Narcotics Anonymous, Alcoholics Anonymous. Information on 12 step fellowships.

[Dickon]

The information on DF concerning the twelve-step fellowships, Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) is patchy at best, and often highly prejudicial. I am starting this thread to try to provide a more balanced point-of-view and to give members the opportunity to make an informed choice about whether these recovery groups would be beneficial to them. This thread is for information on the twelve steps. Please use the thread N.A. or not N.A?: that is the question. For or against 12-step recovery? to argue your views, pros and cons. I'd be really glad if people posted how NA in the USA or other countries differs from NA in the UK, etc.

There is a fairly prevalent view that these groups are cults, religious in nature, and this position is usually backed up by pointing to the 12 steps (of which more later) and observing the mention of the word "God". I shall start by outlining the principles of "The Programme" as it is often called.

Abstinence

First and foremost it should be unequivocally stated that these are abstinence-based programmes. AA advocates total abstinence from alcohol and NA from all mood-altering drugs (except caffeine and nicotine). That does not mean you have to be abstinent to attend a meeting, simply that a majority of members will be abstinent, and this is what they will expect you to aim for. In NA the literature says "The only requirement for membership is a desire to stop using". In AA "using" is replaced by "drinking". Let me clarify what this means. These programmes frown upon controlled using or drinking, or rather AA's "Big Book" (the programme's "Bible"), says something along the lines of "if any man can turn round and drink like a gentleman, our hats are off to him", but then clarifies that such a man is not properly an "alcoholic". Similarly in NA a man who can control his using of any drug is not properly an addict. Those on substitute prescriptions (methadone, buprenorphine (subutex, suboxone), etc.) are considered no more clean than those using heroin. In NA alcohol is also classified as a drug. This leads to the somewhat strange situation where someone 10 years off opiates is said to have "relapsed" if he has a small glass of port at Christmas. There is no distinction between a lapse and a relapse, and emphasis is put on obtaining large contiguous chunks of "clean time" or time sober.

Henceforth I shall limit my discussion to NA. I shall outline the differences between NA and AA later on. This might be seen as arse-over-elbow as AA was the parent fellowship, but this is drugs-forum, and my own experience, though of both fellowships, is greater of NA. The programme is often said to rest on four legs, meetings, steps, sponsor and service. For someone at a first meeting, there will almost certainly be some odd language, some of which I shall decrypt for you here. This may put some off, lending credence to the cult hypothesis. But go to a gym and you'll hear talk of abs, reps, quads, lats, sets, etc. which to the uninitiated might sound like gobbledygook. Gym-goers do not belong to a cult!

NA meetings

So what should one expect from a first NA meeting? First off, NA is free, although a pot is passed, usually at the end, for voluntary contributions. These go for paying for the venue, printing literature, running helplines, bring NA into hospitals and prisons etc., and other things. Usually there will be tea and coffee on offer. In the more organised meetings there will be a greeter who's job it is to welcome people, especially newcomers, but even if there is no greeter, in most meetings a newcomer will be welcomed anyway, offered a cup of tea or coffee, and chatted to before the meeting starts. Then the secretary of the meeting will start the meeting proper. Although meetings differ, at least in England, for the majority of meetings, the format is fairly standard. Usually the meeting will be started with a moment of silence to remember the "still suffering addict", i.e. the addict who has not "found" NA yet. Then it is customary for everyone to introduce themselves. This is a case of "Hi. I'm/My name is X and I'm an addict", where X is a first name. Then there are a series of readings from cards. These are often laid out on chairs, or handed out. If offered a card, you do not have to accept if you do not wish to read; alternatively, don't sit on a chair with a card on it! These describe "Who is an addict?", "What is the NA programme?", "Why are we here?", "How it works", and sometimes "The 12 traditions of NA" (these describe how NA is organised. Do not concern yourself with these for now.)

The preamble over, the "main share" will start. Main shares vary enormously in content, but usually they are a life-story, focusing on the sharer's drug use, and on how he (s/he or they if you prefer) found NA and managed to achieve abstinence for such and such a period of time. They might include descriptions of any relapses along the way. Usually a main sharer will have several months or years of abstinence to his credit. If said sharer is "conscientious", he will describe how he "works the programme", which will usually involve having (and using) a sponsor, working the steps, doing service, and of course attending NA meetings. He may refer to his higher power or to God. These two are for many one and the same, but a higher power, i.e. a power greater than ourselves (see the 12 steps later, specifically step 2) can just be NA, or the particular NA group. These concepts are left vague and God is always qualified in the steps with "as you understand him". For the atheist wishing to fit in, God could just be nature, the universe, or some non-monotheistic concept. Not all main sharers talk about God, or even believe in God, but some do. If this is a first meeting, and you get a religious zealot sharing, remember this is just HIS story. NA is a broad church (bad analogy!). Usually main sharers express gratitude to NA, and often go so far as to say NA saved their lives. Shares as people may be exciting or dull, inspiring or otherwise.

