In 2011, we (Chris Budnick, Boyd Pickard, and William White) published the first chronology of scientific and professional literature related to Narcotics Anonymous. We wrote:
“Narcotics Anonymous (NA) has not received the degree of attention from the academic and professional communities commensurate with its longevity as an addiction recovery mutual aid society, its membership growth, and its international dispersion. No academic history of NA has been published comparable to Not-God: A History of Alcoholics Anonymous by Harvard-trained historian Ernest Kurtz. Where thousands of articles have appeared in professional journals on Alcoholics Anonymous (AA), the number of comparable studies focusing specifically on NA is miniscule, and even fewer achieve any kind of methodological rigor in evaluating the effects of NA participation on long-term recovery outcomes. In fact, there are more reviews and meta-analyses of AA-related studies than there are focused scientific studies of NA.”
Since then, we periodically update the chronology to include newly published and newly discovered scientific and professional literature. Since the last update, December 31, 2022, seventeen items have been added to the chronology. They are listed at the end of this blog. The current version of the chronology (January 15, 2025) can be viewed at William White Papers and Preserving the Message.
Two additions to the chronology are worth mentioning. Both are from the 1970’s. The first is a monograph (1971) titled Engaging Opioid Addicts in a Continuum of Services: A Community-Based Study in the San Antonio Area. This monograph includes a review of San Antonio Narcotics Anonymous (SANA).
The second is a monograph (1978) titled Nonresidential Self-Help Organizations and the Drug Abuse Problem: An Exploratory Conference. N.A. members Greg P. (N.A. World Service Office) and Richard B. (Scranton, PA) participated in this conference.
Engaging Opioid Addicts in a Continuum of Services: A Community-Based Study in the San Antonio Area
We discovered this monograph in the notes of Holly M. Karibo’s 2024 book, Rehab on the Range: A History of Addiction and Incarceration in the American West. While there have been many publications related to the Narcotic Farm in Lexington, KY, this is the first academic study of the Narcotic Farm in Fort Worth, TX.
This monograph describes the formation of a San Antonio Narcotics Anonymous group referred to as SANA. Nothing in the monograph, nor the structure, function, and focus of SANA suggests that it was affiliated with today’s Narcotics Anonymous. Instead, it emerged from caring professionals, members of Alcoholics Anonymous, and addicts participating in AA meetings in the Narcotic Farm in Fort Worth.
“In the summer of 1966, after the service phase of the continuum of services project began, one of the field office social workers (John R. Moore) found interest among Alcoholics Anonymous leaders in San Antonio in setting up a special group for opioid addicts, and about the same time, addict patients participating in the Alcoholics Anonymous group in the Clinical Research Center asked if a group could be organized for them in San Antonio.”
The first meeting was held on December 7, 1966, with six members of Alcoholics Anonymous, a social worker, and one addict. During the first three months, four addicts attended regularly but after one member discussed “chipping” at the meeting he “induced the other three to join him” in resuming heroin use.
In its first year, a social worker was heavily involved, often providing transportation to meetings while also lamenting in a progress note that he found himself “practically alone” at meetings. At the end of the year a weekend retreat was organized. “Although group members expressed enthusiasm, attendance proved to be small. The social worker did practically all the work of planning and carrying out this event.”
In an attempt to establish greater autonomy, SANA members took the advice of Spanish-speaking A.A. members and started holding meetings at their clubhouse. However, the continued use of heroin among members thwarted progress. The clubhouse became a “shooting gallery.” Some members privately asked the social worker to take action, but he declined.
Conversations began among the members about disbanding the group. The social worker, who had attended almost every meeting, began to question the wisdom of what “seemed to be severe and constant passive dependency” of the group upon him. To see what would happen, he stopped attending meetings for a month. SANA collapsed.
Eventually, some of the members approached the social worker for help in starting again. He agreed as long as the group members would arrange their own transportation to meetings. A meeting was held to restart the group and rules were adopted. Some of these included:
“Complete honesty will be the keynote, no subject will be held objectionable.”
