AA Alternatives: The Behavioral Science of SMART Recovery

SMART Recovery is a mutual aid group for individuals interested in abstaining and recovering from any type of addictive behavior, whether it be a substance or behavior.1 SMART stands for Self-Management and Recovery Training, and the method is built on the foundational elements of four “points,” six stages of change, and the use of cognitive-behavioral therapy.2, 3

What Is SMART Recovery?

SMART Recovery is a nonprofit, research-based organization founded in 1994.¹ It’s considered an “alternative” mutual aid group, as it differs in significant ways from 12-step programs such as Alcoholics Anonymous (AA).1

SMART Recovery is unique in that it promotes a mindset of self-reliance and self-empowerment, as opposed to the “powerlessness” lens of AA and related organizations like Celebrate Recovery

Like AA and many other peer support groups like LifeRing and Secular Organizations for Sobriety, SMART Recovery is abstinence-based. However, in SMART Recovery, strict abstinence is strongly emphasized and encouraged, rather than strictly required, which is similar to HAMS.4

What Is the SMART Recovery Method Based On?

SMART Recovery is founded on elements of cognitive-behavioral therapy (CBT), specifically rational emotive behavior therapy (REBT).¹ It also incorporates motivational interviewing and enhancement, all of which are behavioral therapies often used in formal alcohol addiction treatment.1, 2

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Cognitive-behavioral therapy focuses on identifying the connection between your thoughts—or cognitions—and behaviors and finding ways to improve unwanted behaviors by changing the thoughts related to them. SMART Recovery worksheets or exercises may use specific CBT exercises, such as cost-benefit analysis or the ABC Method.

Cost-Benefit Analysis

In a cost-benefit analysis (CBA) activity, you identify the costs and benefits of engaging in your addictive behaviors versus not engaging. This exercise recognizes that while the addictive behavior may be harmful, you were gaining something, and there will be costs to not engaging in this behavior anymore.1 For example, if you engage in alcohol misuse as a behavior, you may feel temporary relief or numbness from racing thoughts or painful emotions. You may also experience costs to this behavior, such as missing out on important events with loved ones.

CBA motivates progress by helping you identify and weigh the benefits of not engaging in that behavior anymore, as well as find alternative ways to meet the same need. 2

Once you identify the needs the addictive behavior used to meet, you can find alternative ways to meet those same needs, such as talking with a trained therapist, journaling, or engaging in exercise.3

ABC Method SMART Recovery is based on CBT.

The ABC Method is a rational emotive behavior therapy (REBT) exercise that helps you reprocess an “activating event.” 1

In the ABC Method, you examine: 2

  • A—Activating events
  • B—Beliefs about these events (e.g., what you “must” do because of this event)
  • C—Consequences of your beliefs (e.g., feelings and behaviors)

To take it a step further, you optionally then (D) dispute this irrational belief and implement (E) effective change in your thinking about the initial activating event.

For example, let’s say you received a bad performance review from your boss at work, and your boss tells you that you struggle with time management. This activating event:

  • A—This activating event triggered feelings of being a “failure.”
  • B—Led to you to fee that you “must” have a drink to reduce the pain caused by that failure.
  • C—If you took a drink after work, however, it would be reverting to an old maladaptive coping pattern with negative consequences you already know about.
  • D—Instead, you examine what you are actually feeling and dispute the negative belief that “you are a failure.”
  • EInstead of having a drink, you choose a different action. This can be one you chose in advance with your therapist or one you choose based on the feelings you identify in the moment.

Other examples of SMART Recovery activities are the Change-Plan SMART Recovery worksheet and the urge log. These and other activities can be found on the SMART Recovery website.3

What Is the SMART Recovery 4-Point Program?

SMART Recovery principles revolve around a 4-Point Program. The 4 Points are not steps that have to be completed in a specific order, and an individual may move between these points at different stages of their life and recovery process.1

This differs from the purpose and intent of 12-step-based programs like AA, where each step is designed to be completed in order the first time and revisited when needed. In SMART Recovery, the 4 Points are:2

  1. Building and maintaining the motivation to change and stay changed
  2. Coping with urges to use and cravings to return to unwanted behaviors
  3. Managing thoughts, feelings, and behaviors in an effective way without addictive behaviors
  4. Living a balanced, positive, and healthy life that takes long– and short-term goals into account

These 4 Points correlate directly with the SMART Recovery acronym. Points 1 and 2 are seen as the “recovery training” elements of SMART, while Points 3 and 4 are considered to be the “self-management” principles.2

What Are the SMART Recovery Stages of Change?

