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Published in: Addiction Science & Clinical Practice 1/2020

Open Access 01-12-2020 | Addiction | Research

One size doesn’t fit all: a thematic analysis of interviews with people who have stopped participating in Narcotics Anonymous in Norway

Authors: John-Kåre Vederhus, Magnhild Høie, Bente Birkeland

Published in: Addiction Science & Clinical Practice | Issue 1/2020

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Abstract

Background

For persons with substance use disorders (SUDs), 12-step groups (TSGs) are the most available and used peer-based recovery resource, worldwide. However, disengagement is common, and attrition may partly be due to practices and procedures within these groups that are unacceptable to a portion of the population with SUDs. Our overall aim was to identify problematic issues related to Narcotics Anonymous (NA) participation in Norway, to inform addiction professionals’ strategies when referring persons to addiction-related self-help groups (SHGs).

Methods

In this qualitative study, we interviewed ten individuals who had previously participated regularly in NA for at least 6 months, to examine their reasons for disengagement. We interpreted the interviews using thematic analysis.

Results

We identified three themes: (1) The model did not fit’, either the strategies utilized in NA (e.g., meeting format and step working) or NA’s explanatory model of addiction, (2) ‘Negative experiences spurred frustration’, and (3) ‘The safe place can become a cage’. The respondents believed that a main aim of recovery was reintegration into society, such that SHG participation should not be an end goal, but rather a platform for normalization back into society. Despite their negative experiences and strong critique, respondents still regarded NA as a valuable recovery resource, but pointed out that one size does not fit all.

