A presentation to the International Council on Alcohol and Addiction's 37th International Congress on Alcohol and Drug Dependence at the University of California at San Diego, 20-25 August 1995

Abstract: Narcotics Anonymous, an international, community-based association of recovering drug addicts, provides peer support to other addicts who desire a drug-free outcome. We are fully committed to collaborating with professionals and community organizations with similar goals. This paper identifies key factors affecting NA's interactions with others, points out means by which professionals can contact Narcotics Anonymous, long-established means of direct interaction between NA and professionals, a number of programs designed to facilitate client introduction and entry into Narcotics Anonymous, and a description of what clients will find when they attend NA meetings and meet NA members. The paper addresses a number of areas where professionals may encounter difficulties in relating with Narcotics Anonymous, and closes by identifying ways to resolve any problems that may arise when interacting with NA. 

Narcotics Anonymous is one of the world's oldest and largest associations of recovering drug addicts. The NA approach to recovery from drug addiction is completely nonprofessional, relying on peer support. We believe the NA program works as well as it does primarily because of the therapeutic value of addicts helping other addicts.

Narcotics Anonymous is organized locally as self-governing, self-supporting groups adhering to a common set of principles, adaptations of the Twelve Steps and Twelve Traditions of Alcoholics Anonymous. Local NA groups are organized worldwide via NA's international delegate assembly, called the World Service Conference, and secretariat, the World Service Office, headquartered in Los Angeles, USA.

The first Narcotics Anonymous meeting was held in 1947 in Lexington, Kentucky, as part of a USA federal public health hospital program. An independent, community-based group using Lexington principles that was formed in Los Angeles in 1953 became the root of today's Narcotics Anonymous. Today, Narcotics Anonymous has nearly 20,000 registered weekly meetings in 70 countries around the world, the greatest concentrations being in the USA (16,000) and in Canada, Latin America, and Western Europe (1,000 each).

A framework for NA community engagement

Our mission as an organization is to communicate to addicts in the community that we may be able to help them learn to live drug-free, recover from the effects of drug addiction, and establish stable, productive lifestyles.

Our public relations activities strive to attract addicts to Narcotics Anonymous without being overtly or unduly promotional.

Our membership is open to anyone who wants to stop using drugs, regardless of the particular drugs they have used. There are no social, religious, economic, racial, ethnic, national, gender, or class-status membership restrictions.

We maintain a policy of "cooperation without affiliation" in our interorganizational relations. This policy allows us to work with others in the community without becoming involved in a manner which might distract us from our mission. This means that:

• We will neither explicitly endorse nor oppose other organizations or approaches to the problems associated with drug addiction.
• We will not allow other organizations to use the Narcotics Anonymous name for their programs.
• We will not provide funding for other organizations, nor will we accept funding from outside our own organization.
• We will take no position on any public issues, even those related to drug addicts or addiction.

We encourage anyone likely to be interacting frequently with Narcotics Anonymous to become familiar with the book on our Twelve Steps and Traditions, It Works: How and Why. The book is available from our World Service Office.

Means of contact with NA

There are three ways to make contact with local NA groups and committees. 

1. Many NA communities have telephone contact services. Their numbers are usually listed in the NA Phoneline Directory, available from our World Service Office. Local telephone contact numbers are also often listed in the local telephone book or through the telephone company's directory assistance service under the name "Narcotics Anonymous."

2. Local NA chapters that have been in existence for some time usually publish local meeting directories that show the days, times, and places where Narcotics Anonymous groups meet and sometimes give additional information about specific meeting formats. You can get a local meeting directory either by visiting an NA meeting or by calling the local NA phoneline.

3. If no means of contacting local NA groups or committees can be found, contact our World Service Office. Using the worldwide group and committee registration information we maintain for our fellowship, we will be able to tell you how to contact the nearest NA community.

There are two basic kinds of Narcotics Anonymous meetings. Anyone from the community may attend an "open" meeting to see for themselves what Narcotics Anonymous is like. "Closed" NA meetings, however, are meant for attendance by addicts only. Be sure to ask the phoneline contact or check the meeting directory to see whether the meeting you are planning to attend is "open" or "closed" before visiting.