Once the main share is over, they usually last about 20-30 minutes, the secretary will thank him for sharing, and talk briefly himself, identifying with similarities and then will open the meeting for sharing from the floor. [there may be a cigarette break if the meeting is a non-smoking meeting]. Here anybody may share back, usually identifying with the main sharer, and/or talking about their own problems/situations/successes etc. The last 10 minutes are often reserved for newcomers or people who find it difficult to share.

When the sharing time is over, the pot is passed (the 12 traditions are sometimes read at this point, not the beginning) and the meeting is closed with the serenity prayer "God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference" sometimes followed by "keep coming back, (it work if you work it, so work it you're worth it)". Often this is done holding hands, which can be strange for a neophyte. Often people hug after this; hugging is quite common in NA, and can be a source of discomfort to some. It is not obligatory, although non-huggers are rare. The meeting then disbands, although often people go for coffee, and a newcomer might well be invited, or given phone numbers of other members. This is more likely if a newcomer shares himself, even if just to say that this is his first meeting, and he finds it bewildering, or wants to stop using.

The 12 Steps

So what on earth are the 12 steps and how do you "work" them? A little copy and paste will give us:

The 12 steps of narcotics anonymous

1. We admitted that we were powerless over our addiction, that our lives had become unmanageable.

2. We came to believe that a power greater than ourselves could restore us to sanity.

3. We made a decision to turn our will and our lives over to the care of God, as we understood Him.

4. We made a searching and fearless moral inventory of ourselves.

5. We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. We were entirely ready to have God remove all these defects of character.

7. We humbly asked Him to remove our shortcomings.

8. We made a list of all persons we had harmed, and became willing to make amends to them all.

9. We made direct amends to such people wherever possible, except when to do so would injure them or others.

10. We continued to take personal inventory, and when we were wrong promptly admitted it.

11. We sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us, and the power to carry that out.

12. Having had a spiritual awakening as a result of those steps, we tried to carry this message to addicts and to practice these principles in all our affairs.


Many people on seeing these steps are put off by the like of "powerless", "unmanageable", "sanity" (so I'm INsane now?), "God" and "power greater than ourselves". Many, if not most NA members had difficulties with these concepts at first. Let me soften the blow. A "using addict" (as opposed to a "recovering addict") is powerless over his addiction means that he can't stop. Often the idea of being powerless over "people, places and things" is discussed. My understanding of this is that people can't always be controlled and shit happens! unmanageability is the idea that one is not in control of one's life when using. One is forced to lie or rob or break one's moral code to obtain drugs. Sanity is derived from a latin word meaning health. One is clearly not healthy (physically or mentally) if one is addicted.

God and Higher Power

I have discussed higher powers (often abbreviated to H.P.s) earlier, but will say a few words about NA and religion. NA is not religious (even though AA is firmly routed in Christian tradition, specifically the Oxford group) and a lot of members would aspire to spirituality rather than religion. However I can understand that steps 3 and 11 would at a first reading seem daunting or weird to an atheist or someone traumatised by bad experience of religion. Although for those who choose to follow a 12-step path, these are questions the individual must solve, let me posit a couple of brief ways to understand these in a more secular context. Maybe one could see these steps as an attempt to align one's conscious self with one's subconscious; maybe to achieve enlightenment or find one's own Buddha-nature; maybe to find one's true will. Meditation and Prayer (why not doing yoga asanas as prayer if that's your thing?) are simply tools to achieve greater harmony. I think it is vitally important to point out that NA is not a bunch of happy clappies, or Christians, although neither happy clapping nor Christianity is a bar to membership. NA members have carte blanche to explore these concepts. One solution for the atheist is to identify God with the acronym Good Orderly Direction.