Conclusion

Addiction professionals should recognize possible problems related to TSG participation, to help prevent negative experiences and possible harms to individuals. Professionals should also inform individuals about alternative support groups, to help them find the recovery resource best suited to them.
Literature
1.
go back to reference Humphreys K, Wing S, McCarty D, Chappel J, Gallant L, Haberle B, Horvath AT, Kaskutas LA, Kirk T, Kivlahan D, et al. Self-help organizations for alcohol and drug problems: toward evidence-based practice and policy. J Subst Abuse Treat. 2004;26(3):151–8.CrossRef Humphreys K, Wing S, McCarty D, Chappel J, Gallant L, Haberle B, Horvath AT, Kaskutas LA, Kirk T, Kivlahan D, et al. Self-help organizations for alcohol and drug problems: toward evidence-based practice and policy. J Subst Abuse Treat. 2004;26(3):151–8.CrossRef
2.
go back to reference Moos RH. Active ingredients of substance use-focused self-help groups. Addiction. 2008;103(3):387–96.CrossRef Moos RH. Active ingredients of substance use-focused self-help groups. Addiction. 2008;103(3):387–96.CrossRef
3.
go back to reference Kleber HD, Weiss RD, Anton RF Jr, George TP, Greenfield SF, Kosten TR, O’Brien CP, Rounsaville BJ, Strain EC, Ziedonis DM, et al. Treatment of patients with substance use disorders. Am J Psychiatry. 2007;164(4):5–123.PubMed Kleber HD, Weiss RD, Anton RF Jr, George TP, Greenfield SF, Kosten TR, O’Brien CP, Rounsaville BJ, Strain EC, Ziedonis DM, et al. Treatment of patients with substance use disorders. Am J Psychiatry. 2007;164(4):5–123.PubMed
4.
go back to reference Laudet AB. Attitudes and beliefs about 12-step groups among addiction treatment clients and clinicians: toward identifying obstacles to participation. Subst Use Misuse. 2003;38(14):2017–47.CrossRef Laudet AB. Attitudes and beliefs about 12-step groups among addiction treatment clients and clinicians: toward identifying obstacles to participation. Subst Use Misuse. 2003;38(14):2017–47.CrossRef
5.
go back to reference Vederhus JK, Timko C, Kristensen O, Hjemdahl B, Clausen T. Motivational intervention to enhance post-detoxification 12-step group affiliation: a randomized controlled trial. Addiction. 2014;109(5):766–73.CrossRef Vederhus JK, Timko C, Kristensen O, Hjemdahl B, Clausen T. Motivational intervention to enhance post-detoxification 12-step group affiliation: a randomized controlled trial. Addiction. 2014;109(5):766–73.CrossRef
6.
go back to reference Kelly JF. Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of mechanisms of behavior change research. Addiction. 2017;112(6):929–36.CrossRef Kelly JF. Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of mechanisms of behavior change research. Addiction. 2017;112(6):929–36.CrossRef
7.
go back to reference Chappel JN. Long-term recovery from alcoholism. Psychiatr Clin N Am. 1993;16(1):177–87.CrossRef Chappel JN. Long-term recovery from alcoholism. Psychiatr Clin N Am. 1993;16(1):177–87.CrossRef
8.
go back to reference Walters GD. Twelve reasons why we need to find alternatives to Alcoholics Anonymous. Addict Disord Treat. 2002;1(2):53–9.CrossRef Walters GD. Twelve reasons why we need to find alternatives to Alcoholics Anonymous. Addict Disord Treat. 2002;1(2):53–9.CrossRef
9.
go back to reference Kaskutas LA. What do women get out of self-help? Their reasons for attending Women for Sobriety and Alcoholics Anonymous. J Subst Abuse Treat. 1994;11(3):185–95.CrossRef Kaskutas LA. What do women get out of self-help? Their reasons for attending Women for Sobriety and Alcoholics Anonymous. J Subst Abuse Treat. 1994;11(3):185–95.CrossRef
11.
go back to reference Chapin RK. Social policy development: the strengths perspective. Soc Work. 1995;40(4):506–14.CrossRef Chapin RK. Social policy development: the strengths perspective. Soc Work. 1995;40(4):506–14.CrossRef
12.
go back to reference Zemore SE, Kaskutas LA, Mericle A, Hemberg J. Comparison of 12-step groups to mutual help alternatives for AUD in a large, national study: differences in membership characteristics and group participation, cohesion, and satisfaction. J Subst Abuse Treat. 2017;73:16–26.CrossRef Zemore SE, Kaskutas LA, Mericle A, Hemberg J. Comparison of 12-step groups to mutual help alternatives for AUD in a large, national study: differences in membership characteristics and group participation, cohesion, and satisfaction. J Subst Abuse Treat. 2017;73:16–26.CrossRef
