July 2022

How smart are you about SMART Recovery and its Family & Friends Program? Wisdom on coming together from social media

In SAVVY, we all know about AA and other 12-Step programs. But Joe Gerstein, Founding President of SMART Recovery, gives us an update on this complementary alternative community mutual assistance organization started in 1994.

In SKILLS, Joe explains how SMART Recovery runs and what skills and goals are the focus; as well as how the Family and Friends Program is integrated with CRAFT [Community Reinforcement And Family Training].

In SOUL, I share some of my favorite quotes and images from social media that helped me think about how to come together in an era of division and information bubbles.

savvy

Last month, I shared some TIPS on the plight of a “40 year old male photographer. He is mainly struggling with alcohol use; has been to many inpatient “detox” programs for 6 days every few months and has refused residential after each one. He typically goes to Intensive Outpatient services (IOP) for a week then stops going to Alcoholics Anonymous (AA) and his treatment sessions and relapses and returns about 6 times in the last two years.”

Joe Gerstein responded as follows:

Thanks for your thorough and well-reasoned response to the plea of this family as to how to induce the photographer with Alcohol Use Disorder (AUD) to attend a residential program.

It appears that after each detox session his attendance at AA was desultory and attendance at formal treatment resisted.

I hate to sound like a broken record on this issue, but should not someone consider perhaps recommending a different free, evidence-based mutual aid approach, such as SMART Recovery (Self-Management And Recovery Training) or Life Ring Recovery, or alternatively, Refuge Recovery, Dharma Recovery, Celebrate Recovery, etc. rather than another iteration of the same failed tactics? Provision of the SMART Recovery Handbook [available in 15 languages] to the individual for his perusal might intrigue him enough to get him to attend a meeting.”

Joe went on to update me on a variety of developments in SMART Recovery that I didn’t know anything about. In SAVVY April 2015 and June 2016, I wrote about SMART Recovery. But it is clearly time for an update on SMART Recovery, so I asked Joe to inform us all. The content is Joe’s, but I formatted it to fit Tips and Topics usual style.

Firstly, who is Joe Gerstein?



Joe Gerstein, MD, FACP graduated Tufts Medical School in 1961.

  • He is a retired Clinical Assistant Professor of Medicine at Harvard Medical School.
  • He practiced Internal Medicine and Pain Management for 30 years and spent the last 10 years of his career as a Medical Director for a non-profit HMO (Tufts Health Plan), overseeing Pharmacy and Medicare Risk programs.
  • His innovations there resulted in an appointment as a Visiting Scholar at Stanford University.

Seeking alternatives for his patients who didn’t seem to benefit from 12-Step programs or refused to attend such meetings, he became involved with Rational Recovery in 1990 and was the Founding President of SMART Recovery when it incorporated as a 501c3 in 1994.

  • Dr. Gerstein has facilitated almost 4,000 SMART meetings, 800 in prisons and jails, instigating a grant from the National Institutes on Drug Abuse (NIDA) that led to development of InsideOut, SMART’s Correctional Version.
  • He introduced SMART Recovery into the UK and Australia where each now supports hundreds of weekly meetings.
  • He still serves on the Board of SMART Recovery USA.  

Tip 1

Consider ‘Multiple Pathways of Recovery’ and Community Mutual Assistance Organizations in addition to 12-Step Programs.

Joe prefaced his update on SMART Recovery [Self-Management And Recovery Training], 501c3, especially its “Family & Friends” Mutual Aid Group Program, based on the CRAFT concept with these two quotes:

  •  “It is time that the styles of ‘Multiple Pathways of Recovery’ fully permeate the philosophies and clinical protocols of all organizations providing treatment and support services.” Bill White & Ernie Kurtz (2005)
  • “…an opportunity to look briefly at what else is available in addition to the 12-Step programs, as community mutual assistance organizations. Such knowledge is an ethical and professional imperative.”   William Haning, MD, DFASAM, President of ASAM, to the Conference of the International Doctors in Alcoholics Anonymous (2019). 

Tip 2

Note the history of SMART Recovery pre and post COVID.

  • It is 28 years since the incorporation of SMART Recovery in 1994.
  • In 2018, the organization was split into SMART Recovery USA, supporting meetings in the Western Hemisphere, and SMART Recovery International, supporting meetings in the rest of the world.

As of the onset of the COVID crisis, there were:

  • About 3,400 free SMART meetings weekly, in 28 countries.
  • About 200 of these were Family & Friends meetings.
  • Meetings are led by facilitators trained via a sophisticated online audio-visual program.
  • About 12,000 have been trained to date, approximately 2/3 licensed or certified professionals and 1/3 mainly successful SMART Recovery participants.
  • Many have also been trained as Family & Friends meeting facilitators.