Sponsors and Sponsorship

Working the steps is done with a "Sponsor". He is like a mentor, and should usually be of the same sex as you are. A newcomer is encouraged to choose a sponsor, someone one has something in common with, respects, and who has more clean time. A sponsor should also have a sponsor of their own and be "working the steps". Not everyone has a sponsor, and asking someone to be one's sponsor can be a little daunting. It should also not be rushed into. Sponsors are there for telephone conversation or visiting when the sponsee feels like using or is having a hard time, or just to touch base. Also a good sponsor's "job" is to guide a sponsee through the steps. This more formal aspect of "working the steps" consists usually of written work centred around the steps. About 10 years ago NA bought out a "step-working guide" that had a list of questions a sponsor could use to guide a sponsee through the steps.

Service in NA

Doing service simply means committing to a regular "job" at a meeting. These usually include making tea, collecting the money (treasurer), chairing the meeting (secretary), a literature secretary and Group Service Representative (GSR), and maybe a greeter. The GSR represents the group at the area level, which usually involves buying literature and keyrings for the group and taking any excess money to support wider NA service, as well as representing the group's views in any decisions made by the area. The literature secretary brings the literature in and sets it out before the meeting. Usually literature is free to newcomers.

AA v NA

AA is similar to NA except there is usually just one reading from the "Big Book" (called simply Alcoholics Anonymous). In most AA meetings the amount of sober time is greater than equivalent clean time in NA. The tempo is, generally speaking different (slower, calmer, some would say more mature), and the average age is higher. I understand these are somewhat crass generalisations, but I stand by them as a rule of thumb.

Pros and Cons of NA

OK, so let's look at the positives and negatives of NA. NA provides a great place to network socially, and feel at home. A good NA group can be incredibly supportive and welcoming, and for a battered addict, getting a cup of tea and a hug and a smile can mean the world. Undoubtedly many people have success with the programme, as evidenced by many members with years of clean time. One can go to a meeting feeling alone in the world, and the realisation that there are others like one can lift the dreaded isolation that plagues so many addicts, and lessen anxiety. The fellowship is worldwide, and so one can find like-minded individuals almost anywhere. It is rightly said "there is a lot of love in NA".

On the negative side, NA can be dogmatic and monolithic. Abstinence is the only way to go, and working the programme is the only way to get it. There are a couple of fudges such as "if you can get away with controlled using, you're not an addict". All drugs are lumped together, so an ex-heroin user who takes LSD or peyote for a spiritual experience has simply relapsed. I never could quite understand why caffeine are nicotine are not considered mood-altering drugs (from which NA members must "abstain in order to recover"). There's a guilt-trip inducing distinction between "staying clean" and recovering. Someone simply staying clean is not doing enough if he is not "working the programme". This is a valid distinction at some level. Being angry, lonely, and an arsehole while clean is not fulfilling, but "working the steps" is often seen as the only means of betterment. Other recovery philosophies are pooh-poohed despite scientific evidence to the contrary. Despite the literature saying honesty, open-mindedness and willingness are needed in order to recover, these principles are lacking regarding other methods of getting and staying clean, or the ability to reduce drug / alcohol use to sensible levels. I think this is a necessary evil for a fellowship such as NA. Perhaps the oft-repeated sentiment that drug use inevitably gets worse after relapse (simply not universally true), and that for an addict drug use inevitably ends in "goals, institutions and death" are useful fictions [Life inevitably ending in death notwithstanding]. To "dilute" the message would only serve to confuse, and there is evidence that people with serious drug problems benefit from abstinence.

To conclude I shall state my own position to allow the reader to asses better if I have slipped from fair and objective exposition. I was a member of NA (I escorted my cat) for about 3 to 3 1/2 years. I managed periods of abstinence of just under 2 years and just under 1 1/2 years. I was an NA zealot, but I found it increasingly hard to belong to an organisation that was not entirely honest with itself. As I write this I am a mere 74 days off everything (no drugs or alcohol or cigarettes for the cat, but he drinks tea and coffee), and am not certain I will not go back to NA one day. I miss it. I made some wonderful friends, and I sometimes curse the fact that I am so bloody-minded. However I know that spontaneous remission from addiction happens, and that NA is not the only way to recover.

Reputation Comments on this post:

	EXCELLENT!! Nice focus, great effort, way to go. The site (and I) definitely needed this perspective.
	excellent write up
	great great resource....thanks for doing this dickon!
	rep is for this incredibly informative and well thought out thread, plus the many other ones you have posted lately - yo...

[Richard_smoker]

wow Dickon, that was excellent.

