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Narcotics Anonymous Reaches Its Prime: A Sixtieth-Anniversary Professional Tribute

Narcotics Anonymous Reaches Its Prime: A Sixtieth-Anniversary Professional Tribute

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Addiction recovery mutual aid societies face enormous challenges to their cultural viability and long-term survival: the vagaries of charismatic leaders, ideological schisms, mission drift, professionalism, and commercialization, to name a few. Of more than 100 such societies birthed in the United States, only a handful survived their founding generations to achieve organizational sustainability and widespread accessibility (White, 2010a). It is thus fitting that addiction professionals acknowledge those recovery mutual aid societies that have achieved maturity and continue to support recovery initiation, recovery maintenance, and enhanced quality of personal and family life in long-term recovery.

Numerous secular, spiritual, and religious recovery mutual aid organizations have made distinctive contributions within the growing varieties of addiction recovery experience in the United States and internationally. It is within this larger understanding that we offer this special tribute to Narcotics Anonymous (NA) on its sixtieth anniversary. For the past several years, the authors have researched the histories of various recovery mutual aid societies and reviewed scientific studies on how participation in such groups affects recovery outcomes. Based on our research to date, here are twelve things we think every addiction professional should know about NA.

1. A Difficult Birth and a Near-Death Experience
No addiction recovery mutual aid organization in American history was born in a more culturally hostile environment than that faced by NA in the 1950s. On the heels of earlier efforts to create a sustainable framework of recovery from addiction to drugs other than alcohol (e.g., Addicts Anonymous, early New York Narcotics Anonymous, Habit-Forming Drugs, and Hypes and Alcoholics), today’s NA held its first publicly announced meeting in Sun Valley, California, on October 5, 1953. The years surrounding NA’s founding witnessed the US Congress passing mandatory sentencing laws (Boggs Act of 1952, Narcotics Control Act of 1956) that increased minimum prison sentences to two to fifteen years for possession of heroin, cocaine, or marijuana.

The 1950s also witnessed “loitering addict” laws, under which known addicts could be arrested or have their probation or parole violated for simply associating with one another in public. Addicts could be arrested, forced to have their stomachs pumped, and charged with “internal possession” before such practices were declared unconstitutional in 1962 (Robinson v. California). Plagued by early meetings that were forced to rotate locations to avoid police surveillance and harassment, NA survived its birth (and near collapse in 1959) because Jimmy K. and a small core of individuals, by committing themselves to NA and its Twelve Traditions, sustained NA in the years before its dramatic growth (Jack G., 1958; White, Budnick, & Pickard, 2011).

2. Recovery from Addiction
NA is the only major recovery mutual aid organization that defines the addict’s essential problem as powerlessness over a process of addiction rather than powerlessness over a particular substance. The NA trustees expressed this as follows:

Drugs are a varied group of substances, the use of any of which is but a symptom of our addiction. When addicts gather and focus on drugs, they are usually focusing on their differences, because each of us used a different drug or combination of drugs. The one thing we all share is the disease of addiction. It [defining NA’s First Step in terms of addiction] was a masterful stroke. With that single turn of a phrase the foundation of the Narcotics Anonymous Fellowship was laid. (Narcotics Anonymous, 1985)

Such a distinction should be appreciated by addiction professionals who, on a daily basis, encounter profiles of concurrent and sequential use of multiple drugs among people entering or reentering treatment because of the role that “secondary” drugs played in addiction recurrence. Polydrug dependence among those entering addiction treatment has historically evolved from the exception to the norm—defying the very concept of “drug of choice.”

No recovery mutual aid organization is more prepared in concept and practice to address vulnerability to and recovery from polydrug addiction than NA. NA’s focus on a process of addiction that transcends a particular drug preference and requires a common recovery process may be viewed by future historians as one of the great conceptual and clinical breakthroughs in the understanding and management of severe alcohol and other drug problems. NA’s position is as simple as it is elegant: “We are a people with the disease of addiction who must abstain from all drugs in order to recover” (Narcotics Anonymous World Services [NAWS], 2008, p. 18).

3. “We Suffer from a Disease”
NA, more than any recovery mutual aid organization before or since, unequivocally defines addiction as a disease. Alcoholics Anonymous (AA) has been praised (or blamed) for the modern conceptualization of addiction as a disease, in spite of historical evidence to the contrary (Kurtz, 2002; Miller & Kurtz, 1994). Such attribution is much more appropriately placed with NA, as is evident in the earliest writings of NA cofounder Jimmy K.: “Addiction is a disorder in its own right—an illness, a mental obsession, and a body sensitivity or allergy to drugs which sets up the phenomenon of craving, over which we have no choice, as long as we use drugs” (Jimmy K., n.d.). This view is further evidenced in the earliest pieces of NA literature: “Here [in NA], we have come to realize that we are not moral lepers. We are simply sick people. We suffer from a disease, just like alcoholism, diabetes, heart ailments, tuberculosis, or cancer” (Narcotics Anonymous, 1954, p. 4). NA’s early conceptualization of addiction as a chronic disease analogous to cancer, diabetes and heart disease predates the modern conceptualization of addiction as a chronic disorder by decades (Dennis & Scott, 2007; McLellan, Lewis, O’Brien, & Kleber, 2000).

