+ 6 Health Times2 Tuesday, March 23, 2010

Mind over addictionThere is a growing belief that nurturinq positive thinking is the smart way

of conquering alcoholism, Denis Campbell writes

lcoholism is a disease.It leaves victimspowerless andneeding to stay illpermanent recovery if

they are serious about stoppingthe demon drink from inflicting

-- further damage. Given lhatrnostpeople can't afford a stay inrehab, then the best way forchronic drinkers to tackle theiraddiction, so the theory goes, isto go to Alcohoiics Anonymous,seek the help of a higher powerwith their struggle, begin usingthe 12 steps, and be ready toattend meetings for the Test oftheir lives.Not so, says joe Gersrein, a

retired professor of clinicalmedicine in the United States.. "A myth has grown up thatyou can't get over a substanceaddiction without AA," he says."It's a widely-held belief, but it'sa myth."rorycars, he admits to buying

.into the myth and referringpatients with alcohol problemstoM,with varying degrees ofsuccess. "I would see people inmy office during the day whohad big, swollen bellies fromliver cirrhosis and tell themabout how serious their problemwas, and then I'd see them againat 7pm coming out of the liquorstore carrying a bag that didn'tcontain doughnuts," he says.He describes AAas "an

absolutely remarkable program"that millions have found usefulover the last 75 years. But hec-riticised the coercion of peopleinto AA, Smart Recovery andother mutual aid support groupsas "ethically wrong, medicallywrong and psychologicallywrong".Gcrstcin is the founding

president of Smart Recovery, analternative to AA that is catchingon in America=where it beganin 1994-·and worldwide. He was

• __the main speaker at a conference-in London, organised by charityAlcohol Concern, and funded byBritain's Department of Health(DB), that was designed topromote Smart Recovery - Self-Management and RecoveryTraining, to give it its full title-as another way to help England's1.1million problem drinkers.The OH, keen to expand the

number of options for treatingthe scourge of alcohol, is fundinga £100,000 ($164,000) two-yeartrial of Smart Recovery, whichhas a low profile and is the Davidto AA's Goliath. In London, forexample, some 300 different AAgroups meet regularly, hut thereare just 20 or so Smart ones in anof England - even Gerstein isunsure exactly how many - andabout the samenumber inScotland.However, it is attracting

attention from experts in thefield. Alcohol Concern's directoror policy and communications,NicolaySorensen, says: "AA ishuge, and people wouldn't go ifit didn't work. Smart Recovery atthe moment is the onlyalternative. It's got rnomcnturn,it's got a goon evidence base,and it's growing in popularity."Similarly, Addaction, the UK's

largest drug and alcoholtreatment charity, is setting upan alcohol recovery service for

+ over-sus in Glasgow, funded by

the brewers Heineken and usingSmart Recovery.Smart is based on cognitive

behavioural therapy (Cfs'I'), andespecially an element of it calledrational emotive behaviourtherapy (HEIl'Ij. Gerstein callsSmart "a self-empowermentprogramme", and rejects utterlyAA's disease thcorv of alcoholand labelling of people withserious drink problems asalcoholics.Smart Recovery and AAare

both intemational not-Ior-profitorganisations. Smart is used inAustralia, Uzhekistan andbeyond. Its handbook has beentranslated into Russian, Farsiand Mandarin, among others.Both progrmnmes are used inprisons, seck abstinence fromparticipants, and are free-although they rely on donationsfrom those attending theirgroups. Hut, crucially, Smart isscience-based and secular, whileM ha, heavy religtous

associat.ions. Many of the peopleattending the 370 Smart groupsacross America have tried AAand been put off by its insistencethat members undergo aspiritual awakening, Gcrstein

For him, though, the keydifference is that Smart is apositive philosophy, "Wc believethat addiction is a velY humancondition that can be corrected.and that it'S the peoplethemselves who do that throughnatural recovery," he says. "Wcdon't think people arehopelessly taken over byaddiction. Other people usebooks, medicines, help fromfamily or professionals, whateverworks for them. But with SmartHccr)VelY,people do it on theirown. Tbat belief that humanbeings have the capacity withinthemselves to overcome evensevere addictions and go on tolead a meaningful life is vital."Where Mhas its Hig Book,

Smart has four key points and a"toolbox" -a set of ways inwhich problem drinkers canchange their behaviour. Ifsomeone is feeling stressed attile end of their working day,they may choose to use the ABCtool. for instance. That is: A forthe Activating Event, the walkingout of work; B for the Belief, thatthe person needs a drink now inorder to relax; and C forConsequences. that someoneends up drinking because oftheir stress.Smart teaches participant')

ways to disrupt this irrationalbelief system by helping themunderstand why they act as theydo - damaging their lives andrelationships in the process-and to then challenge that. thinking. CBT is also the basis ofthe "talking therapies" programrhat the DH has been rolling outin recent years to help peopleranging from long-term benefitclaimants wanting to resumeworking to couples whoserelationship is in peril.A key part of tile Smart trial is

the creation of six SmartRecovery groups in Britain - inBirmingham, Norwich, Croydon,Gateshead, Cumbria andSheffield - so that alcoholics inthose areas needing major helpcall choose between that and AA.Don Lavoie of the D1i's

Alcohol PolicyTcam explains:"The DH has issued some highimpact changes for the alcoholsector, one of which is aimed atsupporting and improvingspecialist alcohol treatment.Involved in thatdevelopment isthe promotion and growth ofpeer support, and ensuring thatthere is a range of choices forpeople with an alcoholproblem." Who comes, why, andhow they fare will be evaluatedto see which approach worksbest.Gerstein says, "At Smart

Recovery meetings wc don'tpray, do the Lord's prayer Or singKumbl1cya.We don't depend onhigher powers to help and wedon't expect people tu comeforever. They come, recover, andget on with their life."

Guardian