The Future of AA, NA and Other Recovery Mutual Aid Organizations

Bill White’s latest is up on Counselor Magazine’s website. Two of the most interesting moments come in a section on the “Emerging science of recovery”

Science also will spark controversies by challenging prevailing beliefs of recovery fellowship members. Research on the potential value of medication-assisted recovery is challenging and softening many AA members’ views about medication. One of the most controversial issues within NA in the coming decade will be the science-driven push to re-evaluate local group policies on methadone and other medications (e.g., denial of the right of more than 265,000 persons in methadone maintenance in the United States to speak at NA meetings, chair a meeting, or head a service committee—even by individuals with prolonged stabilization, no secondary drug use, and achievement of global health and positive citizenship.) Some will attempt to avoid this debate by declaring that scientific studies on methadone maintenance are an “outside issue,” but the growing weight of science will exert enormous pressure on NA as an institution, as it will all recovery mutual aid fellowships.

All recovery mutual aid societies will be scientifically evaluated in the coming decades on such dimensions as accessibility, attraction, engagement (affiliation and retention rates), short- and long-term effects on the course of AOD problems, effects on global health and functioning and the potential social cost offsets from such participation. Some groups will face this scrutiny and actually achieve heightened scientific credibility (as has happened with AA in the past decade); others will not withstand the effects of such scrutiny.

An issue most critical to the survival of recovery mutual aid groups is the question of how long members should continue to participate. While 12 Step fellowships have implicitly encouraged sustained if not lifelong participation, many of the alternatives to 12 Step Fellowships do not expect sustained member participation. Among the latter, members are expected to avail themselves of sufficient support to initiate stable recovery and then leave and get on with their lives.

Science is actually revealing that this latter position may work at an individual level. Recent studies of AA reveal a population of positively disengaged individuals who initiated recovery within AA, then later ceased active participation but continued to sustain their sobriety and emotional health over time (Kaskutas, Ammon, Delucchi et al., 2005). An interesting outcome of this finding is that the actual societal impact of AA may have been grossly underestimated, as its contributions have generally been measured by its active membership numbers—a figure that ignores the existence of this larger community of people positively affected by but no longer actively participating in AA. The same is likely true for other recovery fellowships.

Interestingly, the “participate as long as and for only as long as you need to” policy may work at a personal level for many individuals but may doom a recovery mutual aid group’s organizational viability. The future of any recovery mutual aid organization rests on its leadership development and long-term meeting maintenance capacity. The personal recovery outcomes of a recovery support group will not always distinguish those groups that will survive and thrive from those that will stagnate and die or regress to the status of a small ideological cult or commercial platform.

5 thoughts on “The Future of AA, NA and Other Recovery Mutual Aid Organizations

  1. 12 Step Programs are like any other human society–it either grows and adapts or fades into obsolescence. You go to a meeting and most of the people you see are between 1 and 3 years abstinent. There's a significant but smaller number between 3 and 5. Smaller yet from 5 to 10, and really drops off after 10. The conclusion could be that the programs really don't work, and hardly anyone stays clean and sober longer than 10 years, or there is a large number of people in recovery who have slowed down or stopped their involvement in 12 Step Programs. I think we all know the answer–but no one wants to tell the newcomer!

  2. I'm a great fan of Bill White's thinking and writing. At times he challenges my beliefs. This is one of those times.I think there is no doubt that many benefit from membeship of the fellowships and then move on. Of course not having to use drugs any more is only one of the benefits. Those hanging around long term may also benefit from altruism, community and social connectedness and a sense of meaning and purpose.I am uneasy with the idea that those on long term methadone have a "right" to attend/speak at meetings etc. I know this is not based on any other evidence than that of my own eyes, but where I am, we don't see large numbers of poeple on methadone in recovery.The majority top up with other drugs, are not working, are on welfare, continue to engage with communities of addiction and generally have low aspirations. Of course we could argue that that's not the fault of the methadone, but of the services which go with it, but are we really happy to accept that hundreds of thousands of people can only get through life on long term sedation? Do we not still need support groups for those who set the goal of abstinence from illicit and licit drugs? Surely it is legitimate to do this and we need to be very careful before we suggest that NA's reluctance to accept folk on methadone as being in full recovery is prejudice. I don't see that written here, but it doesn't feel very far away. I don't like the implication here that the science is the issue and that NA folk just need to believe it and all will be well. There is a spiritual element to recovery and the principles of recovery which science stuggles to get to grips with.Difficult stuff and we need to see a debate.

