If your compulsion has no name and no fellowship, start with SMART Recovery, because its meetings are scoped to problem behaviours generally rather than to one substance, so you do not have to translate yourself to get in the door. Twelve-step fellowships are free and everywhere and are mostly organised around named problems. Therapy reaches furthest and costs most, and in the UK the titles are not protected, so you have to check.
Here is what each actually asks of you.
The problem this article exists for
Most support was built around a named thing. Alcohol has its fellowship, gambling has a NICE guideline and an NHS clinic, gaming has an NHS service. If your behaviour is checking, buying, picking, rereading, counting, watching, tidying, planning or something you have never seen described anywhere, none of that infrastructure has a door with your name on it.
That does not mean nothing fits. It means the choice is made differently: you are looking for routes that do not require your problem to be diagnosable, because for most behaviours it is not. Only gambling and gaming have addiction status in the international diagnostic manual, and the NHS says plainly that "it's possible to be addicted to just about anything".
SMART Recovery
**What it is.** Free mutual-aid meetings grounded in cognitive behavioural therapy and rational emotive behaviour therapy, secular, run by trained facilitators rather than sponsors. SMART Recovery UK's line is 0330 053 6022, and meetings run online and in person.
**What it asks of you.** Turning up and doing exercises. It is closer to a workshop than a confession, with tools you use between meetings. There is no requirement to accept any model of yourself and no requirement to say your problem out loud on day one.
**Its own position on the person.** "The power to change addictive behaviors resides within each individual." That is the load-bearing difference from the twelve-step frame, and it is the reason some people find it a relief and others find it thin.
**Why it fits an unnamed compulsion.** Because it is scoped to problem behaviours rather than to substances. You can describe what you do in your own words and nobody has to decide whether it counts.
**Its limits.** It is peer support, not treatment. There is no assessment, nobody is treating an underlying anxiety or depression, and the quality of a meeting depends on the facilitator and the group, so trying two is more informative than trying one.
Twelve-step fellowships
**What they are.** Free, volunteer-run peer fellowships built on twelve steps and, usually, sponsorship. There are dozens, most organised around a specific substance or behaviour.
**How they operate.** UK government guidance describes them neutrally and accurately: they "maintain independence from professional bodies and make sure they remain led by people in recovery in a volunteer capacity and do not accept funding from external sources". That independence is a genuine strength and it also means no clinical oversight and no treatment of anything underneath.
**What they ask of you.** Attendance, working the steps, usually with a sponsor, and a willingness to describe your own experience in front of other people. Most also ask you to accept some version of powerlessness over the behaviour, which is precisely the thing SMART Recovery rejects. Neither position is proven and you are allowed to pick the one you can live with.
**The fit problem for this stream.** Fellowships are organised around named problems, so if yours has no name you may find no meeting that matches. Some people attend anyway and find the shape of the room useful even when the subject is not theirs. Others find that irritating and go elsewhere. Both are reasonable.
**On evidence, honestly.** The best-known trial evidence here is for alcohol, where a Cochrane review found "high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence". Two important caveats travel with that. The high-certainty result is for manualised Twelve-Step Facilitation, which is a professional intervention, rather than for going to meetings, and Cochrane itself says "Non-manualized AA/TSF may perform as well as other clinical interventions". The finding has also been disputed in the literature over its external validity. And none of it is about your behaviour, since it was measured on alcohol.
Therapy
**What it is.** One-to-one work with a practitioner, usually weekly, and the route with the most reach into what sits underneath a compulsion.
**What it asks of you.** Money in most cases, a regular time, and a willingness to look at material you may have been outrunning for years. It is the slowest of the three to show results and often the one that changes most.
**Check the credentials yourself, because nobody else will.** In the UK, "Psychotherapists are not regulated by law, but can choose to join an Accredited Register." "Counsellor" and "psychotherapist" are not protected titles, so anyone may use them. Before you pay anyone:
- Check they appear on a register accredited by the Professional Standards Authority, or on the HCPC register if they are a practitioner psychologist.
- Ask what model they work in and why they think it suits what you have described. A straight answer is a good sign.
- Ask about supervision, insurance and their complaints route.
- Be wary of a package of sessions sold up front, of anyone promising a specific outcome, and of anyone who tells you what your problem is before they have heard much of it.
