AA’s main text, the so-called “Big Book” (its real title is: Alcoholics Anonymous7) has a chapter titled, “We Agnostics.” AA has many long-time members who have found support in the fellowship but never “found God” or a belief in a higher power other than the fellowship itself. These secular 12-step members demonstrate one of the many ironies of AA and NA—that spiritual fellowships can work even for individuals who reject spirituality.
Patients who resist spirituality are advised to “take what you can use” from the fellowship and “leave the rest.” While 12-step members will propose that the newcomer keep an open mind about spirituality, patients should also be assured that a seat is always waiting for them, regardless.
Whether your patient smokes
Most 12-step meetings today are smoke-free, not because of enlightenment within the fellowships but because meetings are usually held in churches, synagogues, and health care facilities where smoking is banned. The perception that attending 12-step meetings can be harmful to your health is out-of-date. Nonetheless, because most meetings have banned smoking, the few in which smoking is allowed are thick with smoke.
In general, 12-step clubhouses are among the holdouts where smoking is allowed during and after meetings. A clubhouse is typically a storefront rented or acquired by AA/NA members where meetings are held around the clock. Given the evidence that quitting smoking may improve overall health,10,11 patients should be encouraged to begin their involvement in smoke-free fellowships, which are identified in 12-step directories.
Your patient’s drug of choice
As its name implies, AA is intended for persons who desire to stop drinking. In practice, however, much of AA’s membership is addicted to more than one substance, and—in some cases—the drug of choice might not be alcohol.
Narcotics Anonymous—contrary to what its name implies—is for individuals addicted to any drug, not just narcotics. Patients generally should be advised to join the fellowship (AA or NA) that best matches their substance use history. There is, however, at least one exception that might best be illustrated with an example:
After I recommended NA meetings to a middle-class nurse addicted to analgesics, she returned for her next appointment quite angry. She attended three different NA meetings, and “all of the members were either heroin or crack cocaine addicts.” It seemed to her that all of them were on probation or parole. She was very uncomfortable throughout the meetings and upset with my recommendation.
In matching patients with meetings, socioeconomic and cultural factors take precedence over biochemistry. At the neuronal level, a nurse addicted to analgesics has a lot in common with a heroin addict, but her ability to relate to another recovering person—particularly in early recovery—may be limited. Arguing with my patient or countering that other nurses were probably at the meetings she attended would not have eased her reluctance to return to NA or helped our therapeutic alliance.
NA meetings are generally attended by individuals addicted to illicit drugs: amphetamines, crack cocaine, cannabis, and heroin. In larger cities, other 12-step fellowships may focus on specific drugs, such as cocaine, but these are rare. Just as individuals addicted to prescription narcotics are a minority in the treatment population, they are also a minority in NA.
For this reason, our prior recommendation—to match patients to meetings based on socioeconomic status—applies. It’s good policy to recommend that patients addicted to prescription medications try both AA and NA meetings and decide where they feel most comfortable.
The third tradition of AA states, “the only requirement for AA membership is a desire to stop drinking.” Though a purist might suggest that our analgesics-dependent nurse should join NA, her need to connect culturally with similar persons in recovery argues strongly for her to blend in at open AA meetings. A social drinker who never fulfilled the diagnostic criteria for alcohol dependence, she will have a better chance of abstaining from analgesics if she abstains from alcohol as well. For this reason, she should qualify for AA membership because she does, in fact, have “a desire to stop drinking.”
Some professionals addicted to prescription drugs will feel at home in NA meetings, whereas others will react as my patient did. Having access to a 12-step contact person who knows about the demographics of local NA meetings can help you make the best patient/meeting match.
Related resources
- Alcoholics Anonymous. www.alcoholics-anonymous.org
- Narcotics Anonymous. www.na.org
- Alanon-Alateen. www.al-anon.org