overcoming addictions & smart recovery: outcomes of a randomized clinical trial & our new...
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Overcoming Addictions & SMART Recovery: Outcomes of a randomized clinical trial & our new web app
Reid K. Hester, Ph.D. Dir., Res. Div., Behavior Therapy Associates, LLC www.behaviortherapy.com [email protected]
Overcoming Addictions An interactive web app based on
the 4-point program of SMART Recovery Additional exercises added:
Increasing change talk (desire, importance, self-confidence exercises)
Values exercise Urge tracking & feedback Mindfulness exercises (Bowen et al.) Happiness Scale & goal setting Sobriety sampling
RCT The First RCT of a self-help group
Other than 2 AA studies w/mandated people (1967 & 1980)
189 participants new to SMART Recovery
Compared OA only, OA + SR, SR only Dropped OA only gp in intent to treat,
examined in actual use analyses
Variable Overall Group
SR SR + OA OA
(n = 86) (n = 83) (n = 19)
Female n (%) 114 (60.6%) 52 (61%) 50 (60%) 12 (63%)
Age M (SD) 44.3 (10.9) 43.4 (10.6) 44.6 (11.1) 48.3 (8.4)
Ethnicity n (%)
White 170 (90.4%) 76 (88.4%) 77 (92.8%) 17 (89.5%)
Hispanic 5 (2.7%) 3 (3.5%) 1 (1.2%) 1 (5.3%)
Other 7 (6.9%) 7 (8.1%) 5 (6.0%) 1 (5.3%)
Education M (SD) 16.1 (2.4) 15.93 (2.5) 16.0 (2.3) 17.3 (2.1)
AUDIT M (SD)a 24.7 (8.1) 24.8 (8.1) 23.95 (8.2) 27.4 (7.2)
BSI M (SD)b 17.4 (12.9) 19.35 (12.5) 15.95 (13.6) 14.8 (11.0)
InDUC M (SD)c 41.4 (17.9) 42.2 (19.0) 40.6 (17.5) 40.8 (15.6)
Pretreatment characteristics of participants by group
Percent Days Abstinent
Baseline 3 months 6 months
OA only 36.46 59.24 54
OA + SR 46.63 82.47 77.2
SR only 41.72 71.5 74.48
40
50
60
70
80
OA onlyOA + SRSR only
Drinks per Drinking Day
Baseline 3 months 6 months
OA only 8.7 4.7 6.2
OA + SR
6.8 3.6 4.2
SR only 8.6 4.7 3.8
0.5
2.5
4.5
6.5
8.5
OA onlyOA + SRSR only
Alcohol Problems
Baseline 3 months 6 months
OA only 40.8 19.5 22.1
OA + SR 35.4 17.8 15.4
SR only 41.2 18.6 17.8
5
15
25
35
45
OA onlyOA + SRSR only
Do attending SR Meetings & other support predict outcomes at 3 mo?
SR only: Yes on all outcome measures at 3 mo.
OA + SR: only #days any support predictive of improvement in PDA & alcohol problems at 3 mo.
Conclusions Both the Overcoming Addictions
Web application and the use of the meetings and other resources of SMART Recovery are effective in helping people recover from heavy problem drinking.
People now have a choice in how they access help in changing.
OA: Cost? There is no free lunch. Much less than treatment or
seeing a counselor. $89 3 mo., $149 12 mo. (w/$30
maintenance fee thereafter in 12 mo.).
Profits from OA are shared with SMART Recovery.
What next? 6 mo. Qualitative data analyses,
part 2 of JMIR paper underway Apply to SAMHSA’s NREPP for
listing 1/1/14 http://www.nrepp.samhsa.gov
Reference Hester, RK, Lenberg, KL, Campbell, W, & Delaney,
HD. (2013). Overcoming Addictions, a web-based application & SMART Recovery, an online and in-person mutual help group for problem drinkers: Part 1, three month outcomes of a randomized clinical trial. Journal of Medical Internet Research. http://www.jmir.org/2013/7/e134