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Narcotics Anonymous (NA) describes itself as a "nonprofit fellowship or society of men and women for whom drugs had become a major problem". Narcotics Anonymous uses a traditional 12-step model that has been expanded and developed for people with varied substance abuse issues. and it is the second-largest 12-step organization.
As of May 2010[update] there were more than 61,800 NA meetings in 131 countries.
The third tradition of NA states that the only requirement for membership is "a desire to stop using". NA says its meetings are where members can "meet regularly to help each other stay clean", where "clean" is defined as complete abstinence from all mood and mind-altering substances, unless taken as prescribed by a doctor.There is an exception to this: if an NA member takes replacement medication ,Suboxone or methadone, even if taken a prescribed, NA considers that person to not be "clean". Membership in NA is free, and there are no dues or fees.
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. NA groups and areas supply outside organizations with factual information regarding the NA program, and individual members may carry the NA message to hospitals and institutions, such as treatment centers and jails.
NA describes addiction as a progressive disease with no known cure, which affects every area of an addict's life: physical, mental, emotional, and spiritual. NA suggests that the disease of addiction can be arrested, and recovery is possible through the NA 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-centeredness.
Regular meetings, hosted by NA groups, are the basic unit of the NA 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.
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 aloud of NA literature regarding the issues involved in living life clean which is written by and for members of NA. Many meetings also include an "open sharing" component, where anyone attending has the opportunity to share. There is usually no direct feedback during the 'share'; 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 NA literature. Some meetings are "common needs" (also known as 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 NA 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 NA-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, key tags, 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 "clean anniversary" will be able to have support group members read the readings for the meeting and he or she will have a speaker carry the NA 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 NA is that "an addict, any addict, can stop using drugs, 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.
NA 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 "good will", which is the basis for the freedom promised by the NA program. Service work is usually chairing a meeting but may be as simple as cleaning up after the meeting, putting away chairs, 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 (GSR) who 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.
NA has also produced dozens of "Informational Pamphlets", or "IPs", 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.
Narcotics Anonymous calls itself a spiritual program of recovery from the disease of addiction. The NA 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 various spiritual and religious backgrounds, as well as many atheists and agnostics, have developed a relationship with their own higher power. NA 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 NA 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.
NA meetings usually close with a group hug and a prayer of some sort. Prayers used to close meetings today include the "we" version of the "Serenity Prayer" ("God, Grant us the serenity to accept the things we cannot change, the courage to change the things we can, and the wisdom to know the difference."); the Third Step Prayer ("Take my will and my life. Guide me in my recovery. Show me how to live.") or the "Gratitude Prayer" ("That no addict seeking recovery need ever die. ... My Gratitude speaks when I care and when I share with others the NA way.")
One addict helping another is an essential part of the NA program. It is therefore highly recommended that members of Narcotics Anonymous find a sponsor. A sponsor is a member of NA who helps another member of the fellowship by sharing their experience, strength and hope in recovery and serves as guide through the Twelve Steps. In doing so, NA members often choose a sponsor with experience in applying the Twelve Steps of Narcotics Anonymous. For stronger identification, many NA members have sponsors of the same sex although members are free to choose any other member as a sponsor. It is also suggested that one should find a sponsor who has not only worked the 12 steps of Narcotics Anonymous, but that person also have a sponsor who has worked the 12 steps of Narcotics Anonymous.
Many NA 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 NA members "need always maintain personal anonymity at the level of press, radio, and films."
Narcotics Anonymous sprang from the Alcoholics Anonymous Program of the mid-1930s, and was co-founded by Jimmy Kinnon. Meetings first emerged in the Los Angeles area of California, USA, in the early fifties. The NA 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.
Alcoholics Anonymous was the first 12-step program, and through it many with drug and drinking problems found sobriety. The Fourth Tradition gives each AA group the autonomy to include or exclude non-alcoholic addicts from closed meetings — where only those with an expressed desire to quit drinking may attend. At open AA meetings non-alcoholics are welcome. As early as 1944 AA's co-founder Bill Wilson discussed a separate fellowship for drug addicts. In 1947 NARCO (also called Addicts Anonymous) met weekly at the U.S. Public Health Service's treatment center inside Lexington, Kentucky federal prison for 20 years, In 1948 a NARCO member started a short-lived fellowship also called "Narcotics Anonymous" in the New York Prison System in New York City.
