Narcotics Anonymous

This article is about the 12-step program of Narcotics Anonymous (NA). For information about the unrelated substance abuse treatment program associated with the Church of Scientology, see Narconon. For information about the twelve-step support group for friends and family of substance abusers, see Nar-Anon.

File:NaGroupLogo.gif

The original "Jimmy K" logo

Narcotics Anonymous (N.A.) is a twelve-step program of recovery from drug addiction, modeled on Alcoholics Anonymous. It describes itself as a nonprofit "fellowship or society of men and women for whom drugs had become a major problem", and it is the second-largest 12-step organization in existence. The program is group-oriented, and is based on the Twelve Steps and the Twelve Traditions, adapted from A.A.

The Narcotics Anonymous program

The only requirement for membership is "a desire to stop using," and members "meet regularly to help each other stay clean," where "clean" is defined as complete abstinence from all mood and mind altering substances (including alcohol). Membership in N.A. is free, and there are no dues or fees. The foundation of the Narcotics Anonymous program is the twelve steps and twelve traditions.

Narcotics Anonymous "has no opinion on outside issues," including those of politics, science, or medicine, and does not endorse any outside organization or institution. The fellowship does not promote itself, but rather attracts new members through public information and outreach. N.A. groups and areas supply outside organizations with factual information regarding the N.A. program, and individual members may carry the N.A. message to hospitals and institutions, such as treatment centers and jails.

The nature of addiction

N.A. describes addiction as a progressive disease with no known cure, which affects every area of an addict's life: physical, mental, emotional, and spiritual. N.A. suggests that the disease of addiction can be arrested, and recovery is possible through the N.A. twelve-step program. The steps never mention drugs or drug use, rather they refer only to addiction, to indicate that addicts have a disease of which drug use is one symptom. Other symptoms include obsession, compulsion, denial, and self-centered fear.

Addicts often first enter N.A. after reaching a "bottom" in their life, a point at which life feels completely unmanageable, characterized by "unemployability, dereliction and destruction" and centered around the getting and using and finding ways and means to get more drugs. Every N.A. member reaches a different bottom, which can be wherever the addict chooses to stop using. In practice, it is drug use and the extreme consequences associated with its abuse that bring most addicts to their bottom.

Meetings

Regular meetings, hosted by N.A. groups, are the basic unit of the N.A. Fellowship. Meetings are held in a variety of places such as church meeting rooms, libraries, hospitals, community centers, parks, or any other place that can accommodate a meeting.

Members who attend the same meeting on a regular basis to establish a recovery network and reliable routine understand this to be their "Home Group". Group members are able to participate in the group's business, and play an important role in deciding how the group's meetings should be conducted.

Formats

There are two basic types of meetings, "open" and "closed". Anyone is welcome to attend an open meeting, while closed meetings are limited to addicts and to people who think they may have a problem with drugs.

Meeting formats vary, but often include time devoted to the reading of N.A. literature–literature that was written by and for members of N.A. regarding the issues involved in living life clean. Many meetings also include an "open sharing" component, where anyone attending has the opportunity to share. There is usually no direct feedback during the sharing, thus only one person ever speaks at any given time during this portion of the meeting. Some groups choose to host a single speaker (such meetings are usually denoted "speaker meetings") to share for the majority of the meeting time.

Other meeting formats include round robin (sharing goes around in a circle or each speaker picks the next person to share). Some meetings focus on reading, writing, and/or sharing about one of the Twelve Steps or some other portion of N.A. literature. Some meetings are "common needs" (a.k.a. special interest) meetings, supporting a particular group of people based on gender, sexual identity, age, language or other characteristic. These meetings are not exclusionary, as any addict is welcome at any N.A. meeting. NA Communities will often make an effort to have an open meeting run at the same time for members who don't identify with the common needs meeting.

During the meeting, some groups allot time for N.A.-related announcements, and many meetings set aside time to recognize "anniversaries" or "birthdays" of clean time. Individuals are sometimes given an opportunity to announce their clean time to the group. In some meetings, and for certain anniversaries, keytags, and medallions, which denote various amounts of clean time, are distributed to those who have achieved those milestones. In some areas, the addict who is celebrating a "cleaniversary" will be able to have support group members read the readings for the meeting and he or she will have a speaker carry the N.A. message. Then the addict celebrating will have his or her sponsor or a friend or family member, give them a medallion at which time the friend will share some of the celebrating addict's achievements during the last year, or from during the entire course of his or her recovery. Then the addict celebrating can share his or her experience, strength, and hope with the group on how they did it.

