Presented at the 2017 NADCP Conference
SMART Recovery is an abstinence-based mutual-help group for dealing with all types of addiction including alcohol abuse, substance abuse, smoking, gambling and other addictions and compulsive behaviors.
SMART Recovery's 4-Point Program focuses on Increasing Motivation, Coping with Urges, Problem Solving, and Lifestyle Balance.
http://www.smartrecovery.org
2. OBJECTIVES
Be aware of
importance of
choice of addiction
recovery program
Be aware of
multiple court
decisions requiring
program choice
Be aware of
availability of
evidence-based
choices
5. Court-ordered
addiction
recovery
process
presupposes
individuals
can modify
their choices
“With limited exceptions,
Anglo-American criminal
law has implicitly adopted
a choice model
and a corresponding
approach to
responsibility.”1
1Stephen J. Morse, “Addiction, choice, and criminal law.” Chapter 23 in Nick Heather & Gabriel Segal:
ADDICTION & CHOICE: Rethinking the Relationship, Oxford Press, 2017 5
https://commons.wikimedia.org/wiki/File%3AScale_o
f_justice_2.svg; By DTR (Own work) [Public domain],
via Wikimedia Commons
6. PRECEDENTS
7 US Courts of Appeal
3 State Supreme Court decisions
state that 12-step and AA are religious
programs
8. HAZLE v.
CROFOOT
(2013)
California State and treatment
contractor ordered to pay $2 million in
damages for refusing to provide a
secular alternative
9. INOUYE v.
KEMNA
(2007)
Request to stop attending 12-step
meetings was Constitutional under
First Amendment due to
“…uncommonly settled case law.”
10. FURTHER
CHALLENGES
US Supreme Court refused certiorari
Unlikely, given uniformity of decisions,
that certiori would be sought or granted
in such a case
Public Domain, FBIemployee. https://commons.wikimedia.org/wiki/File:Supreme_Court.jpg
11. Presume decisions
apply to any
government
program,State or
Federal, or to any
outside program
that receives
government funds
Public domain: ByBacon, George Washington. [from oldcatalog] -https://www.flickr.com/photos/internetarchivebookimages/14772561202/Source book page:
https://archive.org/stream/baconsdescriptiv00baco/baconsdescriptiv00baco#page/n51/mode/1up, No restrictions,
https://commons.wikimedia.org/w/index.php?curid=43736357
15. DICHOTOMIES
Locus of Control
Internal vs. External
Self-empowerment
By sarang (Own work) [Public domain], via Wikimedia Commons:
https://commons.wikimedia.org/wiki/File%3AYin-yang_BBI.jpg
18. SCIENTIFIC
BACKGROUND
Studies, going back 30-
40 years, demonstrate
that when clients/
patients are allowed to
select their own
treatment, better
outcomes are
achieved.
ByXenia Alexiou& Marina Sagnou -Ownwork, CC BY-SA4.0, https://commons.wikimedia.org/w/index.php?curid=45333287
19. CLINICAL
EXAMPLES
Raytheon Employee
Study of an Ethanolamine drug
Motivation-enhancement program
- effects present for 6 years!
SFVA Region
1 (Richard Lieber, et al. [2007]. 600 males with biopsy-proven Laennec's cirrhosis, 4 VAH sites.)
22. AMA Journal
of Ethics®
Addiction, 12-Step Programs, and
Evidentiary Standards for Ethically and
Clinically Sound Treatment
Recommendations: What Should
Clinicians Do?
Annette Mendola, PhD, and Richard L. Gibson, MD, MPH
26. Study of 6,000
inmates in
NSW,Australia
SMART Sharply
Reduced Recidivism
Inmates attending
SMART meetings and
SMART-based prison
program (3,000) showed
42% lower rate of
committing violent
crimes after release.