Exactly what i wanted needed to know about this group. One of the most daunting things about finding out good information about NA is maneuvering around various roadblocks to obtaining info (on the net anyways)--for example, this forum tends to bias against it (naturally! haha), and the 'recovery' sites/forums tend to use too much jargon and undecipherable talk as well as what I previously thought was a judgmental attitude both of which i personally found off putting.

I think the idea of the groups being 'cult-like' is only partially due to the mysterious higher-power/God requirements. In my opinion, the obsessions with endless meetings and working the steps and counting the days of being completely sober from anything mind-altering but cigarettes and coffee might be hitting closer to the real concerns about being a quasi-religion.

And it is a valid question--what the hell is so good or 'ok' about nicotine?? the death rates & complications of smoking are right up there with alcoholism. It couldn't be that tobacco is LEGAL because so is vodka! I don't even need to mention that cigarette smoking is one of the most addictive of all drug-using behaviors... all i can come up with is that
1. smoking was acceptable at the conception of AA/NA and thus, allowing tobacco use is a lasting, living archive from the past. OR
2. the nature of cigarette smoking has somehow been found to be distinct from drug or alcohol relapse and is not a trigger to use other things. In other words, if someone were to be completely 'clean and sober' for 3 years, his odds of relapsing on cigarette smoking may be rather high... so, perhaps coffee and nicotine are 'ok' because if someone were to 'give in' to their cravings to smoke, there's no inherent danger of discontinuing their sobriety efforts at remain off alcohol and drugs.

To this degree, it could be reasonably argued that quibbling over smoking is possibly counter-productive and takes everyone's focus off what is important--maintaining "sobriety" being more important than a 100% healthy & clean, toxin-free mind and body.

After reading your posts, I can see how the 'cult'-claims are probably invalid judgments. It is most likely that adherence to the 12 steps and the remainder of the program must be of absolutely vital importance when dealing with severely ingrained bad habits (addictions yes, but also what addictions attempt to hide or cover-up: avoidance, self-destruction, depression, insomnia, hopelessness, shame, guilt, inability to cope with the past or with specific trauma, anger, inability to forgive others, etc).

While anyone can become addicted to a mild-altering drug, perhaps there actually is kind of a 'rock-bottom' requirement for inclusion into the group of addicts which NA/AA considers actually worthy of total abstinence and thus inclusion in their club(?). I have a feeling that if i were to bring up these concerns at a meeting, i would be told that i am living in denial of my own nature... and perhaps that might be technically true, but i'm really asking these questions for the sake of OTHER people who may have problems with drugs or alcohol...

is it necessary for a problem drinker who is able to stop drinking entirely on their own to believe that he/she cannot smoke an occasional joint or take hallucinogens or pain-killers after surgery?

or is the inevitable way of finding oneself at the program only AFTER this ex-drinker discovers that his/her life has AGAIN become unmanageable?

great thread Dickon. I plan to add to this discussion a psychological/philosophical non-religious interpretation of the steps & faith in a higher power for atheists, agnostics, and those who've been burned or put-off by religion.

-DICK

[Ilsa]

great write-up, D

thanks for clarifying the 'higher power' thing...it always struck me as very religious, esp considering my history, but i think i was just being overly sensitive to that rather minor point. the program itself is pretty dogmatic, and Dick makes a valid point about quasi-religion, but overall i'd be willing to give na a try if i hit another really difficult patch. i've also heard that na has a slightly different atmosphere than aa...very informative and much needed

[methMADMAN]

Dickon, sorry I did not respond to the PM, just got busy then forgot. Looks pretty good to me, although I must say that about AA being rooted in Christianity, is not quite completely accurate. Yes the 12 steps were adapted from the six steps of the Oxford group which is a Christian organization. The original members were for the most part Christians but as time went on many who came were agnostic (thus the chapter "We Agnostics"). I think some of the founding members also stumbled onto the knowledge, (and this is only my belief) that really there is a higher power force and it's the same from religion to religion, it's just that smaller minds have to be divisive. I just know I have seen the "God as you understand it" concept work for so many different people with different views.

The thing is that all of the twelve steps suggestions can be found in the Bible and I am told also the Koran. I know most of the concepts can also be found in the I Ching. I suspect as well they would be found in just about every holy book known to man.

Further there are even Atheists among us who it works for, but I won't like, they are rare, but that is why the step says "God as we understand him". Though if there was one and only one thing I would change about that is to replace "him" for "it".