4. The Recovery Process
NA conceptualizes recovery as a process of complete abstinence from all drugs made possible only by a larger spiritually driven transformation of personal character, identity, and interpersonal relationships—changes achieved through the daily application of NA’s Twelve Steps. NA views recovery as far more than the removal of drugs from an otherwise unchanged life. As early as 1966, NA presented a quite nuanced understanding of the relapse and recovery processes—views currently reflected in NA’s basic text: 

Many people think that recovery is simply a matter of not using drugs. They consider a relapse a sign of complete failure and long periods of abstinence a sign of complete success. We in the recovery program of Narcotics Anonymous have found that this perception is too simplistic. . . . Recovery as experienced through our Twelve Steps is our goal, not mere physical abstinence. (NAWS, 2008, pp. 77–78)

NA’s understanding of recovery is congruent with recent professional consensus panels that have defined addiction recovery in terms of abstinence, improvements in global health (physical, emotional, relational, spiritual wellness), and citizenship (positive community reintegration) (Betty Ford Institute Consensus Panel, 2007).

5. Growth and International Dispersion
NA has grown from one meeting in 1953 to more than sixty-one thousand meetings by 2009 and in 129 countries by 2013. Of particular historical interest is the particularly dramatic growth of NA in predominantly Islamic Middle East countries. The growth of NA meetings and its international dispersion over the course of its history are displayed in the two graphs below.
This accelerating pattern of growth would not have been possible if thousands of NA members had not risen beyond their own personal recovery processes to forge a service structure whose message now reaches around the world, traversing barriers of race, social class, religion, politics, culture, and language. Also of importance is that NA continues to reach those individuals with the most severe and complex patterns of addiction: more than 85 percent of NA members have prior addiction treatment, and more than 25 percent have prior psychiatric treatment (Galanter, Dermatis, Post, & Santucci, 2013).

6. NA Literature
NA has developed a distinctive and extensive body of recovery support literature for its members: the basic text, Narcotics Anonymous; a collection of essays on NA’s Steps and Traditions, It Works—How and Why; a history of NA, Miracles Happen; a magazine, NA Way, published in English, Farsi, French, German, Japanese, Portuguese, Russian and Spanish; numerous pamphlets and service-related handbooks; and a recently released text on life in long-term recovery, Living Clean: The Journey Continues.  

In the past twenty-five years, NA has translated 951 pieces of literature that are now available in forty-two languages (including Afrikaans, Arabic, Chinese, Farsi, Greek, Japanese, Polish, Punjabi, Russian, Spanish and Swahili), with translations into an additional twenty-three languages currently under way. The basic text (NAWS, 2008) is available in twenty-four languages. NA meetings are held worldwide in seventy-six languages (NAWS, personal communication, May 4, 2013). 

7. Membership Diversity
NA membership is the most culturally diverse of any major addiction recovery mutual aid organization. NA membership is 47 percent women—up 5 percent from the 1996 survey and the highest percentage of any abstinence-based group other than Women for Sobriety; 8 percent Hispanic—nearly twice the percentage of any other addiction recovery mutual aid society; 11 percent African American—up from 4 percent in 1996; and 7 percent Native American, Asian American and multiracial. Two percent of NA members are under age twenty-one—comparable to AA and higher than other major mutual aid fellowships (NAWS, 2011).

The cultural diversity of NA is underscored by the growth of NA meetings within communities of color, the recovery stories represented in the sixth edition of NA’s basic text (NAWS, 2008), and the worldwide growth of special NA meetings for women, youth, gays and lesbians, transgender people, couples, agnostics, and people living with HIV/AIDS, to name just a few of the early special meeting categories (NAWS, 2012b).

8. Recovery Stability and Durability
The mean duration of years in long-term, continuous recovery within NA has progressively increased. Today, the mean duration of recovery (clean time) within NA is 10.87 years—up from 5.5 years in 1996 (NAWS, 1997, 2011). This level of recovery stability is also reflected in NA’s strong service ethic: nearly half (49 percent) of NA members reach NA through the influence of another NA member (NAWS, 2011); 89 percent of NA members have had a sponsor; and 48 percent of members have sponsored others (Galanter et al., 2013).

9. NA Culture
NA openly acknowledges modeling itself on AA in its beginnings, but today’s NA has its own distinct program of recovery and its own recovery culture—its own history, iconic figures, core ideas, language, recovery and service rituals, etiquette, symbols, and literature (NAWS, 2012a). Homogenized references to “AA and other 12-Step groups” mask NA’s distinctive contributions and its distinctive culture. Attending open meetings of local AA and NA groups can help cultivate an appreciation of such differences and show how addiction professionals can best match individuals to particular recovery fellowships and particular meetings.

