Abstract:
Narcotics Anonymous, an international, community-based association of recovering drug addicts, provides peer support to other addicts who desire a drug-free outcome. We strive to cooperate with professionals such as therapeutic communities and other organizations with similar goals. This paper identifies key factors affecting NA's interactions with others, points out means by which professionals can contact Narcotics Anonymous, long-established means of direct interaction between NA and professionals, a number of strategies to facilitate client/resident introduction and entry into Narcotics Anonymous, and a description of what clients will find when they attend NA meetings and meet NA members. The paper addresses a number of areas where professionals may encounter difficulties in relating with Narcotics Anonymous, and closes by identifying ways to resolve any problems that may arise when interacting with NA.

Narcotics Anonymous is one of the world's oldest and largest associations of recovering drug addicts. The NA approach to recovery from drug addiction is completely nonprofessional, relying on peer support. We believe the NA program works as well as it does primarily because of the therapeutic value of addicts helping other addicts. It is an ideal aftercare support network for clients who wish to pursue and maintain a drug free outcome no matter where in the world where they live.

Narcotics Anonymous is organized locally as self-governing, self-supporting groups adhering to a common set of principles, adaptations of the Twelve Steps and Twelve Traditions of Alcoholics Anonymous. Local NA groups are organized worldwide via NA's international delegate assembly, called the World Service Conference, and secretariat, the World Service Office, headquartered in Los Angeles, USA.

The first Narcotics Anonymous meeting was held in 1947 in Lexington, Kentucky, as part of a USA federal public health hospital program. An independent, community-based group using Lexington principles that was formed in Los Angeles in 1953 became the root of today's Narcotics Anonymous. Today, Narcotics Anonymous has approximately 20,000 registered weekly meetings in 70 countries around the world, the greatest concentrations being in the USA (16,000+) and in Canada, Latin America, and Western Europe (1,000 each). NA communities have been developing in the Asia Pacific Rim over the last 5-10 years.

A framework for NA community engagement
The Narcotics Anonymous commitment to community partnerships can best be understood within the context of NA's Twelve Steps and Twelve Traditions. Our Twelfth Step for personal recovery encourages every individual NA member to try "to carry [the NA recovery] message to addicts". Among our Twelve Traditions are certain guiding principles for NA's engagement, as groups and as an organization, with others in the
community:

• Our mission as an organization is to communicate to addicts in the community that we may be able to help them learn to live drug-free, recover from the effects of drug addiction, and establish stable, productive lifestyles.
  
• Our public relations activities strive to attract addicts to Narcotics Anonymous without being overtly or unduly promotional.
  
• Our membership is open to anyone who wants to stop using drugs, regardless of the particular drugs they have used. There are no social, religious, economic, racial, ethnic, national, gender, or class-status membership restrictions.
  
• We maintain a policy of "cooperation without affiliation" in our inter- organizational relations. This policy allows us to work with others in the community without becoming involved in a manner, which might distract us from our mission. This means that:
  
• We will neither endorse nor oppose other organizations or approaches to the problems associated with drug addiction.
  
• We can not allow other organizations to use the Narcotics Anonymous name for their programs.
  
• We will not provide funding for other organizations, nor will we accept funding from outside our own organization.
  
• We will take no position on any public issues, even those related to drug addicts or addiction.

Narcotics Anonymous has only one mission: to provide an environment within which drug addicts can help one another stop using and find a new way to live. We are not an anti- drug or prohibitionist organization, nor do we take any position concerning decriminalization or legalization. We are neither for nor against free-needle-and-syringe exchange programs, drug-replacement clinics, or other efforts to reduce drug-related harm. We will work with anyone to provide their clients with our services, without interfering with their therapeutic regimen or client relationships. We encourage anyone who interacts frequently with Narcotics Anonymous to become familiar with our book on the Twelve Steps and Traditions, It Works: How and Why. It is available from our World Service Office.

Means of contact with NA
There are two points of contact with Narcotics Anonymous at the local level: NA groups, and NA service committees. Narcotics Anonymous groups hold the actual recovery meetings where drug addicts interact with one another. Our service committees coordinate volunteer activities for a number of NA groups in a community, district, or country.

There are three ways to make contact with local NA groups and committees:
1. Many NA communities have telephone contact services. Their numbers are usually listed in the NA Phoneline Directory, available from our World Service Office. Local telephone contact numbers are also often listed in the local telephone book or through the telephone company's directory assistance service under the name "Narcotics Anonymous."
2. Local NA chapters that have been in existence for some time usually publish local meeting directories that show the days, times, and places where Narcotics Anonymous groups meet and sometimes give additional information about specific meeting formats. You can get a local meeting directory either by visiting an NA meeting or by calling the local NA phoneline.
3. If no means of contacting local NA groups or committees can be found, contact our World Service Office (USA). Using the worldwide group and committee registration information we maintain for our fellowship, we will be able to tell you how to contact the nearest NA community.

