How it works What's new Evidence About Safety Open Marrow

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the evidence

Built on what
actually works.

Recovery has decades of real science behind it. Marrow is built on that science, and this page is where we show our work, including where the evidence is strong and where it is honestly still thin.

why this page exists

Most recovery apps tell you they work. Very few show you why, or admit what they cannot do. We think that is backwards, especially for something as serious as recovery.

So here is every load-bearing design choice in Marrow, the research behind it, and an honest label for how strong that evidence really is: strong when it rests on meta-analyses or randomized trials, moderate when it rests on solid but fewer studies, and emerging when it is promising but early. Where a choice is principled rather than proven, we say so plainly.

the core of it

Why Marrow has no streaks.

This is the decision everything else grows from, and it is the one most recovery apps get backwards.

design choice: a return never resets your practice

A counter that resets to zero can turn one slip into a full relapse.

The abstinence violation effect describes how a single lapse, when read as proof of personal failure, sets off the guilt and hopelessness that push a lapse into a full return to use. A sober-day counter that drops to zero on a slip is that failure story, drawn as a user interface. Marrow keeps two numbers instead: your days in practice, which never reset, and your current stretch, which begins again without erasing anything.

moderateLarimer, Palmer & Marlatt, Relapse Prevention: An Overview of Marlatt's Cognitive-Behavioral Model, NIAAA. PMC6760427
design choice: a return is met with warmth, never shame

Shame, not guilt, is what predicts the next relapse.

In a prospective study, recovering people who showed more shame while describing a past slip were more likely to relapse, and to relapse harder, over the following months. Self-reported guilt showed no such link. The takeaway the authors themselves drew: shaming people for a hard-to-control behavior is close to the worst thing you can do. Marrow's return flow is built to lower shame first, separating what happened from who you are, before anything else.

strongRandles & Tracy, Nonverbal Displays of Shame Predict Relapse and Declining Health, Clinical Psychological Science, 2013. DOI 10.1177/2167702612470645
the pull

Riding a craving, not fighting it.

design choice: the pull is a wave you surf, with breath and time

Cravings crest and pass, and learning to ride them out changes outcomes.

Urge surfing, watching a craving rise and fall without acting on it, is the core skill of Mindfulness-Based Relapse Prevention. In a randomized trial against standard relapse prevention and usual care, MBRP showed added benefit at twelve months, with fewer days of use and heavy drinking. The Pull turns this into something you do: rate the wave, breathe, and watch it come down, then keep a record of every wave you have ridden.

strongBowen et al., Relative Efficacy of Mindfulness-Based Relapse Prevention, JAMA Psychiatry, 2014. JAMA Psychiatry
the work

A program, walked many ways.

Marrow offers the twelve steps and a secular, CBT-based track side by side, because the evidence points to more than one valid road.

design choice: the twelve steps, in plain language, with a guide

Twelve-step work has a real, specific edge on staying abstinent.

The 2020 Cochrane review of 27 studies found that manualized twelve-step facilitation produced higher rates of continuous abstinence than other active treatments, including standard CBT, and did so at lower cost. Marrow walks the steps in its own plain words, never reproducing copyrighted literature, and always points toward real meetings and a human sponsor.

strongKelly, Humphreys & Ferri, Cochrane Review, distilled in Alcohol and Alcoholism, 2020. PMC8060988
design choice: every step turns you toward a real person

What carries recovery most is connection, not the paperwork.

When researchers took apart how twelve-step programs actually work, the single strongest driver was social: shedding people who use, adding people who do not, and building confidence in hard social moments. It accounted for the majority of the benefit. So Marrow treats the written work as a beginning, and keeps turning you outward, toward one person to tell, a meeting, or a room of people doing the same work.

strongKelly, Hoeppner, Stout & Pagano, mechanisms-of-behavior-change analysis, 2011. PMC3242865
design choice: a secular, CBT-based pathway alongside the steps

There is no single road, and choosing your own improves the odds you stay.

SAMHSA is explicit that recovery has many pathways, and comparisons across twelve-step, SMART, and other frameworks find broadly comparable outcomes, with the freedom to choose a good fit lowering the odds you drop out. Marrow's SMART track offers the same evidence-based tools, cost-benefit work and catching the thought that gives the pull permission, in the app's own voice.

moderateSAMHSA, many-pathways framework; Zemore et al., mutual-help comparison, 2018. samhsa.gov
the return

Coming back, safely.

design choice: a return is treated as expected, not as failure

Recurrence is normal in recovery, on par with other chronic conditions.

NIDA is clear that a return to use does not mean treatment has failed. Recurrence rates for substance use disorders, roughly forty to sixty percent, sit right alongside those for asthma and high blood pressure. It is a signal to resume and adjust support, not a verdict. Marrow says this plainly at the moment it matters most, and keeps the door back in one tap away.

strongNational Institute on Drug Abuse, Treatment and Recovery. nida.nih.gov
design choice: the return names safety before anything else

The window right after a return can be the most dangerous of all.

After a period away, tolerance drops, so a dose that once felt ordinary can become an overdose, a risk that is especially acute with opioids. Because of this, Marrow's return flow checks on your safety first, surfacing plain harm-reduction guidance and a real human line, before it offers any reflection or reframe. Self-compassion, rather than self-blame, is associated with better outcomes from here.

moderateNIDA (overdose after abstinence); Garner et al., self-compassion and substance use, 2020. PMC7047423
standing

Progress you can feel,
not a score.

design choice: growth is measured as recovery capital, shown as a picture, not a number

The truest measure of recovery is the ground you stand on, not days counted.

