How Addiction Recovery Mutual Organizations Grow or Wither

For more than two centuries, recovery mutual aid organizations have constituted a primary resource for individuals and families around the world seeking resolution of alcohol and other drug problems. While considerable research has been devoted to evaluating the effectiveness of religious, spiritual, and secular addiction recovery mutual aid groups, the factors that promote the rise, growth, and demise of these groups remain something of a mystery. Based on my study of the history of these groups in the U.S. and in other countries, I would suggest the following propositions related to the external and internal factors that influence the viability and sustainability of addiction recovery mutual aid (ARMA) groups.

External Growth Factors

Population Demographics: ARMA growth is highest during periods in which those aged 25-40 reach peak concentrations in the population. The Baby Boomers entering this age cohort in the U.S. in the 1970s and 1980s exerted tremendous influence on the growth of Twelve Step programs in the U.S. and the subsequent rise of secular and religious alternative to Twelve Step groups.

Social Density of Addiction: Exponential ARMA growth is most likely in countries with the highest rates of addiction. ARMA growth rises in the wake of, not in tandem with, peak personal and social addiction consequences. The birth and growth of Alcoholics Anonymous required a resurgence of alcohol problems following repeal of alcohol prohibition in the U.S. ARMA participation among people using opioids and experiencing opioid use disorders will rise not during the apex of opioid overdose deaths (events marking the ascension of opioid use), but in the years following the peak of such deaths.

Cultural Congruence and Stigma Reduction: ARMA existence and growth is contingent upon the right of citizens to assemble voluntarily without governmental oversight. ARMA growth will be fastest in cultures amenable to citizens organizing for mutual support and community service. For example, the Persian values of family, hospitality, mutual help, service, and sacrifice created the necessary soil for the unprecedented growth of NA in the Islamic Republic of Iran. ARMA groups flourish as cultural stigma attached to addiction and related help-seeking descend within a culture. ARMA growth is fastest in cultures that support ARMA development and remove obstacles of ARMA suppression. In the U.S., “loitering addict” laws and police surveillance inhibited early NA growth, whereas governmental support of and respect for NA contributed to the early growth of NA in countries like Iran.

Growth of Allied Resources: ARMA growth will be greatest in tandem with the growth of professionally-directed addiction treatment programs that integrate ARMA philosophy and practices and provide assertive linkage to ARMA groups for post-treatment continuing care. ARMA growth and vitality could decline if treatment takes over ARMA functions and if the distinguishing boundary between ARMA and professional treatment is lost.

Local/National Media Coverage: Local/national mainstream media and social media coverage of ARMA history, philosophy, practices, and accessibility serve as a direct catalyst of ARMA growth. AA growth was slow until the 1939 Cleveland Plain Dealer newspaper series on AA and Jack Anderson’s 1941 Saturday Evening Post article on AA.

Scientific Validation: Support of ARMA groups by treatment institutions and allied health and human service organizations increases in tandem with scientific studies affirming the positive role ARMA group participation plays in enhancing long-term treatment/recovery outcomes and quality of life of affected individuals and families. The explosive growth of NA in Iran was supported by the conduct of more scientific studies of NA than anywhere in world, including in the U.S. and U.K.

Internal Growth Factors

ARMA Program Codification via Basic Literature: Exponential growth and maintenance of program integrity of an ARMA group is contingent on the creation/translation and dissemination of literature outlining its philosophy, principles, practices, and recovery stories. Such codification is critical in reaching people in areas where face-to-face or online meetings are not available. It is also critical in reducing the risk of program dilution or corruption. Major surges in growth of ARMAs in the U.S. occurred after publication of their core literature, and their spread to non-English-speaking countries surged only after literature translation and creation of new indigenous ARMA literature. The failure to codify their program of recovery contributed to the demise of the Washingtonians, abstinence-based fraternal temperance societies, and the reform clubs of the nineteenth century.

ARMA Service Ethic and Service Structure: The growth and long-term survival of ARMA groups is enhanced in those groups in which each member is expected to offer support to new and existing members as part of his or her own recovery support activities. That ethic is strongest in ARMAs that have a formal voluntary service structure. Helping others enhances group solidarity and is a powerful mechanism of change among people recovering from addiction.

Membership Diversification: ARMA growth is enhanced via efforts to reach the spectrum of populations affected by AOD problems. These efforts include special interest meetings, literature that transcends demographic and cultural boundaries, and refinement of program philosophy and practices to fit the values and folkways of diverse groups. ARMA diversification and growth of ARMA specialty meetings attracts new populations and retains populations that might otherwise be lost due to failure of mutual identification. Specialty literature and specialty meetings have contributed significantly to ARMA growth in the U.S. and other countries.

ARMA Recovery Culture: ARMA growth is aided by development of a distinct ARMA recovery culture—distinct ideas, language, rituals, symbols, history, iconic figures, memorial sites, etc. ARMA growth is fastest among groups that build both a face-to-face and an online ARMA culture. COVID-influenced online meetings have led to an unprecedented cross-fertilization of ARMA cultures across cultural and national boundaries.

Recovery Viability, Stability, and Durability: Sustaining the stability and exponential growth of ARMAs is dependent upon a core of members in stable recovery sustaining ARMA participation and active service work. This vanguard serves as living proof of program philosophy and practices both internally and externally and serves as carriers (elders) of the ARMA culture.

Sustaining Organizational Integrity: Sustained ARMA growth will be most evident in those ARMA groups that avoid the pitfalls that led to the withering or demise of earlier ARMA groups. ARMA survival and growth is contingent upon codification of its recovery program but also contingent upon the codification of the values/principles/prescriptions governing organizational life. ARMA groups lacking such adherence may experience explosive growth only to then rapidly decline and experience institutional death. The rise and fall of the Washingtonians, Synanon, and other ARMA groups in the U.S. offer less than sobering examples of the potential transience of ARMA organizations. ARMA groups concerned about organizational longevity, regardless of their orientation, are well advised to become students of A.A. and N.A. history and the close calls experienced within those fellowships that could have ended their existence. (See HERE and HERE).

The potentially fatal threats to ARMA groups include charismatic leadership, cult-like organizational closure, internal schisms, mission diversion, professionalization, colonization by other institutions, commercialization, and the failure of leadership development and succession planning. Those ARMA groups who outlive their founding generations are those who successfully navigate these challenges. The same is true for the broader spectrum of recovery community organizations. 

Data Source in Image: NAWS, Inc. (2008).  Meeting Count (Adobe Flash Graphic); NAWS, Inc. (2010, 2012, 2014, 2016, 2018, 2020).  World Service Conference Reports.