WEBINAR: The role of peer support in treatment

The role of peer support in treatment: The latest on research and practice

Watch Associate Professor Victoria Manning, Head of the Research and Workforce Development unit at Turning Point, and Associate Professor in Addiction Studies at Monash University and Crystal Clancy, CoordinatorPeer Projects, Self Help Addiction Resource Centre (SHARC), presenting on the ‘The role of peer support in treatment: The latest on research and treatment’. The discussant for the webinar was Heather Pickard, ACEO, Self Help Addiction Resource Centre (SHARC).

Associate Professor Victoria Manning is a member of the SMART Recovery Australia Research Advisory Committee and the SMART Recovery Global Research Advisory Committee.

A Delphi yarn: applying Indigenous knowledges to enhance the cultural utility of SMART Recovery Australia

Background: Mutual support groups are a popular treatment for substance use and other addictive behaviours. However, little is known about the cultural utility of these programmes for Indigenous peoples.

Methods: A three-round Delphi study, utilising Indigenous research yarning methods was conducted to: (1) Obtain expert opinion regarding the cultural utility of an Indigenous SMART Recovery handbook; (2) Gain consensus on areas within the SMART Recovery programme that require cultural modification and; (3) Seek advice on how modifications could be implemented in future programme design and delivery. The panellists were 11 culturally, geographically, and professionally diverse Indigenous Australian health and wellbeing experts. A group consensus level of 80% was set prior to each survey round.

Results: There was 100% participant retention across all three Delphi rounds. The panel reached consensus on five key programme modifications (composition of a separate facilitator and group member handbook; culturally appropriate language, terminology, and literacy level; culturally meaningful programme activities; supplementary storytelling resources; and customisation for diverse community contexts). The panel also developed a series of practical implementation strategies to guide SMART Recovery through a modification process.

Conclusion: The findings highlight the importance of involving Indigenous peoples in the design, delivery and validation of mainstream mutual support programmes. Indigenous-led programme modifications could help improve accessibility and usefulness of mutual support groups for Indigenous peoples worldwide. This study is an example of how Indigenous research methods can be used alongside the Delphi technique. This approach demonstrated a way that Indigenous peoples from culturally and geographically diverse locations can participate in research anonymously, autonomously and without added burden on personal, community or professional obligations.

Ms Elizabeth Dale is a Worimi woman and member of the SMART Recovery Australia Research Advisory Committee member. Ms Dale is currently in the final stages of completing a PhD (Clinical Psychology) at the University of Wollongong, Australia. Her doctoral thesis is titled: Understanding the Cultural Utility of Mainstream Addiction Recovery Mutual Support Groups for Indigenous peoples’: A Case Study of SMART Recovery through an Indigenous Australian lens”.

Dale, E., Conigrave, K.M., Kelly, P.J., Ivers, R., Clapham, K., Lee, K.S. (2021). A Delphi Yarn: applying Indigenous knowledges to enhance the cultural utility of SMART Recovery Australia. Addiction Science & Clinical Practice, 16,2.

You can access the full article via ResearchGate

Providing addiction services during a pandemic: Lessons learned from COVID-19

During the COVID-19 pandemic, social distancing measures have made in-person mutual help groups inaccessible to many individuals struggling with substance use disorders (SUDs). Prior to the pandemic, stakeholders in our community of Douglas County, Kansas, USA, had sponsored a program to train volunteers to facilitate local Self-Management and Recovery Training (SMART Recovery) groups. As a result, the community established seven weekly SMART Recovery groups, which more than 200 community members attended. In March 2020, the community discontinued these groups due to the COVID-19 pandemic. To provide SMART Recovery during social distancing, we developed a one-on-one phone-in service for people with SUDs and addictions: the SMART Recovery Line (SMARTline). In this paper, we share our experience training volunteers to facilitate SMART Recovery groups and SMARTline.

Bruce Liese is a Professor of Family Medicine & Psychiatry at the University of Kansas and Clinical Director, Cofrin Logan Centre for Addiction Research & Treatment.  Corey Monley is Project Coordinator with the Cofrin Logan Centre for Addiction Research & Treatment.

