04 December 2014

Narcotics Anonymous Impressions

Narcotics Anonymous plays an essential role in maintaining abstinence for many drug addicts. While this author has attended 12-step programs for more than a decade and has worked as a counselor for addicts for the past year, he had never before attended an NA meeting. While based on the same principles as the Alcoholics Anonymous and Al-Anon meetings familiar to the author, NA is spoken of in the addict community as having a distinct culture of its own. In reading the NA literature, one can find the roots and reflections of this culture, and in attending NA meetings one may experience it firsthand. Through going to NA meetings, the author sought a deeper understanding of the lives of his own clients and to visualize forms their recovery might take.

Into the Fire
It would not have been possible to enter my first Narcotics Anonymous meeting unnoticed. The moment I walked through the door I was hugged by two men in succession. It may have been said that my observer status was further compromised, once the meeting got underway, by at least four members directing their “share” specifically at me. “I know how hard it can be to be here the first time when you feel like you don’t fit in. But trust me, if you keep coming back. . . etc.” As tempted as I was to explain that I am neither chemically dependent nor new to 12-step work, their assumptions placed me in a unique, albeit central, position to observe the attention given the newcomer. As the meeting broke up, I was recipient of additional hugs and encouragement from both men and women, none of whom felt obligated to know any particulars about me before bestowing their embrace. While hugging does not pose an issue for me, I would want to forewarn those with boundary issues to prepare themselves for physical contact at their first meeting. As maintaining sobriety has been found to depend on reaching out to the newly sober (Narcotics Anonymous Fellowship, 2008), it seemed that the best way for me to support abstinence of meeting attendees was to silently maintain the role in which I had been cast.

Getting Physical
The N.A. literature suggests why hugging is more of a component than this author has experienced in other 12-step based meetings (such as A.A. or Al-Anon). “Recovery becomes a contact process; we lose the fear of touching and of being touched. We learn that a simple, loving hug can make all the difference in the world when we feel alone. We experience real love and real friendship.” (NAF, 2008, Kindle location 1614). “We hug all the newcomers who are courageous enough to say, ‘I have three days today.’ We hug you if you have two days clean or two years clean.” (ibid, Kindle location 2951). Offering greeting hugs is commonly assigned as “service work” (ibid).

The Narcotics Anonymous Fellowship was begun in 1953, inspired by the Alcoholics Anonymous program—which itself originated in the late 1930s. AA was the byproduct of one man’s tireless search for long-term sobriety, Bill Wilson. Wilson came to realize that addicts, through the sharing of stories, could be effective in supporting one another’s sobriety—a goal which had eluded the medical field. Drug addicts who were drawn to AA eventually came to desire a program more clearly targeted to them. “Alcoholism is too limited a term for us; our problem is not a specific substance, it is a disease called addiction.” (NAF, 2008, Kindle location 312). The NAF adopted the AA Twelve Steps, making only slight changes in substituting the word ‘addiction’ for ‘alcohol’ and ‘addicts’ for ‘alcoholics.’ That these “principles that made our recovery possible” (NAF, Kindle location 523) are still adhered to is a testament to the power of Wilson’s original concepts. 
In comparing the Basic Texts of both fellowships, however, one finds significant differences in style. The core chapters of Alcoholics Anonymous are imprinted with the literary style of Wilson, which includes metaphors, 1930s colloquialisms, and non-inclusive male pronouns. The NA text—originating in the 1960s—does not convey the personality of any one author to the same degree, and may be considered more accessible and direct. The two texts serve to complement one another. 
The particular NA meeting attended by this author has been going for decades in the Hilltop area of Tacoma. At one time, it was explained to me afterwards, the meeting was exclusively for African-Americans. But in recent years a decision was made to open it up to all ethnicities. It then also became open for non-addicts to attend, as are the many 12-step meetings designated as “open.” 
Members frequently commented on how addiction unites us. An older African-American man gestured to the woman sitting next to him saying, “It’s hard to believe that a young white girl’s story could be so close to mine, but I could have just moved my lips and let her speak it for me!” Another man spoke powerfully about the fear he had to face in recovery. The woman who next spoke appreciated his “share” as “just what I needed to hear today.” In that first meeting, I counted sixteen of us in attendance.

Narcotics Anonymous has in common with other 12-step programs—Alcoholics Anonymous being the best known—a format that opens by reading a standard preamble, followed by the twelve steps and traditions, then perhaps a daily reader entry, leaving the bulk of the meeting for open sharing—frequently on an agreed-upon topic. A universally observed guideline is that there be no “cross-talk”, that is, anyone who shares is given the floor without interruption or direct comment. Those who choose to share will often refer to what they identified with in the sharing of another, but not until after that person’s turn has ended and the new sharer’s has begun. Issues, therefore, are not discussed so much as reflected on individualistically. This practice helps to maintain equality between those tending toward introversion with those tending toward extroversion.
For my second visit, I was permitted to recede into the background as I was no longer distinguished as a newcomer. In fact, there was another newcomer, sitting next to me, to don that mantle. He had a month sober—I learned by asking him as the meeting ended. I guessed correctly that he was in outpatient as he was getting an attendance slip signed. This meeting ended up having about 24 in attendance, men being in the majority. Emerging that day was a common theme on how romantic attachments can challenge or put an end to sobriety. It was more than thought presented on a topic; the desperation to survive a powerful disease could be felt at an animal level. One man stated that it was his third meeting in 12 hours, as though his addiction would route him out if he remained alone for any stretch of time. I had the sense of this roomful of people working together stacking sandbags to stem a flood that would overwhelm anyone of them working on his/her own.

