How SMART Recovery Works

By Tom Horvath, PhD

Mutual help groups for addictive problems have been in existence for centuries. No one knows exactly how they work. What follows is my best estimate of what happens in SMART Recovery meetings, and how they help.

How SMART Recovery Works

SMART offers an approach that will appeal to many (for either substance problems, activity problems, or both) because it is self-empowering, science based, progress-oriented, and holistic. Other mutual help approaches will appeal to other people. Some people may use multiple approaches.

In 1994, when SMART Recovery began operating under that name, SMART elected to move beyond specific tools (which had been prominent in its pre-history) by identifying 4 common tasks for the process of addressing an addictive problem, the 4 Points. The 4 Points summarize what to do.

1. Building and maintaining motivation
2. Coping with urges
3. Managing thoughts, feelings, and behaviors
4. Living a balanced life

Any specific tool is a suggestion about how to accomplish a Point (or the broader underlying task of addressing an addictive problem). SMART assumed that new psychological tools (coping skills, behavioral techniques, etc.) would be discovered or created in the future, and we wanted to leave room for them.

At the foundation of every tool there appears to be what can be called “the fundamental tool,” which is reinterpreting one’s experience (of oneself, the world, the future, etc.) to lead a more satisfying and more meaningful life.

One summary of the fundamental tool is the ABC tool: A is the Activating event (something happens), B is the Belief (about what happens), and C is the emotional and/or behavioral consequence. The ABC helps us remember that our C is based on B, not on A.  If you are not familiar with the ABC, or any other commonly used tool in SMART, they are easily available at www.SMARTRecovery.org.

To illustrate with one example: Imagine that you have been informed by your spouse that the spouse is filing for divorce. How do you feel? Now name any emotion you can think of (fear, rage, elation, depression, etc.). Now imagine the belief that you would have to explain the emotion. For instance, if fear, you might be thinking (Believing) that “I will never find someone else, and I’ll be alone the rest of my life.” If rage, “how could this person do this to me after all I’ve done for them?” If elation, “I have wanted to file for divorce myself, but felt stuck about it, and now I’m not stuck!”

The 4 Points roughly align with the Stages of Change, which have been used for decades to describe how someone views their relationship with an addictive behavior. The Stages are:

1. Precontemplation (“I don’t have any problems with that substance/activity”)
2. Contemplation (“Maybe I have problems, so I need to think about them”)
3. Preparation (“I am getting ready to change”)
4. Action (initial change)
5. Maintenance (sustained change, beginning after three to six months in Action)

If we look at how SMART Recovery works, the alignment between the Stages of Change and SMART’s 4 Points is roughly:

• Contemplation: Point 1
• Action: Points 2, 3
• Maintenance: Point 4

Various tools could be used under any Point or Stage. Many participants will resonate more with the stories they hear in meetings or the connections they make, rather than the use of tools. If someone does use tools, the participant is increasing their ability with System 2 thinking.

System 1 thinking is the automatic, rapid, and easy way we make decisions moment to moment. System 2 is the careful, slow, and sometimes difficult approach we need when we face complex problems. We would rather go along in life in System 1 but we often face issues that would benefit from System 2 analysis.

For instance, imagine that you get a job offer. Using System 1, you might feel excited, pleased by the pay and the chance to be employed by a prominent company. You accept, because it feels right. If you use System 2, you might still accept the offer, but you would also consider issues like how the job aligns with your long-term goals, what the work/life balance in the new company might be, how strong the benefits package is, what the company culture is like and how would you fit in, etc. Using System 2 is more effortful, but it will usually lead you to a more accurate conclusion.

Presumably all participants use the fundamental tool (reinterpretation), even if they do not recognize their use of it. Classic reinterpretations that one might hear in a SMART meeting, with numerous variations, include:

My addictive behavior is more good than bad

My addictive behavior is more bad than good

I cannot resist craving

I can resist craving

My problems make life unbearable

I can make progress with and possibly resolve my problems

I am a terrible (bad, awful) person

I am an acceptable person, and there is a place for me in the world, despite my past mistakes

I do not have a meaningful future

I have a meaningful future

Exactly how these reinterpretations occur is not clear in many cases. However, when stated out loud, reinterpretations are a striking aspect of meetings. When we make statements out loud, they appear to reach a higher level of reality for us. We could even say these ideas come fully into existence for us. Jumbled words in our minds do not have the same power for us as statements we make out loud, especially with other people listening. As previously mentioned, we do not understand exactly how mutual help groups work. Nevertheless, it does appear that the opportunity to state important ideas (ideas important to us, and perhaps newly important to us) to an audience of concerned individuals (who may then add their own experiences in support of our statement), may be one of the most important aspects of a mutual help group.

For some, reinterpretations appear to arise after extensive effort devoted to working one or more tools. For others, a reinterpretation appears to arise spontaneously out of the group discussion or other experiences. Although the public statement of the reinterpretation is a powerful step (and sometimes a dramatic one), stating a reinterpretation may be only one step in a much longer process of change.

One of the striking differences between mutual help groups is the degree of conversation. AA meetings often have one person speaking after another, with no interaction between speakers. SMART meetings almost always include conversation (even if a tool was presented at first). Sometimes the meeting is almost entirely conversation. The topics of these conversations may be chosen by the participants or by the facilitator. However, regardless of the exact topic under discussion, it seems likely that each participant keeps in mind their own specific issues and concerns (i.e., their current interpretations and possible new interpretations), and weaves aspects of them into the discussion.

The environment in which interpretations are considered and reinterpretations stated is perhaps the most important aspect of any mutual help meeting. We express ourselves deeply only when we are confident that we will not be judged or criticized. It is the role of the facilitator especially, but all participants, to set an example of empathic listening. A foundation for empathic listening is the appreciation that all of us at times choose short-term benefits over long-term ones, that there are typically situational factors that press on us (and our short-term oriented decisions are not entirely based on low willpower), and that progress in addressing addictive problems is typically slow and back-and-forth (therefore we need to persist, but with patience).

SMART recently described itself as where “personal autonomy meets community support.” In the self-empowering approach, you make the reinterpretations and the decisions, but you don’t have to do it alone. And that’s how SMART Recovery works.

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