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The Power of Choice in Achieving Recovery, by Joe Gerstein, MD, SMART Recovery
- 1. THEPOWEROFCHOICE INACHIEVINGRECOVERY SMART Recovery® Dr.JoeGerstein President Self-Management and RecoveryTraining
- 2. OBJECTIVES Be aware of importance of choice of addiction recovery program Be aware of multiple court decisions requiring program choice Be aware of availability of evidence-based choices
- 4. LEGAL
- 5. Court-ordered addiction recovery process presupposes individuals can modify their choices “With limited exceptions, Anglo-American criminal law has implicitly adopted a choice model and a corresponding approach to responsibility.”1 1Stephen J. Morse, “Addiction, choice, and criminal law.” Chapter 23 in Nick Heather & Gabriel Segal: ADDICTION & CHOICE: Rethinking the Relationship, Oxford Press, 2017 5 https://commons.wikimedia.org/wiki/File%3AScale_o f_justice_2.svg; By DTR (Own work) [Public domain], via Wikimedia Commons
- 6. PRECEDENTS 7 US Courts of Appeal 3 State Supreme Court decisions state that 12-step and AA are religious programs
- 7. Decisions re mandated attendance are clear
- 8. HAZLE v. CROFOOT (2013) California State and treatment contractor ordered to pay $2 million in damages for refusing to provide a secular alternative
- 9. INOUYE v. KEMNA (2007) Request to stop attending 12-step meetings was Constitutional under First Amendment due to “…uncommonly settled case law.”
- 10. FURTHER CHALLENGES US Supreme Court refused certiorari Unlikely, given uniformity of decisions, that certiori would be sought or granted in such a case Public Domain, FBIemployee. https://commons.wikimedia.org/wiki/File:Supreme_Court.jpg
- 11. Presume decisions apply to any government program,State or Federal, or to any outside program that receives government funds Public domain: ByBacon, George Washington. [from oldcatalog] -https://www.flickr.com/photos/internetarchivebookimages/14772561202/Source book page: https://archive.org/stream/baconsdescriptiv00baco/baconsdescriptiv00baco#page/n51/mode/1up, No restrictions, https://commons.wikimedia.org/w/index.php?curid=43736357
- 12. PRAGMATIC
- 13. DICHOTOMIES By Adonia - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=31937411
- 14. DICHOTOMIES Plato vs. Aristotle Temperaments World views Perspectives Thinking styles Weltanschauung
- 15. DICHOTOMIES Locus of Control Internal vs. External Self-empowerment By sarang (Own work) [Public domain], via Wikimedia Commons: https://commons.wikimedia.org/wiki/File%3AYin-yang_BBI.jpg
- 17. CLINICAL
- 18. SCIENTIFIC BACKGROUND Studies, going back 30- 40 years, demonstrate that when clients/ patients are allowed to select their own treatment, better outcomes are achieved. ByXenia Alexiou& Marina Sagnou -Ownwork, CC BY-SA4.0, https://commons.wikimedia.org/w/index.php?curid=45333287
- 19. CLINICAL EXAMPLES Raytheon Employee Study of an Ethanolamine drug Motivation-enhancement program - effects present for 6 years! SFVA Region 1 (Richard Lieber, et al. [2007]. 600 males with biopsy-proven Laennec's cirrhosis, 4 VAH sites.)
- 20. Project MATCH Study failed to demonstrate superiority of any individual therapy
- 21. ETHICAL
- 22. AMA Journal of Ethics® Addiction, 12-Step Programs, and Evidentiary Standards for Ethically and Clinically Sound Treatment Recommendations: What Should Clinicians Do? Annette Mendola, PhD, and Richard L. Gibson, MD, MPH
- 23. Abstract
- 24. SMART RECOVERY®
- 26. Study of 6,000 inmates in NSW,Australia SMART Sharply Reduced Recidivism Inmates attending SMART meetings and SMART-based prison program (3,000) showed 42% lower rate of committing violent crimes after release. (2016)
- 27. SMARTis Self-Management and Recovery Training Science-based, evidence-based Self-empowering approach Abstinence-oriented Non-profit 501(c)(3) Partnership of professionals and peers
- 28. smartcovery.org Comprehensive, Current Resource 1.1 million website visitors per year SMART Blog SMART Webinars & Podcasts Checkup & Choices YouTube videos Family & Friends Program also science- based SMARTTools!
