In the United States and elsewhere, addiction treatment programs routinely recommend that patients make use of mutual support groups, also known as “self-help” groups. Twelve-Step programs, particularly Alcoholics Anonymous (AA) and programs modeled after it such as Narcotics Anonymous (NA), are recommended most often. They are widely available and have been central to the recoveries of many individuals with addiction, some having achieved success with 12-Step or other mutual help programs as their sole support.
Most often, however, peer assistance by itself is not sufficient. To stabilize and emerge from active addiction, many individuals require formal addiction treatment programs that feature professional counseling in individual and group settings. These programs may be brief or long-term and some provide residential separation from common relapse triggers. Medications may be necessary for detoxification, medical or psychiatric problems, and/or relapse prevention. Medications often are needed beyond the initial treatment episode, some indefinitely.
Formal treatment is far more comprehensive than mutual help—and far more expensive. Participants in mutual help programs generally pay nothing, though they may make voluntary contributions. Many individuals are introduced to mutual help meetings as an adjunct to formal treatment, then later rely on them as the primary support for long-term recovery.
AA and NA are the largest and most well established mutual help programs and are the ones best known to addiction treatment professionals and the public. A recent article in this series highlighted issues for professionals and prospective participants to consider prior to referrals to 12-Step meetings.
The purpose of this article is to increase familiarity with lesser known mutual help programs, which can supplement or serve as alternatives to 12-Step programs. These programs include: SMART Recovery, LifeRing Secular Recovery, Women for Sobriety, Secular Organization for Sobriety (SOS), and Refuge Recovery. I invited some of those involved in the leadership of these programs to share information on their programs, aimed at both individuals who can benefit from them and health professionals who may refer to them.
Self-Management and Recovery Training (SMART) Recovery is the second largest mutual help network in the U.S. with an estimated 1500 meetings and a robust online presence in the form of blogs, discussion boards, and “virtual” online chatrooms or groups.
The organization is a non-profit originally named the Rational Recovery Self-Help Network. It changed its name in 1994 when it split from the for-profit Rational Recovery Systems. SMART incorporates techniques from Rational Emotive Behavior Therapy (REBT), the form of cognitive-behavioral therapy promoted by psychologist Albert Ellis, and from motivation enhancement therapy (MET/motivational interviewing).
Unlike 12-Step programs, SMART does not refer to a “higher power” or to individuals facing substance use disorders as “powerless.” Meetings are facilitated by trained individuals who are often also therapists, but who run these meetings at no charge to participants. The approach is abstinence-oriented and accepts that progress to abstinence may be gradual.
Handbooks and workbooks are available for purchase. Some SMART participants access formal counseling or therapy, or also attend 12-Step meetings; but such outside activities are neither promoted nor required. SMART’s “four-point program” involves 1) building and maintaining motivation, 2) coping with urges, 3) managing thoughts, feelings, and behaviors, and 4) living a balanced life. Ongoing engagement with SMART Recovery groups or therapists is optional. Contact www.smartrecovery.org/get-started or 1-888-510-3898.
LifeRing Secular Recovery is an abstinence-oriented group of individuals who also do not consider spiritual or religious beliefs, or concepts of powerlessness, necessary in order to attain recovery. Members characterize themselves as open-minded, independent, self-aware, and not looking for a "program" or a simple answer to the challenges of addiction. Many participants have tried other mutual help groups, commenting that they liked the people they met and their sense of shared purpose, but that they could not squeeze themselves into the mold of the other groups’ approaches. Rather than identify with "powerlessness," LifeRing adherents seek support for their own efforts.
Women for Sobriety (WFS)—more details at womenforsobriety.org—administer the New Life Program, which is a stand-alone, holistic program that empowers women to overcome substance use disorders. The program is based on 13 Acceptance Statements, which are affirmations participants use to retrain their thoughts to be more positive. Women increase their sense of personal efficacy by developing a sense of self-value and self-worth as they proactively address challenges and growth opportunities in their lives. Options include in-person (womenforsobriety.org/meetings) and online meetings, led by certified peers in recovery who have demonstrated a solid foundation of knowledge of the New Life Program. Dynamic group discussion is the norm and made easier by small meetings—typically fewer than 10 women. Women are asked to introduce themselves as “a competent woman” to reinforce positive self-regard. An online message board provides 24/7 information and support. There is no charge for WFS resources. (The Annual Weekend Conference has a fee, but work scholarships are available.)
At WFS, all expressions of female identity are welcome. WFS does not discourage participants from using medical supports for their recovery, making it an appropriate referral for women taking prescribed methadone, buprenorphine (Suboxone and others), naltrexone, disulfiram (Antabuse), or other medications. The small size of WFS groups often attracts women who are shy or anxious. Women who have experienced difficulty with sexuality, trauma, domestic violence, or predation at mixed-gender meetings may be more comfortable opening up in the all-female atmosphere.
Secular Organizations for Sobriety (SOS) was founded in 1985 by James Christopher. His book “How to Stay Sober—Recovery without Religion” is a standard feature of SOS meetings. Groups are autonomous and loosely affiliated with the central organization. An online presence is also available. This program, like those above, does not have a spiritual or religious basis, although participants may have their own beliefs. It does not require concepts of surrender or powerlessness and is abstinence-based. The website www.sossobriety.org/meetings-data-page, offers information on in-person and online groups.
Other Groups. Refuge Recovery (https://refugerecovery.org ) is an abstinence-based program that offers peer-led groups utilizing Buddhist-inspired guidance and meditations to anyone seeking recovery from addiction. One group that does not require or advocate abstinence as a response to alcohol or drug problems is Moderation Management (MM).
MM has a controversial history. A member admitted to murdering a family member on the program’s bulletin board. He was arrested, prosecuted, and incarcerated. MM’s founder, Audrey Kishline, identified herself as a problem drinker but in 2000 she was involved in a fatal vehicular crash when intoxicated. She later communicated to MM participants that she would continue to support the program but planned to pursue abstinence herself. Some programs advocating MM have incorporated naltrexone prescriptions to facilitate moderate alcohol intake.
Celebrating Recovery is an overtly Christian 12-Step recovery program. They are grouped with other “non-sanctioned” 12-Step meetings, meaning they are not listed in official 12-Step meeting directories and do not participate in regional or national 12-Step program governance. Activities of Sober Living (ASL) has meetings in several houses of worship in New England, and its meetings are essentially 12-Step meetings, though they may be more tolerant of medication use than meetings affiliated with national organizations.
I will mention one additional organization, only to strongly discourage patients and clinicians from becoming involved with it. Narconon (not to be confused with Narcotics Anonymous or Nar-Anon) originated out of the Church of Scientology and has engaged in medical practices that some medical authorities consider dangerous.
Several of the groups above also provide support systems for family members, friends, and other loved ones of individuals affected by substance use disorders or process addictions. Further information on this may be found on their websites or via other contact information.
The NCADD Addiction Medicine Update provides NCADD Affiliates and the public with authoritative information and commentary on specific medical and scientific topics pertaining to addiction and recovery.