13.
go back to reference Vederhus JK, Kristensen O, Laudet A, Clausen T. Attitudes towards 12-step groups and referral practices in a 12-step naive treatment culture; a survey of addiction professionals in Norway. BMC Health Serv Res. 2009;9:147.CrossRef Vederhus JK, Kristensen O, Laudet A, Clausen T. Attitudes towards 12-step groups and referral practices in a 12-step naive treatment culture; a survey of addiction professionals in Norway. BMC Health Serv Res. 2009;9:147.CrossRef
14.
go back to reference Kurtz LF. Self-help and support groups: a handbook for practitioners. London: Sage; 1997. Kurtz LF. Self-help and support groups: a handbook for practitioners. London: Sage; 1997.
15.
go back to reference Laudet AB. The impact of Alcoholics Anonymous on other substance abuse-related twelve-step programs. Recent Dev Alcohol. 2008;18:71–89.CrossRef Laudet AB. The impact of Alcoholics Anonymous on other substance abuse-related twelve-step programs. Recent Dev Alcohol. 2008;18:71–89.CrossRef
16.
go back to reference World Service Office. Narcotics Anonymous: it works—how and why. Van Nuys: World Service Office; 1993. World Service Office. Narcotics Anonymous: it works—how and why. Van Nuys: World Service Office; 1993.
17.
go back to reference World Service Office. Narcotics Anonymous: information about NA. Van Nuys: World Service Office; 2016. World Service Office. Narcotics Anonymous: information about NA. Van Nuys: World Service Office; 2016.
18.
go back to reference Narcotics Anonymous World Services. Narcotics Anonymous: basic text. 6th ed. Chatsworth: Narcotics Anonymous World Services; 2008. Narcotics Anonymous World Services. Narcotics Anonymous: basic text. 6th ed. Chatsworth: Narcotics Anonymous World Services; 2008.
19.
go back to reference Mäkelä K, Arminen I, Bloomfield K, Eisenbach-Stangl I, Bergmark KH, Kurube N, Olafsdottir H, Petersen JH, Phillips M, Rehm J, et al. Alcoholics anonymous as a mutual-help movement: a study in eight societies. Madison: The University of Wisconsin Press; 1996. Mäkelä K, Arminen I, Bloomfield K, Eisenbach-Stangl I, Bergmark KH, Kurube N, Olafsdottir H, Petersen JH, Phillips M, Rehm J, et al. Alcoholics anonymous as a mutual-help movement: a study in eight societies. Madison: The University of Wisconsin Press; 1996.
20.
go back to reference World Services, Inc. Narcotics Anonymous: who, what, how, and why. Van Nuys, CA: World Services, Inc.; 2000. World Services, Inc. Narcotics Anonymous: who, what, how, and why. Van Nuys, CA: World Services, Inc.; 2000.
21.
go back to reference Kaskutas LA, Ye Y, Greenfield TK, Witbrodt J, Bond J. Epidemiology of Alcoholics Anonymous participation. Recent Dev Alcohol. 2008;18:261–82.CrossRef Kaskutas LA, Ye Y, Greenfield TK, Witbrodt J, Bond J. Epidemiology of Alcoholics Anonymous participation. Recent Dev Alcohol. 2008;18:261–82.CrossRef
22.
go back to reference Vederhus JK. Mind the gap—a European viewpoint on Alcoholics Anonymous. Addiction. 2017;112(6):937–8.CrossRef Vederhus JK. Mind the gap—a European viewpoint on Alcoholics Anonymous. Addiction. 2017;112(6):937–8.CrossRef
23.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
24.
go back to reference Høie MM, Sjøberg B-MD. Damned, loved child: Drug abuse in light of close relatives experiences. [Forbannede, elskede barn - narkotikamisbruk sett i lys av pårørendes erfaringer]. Oslo: Cappelen Akademisk; 2007. Høie MM, Sjøberg B-MD. Damned, loved child: Drug abuse in light of close relatives experiences. [Forbannede, elskede barn - narkotikamisbruk sett i lys av pårørendes erfaringer]. Oslo: Cappelen Akademisk; 2007.
25.
go back to reference Tsutsumi S, Timko C, Zemore SE. Ambivalent attendees: transitions in group affiliation among those who choose a 12-step alternative for addiction. Addict Behav. 2020;102:106143.CrossRef Tsutsumi S, Timko C, Zemore SE. Ambivalent attendees: transitions in group affiliation among those who choose a 12-step alternative for addiction. Addict Behav. 2020;102:106143.CrossRef
26.
go back to reference Hogg MA, Abrams D, Otten S, Hinkle S. The social identity perspective: intergroup relations, self-conception, and small groups. Small Group Res. 2004;35(3):246–76.CrossRef Hogg MA, Abrams D, Otten S, Hinkle S. The social identity perspective: intergroup relations, self-conception, and small groups. Small Group Res. 2004;35(3):246–76.CrossRef
27.
go back to reference Goffman E. Stigma. Hammondsworth: Penguin; 1963. Goffman E. Stigma. Hammondsworth: Penguin; 1963.
