For years, I was a card-carrying member of Narcotics Anonymous, because once upon a time narcotics, for me, were just the best. These days, I am a licensed mental health and substance abuse counselor, and my views on recovery from drug addiction — as well as the efficacy of 12-Step Programs — have changed.
If these programs work for you, then, by all means, keep at it. However, peer-reviewed studies indicate that 12-Step Programs have close to a 90% failure rate, so what else can you try if they’re not working for you?
Twelve Step groups get a great deal of press, but they aren’t the only game in town when it comes to support for alcoholism and drug addiction. SMART Recovery® has been growing in popularity for several years. If faith-based support doesn’t sit well with you, here are 4 reasons to consider this alternative.
1. It’s okay to talk about mental illness.
When I was new to recovery, I just assumed that everybody who was in recovery was also mentally ill. Clinically, this is called “co-morbidity.” Basically, you are an addict AND you suffer from something like depression or anxiety.
However, I knew a number of recovering addicts who claimed they had never experienced any mental health issues — aside from the addiction, of course, which invariably had ruined their lives. Moreover, I soon found that those addicts who did suffer from mental illness were reluctant to admit it. You could certainly talk about it with your sponsor, but not so much in a meeting. Some members would even object, calling it an “outside issue.”
This is a big deal, as both The National Institute on Drug Abuse (NIDA) and The Substance Abuse and Mental Health Services Administration (SAMHSA) report that 30 million people (9.5% of the adult population of the United States) have a substance use disorder. And of those 30 million, about 45% have a co-occurring mental health disorder (5% of pop.). Bottom line: Addicts tend to struggle with mental illness.
I never understood why frank discussions of mental health were verboten. I suspect it has something to do with the 12-Step belief in a Higher Power and the power of The Program. The idea is, if you’re working the program the way you should, your sanity should be restored and you get to be a productive member of society.
Extremists in the groups would inevitably claim that you were not working the program to the best of your ability if you were still depressed or manic or any of the other things that come with a mental illness. This is from AA’s Big Book:
“Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.”
And from NA’s Basic Text:
“We have never seen a person relapse who lives the Narcotics Anonymous program.”
SMART Recovery®, on the other hand, completely recognizes mental illness as a real thing, sometimes separate from the addiction but often linked. They acknowledge “possible psychological factors” and members are treated accordingly.
I spent a few years working on the front lines of the opioid epidemic, and I can report a correlation between sustained drug abuse and post-traumatic stress. I’d estimate that 75% of the women I treated had been sexually or physically abused as a child, and about half that number had suffered domestic violence and other forms of abuse as an adult. The men too were coming from traumatic histories as well — abuse, prison, gang activity, etc. Rarely did a well-adjusted person with a happy life enter the facility where I worked.
While AA and NA talk about the virtues of changing “people, places, and things,” the post-traumatic stress lingers in the mind. It can stay with you for decades, too, if you don’t address it.
2. SMART Recovery® supports evidence-based psychological interventions and the legal use of prescribed psychiatric medication.
This might be the single biggest difference between SMART Recovery® and NA. Both NA and AA make a point of separating themselves from “professional services.” It’s even against their guidelines to have trained clinicians involved in meetings. NA, for example, believes that “the therapeutic benefit of one addict helping another is without parallel.” That sounds great, and for many it’s true. But what if you need more?
This is taken from their website:
“SMART Recovery® is the leading self-empowering addiction recovery support group. Our participants learn tools for addiction recovery based on the latest scientific research and participate in a world-wide community which includes free, self-empowering, science-based mutual help groups.
The SMART Recovery® 4-Point Program® helps people recover from all types of addiction and addictive behaviors, including: drug abuse, drug addiction, substance abuse, alcohol abuse, gambling addiction, cocaine addiction, prescription drug abuse, sexual addiction, and problem addiction to other substances and activities. SMART Recovery® sponsors face-to-face meetings around the world, and daily online meetings. In addition, our online message board and 24/7 chat room are excellent forums to learn about SMART Recovery® and obtain addiction recovery support.”
In reality, 12-Step Programs are populated by sick people, with no training, helping other sick people. Admittedly, this does work for some, but why is it a bad idea to use evidence-based therapies or even prescribed medications in the fight against addiction and co-occurring mental illness? Many members of NA despise the very idea of medication, for any reason. Some would go as far as to say you are not working an honest program if you are using any drug, prescribed or otherwise. Total abstinence from everything.
When you consider that 45,000 die in this country every year from suicide, it is alarming to see a “support group” taking such a cynical attitude towards professional interventions.
While it is perhaps not a good idea for a recovering heroin user to take narcotic pain killers when Advil would do, this belief gets a bit more murky when you start looking at mental illnesses such as schizophrenia and bi-polar disorder. These are conditions can absolutely be managed with medication and therapy, but schizophrenics and people diagnosed with Type 1 Bipolar are completely unable to function without medication.
