The concept of 12-step or Self-help programs as a recovery modality for addiction and other psychosocial issues is receiving wide acceptance and recognition. Self-help means the use of one’s effort to achieve recovery without assistance from other people such as professionals. Individuals in self-help join fellowships and support each other in the process. This model is attributed to Alcohol Anonymous (AA), a body of dedicated individuals who felt the need to develop a program that will help other alcohol addicts follow a path towards recovery. The 12-step model was created in 1938 when one of the founding members, Bill Wilson, through personal experiences created the ideas of alcoholism recovery. Wilson wrote on the benefits of one addict sharing stories with another user struggling with addiction. Many other organizations and institutions have adopted and modified the model in wide-ranging peer-help, self-supporting addiction programs across the world. The focal goal of the programs is to assist members to engage in behavioral transformation. The 12-step model advocates abstinence and surrender to a higher power of control. Research documents that, people who abstain have better mental health results compared to those who do not abstain (Vaillant, 1983). This paper provides a reflection on Narcotic Anonymous (NA) meeting in my location by locating a meeting, attending, and reflecting on the experience. A comparison and contrast of a treatment alternative to the 12-step program will also follow including a discussion on how these meetings work.
The most common marks of addictions are isolation and disruption of relationships. Many self-help groups and organizations seek to explore pathways through which addicts can locate such recovery routes and align their behaviors towards achieving that relationship. The NA recognizes this fact in their literature stating, “That active addiction is marked by increased isolation and destruction of relationships. Recovery in NA has helped survey respondents to repair the damage in their lives from drug addiction” (n.p). The NA organizational philosophy is based on AA’s model. The 12-Step model offers individuals a structural and functional framework to release their addiction, evaluate experiences, and move on into new forms of behavior. The 12-steps, as outlined by AA are:
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1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with
God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs (AA, 1952).
Meeting Location, Time, Number
There are few NA locations in my state, but I chose one nearest to me online. It was interesting to note that they have meetings line-up every day in the week. The meeting I attended takes place on Thursday, July 6, 2017, at the [ ]. One was warmly welcomed into the meeting space, and the leader of the group offered me a pamphlet and other information materials concerning NA. Each member is requested to state his or her name before sharing. It is one of the meetings that are opened to the public. The discussions are open as each member shares their experiences and challenges in the process. I realized that some meetings are exclusive to members and others are general or opened for non-addicts or nonmembers. The time was 1:30 PM and the number of participants was 16, composed of young men and women. The age and gender disparity in this group gave me an opportunity of curiosity. One noticed that circumstances are one factor that separated these people in the way they communicate and share their experiences. The members are also at different stages of recovery because the group is not formed according to dates. Some attention was directed at me for attending, but after explaining my purpose, the atmosphere was calm as people took turns to share. The design of the meeting is around creating a non-threatening environment for each participant.
Membership into NA is free and open to any drug addict irrespective of drug usage and time. There is also no age limit to participation in the peer-support program. According to NA, “Members share their successes and challenges in overcoming active addiction and living drug-free, productive lives through the application of the principles contained within the Twelve Steps and Twelve Traditions of NA. These principles are the core of the Narcotics Anonymous recovery program” (NA, 2016, n.p). There is no racial, ethnic, social, political, economic, religious, national, gender, or class-status restrictions regarding membership. The only criterion for membership is a desire to stay drug-free including alcohol. Also, the founding principle of abstinence is strongly advised in NA.
Meeting Process [How it Works]
NA meetings are informal and regular for members who are drug addicts with a strong desire to recover. They either are willing members or referred. Other meetings are open for non-addicts as well. Meetings are discussion and speaker based. The one I attended is a discussion meeting, where each member shares his or her story in recovery. Speaker sessions involve one or more individuals sharing for an extended period, as opposed to the five minutes per individual in discussion meetings. The usual greeting pattern in NA meetings is hugs. They are without a professional counselor, social worker, or psychotherapists. It is simply a meeting of drug addicts. A routine and systematic pattern of members sharing and others listening, appreciating their efforts, in turn, is my observation. Non-addicts are not allowed to contribute to these meetings but listen and observe.
