Medicine & Health

12-Step Alternative
A science-based, non-religious recovery program has become #2 after A.A.

By Tim Murphy ’91 / April–May 2024
April 8th, 2024
Illustration by Joana Grochocka of a man looking through a wine glass at a greek bust.
ILLUSTRATION: Joanna Grochocka

In the 1960s through the ’80s, Dr. Joseph Gerstein ’57 was a professor at Harvard Medical School and an internist at Mt. Auburn Hospital. He had several patients with alcohol or drug dependency who didn’t like the religious overtones or “you are powerless” message of 12-step programs like A.A.—at the time, the only free, ongoing resources available to people seeking recovery. Then, in the early nineties, he heard about Rational Recovery, an approach started by social worker Jack Trimpey that shared 12-step’s peer-support model but was rooted in scientific methods such as cognitive behavioral therapy (CBT)—based on the idea that if we better understand how our thoughts trigger our feelings, we can control our actions. 

Gerstein was hooked. “The recognition that our emotions are based primarily on how we think about things is essentially the Stoic philosophy from two millennia ago,” he says. With others, he took the essence of Rational Recovery and in 1994 created a nonprofit, SMART Recovery, becoming its founding president. “We want to help people clarify their thinking so they can make better decisions for themselves,” he says.

Nearly three decades later, SMART has become the worldwide #2 mutual-aid recovery pathway after the 12-step model, with about 2,000 meetings in 34 countries, 600 of them on Zoom and about 1,200 in the U.S., according to Gerstein. The program has been given major support by U.S. and other governments as an alternative to 12-step, whose religious aspects multiple U.S. courts have ruled cannot be mandated for people coming out of prison.

“From the first SMART meeting I facilitated,” he says, “I knew this program was going to go around the world.” He predicts that SMART will attain 12-step’s scale “not while I’m on earth, but hopefully in the future.” Though no longer president, Gerstein is a SMART board member and still facilitates four SMART meetings a week—and he’s not giving that up anytime soon. “My father had Alzheimer’s,” he says. “One way to fight it off is to stay intellectually challenged, and running meetings is extremely good in that regard.”

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