Twelve Steps
Addicts successfully abstaining from drugs are described as being “in recovery.” “Recovery is what happens in our meetings. Our lives are at stake.” (NAF, 2008, Kindle location 508). Most addicts who have managed a significant period of sobriety say that their recovery came through “working the steps.” “By working the steps, we come to accept a Higher Power’s will. Acceptance leads to recovery.” (ibid, Kindle location 522)
The Twelve Steps were designed to be “worked” in sequence with the guidance of a sponsoring individual. “Working” steps 1-8 would take the form of journaling and conversing with one’s sponsor. Step Nine involves making amends to those “we had harmed” and Step Twelve involves “carrying this message to addicts.” (ibid, Kindle location 546). This last is rooted in one of Wilson’s most significant findings. During the period he first experimented with reaching out to other alcoholics, bringing them home for his tutelage, he was unsuccessful in leading any of them to sobriety. Yet he, himself, was remaining sober. It was then he came to realize what he had that the other alcoholics lacked, and understood that they would not be able to stay sober until they too became active in reaching out to help other drunks (Alcoholics Anonymous, 2001).

The Research
Linkenbach (1993) describes an Adlerian take on the Twelve Steps known as “The Bi-directional Addictions Model” in which a therapy client is shown that she/he has chosen behaviors the exact opposite of those outlined in each step. Step Four, for example, originally reads, “Made a searching and fearless moral inventory of ourselves.” The therapist encourages the client take ownership of what she/he has actually been doing: “We avoided through fear, honestly looking at ourselves.” Each of these opposing steps constitute “The Addictions Blueprint” (Linkenbach, 1993).
However effective NA members feel their program is, there are those who are opposed to joining it for a number of reasons. One wonders as to their chances of remaining abstinent. A five-year study of addicts attending versus not attending 12-step meetings concluded that, “Frequent attenders at NA/AA meetings were more likely to be abstinent from opiates and alcohol compared to both non-attenders and to infrequent attenders” (Gossop, M., Stewart, D., Marsden, J., 2007). A sobering further finding was that “less than weekly NA/AA attendance appears to be no more effective than non-attendance” (Gossop, M., et al, 2007). While Gossop, et al did not find statistically significant effectiveness of NA/AA for stimulant users, Donovan and Wells (2007) did. “Increased 12-Step meeting attendance and/or involvement appear to lead to a decrease in subsequent substance use among stimulant abusers.” Their findings therefore, “have prompted clinical researchers to recommend that treatment programs emphasize the importance of self-help groups and encourage 12-Step meeting attendance and participation” (Donovan, D. M., Wells, E. A., 2007). Davey-Rothwell, et al (2008) performed a study of how 12-step involvement can be spread through social networks (in the sense of ‘those one hangs out with’), concluding, “These interactions not only serve as a motivation to decrease drug use through increased social support, but are also an opportunity to exchange resources regarding treatment options” (Davey-Rothwell, M. A., Kuramoto, S. J., Latkin, C.A., 2008)
In a qualitative study of Appalachian women in recovery, Grant (2007) identified three stages of recovery: the disgusted self, the aware self, the alternative self, and the stable self (Grant, J., 2007). Drawing conclusions in reflecting back on one’s recovery process would be essentially what Wilson did when distilling the Twelve Steps. It was in the “alternative self” phase that women in the study availed themselves of the 12-step program. “As many participants stated, help within memberships at A.A. and/or N.A. was giving them proper tools to assimilate themselves into a new social world that included new associations, new and necessary structure, support, knowledge about addiction and recovery, love, the opportunity to relinquish old ways of thinking, and a commitment to something besides alcohol and/or drugs” (Grant, J., 2007).

Living in active addiction is to live without meaning. All humans share an innate desire for meaning in life. Recovery from addiction requires resuming the search for meaning postponed while in addiction. It was found by this author that to attend Narcotics Anonymous meetings is to witness a compelling search for meaning, made imperative by the jaws of relapse ever nipping at the addict’s heels. The testimony shared in these meetings ideally fills one with a profound sense of what it means to be fully human and alive. It is hard to imagine anyone living in this material world who could not benefit from that. 

Davey-Rothwell, M. A., Kuramoto, S. J., Latkin, C.A. (2008). Social networks, norms, and 12-step group participation. The American Journal of Drug and Alcohol Abuse, 34, pp 185-193.
Donovan, D. M., Wells, E. A. (2007). ‘Tweaking 12-step: the potential role of 12-Step self-help group involvement in methamphetamine recovery. Addiction. 102 (Suppl. 1), pp 121-129. 
Gossop, M., Stewart, D., Marsden, J. (2007). Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study. Addiction. 103, pp 119-125.
Grant, J. (2007). Rural women’s stories of recovery from addiction. Addiction Research and Theory. 15 (5), pp 521-541.
Linkenbach, J. (1993). A bi-directional addictions model. Individual Psychology. 49 (2), pp 248-256.
Narcotics Anonymous Fellowship (2008). Narcotics Anonymous, Sixth Edition. (Also known as The Basic Text). Van Nuys, CA: Narcotics Anonymous World Services.
Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.

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