The meetings are not designed as classes or group therapy sessions but sharing of experiences. They maintain anonymity throughout the meeting. A financial token is taken from each member who can, for other services and meetings, but non-members are not asked to contribute financially. The leader of the meeting usually invites visitors and newcomers to introduce themselves by their first name. A handshake, hug, and a key tag is what newcomers encounter as they get into the general or open meetings. A newcomer can share during the participation period of the meeting but are often encouraged to listen. Any material or actions that will cause distractions are discouraged during meetings. Also, some of the meetings have short breaks for members to refresh, chat or smoke. Focus in the meeting is the implementation of the 12-step model and adherence to the twelve NA traditions.
NA is an offshoot of AA program with roots from the Los Angeles areas of California, U.S. From the 1950s; it is now offering services to many nations in the world. As a nonprofit organization that is directed at men and women with drug problems, NA is not affiliated with any institution or organization but open to cooperation with public and private institutions. The primary function of NA is the organization of its members’ meetings and encouragement of abstinence from drug use. Each group meeting operates singularly with universal principles of the organization. In countries where NA has developed significantly, committees are created to offer particular types of services for addicts. The local committees provide guidance on the group’s activities, information formats, and distribution, directories, including presentations to institutions and individuals.
NA operates on a principle of non-involvement with the external agencies. Its emphasis is on the members assisting one another through sharing experience and support networks. Spirituality is differentiated from religious affiliation so that members can identify on their own the power through which they can pursue recovery. The power that can help the individuals recovery is individualized. The organization applies “a tradition of non-endorsement and does not take positions on anything outside its own specific sphere of activity. Narcotics Anonymous does not express opinions—either pro or con—on civil, social, medical, legal, or religious issues” (n.p). Also, it has no attachment to other self-help groups that utilize the 12-step model and no affiliation with treatment centers and correctional facilities. It does not employ professionals nor offer any other services other than “to provide an environment in which addicts can help one another stop using drugs and find a new way to live” (n.p). Thus, NA is an organization that focuses on the process of addiction recovery based on group dynamics with similarities of challenges. People with similar addictions come together to offer experiences, encouragement, support with the aim of overcoming addiction through abstinence.
Personal Observations
The meeting demonstrates the level of commitment and engagement by each member as they arrived on time, though a few came some minutes late. One can observe that some members are newcomers who have spent a few days or weeks while others have spent months in the group. The age and gender mix create an atmosphere of support and sharing of experiences as I listen and observe. As they share, they seem to be a general agreement with the person sharing. After which, some will appreciate as the next person proceeds with the sharing. There is no evidence of judgment and bias as the meeting proceeds. One can see the power of addiction on individuals as some of them narrate the urge to continue using the substances that brought them to NA. The experienced and advanced members who are at different levels of recovery encourage and proffer strategies on how to deal with the urge whenever it arises.
My presence did not change the ambiance of the meeting as they sat in a circle to encourage eye contact with one another. The group is at its working phase because it is open to newcomers every other day. Evidenced in the group is the trust building approach that is applied so that members do not share others details outside the meeting place. The trust factor enhanced the cohesiveness of the group as they move towards sharing and recovery. It reveals altruism in the group as they seek to help each other (Curry, Roberts & Dunbar, 2013). Further, because some members are almost clean, there is a high probability that they will leave the group and act as sponsors or advisors. The sharing process was cathartic for many of the members even with the limited time. The leader recants a personal experience to reassure others that recovery is possible. There is also a commonality of experiences, problems, and feelings of hope.
The exposure to the meeting invigorates a passion for individuals trapped by substances and other societal constructs. Empathy is what was apparent while at the meeting, imagining if it was I, who is participating in the recovery program. I ponder upon the ideal or relationships and isolations that have transformed these individuals into addicts. Thought of ways in which society can have a common goal towards ameliorating the conditions of some of these people suffering from different disorders, abnormalities, and diseases. I wish I could help, but hoped that the participants would follow through and find freedom and restoration. Thus, there is the feeling of hope, empathy, and concern for the members.