You can access the full article via RESEARCH GATE

SMART Recovery: a summary of the Research

Presented by Dr Peter Kelly, Deputy Director - Head of Research, School of Psychology

SMART Recovery is a mutual support group for people impacted by addictive behaviours. It is widely used in Australia and internationally, with over 3000 groups run each week across 26 countries. The presentation provides an overview of the research that is being conducted examining SMART Recovery.

Peter Kelly is an Associate Professor and Clinical Psychologist at the University of Wollongong. He is also the Chair of the SMART Recovery Australia Research Advisory Committee and the Chair of the SMART Global Research Advisory Committee. The research is focused on understanding and improving alcohol and other drug treatment.

Webinar: How mainstream approaches work for Aboriginal people

The 2020 Symposium Series for the Centre of Research Excellence: Indigenous Health + Alcohol showcased the research being conducted by the Centre's students and early career researchers. All presenters are Aboriginal and so bring a unique insight into the challenges and opportunities in this field.

Ms Elizabeth Dale is a Worimi woman and member of the SMART Recovery Australia Research Advisory Committee member. Ms Dale is currently in the final stages of completing a PhD (Clinical Psychology) at the University of Wollongong, Australia. Her doctoral thesis is titled: Understanding the Cultural Utility of Mainstream Addiction Recovery Mutual Support Groups for Indigenous peoples’: A Case Study of SMART Recovery through an Indigenous Australian lens”.

Peer Alternatives for Addiction (PAL) follow up study receives funding

Dr Sarah Zemore has been successful in securing funding from the National Institute on Alcohol Abuse and Alcoholism to examine the benefits and mechanisms of mutual health alternatives for alcohol use disorders. This highly competitive grant helps to extend Dr Zemore’s previous work examining the longitudinal benefits of mutual aid for people living with alcohol use disorders.

Here is the abstract for her new project:…..

Mutual Help Alternatives for Alcohol Problems: Benefits and Causal Mechanisms

Principal Investigator: Sarah Zemore, PhD, Senior Scientist, Center Associate Director, and Director of Training, Alcohol Research Group.

Rationale: Mutual help groups represent an important and unique resource on the recovery care continuum, and Alcoholics Anonymous and other 12-step groups have been well-studied and found to be highly effective.Yet, very little is known about the nature and effectiveness of mutual help alternatives for addiction. This is a critical gap because 12-step groups remain unappealing for most people with substance use disorders (SUDs), even following 12-step facilitation interventions, and because those deterred by 12-step groups may be attracted to alternatives. Understanding 12-step alternatives is also important because a sizeable minority of people with SUDs are mandated to treatment, and numerous higher courts have ruled that mandating 12-step attendance violates First Amendment rights, stipulating that mandated attendance is permissable only given secular options.Accordingly, the current R01 proposes a national, longitudinal study of the largest known secular, abstinence-based alternatives to 12-step groups: Women for Sobriety (WFS), LifeRing Secular Recovery (LifeRing), and SMART Recovery (SMART).

Approach: Our NIAAA-funded R21 was the first longitudinal, comparative study of 12-step groups and 12-step alternatives, and surveyed U.S. adults with lifetime alcohol use disorders attending WFS, LifeRing, SMART, and 12-step groups. This R01 will capitalize on and extend our R21 data by adding 800 new cases collected using parallel protocols and measures, permitting us to combine data.Data will be collected at baseline via collaboration with mutual help group directors and IntheRooms, an online meeting hub for those in recovery.Follow-ups will be collected at 6 and 12 months. Leveraging these well-powered data, we will 1) examine associations between both in-person and online involvement and substance use outcomes over time. We incorporate study of online involvement because extremely little is known on this topic, and because online resources have great potential where meeting access is limited. We will also 2) compare mechanisms of action across mutual help groups, testing a novel theory of behavior change—the Affect, Cognition, Motivation, and social Engagement in recovery (ACME) model—designed to predict sustained recovery.Tests will help determine whether 12-step alternatives have common or distinct mechanisms of action, and will inform interventions for SUDs broadly. Finally, we will 3) examine participant-level moderators of the benefits of mutual help involvement, informing treatment tailoring. In anticipation of this R01, R21 surveys included most key measures.