“No drugs or paraphernalia will be allowed on the premises.”
“Complete abstinence will be required on the night of the meeting.”
“Abstinence dates will be set and cards issued to all members.”
“Group action will be taken on any rules broken by the members or guests.”
Despite recommitting, several members “sat nodding” during meetings as the group wrestled with the question of whether abstinence was required for attendance.
A positive change occurred in the fall of 1968 when a “strong new member joined the group.” This member had been abstinent for nearly two years and was employed by a local provider as a “field specialist” working with addicts. This led to a period of stability that lasted almost 18 months. The group “held to the abstinence rule.” Nobody could attend if under the influence of an opioid. Members were able to attend meetings without “the provocation of observing companions who were ‘high’ (euphoric) or ‘nodding’ (somnolent).” In April 1970, the new leader was unable to attend meetings, and SANA “entered a period of suspended animation.”1
Nonresidential Self-Help Organizations and the Drug Abuse Problem: An Exploratory Conference
In My Years with NA, Bob Stone recounts how in 1978 Greg P. attended a conference in Pennsylvania hosted by the National Institute for Drug Addiction (NIDA). NIDA paid for Greg’s ticket and he used the trip as an opportunity to visit the NA fellowship in Pennsylvania, and, after the conference, Bo and the Georgia fellowship. This was the first time a member of the Board of Trustees had visited the new and growing East Coast fellowship. Regarding the conference, Bob Stone wrote “The conference represented the federal government’s most significant recognition of NA up to that time.”2
We were curious if a report from the conference existed, so we reached out to NIDA. The NIDA Public Inquiries Team provided a link to a monograph of the conference titled Nonresidential Self-Help Organizations and the Drug Abuse Problem: An Exploratory Conference.
“Since their initial development, self-help groups have emerged as important sources of support and aid for a wide range of individuals with differing problems and needs. Recognizing their growing significance in the area of substance abuse, the National Institute on Drug Abuse (NIDA) identified as a new priority the encouragement of self-help groups for drug abusers. On March 8-9, 1978, NIDA’s Services Research Branch convened a conference to examine this topic. The objectives included an exploration of the potential of self-help for drug abusers, an examination of methods to support their continued expansion, and the formulation of recommendations on what activities the Federal Government could implement in this area…”
Thirty-seven individuals participated in this conference. In addition to Narcotics Anonymous, representatives from Families Anonymous, Parents Anonymous, Al-Anon, Women for Sobriety, Fortune Society, and SmokEnders attended.
The conference explored the conceptual boundaries of “self-help” at a time before better clearly defined pathways and styles of recovery had been mapped (i.e., see Kurtz and White). For instance, it explored the question, Can “self-help” groups serve as the sole or primary treatment for “drug abusers?” In terms of “parallel support,” an interesting recommendation was made that individuals enrolled in “methadone-to-abstinence” programs represent a special group that may not be “welcomed in many self-help groups that are designed to help members remain drug free.” Therefore, “separate groups might have to be formed to provide support for clients’ rehabilitation while they remain in treatment.”
The conference also defined two patterns for the initial formation of “self-help” groups. Member-founded “self-help” organizations and professionally organized “self-help.” The description of member-founded “self-help” is worthy of full quotation:
“Historically, most member-founded self-help organizations have started through the spontaneous efforts of one charismatic leader (or a small group of motivated persons) who had a need that was not being met, formulated a method for addressing that need, and then reached out to the community to involve others. These persons only have acted as leaders initially. Once the groups were organized, they have receded into the background, allowing each individual chapter to function on a fellowship, member-led basis.”
