Tag: NA

01/10/23

Common Grace & “The Triangle of Self Obsession,” Part 2

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In “The Blame Game: Accepting Accountability” Gina M. asked how many times you have made a poor choice out of spite, or a defense mechanism, or in reaction to something done to you? She said it took her a long time to admit that she had been playing the blame game for much of her life. She said she had been living in the triangle of self-obsession—anger, fear, and resentment. More and more everyday she’s realized how often she uses the excuse of “what’s happened to me” as a cop-out for every poor choice she’s ever made.

But the reality is that I was just rewarding my self-pity, living in the triangle of self-obsession, finding every excuse in the book for my questionable behavior. I was playing the blame game just so I had a “reason to.” A reason to deceive myself. A reason to justify my poor choices…because it was too hard to accept the fact that sometimes I actually do make poor choices. And because those poor choices carried more shame, guilt and regret than I cared to admit, because I was a people pleaser who lacked self-love and self-respect, my fear of judgement led me straight into a triangle of self-obsession.

In Part 1, we pointed out how common grace and the triangle of resentment, anger and fear could be applied to the consequences of Adam and Eve eating of the tree which God commanded Adam not to eat. Recall that it was said NA literature was a common grace description of how God restrains drug addiction and alcoholism. Recovery is God’s bounty poured out on all people in order for them to recover, regardless of their faith in Him. It won’t save them from their sin, but it can prevent them from the further guilt, shame and unmanageability of an active addiction. Here in Part 2, we’ll unpack the common grace found in “The Triangle Self-Obsession,” where it said self-obsession was at the heart of addictive insanity.

Not realizing she had affirmed what I’ve called the common grace of recovery, Gina M. said it was not just addicts who could benefit from the self-discovery recovery brings. “You don’t need to be an addict to hold resentments, to be angry, or to feel fear.” She said she was “learning to replace anger with love, resentment with acceptance, and fear with faith.”

“The Triangle of Self-Obsession” said resentment is the way most addicts (or most people) react to their past. This resentment was reliving past experiences over and over again. Anger is how most people deal with the present. “It is their reaction to and denial of reality.” Fear is what we feel when we think about the future. “It is our response to the unknown.”

NA pictured the way we react to people, places, and things as follows:

All three of these things are expressions of our self-obsession. They are the way that we react when people, places and things (past, present, and future) do not live up to our demands.

In Narcotics Anonymous we are given a new way of life and a new set of tools. These are the Twelve Steps, and we work them to the best of our ability. If we stay clean, and can learn to practice these principles in all our affairs, a miracle happens. We find freedom—from drugs, from our addiction, and from our self-obsession. Resentment is replaced with acceptance; anger is replaced with love; and fear is replaced with faith.

Following the distinction between spiritual and religious made by AA, Alcoholics Anonymous, NA avoids beliefs or doctrines that it sees as institutional religion. NA and AA follow the thought of William James in The Varieties of Religious Experience, who saw institutional religion as worship, sacrifice, ritual, theology, ceremony and ecclesiastical organization. Personal religion or spirituality for James was “the feelings, acts and experiences of [the] individual . . . in their solitude, so far as they apprehend themselves to stand in relation to whatever they may consider to be divine.” In the broadest sense possible, this spirituality consisted in the belief that there was an unseen order to existence; where supreme good lay in harmoniously adjusting to that order.

“The Triangle of Self-Obsession” said seeking help from belief in a Power greater than yourself was a natural part of growing up, but here it stumbles. Belief in Adam and Eve, accepting the reality of the story of the birth of original sin and the promise of salvation in the protevangelium is theology—part of institutional religion—which it avoids. So, it must have a nonreligious explanation for why people become addicts. It does this by describing how when people are born, they are only conscious of themselves, “we are the universe;” we are self-centered. As we grow up, we realize the outside world cannot provide all our wants and needs, and we begin to supplement what is given to us with our own efforts.