Innovation and Significance: Evidence on 12-step alternatives is severely lacking: Other than our team’s R21, there are no published longitudinal, comparative studies of 12-step groups and secular alternatives.Results of this study, led by experts in mutual help groups for addiction, will contribute substantially to understanding whether, when, and why mutual help alternatives are effective. Findings should inform court referrals and treatment planning, and may enhance the growth of effective alternatives. Results may also help to identify core drivers of recovery that can be targeted in diverse interventions for SUDs.

Dr. Sarah Zemore is the Senior Scientist, Center Associate Director and Training Grant Director for the Alcohol Research Group in Emeryville, California. Dr. Zemore is also a member of the SMART Recovery Global Research Advisory Committee and Principal Investigator on the Peer Alternatives for Addiction Study.

Systematic Review of SMART Recovery

Clinical guidelines recommend Self-Management and Recovery Training (SMART Recovery) and 12-step models of mutual aid as important sources of long-term support for addiction recovery. Methodologically rigorous reviews of the efficacy and potential mechanisms of change are available for the predominant 12-step approach. A similarly rigorous exploration of SMART Recovery has yet to be undertaken. We aim to address this gap by providing a systematic overview of the evidence for SMART Recovery in adults with problematic alcohol, substance, and/or behavioural addiction, including (i) a commentary on outcomes assessed, process variables, feasibility, current understanding of mental health outcomes, and (ii) a critical evaluation of the methodology. We searched six electronic peer-reviewed and four gray literature databases for English-language SMART Recovery literature. Articles were classified, assessed against standardised criteria, and checked by an independent assessor. Twelve studies (including three evaluations of effectiveness) were identified. Alcohol-related outcomes were the primary focus. Standardised assessment of non-alcohol substance use was infrequent. Information about behavioural addiction was restricted to limited prevalence data. Functional outcomes were rarely reported. Feasibility was largely indexed by attendance. Economic analysis has not been undertaken. Little is known about the variables that may influence treatment outcome, but attendance represents a potential candidate. Assessment and reporting of mental health status was poor. Although positive effects were found, the modest sample and diversity of methods prevent us from making conclusive remarks about efficacy. Further research is needed to understand the clinical and public health utility of SMART as a viable recovery support option.

Dr Alison Beck is a Research Project Coordinator at the University of Wollongong, Australia. Dr Beck is also a member of the SMART Recovery Australia Research Advisory Committee.

Beck, A.K., Forbes, E., Baker, A.L., Kelly, P.J., Deane, F.P., Shakeshaft, A., Hunt, D., and Kelly, J.F. (2017). Systematic Review of SMART Recovery: Outcomes, process variables and implications for research. Addictive Behaviours, 36, 1.

 You can also access the full article via ResearchGate

International Facilitator Forums

In 1990 when Dr Joe Gerstein, Founding President of SMART Recovery, started his first SMART meeting out of a basement in Memorial Hall at Harvard University he never planned to get so involved. Rather, he was only looking for a way to increase the availability of the program for his patients who wanted an alternative to 12 step programs.

Twenty years on and some 3,000 meetings later Joe reflected ‘After my 6th basement meeting I thought to myself this program is going to change the world. I didn’t mention that to anyone else because if I did, I would have been classed as crazy! But, at 6am this morning I met 17 Facilitators across multiple time zones who interrupted their days and nights to talk about how they are running SMART meetings in their countries!’

Our International Facilitator Forums are our way of supporting and acknowledging the energy and effort they put into their communities by providing SMART meetings.

SMART meetings are held in 27 countries around the globe. To find a SMART meeting running in a time zone and language that works for you visit our COVID-19 response page.

Becoming a Facilitator is Just the Start

Every year hundreds of people take the SMART Recovery Facilitator training. Many professionals take the course to broaden the services they can offer their clients. For some people it is part of their own recovery and some people find the course through their studies or personal interest in giving back to their community.

We recently spent some time with Denis who is an Australian that has called Indonesia home for many years.  Denis shares his reflections on the SMART Recovery program and his decision to become a SMART Recovery Facilitator. 