There are two basic kinds of Narcotics Anonymous meetings. Anyone from the community may attend an "open" meeting to see for themselves what Narcotics Anonymous is like. "Closed" NA meetings, however, are meant for attendance by addicts only. Be sure to ask the phoneline contact or check the meeting directory to see whether the meeting you are planning to attend is "open" or "closed" before visiting.

Direct NA interaction with professionals and the community:
Narcotics Anonymous communities have two primary ways in which they regularly interact directly with professionals and the community. NA public meetings are sometimes held to present NA on a broad scale to an entire community. Local NA 'public information' committees also make regular presentations to community organizations, treatment administrators and clinical staff, policy makers, and researchers.

One direct contact between NA and professionals is in the Narcotics Anonymous meetings that are sometimes started by non-addict treatment staff, health care professionals, social workers, educators, and others. We encourage professionals to support Narcotics Anonymous in their local communities and to start NA meetings in communities where there is no Narcotics Anonymous as yet. However, we have two cautions to offer in regard to such meetings:

We ask that NA meetings started by non-addict professionals be turned over to the addicts themselves as soon as possible. One of the key reasons Narcotics Anonymous works as well as it does as an organization is its independence. New NA members should be encouraged to take responsibility for their own NA meeting as quickly as they can, without compromising the stability of the meeting. The professional who started the meeting should then take an outside support role in relation to the new NA group, thus empowering this new NA group.

When NA meetings are held on the grounds of a treatment facility or in a professional's offices, special care should be taken to explain the distinction between the facility and Narcotics Anonymous. It serves everyone well to maintain the distinction between professional therapeutic facilities and NA's nonprofessional, addict-to-addict approach to recovery. When an NA meeting is held in a treatment facility or a therapist's offices, some explanation should be made to those attending that the NA group is simply meeting there but is not a function of the facility or therapist.

Client/resident interaction
In local communities where Narcotics Anonymous is fairly well established, we offer a number of services designed to make for easy interaction between your clients and our fellowship.

Local service committees regularly organize panel presentations of the NA program for client groups , correctional inmates and residents in residential facilities. These are organized by "hospitals and institutions" committees and are known within NA as "H&I panels." If you would like an H&I panel conducted for your clients/residents, call the local NA phoneline and ask for a return call from the H&I committee chairperson to make arrangements.

Narcotics Anonymous meetings welcome visits from your client groups/community, in fact, our literature says that "the newcomer is the most important person at any meeting." If you would like to take a client group or some residents to visit an NA meeting, just call your local phoneline and find out when and where the nearest meeting is being held. If you are bringing a large group, you may want to ask the person answering the phoneline whether the meeting you are considering will be able to accommodate your group.

Many Narcotics Anonymous meetings are accustomed to identifying some person who will sign attendance verification cards for persons in outpatient treatment or on judicial referral. You should be aware that at some NA meetings, the person signing the card may take a special effort to emphasize to the client that this is being done as a service to the client, not because of some direct affiliation between your organization and Narcotics Anonymous or between Narcotics Anonymous and the judicial system. You should also be aware that in other NA meetings, it is not customary to sign attendance cards because of the local perception that doing so creates too great an appearance of affiliation between NA and other organizations. If you have any questions about this service, you should call the local NA phoneline. If the person on the line cannot answer your questions, ask them to have either an ASC (area service committee) or RSC (regional service committee) officer or the public information committee chairperson return your call.

If you have sufficient confidence that Narcotics Anonymous could be helpful for your residents/clients, you can encourage them to ask experienced NA members "sponsors" to help them engage in our recovery program All they need to do is listen carefully at NA meetings until they hear someone with whom they identify, preferably someone of their own gender. Once they've found someone, they should ask that person if they can talk further with her or him. If all seems well, they should then simply ask that person to sponsor them. The person may decline, perhaps because they are already sponsoring a number of people, perhaps because they do not feel ready for the responsibility. If they accede to the request, the sponsor will help your client work through NA's Twelve Steps and offer her or his own experience as a backdrop to the NA program; these are the only services offered by sponsors qua sponsors. Sponsors do not charge any fees for the services they render their sponsees ( person being sponsored).

Finally, probably the most important service we can offer your resident/client is the environment of the Narcotics Anonymous group: a place where other drug addicts can offer first-hand hope of recovery to your client/resident based on their own direct, personal experience. The NA group atmosphere is intensely social; if your client has difficulties in this area, you may want to specially prepare him or her for the first NA meeting. Once your client has made a firm connection with a NA group, usually by attending that group's meetings regularly for a number of weeks, your client will be able to count on twenty-four-hour personal support from NA contacts made in the meetings. Narcotics Anonymous members not only expect requests from newcomers for such help, they actively encourage these requests, seeing their work with new members as integral to their own recovery.