As this dependency on people, places, and things decreases, we increasingly rely on ourselves to meet our wants and needs. We become more self-sufficient “and learn that happiness and contentment come from within.” As we grow and mature, we recognize not only our strengths, but also our weaknesses and limitations. And most people develop a belief in a “Power greater than themselves to provide the things they cannot provide for themselves.” Here is where addicts are said to “falter along the way.”

We never seem to outgrow the self-centeredness of the child. We never seem to find the self-sufficiency that others do. We continue to depend on the world around us and refuse to accept that we will not be given everything. We become self-obsessed; our wants and needs become demands. We reach a point where contentment and fulfillment are impossible. People, places, and things cannot possibly fill the emptiness inside of us, and we react to them with resentment, anger, and fear.

Without a belief in a Power greater than ourselves that can be trusted to provide the things we cannot provide for ourselves, the addict cannot grow out of childish self-centeredness. Their wants and needs of people, places, and things become demands that are impossible to fulfill. This leads to a negative reaction to that failure with resentment, anger, and fear. It cannot be a sinful reaction to not getting their wants and needs met, since sin is religious.

Instead of fallen, sinful human nature, NA says addicts have a metaphorical “disease” that forces them to seek help from a greater Power, one that Christians confess to be Jesus Christ, who is the same yesterday, today and forever (Hebrews 13:8). Relating Hebrews 13:8 to the above diagram from “The Triangle of Self-Obsession,” we’d say Jesus is the same in the past, present and future. “We are fortunate that we are given only one choice; one last chance. We must break the triangle of self-obsession; we must grow up, or die.”

To the Christian who believes in the truth and reality of the Genesis story of the Fall of Adam and Eve and the origins of sin, “The Triangle of Self-Obsession” will seem to be an incomplete explanation of how addicts “falter along the way.” But it can be used as a point of contact to explore a deeper, and truer sense of spirituality and religion beyond that of William James, NA, or AA. See “Is AA Religious?” and “Religious Alcoholics; Anonymous Spirituality” for a discussion of the differences between true religion and mere religion; true spirituality and mere spirituality.

01/3/23

Common Grace & “The Triangle of Self-Obsession,” Part 1

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Adam and Eve could have used a good NA (Narcotic Anonymous) meeting after they ate of the fruit of the tree in the middle of the Garden. They used “what’s happened to me” as an excuse for their poor choice and the shame, guilt and regret that followed. They floundered in self-pity and let their self-centeredness lead the way into even more poor decisions. At a meeting, they would have learned they were living in the triangle of self-obsession, making excuses for their questionable behavior.

Let’s look at Genesis chapter 3 to see how this works out. The serpent tells Eve she won’t surely die if she eats of the fruit of the tree in the midst of the garden. She saw the tree was good for food, a delight to the eyes, and was desired to make you wise. So, she took the fruit and gave some to Adam, who ate it with her. They got what they had craved, but along with their eyes being opened to their poor decision, there were negative consequences for their actions.

They realized they were naked, and that they had impaired their relationship with God. They now saw their guilt before God (they were naked) and were ashamed. So then they sewed fig leaves together and made themselves loincloths (Genesis 3:4-7).

When God called to Adam and said “Where are you?”, He was calling on Adam to consider what he did wrong. A commentator observed that there is no possibility for reconciliation if the guilty are unwilling to confess their deeds. When Adam said he was afraid because he was naked, he was afraid to appear before God in his nakedness—he was ashamed of his disobedience. “Adam admits his sense of shame, which was motivated by his guilt.”

There were also problems from how they responded to God’s questions. When God asked if he ate of the tree which he was commanded not to eat from, Adam failed to take responsibility for his actions. He actually blamed both Eve and God, saying the woman that God gave him gave him the fruit and he ate. It’s like he’s saying, “I only too what she gave me!” Adam implied God was ultimately responsible for the success of the serpent and Adam’s eating the fruit. Here we see how by shifting the blame, Adam tried to evade accountability for his actions—and in the process alienated his relationship with Eve. In effect, Adam said, “The helper you gave me God, she’s responsible!”