"Each group has but one primary purpose--to carry the message to the addict who still suffers" (Narcotics Anonymous' Fifth Tradition). Therefore, the newcomer is considered to be the most important person in any meeting. The message of Narcotics Anonymous is hope: that there is another way to live. The one promise of N.A. is that "an addict, any addict, can stop using, lose the desire to use, and learn a new way of life" (Basic Text). According to the Narcotics Anonymous Basic Text, the "Twelve Steps" are the source of this hope and freedom when worked to the best of one's ability.

Service

N.A. literature suggests that service work is an essential part of a program of recovery. Service is "doing the right thing for the right reason," and is the best example of Goodwill, which is the basis for the freedom promised by the N.A. program. Service may be as simple as being present in a meeting or answering a phone. Additionally, there are basic, formalized service positions at the group level to help the group perform its function: examples include treasurer, secretary and "Group Service Representative" which represents the group in the larger service structure.

The Narcotics Anonymous service structure operates at area, regional and world levels. These levels of service exist to serve the groups and are directly responsible to those groups, they do not govern. World services is accountable to its member regions, who are in turn responsible to member areas. Area Service Committees directly support member groups and often put on special events, such as dances and picnics. Area service committees also provide special subcommittees to serve the needs of members who may be confined in jails and institutions, and will also provide a public interface to the fellowship.

Literature

Narcotics Anonymous currently has several book length pieces of "Fellowship-approved" literature. These include the following bound books:

• The Basic Text is divided into two books. Book one discusses the basics of the N.A. program and the twelve steps and traditions. Book two is composed of many personal stories.

• It Works: How and Why offers detailed discussion of the twelve steps and traditions.

• The Step Working Guides is a workbook with questions on each step.

• Just For Today is a book of daily meditations with quotes from the Basic Text and other NA approved literature including the "Information Pamphlets".

• Sponsorship is an in-depth discussion of the role of sponsorship in N.A., including the personal experiences of members.

N.A. has also produced dozens of "Informational Pamphlets", or "IP's", of varying length, that cover a wide range of recovery related topics including questionnaires for those who think they may have a drug problem, and information for those addicts trying to stay clean while still inside hospitals or institutions.

Spirituality

Narcotics Anonymous calls itself a spiritual program of recovery from the disease of addiction. The N.A. program places importance on developing a working relationship with a "higher power". The literature suggests that members formulate their own personal understanding of a higher power. The only suggested guidelines are that this power be "loving, caring, and greater than one's self." Members are given freedom in coming to an understanding of a higher power that works for them. Individuals from countless spiritual and religious backgrounds, as well as many atheists and agnostics, have developed a relationship with their own higher power. N.A. also makes frequent use of the word "God" and some members who have difficulty with this term substitute "higher power" or read it as an acronym for "Good Orderly Direction."

The twelve steps of the N.A. program are based upon spiritual principles, three of which are honesty, open-mindedness, and willingness, embodied in the first three steps. According to NA members these principles, when followed to the best of one's ability, allow for a new way of life.

N.A. meetings often close with the Third Step Prayer ("Take my will and my life. Guide me in my recovery. Show me how to live.")

Sponsorship

One addict helping another is an essential part of the N.A. program. It is therefore highly recommended that members of Narcotics Anonymous find a sponsor. A sponsor is a member of N.A. who helps another member of the fellowship by sharing their experience, strength and hope in recovery and serves as guide through the Twelve Steps. A substantial number of N.A. members suggest getting a sponsor of the same sex (or of opposite sexual preference) with over one year clean time, although there are no such rules. Any N.A. member is free to choose any other member as a sponsor.

Anonymity

"Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities." (12th Tradition, Basic Text)

Many N.A. members identify themselves in meetings by their first name only. The spirit of anonymity is about placing "principles before personalities" and recognizing that no individual addict is superior to another, and that individual addicts do not recover without the fellowship or its spiritual principles.