In 1953 Narcotics Anonymous, originally called AA/NA, was founded in California by Jimmy Kinnon and others. Differing from its predecessors, NA formed fellowship of mutually supporting groups. Founding members, most of whom were from AA, debated and established bylaws of the organization. On September 14, 1953, AA authorized NA the use of AA's 12 steps and traditions on the condition that they stopped using the AA name, causing the organization to call itself Narcotics Anonymous.
In 1954, the first NA publication was printed, called the "Little Brown Book". It contained the 12 steps, and early drafts of several pieces that would later be included in subsequent literature.
At this time, NA 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. 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 NA became recognized as a beneficial organization, although some early press accounts were very positive. In addition, many NA 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 AA with NA, 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 into action by this, Jimmy Kinnon and others dedicated themselves to restarting NA, promising to hold to the traditions more closely.
In the early 1960s, meetings began to form again and grow. The NA White Booklet was written in 1962, and became the heart of NA meetings and the basis for all subsequent NA literature. NA 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 NA White Book, and included the personal stories of many addicts.
The first NA phone line started in 1960, and the first "H&I" group (H&I [Hospitals and Institutions] 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 NA 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 NA program grew slowly in the 1960s, but the program was learning what was effective and what was not, as relapse rates declined over time and friction between NA groups began to decrease.
The 1970s was a period of rapid growth in NA's history. In 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. In 1971, the first NA World Conference was held, and others have followed annually.
From the beginnings of NA, the need for official NA literature was evident. Unfortunately, the process of creating and approving official NA 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 AA literature at meetings, while others considered writing their own books on recovery. One group even planned to print a bootlegged version of AA'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 NA World Literature Conference was held in Wichita, Kansas.
While previous literature had been written by just a few addicts (primarily by Jimmy Kinnon), the NA 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 1981, a finalized version was distributed to all of NA 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 NA service groups. The book was printed in 1983 with the passages removed. A second edition that restored the passages quickly followed. A hasty vote again removed the controversial sentences in a third edition.
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 1987, was improperly reviewed and had many problems, including 30 lines which were inadvertently missing and text that was inconsistent with other NA literature. A 5th edition was released in 1988, correcting these problems. Copies are sold (or given away for free at the groups expense)at NA meetings, and are available in over 30 different languages. Millions have been sold worldwide, and have been useful to many addicts.
In 2004, the WSC initiated a project to revise the Basic Text. This new edition would remove some of the personal stories from the 5th edition, and supplement the remainder of the original stories with more diverse personal stories from around the world. The first 10 chapters were to remain the same. Also, the Preface would remain the same, as well as the "Symbol" page. There is a new preface but the original preface will be called "preface to the 1st edition". There were some other changes to the structure of the book, including the layout and flow of the book, while keeping the original message clear and unchanged. 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, where each member had a chance to review the new text.
When the Approval Draft came out on September 1, 2006, 7500 copies were distributed (4493 copies were mailed and 3009 copies were electronic copies downloaded by members). The approximate number of input received was 350 pieces, of which 60% came from individuals, 17% came from groups, and 23 percent came from committees. More than 20% (161) of the personal stories submitted came from outside of the United States. Submissions were received from the following countries (although later on more personal stories were submitted and the additional statistics are unknown): Argentina, Australia, Belgium, Brazil, Canada, Colombia, France, Germany, Greece, India, Ireland, Israel, Italy, Japan, Mexico, Nepal, Netherlands, New Zealand, Nicaragua, Norway, Portugal, Puerto Rico, Russia, Saudi Arabia, Singapore, South Africa, Spain, Sweden, Switzerland, Trinidad, Turkey, United Kingdom, United States, Venezuela, and the West Indies.
The 6th edition of the NA Basic Text was approved and is currently being printed, with over forty new "personal stories" from around the world. Because of the addition of so many new stories of NA member experiences, it will be larger in size than all earlier editions. After the rapid succession of five editions during the 1980s, this is the first new edition in twenty years.
Release of the new Basic Text is slated for October 1, 2008. On that date, the 5th edition will be replaced by the 6th edition in the Narcotics Anonymous World Services inventory at NA.org, and only the 6th edition will be distributed from then on.
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The Sixth Edition Basic Text along with the 25th Anniversary Commemorative Sixth Edition Basic Text was published in 2008.
