# Expanding the science on recovery mutual aid for alcohol use disorder: An investigation of SMART Recovery

> **NIH NIH R01** · MASSACHUSETTS GENERAL HOSPITAL · 2020 · $363,375

## Abstract

Project Summary
Professional treatment plays a vital role in helping individuals with alcohol use disorder (AUD) stabilize and
begin recovery. Typically, however, some form of ongoing support is needed to increase the chances of stable
remission. Consequently, a common clinical strategy is to link patients with freely available mutual-help
organizations (MHOs), which can provide flexible ongoing community-based support. MHO effectiveness and
cost-effectiveness have been supported empirically and, consequently, referral to MHOs is recommended in
most practice guidelines. A limitation of the current standard of care, however, stemming from a lack of data, is
the fact that referrals are typically made almost exclusively to spiritually-oriented 12-step organizations, such
as Alcoholics Anonymous (AA). One important consequence of this virtual predominance of studies on 12-step
MHOs is that they are the only empirically-supported MHO continuing care referral option. Given the spiritual
orientation of 12-step organizations, however, and rulings by some US states’ supreme courts that 12-step
MHOs are technically religions and thus cannot be the sole referral option, it is important to offer secular
alternatives. One prime candidate is SMART Recovery, a secular cognitive-behavioral MHO providing peer
support in 1,200 face-to-face meetings in the US. Little is known, however, regarding its real-world benefit. A
rigorous study showing SMART Recovery can help reduce relapse risk would provide valuable information that
could boost clinical confidence in SMART as a low-cost recovery resource and thus be a secular empirically-
supported clinical referral option. As a next step in evaluating the real-world clinical and public health utility of
SMART Recovery, the current study will: 1. Characterize and describe professional and non-professional
recovery support service participation choices, migrations, and pathways using group trajectory analyses over
a two-year period for individuals (N=348) starting a new AUD recovery attempt. 2. Investigate the comparative
effectiveness of SMART Recovery by comparing outcomes of AUD individuals making the new recovery
attempt (N=348) pursuing either a SMART Recovery (n=174), or a non-SMART recovery (n=174), pathway.
Because roughly half of SMART participants also choose to attend AA, we will use a stratified design to enroll
persons with AUD making naturally occurring continuing care choices vis-à-vis participation in MHOs in a
balanced fashion, and follow them prospectively across a 2-year period (i.e., SMART + AA vs. SMART-Only
vs. AA-Only vs. Neither). Because prior data shows SMART participants may be less severe than AA
participants, we will stratify groups by AUD severity (mild, moderate, and severe). In addition to using
propensity score matching, this stratification will allow us to compare with greater scientific rigor the outcomes
of persons choosing to participate in SMART Recovery vs. not, while accounting for s...

## Key facts

- **NIH application ID:** 9920071
- **Project number:** 5R01AA026288-03
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** JOHN F. KELLY
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $363,375
- **Award type:** 5
- **Project period:** 2018-05-01 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9920071

## Citation

> US National Institutes of Health, RePORTER application 9920071, Expanding the science on recovery mutual aid for alcohol use disorder: An investigation of SMART Recovery (5R01AA026288-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9920071. Licensed CC0.

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