The Eleventh Tradition states that N.A. members "need always maintain personal anonymity at the level of press, radio, and films."

History

Narcotics Anonymous sprang from the Alcoholics Anonymous Program of the late 1940s, and was co-founded by Jimmy Kinnon. Meetings first emerged in the Los Angeles area of California, USA, in the early Fifties. The N.A. program, officially founded in 1953, started as a small US movement that has grown into one of the world's oldest and largest organizations of its type.

Predecessors

Alcoholics Anonymous was the first 12-step program. Many people with both drug problems and drinking problems found sobriety through this program, although people without a drinking problem were not (and are still not) able to attend closed A.A. meetings.Open A.A. meetings are very common and people with drug problems are welcome. The idea for creating a 12-step program specifically to help drug addicts emerged several times; the earliest mention was in a question asked to Bill Wilson, A.A.'s founder, in 1944.

On February 16 1947, a group of drug addicts began to meet as part of a treatment center in Lexington Federal Prison in Lexington, Kentucky. It was founded by a man named Houston Sewell, and was based on the 12 steps of A.A. This group called itself NARCO or Addicts Anonymous, and continued to meet weekly for over twenty years. Then in 1948, one of the members from the NARCO program moved to New York City and started a similar group in the New York Prison System. This was the first group to be called "Narcotics Anonymous", but it did not last long, and dissolved soon after it was founded. Another group in Fort Worth, Texas followed the "Lexington model" in its own 12-step group. A similar group in Lorton, Virginia called itself NOTROL. In 1950 an unrelated group in California called the "Habit Forming Drug Group" used the 12 steps to address drug addiction. Each of these groups were largely independent, and were not a part of N.A. as it now exists; however they showed that there was a need for such an organized program.

Early history of N.A.

Narcotics Anonymous was founded (as AANA) in California in 1953 by Jimmy Kinnon and others. This group differed from its predecessors in that it specifically attempted to form a fellowship or network of groups that would be mutually supporting. Throughout that summer, founding members, most of whom had found recovery in A.A., debated the bylaws of the organization, and the first documented meeting occurred August 17, 1953. On September 14, 1953, they received notice from the leadership of A.A. that they could use the A.A. steps and traditions, but not the A.A. name. The organization then officially changed its name to Narcotics Anonymous.

In 1954, the first N.A. publication was printed, called the "Little Yellow Booklet". It contained the 12 steps, and early drafts of several pieces that would later be included in subsequent literature.

At this time, N.A. was not yet recognized by society at large as a positive force. The initial group had difficulty finding places that would allow them to meet, and often had to meet in people's homes. One of the most difficult places for NA to become established was in the State of New York. The Rockefeller drug laws there had made it a crime for drug addicts to meet together for any reason, making N.A. in effect illegal. Addicts would have to cruise around meeting places and check for surveillance, to make sure meetings would not be busted by police. It was many years before N.A. became recognized as a beneficial organization, although some early press accounts were very positive. In addition, many N.A. groups were not following the 12 traditions very closely (which were quite new at the time). These groups were at times accepting money from outside entities, conflating A.A. with N.A., or even adding religious elements to the meetings. For a variety of reasons, meetings began to decline in the late 1950s, and there was a 4-month period in 1959 when there were no meetings held anywhere at all. Spurred in to action by this, Jimmy Kinnon and others dedicated themselves to restarting N.A., promising to hold to the traditions more closely.

Resurgence

In the early 1960s, meetings began to form again and grow. The N.A. White Booklet was written in 1962, and became the heart of N.A. meetings and the basis for all subsequent N.A. literature. N.A. was called a "hip pocket program", because the entire literature could fit into a person's hip pocket. This booklet was republished in 1966 as the N.A. White Book, and included the personal stories of many addicts.

The first N.A. phone line started in 1960, and the first "H&I" group (H&I is a sub-committee of Narcotics Anonymous that carries the message into hospitals and institutions where people cannot get to an outside meeting) was formed in 1963. That year a "Parent Service Board" (later renamed the World Service Board) was formed to ensure that N.A. stayed healthy and followed closely to the traditions. Confusingly, in 1962, the Salvation Army started a group also called "Narcotics Anonymous" that followed a different "13-step" program, but this program soon died out. The N.A. program grew slowly in the 1960s, but the program was learning what was effective and what was not, as relapse rates became less common over time and friction between N.A. groups began to decrease.