The SMART Recovery Handbook, 3rd Edition, is published in 15 languages, the latest Russian, Haitian Creole and Japanese. A Swedish translation is in progress by the Swedish Prison System.

Prior to COVID, there were 26 weekly online meetings.

  • Since then, there are about 600 “local” (smartrecovery.org/meetings) and 70 national/international, foreign-language and specialized meetings (smartrecovery.org/community) weekly via ZOOM.
  • There are about 2,000,000 website visitors annually, who can also participate in chat rooms and message boards. 

Tip 3

The SMART Recovery Program is science-based and abstinence-oriented.

It is applicable to any sort of addiction, substance or behavior.

  • There are numerous scientific articles validating its approach, which is based primarily on Cognitive Behavior Therapy (CBT)/Rational Emotive Behavior Therapy (REBT), Motivational Interviewing, Stages of Change and Motivational Enhancement Therapy. [http://www.williamwhitepapers.com/pr/dlm_uploads/SMART-Recovery-Bibliography.pdf]  
  • The SMART Recovery Program is recommended by National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), Substance Abuse and Mental Health Services Administration (SAMHSA), National Association of Drug Court Professionals (NADCP), Health Resources and Services Administration (HRSA), the Surgeon General, the US & Canadian Federal Prison Systems, National Institute for Health and Care Excellence (NICE) (UK), Australian Council on Healthcare Standards (ACHS), etc.
  • Two large studies on SMART Recovery in Alcohol Use Disorder (AUD) recovery are currently in progress, sponsored by NIAAA, one at Harvard Medical School.

Tip 4

Two general types of world-views – Platonic and Aristotlian. SMART Recovery appeals more to an Aristotlian view.

Two general types of world-views have been known since antiquity: Platonic and Aristotlian. The former tends to the spiritual, idealistic, religious. Our Declaration of Independence would exemplify this approach.

The other tends to the empiric, objective, scientific and would be more typified by our Constitution.

  • People of the latter temperament tend to respond better to the SMART approach.
  • To some in recovery, the ideology of a program is crucial. However, about 30% of regular SMART participants also attend 12-Step meetings, at least occasionally.

Tip 5

SMART has a suite of effective correctional materials in use in prisons and jails throughout the world.

Besides the standard SMART Program and the Family & Friends Program, SMART’s correctional materials include:

  • The 24-meeting InsideOut Program’s development that was funded by NIDA for prison use.
  • There are also two 12-meeting versions, mainly for jails and reentry programs.
  • The SUCCESSFUL LIFE SKILLS Program is being introduced into 100 rural sober houses/reentry residences in conjunction with the Fletcher Group, in a program funded by HRSA.

A propensity-controlled study on 6,000 Australian prison inmates with addiction histories demonstrated a 42% reduction in reconvictions for violent crimes for those exposed to at least 10 SMART group meetings vs. 6 other programs, with similar results throughout all socio-cultural groups, including Aboriginals. 

The InsideOut Program has been successful in a diversity of correctional systems, from the US, UK and Canada to Namibia and the Punjabi Constabulary.

skills

Tip 1 

How SMART Recovery meetings are run.

SMART Recovery meetings:

  • Led by trained facilitators.
  • Interactive and provide 14 useful tools.
  • Open to discussion and avoid stigmatizing language and shaming.
  • Participants are not told what to do, but set their own goals.
  • There are no sponsors, though facilitators often act as mentors.

Since its inception, the SMART Recovery organization and program has supported a participant’s choice to use prescribed medications as aids to their recovery plans.

Although meditative techniques are not integral to the SMART Program, they are encouraged as an adjunct to meeting participation and homework.

Tip 2

SMART Recovery’s 4 Point Program.

Skills and goals of the SMART Recovery 4 Point Program:

1. Enhancing the Motivation to Change

2. Coping with Urges More Effectively

3. Dealing with the Problems of Life More Adaptively with Cognitive-Behavioral Techniques

4. Learning a New Lifestyle: Balancing Immediate gratification with Enduring Satisfactions



Tip 3

Helping families and friends affected by addiction with SMART’s Family & Friends Program.

The evidence-based family aid program CRAFT [Community Reinforcement And Family Training] is a well-reputed, widely-accepted approach to a positive-reinforcement-oriented behavioral change concept.

  • The CRAFT approach attempts to avoid a confrontational atmosphere among those involved in the often chaotic addiction family milieu.
  • For the Family & Friends program, the CRAFT Program has been integrated with a support-group format to produce a revolutionary merger, which has proved very attractive and effective.
  • This SMART Recovery version of CRAFT utilizes a participatory group which tends to add an important element of support to the CRAFT concept.
  •  There are still a number of local, in-person Family & Friends [F & F] meetings available and daily ZOOM meetings as well.
  • Trials of the CRAFT Program vs. confrontational approaches have demonstrated CRAFT’s effectiveness in helping a person seek treatment, as well as to improve communication and interaction among the participants.