AA and NA and the concepts they are based on are by no means new stuff. As a group to help addicts and alcoholics recover, yes, but not as what I would consider to be "truths of universal law".

All AA steps are exactly the same as NA save for the word alcohol is replaced by addiction. Personally I find more more direct and enjoyable reading from the AA book but I also like the NA basic text.

Another thing that should end the whole religious connection once and for all is found in two of our traditions:

Originally Posted by Alcoholics Anonymous

6.) An A.A. group ought never endorse, finance or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property and prestige divert us from our primary purpose.

10.) Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.

Lastly there is a lot of BS going around the internet about AA being ineffective. The truth is that for those who are involved and do what is suggested it is very effective. This Powerpoint presentation, from this website, shows a much more comprehensive, scientific, and accurate study of AA's effectiveness.

If you do not have Micro$oft Office, then Open Office can be downloaded for free here, and it can read the file.

[missparkles]

Swim attended NA and AA whilst she was in treatment. She found some very positive people there. Some took the bits they could use, the rest they discarded. But some people who use NA/AA appear to have swapped one addiction for another, albeit a healthier addiction.
Swim found it did help her gain some awareness and insight into her specific problems and was a whole social network of support if she wanted it.
However, swim found the "disease" and "powerlessness" aspect of the programme very difficult to internalise. Both of these concepts took personal responsibility from swim and gave it to the group as a whole, and for swim getting clean and staying that way was about personal choice, not something anyone, or anything, could take or give.
If swim wanted it, it was hers.
Having said that swim has some friends who use the steps and they're still clean and sober, so for swim it works.
The bottom line is they do save lives that might be lost to addiction. And one thing swim has learned is that recovery is personal to every person doing it. The 12 step programme helped her when she needed it, and if necessary she would use it again.

[Dickon]

I suffer from the disease of asthma over which I am powerless. I do have an inhaler which I can use to treat it with (the symptoms of the disease, not the disease itself) over which I am not powerless. If I do not use the inhaler when an attack is imminent my breathing could become unmanageable.

This would be an analogy that makes sense of disease and powerlessness (I even worked in unmanageability here - another NA buzz-word) in a way that is not ultimately disempowering.

We could make this analogy with poor eyesight and glasses, diabetes and insulin, and so on and so forth. The disease concept is useful as many people find it impossible to return to a "normal" (read "non-addictive") pattern of drug use after being in active addiction. NA would hold that should you be able to do this you do not suffer from the disease of addiction. In this sense it would be possible to differentiate dependence from true addiction. Someone who is heroin dependent may be able to quit and then use drugs in moderation, but an addict is forever doomed to fail should he endeavour this.

Please note, I am trying to elucidate a perspective here. I argue to some extent for it's internal consistency and for the fact that it is not necessarily, I believe, disempowering, at least no more so than suffering from treatable asthma, poor eyesight, diabetes etc. I make no claims as to the validity of the perspective. I've come to the conclusion that should cat ever be well enough to be able to use drugs again sensibly, he would not want to do so. I leave it to those with a logical frame of mind to see how neatly this view kicks a whole host of question into touch! We can see the "disease of addiction" now as treatable or not. Maybe thinking "I suffered from the disease of addiction but I was cured when I stopped using and became sufficiently well as to no longer to desire drugs" is more palatable than "I suffer from the disease of addiction, and will do so until I die".

That's a new thought to me.

Dickon

Reputation Comments on this post:

Gives others a different perspective on NA/AA.

[methMADMAN]

I think what I take from the words "powerless" and "unmanageable", are quite different from what I see people seeing them as.

To me I am not powerless over whether I drink or do drugs anymore, the say so would be ludicrous. I am, however, powerless over the effect they have on me when I do drink or drug. By that I mean I have tried it a thousand times and it invariably ends up badly for me.

To me, life itself is unmanageable. Yeah that's right, even now, working a 12 step program and being clean and sober I have come to accept that life is an unmanageable game. I can of course control what I do, how I react to life, and the people I choose to have in my life, but I have no control over anybody or anything else. For instance if I plan a picnic and then it rains, there was never anything I could have done to change that. If I ask my wife to do something a certain way, if she doesn't do it, I have no real control. I can either accept the unmanageable aspects of life and "roll with the punches", or I can rail against the things which ultimately I have no power over. Not very constructive but a lot of people, including myself sometimes do it anyway.

Reputation Comments on this post:

spoken like a true warrior