Addiction and Co-occurring Disorders from a SMART Recovery Perspective

Posted on August 21, 2012

A Manual for Group Therapists
Bob Keim, SMART Recovery Facilitator

Addiction and Co-occuring Disorders

When I saw this manual announced by SMART Recovery, I thought that it would be very appropriate for my use so I agreed to review it. I have used it for six months so now is an appropriate time to rate it.

Anoka-Metro Regional Treatment Center is a locked mental health treatment center where people are committed with a primary diagnosis of mental illness. Recently we have expanded to treating co-occurring substance abuse also. The majority of our patients have such dual diagnoses. The book claims to help professionals without specific substance abuse training lead SMART Recovery groups for people with co-occurring disorders. My recent professional training was in chaplaincy and I have no experience in recovery. At the time that I got this book I was facilitating a SMART group at our hospital. I had gone through the online training in 2010 and started the group in December 2010. The group was going well, but I thought that I could use some new ideas especially related to our dual diagnosis clients as the SMART training assumes healthy clients.

The authors delivered what they promised. The book is well laid out. It has specific chapters for the various SMART tools in an orderly progression. One of the problems with the normal SMART meeting format is that it is so client directed. I needed to get more control over our meetings as our patients/clients had short attention spans. In fact we hold two 45 minute meetings per week instead of one 90 minute meeting. I found that I could adapt Adamson and Ahmed’s chapters to our schedule.

I really appreciated the outlines and especially the many worksheets — more than in some of the other SMART Recovery materials. But the most important point for me was the emphasis on relapse prevention. Since we are a locked hospital, patients cannot use while in treatment. In some sense they are all in the action phase even if it is against their will. Therefore it is important to help them master the techniques and SMART tools that will prevent a relapse. Building motivation is also very important as many patients are just waiting to get out so that they can resume using. The material that Adamson and Ahmed present on relapse prevention is much more detailed and focused than that in the SMART Recovery® Handbook so this is an excellent addition to my library.

Both the abstinence focus and the emphasis that the authors gave to the interactions between psychiatric medications and street drugs were also important for our institution. SMART has never discouraged people from taking their prescribed drugs as many Alcoholics Anonymous groups do. AA has officially changed their policy but we still get people back in the hospital from a relapse due to stopping medication and it is sometimes due to an AA group’s encouragement. Having the dual diagnosis material fully integrated with the SMART program, rather just a note at the end, really makes this manual unique. I highly recommend it to SMART Recovery group facilitators whose groups contain any people also fighting mental illness.

There is one place where Adamson and Ahmed’s simplification of SMART goes too far especially for our use. They drop a whole stage from the Prochaska and DiClemente change model. The stage that they drop is planning. This is a critical stage for patients in the artificial environment of life in a treatment center. Clients cannot really be in the action stage when they do not have access to drugs, alcohol, or tobacco. Since our hospital is fully committed to implementing the change model and has trained many staff members in motivational interviewing, I just present the standard change model rather that Adamson and Ahmed’s simplified version. This is not a serious problem but I hope that they incorporate the full version of the change model in the next edition. The full model is available in papers on the SMART Recovery website.

In summary, this is a well-planned and written book that will help any profession without a recovery background to be a better SMART Recovery® facilitator. It is especially well suited to its target market of groups with dual recovery clients.

Addiction and Co-Occurring Disorders from a SMART Recovery® Perspective: A Manual for Group Therapists by Dawn Adamson, RN, CPMHN(c), CARN, and A.G. Ahmed, MD, FRCP is available in the SMART Recovery online bookstore.

One thought on “Addiction and Co-occurring Disorders from a SMART Recovery Perspective

  1. Kris W.

    AA has no policies. There are no rules or regulations to follow and the 12 steps are merely suggestions, so the claim that AA has a “policy” about medication is completely false.
    I have been in the addiction field for almost 20 years now. Unfortunately there are some members of AA who are biased against medication, however those opinions are just that. “AA has no opinions on outside issues; hence the AA name ought never be drawn into public controversy.” That’s from the AA Traditions, which gives suggestions on how to run AA meetings. There are those who are ignorant of the values of medication and are not open-minded to the fact that AA cannot cure everything. However, one thing AA does teach is personal responsibility. If a client stops medicating, it is their choice in doing so and no one is to blame for that. The nature of the disease of addiction is to avoid responsibility for our actions through a multitude of defenses. Blame is one of them.
    A final word, if the SMART recovery program is as stellar as you say, why not credit it on its own merits rather than putting down another recovery program?
    Good luck to you in all your endeavors.

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