(2016)
27. SMARTis
Self-Management and Recovery
Training
Science-based, evidence-based
Self-empowering approach
Abstinence-oriented
Non-profit 501(c)(3)
Partnership of professionals and
peers
28. smartcovery.org
Comprehensive, Current Resource
1.1 million website visitors per year
SMART Blog
SMART Webinars & Podcasts
Checkup & Choices
YouTube videos
Family & Friends Program also science-
based
SMARTTools!
30. HISTORY
Started as Rational Recovery in 1989
Non-profit element renamed SMART
Recovery in 1994
Introduced in MA in 1990, over 30,000
meetings started since
31. CURRENTLY
>2,400 groups meet
weekly in 23 countries
>1,400 in the US and 200
in Canada
Handbook published in 11
languages plus special
edition for Australian
Aboriginals
Articles, Books, DVDs
Stop by our SMART Recovery exhibit!
32. TRAINING
Online Distance
Training Program
About 300 trainees
per month
Currently around 70%
professionals
By www.Pixel.la Free Stock Photos (Download Thousands Of Free Stunning Stock Photos.) [CC0], via Wikimedia Commons:
https://commons.wikimedia.org/wiki/File%3AMan_writing_while_using_his_laptop_1.jpg
34. NADCP
"Participants regularly attend self-help or peer support
groups in addition to professional counseling. The peer
support groups follow a structured model or curriculum
such as the 12-step or Smart Recovery models.19
19 "Drug Courts must offer a secular alternative to 12-step programs such as
Narcotics Anonymous because appellate courts have interpreted these
programs to be deity-based, thus implicating the FirstAmendment (Meyer,
2011)."
~ NADCP, Adult Drug Court Best Practice Standards, July 2013
35. Bureau of
Prisons
RDAP
Program
The BOP recommends SMART meetings for
“participants [who] immediately reject AA and NA
as a result of the spiritual component of these
programs and/or as a result of the fact that these
programs subscribe to the disease model of
addiction.” …
“Despite the differences, AA, GA, NA, and SMART
Recovery can be used as a support system for a
participant in his recovery.”
36. SAMHSA
“Research on mutual support groups indicates
that active participation in any type of mutual
support group significantly increases the
likelihood of maintaining abstinence. ...
“Clients who are ‘philosophically well matched’
to a mutual support group are more likely to
actively participate in that group.Thus, the best
way to help a client benefit from mutual support
groups is to encourage increased participation in
his or her chosen group.”
37. NIDA
“No single treatment is appropriate for all
individuals. Matching treatment settings,
interventions, and services to each individual’s
particular problems and needs is critical to his or
her ultimate success in returning to productive
functioning in the family, workplace, and society.
Most commonly used models include 12-Step (AA,
NA) and SMART Recovery®.”
38. NIDA
“Most treatment programs encourage self-help
participation during/after treatment.”
“Outpatient behavioral treatment encompasses …
Cognitive-behavioral therapy, which seeks to help
patients recognize, avoid, and cope with the situations
in which they are most likely to abuse drugs.
Motivational interviewing, which capitalizes on the
readiness of individuals to change their behavior and
enter treatment.”
39. SMART
RECOVERY
PROGRAM
Small discussion groups led by trained facilitators
– successful “graduates” of SMART Recovery as well as professionals (having
removed their professional hats)
CBT tools adapted for addiction
Based on CBT and REBT, Motivational Interviewing, Motivational Enhancement
Therapy, Solution-FocusedTherapy, Stages of Change
Primarily volunteer-led
7 US Courts of Appeals
(6 different districts)
3 State Supreme Court Decisions
- Barry Hazle, a Non-theist, sent back to prison after refusing to attend 12-Step program as condition of parole – 101 days added back to his sentence.
- District Court jury first found his constitutional rights violated but assigned no damages.
- Circuit Court required damages be awarded.
- State of California and the treatment center with whom they contracted that refused to provide a secular alternative, both required to pay Hazle $1 million.
- U.S. Supreme Court has declined certiori in other cases. It is unlikely, given uniformity of decisions, that certiori would ever be sought or granted in such a case.
- Inouye, Buddhist (and diabetic) on parole, stopped attending prison 12-Step Program. Parole officer ordered him back to prison, where he died.