10. NA Governance
NA has forged a service structure for effective self-governance and worldwide service. 

NA is self-governed through the collective conscience and guidance of NA groups across the globe. Representatives of these NA communities assemble every two years at the NA World Service Conference to provide that guidance. Narcotics Anonymous World Services (NAWS), composed of the World Service Office and the World Board, is delegated the responsibility for day-to-day support activities of the NA fellowship. There are NAWS offices in the United States, Canada, Belgium, India, and Iran.

11. Self- and Scientific Evaluation
Both NA membership surveys and independent scientific studies affirm the role of NA participation in long-term addiction recovery and an enhanced quality of life in recovery. NA’s surveys of its own membership reveal numerous positive effects associated with NA participation, including enhancement of the quality of family relationships (95 percent), social connection (89 percent), stable housing (80 percent), employment (76 percent) and education (59 percent). Only 11 percent of NA members are unemployed—a rate only 3.5 percent higher than the current national unemployment rate of 7.5 percent (U.S. Department of Labor, 2013) and a dramatic drop from the 56 percent of members who were unemployed before coming to NA (NAWS, 2011).

Although scientific research on NA is meager compared to the hundreds, if not thousands, of AA-focused studies, attention to NA in the scientific literature is progressing from brief, descriptive accounts (Nichols, 1988; Wells, 1987) to cross-disciplinary investigations of NA and more formal studies of the effects of NA participation (Krentzman et al., 2011). To date, research on NA suggests the following:

  • NA’s Twelve Step framework is acceptable to the majority of drug users entering inpatient detoxification (Best et al., 2001).
  • NA participation is associated with enhanced long-term recovery outcomes as well as improved emotional health for adults (Christo & Franey, 1995; Christo & Sutton, 1994; Gossop, Stewart, & Marsden, 2008; Kelly, Dow, Yeterian, & Kahler, 2010) and adolescents (Kelly et al., 2010; Kelly & Myers, 2007; Sussman, 2010).
  • The mechanisms of change within NA include meeting attendance, mutual identification and affiliation, step work, spiritual awakening, identity reconstruction, and the therapeutic effects of helping others (Crape, Latkin, Laris, & Knowlton, 2002; Galanter, Dermatis, Post, & Sampson, in press; Rafalovich, 1999; Toumbourou, Hamilton, U’Ren, Stevens-Jones, & Storey, 2002).
  • Service work within NA extends to broader patterns of community involvement, citizenship, and service by NA members (Kurtz & Fisher, 2003).
  • NA seems to have a high degree of universality across national and cultural boundaries (Flora & Raftopoulos, 2007; Ronel, 1997).

NA World Services is currently collaborating with addiction researchers to expand the number and quality of studies conducted on NA (e.g., Galanter et al., 2013).

12. Professional Acceptability
NA participation is being increasingly integrated with professionally directed addiction treatment (Troyer, Acampora, O’Connor, & Berry, 1995). In the latest survey of NA members, 49 percent reached NA through referral from a treatment or counseling agency (NAWS, 2011). Many local NA groups maintain a Hospitals and Institutions (H&I) committee to help carry the NA message to people in institutional settings (NAWS, 1997). These H&I committees may be contacted to discuss such collaboration, particularly on how to reach individuals with the NA message who do not have access to NA meetings in the community.

Closing Reflections
NA has distinguished itself through its survival as an organization and its sixty years of service toward the singular goal of addiction recovery. It has earned a position of honor within the growing menu of secular, spiritual, and religious recovery mutual aid organizations. As addiction professionals, we have a responsibility to become knowledgeable about NA and the culture of local NA groups, to orient those we serve about NA and other recovery support options, and to assertively link those individuals who are interested in exploring NA to the organization as a pathway of long-term addiction recovery.

NA’s enduring legacy is a milestone worthy of acknowledgment and celebration. NA will continue to confront the internal and external challenges faced by all recovery mutual aid organizations (White, 2010b), but in the year of its sixtieth anniversary, NA’s future could not look brighter. In 2013, NA members can claim a most notable achievement: “Never before have so many clean addicts, of their own choice and in free society, been able to meet where they please, to maintain their recovery in complete creative freedom” (NAWS, 2008, p. 88).

Happy Birthday, NA! 

References
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Betty Ford Institute Consensus Panel. (2007). What is recovery? A working definition from the Betty Ford Institute. Journal of Substance Abuse Treatment, 33, 221–228. Christo, G., & Franey, C. (1995). Drug users’ spiritual beliefs, locus of control and the disease concept in relation to Narcotics Anonymous attendance and six-month outcomes. Drug & Alcohol Dependence, 38(1), 51–56. 

Christo, G., & Sutton, S. (1994). Anxiety and self-esteem as a function of abstinence time among recovering addicts attending Narcotics Anonymous. British Journal of Clinical Psychology, 33, 198–200. 

Crape, B. L., Latkin, C. A., Laris, A. S., & Knowlton, A. R. (2002). The effects of sponsorship in 12-step treatment of injection drug users. Drug & Alcohol Dependence, 65(3), 291–301. 

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