In 2003, NA World Services approved a new text entitled Sponsorship. This book endeavors to help people explore the concept of NA 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.
Along with the 6th Edition Approval Draft results, a CAR (Conference Agenda Report) contained some proposed revisions and additions to NA literature. One piece was a revised pamphlet geared towards young members and the other was a pamphlet for their parents and guardians. "By Young Addicts, For Young Addicts" was approved at WSC 08. "For the Parents or Guardians of Young People in NA" was also approved at WSC 2008.
Additional service pamphlets new for 2007/2008 included:
In the more recent months, there has been a motion to revise the pamphlet "In Times of Illness".
To the excitement of many addicts (Literature junkies or otherwise), a Commemorative 6th Edition has been published. The 25th Anniversary (of the First Edition Basic Text) Sixth Edition was published in 2008.
A new piece of literature, Living Clean, was released to the public in 2012.
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 NA world conventions; the diversity of 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: 51% Caucasian, 24% African-American, 14% Hispanic, and 11% 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.
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 in attracting members 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.
Members meet at NA 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 NA World Services. The foundation for this structure is the Twelve Traditions of NA.
Narcotics Anonymous is fundamentally made up of NA Groups. An NA Group is a number of NA 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 NA 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."
An ASC is made up of all the participating NA Groups in a given Area. The Group Service Representatives (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.
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 NA 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.
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.
The NA 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 NA World Board. This service conference has the executive right to make decisions for the entire NA Fellowship. This includes electing members to serve on the World Board, approving all new NA 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 NA 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.
The WSC through the World Board is responsible for the NA 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.
Narcotics Anonymous members are not required to pay any dues or fees. NA is committed to being fully self-supporting, declining any outside contributions. 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. NA does not accept donations from non-members, organizations or governments. NA recovery literature is produced by the NA World Service Office (NAWS) located in California, USA. Typically NA 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 NA website. The 2007 World Convention of NA ran at a net financial loss of $596,000.
The first sophisticated outcome studies of NA were conducted in the early 1990s in London, UK. The first study found a roughly linear relationship between length of membership and abstinence with reduced anxiety and increase self-esteem  While the NA sample had higher anxiety than the non-addicted comparison groups, these levels were equivalent for those with three or more years membership, which is consistent with the hypothesis that NA membership reduces anxiety as well as substance use. This study also, contrary to the authors expectations, found that spiritual beliefs and disease concept beliefs were not prerequisites for attendance of NA and even if these beliefs were adopted they were not found to cause external attributions for previous drug use or possible future lapse events.
A study of the early experience of new NA members in Victoria Australia in 1995 interviewed 91 members initially and 62 (68%) after 12 months and found that higher self-help participation as measured by service role involvement, step work and stable meeting attendance, in the 12 months prior to follow-up was associated with a four-fold reduction in levels of hazardous drug and alcohol use, less illicit income and sickness benefits and higher emotional support at reinterview.
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 counselors.
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.
The NA 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 NA 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 NA throughout its history.
Early in the history of NA, different groups emphasized different aspects of recovery. In particular, the make-up and process of creating an NA 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 NA, or as a separate group with no decision-making power. This dispute reached its nadir when the NA World Service Organization sued an NA member to prevent him from distributing free versions of the Basic Text. Although there are still some "traditionalist" NA members who use the third edition (revised) of the Basic Text.
Other disputes regarding the style of writing, the cost of producing, and how best to use the money raised by the sale of NA literature have led to acrimonious internal controversies. At one point Jimmy Kinnon, NA's co-founder, was described as being "locked out" of the NA World Service offices.
Other 12-step groups differ in their approach to the treatment of addiction and recovery. Alcoholics Anonymous "is a program for alcoholics who seek freedom from alcohol" but does refer to "some AA members who have misused drugs...in such a manner as to become a threat to the achievement and maintenance of sobriety" and mentions that drugs can " create a dependence just as devastating as dependence on alcohol". However, according to AA literature, "only those with a desire to stop drinking may attend closed meetings ". Anyone at all may attend an open meeting of Alcoholics Anonymous. 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 NA, but considers the use of methadone to be a tool of recovery and not a drug. NA has no opinion on these groups, as these are outside issues and the traditions suggest against taking a definitive stand on outside issues.