NARCOTICS ANONYMOUS AND HARM MINIMIZATION STRATEGIES A self-help society known as Narcotics Anonymous should be included as one valuable component in any national or community strategy to reduce and prevent the harmful effects of the use of alcohol and other drugs. WHAT IS NARCOTICS ANONYMOUS? Narcotics Anonymous is a community-based association of recovering drug addicts. The NA approach to recovery from drug addiction is completely nonprofessional, relying on peer support. Narcotics Anonymous is organized locally as self-governing, self-supporting groups adhering to a common set of principles. These groups are organized worldwide via NA's international delegate assembly, called the World Service Conference, and secretariat, the World Service Office. The first Narcotics Anonymous meeting was held in 1947 in Lexington, Kentucky, as part of a USA federal public health hospital program for the treatment of opiate dependency. An independent, community-based group using Lexington principles that was formed in Los Angeles, California, in 1953 became the root of today's Narcotics Anonymous. The movement's focus expanded from opiates to include all mind- and mood-altering drugs. The NA movement grew very slowly from 1953 through 1983, spreading gradually from California to other major USA population centers, then to Canada, Australia, the Federal Republic of Germany, and the United Kingdom by the early 1980s. The publication of NA's self-titled basic text in 1983 sparked tremendous growth. The core of the Narcotics Anonymous program is its Twelve Steps, adapted from those of Alcoholics Anonymous. They call upon the addict to admit that there is a problem, seek help, engage in a thorough self-examination, engage in confidential self- disclosure, make amends for harm done, and help other addicts. We believe the NA program works as well as it does primarily because of the therapeutic value of addicts helping other addicts. How do we know the Narcotics Anonymous program works? We do not keep attendance rolls or track individual success figures because of our focus on personal anonymity within Narcotics Anonymous. However, we can point to the movement's phenomenal growth over the last sixteen years as an indicator of NA's effectiveness: NA meetings Narcotics Anonymous is a simple, inexpensive program to start and maintain. NA offers no professional services, maintains no residential facilities or clinics, and keeps no equipment. Narcotics Anonymous groups usually rent meeting space from municipal, civic, or religious organizations; hence the groups have no building costs. Group expenses are paid out of small voluntary member contributions. We emphasize here the word voluntary, since there are no enrollment fees, membership dues, or costs of any kind associated with the NA program, either for individual membership in the NA Fellowship or for local group membership in the international organization. The only tools usually associated with the NA program for use by its members are the books and pamphlets distributed at minimal cost by the fellowship's World Service Office. To date, all Narcotics Anonymous literature has been composed in English. The movement has four books—its basic text, a book of daily thoughts, a study of NA's core principles, and a compilation of NA beginner's material—plus six booklets and twenty- one pamphlets on a variety of subjects. Many of these items are currently available in translation in Castilian Spanish, Continental and Brazilian Portuguese, French, German, Italian, Swedish, and Norwegian. Additional translation work is proceeding in these and numerous other languages. NARCOTICS ANONYMOUS AND HARM MINIMIZATION A harm-minimization approach to managing drug use seeks to reduce to the lowest possible level the amount of damage done by drugs to the nation, the community, the family, the workplace, and the individual drug user. Harm-minimization theories acknowledge that a policy whose sole goal is total abstinence for all citizens is unrealistic. It should not be forgotten, however, that harm minimization also acknowledges that total abstinence, wherever achievable, is the surest possible means of reducing harm to the addict and the rest of the community. Narcotics Anonymous can be a peer support in your community for addicts interested in or curious about total abstinence. NA is a program of total abstinence because the experience of its members has been that, for them, total abstinence has provided the surest foundation for recovery from the results of their drug abuse and for further personal growth. Narcotics Anonymous does not, however, as a movement, either oppose drug use or maintain that all drug users ought to stop using drugs. In fact, one of our most commonly used public notices reads, "If you want to use drugs, that is your business. If you want to stop using drugs, and want help, that is our business." Narcotics Anonymous has only one membership requirement: a desire to stop using drugs. As we noted earlier, NA focuses not only on opiates but on all mind- and mood-altering drugs. Drug addicts who are still using are welcome in NA meetings, though of course group members will assume that an addict attending their meeting has some degree of interest in achieving total abstinence for him or herself, and members will encourage the newcomer toward this goal. Narcotics Anonymous has taken no position, as a