NA and “understanding their reality”

I see professionals and advocates criticize Narcotics Anonymous (NA) on a near daily basis for their views on opioid agonist medications (methadone and buprenorphine), often referring to them as problematic, backwards, and complicit in the opioid overdose crisis.

The published guidance for groups is here and might be summarized as follows:

  • implying that people on agonist treatments may not be “abstinent”;
  • asserting that people on agonist medications should be welcomed in NA meetings; and
  • leaving it to groups to define “abstinent/recovery” and decide the roles people on agonist treatments can play in their group.

In the rush to condemn NA, I don’t see critics trying to understand their reasons.

This brought to mind something Isabel Wilkerson said [emphasis mine], “Empathy means getting inside of them, and understanding their reality, and looking at their situation and saying not, ‘What would I do if I were in their position?’ but, ‘What are they doing? Why are they doing what they’re doing from the perspective of what they have endured?'”


So, if we take Wilkerson’s advice (or Ta-Nehisi’s admonishment to practice a “muscular empathy”), what might we consider?

First, addicts formed NA in the context of neglect/abuse from helping systems that believed they couldn’t recover.

In a recent post, Bill White summarized some of that context:

Such treatment insults span bleeding, purging, and toxic, mercury-laden medicines in the 18th century. They include the fraudulent boxed and bottled home cures and the use of cocaine to treat morphine addiction in the 19th century. And they encompass the oft-lethal withdrawal procedures, prefrontal lobotomies, electro- and chemo-convulsive therapies, prolonged institutionalizations, and the harmful use of stimulants, sedatives, and anti-psychotic medications to treat addiction in the early to mid 20th century.

The Irrationality of Addiction Treatment

Further, many of the groups that are precursors to NA were formed in prisons.

Second, before the emergence of NA, many went to AA but were told that their needs were incompatible with AA’s singleness of purpose.

Simultaneously, another precursor to growth of NA was the experience of addict AA members who felt threatened by the overmedication (stimulants, sedatives and sleep aids) of other AA members.

So, these people who had been abandoned and abused by helping systems, whose cultural ownership had been relegated to criminal justice systems, created their own community to support each other and help others join them in their recovery.

More recently, it’s well-known that agonist misuse is common. (Professionals characterize it as instrumental use to avoid withdrawal. Patients in non-agonist residential treatment paint a more complicated story.)


Given this context, it’s not surprising that NA is relatively uninterested in the opinions of professionals telling them that they are doing it wrong. Particularly since NA members are not professionals and are simply a fellowship of people who have come together to share their path from addiction to recovery.

We might also imagine that this perceived contempt and condescension is experienced by NA members not as a 2019 reaction to a 2019 medical treatment, but as another chapter in a long history of professional neglect, abuse, domination, control, disrespect, and contempt.

Further, if groups like Medication Assisted Recovery Anonymous (MARA) were much more widely available, few would care what NA does or doesn’t do.

Given this, rather than criticize NA, a more productive use of time and energy might be to use NA as inspiration and as a model for facilitating the growth of groups like MARA. (Much like NA did with AA.)

2 thoughts on “NA and “understanding their reality”

  1. Hello Jason

    I must admit I am still a little confused as to where exactly you stand regarding the use of buprenorphine regardless

    I do feel NA deserves the heat being brought upon them, people who take MATs are regularly maligned in meetings, told to sit in the back, not hold service positions and that ‘they’ are not really ‘clean’

    Yes I understand the history of pharmas idiotic two bit alledged ‘cures’ like Bayers ‘Heroin’ and how well meaning (or not)
    Doctors often have made addicts lives hell by getting them addicted to say ‘benzodiazepines’ while they come in stressed out about some other addiction

    However in todays world this is getting more and more difficult with the availability of mass communication Doctor monitoring and regulatory oversight than ever before

    I have been on suboxone for 5 years I work, take care of my family, pay taxes and contribute to society I own a home and my quality of life is great

    Except that I cant go to a NA meeting without some yahoo nicotine use disorder overly caffeinated glucose abuser telling me ‘I’ am not ‘clean’ while brandishing a NA pamphlet “for those on methadone”
    -which isnt even suboxone fwiw
    but they have been to NAs website and read the pamphlet on MAT which says basically the same thing

    Whats even more frustrating is the ones who look down their nose in this way are usually unemployed and living in a sober living facility on MY tax dollars
    I am sorry Jason but if recovery is for everyone then it needs to be for ‘everyone’

    Human beings need/use drugs
    Thars just a fact, whether its insulin, nicotine, chaymameal, caffeine, glucose or whatever

    When NA realizes that each path to recovery is different and that SOME folks need MAT

    I abused opioids for 20 years of my life, my recepters are fried
    I relapsed constantly when not on methadone however I worked my backside off to lower my dose and try suboxone to see if it WAS a case of ‘low dopamine’ and guess what?
    It was so my 5 mg of suboxone keeps me from holding a service position or getting actively involved in NAs pick and choose programn of what drugs members can be on I find this very sad and yes I have seen people shamed out of meetings

    I am a stubborn SOB and will kerp foghting for those in recovery (yes their time counts)
    Who are on MATs

    The addict knows if he/she is recovering or lying.
    its between them and god

    We dont get to decide that based solely on what medication they are on

    NA needs to quit playing God

    Why cant we all get that quality of recovery you espouse without the stigma of the recovery community shaming those who have got their life together but are excluded from a valuable resource?

    Thank god I at least dont allow these morons at NA meetings run my programn
    And thank god for AAs pamphlet on prescription drugs

    “We are not Doctors”

    Well niether is NA or most of its members

    -Marty

    1. Here’s where I stand.

      I wish you continued success and I hope that advocates and treatment providers invest their energy in growing groups like MARA so that you and others can benefit from fellowship with people who share your pathway to recovery and validate your experience. I hope that those groups grow numerous enough and widespread enough that what NA does or doesn’t do is of no concern.

      Likewise, I wish continued success to NA. A lot of addicts have found that opioid agonists were part of their addiction rather than a pathway to recovery. I want those people to have a fellowship that provides safety and validates their experience.

      I don’t have a problem with peers criticizing peers. (Like you criticizing NA.) However, professionals criticizing NA feels like punching down. Punching down is never a good look, but it’s worse when your profession has a fairly recent history of failing, abusing, and neglecting the people you now criticize.

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