The experience from this meeting is profound. It explains the multiple forms of solutions available for different social issues. Although the social environment of each is not captured in this 12-step recovery program, it offers a spiritual dimension to recovery. The systems theory takes into consideration the particular environment, which may likely involve the family because it is the basic structural and functional unit of the society. It recognizes how each system contributes to the problem and how it can be addressed. The 12-step program of NA is a tool that engages the addict in surrender mode, with an internal will to abstain from addiction. It means that if an individual has the will, desire to change, support groups can enhance that process of recovery (Seebohm, Chaudhary & Boyce, 2012). The 12-step program deals with the individual to the exclusion of the family members. This approach means that the individual is detached from other external elements that may have contributed to the addiction. It is in my thinking that even though family members refer the members, at some stage of the process family should be part of the recovery process. Maybe, in the 12-step program, the 8-9 step is part of the process that involves the family but how that is achieved is not explicit. The 12-step program can be incorporated into other psychotherapy methods according to individual preference.
There is no conclusive research data on the effectiveness of 12-step program when compared to formal psychotherapy. However, many experts in the field of social work and psychology tend to believe that evidence-based, residential treatment program that is tailored to a client’s needs is the most effective approach towards achieving and maintaining recovery. Cognitive Behavioral Therapy (CBT) is one of the evidence-based therapeutic modality that has shown greater improvement in addiction recovery. It has sufficient empirical support in rehabilitations. However, what works for one individual may not work for another.
CBT is commonly used to treat phobias, depression, eating, and sleeping disorders. However, it has the potential of treating addictions as well. CBT is treatment system that holds that someone’s behavior is a function of thoughts and external stimuli. Thus, the meaning that people give to things affects them. Some thought patterns are negative giving rise to negative feelings or emotions. CBT helps an individual identify the negative thoughts and confront them to change the behaviors that are associated with such thoughts. Therefore, CBT makes the connection between the person’s problems, ideas that give rise to that behavior, and the behavior that causes these problems. It engages the individual to address the thoughts and the behavior to stop the problem.
CBT is a short-term treatment method but offers an opportunity for follow-up aftercare. It has two primary approaches, functional analysis, and skills modification. The technical analysis involves the evaluation of individual thoughts, situation, and feelings. The therapist and client work in close cooperation on identifying these elements. This exercise is to locate the source of the behavior. The skill aspect of CBT is a process of unlearning old ways and learning new ones that will help the individual cope with a new identity and thought pattern. Individuals who engage in CBT discover what led to addiction or disorder.
The 12-step program is a treatment model that involves some form of spirituality. It encourages the addict to realize and admit his/her inability to control or stop the addiction. Also, the individual joins a group with similar addiction problems. They surrender their will to a higher power, assumed to influence their recovery. During group meetings, participants share their experiences with others through which they receive encouragement, support, and healing. There is no professional guidance in a 12-step program. Abstinence is emphasized in 12-step programs.
The difference between the self-help groups and CBT is that self-help involves spirituality, group participation, sharing, encouragement, and abstinence. There are also almost free. CBT, on the other hand, is an evidence-based behavioral therapy that involves a professional with sufficient empirical sources of information. CBT engages the client in thought, feelings, and behavioral evaluation that transforms into the identification of the origin of the behavior as well as the problem. It is a short-term program with a potential for follow-up.
Thus, self-help groups are gaining significance in the treatment of addictions. They offer an alternative to formal treatment. The availability of self-help groups provides opportunities for those who do not have insurance and the finances for professional treatment. However, the best treatment is a research-based, customized treatment. What may work for one may not be appropriate for another. A combination therapy might be the option to explore.
References
Alcoholic Anonymous. (1952). The Twelve Steps Of Alcoholics Anonymous. Retrieved from http://www.aa.org/assets/en_US/smf-121_en.pdf
Curry, O., Roberts, S., & Dunbar, R. (2013). Altruism in social networks: Evidence for a 'kinship
premium.' Br J Psychol. 104 (2):283-95. doi: 10.1111/j.2044-8295.2012.02119.x.
Narcotic Anonymous. (2016). Information about NA. Retrieved from https://www.na.org/admin/include/spaw2/uploads/files/EN3129.pdf
Seebohm, P., Chaudhary, S., & Boyce, M. (2013). The contribution of self-help/mutual aid groups to mental well-being. Health Soc Care Community. 21 (4):391-401. doi: 10.1111/hsc.12021.
Vaillant, G.E. (1983). The natural history of alcoholism . Cambridge: Harvard University Press.