In 1971, the first N.A. World Conference was held, and others have followed annually. This was a period of rapid growth in N.A.'s history. By 1970, there were only 20 regular, weekly meetings, all of them in the United States. Within two years there were 70, including meetings in Germany, Australia, and Bermuda. By 1976, there were 200 regular meetings, including 83 in California alone, and others in Brazil, Canada, Colombia, India, the Republic of Ireland, Japan, New Zealand, and the United Kingdom. Five years later, there were 1100 different meetings all over the world. A World Service Office was officially opened in 1977.

The development of N.A. literature

From the beginnings of N.A., the need for official N.A. literature was evident. Unfortunately, the process of creating and approving official N.A. literature has seen some of the most contentious periods of debate within the fellowship. Although the Yellow Booklet, Little White Booklet, and Little White Book were used in the 1960s and 1970s, many people desired to have a more detailed book on recovery, paralleling the "Big Book" of Alcoholics Anonymous. Some meetings offered A.A. literature at meetings, while others considered writing their own books on recovery. One group even planned to print a bootlegged version of A.A.'s Big Book with every instance of the word "alcohol" replaced with "drugs". The need for a unified text approved by the fellowship's "group conscience" was recognized, and in October 1979 the first N.A. World Literature Conference was held in Wichita, Kansas.

While previous literature had been written by just a few addicts (primarily by Jimmy Kinnon), the N.A. Basic Text was written as a massive collaboration between hundreds of people. There were a total of seven World Literature Conferences within three years, all of them open to any addict who wished to help. It was decided that the book would use the Little White Book as its outline, filling in and expanding on the subjects discussed in that text. In November of 1981, a finalized version was distributed to all of N.A. for approval, and the text was approved with a 2/3 majority required for passage. After passage, however, publication was held up due to a spirited disagreement regarding a few key sentences which described the nature of the World Service Organization and other N.A. service groups. The book was printed in 1983, with those passages altered, and was subsequently quickly reprinted (as the second edition) with the passages reinserted. After a hasty vote on the issue, the third edition was published, substantially identical to the first edition, with the controversial passages removed again.

Professional editors and writers were hired in 1986 to improve the Basic Text so that it was more consistent in tone and style. The resultant 4th edition, released in 1988, was improperly reviewed and had many problems, including 30 lines which were inadvertently missing and text that was inconsistent with other N.A. literature. A 5th edition was released in 1991, correcting these problems, and is the version currently in wide use today. Copies are sold at N.A. meetings, and are available in over 30 different languages. Millions have been sold worldwide, and have been useful to many addicts.

In the mid 2000's, work on the 6th edition began. This new edition would replace the personal stories, from the 5th edition, and update them with shorter but more diverse personal stories. The task of choosing these stories was handed down from the World Service Office, to Regional meetings, to Area Service Committee meetings and then to the individual home group meetings, were each member had a chance to review the new text. Final approval for the 6th edition is estimated be made by 2008.

More recent history

In 2003, N.A. World Services approved a new text entitled Sponsorship. This book endeavors to help people explore the concept of N.A. sponsorship. The book is unique in that it shares personal anecdotes of recovering addicts instead of making direct recommendations. It was re-released in 2006 with the NA logo 'in clouds' on the front removed.

Membership demographics

Membership in Narcotics Anonymous is voluntary; no attendance records are kept either for NA’s own purposes or for others. Because of this, it is sometimes difficult to provide interested parties with comprehensive information about NA membership. There are, however, some objective measures that can be shared based on data obtained from members attending one of our world conventions; the diversity of our membership, especially ethnic background, seems to be representative of the geographic location of the survey. The following demographic information was revealed in a survey returned by almost half of the 13,000 attendees at the 2003 NA World Convention held in San Diego, California: • Gender: 55% male, 45% female. • Age: 3% 20 years old and under, 12% 21–30 years old, 31% 31–40 years old, 40% 41–50 years old, 13% over age 51, and 1% did not answer. • Ethnicity: 70% Caucasian, 11% African-American, 11% Hispanic, and 8% other. • Employment status: 72% employed full-time, 9% employed part-time, 7% unemployed, 3% retired, 3% homemakers, 5% students, and 1% did not answer. • Continuous abstinence/recovery: ranged from less than one year up to 40 years, with a mean average of 7.4 years.