Direct NA interaction with professionals and the community

Narcotics Anonymous has a strong interest in cooperation with addiction researchers to independently study the nature and effectiveness of our program. However, we have had difficulty establishing such relationships so far. Our fellowship has a very strong interest in maintaining the personal confidentiality of its members. We also need to discuss how to connect a researcher with NA interviewees without inferring an outright endorsement by NA of the researcher's organization or compromising the autonomy of local groups and service committees. Our World Service Office is eager to discuss innovative ways to cooperate with researchers in surmounting these challenges.

One direct contact between NA and professionals is in the Narcotics Anonymous meetings that are sometimes started by nonaddict treatment staff, health care professionals, social workers, educators, and others. We actively encourage professionals to support Narcotics Anonymous in their local communities and to start NA meetings in communities where there is no Narcotics Anonymous as yet. We have two cautions to offer in regard to such meetings:

1. NA meetings started by nonaddict professionals should be turned over to the addicts themselves as soon as possible. One of the key reasons Narcotics Anonymous works as well as it does as an organization is its independence. New NA members should be encouraged to take responsibility for their own NA meeting as quickly as they can, without compromising the stability of the meeting. The professional who started the meeting should then take an outside support role in relation to the new NA group.
2. When NA meetings are held on the grounds of a treatment facility or in a professional's offices, special care should be taken to explain the distinction between the facility and Narcotics Anonymous. It serves everyone well to maintain the distinction between professional therapeutic facilities and NA's nonprofessional, addict-to-addict approach to recovery. When an NA meeting is held in a treatment facility or a therapist's offices, some explanation should be made to those attending that the NA group is simply meeting there but is not a function of the facility or therapist.

Client interaction

Though we generally do not take a primary role in interventions, we do offer something called a "Twelfth Step call" that could be used as a follow-up to an intervention. If your client agrees, you can call the local NA phoneline and ask that a couple of experienced NA members visit your client to explain the NA program. To avoid confusion, it may be advisable to have your client call the phoneline him or herself.

Local service committees regularly organize panel presentations of the NA program for client groups and correctional inmates in residential facilities. These are organized by "hospitals and institutions" committees and are known within NA as "H&I panels." If you would like an H&I panel conducted for your clients, call the local NA phoneline and ask for a return call from the H&I committee chairperson to make arrangements.

Narcotics Anonymous meetings welcome visits from your client groups—in fact, our literature says that "the newcomer is the most important person at any meeting." If you would like to take a client group to visit an NA meeting, just call your local phoneline and find out when and where the nearest meeting is being held. If you are bringing a large group, you may want to ask the person answering the phoneline whether the meeting you are considering will be able to accommodate your group.

Many Narcotics Anonymous meetings are accustomed to identifying some person who will sign attendance verification cards for persons in outpatient treatment or on judicial referral. You should be aware that at some NA meetings, the person signing the card may take a special effort to emphasize to the client that this is being done as a service to the client, not because of some direct affiliation between your organization and Narcotics Anonymous. You should also be aware that in other NA meetings, it is not customary to sign attendance cards because of the local perception that doing so creates too great an appearance of affiliation between NA and other organizations. If you have any questions about this service, you should call the local NA phoneline. If the person on the line cannot answer your questions, ask them to have either an ASC (area service committee) or RSC (regional service committee) officer or the public information committee chairperson return your call.

If you have sufficient confidence that Narcotics Anonymous could be helpful for your clients, you can encourage them to ask experienced NA members—"sponsors"—to help them engage in our recovery program. All they need to do is listen carefully at NA meetings until they hear someone with whom they identify, preferably someone of their own gender. Once they've found someone, they should ask that person if they can talk further with her or him. If all seems well, they should then simply ask that person to sponsor them. The person may decline—perhaps because they are already sponsoring a number of people, perhaps because they do not feel ready for the responsibility. If they accede to the request, the sponsor will help your client work through NA's Twelve Steps and offer her or his own experience as a backdrop to the NA program; these are the only services offered by sponsors qua sponsors. Sponsors do not charge any fees for the services they render their sponsees.