SMART Recovery also uses the Stages of Change Model to conceptualize recovery and its process, which as the following six stages:2

  1. Precontemplation—You do not see a problem with your behaviors and actions, so therefore you do not see a need to make any change. Or, you may see a problem with your behaviors and actions, but are strongly against making any changes at this point.
  2. Contemplation—You are beginning to see the problem with your behaviors but are still ambivalent to change. You are beginning to consider making changes.
  3. Preparation—You are now committed to change and develop a plan to make these changes.
  4. Action—The plan is put into action, and behavior changes are adopted.
  5. Maintenance—New behaviors have been established, and behavior changes have been in effect for six months.
  6. Termination/Graduation—You can consistently respond appropriately to any temptations or urges to engage in the problematic behavior.

Motivational interviewing can be an effective intervention at any stage of change. Motivational interviewing may be done using SMART Recovery worksheets or sessions with a therapist.5

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It is important to note here that relapse is considered a potential deviation throughout the six stages and can occur at any time in the process. SMART Recovery maintains the belief that “slips,” or relapses, provide individuals with the opportunity to learn and grow. Many people will go through the stages multiple times before completing the cycle of change without a lapse.2

What Are the Major Differences in SMART Recovery vs. AA?

A significant difference between SMART Recovery and AA is the perceived locus of control in each of these programs. In the SMART Recovery framework, the individual has control, which encourages self-motivation and self-reliance in recovery.1 In AA, the control is external, which is exemplified by concepts such as admitting powerlessness over one’s addiction in Step 1.

SMART Recovery also does not follow the disease model of addiction, which describes addiction as a mental health condition. SMART Recovery looks at addiction as a problematic pattern of behavior that can be changed with motivation and the use of cognitive-behavioral skills.6 SMART Recovery emphasizes active learning of various skills and tools to work through recovery, including the use of worksheets.1

SMART Recovery meetings are more interactive than AA meetings. Conversations and feedback are encouraged during SMART Recovery meetings, whereas AA meetings are structured as a “sequence of monologues.”1 SMART Recovery can also be particularly helpful for those living with co-occurring substance use and mental health disorders, as individuals are invited to discuss any relevant topic at meetings, not just the topic of addiction.7

Unlike AA, facilitators of SMART Recovery meetings receive training on how to run the meetings. While the facilitators are volunteers, not licensed mental health professionals, SMART Recovery meeting facilitators do not have to identify as being in recovery themselves, unlike AA facilitators.4, 7

How Can I Get Involved in SMART Recovery?

If you think SMART Recovery would be helpful for you, the SMART Recovery Toolkit provides many SMART Recovery worksheets for download.3

SMART Recovery meetings are available in-person and online. Online meetings are conducted in both English and Spanish.8

Peer support complements and often supports alcohol rehab treatment. SMART Recovery’s use of cognitive-behavioral therapy and motivational interviewing principles may help you build on skills you learn in a treatment program or working with your therapist.

Remember that your recovery journey is unique. There are many different peer support organizations because the purpose of peer support is providing the critical social element needed whether you are in professional treatment, transitioning out of treatment, or have been in recovery for years.

To learn more about professional alcohol addiction services, call 800-948-8417 Who Answers? for more information.

Resources

  1. Horvath, A. T., & Yeterian, J. (2012). SMART recovery: Self-empowering, science-based addiction recovery support. Journal of Groups in Addiction & Recovery, 7(2-4), 102-117.
  2. Horvath, A. T. (2000). Smart Recovery®: addiction recovery support from a cognitive-behavioral perspective. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 18(3), 181-191.
  3. SMART Recovery. (2021). SMART Recovery Toolbox
  4. O’Sullivan, D., Blum, J. B., Watts, J., & Bates, J. K. (2015, July 31). SMART recovery: Continuing care considerings for rehabilitation counselors. Rehabilitation Counseling Bulletin, 58(4), 203-216.
  5. Diclemente, C. C., & Velasquez, M. M. Motivational Interviewing and the Stages of Change. MOTIVATIONAL INTERVIEWING, 201.
  6. Humphreys, K., Wing, S., McCarty, D., Chappel, J., Gallant, L., Haberle, B., Horvath, T., Kaskutas, A., Dr. P.H., Kirk, T., Kivlahan, D., Laudet, A., McCrady, B., McLellan, T., Morgenstern, J., Townsend, M., & Weiss, R. (2004). Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. Journal of Substance Abuse Treatment, 26(3), 151-158.
  7. Penn, P. E., Brooke, D., Brooks, A. J., Gallagher, S. M., & Barnard, A. D. (2016). Co-Occurring Conditions Clients and Counselors Compare 12-Step and Smart Recovery Mutual Help. Journal of Groups in Addiction & Recovery, 11(2), 76-92.
  8. SMART Recovery. (2021). SMART Recovery Meetings.
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