Recovery capital, the sum of the internal and external resources you can draw on, your people, health, meaning, and coping, predicts who initiates and sustains recovery. It is a strengths measure, not a deficit one, and it survives a return untouched. Marrow's Standing reading uses the validated short-form items over these domains, scored only on your device and shown as a picture that grows with your resources, never as a number to protect.

moderateVilsaint et al., validation of the Brief Assessment of Recovery Capital (BARC-10), 2017. Drug and Alcohol Dependence
the small things that hold

Plans, and moments that add up.

design choice: you keep simple if-then plans for your own hard moments

Coping rehearsed before the wave beats coping improvised inside it.

Implementation intentions, plans in the shape of "when this happens, then I will," reliably improve follow-through on a goal. The effect is smaller and more mixed in substance use specifically than in general behavior change, so Marrow offers plans, never demands them, and resurfaces your own words at the moment your trigger tends to arrive.

moderateGollwitzer & Sheeran, meta-analysis of implementation intentions, 2006. goal_intent_attain.pdf
design choice: helping others is treated as part of the work

People who help other people in recovery stay better themselves.

The helper-therapy principle is well documented: those who support fellow members are meaningfully more likely to stay abstinent and report less depression. It is a genuine active ingredient, not a nicety. Marrow builds simple, unquantified ways to turn outward and give something back, with no service streak to chase.

moderateZemore & Pagano, AA-related helping and the helper-therapy principle. PMC3603139
safety is not optional

An AI companion needs
hard limits.

design choice: a deterministic safety layer, warmth then a human handoff

Guidance on AI wellness companions is clear, and we follow it.

Professional guidance on AI wellness chatbots calls for persistent transparency that you are talking to an AI, rigorously tested crisis escalation to real human services, firm boundaries against diagnosis and medical advice, and safeguards against dependency. Marrow's guide, Heron, is fenced by all of these. A safety check runs the instant you type, before any model call, and it is tuned to catch even indirect or metaphorical expressions of despair.

strongAmerican Psychological Association, Health Advisory on the Use of Generative AI Chatbots and Wellness Apps, 2025. apa.org
what we do not claim

The honest limits.

  • Marrow is a companion, not a treatment. It is not therapy, not medical care, and not a crisis service. It is built to sit beside real care, and to hand you to a real person the moment that is what you need.
  • Self-guided tools usually match, rather than beat, other approaches. The honest reading of the digital-recovery literature is that a well-built app can help, often as much as other options, but it is rarely a silver bullet, and it works best alongside human support.
  • The no-streaks stance is principled, not proven in a trial. It is grounded in strong theory about the abstinence violation effect and shame. We believe it is more accurate than a resetting counter, and we are not claiming a head-to-head study has crowned it.
  • We do not inflate the numbers. Where an effect is small or mixed in substance use specifically, we label it moderate or emerging, even when a bigger number exists for behavior change in general.
the record

Sources.

  1. Larimer, Palmer & Marlatt. Relapse Prevention: An Overview of Marlatt's Cognitive-Behavioral Model. NIAAA, Alcohol Research & Health. pmc.ncbi.nlm.nih.gov/articles/PMC6760427
  2. Randles & Tracy. Nonverbal Displays of Shame Predict Relapse and Declining Health in Recovering Alcoholics. Clinical Psychological Science, 2013. doi.org/10.1177/2167702612470645
  3. Bowen et al. Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual. JAMA Psychiatry, 2014. jamanetwork.com
  4. Kelly, Humphreys & Ferri. Alcoholics Anonymous and other 12-step programs (Cochrane Review), distilled in Alcohol and Alcoholism, 2020. pmc.ncbi.nlm.nih.gov/articles/PMC8060988
  5. Kelly, Hoeppner, Stout & Pagano. Mechanisms of behavior change in Alcoholics Anonymous. 2011. pmc.ncbi.nlm.nih.gov/articles/PMC3242865
  6. National Institute on Drug Abuse. Drugs, Brains, and Behavior: Treatment and Recovery. nida.nih.gov
  7. Garner et al. Self-Compassion and Alcohol Use. Substance Abuse: Research and Treatment, 2020. pmc.ncbi.nlm.nih.gov/articles/PMC7047423
  8. Vilsaint et al. Development and validation of the Brief Assessment of Recovery Capital (BARC-10). Drug and Alcohol Dependence, 2017. sciencedirect.com
  9. Gollwitzer & Sheeran. Implementation Intentions and Goal Achievement: A Meta-Analysis. 2006. cancercontrol.cancer.gov
  10. Zemore & Pagano. Kickbacks from helping others: AA and related helping. pmc.ncbi.nlm.nih.gov/articles/PMC3603139
  11. American Psychological Association. Health Advisory on the Use of Generative AI Chatbots and Wellness Apps, 2025. apa.org
  12. SAMHSA. Recovery and the many pathways to it. samhsa.gov

Marrow is informed by these approaches and affiliated with none of them. Nothing here is medical advice, and citing a study is not a claim that Marrow reproduces its intervention. Questions or corrections, from clinicians or anyone else, are genuinely welcome at hello@martori.studio.

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