Managing alcohol use disorder requires several interventions to ensure success. One of the most effective tools that best predicts against relapse prevention are behavioural interventions. Behavioural interventions force individuals to confront their thoughts and beliefs surrounding alcohol and develop strategies and modify behaviour in order to maintain alcohol abstinence or controlled drinking.
Alcoholics Anonymous (or AA) was founded in 1935 by Bill W and Dr Bob and in the ensuing 86 years has helped an untold number of people achieve meaningful and sustained behaviour change in their relationship with alcohol. The only requirement for membership of AA is a desire to stop drinking. AA is a close social network supportive of abstinence and is based around the 12 Steps and 12 principles outlined in the AA manuals. The 12 step model is based around themes of powerlessness, self-awareness and spirituality. New members are encouraged to attend90 meetings in 90 days. A Cochrane review in 2020 by John Kelly and his team found that manualised AA and 12 step framework programs were more effective than other behavioural based interventions in achieving abstinence.
SMART Recovery is an acronym for 'Self Management and Recovery Training'. The program is based around four points of:
Coping with urges
The program is based around weekly classes of 90 minutes facilitated by a trained peer or AOD clinician and focusses on the addiction behaviour rather and on any substance. Patient goals are identified and the participant is set achievable goals and tasks for the upcoming week. The focus is to concentrate on the present and future rather than the past. The basis of SMART Recovery is around cognitive behavioural therapy and motivational interviewing. This is also an extensively studies and reviewed methodology with good evidence for it's success.
Author: Dr Thileepan Naren MBBS FACRRM FRACGP
Thileepan is an Addiction Medicine Advanced Trainee and experienced general practitioner with a demonstrated history of working with disadvantaged and marginalized groups.