When God asked Eve to explain what she had done, she also played the blame game, saying the serpent deceived her and she ate. Adam and Eve were trying to excuse their sinful behavior, but they were really deceiving themselves. And because of their failure to take responsibility for their actions, they experienced more shame and guilt, and were led straight into the triangle of self-obsession.

NA says self-centeredness is the core of their disease, their addiction. And as we saw above, it is the heart of all sin from the beginning. In “The Triangle of Self-Obsession,” it says:

Resentment, anger, and fear make up the triangle of self-obsession. All of our defects of character are forms of these three reactions. Self-obsession is at the heart of our insanity. Resentment is the way most of us react to our past. It is the reliving of past experiences, again and again in our minds. Anger is the way most of us deal with the present. It is our reaction to and denial of reality. Fear is what we feel when we think about the future. It is our response to the unknown; a fantasy in reverse. All three of these things are expressions of our self-obsession. They are the way we react when people, places, and things (past, present, and future) do not live up to our demands.

If Adam and Eve had been able to attend that NA meeting, they would have been introduced to a new set of tools— the Twelve Steps. However, God had a better plan than an NA meeting or the Twelve Steps for Adam and Eve. In His judgment against the serpent, God said there would be hostility between the serpent and the woman, between her offspring and the serpent’s offspring (Genesis 3:15). Christian tradition refers to God’s statement in Genesis 3:15 at the protevangelium, the first gospel. The New Testament presents Jesus as the Christ—the long-awaited Messiah and Savior predicted by the prophets and alluded to in God’s judgment against the serpent in Genesis 3:15.

However, the NA fellowship does not go there in “The Triangle of Self-Obsession.” Instead of Jesus Christ, the recovering individual is supposed to seek the help of a “Power greater than themselves.” Many Christians will have an automatic rejection of whatever NA says about recovery if that greater Power is not explicitly called Jesus Christ. But remember, “The Triangle of Self-Obsession” is not about salvation from sin, but recovery from addiction.

Jimmy K., considered to be the founder of NA, made a profound contribution to the fellowship when he successfully argued the NA First Step should say members were powerless over “our addiction” instead of alternatives like drugs, alcohol and drugs, or narcotic drugs. Instead of centering their institutional identity on a single drug, as AA did, NA focused its attention on the shared process of addiction. So, you won’t hear about the Fall, or Adam and Eve, or the protevangelium in “The Triangle of Self-Obsession.” But you will hear about faith, love and acceptance from the perspective of common grace: 

Common grace is understood to be the unmerited favor of God towards all men whereby (1) he restrains sin so that order is maintained, and culture and civil righteousness are promoted; and (2) he gives them rain and fruitful seasons, food and gladness, and other blessings in the measure that seems to him to be good.

When you read any NA or AA literature, think of it as a common grace description of how God restrains drug addiction or alcoholism; how it is God’s bounty poured out on all men and women in order for them to recover, regardless of their faith in Him. With this in mind, we’ll continue to reflect on “The Triangle of Self-Obsession,” in part 2 and consider how the addict is given “a new way of life and a new set of tools.”

For more on Jimmy K. and NA, see “The Birth and Near-Death of Narcotics Anonymous” and Growing Pains with Narcotics Anonymous.”

09/8/20

Growing Pains with Narcotics Anonymous

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Narcotics Anonymous (NA) rose up from the fragments of an earlier fellowship of the same name that had stopped holding meetings in the fall of 1959. The earlier NA, organized in 1953, struggled and ultimately could not overcome issues stemming from internal dysfunction and personality conflicts. In “Narcotics Anonymous: Its History and Culture,” William White, Chris Budnick and Boyd Pickard said that “NA as we know it today” learned lessons from the dangers of relying on a single dominant leader like Cy M., and of abandoning adherence to the Traditions of NA. They also needed to develop a distinctive culture for it fellowship, one that helped articulate the implications of inserting “our addiction” in the First Step instead of “alcohol.”

