Drug-focused twelve-step fellowships

1. Introduction

Version followed: each fellowship's current self-published public material as of October 2026: NA World Services IP #29 An Introduction to NA Meetings, NA: A Resource in Your Community and NA and Persons Receiving Medication-Assisted Treatment (2016 text, 2026 printing); Cocaine Anonymous 2026 Meeting Formats (approved by the 2025 World Service Conference), Tools of Recovery and the CA professionals page; Marijuana Anonymous professionals page and FAQ; Nicotine Anonymous sample meeting format and To the Newcomer and Sponsorship pamphlet; Heroin Anonymous World Services home page. Crystal Meth Anonymous and Pills Anonymous are described from secondary summaries citing their own literature [uncertain]. Clinician preparation procedures follow the MAAEZ manual (Kaskutas & Oberste, 2002).

What these are. Narcotics Anonymous (NA), Cocaine Anonymous (CA), Crystal Meth Anonymous (CMA), Heroin Anonymous (HA), Marijuana Anonymous (MA), Pills Anonymous (PA) and Nicotine Anonymous (NicA) are peer-run mutual-aid fellowships adapted from the Alcoholics Anonymous Twelve Steps and Twelve Traditions. They are not therapies and a clinician does not deliver them. NA states plainly that it has no professional counsellors, clinics or residential facilities and keeps no attendance records; HA states that it provides no counselling, medical, psychiatric or chemical-dependency treatment [source: NA: A Resource in Your Community; heroinanonymous.org]. Meetings are member-led and are explicitly not classes, group therapy or counselling [source: IP #29]. This guide is therefore written for a clinician who refers clients to these fellowships, prepares them to attend, works alongside them during treatment, and handles the clinical problems that arise.

How change happens (as the fellowships describe it). Addicts learn from one another how to live drug-free: through regular meetings where members share personal experience, individual work through the Twelve Steps with a sponsor (a more experienced member), service to the group, and spiritual principles such as honesty, open-mindedness, willingness and humility whose application each member decides for themselves [source: NA: A Resource in Your Community; IP #29; CA Tools of Recovery]. The shared programme aims at complete abstinence, lived one day at a time. The fellowships differ mainly in their membership wording (the drug named), what counts as abstinence, their own literature, and meeting culture. From the clinician's side, change is supported by linking the client to a fitting meeting, removing practical and attitudinal barriers to attending, and coaching early sponsorship and involvement [source: MAAEZ manual] [synthesis for the clinical framing].

2. Framework

The fellowships have no clinical phases or session counts. Two parallel tracks are described below: (A) the member's path as the fellowships publish it, and (B) the clinician's linkage pathway, built on the MAAEZ structure plus [synthesis].

A. The member's path (fellowship-published)

Newcomer / first meetings. Anyone with a desire to stop using may attend; still-using and detoxing people are welcome [source: IP #29; PRMAT]. NA suggests a meeting every day for at least 90 days; CA suggests daily meetings plus reading CA literature [source: IP #29; CA Tools of Recovery]. NicA asks newcomers to try several meetings before deciding whether the programme fits [source: NicA sample meeting].
Getting a sponsor. Encouraged early; NicA advises getting one as soon as possible, even before quitting, possibly on a temporary basis [source: NicA To the Newcomer and Sponsorship]. CMA encourages but does not require a sponsor who has worked all twelve steps [source: Wikipedia CMA, citing CMA FAQ] [uncertain].
Working the Steps with the sponsor. The steps are the core of the programme and are described as practical guidelines for recovery [source: NA: A Resource in Your Community]. No fellowship drawn on sets a timetable; recovery is presented as an ongoing personal process with no set timeline [source: NA: A Resource in Your Community].
Service and the Twelfth Step. Simple jobs at meetings early on (setting up, cleaning up), later service positions, Hospitals & Institutions (H&I) panels and sponsoring others [source: CA Tools of Recovery; NicA To the Newcomer and Sponsorship; NA: A Resource in Your Community].
Milestones. Keytags (NA), chips at 1 week, 30, 60, 90 days, 6, 9, 12, 18 months and cakes yearly (CA), medallions (PA), free virtual chips and app sobriety counter (MA) [source: IP #29; CA 2026 Meeting Formats; MA FAQ; Wikipedia PA].

B. The clinician's linkage pathway

Phase	Goal	Format and typical length	Move on when
1. Assess and match	Decide whether a drug-focused fellowship fits; choose which one(s) and which meetings	Part of 1–2 assessment sessions [synthesis]	Client agrees to try at least one named meeting [synthesis]
2. Prepare	Explain what happens at meetings, defuse barriers (spirituality, abstinence definition, medication, sharing), coach sponsorship	MAAEZ: six-week cycle of weekly 90-minute group sessions (one introductory plus four core sessions on spirituality, principles-not-personalities, sponsorship, living sober, then graduates return); individually, 15–20 minutes within each therapy session [source: MAAEZ manual; individual format is synthesis]	Client has attended at least one meeting and debriefed it [synthesis]
3. Link and early engagement	Regular attendance, phone list, home group, temporary sponsor	First 90 days (mirrors NA's suggestion); weekly check-in [source: IP #29; check-in is synthesis]	Has a home group and sponsor or a plan to get one; attending at a stable frequency [synthesis]
4. Integrate	Use step work and fellowship contacts alongside therapy; manage conflicts (medication, trauma, co-occurring disorders)	Ongoing; review monthly [synthesis]	Fellowship involvement self-sustaining; therapy focuses on other goals [synthesis]
5. Maintain and re-engage	Keep fellowship as continuing-care resource; plan for lapses and re-entry	Booster or follow-up sessions [synthesis]	n/a

