Sociology

Prescription drugs and illegal street drugs have unified and given the face of narcotic drug addiction a whole new image.  In the past, the stereotypical image associated with a drug addict resembled a bum in an alleyway.  Drug addicts often panhandled or prostituted as a means of supporting their compulsions.  The present day illustration of a drug addict reflects that of a typical housewife, mother, lawyer, doctor, star-athlete, and even members of law enforcement.  The misuse of prescription drugs or the use of illegal street drugs propels the user into a downward spiral of addiction.  The user ends up devastated and desperate as a job is lost, a marriage suffers or ends, a family becomes broken, and the knowledge of oneself disappears.  This rock bottom is a pivotal moment of addiction as this is where the addiction is realized.  Addicts come from every corner of the world, and all present with the same issue of captivity narcotic addiction.
   
Drug addicts have many options available within both the field of medicine and the area of psychology.  There are countless hospitals and recovery centers with programs specifically designed to combat narcotic addictions.  Mental health associations offer outpatient services to admitted addicts through individualized cognitive therapy, client centered therapy, aversion therapy, and group therapy.  Some individual drug addicts opt to circumvent a therapeutic setting altogether and embark upon regaining control of their lives independently through community meetings.  Community meetings concentrate on the implementation of the twelve-step recovery process.  The utilization of a twelve-step program enables an individual addict to recognize a personal addiction, receive emotional support, become educated about their disease, and accept the open doors to recovery.
   
Twelve-step program meetings take place all day long in every city.  These meetings are held in various locations like a hospital conference room, a hotel conference room, or local churches.  Local churches often volunteer their space as a means of community outreach.  Many churches have fellowship halls, large conference rooms with many tables and chairs, which are ideal for meetings.  Display tables are set up by the meeting leaders to offer literature and information on narcotic addiction.  This information is vital to newcomers as education often provides comfort and reassurance that recovery is possible.  Coffee makers are essential fixture at meetings.  Refreshments similar to cookies, chips, nuts, soda, water, and coffee aid in providing a more relaxed atmosphere and encourage verbal interaction among those attending the meeting.  It would be nice to see other community business owners offer space for twelve-step meetings as a form of community resource and outreach.  In volunteering meeting space, it sends a message to those drug addicted to narcotics that the community supports their recovery.
   
Twelve-step meeting do not require that one admit to being an addict.  Sometimes, an individual will attend the meeting to simply check it out.  Occasionally, something that is heard will trigger the questions of addiction within the individual, but ultimately, it is up to the person to determine if he or she is an addict.  The meeting begins with someone suggesting commencement or tapping a spoon on a coffee mug or table.  Those in attendance spend the moments before the meeting talking and welcoming one another, especially the new faces.  Attendees who are not yet seated begin filing into the empty chairs at various tables.  The chairman of the meeting starts by introducing himself by saying, Hello.  My name is John Q. and Im a drug addict (Narcotics Anonymous, 1983).  This informal introduction breaks the ice and sets the atmosphere for the meeting.  The entire room responds by saying, Hi John Q  

(Narcotics Anonymous,1983).   The leader of the meeting then suggests going around the room to allow everyone to introduce themselves.  If someone has not claimed to be an addict, then they usually state that they are just visiting.  The chairman then asks for a moment of silence, or prayer.  It is not a formality that one must be a Christian to attend the meetings, but there is a deep rooted level of spirituality contained in the twelve-step process.  This level of supremacy is referred to as a Higher Power.  Before the meeting gets fully underway, the chairman reads various selections and paraphrases specific items that have been the foundation of Narcotics Anonymous (NA) for many years.  The twelve-steps, the anonymity clause, and the purpose of NA and what it stands for are read aloud.  The anonymity clause is very important as it protects the identity and any personal information volunteered during the course of the meeting.  The chairman then references the fact that, Narcotics Anonymous is a fellowship of men and women who share their experiences, strength, and hope with each other that they may solve their common problem and help others to recover (Schenker, 2009).
   
The chairman of the meeting will open the floor for discussion.  This informal setting allows those in attendance to ask questions, share experiences, or choose a topic to be the discussion for that particular meeting with regard to narcotic addiction.  Issues of withdrawal and latent physical problems being experienced as a result thereof or someone may wish to discuss a more social issue like the rising number of adolescents misusing prescription drugs.  Discussions are narcotic addiction oriented.  These are called open meetings.  In a closed meeting, only addicts are permitted to attend and the program usually has a special guest speaker lined up who gives their personal testimony of addiction.  An individuals testimony can be an awe inspiring experience to behold.  The speaker generally tells of many pitfalls, trials, shattered lives, and near death experiences suffered at the hands of their addiction.  Recovery is referred to as a one day at a time process where each addict could easily relapse (Narcotics Anonymous, 1983).  It is heavily emphasized during group discussion that each person attending is only one needle, one inhalation, or one pill away from devastation.  This realization serves as a platform to keep pushing forward towards the better side of life rather than reliving all the elements of despair again.
   