One of the first things Jimmy K., Sylvia W., and Penny K. did after rekindling NA meetings at Moorpark in late 1959 was to write new NA-based literature. Who Is an Addict?, What Can I Do?, What Is the NA Program?, Why Are We Here?, and Recovery and Relapse were all written in 1960. We Do Recover was added in 1961. These writings were gathered into a publication also published in 1962 called the Little White Booklet. Personal stories were added in 1966 and the White Booklet served as the center piece of NA literature until the Basic Text, Narcotics Anonymous, was published in 1983. See the NA World Services Recovery Literature page for copies of these and other pamphlets and booklets.

In 1972, NA Trustees looked at the idea of publishing a book similar to AA’s Big Book, but the plan did not get off the ground. It was not until 1977 when Bo S. began to pursue work on the Basic Text with the support of Jimmy K. that the idea became something more than just a thought. “The book was written between 1979 and 1982 over seven World Literature Conferences that involved over 400 recovering addicts in NA. NA’s Basic Text was approved in 1982 and officially released in 1983.”

Following the publication of the Basic Text, NA focused much of its publication efforts on It Works – How and Why, a collection of essays on the Twelve Steps and Twelve Traditions. Just for Today, a book of daily meditations, followed closely afterwards. Further efforts included a workbook on the Steps titled The Step Working Guide and a collection of sponsorship experiences simply called Sponsorship.

The Basic Text was the first substantial piece of literature created by addicts for addicts, and White, Budnick and Pickard said it marked the beginnings of NA’s own language and culture. NA growth had been progressing before the publication of the Basic Text, but after the release of the Basic Text, NA grew exponentially. There were five meetings by 1964, then 38 meetings in 1971, which grew to 3,382 meetings in 1983. This grew to 10,147 NA meetings by 1988, 16,575 by 1993 and 30,886 by 2003. In 2020, there are an estimated 71,000 NA meetings worldwide. See the following chart taken from “We Do Recover: Scientific Studies on Narcotic Anonymous.”

The presence of NA meetings in other countries also grew rapidly after the publication of the Basic Text. By 1968, there was a second country with NA meetings. In 1972, a third country was added and by 1983, there were 12 countries globally with NA meetings. By 1993 there were 60; by 2003, 106; by 2013, 129. There are an estimated 144 countries with NA meetings by 2020. NA literature is now available in 39 languages, with translations into 16 additional languages in process. In 2009, there were more NA meetings being held outside the US than in the US. See the following chart taken from “We Do Recover: Scientific Studies on Narcotic Anonymous.”Throughout much of its history, NA was in the shadow of its more well-known parent, AA. NA as we know it today, was founded by “bridge members” of AA (with dual addictions to alcohol and drugs). Its Steps and Traditions were drawn from those found in AA. Meeting formats, use of the Serenity Prayer and the Lord’s Prayer were copied from AA. But in the mid-1980s a large consensus emerged within the program that “challenged NA to step away from AA’s shadow and distinguish itself as a distinct recovery fellowship.” A 1985 communication from NA Trustees entitled, “Some Thoughts on Our Relationship with AA” acknowledged NA’s gratitude to AA. But it also noted its departure from AA in the language of NA’s First Step and then further elaborated on this divergence:

We are powerless over a disease that gets progressively worse when we use any drug. It does not matter what drug was at the center for us when we got here. Any drug use will release our disease all over again… Our steps are uniquely worded to carry this message clearly, so the rest of our language of recovery must be consistent with those steps. Ironically, we cannot mix these fundamental principles with those of our parent fellowship without crippling our own message.

The consensus begun in the 1980s has continued to grow and with it, the use of NA-specific language such as: addiction, self-identification as an addict, clean, and recovery from the disease of addiction. Meeting etiquette, terms and rituals are described in the NA pamphlet An Introduction to NA Meetings. There is an emphasis on solution-focused rather than problem-focused statements. Attention is placed on sustained NA service activity. And most importantly, there are NA members in long-term recovery who stay active in NA rather than disengaging or changing to another fellowship.