  3. Bill and I have spoken about this several times. I have similar reservations to yours. He has enough respect for the traditions that he has no illusions that these decisions belong to anyone other than NA groups themselves. He just sees it as a coming storm.I think you will soon find your beliefs challenged even more. He's written a few more papers that I believe will be published soon.Here are few of my thoughts in response to these papers:As you might imagine, I've been experiencing a little dissonance over it. I suppose that's the goal.I don't mean this in a facetious way at all, but it's a little like you're describing a unicorn. I can imagine it, it seems intellectually possible (maybe even probable), but I've NEVER seen it and I don't know people I trust who have–until you. Based on our conversations, I'm willing to believe that it is possible and that it happens….This seems to be one of those areas where empirical knowledge and the experiential knowledge of many people who care deeply about the matter are in conflict. I think that there's a tendency to dismiss that experiential knowledge as a product of stigma, rather than the stigma being (at least, in part) being a product of this experiential knowledge.I get that this probably creates a vicious cycle of stigma limiting exposure and therefore biasing that experiential knowledge. I also get that poor treatment contributes to this. (I also recognize that there are plenty of bad abstinence oriented providers.)

  4. That's interesting: I mean that there is clear overlap on thinking here.There are so many directions my mind wants to run off in on the topics Bill White brings up here.If I stick with the evidence for the benefits of methadone maintenance treatment, then I stuggle in the UK to find it beyond the clinical studies, often done in rarified settings. The outcomes seem to me to be more imprtant to public rather than individual health.We have several clinical studies but when you ask the question "how many folk on prescribed methadone are achieving their goals", you struggle. We have no idea here how many get back into education and employmenT are able to fulfil their duties as partners, parents, sons and daughters and citizens. I've met folk in maintenance programmes who have got these things and more, but they are notable as exceptions. If I were asked on my experience I would say methadone as we do it here slows down moving to full recovery rather than facilitates it.I may be wrong.

  5. hi my name is zach and im an addict…i have seen many new members in the 2 years i've been clean. i have seen a few members with more time go out… and a good amount come back… i have stayed in contact with many members with less time then me who have left because they we're done and didn't need a 12 step fellowship, and every single one then went to use. meeting attendance goes down, the more productive of a member of society you become. but of course its true that the population of people with more time is smaller. BUT, the guy with 30 years sponsors a guy with 25 years and he sponsors a guy with 15 who sponsors a guy with 8 who sponsors a guy with 2. Now if everyone left with 3 years, then who would be left to sponsor, they steps dont take 12 days you know. whats more interesting to me is the # of people in a 12 step fellow ship who dont work steps… i should be working on my 6th step right now, but instead im on google reader reading about recovery… or in other words procrastinating. i have the upper hand being from LA where it all started with Jimmy K… yes who adapted the program from AA (no hate). the reason we don't speak about methadone is because it is against our traditions. are traditions keeps us from straying away from our primary purpose to carry the message to the addict who still suffers. and to carry doesn't mean to force it on them.Oh did i mention i was only 20. this shit works.but im only on step 6, and i know i have to work all 12 so i can show someone else… maybe it doesn't work maybe tomorrow i wake up and decide to use. or maybe i wake up tomorrow and decide a better life for myself, one that i obviously couldn't do on my own. oh and one more thing. i don't believe in god. i believe in science, i believe that we evolved from what ever, cavemen if you will… i will blindly follow science in where we came from. but i will not give up on recovery, i don't have to use again… even if i want to…. even if a doctor tells me i should…my grand sponsor says if they invented a pill that for 20 dollars you would stay high for the rest of your life and it didn't effect your productivity in society to take it. but its not the drug its not the high, its ME!I (me personally) don't think methadone clinics are a bad… i don't think free needles are good… i do think needle exchanges are good… i don't think someone on methadone can be in recovery yet… i think it can help the process along, what ever helps you to find the desire….THE ONLY REQUIREMENT IS THE DESIRE!not to stop using. not to stay clean…wow im fucking tired… acting out in old behaviors not going to bed (honesty) when i should… got to be at work tomorrow… and sell recovery to parents for ridiculous amounts of money. aka treatment center… but its a good job i love it.

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