Title: SMART Recovery and AA: How different?

Biography:

A. Tom Horvath, Ph.D., ABPP (Clinical Psychology), is the founder and president of Practical Recovery Psychology Group, a self-empowering addiction treatment center in San Diego, past president of the American Psychological Association’s Society of Addiction Psychology (Division 50), the world’s largest organization of addiction psychologists, past president of the San Diego Psychological Association, and author of Sex, Drugs, Gambling & Chocolate: A Workbook for Overcoming Addictions (recognized as a “Self-Help Book of Merit” by the Association for Behavioral and Cognitive Therapies, and in Self-Help That Works, edited by Norcross, Campbell, Grohol and Santrock). He was the volunteer president of SMART Recovery, an international non-profit offering free, self-empowering mutual help groups for abstaining from any substance or activity, for 20 years. He is a fellow of the San Diego Psychological Association, the Association for Behavioral and Cognitive Therapies, and the American Psychological Association.

Abstract

On the surface SMART Recovery, with its self-empowering approach, and AA (Alcoholics Anonymous), with its powerlessness approach, appear to be opposites.  SMART’s slogan is “Discover the Power of Choice.” AA’s first step is “We admitted we were powerless over alcohol—that our lives had become unmanageable.”

However, recent findings suggest that SMART and AA, as well as LifeRing and Women for Sobriety, are similarly effective (Atkins & Hawdon, 2007; Zemore, et al., under review). Further, these groups may work by the same mechanisms of behavior change (MOBC). Specifically for AA: “While AA’s original main text (‘the Big Book’, 1939) purports that recovery is achieved through quasi-religious/spiritual means (‘spiritual awakening’), findings from studies on MOBC suggest this may be true only for a minority of participants with high addiction severity. AA’s beneficial effects seem to be carried predominantly by social, cognitive and affective mechanisms” (Kelly, 2017). Although MOBC studies are not yet conducted for other groups, all groups may work in the same manner, just as common factors may primarily account for the effectiveness of individual psychotherapy (Norcross & Lambert, 2011). Specifically for AA: “Overall, AA confers benefit through multiple mechanisms simultaneously but, in particular, through facilitating adaptive social network changes and, by boosting social and negative affect, abstinence self-efficacy” (Kelly, 2017).

Disseminating knowledge about common group factors, while clarifying differences in each group’s manner of operation (e.g., the differences between how SMART and AA meetings are conducted) may improve the functioning of all groups, increase mutual respect, increase collective attendance, and improve outcomes.  Future research may identify factors that predict client preference for a particular group. Communities that lack a full range of mutual help groups might engage in affirmative action to establish them.