In “We Do Recover,” White and others said active drug users typically had a positive view of NA and sought help from NA through a variety of sources including an NA member (49%), referral by a treatment agency (45%) and encouragement from family members (32%). There was a strong association between NA participation and reduced drug use and increased rates of abstinence. The 2018 survey NA members reported an average of 11.4 years of continuous abstinence, with 85% reporting five or more years of stable recovery. But some friction has arisen with NA, and within NA regarding its stand on maintenance medications.

Attitudes and policies of NA towards the use of maintenance medications such as methadone, buprenorphine and naltrexone have been a source of tension within the NA fellowship and within the addiction treatment field, where medication-assisted treatment (MAT) is widely considered to be the gold standard treatment approach for opioid use disorder. Table 9 in “We Do Recover” summarized conclusions from various research studies of NA participation among individuals in medication-assisted treatment (MAT). Overall, they suggested NA involvement could be of potential benefit to people during MAT and as a source of post-MAT recovery support. But there are conclusions of a couple studies to take note of here.

Parran et al in “Long-term outcomes of office-based buprenorphine/naloxone maintenance therapy” conducted an 18-48 month follow-up study of opioid-dependent individuals and found that those who were still on buprenorphine/naloxone (bup/nx) at follow-up (85 of 110, 77%) were more likely to report abstinence from opioids and improvement on many quality of life measures. The major reason for discontinuing bup/nx maintenance was repeated evidence of substance use or the “failure to fully adhere with the abstinence based 12-step treatment.” White and others said the primary reason individuals discontinued medication maintenance in the study was the perceived incompatibility between MAT and 12-Step philosophy. But it seems to me another way of understanding why some individuals discontinued MAT was because they found themselves unable to maintain abstinence on MAT. Paran et al said: “Thus improved psychosocial functioning in bup/nx maintained patients was likely due to their marked decreased rate of substance use and not solely due to the bup/nx.”

There certainly is an incompatibility between MAT and NA 12-Step philosophy, but it was not clear if Paran et al tracked NA participation distinct from other 12-Step groups (which includes Methadone Anonymous, established in 1991), as they identified the 12 Step outcome variable as: “AA affiliated.” It was also not clear to me from their discussion if the researchers were even aware of how their blending of all 12 Step attendance into “AA affiliated” failed to distinguish this important nuance.

Monaco et al studied the effects of 12-Step participation on individuals treated for opioid dependence with buprenorphine in “Buprenorphine treatment and 12-step meeting attendance.” They found that despite the potential for philosophical conflicts between 12-Step groups and buprenorphine maintenance treatment (BMT), greater 12-step meeting attendance was associated with superior abstinence outcomes. In the six months after starting treatment, only 14% reported attending 5 or less NA meetings over the previous six months. However, only 33% reported disclosing their BMT status to an NA member. Of the participants who did disclose their BMT status, 26% reported that someone at NA encouraged them to stop taking buprenorphine or decrease their dose.

Qualitative data through semi-structured interviews of participants in the study indicated they were told by some in NA that the use of buprenorphine was a “crutch”; taking buprenorphine meant they weren’t “clean.” The typical view was that genuine clean time cannot be accumulated if you are taking buprenorphine, even if you are otherwise abstaining from all illicit drugs. Monaco et al said this presents a significant barrier for buprenorphine patients who find they benefit from both NA and BMT. But this conclusion failed to consider the historical context within which NA came into being. See “The Birth and Near-Death of Narcotics Anonymous” for more information on the origins of NA.

While this view may be a barrier, Monaco and others failed to acknowledge how buprenorphine has a dependency potential. It is not a neutral substance when it comes to how NA has historically unpacked “our addiction” in its First Step and described “the disease of addiction” in its literature. This means that NA is being implicitly asked to fundamentally blur how it defines being “clean” and confuse what it means by recovery from the disease of addiction. Pointing to the barriers MAT individuals encounter when they attend 12-Step groups and lamenting how they are stigmatized when told they aren’t “clean” (if they continue to use a MAT drug) seems to miss the point. The reality of buprenorphine and methadone as Scheduled substances with a defined abuse or dependency potential has to be acknowledged and addressed, but in most cases is ignored.

