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.)