Characteristics of Australian SMART Recovery Groups

Mutual support groups are one of the most accessible forms of treatment for people in recovery. While the 12-step approach is used by a majority of groups (e.g., Alcoholics Anonymous), other mutual aid groups are available to those seeking an alternate method.

SMART Recovery is a not-for-profit organization that provides mutual help groups with a focus on cognitive behavioral therapy (CBT) to promote positive behavior change for people experiencing substance use issues or behavioral addictions (e.g., shopping or gambling). Groups are led by facilitators specifically trained in the SMART Recovery approach.

With over 800 meetings worldwide, more information is needed to establish a knowledge base for SMART Recovery before research can evaluate the program’s efficacy.

Kelly, Deane, and Baker conducted a cross-sectional survey of people attending SMART Recovery groups in Australia. The objective of the survey was to describe participants accessing meetings, determine how frequently participants use cognitive and behavioral skills outside of meetings, and examine variables that may predict use of these skills. The authors estimated approximately 582 members attended meetings each week based on average group size of five or six people. Surveys were given to group facilitators to distribute over a 1-month period. The final sample was comprised of 124 participants (response rate of 21%).

Fifty-seven percent of participants were male with an average age of 41 years. Almost 70% of participants were unemployed. A vast majority (99%) reported history of problematic alcohol or other drug use with 18 years as the average length of substance use. Addictions included alcohol (73%), tobacco (46%), drugs (43%), and 10% or fewer reporting food, gambling, shopping, pornography, and/or sex addiction. Two thirds reported previously attending treatment for a mental health issue, and 29% had previously attempted suicide. Average monthly attendance was 9 months but ranged from 1 week to 96 months. About three quarters attended group weekly.

On average, patients reported “sometimes” to “frequently” using cognitive behavioral skills (i.e., cognitive restructuring or behavioral activation) outside of meetings; patients were significantly more likely to use cognitive restructuring than behavioral activation.

Contrary to the authors’ hypothesis, length of time attending SMART Recovery was not correlated with cognitive behavioral skill use. Using regression analysis, the authors found that group cohesion was a significant predictor of use of cognitive restructuring and between session homework activities was a significant predictor of behavioral activation.

IN CONTEXT

Characterization of SMART Recovery groups in Australia is an important first step in establishing a knowledge base for this program. As SMART Recovery continues to expand worldwide, it is necessary to know what types of people attend meetings and how these participants use the cognitive behavioral skills learned in meeting; this information is crucial for improving the development and translation of recovery skills.

This study identified group cohesion and homework activities as predictors of skill use suggesting that these variables may be important for program success.

Thus, they can be used to inform future program development and facilitator training.

LIMITATIONS

This sample was comprised of largely unemployed residents in Australia with comorbid mental health issues. Characteristics and predictors found in this sample may not be representative of groups in other geographic locations.
Other limitations of the study include a small sample size and a low response rate of 21%. Due to the method of survey distribution, it is possible that participants with greater motivation (e.g., wanting to express opinions about SMART Recovery) were more likely to complete the survey, making it difficult to generalize to the entire population of SMART participants because a large proportion of potential respondents are not represented in the survey.

NEXT STEPS

There are many directions for future research on SMART Recovery. Most importantly is evaluating its effectiveness at reducing problem behaviors, and more specifically, substance use.

BOTTOM LINE

For individuals & families seeking recovery: Since there are many pathways to recovery it is important to explore different options. SMART Recovery is an available resource if looking for a mutual help group that does not use a 12-step approach. It can also be useful for 12-step meeting attendees who are looking to try something new or who wish to augment their 12-step participation with CBT-oriented training. Click here to find a meeting in your area.
For scientists: Research is needed to evaluate the recovery benefit offered by participation in SMART Recovery meetings. Research into the mechanisms through which the program may work is also of interest.
For policy makers: Awareness of 12-step alternatives such as SMART Recovery is needed to provide more options for those who have not found 12-step programs to be of help in the past. Currently, there is a large disparity between the number of SMART Recovery groups and Alcoholics Anonymous groups worldwide— 800 versus 100,000, respectively.
For treatment professionals and treatment systems: SMART Recovery may be a helpful and cost-effective option for patients seeking recovery. Discussing the nature of SMART Recovery, helping patients to locate local meetings that they can attend, and monitoring patients’ response and experience with SMART meetings during treatment is likely to help patients engage with this recovery option and enhance treatment outcomes.

CITATIONS

Kelly, P. J., Deane, F. P., & Baker, A. L. (2015). Group cohesion and between session homework activities predict self-reported cognitive-behavioral skill use amongst participants of SMART Recovery groups. J Subst Abuse Treat, 51, 53-58. doi: 10.1016/j.jsat.2014.10.008