Most of us are pretty familiar with Alcoholics Anonymous (AA), and asking about AA attendance and participation is routine during appointments with patients trying to curb their alcohol use (see the November/December 2015 CATR for more info on AA). But what about Narcotics Anonymous (NA)? Is it just an opioid-focused version of AA? In this article, we’ll summarize some basic info on NA and give you tips for how to educate your patients about it.
What is NA? NA is a 12-step program founded in 1953. It was created to provide a simply written set of principles that patients can follow in their daily lives (see: https://www.na.org/admin/include/spaw2/uploads/pdf/handbooks/IGG.pdf). Meetings vary in structure and format and are not run by medically trained professionals; instead, they are conducted as a fellowship of people who volunteer to help one another. Despite having “narcotics” in its title, NA is for anyone struggling with any addiction—this can include cocaine/stimulants, cannabis, alcohol, benzodiazepines, etc. If patients have multiple addictions, they can choose to attend either NA or AA, or even to attend both, in accordance with their personal preferences and their comfort level.
What are NA meetings like? Like AA, NA meetings are free to all comers and follow the 12-step philosophy. Meetings are led by members and take place in churches, community centers, hospitals, and similar places. Each meeting is slightly different, but there are typically 3 types. Speaker meetings feature speakers who tell the story of their recovery; topic meetings often focus on a particular NA step or recovery issue; and reading meetings begin with a reading from the library of 12-step literature (such as Narcotics Anonymous, which is often called the Basic Text, or The Narcotics Anonymous Step Working Guide) and proceed to a discussion of issues raised.
Unlike AA, which does not take any official position on agonist treatment with buprenorphine or methadone, NA explicitly considers such treatment to be inconsistent with its abstinence model of recovery, and NA culture discourages its use. While participants are not required to abandon agonist treatment, NA’s official stance is that members on agonist treatment should not lead meetings, serve as speakers or sponsors, hold office in NA, or even share at meetings (https://www.na.org/?ID=bulletins-bull29). This can be an impediment to our patients, who often feel that they have to hide being on agonist treatment in NA meetings. Fortunately, some individual NA groups have recently adopted an open attitude toward agonist treatment.
Is NA effective? There is more research for AA than NA, though neither have conclusive evidence of efficacy. Research on NA is not only scant, but also based on the relatively small numbers of patients who do not drop out of NA meetings early (80%–90% of patients drop out from NA within the first month). Nonetheless, the limited research has found that the outcome of NA correlates to the degree of a patient’s participation. People who regularly attend meetings, who consider themselves to be “members,” and who actively work through the 12 steps are more likely to have sustained abstinence greater than 1 year (Krentzman AR et al, Alcohol Treat Q 2010;29(1):75–84). Similarly, continuous weekly NA attendance for at least 3 years is associated with higher rates of sustained abstinence. Specific participation characteristics that are predictive of abstinence include having a sponsor, doing service in a manner that gives back to NA (eg, becoming a sponsor, hosting or coordinating a group meeting, etc), reading recovery literature, and contacting other members outside of meetings. Women may be more likely than men to benefit from NA meetings.
How to talk to your patients about NA The bottom line is that while NA has limited evidence for its effectiveness, it is widely available and free, and will likely help your patients build up a network of people who will support their sobriety. Beware, however, of NA groups that pressure people to stop taking opioid use disorder (OUD) meds.
Here are some recommendations for points to make to your patients as you talk to them about NA:
Tell your patients that NA is a cost-free mutual-aid fellowship that provides consistent, dependable recovery-oriented support and can positively impact their social network.
Be honest with your patients about NA’s philosophy of complete narcotic abstinence, which can be at odds with agonist treatment. Emphasize that agonist treatment saves lives, preserves health, improves quality of life, and is an essential component of recovery.
If you have patients on agonist treatment who opt for NA, be sure to ask about their participation in meetings and how they communicate their treatment to other members. Some choose to withhold that information, while others opt to share it.
Discuss finding meetings that welcome people on OUD meds. Patients can try different NA groups to see which ones they like, they can go to AA instead (though AA groups vary in their openness to non-alcohol addictions), or they can try alternatives such as Self-Management and Recovery Training (SMART) Recovery (https://www.smartrecovery.org), Women for Sobriety (https://womenforsobriety.org), or Secular Organizations for Sobriety (SOS) (http://www.sossobriety.org). For more information on alternatives to 12-step programs, see the June/July 2017 CATR.
CATR Verdict: NA is a free and widely available recovery fellowship, but it has a hard-line philosophy that may pressure patients to come off buprenorphine and methadone. Refer patients to groups that welcome people on OUD meds, whether they are NA groups that have an accepting attitude toward meds, AA groups, or increasingly widespread alternatives.