- 29. SMART RECOVERY ONLINE (SROL) Supportive Community Multiple meetings every day Meeting AttendanceVerification system Message Boards, 24/7 Chat Room, Forums
- 30. HISTORY Started as Rational Recovery in 1989 Non-profit element renamed SMART Recovery in 1994 Introduced in MA in 1990, over 30,000 meetings started since
- 31. CURRENTLY >2,400 groups meet weekly in 23 countries >1,400 in the US and 200 in Canada Handbook published in 11 languages plus special edition for Australian Aboriginals Articles, Books, DVDs Stop by our SMART Recovery exhibit!
- 32. TRAINING Online Distance Training Program About 300 trainees per month Currently around 70% professionals By www.Pixel.la Free Stock Photos (Download Thousands Of Free Stunning Stock Photos.) [CC0], via Wikimedia Commons: https://commons.wikimedia.org/wiki/File%3AMan_writing_while_using_his_laptop_1.jpg
- 33. RECOGNITION
- 34. NADCP "Participants regularly attend self-help or peer support groups in addition to professional counseling. The peer support groups follow a structured model or curriculum such as the 12-step or Smart Recovery models.19 19 "Drug Courts must offer a secular alternative to 12-step programs such as Narcotics Anonymous because appellate courts have interpreted these programs to be deity-based, thus implicating the FirstAmendment (Meyer, 2011)." ~ NADCP, Adult Drug Court Best Practice Standards, July 2013
- 35. Bureau of Prisons RDAP Program The BOP recommends SMART meetings for “participants [who] immediately reject AA and NA as a result of the spiritual component of these programs and/or as a result of the fact that these programs subscribe to the disease model of addiction.” … “Despite the differences, AA, GA, NA, and SMART Recovery can be used as a support system for a participant in his recovery.”
- 36. SAMHSA “Research on mutual support groups indicates that active participation in any type of mutual support group significantly increases the likelihood of maintaining abstinence. ... “Clients who are ‘philosophically well matched’ to a mutual support group are more likely to actively participate in that group.Thus, the best way to help a client benefit from mutual support groups is to encourage increased participation in his or her chosen group.”
- 37. NIDA “No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. Most commonly used models include 12-Step (AA, NA) and SMART Recovery®.”
- 38. NIDA “Most treatment programs encourage self-help participation during/after treatment.” “Outpatient behavioral treatment encompasses … Cognitive-behavioral therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs. Motivational interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.”
- 39. SMART RECOVERY PROGRAM Small discussion groups led by trained facilitators – successful “graduates” of SMART Recovery as well as professionals (having removed their professional hats) CBT tools adapted for addiction Based on CBT and REBT, Motivational Interviewing, Motivational Enhancement Therapy, Solution-FocusedTherapy, Stages of Change Primarily volunteer-led
- 40. SMART RECOVERY 4-POINT PROGRAM ® Building and Maintaining Motivation Coping With Urges ManagingThoughts, Feelings and Behaviors (Problem-Solving) Living a Balanced Life
- 41. HOV INDIVIDUAL 1. Wife 2. Sisters 3. Kids 4. Health 5. Trips to Italy GROUP 1. Integrity 2. Honesty 3. Sincerity 4. Reliability 5. Love 6. Responsibility 7. Predictability 8. Health 9. Democracy, freedom, etc. Hierarchy ofValues
- 43. WE LOOK FORWARD TO WORKING WITHYOU! By AlphaZeta (Own work) [CC0] with attribution, via Wikimedia Commons: https://commons.wikimedia.org/wiki/File%3AHelpinghands.svg
- 44. THANK YOU FOR YOUR ATTENTION!! Discover the Power of Choice courtoutreach@smartrecovery.org www.smartrecovery.org/courts 866-951-5357
Editor's Notes
- 7 US Courts of Appeals (6 different districts) 3 State Supreme Court Decisions
- - Barry Hazle, a Non-theist, sent back to prison after refusing to attend 12-Step program as condition of parole – 101 days added back to his sentence. - District Court jury first found his constitutional rights violated but assigned no damages. - Circuit Court required damages be awarded. - State of California and the treatment center with whom they contracted that refused to provide a secular alternative, both required to pay Hazle $1 million. - U.S. Supreme Court has declined certiori in other cases. It is unlikely, given uniformity of decisions, that certiori would ever be sought or granted in such a case.