Imagine, for a moment, that you struggle with auditory and visual hallucinations, delusional thinking and disorganized thought. How helpful do you think NA’s attitude about medication will be to your mental health?
In an example like this, abstinence from all substances seems like a horrible idea. I attended NA meetings for years, and was under a doctor’s care the entire time for both severe anxiety and depression. I was prescribed medication for both. I told exactly zero people in NA about that part of my life. Not because I was ashamed, but because I didn’t want to be accused of “relapsing” when all I was doing was taking legally prescribed medications. This ended up being a major reason I eventually stopped going.
Even as a licensed counselor, I’m hesitant to talk with people about psychotropic medications, as I’m not a physician. It’s a bad idea to have untrained people giving medical advice about anything. Too many people think that they are experts because they can read an abstract on WebMD, and bad information rots the discourse like black mold. This is high-stakes poker. People die. All the time. There are good reasons why you have to have a license to practice medicine or perform psychotherapy.
3. AA sees addiction in simple terms; SMART Recovery®recognizes its complexity.
AA touts itself as a simple program for complicated people. That sounds great. Except that addiction is a complicated disease that gets further complicated when you try to oversimplify it.
Not all addicts are the same. I know many addicts in recovery who claim they can get addicted to anything — heroin, crack, sex, soap operas, you name it. I know others who had their one drug of choice and who never really had problems with anything else. I was one of those types of addicts. I had what can best be described as a psychological addiction to marijuana. In my past, I’ve tried many other drugs. None of them really interested me.
To this day, I have a beer occasionally, but I can’t remember the last time I ever got drunk. I’ve also never been arrested or in trouble with the law, which for many addicts is the norm. Some addicts forego drugs and instead find themselves addicted to shopping, gambling, work, or sex.
The point is, we are not all alike. SMART Recovery® accepts that this is a complicated, multi-faceted disease. Some addicts require medication; some don’t. Some addicts require hospitalization; some don’t. Some addicts need therapy; others need accountability, direction, structure, or all of these things, or none.
Addiction is often a secondary issue, as I’ve discussed earlier with the concept of co-occurring disorders and co-morbidity. Sometimes addiction is self-medication for depression. Sometimes it’s more on the Obsessive-Compulsive (OCD) spectrum. Sometimes people truly are physically addicted to a drug, as is often the case with opiates and heroin. Sometimes it’s more psychological. Often, it’s a combination of several factors.
Faith in a higher power is certainly helpful, but is it enough?
4. SMART Recovery® is based on science, not spirituality.
At NA meetings, I’m supposed to say “Hi my name is Randy, and I’m an addict.” It’s weird if you don’t. NA’s position is that we have to accept who we are, and I do agree with that. But is it possible that we can change? I think it is. But if I went to an NA meeting and said “Hi my name is Randy and I used to be an addict,” rest assured there would be drama.
The following is taken from the SMART Recovery® FAQ section:
SMART Recovery® has a scientific foundation, not a spiritual one. SMART Recovery® teaches increasing self-reliance, rather than powerlessness. SMART Recovery® meetings are discussion meetings in which individuals talk with one another, rather than to one another. SMART Recovery® encourages attendance for months to years, but probably not a lifetime. There are no sponsors in SMART Recovery®. SMART Recovery® discourages use of labels such as “alcoholic” or “addict”.
The basic assumption with 12-Step groups is that you attend those meetings for the rest of your life. Even if that is the right thing to do, how realistic do you suppose that is?
SMART Recovery®, on the other hand, recognizes that at some point treatment has to stop. It’s just the way things are. Professional counseling these days is centered around brief therapies that are really not supposed to last for more than six months.
If you’re seeing the same therapist five years later, you really have to ask yourself if any work is actually being done. Wouldn’t the same thing be true with NA?
Finally, the concept of “powerlessness” was always an issue I had with NA. It’s also a HUGE part of their philosophy. We have to admit that we are powerless. Only then can we admit we need help. That’s true, but the problem is that people tend to use powerlessness as an excuse for all sorts of things, including relapse.
SMART Recovery® advocates self-reliance, which is the cornerstone of any modern treatment modality. If we are to get better, we will need to lean on others at first, but eventually, we are going to have to lead our own lives. In addition to this being a more realistic way of looking at things, it also has the benefit of being true.
If parts of NA or AA just don’t sit well with you, or you prefer a more scientifically-based approach to substance abuse treatment, check out SMART Recovery®. It’s free, they offer meetings both online and in person, and they even have an online chat feature if you have any questions or concerns.
If you or someone you know is struggling with an addiction, use whatever tools you have to fight this cunning and elusive disease. 12-Step meetings are not the only thing out there. Do your research and make an educated, informed decision. After all, your life hangs in the balance.