Rate of growth

Because no attendance records are kept, it is impossible to estimate what percentages of those who come to Narcotics Anonymous remain active in NA over time. The only sure indicator of the program's success is the rapid growth in the number of registered Narcotics Anonymous meetings in recent decades and the rapid spread of Narcotics Anonymous outside North America. • In 1978, there were fewer than 200 registered groups in three countries. • In 1983, more than a dozen countries had 2,966 meetings. • In 1993, 60 countries had over 13,000 groups holding over 19,000 meetings. • In 2002, 108 countries had 20,000 groups holding over 30,000 meetings. • In 2005, 116 countries had over 21,500 groups holding over 33,500 weekly meetings. • In 2007, there are over 25,065 groups holding over 43,900 weekly meetings in 127 countries.

Organizational structure

Members meet at N.A. Groups, representatives of which are organized into an area service committee (ASC). Several RCM's (Regional Committee Members) form a regional service committee (RSC), and the RD's (Regional Delegates) make up N.A. World Services. The foundation for this structure is the Twelve Traditions of N.A. and is often facilitated by the 12 Concepts for Service in NA.

N.A. Groups

Narcotics Anonymous is fundamentally made up of N.A. Groups. An N.A. Group is a number of N.A. members who meet regularly; usually at the same time and place each week. Some Groups have more frequent meetings but are considered to be part of a single Group. Groups have one primary purpose, to carry the message to the addict who still suffers. Groups are largely independent from one another and members of N.A. are encouraged to choose a home group to belong to, a group they attend regularly and where they will be missed if they are absent. Each Group elects any number of leaders, or "trusted servants", to serve the needs of the Group they made include: a secretary, a treasurer, a chairperson, a GSR (Group Service Representative), and an alternate GSR. This election process is carried out by the Group Conscience which is a business meeting made up of the members of the Group who strive for consensus based decisions. With each group being autonomous, without affecting NA as a whole, the responsibilities of trusted servants vary from meeting to meeting. These responsibilities or "group policies" are contrived through the group's business meeting by inviting a Higher Power to guide each individual recovering addicts' decision, also known as a group conscience. An example of one specific trusted servants responsibilities are, "The secretary is responsible for opening the meeting, choosing someone to chair the meeting, making sure coffee gets made, etc. He or she also arranges for purchasing supplies and keeping group records. The treasurer keeps financial records and pays the group's bills. The GSR attends the Area Service Committee meetings and represents the group to the ASC. The alternate GSR assists the GSR and prepares to replace the GSR when need be."

Area service committees

An ASC is made up of all the participating N.A. Groups in a given Area. The GSRs and alternate GSRs from each Group in an Area meet regularly together for a business meeting where issue are raised and discussed in order to better meet the needs of the groups in the Area. Each ASC elects its own officers: the chairperson, vice chairperson, secretary, treasurer, and regional committee members (RCMs). Frequently an ASC will have various subcommittees (such as a but not limitied to Hospitals and Institutions (H&I), Public Information (PI), Activities, Website, Outreach, Policy, Literature, Literature Review, Newsletter, Recovery By Mail and Convention) which are led by subcommittee leaders that are elected by the entire ASC. In some regions, several ASCs will be grouped into a Metropolitan Service Committee at the sub-regional level; this is typical in especially large cities, like Los Angeles, that contain multiple ASCs.

Regional service committees

An RSC is composed of the regional committee members (RCMs) of all the participating ASCs in a region. It is similar in organization to an ASC, but is further removed from the day-to-day activities of individual home groups. Many of the issues dealt with by RSCs are the same ones that will come before the World Service Conference, with the RSC being the best way for local groups to help craft policies that will affect N.A. as a whole. In some cases, only the RCMs in a region will meet to vote on issues; in other situations, all GSRs in a region will be invited to attend an RSC meeting. The RSC elects a delegate to attend the World Service Conference.

Zonal Forums

The Zonal Forums are service-oriented organizational structures designed to improve communication between RSCs. They are not decision-making entities.