An excellent exposition of the CRAFT theme is by its originator, Robert Meyers, of UNM, and Brenda Wolfe:” Get Your Loved One Sober: Alternatives to Nagging, Pleading and Threatening.” Another excellent book, espousing the same general themes, is “Beyond Addiction: How Science and Kindness Help People Change” by Jeff Foote, et al. Both are useful introductions to the CRAFT concept. Professor Meyers runs several training seminars, annually, some online, aimed at professionals.

  • A SMART Recovery Family & Friends Handbook (for participants) was developed by SMART Recovery Australia.
  • The SMART Recovery Family & Friends Facilitator Manual (for facilitators) was developed by UK SMART Recovery.
  • The Handbook and Manual are available at smartrecovery.org/resources. The Manual is also provided to F & F trainees.

Although the Family & Friends Program is fundamentally based on CRAFT and Motivational Interviewing, both well-established, evidence-based concepts, there is as yet no evidence-base for the F & F program, per se, other than its popularity and anecdotal successes, for the people with addiction and for their loved ones.     

soul

With elections in full swing in the USA and political conflicts around the world, I feel troubled about how do people of good will come together from our divided positions? So I turned to my collection of quotes and images from social media to share some of my favorites with you. I find myself getting judgmental with people whose violent talk and behavior floods TV or social media. Then I remember that if we could start talking to each other, there is a lot of pain under that tough exterior.

It’s hard not to want to change others to fit your own world view and get them to ‘see the light’. But it doesn’t work trying to change someone who is not a willing participant.

I enjoyed this twist on the Serenity Prayer and wonder if I have the Courage to “change the things I cannot accept”.

Through COVID and in the midst of other crises, it is popular to say “we are all in this together” and ideally we are. We are in the same “Storm” but we really are not in the same “Boat”. Because of different upbringings, resources, role models, social determinants and drivers of health and well-being, it takes empathy, understanding and compassion to really listen and communicate.

We are surrounded by clenched fists in addressing the many polarized issues that confront our daily sensibilities. There seems to be no appetite for talking together, aware of the hurt and fear that lie under the angry exterior.

God grant me the courage to change the things I cannot accept; empathy for those in different boats; and the compassion to unclench my fist.

June 2022

Helping families with addiction – Residential treatment is not the gold standard; Intervention, Tough Love or CRAFT?; Exercise training is hard work. How do those athletes do it?

In SAVVY, STUMP THE SHRINK and SKILLS, I share a colleague’s request for recommendations for a residential program on behalf of a family affected by addiction. The family wanted their son in long-term residential treatment. But is residential treatment the gold standard? We have to use the whole continuum of care to give long-term, life long addiction treatment if necessary.

What should be done for a son who the parents are financially supporting and who doesn’t follow through with treatment?

In SOUL, I recently started strength and core exercise training. Better late than never, but it is hard. I have a new found admiration for all those athletes who workout everyday to reach their peak performance

Read More

May 2022

Pandemic Parenting: Do you have Parental Burnout?; Strategies to help with Parental Burnout; 13 million pounds of discarded soap.

In SAVVY, an online survey of 1,285 working parents was conducted between January 2021 and April 2021. Earlier in May, the researchers from Ohio State University published their report, Pandemic Parenting: Examining the Epidemic of Working Parental Burnout and Strategies to Help.

In SKILLS, after describing what Parental Burnout is, the report went on to provide some strategies to help parents deal with burnout. So whether you are a parent yourself, or helping parents cope, the report has strategies for you.

In SOUL, In 2008, Shawn Seipler was staying at a hotel in Minneapolis and wondered what happens to all the unused hotel room soap? This got me thinking about what would be the ‘wasted hotel soap’ of the healthcare industry? What better systems could we build that could save as many lives as 13 million pounds of discarded soap?

Read More

April 2022

My three career bridge-building targets; Where to start in helping people change; 50 years for Elon Musk and me.

Welcome to the start of my 20th year of writing Tips and Topics. The first edition was published April 2003.

In SAVVY, this edition of Tips & Topics begins the 20th year of publication. I look back at what I’ve written before in three areas of bridge-building: Addiction as an illness – the general public and health care in general; Addiction and mental health – Co-Occurring Disorders; Justice and Treatment teams.

In SKILLS, it requires skillful bridge-building to attract people into lasting, accountable change, and cross the bridge from expecting compliance to treatment to collaborating in person-centered care planning: Start with what the person is at Action for, not what you are at Action for; Hold the participant accountable to their goal and track their engagement, good faith effort and outcomes.

In SOUL, this year is 50 years since I graduated from medical school and started my career. See my ASAM Educator of the Year award photo and video bio. Elon Musk is 50 years old. I’ve had a good career, but find out what drives Elon and what someone who was one year old when I started my career has achieved.