movement, on drug-replacement strategies for managing drug use in the community--programs such as methadone maintenance, for example. We neither endorse nor oppose such strategies. Addicts taking advantage of such programs are more than welcome to attend NA meetings, especially if they are curious about or want peer support in trying the total-abstinence approach to addressing their drug problem. Just as Narcotics Anonymous, as a movement, takes no positions on drug- replacement programs, NA has no opinion on any related issues such as HIV control and treatment, needle and syringe exchange, drug regulation or legalization, prostitution, criminality, or addict health maintenance. Narcotics Anonymous will neither oppose nor support particular drug policies or programs. NA tries to expend its energies exclusively within its sphere of competence: providing a setting in which addicts seeking total abstinence can support one another. We do this to keep our program as free of controversy as possible. We do not claim to have the only workable approach to the problem of addiction, nor do we assert that all other approaches are flawed. We claim only that the Narcotics Anonymous approach to the drug problem has proven very useful to hundreds of communities and tens of thousands of addicts around the world, and may prove useful to your community as well. Narcotics Anonymous stands ready to be as helpful as possible to your nation, community, or agency in providing support for addicts who wish to stop using. We encourage you to include NA in whatever strategy you choose to manage drug use in your community and to give addicts you come in touch with the option of accessing Narcotics Anonymous as they try to come to grips with their condition. USING NARCOTICS ANONYMOUS There are a number of ways in which you can incorporate Narcotics Anonymous into your total drug-use management strategy: Include Narcotics Anonymous in your discussions of national and local strategies to address and minimize the harm associated with drug abuse. You can introduce the Narcotics Anonymous program to legislators, government policy makers, health-care providers, judicial, correctional, and law enforcement officials, clergy, and civic leaders in your nation or community. Ask us for help by writing, calling, or faxing our World Service Office. You will find the address at the end of this paper. We may even be able to provide you with local contacts who will be able to represent their Narcotics Anonymous community in your discussions. If NA meetings are already being held in your country, you can refer addicts who want to stop using to Narcotics Anonymous. You can even arrange to bring client groups on a regular basis to local meetings so they can see for themselves what Narcotics Anonymous is like. Call, write, or fax our World Service Office for a local NA contact number or meeting information. If there are no NA meetings in your country or locale, you can start a Narcotics Anonymous meeting for addicts in your community. This is how the NA movement was originated, when a public health physician in the USA started a self-help group at his hospital for addicts under his care. His success has been replicated in many locations throughout the world. NA's World Service Office will provide you with a group starter kit and will answer your questions on how to open an NA meeting. Just call, write, or fax one of the addresses appearing at the end of this paper. An alternative to starting an NA meeting yourself is to inform addicts of Meeting by Mail, the NA Loner Group's bimonthly English-language newsletter, published by our World Service Office. Meeting by Mail contains the shared experience of addicts recovering in isolation from other recovering addicts around the world, providing them the kind of peer support Narcotics Anonymous members in established NA communities find in regular NA meetings. Please pass along our mailing address, telephone, and fax numbers to any addicts you know who might be interested in the NA Loner Group. KEEPING IN TOUCH WITH NA Narcotics Anonymous interacts with professionals in a number of ways: Our World Service Office periodically publishes NA Update, a newsletter for professionals interested in Narcotics Anonymous. Ask us or contact our office to be included on the NA Update mailing list. In locales where Narcotics Anonymous is firmly established, members often form service committees whose functions are to cultivate and maintain community relations. These committees may be able to provide speakers for professional or community association meetings, in-service training sessions, or client gatherings. Contact our office for further details on such committees in your locale. We are proud to participate in the ICAA's Prague Institutes. We regularly attend the annual IFNGO conference and other such events. If you would like us to conduct a workshop or make a presentation at the plenary session of a conference focusing on drug use, please contact our office. World Service Office PO Box 9999 Van Nuys, California 91409 USA Telephone (818) 773-9999 Fax (818) 700-0700 WSO Europe Avenue Winston Churchill Laan 249/B15 B-1180 Brussels, Belgium Telephone 32-2-346-1400 Fax 32-2-346-2282 [This paper was first presented at the ICAA's 22nd International Institute on the Prevention and Treatment of Drug Dependence, Prague, June 1994. It was updated in May 1995.]