NA and Recovery from Opioid Addiction (William White, Dr. Marc Galanter, Dr. Keith Humphreys, and Dr. John Kelly)

NA ImageRecent surges in opioid addiction and opioid overdose deaths in the United States have triggered considerable public and professional alarm, including its emergence as an issue in the 2016 Presidential campaign. Public health responses to the rise in opioid-related problems have focused primarily on: 1) suppression of illicit opioid markets, 2) public education on opioid addiction risks, 3) prescription opioid disposal campaigns, 4) physician training and monitoring, 5) new non-opioid protocols for non-cancer pain management, 6) introduction of abuse-deterrent opioid formulations, 7) increased legal access and distribution of naloxone (Narcan®) for overdose intervention, and 8) efforts to expand access to addiction treatment—particularly medication-assisted treatment.

As long-tenured addiction researchers, the authors have supported these efforts, but have been struck by the scant attention given to the role recovery mutual aid organizations, such as Narcotics Anonymous (NA), are playing and can yet play in the national response to opioid addiction. If NA is mentioned at all in public or policy discussions of opioid addiction, it is as a fleeting reference to its existence as a post-treatment referral option, or, more frequently, in criticism of its alleged hostility toward maintenance medications in the management of opioid addiction. Such neglect, peripheral attention, or narrow coverage is puzzling, given that NA is the one surviving recovery mutual aid organization whose birth in the early 1950s focused almost exclusively on recovery from heroin and other opioid addiction.

NA Blog Image Muir_HeroinReportRecent one-hour specials on ABC and CNN and a CBS 60 Minutes segment on prescription opioid and heroin addiction, like numerous other reports, failed to even acknowledge the existence of NA, nor did they mention other recovery mutual aid fellowships devoted specifically to supporting recovery from opioid addiction (e.g., Heroin Anonymous, Methadone Anonymous, Advocates for the Integration of Recovery and Methadone, Mothers on Methadone).  Further, brief mentions of “AA and other Twelve-Step programs,” when such references do appear in media and policy discussions, convey the impression of NA as an Alcoholics Anonymous (AA) clone and fail to convey NA’s distinct history, culture, and program of recovery.

The authors have just published a research review and commentary suggesting that this lack of attention stems from a number of misconceptions about NA that are challenged by the scientific research. We contend, based on the available evidence we review, that:

1) NA is NOT a professionally-directed treatment for opioid addiction, but, similar to professional interventions, participation in NA’s community of shared experience and its Twelve-Step program can play a potentially important role in recovery initiation and recovery maintenance.  

2) NA meetings and the broader NA program of recovery are increasingly accessible in the United States and in other countries.

3) The strength of the recovery culture within NA (and the average duration of continued abstinence) has progressively increased as NA has matured as a fellowship locally and globally.

4) NA participation enhances recovery outcomes for adolescents and young adults, and safety concerns have not been identified as a contributing factor to NA disengagement among young people.

5) NA effectively serves women, ethnic minorities, and other historically disenfranchised populations.

6) NA does not formally affiliate with any outside enterprise but has established effective service collaborations with addiction treatment programs and correctional institutions through its Hospital and Institutions subcommittees.

7) Though NA is explicitly abstinence-based in its orientation to recovery, it welcomes the participation of peopled in medication-assisted treatment (MAT) who are considering or in the process of sustaining their recovery without MAT support.    

8) Taking medications for a mental health condition as prescribed is compatible with NA’s abstinence orientation, and nearly one quarter of NA members report the current use of such medications.

9) The degree to which NA’s perceived religious/spiritual orientation inhibits attraction to NA or contributes to NA drop-out is unclear, but studies have found that people with less religious orientation who participate in Twelve-Step groups experience benefits similar to those with greater religious orientation. Most NA members report a spiritual but not a religious orientation.

10) NA participation by adults has been found to enhance recovery stability, emotional health, quality of life, and community involvement.

11) NA participation has the potential to significantly reduce the social and health-related costs of opioid addiction and does so at no cost to families, governmental agencies, or private insurers.

The NA research upon which these conclusions are drawn is tentative due to the limited number of studies and varying degrees of methodological rigor, but they represent the most credible scientific data available on NA and the effects of NA participation on recovery outcomes.

Media coverage and professional discourse related to opioid-related deaths and devastation heighten awareness and fear, but all too often reveal little if any information on the lived solutions to opioid addiction as experienced within NA and other peer-based recovery support institutions. We believe the reviewed misconceptions about NA contribute to the paucity of such attention. Increased coverage of people in long-term recovery from opioid addiction and the role of NA and other recovery support institutions in such achievements would help move the national conversation on opioid addiction from a focus on the problem to a focus on the lived solutions that now exist in communities across America.

How might the individual, family, and community trajectory of opioid addiction be altered if every naloxone administration, every treatment admission and discharge (regardless of modality or setting), every drug-related visit to a general practitioner or health clinic, and every drug-related HIV or Hepatitis C screening were accompanied by assertive linkage to NA or other recovery mutual aid resources? We believe it is time to test that potential. Forging an assertive, long-term public health response to opioid addiction will require more than a rising sense of urgency; it will require forging partnerships with those individuals and organizations who understand the need for such urgency in its most human terms.

There is a pervasive pessimism about the long-term prospects of recovery from opioid addiction. Tens of thousands of NA members in long-term recovery from opioid addiction stand as a living refutation of such pessimism. That fact is the least told story in the public media and in professional discussions of opioid addiction. Innumerable individuals, families, and communities will be ill-served if we neglect the role NA and other recovery mutual aid organizations can play in supporting long-term recovery from opioid addiction. 

NA has distinguished itself for more than 60 years as an organization with the singular goal of supporting addiction recovery. It is time such contributions were more fully appreciated at public and professional levels, more research attention was conducted on NA, and NA resources were more fully integrated within public health responses to rising opioid addiction.

To read the complete review and commentary with all study citations, click HERE. .

About the Authors: William White, M.A., is Emeritus Senior Research Consultant at Chestnut Health Systems and the author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America. Marc Galanter, M.D., is Professor of Psychiatry at New York University School of Medicine, the former president of the American Society of Addiction Medicine, the lead author on several NA-related studies, and the author of the recently-released book, What is Alcoholics Anonymous? John Kelly, Ph.D., is the Elizabeth R. Spallin Associate Professor of Psychiatry in Addiction Medicine at Harvard Medical School, the founder and Director of the Recovery Research Institute at the Massachusetts General Hospital (MGH), and a former President of the American Psychological Association (APA) Society of Addiction Psychology. Keith Humphreys, Ph.D., is a Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University, a Senior Research Career Scientist at the VA Health Services Research Center, a former Senior Policy Advisor at the White House Office of National Drug Control Policy, and author of Circles of Recovery. All of the authors have conducted and published studies on addiction recovery mutual aid organizations.