However, until that time, there are a couple of strategies identified by Monaco et al that can be used by BMT individuals who find value in attending NA meetings. The first one is to draw a clear, strong distinction between the use of buprenorphine and the abuse of other drugs. “This distinction is primarily based on two properties that separate BMT with substance abuse: 1) understanding buprenorphine medicinally, and 2) specifying the process of taking and acquiring buprenorphine through legitimate (and legal) channels.” Another strategy is to seek out 12-Step groups receptive to MAT, where there are others who take buprenorphine. This provides strength as a collective of similar others. “Despite the potential for philosophical conflicts between 12-step groups and BMT, greater 12-step meeting attendance during the first 6 months of treatment does not precipitate early treatment discontinuation and is associated with superior abstinence outcomes.”

The global expansion of NA has roughly paralleled the rise of the opioid epidemic and the addition of buprenorphine to the MAT arsenal in 2003. These three intertwined circumstances have intensified the debate over medication assisted treatment and recovery and seems to have immobilized our ability to move beyond the debate. Using rhetoric like “crutch” when referring to MAT users or saying the NA member who thinks someone who uses such language is “stigmatizing” perpetuates the polemic split of like-minded individuals into sides of medication haters and medication advocates. Even this distinction has a subtle categorization of individuals into the negative connotation of “haters” and the more sympathetic “advocates.”

William White, one of the coauthors of “Narcotics Anonymous: Its History and Culture” and “We Do Recover,” has tried for a long time to get a dialogue going between the pro-MAT and the anti-MAT groups. In an attempt to create that bridge, he wrote “From Bias to Balance: Further Reflections on Addiction Treatment Medications.” His advice there needs to be heard and acted on: “The key is our ability to objectively portray the potential value and risks of ALL treatment and recovery support options so that affected persons can make informed choices.” He called for rigorous, sustained personal, scientific and clinical investigation. “It also means that any initial distrust of medications from members of recovery communities should be respected by recovery advocates as grounded in the experiential knowledge of those communities.”

I think first there should be an acknowledgement of the value of buprenorphine as a treatment for opioid use disorder. There should be an investigation of its risks in MAT that begins by viewing buprenorphine through the lens of drug-centered action, as articulated by Joanna Moncrieff. Serious, sustained clinical investigation of the possibility of medically supported tapering for buprenorphine needs to be investigated. See the following articles for further interaction with William White’s “From Bias to Balance” and the application of Joanna Moncrieff’s thoughts to buprenorphine assisted recovery: “The Complexities and Limitations of Buprenorphine, Part 1” and “The Complexities and Limitations of Buprenorphine, Part 2.”

09/1/20

The Birth and Near-Death of Narcotics Anonymous

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In “We Do Recover” William White and others reported that in the beginning of 2020, there are 71,000 weekly Narcotics Anonymous (NA) meetings in 144 countries. The number of NA meetings worldwide has more than doubled in the past 15 years. Unlike Alcoholics Anonymous (AA) for alcoholics, it was not the first self-help group for addicts. The current NA was not even the first self-help group for addicts called Narcotics Anonymous. And there was even a brief time in the fall of 1959 when NA as we know it today stopped having meetings.

In “Narcotics Anonymous: Its History and Culture,” William White, Chris Budnick and Boyd Pickard said the history of the birth and near-death of NA is best understood within the cultural context of the 1950s. They said this was a time when the idea of “good” drugs like alcohol, tobacco and caffeine, and “bad” drugs like heroin and cannabis, became “fully crystallized.” There was a post-World War poly-drug epidemic in the hip youth culture surrounding jazz musicians and some well-known entertainers. Then during the late 1940s cocaine use became more widespread. “As one observer pointed out, heroin use spread from street corner to street corner very much like an infectious disease epidemic.”