28.
go back to reference Rappaport J. Narrative studies, personal stories, and identity transformation in the mutual help context. J Appl Behav Sci. 1993;29(2):239–56.CrossRef Rappaport J. Narrative studies, personal stories, and identity transformation in the mutual help context. J Appl Behav Sci. 1993;29(2):239–56.CrossRef
29.
go back to reference Borkman T. The twelve-step recovery model of AA: a voluntary mutual help association. Recent Dev Alcohol. 2008;18:9–35.CrossRef Borkman T. The twelve-step recovery model of AA: a voluntary mutual help association. Recent Dev Alcohol. 2008;18:9–35.CrossRef
30.
go back to reference Mueser KT, Noordsy DL, Drake RE, Fox L. Integrated treatment for dual disorders: a guide to effective practice. New York: Guilford Press; 2003. Mueser KT, Noordsy DL, Drake RE, Fox L. Integrated treatment for dual disorders: a guide to effective practice. New York: Guilford Press; 2003.
31.
go back to reference Tomasson K, Vaglum P. Psychiatric co-morbidity and aftercare among alcoholics: a prospective study of a nationwide representative sample. Addiction. 1998;93(3):423–31.CrossRef Tomasson K, Vaglum P. Psychiatric co-morbidity and aftercare among alcoholics: a prospective study of a nationwide representative sample. Addiction. 1998;93(3):423–31.CrossRef
33.
go back to reference Marich J. Trauma and the Twelve Steps—a complete guide to enhancing recovery. Warren: Cornersburg Media; 2012. Marich J. Trauma and the Twelve Steps—a complete guide to enhancing recovery. Warren: Cornersburg Media; 2012.
34.
go back to reference Najavits LM, de Haan H, Kok T. How do females with PTSD and substance abuse view 12-step groups? An empirical study of attitudes and attendance patterns. Subst Use Misuse. 2015;50(14):1786–94.CrossRef Najavits LM, de Haan H, Kok T. How do females with PTSD and substance abuse view 12-step groups? An empirical study of attitudes and attendance patterns. Subst Use Misuse. 2015;50(14):1786–94.CrossRef
35.
go back to reference Rice C, Mohr CD, Del Boca FK, Mattson ME, Young L, Brady K, Nickless C. Self-reports of physical, sexual and emotional abuse in an alcoholism treatment sample. J Stud Alcohol. 2001;62(1):114–23.CrossRef Rice C, Mohr CD, Del Boca FK, Mattson ME, Young L, Brady K, Nickless C. Self-reports of physical, sexual and emotional abuse in an alcoholism treatment sample. J Stud Alcohol. 2001;62(1):114–23.CrossRef
36.
go back to reference Salem DA, Reischl TM, Gallacher F, Randall KW. The role of referent and expert power in mutual help. Am J Community Psychol. 2000;28(3):303–24.CrossRef Salem DA, Reischl TM, Gallacher F, Randall KW. The role of referent and expert power in mutual help. Am J Community Psychol. 2000;28(3):303–24.CrossRef
37.
go back to reference Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: guided by Information Power. Qual Health Res. 2016;26(13):1753–60.CrossRef Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: guided by Information Power. Qual Health Res. 2016;26(13):1753–60.CrossRef
38.
go back to reference Montgomery HA, Miller WR, Tonigan JS. Differences among AA groups: implications for research. J Stud Alcohol. 1993;54(4):502–4.CrossRef Montgomery HA, Miller WR, Tonigan JS. Differences among AA groups: implications for research. J Stud Alcohol. 1993;54(4):502–4.CrossRef
39.
go back to reference Vederhus JK, Høie MM. The Pragmatic Believer—Faith Development and Personal Experiences of a ‘Higher Power’ in Seasoned Members of Narcotics Anonymous. In: Res Soc Sci St Rel, vol. 29. 2018. p. 123–44. Vederhus JK, Høie MM. The Pragmatic Believer—Faith Development and Personal Experiences of a ‘Higher Power’ in Seasoned Members of Narcotics Anonymous. In: Res Soc Sci St Rel, vol. 29. 2018. p. 123–44.
40.
go back to reference Hanninen V, Koski-Jannes A. Narratives of recovery from addictive behaviours. Addiction. 1999;94(12):1837–48.CrossRef Hanninen V, Koski-Jannes A. Narratives of recovery from addictive behaviours. Addiction. 1999;94(12):1837–48.CrossRef
Metadata
Title
One size doesn’t fit all: a thematic analysis of interviews with people who have stopped participating in Narcotics Anonymous in Norway
Authors
John-Kåre Vederhus
Magnhild Høie
Bente Birkeland
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2020
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-020-00191-w

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