NA membership silhouette
Who will your client meet when she or he attends an NA meeting? Unfortunately, we cannot give you a detailed demographic profile on the NA membership in your particular country today. We do have some information, however, from an informal poll taken in 1989 of 5,000 Narcotics Anonymous members and a pilot survey conducted at our 1996 World Convention wherein a random sampling of 20% of the 7,117 registered attendees (N=1091) completed surveys. The information derived from both have limitations in terms of generalizability and selection biases, however they may be helpful in providing a "silhouette" of our membership. Of interest for this presentation is the following:

1989 Poll:
Age
· 11% of our members are under 20
· 37% are between 20 and 30
· 48% are between 30 and 45
· 4% are over 45

Gender
· 64% of our members are male
· 36% are female

Initial referral
· 47% of our members were introduced to Narcotics Anonymous through a treatment facility or while incarcerated
· 29% were introduced to NA through another member
· 24% were introduced by a community professional (doctors, attorneys, clergy, judges)

1996 Survey:
Age
· Average age was 37, with an age range from 16 to 69 years.

Gender
· 58% of respondents were male
· 42% of respondents were female

3 entities most influential in deciding to attend the first NA meeting:
· 48% of our members identified a treatment facility as one of those entities.
· 51% identified another member
· 10% identified jail or other correctional facility
· 20% identified a community professional (doctor, attorney, clergy, judge)

Different types of NA meetings
There are a number of kinds of Narcotics Anonymous meetings. When referring a client to NA, you may want to inquire about these factors first. Meetings vary in:

Format: Some of the formats of which we are aware are open discussion, topic discussion, newcomer meetings, and studies of NA literature.
Size: Some are large (100 or more); some are very small (5 or less).

Smoking: Some meetings have tobacco smoking; others do not.
Special focus meetings: Some meetings are intended specifically for women or for men. Some meetings are targeted especially at lesbians and/or gay men. Other meetings have their own special focus, intending to offer extra identification to those seeking a point of entry into Narcotics Anonymous.

Length of meetings. Most meetings of which we are aware are either sixty or ninety minutes in length.

Degree of participation expected. Speaker meetings require almost no participation; discussion meetings may require some, though not everyone is asked to participate in the larger meetings.

Open/closed meetings. As we discussed earlier, some NA meetings allow non-addicts to attend, though usually not to participate. Only at closed meetings can your client count on finding addicts only.

Potential difficulties between the NA program and your treatment regimen
There are a few points where the Narcotics Anonymous program, or the local variety thereof, may conflict with your treatment philosophy. Rather than evade these points, we prefer to state them in the open so that you can make informed decisions about referring clients to Narcotics Anonymous.

Disease concept. Narcotics Anonymous views addiction as a disease. We use a very simple, experience-oriented 'disease concept'. We do not qualify our use of the term "disease" in any medical or specialized therapeutic sense, nor do we make any attempt to persuade others of the correctness of our view. The 'disease concept' works well as an analogy by which our members can understand their condition: We believe addiction can be "arrested" but not "cured." Untreated, addiction has effects similar to a disease.

Total abstinence. The experience of our members has been that total, continuous abstinence from all drugs has provided them with a reliable foundation for recovery and personal growth. However, abstinence is not in itself the sole goal of our members; more importantly, we seek a comprehensive change in attitude and lifestyle. "Relapse" is seen as a sometimes "necessary" part of the overall addiction/ recovery process for many individuals. Relapsers are not "shamed" but are encouraged to pick up the pieces, learn from their experience, and move on.

Narcotics Anonymous views alcohol as a drug, and we find the "drug of choice" designation irrelevant to our program since we focus on the disease of addiction itself, not any particular drug or drugs. The use of psychiatric medication and other medically indicated drugs prescribed by a physician and taken under medical supervision is not seen as compromising a person's "clean time."(i.e. drug free time). Regarding the use of nicotine and caffeine, members are encouraged to consult their own experience, the experience of other members, and qualified health professionals.

Other twelve-step programs. Narcotics Anonymous makes a clear distinction, based on very different program goals, between itself and other anonymous fellowships, for instance, Alcoholics Anonymous and Cocaine Anonymous. The primary distinction is noted in our First Step; in being powerless over our addiction, not merely a specific substance.

Some anti-professional sentiment. Though NA as a movement takes no such position, we have noted that some Narcotics Anonymous members bear some antagonism toward professional therapists and psychotherapeutic concepts. We cannot speculate on the reason for such antagonism. Thankfully, this antagonism is not an overwhelming feature in the life of the NA groups where it can be found.

Spirituality. The Narcotics Anonymous program has a distinctly spiritual orientation, with a theistic bent to most of our literature. We are neither sectarian nor religious, but we are not antagonistic toward organized religion, at least not as a movement. Some of our members, however, are atheists, agnostics, and/or anti-religious.

Problems with local organization? It is quite possible that, if you have a long-term association with Narcotics Anonymous, you or your clients may run into a problem with NA members sooner or later. If you do, we suggest that you contact the local NA phoneline as we have already indicated and ask for an ASC or RSC officer or the PI chairperson to give you a return call so that you can discuss the matter with them. If you do not succeed in contacting anyone in a responsible position in the local NA community, feel free to contact our World Service Office. The world office may be able to untangle a communication knot or mediate a dispute for you.