How did you first hear about the SMART Recovery program?

 I initially came across SMART Recovery through my health science studies. I went to an online meeting to see what it was all about and have been going ever since. I also subscribed to the SMART podcasts which gave me a perspective on the program.

 What elements of the program really resonated with you and continue to resonate with you?

 The practical nature of the program is what appeals to me the most. In particular the tools, learning from the discussion and having a plan each week.

 I also like that SMART is science based and so I’m working with the best treatment approaches and theory in the field. 

What difference did SMART Recovery make to your life?

SMART helped me work on the unhelpful beliefs and thinking that was holding me back from leading a more contented life. I’ve since become a big fan of the CBT approach and read everything I can on it.

 Also, I had some unhelpful behaviours that I wanted to change. I had done the personal work but needed to go that extra step and talk about it and have some accountable for myself through the calls.  

You recently completed your Facilitator training, what led you to make the decision to become a SMART Recovery Facilitator?

 I did the training because I wanted to help others and do something which had a sense of purpose. If I could look back in a few years and see that I helped support people to be self-empowered in their addiction and make positive change – that would be worthwhile.

 I had been in the corporate world for most of my life. However, I often asked myself if I could do more to help others and how could I give back? SMART gave me that opportunity.

 Any highlights from your meetings that you would like to share?

 The major highlight for me is to watch people progress with their programs. It’s great to see people taking steps towards leading a better life and build a sense of hope.   

 Would you recommend becoming a SMART Facilitator to others?

I would definitely recommend becoming a facilitator for the learning and personal growth that it offers.

Becoming a facilitator is just the start. There are catch up’s with other facilitators, opportunities for further training, newsletters with the latest science and podcasts. I also find it helpful to learn from other facilitators at their meetings and keep a reflective journal.

 If you are studying health or psychology, then this is a great program because it uses proven science and helps with recognisable skills. I had studied some of the treatments used in SMART before but the facilitator role bought it all to life.

SMART Recovery helping people in the Punjab

I am Dr Kaustubh Sharma and I serve in Punjab State of India as Inspector General of Police, Faridkot Range. I am a post-graduate in Internal Medicine from Gajra Raja Medical College, Gwalior.  I joined the Indian Police Service in year 2001.  

I have been involved in anti-narcotics work throughout most of my career. I gained insights and experience in narcotics control, treatment and prevention aspects during my various policing stints in Patiala, Amritsar, Firozepur and State Special Operations Cell, while the state was witnessing a high opioid use epidemic.  

Over the last two decades, the state started to see a shift in opioid use pattern from natural low potency opioids to heroin emanating from the Golden Crescent area. The matter of opioid dependency and deaths soon became a political issue and special operations were launched. 

Punjab police launched one of the most extensive and long running narcotics control campaigns which was associated with expansion of treatment and drug prevention programs by the Health Department of Punjab. 

In the year 2018, I was selected for a Hubert H Humphrey fellowship program at Virginia Commonwealth University, part of Fulbright programs sponsored by the US Department of State.  

On my return from fellowship in the year 2019, I was assigned to work with the Special Task Force on drugs constituted by the state of Punjab which has been implementing ‘Comprehensive Action Against Drug Abuse Program’. The CADA is being implemented under supervision of the Special Principal Secretary to the Chief Minister of Punjab State. It has Health, School Education, Higher Education and law enforcement officers as its chief components. The group reviews the current program and the progress made in implementation of the core strategy and decides on the future thrust areas. 

How did you first hear about the SMART Recovery program? 

I was undertaking Fulbright fellowship at VCU, USA in year 2018 where I found regular SMART Recovery sessions being organised at the campus. I got the chance to attend a few sessions. I did not, at that time, think of it being the program to be implemented in Punjab and went to the few sessions with an aim to experience the difference in techniques. 

What elements of the program really resonated with you and made you think it would be a good addition to your current treatment program? 

