This change does not mean that we advocate or teach moderation for people trying to recover. SMART meetings and our 4-Point Program® are designed to help people stop addictive behavior.
Our Motivational Interviewing approach does not advise or tell people what their recovery goal should be. Research has well established that people change behavior and recover most effectively when they are empowered to act and set their own recovery goals. We welcome people at any stage of change, from wondering if they might have an addiction problem to currently taking action.
Using SMART, participants learn how to stop harmful behavior. The tools and strategies they use for their recovery, including prescribed medications for treatment, are their choice and not for us to dictate or judge.
In fact, we welcome people and want to help them long before they reach the proverbial “rock bottom.”
We hope those with opioid addiction stop using earlier because they run the risk of using heroin, cocaine, and methamphetamine contaminated with extremely powerful synthetic opioids such as fentanyl and carfentanyl. And we also hope they are taking opioid agonists under professional care.
SMART Recovery has always held an enlightened view of the use of language that can be detrimental to recovery, discouraging the use of terms such as “addict,” “alcoholic,” “junkie,” and worse. We can add “abstinence-based” to this list because this terminology is linked to outdated treatment protocols and support programs that do not recognize the overwhelming science supporting the life-saving benefits of using prescribed opioid agonists to recover from opiate addiction.
I congratulate you on your forward thinking and use of harm reduction in terms of treatment for opiate use. It was not that many years ago that 12 step programs said you couldn’t be “sober,” or “clean” if you were taking psychotropic medications for mental health issues. Hopefully that idea has evolved and members understand the importance of taking prescribed medications no matter the kind.
This is huge and I speak for my thousands of members that are on MAT, Thank-you! Thank-you!
Thank you Smart Recovery for your help in enlightening people about the benefits of methadone and buprenorphine. The stand that M.A.T. is somehow a negative is a dangerous and life-threatening stance. Keep up the good work.
This is so great to read and solidifies my commitment to join this program. Thank you for understanding that some of us have to walk a different road to get to our destination of becoming 100% free of toxins or “clean”. Thank you!
Whatever method that promotes a healthier way of life should be considered so that may occur.
In the same vein, I have a question. Would SMART Recovery reccomend using Marijuana in lieu of alcohol for a chronic alcoholic?
For information about SMART Recovery’s purpose and methods, please visit https://smartwww.wpengine.com/about-us/?highlight=policies. SMART Recovery does not offer medical advice.
I congratulate SMART for its courageous position. Fifty years ago when I was a school administrator we developed a program for our students. Many of those using drugs were banished and or ridiculed in AA meetings by the senior recovering alcoholics. Many were told they were not welcomed. Thirty years forward I was a psychologist in the prison system. I started a group for women addicted to opioids before there was any community intervention. They too had “acceptance” problems.
I guess what I have learned over the years is that some people always need someone to kick. Glad for your efforts to reach out.
Thank you for your position to help more people. I have clients who need medication and we do not need to punish people or makes them feel less than anyone else.