The role of the Federal government in supporting “self-help” groups was discussed and consensus was reached on “the utility of some limited Federal activity in the areas of endorsement, stigma reduction, information dissemination, technical assistance, research, direct funding, and establishment of an advisory group.” With respect to information dissemination and “an ongoing initiative to support the growth and development” of self-help groups, the monograph included descriptions of the “self-help” organizations represented at the conference and a preliminary listing of groups/chapters. Of the 700 identified NA chapters, 80 are included in the preliminary listing.
The NIDA conference was held only seven years after the San Antonio monograph was published, yet reflects a significant stride forward in the recognition and value of mutual aid.3
Concluding Thoughts
It is important to recognize that what is known about SANA comes from one source and one perspective. Therefore, it is likely an incomplete story. However, enough information is provided to recognize that SANA existed at a time and place where recovery from opioid addiction seemed rare and unlikely. This is especially the case when groups are forming, exist in isolation from other groups, and members are struggling to sustain recovery. SANA’s formation is more characteristic of NIDA’s definition of professionally organized “self-help” groups.
Reflecting on the many “self-help” groups, like SANA, that existed only for a season, provides an opportunity to consider contributing factors to the growth and visibility of mutual aid groups that exist in 2025. There is the individual persistence and perseverance of countless known and unknown individuals who stayed clean and carried a message of recovery. There is the adoption of organizing practices, such as the 12 Traditions, which create a method of sustainability that can outlive the founding member(s). There are the service structures developed to connect groups into a unified whole. For instance, Bob Stone observed that Greg’s visit to NA groups in Pennsylvania served as “the final push that was necessary for the Pennsylvania fellowship to raise the money necessary to pay for their delegate to attend the April conference.” Lastly, there is the role of organizations like the National Institute on Drug Abuse that study, disseminate, and connect grassroots efforts that support recovery. The number of scientific and professional publications on NA has grown exponentially as this chronology affirms and will continue to increase in the coming years within a larger recovery research agenda.
New additions to the chronology
Chen, G.. (2024). Self-forgiveness and gratitude in recovery from substance use disorders. J Psychoactive Drugs. 1-10. doi: 10.1080/02791072.2024.2366172. Epub ahead of print. PMID: 38860454.
Dehghan, M., Mirza, H. K., Alaeifar, S., Jazinizadeh, M., Iranmanesh, M. H., Mohammadiakbarabadi, F., Salehi, M., Ghonchehpour, A., Zakeri, M. A. (2023). Quality of Life and Use of Complementary and Alternative Medicines among Narcotics Anonymous Patients: A Cross-Sectional Study in Southeast Iran. Evid Based Complement Alternat Med. 2023:3003247. doi: 10.1155/2023/3003247. PMID: 37727769; PMCID: PMC10506870.
Di Carlo, F., Alessi, M. C., Picutti, E., Pettorruso, M., Martinotti, G., di Giannantonio, M. (2022). Online 12-step groups during the Covid-19 pandemic: A patient’s perspective. Emerg Trends Drugs Addict Health, 2:100047. doi: 10.1016/j.etdah.2022.100047. Epub 2022 Sep 11. PMID: 36119451; PMCID: PMC9464309.
Galanter, M., White, W. L., Hunter, B., Khalsa, J. (2024). Internet-based, continuously available Narcotics Anonymous meetings: a new resource for access to Twelve Step support for abstinence. Am J Drug Alcohol Abuse, 50(3), 321-327. doi: 10.1080/00952990.2024.2309648. Epub 2024 Apr 1. PMID: 38557160.
Hassett-Walker, C. (2023). Recovering Individuals’ Feelings About Addict and Alcoholic as Stigmatized Terms: Implications for Treatment. Subst Abuse., 17:11782218231213769. doi: 10.1177/11782218231213769. PMID: 38033430; PMCID: PMC10687927.
Hassett-Walker, C. (2024). The impact of the COVID-19 pandemic on recovery from substance use disorder: Findings from a qualitative study. Subst Use. 18:29768357241287405. doi: 10.1177/29768357241287405. PMID: 39430690; PMCID: PMC11489921.
