Many newcomers to Self Management and Recovery Training (SMART) meetings have previous experience with Alcoholics Anonymous (AA). Although they have decided to investigate SMART because of dissatisfaction with AA, frequently with its “spiritual” component, they are still unclear about both what they themselves are looking for (aside from either not drinking or cutting back), and what SMART specifically stands for and how it differs from AA. One member of the Washington, DC Area SMART groups offers some thoughts on the subject (which may differ from other members of the groups):

1. SMART Recovery is not an ideology, that is, a fixed set of beliefs. The emphasis is not on belief, but on rational analysis and action. Unlike AA, SMART works to provide an analytical framework which allows each participant to chart his or her own path to freedom from addiction. The mainstay of this framework is Albert Ellis’ Rational-Emotive Behavior Therapy (REBT), but this is not the only approach used in our meetings. SMART’s view, unlike AA’s, is that we should “utilize and analyze.”
2. It follows from this that SMART does not consider that all addicts are alike. Thus, no one “solution” fits all. Objective scientific studies have shown that everything from drinking patterns (for example, daily use to binge drinking) to degree of dependency, age at the outset of addiction, sex, family patterns, psychological reasons to use (i.e., to get “high” or to avoid feelings of inadequacy or discomfort) etc., produce strikingly different types of addicts.
3. Therefore, SMART does not claim that it is the best program for everyone with addiction problems. SMART emphasizes the goal of abstinence, as does AA. SMART might be best for some, AA for others, Moderation Management for others, religious denomination-based programs for others, or even personal determination to quit. The only way for a person with an addiction habit he or she wishes to end is to experience SMART Recovery or AA or some other program and see if it works; if it doesn’t something else should be tried.
4. Thus, we see that, SMART emphasizes personal choice and responsibility for one’s actions. It is up to each addict to determine what is best for him or her, not have the choice forced upon him or her. This point is in particularly strong contrast with AA’s emphasis on “powerless.” Rather, SMART believe strongly in rational analysis leading to freedom for the individual and his or her empowerment through self-knowledge leading to control over one’s decisions.
5. While SMART fully respects diverse religious views, and indeed some of its participants hold personal religious and spiritual beliefs, they do not view religious and spiritual beliefs as essential in solving our problems of addiction. SMART does not consider that a malevolent or benevolent “Higher Power” is either responsible for our addiction problems nor will it intervene to aid us in our individual efforts to overcome them.
6. SMART also does not consider “alcoholism” a life-long preoccupation. They prefer the term “addiction,” which refers to the physical addiction experienced while using (and for some time thereafter during withdrawal). After this physical addiction is over, the real problem is psychological—and solvable by the individual. Following this—or occurring simultaneously with it—the individual can move on to work on his or her other goals in life.
7. Simple observation as well as scientific studies show that there is no single “alcoholic personality” type or profile which can usefully describe an individual and his or her addictive actions. SMART instead observes that conflicting desires exist within each individual, some strong to use, but others equally earnestly desiring to end the addiction. We do not dwell on the historical sources of these desires, as is often done in traditional psychoanalysis, but instead on identifying and analyzing the underlying rational and irrational beliefs causing these desires in the here and now.
8. SMART meetings are self-help groups, not support groups. While attendees sympathize with, and try to assist others in the group, the primary goal of participants in our meetings is to support and strengthen their own efforts to be free of addiction. Unlike AA, probing discussion through cross-talk and feedback is encouraged. Like AA, however, these groups are confidential and administered by their own participants. Also like AA, SMART meetings are free, with minimal contributions encouraged but not required.
9. SMART has no definitive and incontrovertible text, such as AA’s Big Book. They have developed and continue to develop our own suggested reading material, which is available at meetings, but also draw on other sources in our discussions.

For more information on Self Management and Recovery Training and their meetings, please visit SMARTRecovery.org.

Differences Between SMART an AA

By Shari Roan
Originally published by The Los Angeles Times, January 6, 2010

Only people with severe depression benefit from antidepressants, says research published in the Journal of the American Medical Assn. Others do better with non-medical approaches.

Antidepressant medications probably provide little or no benefit to people with mild or moderate depression, a new study has found. Rather, the mere act of seeing a doctor, discussing symptoms and learning about depression probably triggers the improvements many patients experience while on medication.

Only people with very severe depression receive additional benefits from drugs, said the senior author of the study, Robert J. DeRubeis, a University of Pennsylvania psychology professor. The research was released online Tuesday and will be published today in the Journal of the American Medical Assn.

Hundreds of studies have attested to the benefits of antidepressants over placebos, DeRubeis said. But many studies involve only participants with severe depression. Confusion arises, he said, “because there is a tendency to generalize the findings to mean that all depressed people benefit from medications.”

The current analysis attempted to quantify how much of antidepressants’ benefit is attributable to chemical effects on the brain and how much can be explained by other factors, such as visiting a doctor, taking action to feel better or merely the passage of time.

Researchers reviewed six randomized, placebo-controlled studies with a total of 718 patients who took either an antidepressant or placebo. The patients were adults with levels of depression ranging from mild to very severe based on the Hamilton Depression Rating Scale, a questionnaire widely used in depression research. The studies did not exclude patients who were likely to have a strong response to a placebo. Researchers then compared the patients’ depression scores at the beginning of treatment with those after at least six weeks of treatment.

The study found that the magnitude of the drugs’ benefit increased with the baseline level of depression. The effect of treatment was similar in people with mild, moderate and severe symptoms, regardless of whether they took an antidepressant or placebo. Only the people who rated very severe on the depression scale at the start of the study showed measurable improvements on antidepressants.

“There is no doubt that there are tremendous benefits from antidepressants, as our study showed,” DeRubeis said. “But this study helps us resolve, to some degree, the question of how much benefit people can expect from the medicines themselves when symptoms are not severe.”

Other research has also found that antidepressants are most effective for severe symptoms, said Dr. Philip Wang, deputy director of the National Institute of Mental Health. Though it could be that antidepressants don’t work well for mild to moderate depression, it’s also possible that people enrolled in antidepressant studies have robust placebo responses that mask some of the impact of the medication.

A severely depressed person who would probably benefit from antidepressants might have symptoms such as frequent weeping, feelings of guilt and sadness, thoughts that life is not worth living, problems sleeping, fatigue and withdrawal from normal activities, DeRubeis said.

Better antidepressants are needed for people with mild to moderate depression, Wang said, as is research on how to diagnose depression with tools, such as biomarkers, that could help personalize treatment.

Of the six studies in the current analysis, three involved selective serotonin reuptake inhibitors, or SSRIs, the most commonly used antidepressants, and three involved an older class of medications called tricyclics. Both classes are thought to be equally effective, although SSRIs are associated with fewer side effects.

One exception to the study findings, DeRubeis said, was people with dysthymia, or chronic, low-level depression. The analysis assessed severity of symptoms, not chronically, he said. Other studies have established that people with chronic depression, no matter how severe, tend to respond well to antidepressants while other treatment may be ineffective.

Study Finds Medication of Little Help to Patients with Mild to Moderate Depression