- Estate sued parole officer.
- District Court ruled in his favor.- Appeal Court ordered retrial, stipulated officer liable for PERSONAL damages if verdict is against him.
- Despite no 9th Circuit precedent, plaintiff's request was Constitutional. Parole officer should have known due to “…uncommonly settled case law.”
- Final trial court decision pending.
Locus of Control Orientation:
Internal vs. ExternalSelf-Empowered vs. Higher Power
Raytheon Employee rejected AA but quickly succeeded with a DUI program
Study of an Ethanolamine Drug’s Efficacy in Reducing Progression of Alcoholic Cirrhosis
Dramatic reduction in alcohol use with a minimal motivation-enhancement program after the great majority of participants refused to attend AA meetings
Study of males, average age 40, in SF VA Region?By leading addiction scientists John F. Kelly, Neil Humphries, et al.
Religiosity
Authoritarianism
Project MATCH
Study failed to demonstrate superiority of any individual therapy with 12-Step Facilitation, CBT or MET, or any particular subject proclivity for determining program assignment.
Several defects in study structure.
Addiction is a complex phenomenon characterized by a loss of control and compulsive, habitual behavior. Since there is no single, specific cause for addiction, there is no single, standard treatment for it. A variety of approaches are used, including counseling, psychotherapy, medications, and mutual help groups (MHG). The best known and most widely available approach to addiction is 12-step (TS) programs of recovery, a variety of MHG. These have been lauded as lifesaving by some and criticized by others. We argue that TS programs are an appropriate mode of help for those seeking to quit an addiction but should not be the only approach considered.
SMART Recovery was modified for correctional use
Developed under grant from NIDA
Now in use throughout the world
Project for prisons in Commonwealth of PA
Prisons in UK
Blog Topics
- Addiction & the Brain: Focus on Opiates
- Addiction, recovery science- Help for family members and friends
- Help for teens and young adults- Stay sober through holidays
- Web apps to stop drinking
- How science & kindness help people change
Community for Recovery Support
28 online meetings per week
Attendance verification to satisfy court orders – verifies complete meeting attendance
Message Boards, 24/7 Chat Room, Forums for general addiction as well as drugs, eating disorders, gambling, self-harm, mood disorders
Private forums for sexually maladaptive behavior, medical professionals and women’s issues
Printed handouts if anyone is interested:
NIDA, NIAAA, NADCP, ASAM, SAMHSA, BOP, ONDCP, EAPA, AAFP in US
NICE in UK (National Institute of Health & Care Excellence)
NCHQ&R in Australia (National Commission on Healthcare Quality & Research)
Australian NSW Prison Study
First, a big Thank you to NADCP for including SMART in its Adult Court Best Practice Standards in 2013!!
Full quote: In addition to the skills that are taught in RDAP, we support the Twelve Steps groups and SMART Recovery as valuable components of the recovery process. The Twelve Step model is consistent with the goals of the community; namely, to help addicts build a program of recovery from drugs and alcohol. Some participants choose to immediately reject AA and NA as a result of the spiritual component of these programs and/or as a result of the fact that these programs subscribe to the disease model of addiction. The disease model assumes that you are powerless over your addiction. The disease model can conflict with the bio-psychosocial model that is utilized in RDAP which asserts that although there are many factors genetics, personality, societal influences, family environment, etc.) that contributed to one’s addiction, the individual is ultimately responsible for all the choices made in his life. Despite the differences, AA, GA, NA, and SMART Recovery can be used as a support system for a participant in his recovery. Upon release, self-help meetings are readily available to anyone who wishes to attend. Therefore, it is useful for participants to find a way to incorporate this into their recovery. treatment staff and peers will provide guidance in assisting participants to incorporate self-help groups into your treatment program. These meetings can provide unconditional support in a time of crisis when a participant is in society and does not have peers or community professionals readily available.
14 Tools in the SMART Recovery Toolbox, distributed among the 4 points.
Time allowing, we will demonstrate a few of these