Karlsson, P. (2024). Becoming an Addict Means Coming Home: Narcotics Anonymous and the Genesis of the Global Drug Ethic (1 ed.). [Doctoral Thesis (monograph), School of Social Work]. Lunds universitet, Socialhögskolan.
Leurent, M., Ducasse, D., Courtet, P., Olié, E. (2024). Efficacy of 12-step mutual-help groups other than Alcoholics Anonymous: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2024 Mar;274(2):375-422. doi: 10.1007/s00406-023-01667-x. Epub 2023 Sep 27. PMID: 37755487.
Maddox, J. F., Berliner, A., and Bates, W. F. (1971). Engaging Opioid Addicts in a Continuum of Services: A Community-Based Study in the San Antonio Area.Behavioral Health Science Monographs, The Texas Christian University Press, Number 71-1, January 1971.
Majer, J. M., Jason, L. A., Bobak, T. J. (2022). Understanding recovery Capital in relation to categorical 12-Step involvement and abstinence social support. Addict Res Theory., 30(3):207-212. doi: 10.1080/16066359.2021.1999935. Epub 2022 Nov 11. PMID: 36275074; PMCID: PMC9585994.
McGovern, W., Addison, M., McGovern, R. (2024). The adoption of a “diseased identity” in traditional 12-Step groups: Exploring the implications of these processes for individuals and practitioners in health and social care services. Int J Environ Res Public Health. 21(10):1297. doi: 10.3390/ijerph21101297. PMID: 39457269; PMCID: PMC11507594.
National Institute on Drug Abuse (1978). Nonresidential Self-Help Organizations and the Drug Abuse Problem: An Exploratory Conference. Services Research Branch, Division of Resource Development, National Institute on Drug Abuse (NIDA). Publication Number (ADM ) 78-752, July 1978. (Note: Greg P. attended)
Nixon, S. (2023). “I’ve Never Been Arrested at a 12-Step Meeting”: How Structural and Functional Mechanisms of 12-Step Programmes Might Support Criminal Desistance. British Journal of Community Justice, https://doi.org/10.48411/0dtk-wg13.
Rubya, S. & Yarosh, S. (2017). Interpretations of Online Anonymity in Alcoholics Anonymous and Narcotics Anonymous. PACM on Human-Computer Interaction, 1, CSCW, Article 91 (November 2017), 22 pages. https://doi.org/10.1145/3134726
Sinclair, D. L., Sussman, S., Savahl, S., Florence, M., Vanderplasschen, W. (2023). Narcotics Anonymous attendees’ perceptions and experiences of substitute behaviors in the Western Cape, South Africa. Subst Abuse Treat Prev Policy. 18(1), 40. doi: 10.1186/s13011-023-00552-z. PMID: 37408038; PMCID: PMC10324242.
Sullivan, A. C. (2021). Opioid Reckoning: Love, Loss, and Redemption in the Rehab State. Minneapolis, MN: University of Minnesota Press, p. 97, 98.
Weddington, W. W. (1991). Towards a Rehabilitation of Methadone Maintenance: Integration of Relapse Prevention and Aftercare. The International Journal of the Addictions, 25(9A & l0A), 1201– 1224, 1990-91.
- Maddox, J. F., Berliner, A., and Bates, W. F. (1971). Engaging Opioid Addicts in a Continuum of Services: A Community-Based Study in the San Antonio Area.Behavioral Health Science Monographs, The Texas Christian University Press, Number 71-1, January 1971. ↩︎
- Stone, B. (1997). My years with Narcotics Anonymous. Joplin, Missouri: Hulon Pendleton Publishing, p. 226 – 227 of PDF. ↩︎
- National Institute on Drug Abuse (1978). Nonresidential Self-Help Organizations and the Drug Abuse Problem: An Exploratory Conference. Services Research Branch, Division of Resource Development, National Institute on Drug Abuse (NIDA). Publication Number (ADM) 78-752, July 1978. (Greg P. attended) ↩︎