Because mental illness and substance abuse tend to co-occur.
If you research how we treat drug and alcohol addiction, you’ll notice an interesting phenomenon. The American Medical Association calls it a disease. Substance abuse counselors treat it like a disease. The DSM has assigned specific symptoms to it, and 150,000 Americans die annually from it. Yet the primary modality of treatment are 12-Step Programs like Alcoholics Anonymous, an organization that treats addiction as a spiritual deficit.
Doesn’t that strike you as a bit odd?
No other diseases are treated in this manner. And maybe that is one of the reasons why the body count keeps rising.
Alcoholics Anonymous has certainly saved the lives of hundreds of thousands since it was founded in 1935. It’s sister organization, Narcotics Anonymous, founded in 1953, can make similar claims as well. Let us not discount their value. And if it works for you, then by all means keep going.
However, several peer-reviewed studies like this one and this oneand this one have shown that 12-Step Programs are only successful for 10–15% of the people who have tried them, which begs the question: why do they only seem to work for a fraction of the people who try them? Logic dictates that we try to understand what it is that works about them and what it is that does not.
12-Step programs treat the spiritual components of addiction, but they fail to address the co-occurring mental illness. And the culture of these Programs is such that even talking about mental illness is sometimes frowned upon. The prevalent belief is that a spiritual deficit exists, which is what one should be focusing on.
Maybe that’s why 12-Step Programs are only successful a fraction of the time. Perhaps the treatment of mental illness is a bit more complicated than remaining abstinent. Most drug addicts self-medicate. Should we not be treating the conditions that keep so many in active addiction?
12-Step Groups get a great deal of press, but they aren’t the only game in town when it comes to support for alcoholism and drug addiction. SMART Recovery® has been growing in popularity for years. Whereas 12-Step Programs are based on faith, SMART® Recovery is built on science. Here are four good reasons to try it:
1. It’s okay to talk about mental illness.
The National Institute on Drug Abuse (NIDA) and The Substance Abuse and Mental Health Services Administration (SAMHSA) report that 20 million adults in this country have a substance use disorder. And of those 20 million, about half have a co-occurring mental health disorder, which means that they are also dealing with some form of depressive, anxiety, mood, or psychotic disorder.
Frank discussions about mental health tend to be frowned upon in 12-Step meetings. It has something to do with the 12-Step belief in a Higher Power and the power of The Program. The idea is, if you’re working the program the way you should, your sanity should be restored and you get to be a productive member of society. Frankly, overt discussions about mental illness disrupt that narrative.
Zealots in those groups will often claim that you are not working the program to the best of your ability if you were still depressed or manic or any of the other things that come with mental illness. This is from AA’s Big Book:
“Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.”
And from NA’s Basic Text:
“We have never seen a person relapse who lives the Narcotics Anonymous program.”
SMART Recovery®, on the other hand, recognizes mental illness is separate from addiction. It acknowledges that psychiatric distress often keeps people using and endorses the use of therapeutic interventions such as Rational Emotive Behavior Therapy (REBT) to address the symptoms.
2. SMART Recovery® supports evidence-based psychological interventions and the legal use of prescribed psychiatric medication.
This might be the single biggest difference between SMART Recovery® and 12-Step Programs, which make a point of separating themselves from “professional services.” It’s even against their guidelines to have trained clinicians involved in meetings. NA, for example, believes that “the therapeutic benefit of one addict helping another is without parallel.” That sounds great, and for many it’s true. But what if you need more?
12-Step Programs are populated by sick people, with no training, helping other sick people. This works for some, but why is it a bad idea to use evidence-based therapies or even prescribed medications in the fight against addiction and co-occurring mental illness? Many members of NA and AA despise the very mention of medication. Some would go as far as to say you are not working an honest program if you are using any drug, prescribed or otherwise. Total abstinence from everything.
When you consider that 45,000 die in this country every year from suicide, 90% of whom had a mental disorder, it is alarming to see a support group taking such a cynical attitude towards professional intervention.
While it is not a good idea for a recovering heroin user to take narcotic pain killers when Advil would do, this belief gets a bit more murky when you start looking at mental illnesses such as Schizophrenia and Bipolar Disorder. These conditions can absolutely be managed with medication and therapy, but schizophrenics and people diagnosed with Type 1 Bipolar are completely unable to function without medication.
Imagine that you struggle with psychosis, delusional thinking, and disorganized thought. How helpful do you think a dismissive attitude about medication will be to your mental health?
3. 12-Step Programs see addiction in simple terms; SMART Recovery®recognizes the complexity.
AA touts itself as a simple program for complicated people. That sounds great. Except that addiction is a complicated disease that gets further complicated when you try to oversimplify it.
Not all addicts are the same. Many addicts claim they can get addicted to anything — heroin, crack, sex, soap operas, you name it. Others have their one drug of choice and never had problems with anything else. Some addicts forego drugs and find themselves addicted to shopping, gambling, work, or sex.
The point is, we are not all alike. SMART Recovery® accepts that addiction is a complicated, multi-faceted disease. Some addicts require medication; some don’t. Some addicts require hospitalization; some don’t. Some addicts need therapy; others need accountability, direction, structure, or all of these things, or none.
Addiction is often a secondary issue, as I’ve discussed earlier with the concept of co-occurring disorders. Sometimes addiction is self-medication for depression. Sometimes it’s more on the Obsessive-Compulsive (OCD) spectrum. Sometimes people truly are physically addicted to a drug, as is often the case with opiates and heroin. Sometimes it’s more psychological. Often, it’s a combination of several factors.
Faith in a higher power is certainly helpful, but is it enough?
4. SMART Recovery® is based on science, not spirituality.
At 12-Step Meetings, you’re supposed to say “Hi my name is “X,” and I’m an addict.” It’s weird if you don’t. The idea is that we have to accept who we are. But is it possible that we can change? SMART Recovery says yes.
SMART Recovery® discourages use of labels such as “alcoholic” or “addict.” It has a scientific foundation, not a spiritual one. It promotes self-reliance over powerlessness. Meetings are discussions where members talk with one another. Meeting attendance is encouraged for months, sometimes years, but not a lifetime.
The basic assumption with 12-Step groups is that you attend those meetings for the rest of your life. Even if that is the right thing to do, how realistic do you suppose that is?
SMART Recovery® on the other hand recognizes that at some point treatment has to stop. It’s just the way things are. Professional counseling these days is centered around brief therapies that are really not supposed to last for more than six months.
If you’re seeing the same therapist five years later, you really have to ask yourself if any work is actually being done. Wouldn’t the same thing be true with support groups?
Finally, the concept of “powerlessness” is problematic for many. It’s also a HUGE part of the 12–Step philosophy. We have to admit that we are powerless. Only then can we admit we need help. That’s true, but the problem is that people tend to use powerlessness as an excuse for all sorts of things, including relapse.
SMART Recovery® advocates self-reliance, which is the cornerstone of any modern treatment modality. If we are to get better, we will need to lean on others at first, but eventually, we are going to have to lead our own lives. In addition to this being a more realistic way of looking at things, it also has the benefit of being true.
What I Have Learned About Recovery
In 2005, I went to rehab for drug addiction. I also started attending Narcotics Anonymous. I’ve worked the !2-Steps. I’ve had a sponsor and I’ve sponsored others. These days I’m a licensed substance abuse counselor, so I have the benefit of both personal and professional experience. Here’s what I have learned:
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