**The NHS route.** The NHS says that ["For many mental health problems, such as anxiety and depression, you can refer yourself to NHS talking therapies without speaking to a GP"](https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/nhs-talking-therapies/), provided you are registered with a GP and aged 18 or over, or 16 or over in some areas. It treats the anxiety or depression rather than the compulsion as such, and for a lot of people that is the thing keeping the loop running anyway.
**Your GP.** Worth seeing regardless. They can rule out or treat what sits underneath, and a compulsion that started after a medication change, a bereavement, chronic pain or a head injury is a different conversation entirely.
Choosing between them
Four questions that decide it faster than reading more.
**Do you want company or tools?** Fellowships give company. SMART gives tools. Therapy gives attention.
**Can you say "I am powerless over this" without your teeth going on edge?** If yes, a twelve-step room may suit you. If no, do not force it. SMART exists precisely because that framing does not fit everyone.
**Is something underneath this?** Anxiety, depression, trauma, grief, a bad situation you cannot currently leave. If yes, peer support alone will keep sliding off it, and a GP or a therapist should be in the mix.
**What can you afford, in money and in time?** Two of the three are free. That matters more than people admit, and it is a legitimate reason to start with a free route.
You can run more than one, and most people do
These are not exclusive. A common combination is one peer group plus a GP appointment, or therapy plus friction that a device enforces.
Whatever you choose, the mechanical work still has to happen alongside it. [Friction, the one move that works for everything](/guides/other/friction-the-one-move-that-works-for-everything) is the piece that reduces the count while the slower work happens, and [how to stop a compulsion you cannot name](/guides/other/how-to-stop-a-compulsion-you-cant-name) has the four moves that do not depend on which route you pick.
The one thing to avoid is spending three months choosing. Pick one, give it six weeks, and change if it is doing nothing.
Renovyn sits alongside any of these: you can define the behaviour yourself, keep count, and let one person you choose see how it is going. It is a support tool rather than treatment.
If you are struggling to cope, the Samaritans are on 116 123, free, at any hour. For urgent mental health support in England, call NHS 111 and press option 2.
Common questions
Which one works best?
Nobody can answer that for an unnamed compulsion, because the trials do not exist. The trial evidence that does exist is mostly about alcohol and mostly about a professional intervention rather than about attending meetings. What is knowable is which one you will actually keep doing, and that is a better basis for the decision than a comparison nobody has run.
Do I have to say my behaviour out loud in a meeting?
No. In most peer meetings you can listen for as long as you like and pass when it comes to you. People consistently overestimate how much attention their own turn attracts and underestimate how much they get from hearing everyone else.
Is there NHS treatment for a compulsion with no name?
Not for the compulsion as such, because there is no diagnosis to treat. There is NHS treatment for the anxiety, depression, sleep problems and distress that usually accompany it, and for many of those you can refer yourself to NHS talking therapies without speaking to a GP first. Start there rather than waiting for a service that matches your behaviour to appear.
What if I try a meeting and hate it?
Try a different one before concluding anything about the whole route. Meetings vary enormously by facilitator, group and format, and online and in person feel very different. Two or three attempts is a fair test; one is not.
Sources
- [SMART Recovery UK](https://smartrecovery.org.uk/). Free mutual-aid meetings grounded in cognitive behavioural therapy, secular, and scoped to problem behaviours generally.
- [GOV.UK, Clinical guidelines for alcohol treatment, chapter 6](https://www.gov.uk/guidance/clinical-guidelines-for-alcohol-treatment/6-recovery-support-services-and-lived-experience-initiatives). A neutral description of how twelve-step fellowships operate, independent of professional bodies and volunteer-led.
- [Cochrane, Alcoholics Anonymous and other 12-step programmes for alcohol use disorder](https://www.cochrane.org/evidence/CD012880_alcoholics-anonymous-aa-and-other-12-step-programs-alcohol-use-disorder). The evidence for manualised Twelve-Step Facilitation, and the separate finding on non-manualised attendance.
- [Professional Standards Authority, Psychotherapist](https://www.professionalstandards.org.uk/practitioners/psychotherapist). That psychotherapists are not regulated by law in the UK and may instead join an Accredited Register.
