The consequences of alcohol, substance use and other addictive behaviours are far reaching. The yearly cost to Australians from harms associated with alcohol and illicit substances has been estimated at $15.3 billion  and $8.2 billion , respectively. The social cost to the community of other addictive behaviours, such as problem gambling is estimated to be at least $4.7 billion a year . Moreover, the impact of addiction on health and wellbeing can be devastating, including premature mortality, elevated morbidity and considerable financial burden . In light of these consequences, and due to the often chronic and relapsing course of addiction, there is a need to improve access to evidence based support. Mutual aid groups represent a promising avenue.
Mutual aid groups offer free, largely accessible, long-term support. The majority of mutual aid-support groups adopt a twelve step philosophy (e.g. alcoholics anonymous). Within this model, addiction is conceptualised as a medical and spiritual disease, with recovery reliant on relinquishing control to a higher power . While evidence supports the efficacy of twelve step approaches, potential barriers to engagement have been identified. For example, individuals may report conflict between personal values and the twelve step philosophy due to low spirituality and/or difficulty with the concept of surrendering to a higher power . Self-Management and Recovery Training (SMART Recovery) was borne from this need for an alternative to twelve step approaches. Enhancing choice over mutual support options represents an important step in enhancing engagement, thereby treatment outcomes for individuals recovering from addictive behaviours.
SMART Recovery is a not-for-profit organisation offering group and on-line mutual aid support for individuals with experience of problematic alcohol, substance and/or other addictive behaviours (e.g. gambling, eating, technology, pornography) . SMART Recovery focuses on self-empowerment and adopts key principles (e.g. self-efficacy) and therapeutic approaches (e.g. motivational interviewing and cognitive behavioural therapy) shown to be effective in promoting recovery from addiction. While clearly derived from an evidence base, further clarity regarding the efficacy of SMART Recovery as a mutual-aid support package is needed.
Accordingly, we are in the process of conducting a systematic review . Our aim is to provide an overview of the current state of evidence for SMART Recovery including outcomes, potential mediators and a critical evaluation of the methods used to evaluate this mutual aid support group. Preliminary searches have identified eleven evaluations of SMART Recovery. Initial impressions suggest that although positive findings are apparent, the existing evidence is largely cross-sectional, seems to focus on process relative to outcome measures and/or evaluates SMART Recovery within a specific treatment context (e.g. dual diagnosis). Campaigning for change in healthcare practice and policy relies on a solid evidence base. This systematic review represents an important step in generating the evidence needed to refine, disseminate and raise the profile of SMART Recovery as an effective alternative to traditional twelve step approaches for long-term addiction recovery support.
This article first appeared in the Issue 11, 2015 newsletter of the NHMRC Centre of Research Excellence in Mental Health and Substance Use
1. Manning, M., Smith, C., & Mazerolle, P. (2013). The societal costs of alcohol misuse in Australia. Canberra: Australian Institute of Criminology. From http://www.druginfo.adf.org.au/topics/statistical-trends#sthash.w 8JpZeKM.dpuf
2. Laslett AM, Catalano P, Chikritzhs T, et al., 2010. The range and magnitude of alcohol’s harm to others. Fitzroy: AER Centre for Alcohol Policy Research. From http://www.fare.org.au/hto2015/#rangeandmagnitude
3. Australian Government The facts: Problem Gambling in Australia From http://www.problemgambling.gov.au/facts/
4. Amatoa, L., Davolia, M., Vecchia, S., Ali, R., Farrell, M. Faggianod, F. et al (2011). Cochrane systematic reviews in the field of addiction: What’s there and what should be, Drug and Alcohol Dependence, 113(1-2), 96-103.
5. Donovan, D. M., Ingalsbe, M. H., Benbow, J. & Daley, D. C. (2013). 12-step interventions and mutual support programs for substance use disorders: An overview. Social Work & Public Health, 28(0), 313-332.
6. SMART Recovery Australia https://smartrecoveryaustralia.com.au/
7. Beck, A. K., Baker, A. B., Kelly, P., Shakeshaft, A., Dean, F. P. & Hunt, D. A systematic review of evaluation research for adults who have participated in SMART Recovery – A self-empowering addiction recovery support group (in preparation).