Social panic triggered harsh new anti-drug laws. Known addicts were arrested for “internal possession” and prohibited from associating via “loitering addict” laws. Any gathering of recovering addicts for mutual support was subjected to regular police surveillance. Mid -century treatments for addiction included electroconvulsive therapy (“shock treatment”), psychosurgery (prefrontal lobotomies), and prolonged institutionalization. This is the inhospitable soil in which NA grew.

The mid-thirties birthed AA and the opening of the first federal “Narcotics Farm” (prison hospital) in Lexington, Kentucky. Houston S., who found permanent sobriety within AA in June of 1944, became interested in helping AA members with dual problems with alcohol and drugs. When his company transferred him to Frankfort Kentucky, which is just 29 miles from the Narcotic Farm, he called upon the medical director of the hospital and proposed starting a group similar to AA for addicts. The first meeting was held on February 16, 1947 and the members christened themselves Addicts Anonymous. By 1950, Addicts Anonymous had 200 members at the hospital.

Danny C. finally achieved sustained recovery on his eighth admission to the Lexington facility in 1949. Following his discharge, he started an Addicts Anonymous group in New York City. “He called the new group Narcotics Anonymous (NA) to avoid the potential confusion of two AAs.” New York NA and the Lexington-based Addicts Anonymous received considerable publicity in prominent newspapers like the New York Times and magazines like the Saturday Evening Post, Time and Down Beat Magazine. The NA created by Danny C. and others did not exist as an organized fellowship, rather they were isolated groups connected by a common service structure. Some groups even chose names other than Narcotics Anonymous. The NA groups formed under the original leadership of Danny C. dissipated by the early 1970s in the wake of harsh new anti-drug laws and the death of Rae L., who led New York NA after Danny’ C.’s death in 1956.

Betty T., a nurse who had left treatment at the Narcotics Farm in 1950, started to correspond with Houston S., Danny C. and Bill W. about starting a support group for “pure addicts,” but did not think she was the one to do it. Among her reservations with New York NA was their failure to adhere to the Twelve Traditions, particularly Tradition Eleven on anonymity, and their minimization of the problems posed by alcohol: In a letter to Bill W. she said: “They do not stress the danger of alcohol as a substitute for drugs!” She did host a special closed meeting in her home that was called “Habit Forming Drugs” for AA members who were recovering from other drugs.

Tension around the issues of addicts attending AA meetings eventually led to the Habit Forming Drugs group being removed from the AA world directory. Bill W. was in correspondence with several people besides Betty T. who were trying to start a support group for “straight addicts.” He eventually wrote an article for the February 1958 issue of the Grapevine, “Problems Other Than Alcohol: What Can We Do About Them?” White, Budnick and Pickard said by clarifying the boundaries AA’s primary purpose, it set the stage for the development of a distinct NA fellowship. When he was repeatedly asked for guidance in starting groups for “mainline addicts,” Bill suggested that “bridge members” (AA members who were recovering from drug addiction) could serve as catalysts for such a group.

And that is what happened. In the middle of June in 1953, there was an NA meeting at the Unity Church on Moorpark Street in Van Nuys, CA. One of the AA members attending was Jimmy K., who is widely considered to be the founder of NA as it exists today. Jimmy K. introduced himself as an “alcoholic addict” from the time he began attending AA in 1950. He attended early meetings of Habit Forming Drugs and communicated with Danny C. in New York. Then on August 17, 1953, Jimmy K. and five others held an organizational meeting and formally organized Narcotics Anonymous, stating in its bylaws that any group could use the NA name as long as they followed the 12 steps and 12 traditions of Narcotics Anonymous. The NA bylaws, approved on August 17, 1953, included the following Purpose statement:

This is an informal group of drug addicts, banded together to help one another renew their strength in remaining free of drug addiction.Our precepts are patterned after those of Alcoholics Anonymous, to which all credit is given and precedence is acknowledged. We claim no originality but since we believe that the causes of alcoholism and addiction are basically the same we wish to apply to our lives the truths and principles which have benefited so many otherwise helpless individuals. We believe that by so doing we may regain and maintain our health and sanity. It shall be the purpose of this group to endeavor to foster a means of rehabilitation for the addict, and to carry a message of hope for the future to those who have become enslaved by the use of habit forming drugs.