Some Zonal Forums actively participate in "Fellowship Development" to help NA fellowships grow in new countries and geographic areas where NA is still forming. Zonal Forums help NA groups, areas or regions to work together to translate literature, inform the local community about NA and create new service committees. This is achieved through annual or biannual Zonal Forum meetings together with development visits to NA groups and members in other countries. Experienced NA members hold workshops, and meetings and present material to help the newer communities.

Zonal forums also provide an important opportunity for World Services and the World Board to interact with newer and growing NA communities to better understand their needs and challenges. Zonal forums are an important part of the growth of NA in some of the most populous and remote parts of the world. Eastern Europe, central and eastern Asia and Latin America NA communities have grown significantly through the work of Zonal Forums.

Some Zonal Forums are a service-oriented sharing session that provides the means by which NA communities in their zone can communicate, cooperate, and grow with one another. Although not a part of NA's formal decision-making system, Zonal Forums interact with World Services in many ways. Each Zonal Forum provides a biannual report on the floor of the World Service Conference and, when requested by the conference, may also answer specific questions or address the body. In order to improve communications, the Zonal Forums are provided with conference participant mailings and send each Zonal Forum meeting record to World Services. In order to more effectively serve the fellowship, World Services and the Zonal Forums maintain an ongoing partnership in order to plan and conduct the Worldwide Workshop system.

N.A. World Service Conference

The N.A. World Service Conference (WSC) is a bi-annual service meeting made up of the Regional Delegates of the seated Regions of the world and the members of the N.A. World Board. This service conference has the executive right to make decisions for the entire N.A. Fellowship. This includes electing members to serve on the World Board, approving all new N.A. Literature, service material and making policy decisions that affect the fellowship including the organizational structure. This responsibility has been executed as recently as the late 90's when the World Service Conference voted to re-structure the N.A. Service structure including the removal of the Board of Trustees, Board of Directors and several other World Service level committees (Public Information, Hospitals & Institutions, Literature and Translations) replacing them with a single board elected by the conference.

N.A. World Service Office

The WSC through the World Board is responsible for the N.A. World Service Office located in Chatsworth, CA, USA. This office handles the production of all approved literature, provides resources for projects approved by the WSC and also provides limited services to the fellowship as a whole. The office also administers the legal responsibilities of the fellowship with respect to copyrights, intellectual property and accounting. The office employs a number of people who carry out these functions.

Finances

Narcotics Anonymous members are not required to pay any dues or fees. Group expenses are covered entirely by voluntary contributions from its members. Groups meet costs such as meeting room rental, tea and coffee, and any literature that the group provides for free from these contributions, after which surplus funds are passed to the service structure. Group often provide some literature items such as IPs (Double sided single sheet pamphlets) and keytags/chips celebrating clean time. Area Service Committees are typically funded from Group contributions plus money raised by events such as dances and recovery events attended by members. In some countries Area committees also supply literature to the Groups. Areas pass funds on to the Regions, which can also receive contributions from Groups and also raise money though conventions attended by hundreds to thousands and tens of thousands of members. Regions also sometimes run Regional Service Offices which buy literature from the World Service Office and its branch offices for sale to Areas and Groups. Because Regional Service Offices can purchase in bulk and sell at list price sometimes this surplus exceeds the running costs of the office. Regions then pass funds to Zonal Forums and also the World Service Conference via the World Service Office according to the decision of the Region. At the World Service level of Narcotics Anonymous expenses are met partially by the voluntary donations of via the service structure and also through the sale of recovery literature. N.A. does not accept donations from non-members, organisations or governments. N.A. recovery literature is produced by the N.A. World Service Office (NAWS) located in California, USA. Typically N.A. groups will purchase literature using group funds from local (area or regional) service offices, or direct from NAWS. Some literature is provided to new members for free (such as the "Information Pamphlets") while other, typically book length pieces, are sold at the purchase cost to the group. Literature is also purchased from Group contributions and made available to new members. NAWS receives 87% (2004/5) of its income from the sale of literature. Other expenses include group refreshments, meeting-place rent, etc. Financial information is publicly available on the N.A. website.