Finally, probably the most important service we can offer your client is the environment of the Narcotics Anonymous group: a place where other drug addicts can offer first-hand hope of recovery to your client based on their own direct, personal experience. The NA group atmosphere is intensely social; if your client has difficulties in this area, you may want to specially prepare him or her for the first NA meeting. Once your client has made a firm connection with an NA group, usually by attending that group's meetings regularly for a number of weeks, your client will be able to count on twenty-four-hour personal support from NA contacts made in the meetings. Narcotics Anonymous members not only expect requests from newcomers for such help—they actively encourage these requests, seeing their work with new members as integral to their own recovery.

NA membership silhouette

Age 

• 11% of our members are under 20
• 37% are between 20 and 30

• 48% are between 30 and 45

• 4% are over 45

Gender

• 64% of our members are male
• 36% are female

Meeting attendance

• 50% of our members attend at least 4 meetings per week 

Initial referral

• 47% of our members were introduced to Narcotics Anonymous through a treatment facility or while incarcerated
• 29% were introduced to NA through another member
• 24% were introduced by a community professional (doctors, attorneys, clergy, judges)

Different types of NA meetings

There are a number of kinds of Narcotics Anonymous meetings. When referring a client to NA, you may want to inquire about these factors first. Meetings vary in:

• Format. Some of the formats of which we are aware are open discussion, topic discussion, newcomer meetings, and studies of NA literature.
• Size. Some are large (100 or more); some are very small (5 or less).
• Smoking. Some meetings have tobacco smoking; others do not.
• Special focus meetings. Some meetings are intended specifically for women or for men. Some meetings are targeted especially at lesbians and/or gay men. Other meetings have their own special focus, intending to offer extra identification to those seeking a point of entry into Narcotics Anonymous.
• Length of meetings. Most meetings of which we are aware are either sixty or ninety minutes in length.
• Degree of participation expected. Speaker meetings require almost no participation; discussion meetings may require some, though not everyone is asked to participate in the larger meetings.
• *Open/closed meetings. As we discussed earlier, some NA meetings allow nonaddicts to attend, though usually not to participate. Only at closed meetings can your client count on finding addicts only.

Potential difficulties between the NA program and your treatment regimen

• Disease concept. Narcotics Anonymous views addiction as a disease. We use a very simple, experience-oriented disease concept. We do not qualify our use of the term "disease" in any medical or specialized therapeutic sense, nor do we make any attempt to persuade others of the correctness of our view. The disease concept works well as an analogy by which our members can understand their condition: When treated, addiction can be "arrested" but not "cured." Untreated, addiction has effects similar to a disease.
• Total abstinence. The experience of our members has been that total, continuous abstinence from all drugs has provided them with a reliable foundation for recovery and personal growth. However, abstinence is not in itself the sole goal of our members; more importantly, we seek a comprehensive change in attitude and lifestyle. "Relapse" is seen as a sometimes necessary part of the overall addiction/ recovery process for many individuals. Relapsers are not "shamed" but are encouraged to pick up the pieces, learn from their experience, and move on. Narcotics Anonymous views alcohol as a drug, and we find the "drug of choice" designation irrelevant to our program since we focus on the disease of addiction itself, not any particular drug or drugs. The use of psychiatric medication and other medically indicated drugs prescribed by a physician and taken under medical supervision is not seen as compromising a person's "clean time." Regarding the use of nicotine and caffeine, members are encouraged to consult their own experience, the experience of other members, and qualified health professionals.
• Other twelve-step programs. Narcotics Anonymous makes a clear distinction, based on very different program goals, between itself and other anonymous fellowships—for instance, Alcoholics Anonymous and Cocaine Anonymous.
• Some anti-professional sentiment. Though NA as a movement takes no such position, we have noted that some Narcotics Anonymous members bear some antagonism toward professional therapists and psychotherapeutic concepts. We cannot speculate on the reason for such antagonism. Thankfully, this antagonism is not an overwhelming feature in the life of the NA groups where it can be found.
• Spirituality. The Narcotics Anonymous program has a distinctly spiritual orientation, with a theistic bent to most of our literature. We are neither sectarian nor religious, but we are not antagonistic toward organized religion—at least not as a movement. Some of our members, however, are atheists and/or anti-religious. Our English-language Twelve Steps and Traditions refer to God as a masculine person, though our fellowship is currently engaged in a discussion of this matter.

Problems with local organization, groups?

Summary