There were significant differences between the New York and California NA groups. New York NA had more morphine or heroin addicts and it had minimal concern about alcohol. Despite being in New York, it also had little contact with AA. The California founders of NA had histories of alcohol and other drug addictions, prior affiliations with AA and emphasized strict adherence to the Steps and Traditions adapted from AA. “When NA groups veered from those principles, those so-called ‘bridge members’ left NA and returned to AA.”

There was considerable debate over how to phrase the NA Steps. Jimmy K. was able to prevail in getting the phrase “our addiction” inserted in the First Step rather than alternatives like alcohol and drugs, drugs, or narcotic drugs. NA Trustees would later look upon this wording as a masterful stroke: “The one thing we share is the disease of addiction. . . With that single turn of a phrase the foundation of Narcotics Anonymous Fellowship was laid.” Instead of centering their institutional identity on a single drug, as AA did, New York AA and other 12 Step groups that followed, NA focused attention on the shared process of addiction.

This had three significant effects. First, it resolved the frequent issue of drug substitution by embracing the renunciation of all drugs, including alcohol, within recovery. Second, it opened the potential for people to enter NA with drug choices other than opiates. Opiates were the primary dug of choice by New York-based NA, and the early members of California NA. Third, it specifically defined addiction as a disease, and the addict as a sick person.

White, Budnick and Pickard said NA’s definition of the problem as a process of “addiction” that required a common recovery process and transcended your drug of choice may be one of the great conceptual breakthroughs in the understanding and management of alcohol and other drug problems. This was all the more amazing as it came at a time when substance-specific disorders were all thought of as distinct from each other. It also anticipated future scientific findings that “addiction to multiple drugs is linked to common reward pathways in the brain.” Jimmy K. made a remarkable conceptual leap that deserves wider recognition today within the scientific and treatment communities. As it was expressed by an early NA member: “It really doesn’t matter whether you’re strung out smoking reefer every day or you’re shooting a couple thousand bucks of heroin a week. It’s about addiction—drug addiction.”

The contemporary emergence of “addiction” and “recovery” as conceptual frameworks for the professional field of addiction treatment and as frameworks for the larger cultural understanding of severe alcohol and other drug problems and their resolution is historically rooted in NA’s formulation of its Twelve Steps in 1954. However, this breakthrough did not assure NA’s survival as an organization.

Between 1953 and 1958, the young California NA group faced severe problems from internal dysfunction and personality conflicts. Jimmy K. later said: “So, the very first meeting, it wound up, oh God, it was a riot. Everybody was fighting with each other. Within two weeks, we only had one or two people left of the original group.” By 1959, the only NA meeting was at the North Hollywood Inebriate Asylum, known as Shier’s Dryer. A critical turning point was reached when Cy M. and another member, who was suspected of being loaded, appeared on a television show in the fall of 1959. As a consequence of the discord that resulted, NA meetings stopped for a time.

Jimmy K., Sylvia W., and Penny K. met in late 1959 and sought to see if they could rekindle NA. There were no existing members, no money in the treasury and no literature. NA was reborn when they started the Architects of Adversity Group at Moorpark, later known in NA as the “Mother Group.” One of early NA’s long-term members said every time he’d come back to the group after another time of using, “Jimmy always seemed to be the one who was standing there with the door open saying, ‘Come on in and have a cup of coffee.’”

NA learned painful lessons through its near-death experience, including the dangers of relying on a single, dominant leader, the risks of abandoning adherence to NA Traditions, and the need for a distinctive NA culture. NA was reborn in late 1959 with those lessons in mind. NA’s near-death experience cleaved its history into “before” and “after,” with the phrase “NA as we know it today” used to denote the new NA that rose in 1959 from the ashes of the old. As earlier members returned and new members joined, NA began its slow growth into the present.

For more information on the history of Narcotics Anonymous, see “Growing Pains with Narcotics Anonymous.”