Read More

March 2022

What to report to Probation and CPS; Dilemmas about drug testing; Client-centered doesn’t mean client anarchy; Win, lose and win

In SAVVY, SKILLS and STUMP THE SHRINK, treatment providers can be confused about their role when clients are referred by Probation, Child Protective Services and other mandating agencies. Focus on improved function and skills, not compliance with assignments and phases in a pre-determined program. How to be “client-centered”.

In SOUL, increasingly I make no distinction between ‘wins’ and ‘losses’. A ‘win’ is an opportunity to discern what works and what doesn’t; and a ‘loss’ is an opportunity to discern what works and doesn’t.

Read More

February 2022

What I didn’t know about growing up Black in America; I thought I pulled myself up by my bootstraps, but….; the 3 year anniversary of losing my wife.

In SAVVY, I learnt a lot from three African American young people. I was aware of some of their experiences but others were totally new to me. Rethinking the terms “microaggressions” and “cultural competence”.


In SKILLS, being person-centered and focused on the individual in their social context addresses siloed initiatives and projects. I thought I pulled myself up by my own bootstraps. But a look at my generational history exposed the myth of meritocracy.

In SOUL, it is three years since the sudden loss of my wife. Current thoughts on my process in Work, Love and Play.

Read More

January 2022

Could you learn something from Buddha? Check out some of his quotes and how to apply them; Using joy to focus on where to put my energy.

In SAVVY and SKILLS, Suzan Dalia shares Quotes by Buddha that will change the way you think….if you apply them. She suggests some ways to apply them.


In SOUL, anything or anyone who doesn’t bring joy to your life; and doesn’t think you are a joy in their life, doesn’t deserve your time or energy.

Read More

December 2021

“Rat Park” and Vietnam – research focuses on the role of environment in addiction; Assess people’s social environment; Educator of the Year Award

In SAVVY, two research studies from the 1970s remind us of the role of the environment in the development and continuation of addiction. Access Michael Pollan’s episode on Science Friday to hear about three plant-based compounds from the three major categories of psychoactive drugs– uppers, downers, and what he thinks of as outers.

In SKILLS, do you focus on your clients’ families, their social communities, their sources of human contact and support? Assessing their social environment is as important as their mental and physical health assessment.

In SOUL, David Mee-Lee, MD, DFASAM, Named ASAM’s Educator of the Year. What that means and how it feels.

Read More

November 2021

30th Anniversary of The ASAM Criteria – A Report Card; Two videos I want you to see

Welcome to the November edition of Tips and Topics and a Happy Thanksgiving to all in the USA.

In SAVVY and SKILLS, I take a look at thirty years since the publication of the first edition of The ASAM Criteria. Here is my report card on how the addiction treatment field has implemented the true spirit and content of the Criteria.

In SOUL, I share two videos I saw this month and found so touching. I hope you can find 8 minutes to view them too, especially at this time of Thanksgiving.

Read More

October 2021

It’s not what you do that counts, but who you are; Self care, Personal Mission and Servant Leadership; Sunset of my career.

In SAVVY, my ‘first draft’ on meeting the challenge to write about the mix of spirit and psychology in a book – to articulate the spiritual context that gives structure to the core tools I have trained on full time for 25 years. It can be summarized by a phrase: “It’s not what you do that counts, but who you are.”  

In SKILLS, tips on ‘how to get there from here’ if you are committed to self care, clarity on your personal mission and are ready to be a servant leader.

In SOUL, trying to balance what I do in the sunset of my career to meet the goals of my personal life direction and my professional mission.

Read More

September 2021

National Recovery Month 2021; Understanding Recovery and Recovery Capital; What to say to someone who doesn’t want AA; Katie’s story

In SAVVY, I explore what we mean by Recovery and Recovery Capital.  It isn’t all about abstinence and mental health stability, but rather whole person and whole systems perspectives.

In SKILLS, I focus on how to assess Recovery Capital and also how to approach a person who doesn’t want to go to Alcoholics Anonymous and prefers an alternative support group.

In SOUL, Katie, a person in long-term recovery, shares her recovery story.

Read More

August 2021

Five key principles in helping people change; Skills to implement those principles; Vaccine hesitancy and using the five principles of the Better Arguments Project

In SAVVY and SKILLS, I share the wisdom of Marvin Goldfried, Ph.D. who presented in one paper five key principles on how people change. He wrote about the common principles of change that he distilled from hundreds of schools of thought and approaches to change. For each principle, I offer a few SKILLS to help implement it.

In SOUL, I don’t plan on talking with my daughter and her family about their vaccine hesitancy.  I respect their right to make their own choices.  But in case the topic of vaccines arises, I want to be grounded and centered to know what to say and do. So I used the five principles of the Better Arguments Project to help guide me.

Read More