It was on my return, that I was entrusted with the coordination work with the Health Department and to implement the community prevention and outreach program. The health department had done a particularly good job by enhancing the number of Outpatient Opioid Assisted Treatment Centres in the State to 198, all of which are Government run and providing free of cost opioid substitution treatment. This step led to enrolment of 550,000 persons into treatment fold in both Government and Private sector. The Government sector did not have a structured program for weaning off and preventing a relapse to substance use. I started to connect to some of the resources that I knew including Thomas Bannard, Program Coordinator of Virginia State University program called ‘Rams in Recovery’ and my guide Dr Mishka Terplan, MD who was professor in Department of Psychiatry. Both of them recommended the SMART Recovery program, suggesting that it would be suitable for the circumstances, as Punjab was already running opioid substitution therapy centres for large numbers of people suffering from substance use disorders. 

How did you and your team find the SMART Recovery Facilitator training program? 

The team members have all completed the SMART Recovery program and found that though counselling activities were being run in some centres over past year or more, the SMART Recovery program provided a structured program for induction of the counselling and peer support activities into the treatment regimen. The premise of introducing it has been to facilitate recovery and long-term abstinence by the participants by bringing change in their behaviours and thoughts and to maintain motivation throughout the recovery process. 

How do you think the SMART program will translate culturally into the Punjabi cultural context? 

The SMART program is being run in major centres of Firozepur, Fatehgarh Sahib, Tarn Taran Districts currently and the concepts are being translated by the psychiatrists and psychologists into Punjabi. Home assignments based on translated sheets from the Facilitator’s Manual are also being provided. A WhatsApp group to create better bonding between participants has also started by the Tarn Taran District team. Some of the group members have welcomed the idea while others who are not part of the group have evinced interest to try it out. 

What are your long-term plans for SMART in your organization? 

SMART Recovery is the first structured recovery support program introduced in Punjab and based on the cultural context there is a need to introduce some more cultural content into the program. Since the facilitators are themselves new to the concept, more experience is required before finding the success rate or finding the right mix of inputs to find the benefits to the participants. Once the program becomes acceptable and shows that it is indeed suited to the people in Punjab, Department of Health would be persuaded to implement the program in all districts and induct more counsellors who could be trained in SMART Recovery program. 

Would you recommend the SMART Recovery program to other treatment providers and why? 

The simplicity of the program and the support provided by SMART Recovery International in training of our psychiatrists and counsellors and the ease of reaching out to the experts involved, has facilitated a smooth induction of the programs in different Districts. I would certainly recommend it; the concepts are sound and simple for the person(s) in recovery. 

What would you like people to know about the SMART program, and/or about recovery? 

Certainly, the SMART Recovery program brings together four simple steps to aid the substance dependents in recovery and encourages people from diverse backgrounds to enter the program and be part of it. 

What would you like people to know about your organization and how can they support your work? 

Punjab has been facing an onslaught of international drug traffickers and it has been a challenge to reduce the availability of substances over last decade. Law enforcement has led to incarceration of thousands of young persons without giving them a chance for proper recovery. However, the introduction of free treatment with Buprenorphine-Naloxone combination through Government run centres and also allowing another 120 centres in private sector to start the dispensing of the opioid substitution therapy has led to enrolment of 550,000 substance dependent persons into the outpatient opioid substitution program in the state. The medicine acts as a great stabilizer and a program like SMART Recovery is being tried as a scientific program to support recovering individuals. 

Anything else you would like to share? 

The project in Punjab is being implemented in close conjunction with Department of Health, Government of Punjab and all the facilitators trained are working for the Government of Punjab. The Psychiatrists Dr Esha Dhawan, Nodal officer for Tarn Taran District, Dr Rachana Mittal, Psychiatrist at Firozepur District, Dr Preetjot Kaur, Psychiatrist at Fatehgarh Sahib District have been primarily overseeing the implementation of the program. 

Currently the Tarn Taran unit under Dr Esha has been implementing the program after training of their psychologists, the Tarn Taran team has been implementing the various facets of the program at four centres and holding regular sessions despite challenges faced due to Covid-19 Pandemic. They have formed groups at four different locations and are introducing the concepts of the SMART Recovery program to group participants. The results should become evident in coming times. We also intend to bring in some peer support through identifying the right persons who are sufficiently capable of taking up a facilitator’s role.