- - Inouye, Buddhist (and diabetic) on parole, stopped attending prison 12-Step Program. Parole officer ordered him back to prison, where he died. - Estate sued parole officer. - District Court ruled in his favor. - Appeal Court ordered retrial, stipulated officer liable for PERSONAL damages if verdict is against him. - Despite no 9th Circuit precedent, plaintiff's request was Constitutional. Parole officer should have known due to “…uncommonly settled case law.” - Final trial court decision pending.
- Locus of Control Orientation: Internal vs. External Self-Empowered vs. Higher Power
- Raytheon Employee rejected AA but quickly succeeded with a DUI program Study of an Ethanolamine Drug’s Efficacy in Reducing Progression of Alcoholic Cirrhosis Dramatic reduction in alcohol use with a minimal motivation-enhancement program after the great majority of participants refused to attend AA meetings Study of males, average age 40, in SF VA Region? By leading addiction scientists John F. Kelly, Neil Humphries, et al. Religiosity Authoritarianism
- Project MATCH Study failed to demonstrate superiority of any individual therapy with 12-Step Facilitation, CBT or MET, or any particular subject proclivity for determining program assignment. Several defects in study structure.
- Addiction is a complex phenomenon characterized by a loss of control and compulsive, habitual behavior. Since there is no single, specific cause for addiction, there is no single, standard treatment for it. A variety of approaches are used, including counseling, psychotherapy, medications, and mutual help groups (MHG). The best known and most widely available approach to addiction is 12-step (TS) programs of recovery, a variety of MHG. These have been lauded as lifesaving by some and criticized by others. We argue that TS programs are an appropriate mode of help for those seeking to quit an addiction but should not be the only approach considered.
- SMART Recovery was modified for correctional use Developed under grant from NIDA Now in use throughout the world Project for prisons in Commonwealth of PA Prisons in UK
- Blog Topics - Addiction & the Brain: Focus on Opiates - Addiction, recovery science - Help for family members and friends - Help for teens and young adults - Stay sober through holidays - Web apps to stop drinking - How science & kindness help people change
- Community for Recovery Support 28 online meetings per week Attendance verification to satisfy court orders – verifies complete meeting attendance Message Boards, 24/7 Chat Room, Forums for general addiction as well as drugs, eating disorders, gambling, self-harm, mood disorders Private forums for sexually maladaptive behavior, medical professionals and women’s issues
- Printed handouts if anyone is interested: NIDA, NIAAA, NADCP, ASAM, SAMHSA, BOP, ONDCP, EAPA, AAFP in US NICE in UK (National Institute of Health & Care Excellence) NCHQ&R in Australia (National Commission on Healthcare Quality & Research) Australian NSW Prison Study
- First, a big Thank you to NADCP for including SMART in its Adult Court Best Practice Standards in 2013!!
- Full quote: In addition to the skills that are taught in RDAP, we support the Twelve Steps groups and SMART Recovery as valuable components of the recovery process. The Twelve Step model is consistent with the goals of the community; namely, to help addicts build a program of recovery from drugs and alcohol. Some participants choose to immediately reject AA and NA as a result of the spiritual component of these programs and/or as a result of the fact that these programs subscribe to the disease model of addiction. The disease model assumes that you are powerless over your addiction. The disease model can conflict with the bio-psychosocial model that is utilized in RDAP which asserts that although there are many factors genetics, personality, societal influences, family environment, etc.) that contributed to one’s addiction, the individual is ultimately responsible for all the choices made in his life. Despite the differences, AA, GA, NA, and SMART Recovery can be used as a support system for a participant in his recovery. Upon release, self-help meetings are readily available to anyone who wishes to attend. Therefore, it is useful for participants to find a way to incorporate this into their recovery. treatment staff and peers will provide guidance in assisting participants to incorporate self-help groups into your treatment program. These meetings can provide unconditional support in a time of crisis when a participant is in society and does not have peers or community professionals readily available.
- 14 Tools in the SMART Recovery Toolbox, distributed among the 4 points. Time allowing, we will demonstrate a few of these