The meeting typically lasts for about an hour.  When the basket starts going around the room, this indicates that the meeting will be coming to a close momentarily.  The basket is for a voluntary monetary collection that serves to purchase more literature and refreshments for future meetings.  The chairman will then thank everyone for sharing and listening so respectively.  Any announcements will be made in reference to future meetings, guest speakers, and group events like a cook-out so that attendees can stay informed and take note.  The chairman then asks if anyone in attendance is celebrating a birthday.  A birthday in Narcotics Anonymous is where an addict celebrates milestone moments of their recovery.  These moments are indicative of thirty days, ninety days, six months, and one year.  A special keychain signifying the stage of recovery is given to the addict to symbolize their achievement thus far.  The chairman will also ask if there is anyone attending to wants to begin their recovery journey.  If anyone responds, then the newcomer is given a starting keychain.  It is an emblem and a reminder that this is where it all begins.  Those attending the meeting show their support for those celebrating birthdays and newcomers by applause.  As the meeting closes, the chairman asks for another moment of silence for the addict who still suffers.  This is followed by the Lords Prayer and immediately followed by the Serenity Prayer (Narcotics Anonymous, 1983).  Different twelve-step meeting groups have incorporated little catch phrases that follow the Serenity Prayer.  This particular group used the phrase, Keep coming back.  It works if you work it (personal communication, 14 January 2010).
   
After the meeting formally ends, attendees stand around talking and drinking coffee.  Some people do go ahead and leave, but others take advantage of this time to get to know one another and establish a rapport.  Newcomers are introduced to other long-time members as possible sponsors.  Each member needs a sponsor.  A sponsor acts as a mentor who interacts one-on-one with the newly admitted addict in recovery.  The mentor offers insight, personal experience, and friendship as a means to keep the addict on the right path and away from relapse.  An NA sponsor is on-call to any addict twenty-four hours a day.  Communication is a key element in the twelve-step recovery process.  As members interact with one another, they subconsciously create a familial bond.  This bond deepens the level of support received and encourages recovery through the twelve-step program (Schenker, 2009).
   
The Serenity Prayer is clich in a twelve-step meeting.  It simply puts everything into perspective with regard to addiction.  This prayer is comprised of three substantial beliefs.  The first belief is acceptance.  With regard to drug addiction, acceptance means that one admits to being an addict in correlation to the physical and mental weakness to drugs.  This acceptance is the first step in the recovery process.  The first step of the twelve step program states, we admitted that we were powerless over our addiction, and that our lives had become unmanageable (Narcotics Anonymous, 1983).  The second belief is change.  An addict must believe that change is possible through recovery.  Changes in recovery are done so for the betterment and improved quality of life.  It is critical that an addict know and understand that some things cannot be changed no matter who or what is behind the motive.  When an impossible obstacle interferes with an addicts direction, then he or she must realize and remember the first belief, acceptance. The third belief is wisdom.  Wisdom is the recovering addict in intellectual motion.  Recovering addicts are in constant search of understanding and truth.  They know full well what lies on the other side of the fence and are willing to learn the most effective means to avoid crossing that line.  Summarily, the Serenity Prayer is useful in that it delivers to the addict a message of hope through acceptance, change, and wisdom.
   
The use of a twelve-step program in a therapy setting is genius.  A substance abusing individual or an addicted patient needs a fundamental basis to provide a better understanding of addiction.  The twelve-step program can be effective independent of other therapies, but many addicts have co-morbid mental disorders which provide for other incorporated methods of treatment (Nowinski, Baker,  Carroll, 2007).  Other methods may include medications, cognitive therapy, client centered therapy, or even aversion therapy.  Aversion therapy has proven to be a productive form of treatment when used conjunctively with a twelve-step program.  A medication called Antabuse, generic name disulfiram, is designed to give the addict severe physical side effects if used in concert with narcotic drugs (Carroll, Nich, Ball, Mocance,  Rounsavile, 1998).  These ill feelings deter the addict from using narcotics and promote the recovery process, although it is up to the client to remember to take the Antabuse.  The twelve-step program can be applied to a clients therapy in a number of ways.  Some clients have been court ordered into a rehabilitation program which would allow the introduction of the twelve-step program.  Inpatient programs collectively mandate the daily attendance of twelve-step meetings for their patients.  Outpatient mental health facilities may offer daily meetings within the facility itself and encourage or mandate particular substance abusers and addicts to attend  (Shives, 2008).  If the clinician has a good rapport with their client, then the suggestion of attendance should not be an impossible request, and the client will most likely be willing to attend.
   
A non-addictive client could also benefit from the mechanism and design of the twelve-steps from a recovery standard.  The twelve-steps essentially outline a better way of living ones life.  If a mental health clinician wishes to incorporate the twelve-step ideology and apply it to a clients therapy, then the best way would be to discuss it with the client.  The clinician should explain to the client that the twelve-steps were originally designed to aid in the recovery of individuals recovering from drug and alcohol addictions, but that they are an effective guideline for any respect of living.  The clinician could print out a copy of the twelve-steps and review them with the client.  This would allow the client to ask questions, voice concerns, and open the dialogue with regard to their therapeutic concerns and aspirations (Nowinski, Baker,  Carroll, 2007).  
   
Drug addictions guarantee an abuser three possible outcomes in life.  Addiction promises financial ruin, jail, or death.  The design and implementation of the twelve-step program has proven to be an essential part of addiction recovery.  Cognitive and client centered therapy have integrated the use of the twelve-step program as a means of providing patients with a list of guidelines for everyday living.  Aversion therapy in addiction uses the medication Antabuse in coordination with the twelve-step recovery process and has generated steady level of success. Individual addicts involved in a twelve-step recovery program, like Narcotics Anonymous, relay a level of comfort associated with their participation.  Members of NA come to know one another almost like family.  The level of support is strong and consistent which are vital needs of a recovering addict.  Overall, the twelve-step program works when it is worked by the addict.