Effectiveness

The evaluation of the effectiveness of community-based 12-step programs, such as NA is difficult. One approach is to provide professional 12-step facilitation (TSF) either in an individual or group setting. TSF sessions are designed to introduce the patient to 12-step concepts and facilitate the entry of the patient into community-based 12-step programs. It must be emphasized that TSF is not NA, it is an implementation of 12-step program elements by professional counselers.

One study, sponsored by NIDA randomly assigned cocaine abusers into four groups, individual drug counseling plus group drug counseling(GDC), cognitive therapy plus GDC, supportive expressive therapy plus GDC, or GDC alone. Individual drug counseling was based on the 12-step philosophy. Group drug counseling was designed to educate patients about the stages of recovery from addiction, to strongly encourage participation in 12-step programs, and to provide a supportive group atmosphere for initiating abstinence and an alternative lifestyle. Nearly 500 patients participated in the study.

The results suggested that all four treatment conditions resulted in similar reductions in cocaine use with the IDC + GDC group (TSF) more effective than the other three groups. One issue with this study is that there was significant attrition of patients, with significantly larger numbers of dropouts from the TSF groups than from the others.

Controversies

Main article: Twelve-step program: Criticism

The N.A. program attempts to avoid controversy through its application of the 12 traditions, which specify that "Narcotics Anonymous has no opinion on outside issues; hence the N.A. name ought never be drawn into public controversy." Even so, the Basic Text points out that there are still "communication problems, differences of opinion, internal controversies, and troubles with individuals and groups outside the Fellowship", and various controversies of this type have disturbed N.A. throughout its history.

Internal controversies

Early in the history of N.A., different groups emphasized different aspects of recovery. In particular, the make-up and process of creating an N.A. text was a contentious period for the fellowship. Different factions supported different versions of the Basic Text, and in the ensuing power struggle there were many accusations made and resentments cultivated. The basis of the dispute was whether the service committees were described as a part of N.A., or as a separate group with no decision-making power. This dispute reached its nadir when the N.A. World Service Organization sued an N.A. member to prevent him from distributing unauthorized and allegedly misleading versions of the Basic Text. Although there are still some "traditionalist" N.A. members who use the third edition (revised) of the Basic Text, N.A. as a whole has agreed upon the 5th edition as being the currently "approved" version.

Other disputes regarding the style of writing, the cost of producing, and how best to use the money raised by the sale of N.A. literature have led to acrimonious internal controversies. At one point Jimmy Kinnon, N.A.'s co-founder, was described as being "locked out" of the N.A. World Service offices. Another major debate involved whether to change the text of an information pamphlet that implied that homosexuality was a moral failing for some. (References to homosexuality were eventually removed from the literature altogether, however, "What is the NA Program" clearly states that: "Anyone may join us regardless of age, race, sexual identity, creed, religion, or lack of religion.") These controversies did not affect the lives of most recovering addicts, however, and there have been no major disputes that seriously threatened to divide the N.A. community since the 1980s until recently when the 2007 World Convention of NA lost $596000 that could have been used to carry out more traditional NA work. This current controversy has the potential to create a split in Narcotics Anonymous because it indicates the organization may have lost touch with it's guiding principles.

Opposition to N.A.

Other 12-step groups differ in their approach to the treatment of addiction and recovery. Alcoholics Anonymous does not explicitly prohibit drug use besides alcohol, and according to A.A. literature, "only those with a drinking problem may attend closed meetings." Cocaine Anonymous seeks to treat cocaine addiction specifically (although it is also a program of abstinence from all drugs, including alcohol and marijuana.) Methadone Anonymous is similar to N.A., but considers the use of methadone to be a tool of recovery and not a drug. N.A. has no opinion on these groups, as these are outside issues and the traditions suggest against taking a definitive stand on outside issues, as per the 12 traditions. However, occasionally some arguments about considering whether or not NA should take a stance on individuals sharing while on methadone has been debated, but the group conscience has refrained from doing so. Some people have found the tools of these other programs to be more helpful than the N.A. program.

Some religious groups oppose N.A. (12-step programs in general) because it is a non-religious program that emphasises surrender to a Higher Power, without requiring a specific belief in God or adherence to any specific religious tenets. As a result of this opposition some religious groups have created competing programs like Celebrate Recovery as part of their own attempts to address the problem of drug addiction.

External links

• Narcotics Anonymous World Services