SMART recovery groups provide addiction services during COVID-19 pandemic

The COVID-19 pandemic has created new perils and challenges for people experiencing substance use disorders and addictive behaviors. Social distancing and isolation can trigger loneliness, anxiety, and depression.

These circumstances have put some "recreational users" at risk for developing addictions and caused some in recovery from addictions to relapse.

At the same time, the pandemic has made it nearly impossible for mutual-help (e.g., AA, NA) recovery groups to gather in person, forcing a scramble to provide remote support through platforms like Zoom.

Now, researchers at the Cofrin Logan Center for Addiction Research and Treatment at the University of Kansas Life Span Institute have published their experience making SMART Recovery groups available via computer and telephone to the community in Douglas County. Their paper appears this month in the peer-reviewed Journal of Substance Abuse Treatment.

According to lead author Dr. Bruce Liese, professor of family medicine and psychiatry at the University of Kansas Medical Center and clinical director at the Cofrin Logan Center, his team established seven weekly in-person SMART Recovery group meetings at various community institutions prior to the pandemic. These meetings took place at the Lawrence Public Library, KU, the Douglas County jail, Mirror Inc., and the Bert Nash Community Mental Health Center.

It's a free mutual-help group, somewhat like a 12-step program, where people support and help each other. The difference is that SMART Recovery is based on scientific principles and evidence - particularly evidence about addiction, treatment, what works and what doesn't work. It's based on Cognitive-Behavioral Therapy and readiness-to-change research. I believed SMART Recovery would be perfect because, coming out of the university, our program had to be based on scientific evidence."

Dr. Bruce Liese, Study Lead Author and Professor of Family Medicine and Psychiatry, University of Kansas Medical Center, Clinical Director at Cofrin Logan Center

Growth of the in-person meetings was slow at first, but soon KU researchers tallied 229 different participants who attended these groups for help with chemical and behavioral addictions ranging from addictions to alcohol, methamphetamine, cannabis, opioids, nicotine, and gambling.

But that all changed once the pandemic took hold in March last year.

"They had to close the library and other facilities where we were meeting," Liese said. "Thanks to the SMART Recovery central office, we returned online with funding for Zoom meetings from their office. And at first, we went through the same thing -- meetings with just one person. But over the past months, we've had upwards of 20 people in online meetings. So, it has grown again. SMART Recovery was very generous in providing us with a Zoom account. Once again, we can have as many meetings as the community needs. We have two active meetings in the community now: on Wednesdays and Fridays from 5 to 6:30 pm."

As with in-person SMART Recovery meetings, the virtual meetings are led by volunteer facilitators drawn from the community and university, who receive online and live (Zoom) training.

"The SMART Recovery central office offers a facilitator training program online for people who are interested in facilitating these groups," Liese said. "The online training involves at least 20 hours of watching videos, reading and taking exams ... so it's a pretty massive endeavor. I took the online training right away and found it interesting and stimulating. It focuses on what works, what doesn't work while emphasizing the importance of interpersonal relationship skills. The training teaches active listening so people know you're hearing what they're saying. It made sense to do this kind of training in the community. SMART's excellent online training enabled us to quickly develop these free groups as a safety net for those who need one."

Soon after starting online meetings, Liese was determined to make meetings available to people who didn't have the high-speed internet access needed for the Zoom platform. So, he extended the remote SMART Recovery meetings to the telephone as well, a service called SMARTline.

"I see up to 30 patients a week on Zoom as a faculty member and clinician in the Family Medicine Clinic at KU Medical Center," he said. "But I have some patients who have no computers or no computer capabilities. I offer telephone visits to them. I thought we could do this for SMART Recovery. So, we came up with SMARTline: a service for anyone with a phone who is struggling with addiction. SMARTline, also based on SMART Recovery principles, is offered every single day of the week from 4 to 8 p.m. If you dial 785-550-0764 you will get to talk to a SMARTline volunteer."

Liese's co-author and collaborator in establishing SMART Recovery groups in Douglas County is project coordinator Corey Monley, at the Cofrin Logan Center for Addiction and Research Treatment.

"He is so vital to the process -- we've had so many logistical demands that could never have been met without his hard work," Liese said. "He's the project coordinator and a volunteer. He runs the group on Fridays. He is the brightest, hardest-working person I've ever had in a position like this. He graduated from KU a couple of years ago. He's applying to Ph.D. programs. This is his first publication, and his work in this area is very likely to be the foundation for the rest of his career."

Liese said he is grateful to the Douglas County Community Foundation and the Douglas County Commission, which provided funding for SMART Recovery facilitator training and supervision. He also appreciates Lawrence Public Library and describes it as "a wonderful community partner." The library has donated meeting space for training and group meetings and treated group participants as valued guests.

Liese said he's learned a lot from his experience running SMART Recovery groups during the pandemic. For example, he now fully understands that flexibility and ongoing communication with stakeholders, as well as people in recovery, are keys to sustaining a program during challenging times.

"We have learned that telehealth is effective for all kinds of psychological services," he said.

"But we found it was difficult, with agencies closed, to let people know where to find us. Back when somebody could pick up an information card at the library and slip it into their pocket, it made it a lot easier. We've also learned the importance of establishing advanced plans, and being light on your feet, ready for what's needed instead of remaining stuck in what you're used to doing. Getting everyone involved -- stakeholders and the public -- is gigantic. And continuing to recruit volunteers has been especially important during COVID."

People seeking help with substance use disorders and other behaviors can contact SMART Recovery in Douglas county by dialing 785-550-0764. They can also reach out to Liese via email. A list of Zoom meetings can be found here.

Source:
Journal reference:

Liese, B, S & Monley, C, M. (2020) Providing addiction services during a pandemic: Lessons learned from COVID-19. Journal of Substance Abuse Treatment. doi.org/10.1016/j.jsat.2020.108156.

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