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12 Step Programs for Eating Disorders and SMART Recovery SMART* Recovery and 12-Step Programs In the world of addiction treatment there are several choices one has in the way of utilizing and attending a community based support group. Should one look more closely at what is offered to those with an eating disorder the choices are somewhat more limited but non-the-less do exist. This article takes a look at two diverse, yet complimentary approaches, 12 Step oriented programs and the SMART Recovery program. A detailed description of both may be beyond the scope of this article. However, suffice it to say both “philosophies” or “beliefs” have inherent similarities as well as differences. To that end I hope to distinguish what each brings to the table that is unique and what they share in common. SMART Recovery Basics Let’s begin with what SMART stands for, namely Self-Management and Recovery Training. In a nutshell, SR offers a 4-Point Program [not to be confused as “steps”] that amount to 1- Building and Maintaining Motivation, 2- Coping with Urges, 3- Managing Thoughts, Feelings, and Behaviors, and 4- Living a Balanced Life. SR can serve as a stand-alone approach or compliment another program such as a 12-step group or professional treatment. SR does not necessarily adhere to the premise that one need attend meetings as part of a life long process as there is a beginning, middle, and end to treatment for an addiction. Hence once an “addict” you are not always an addict. Another, what I believe to be very important distinction, is SR to intended to be open to support any addiction and does not hold separate groups for compulsive overeaters, alcoholics, drug addicts, compulsive gamblers, and affected family members. Virtually anyone with an addictive or compulsive behavior[s] with a desire for abstinence from these may benefit from attendance and are welcomed. Having the benefit of experiencing both a 12-Step Program for many years and, more recently becoming a trained facilitator for a SMART Recovery group, I would say SR represents a more updated approach to addictive problems. Although there are no bona fide studies to support the efficacy of one support group over another, there is ample research to support the effectiveness of the “tools” and techniques taught in the groups. These include motivational interviewing techniques, cognitive behavioral approaches to confronting urges and destructive behaviors, and developing alternate healthy lifestyles to replace addictive and compulsive behaviors. SR encourages participants to take an active role in the group process, and unlike the format of a 12-Step meeting, talking between group members is encouraged. In effect, each participant serves as a therapeutic agent in the meeting. Last, but certainly not least much of the literature offered by SR incorporated a “how to” compilation of the tools and techniques discussed at the meetings. Rather than “steps” to be completed, the SR Handbook, as an example, provides an ample supply of worksheets and structured assignments that correlate with the four point program outlined from the beginning – Motivation, Coping with Urges, Managing emotions, thoughts, behaviors, and lifestyle change. Although not dissimilar from the 12-step notion of “into action”, SR is a program of “doing is believing” rather than an intellectual exercise. In passing, it’s worth noting SR holds no formal belief of the necessity of a spiritual belief system or philosophy being a pre-requisite for benefiting from their program. SR does not discourage or encourage individuals from bringing their religious or spiritual beliefs into their “personal” program of recovery. SR is quick to point out it is not a spiritual based program and as such, steers clear of incorporating such principles in their approach to abstinence. Comparison with 12-Step Programs First, I would begin by stating both programs are careful not claim superiority with the belief “one size fits all” when it comes to addiction recovery. As such, the “bashing” of one program versus the other is discouraged and both programs encourage a philosophy of open mindedness and seeing what works best for someone seeking abstinence* from their addictive substance or behavior[s]. *Both programs discourage “moderation” with regard to the addictive substance or behavior and clearly state the goal of successful recovery is total abstinence. While on the topic of similarities, it’s also important to note both programs encourage the use of medical and relevant professionals when appropriate as an integral part the recovery process. Inherent with that policy is the notion SMART Recovery and 12-Step programs are there to serve as a support network and not a substitute for medically necessary treatment when called for. Indeed, one may argue there is a practical difference between a support group and a treatment program. For a substance dependent person medically supervised detoxification may be indicated as a life saving procedure. Likewise, for someone in the throws of an eating disorder, medical stabilization and a structured setting may be necessary to gain a foothold in the beginning stage of the recovery journey. Yet for others, the frequently associated mental health issues such as depression may require the use of a suitable medication, and so on. Although I could go one with a list of other relevant common denominators, I would suggest someone approach each with an open mind and experience both groups a fair number of times to be in a position to choose which, if both both, offer the best opportunity for continued abstinence. Indeed, some people will choose one program over the other while still others will see each group as offering something unique and worthwhile – opting to attending both on an on-going basis. To someone with no prior experience in a 12-step program, I would suggest it is, at least for me, difficult to put an aggregate of experiences into words to adequately describe them. What I would say, unlike SR meetings, 12-Step groups are intended primarily for specific addictions and are not one “fellowship” but many. In other words, alcoholics would attend an AA [Alcoholics Anonymous], Overeaters go to OA, Anorexics and Bulimics [ABA], Compulsive Gamblers {GA], and so forth. Although not a religious program there is a strong current of encouraging ones’ own brand of spirituality without defining what that should be for the individual. To be sure, there are members who have succeeded in these fellowships who are agnostic or atheists and there are no “musts” in the program as outlined in their literature. The steps represent a series of actions or a progressive formula participants are encouraged to complete over time – with the inherent belief that doing so will not only result in continued abstinence but also lead to a more productive and satisfactory lifestyle, usually referred to as recovery. Although much can be said pro or con for 12-step programs, the proliferation of groups and meetings is enormous, with hundreds of meetings taking place on a weekly basis in just about every major city here in the U.S. and throughout the world. Membership in AA alone is in the several millions and the off spring programs attended by hundreds of thousands if not millions of others. Perhaps one of the greatest strengths of 12 step programs is the frequency of meetings and the fellowship opportunities they provide for people to find support and some hope with their struggle to free themselves from the tyranny of their addiction. Suggestions: As mentioned, I would encourage someone looking to initiate the recovery process or to add to an existing repertoire of recovery support, to attend several of these meetings and then decide which, if not both, prove helpful. To learn more about these meetings and groups you can go to http://www.smartrecovery.org as well as a particular 12-step fellowship site such as http://www.AA.Org or http://www.aba12steps.org/, etc. Marty Lerner, Ph.D. CEO, Milestones In Recovery Eating Disorders Program 800-347-2364 http://www.MilestonesProgram.Org
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