3. Guiding principles

Principles the fellowships publish (shape how you describe and use them)

The only requirement for membership is a desire to stop. Wording differs: NA, CMA and PA a desire to stop using (PA: pills), CA cocaine and all other mind-altering substances, HA a desire to stop suffering from heroin addiction, MA marijuana, NicA nicotine [source: PRMAT; CA 2026 Meeting Formats; heroinanonymous.org; MA FAQ; NicA sample meeting; Wikipedia CMA, PA]. Practical meaning: clients need not be abstinent, diagnosed or convinced to attend; they self-identify.
Abstinence, not moderation. NA describes a programme of complete abstinence and usually defines clean as free of all drugs including alcohol; CA asks for total abstinence from all mind-altering substances; PA defines clean as abstinence from all mood- and mind-altering substances including alcohol [source: PRMAT; CA Tools of Recovery; Wikipedia PA]. Practical meaning: clients with moderation or harm-reduction goals should hear this before attending.
Abstinence and membership are not the same. NA says so explicitly [source: PRMAT]. Practical meaning: a client who lapses or is on medication can still attend.
Group autonomy. Each group makes its own decisions, including how members on medication participate [source: PRMAT]. Practical meaning: meetings vary; match the client to a specific group, not just the fellowship.
Addiction, not the drug, is the focus (NA). NA is not concerned with what or how much was used, uses the word addict, and some groups discourage explicit drug talk [source: IP #29]. Practical meaning: prepare clients not to recount using in detail.
Personal experience only; no crosstalk. Members share their own experience and do not respond to others' shares [source: IP #29; CA 2026 Meeting Formats; NicA sample meeting]. Practical meaning: meetings will not give feedback; that happens in therapy or with a sponsor.
Spiritual, not religious. No belief system is mandated; members define a Higher Power of their own understanding [source: NA: A Resource in Your Community; MA FAQ; Wikipedia CMA, PA]. Practical meaning: atheist and agnostic clients can attend; prepare them for prayers at opening and closing.
Anonymity. First names only; anonymity protects members from legal and social repercussions and keeps principles above personalities [source: NA: A Resource in Your Community; NicA sample meeting]. Practical meaning: never ask a client to identify other members; keep fellowship details confidential in records.
Self-support and non-affiliation. No dues; groups decline outside money and take no position on outside issues, including medical matters and legalisation [source: IP #29; MA FAQ; CA 2026 Meeting Formats]. Practical meaning: your service cannot fund, endorse or direct a group; NA has no opinion on the client's medication.
Non-professional. NA calls itself not professional and offers no opinions on medical matters [source: IP #29]. Practical meaning: clinical decisions stay with you and the prescriber; sponsors are not therapists.
One day at a time. [source: CA Tools of Recovery; NicA To the Newcomer]. Practical meaning: frame goals in 24-hour units when clients feel overwhelmed.

Clinician principles [synthesis, partly from MAAEZ]

Refer to a specific meeting, not a fellowship in general. Meetings vary widely in format and culture [source: PRMAT advises trying several meetings].
Prepare, do not just recommend. MAAEZ exists because newcomers reject groups before giving them a fair chance [source: MAAEZ manual].
Respect the boundary. Do not run a meeting, act as sponsor, or present step work as your intervention; use fellowship involvement as a resource the client owns.
Medication is a clinical decision. Support evidence-based medication for opioid use disorder and other conditions; help the client find medication-friendly groups rather than stopping medication to fit a group [source: PRMAT for group variation; clinical stance is synthesis].
Fit over ideology. If the abstinence goal, spiritual language or culture does not fit after a fair trial, offer other mutual-aid options without treating it as failure.
Monitor, do not police. Ask about meetings each session out of interest, not compliance; mandated-attendance verification is the client's business with the referrer.
Mind safety. Meetings are informal public gatherings; screen for vulnerability to exploitation (NA itself discourages sexual, romantic, financial or religious solicitation) [source: IP #29].

4. Intervention inventory

The inventory has three parts: 4A clinician procedures for referral and facilitation (the clinician's own work); 4B the shared fellowship tools as the fellowships publish them (what the client will do; you explain and support, you do not run them); 4C one sub-section per fellowship. MAAEZ was written for AA with NA and CA alternatives; applying it to CMA, HA, MA, PA and NicA is [synthesis].

4A.1 Assess fit and choose the fellowship

Purpose: Match the client to the fellowship and specific meetings most likely to feel relevant; identify barriers early. Use at intake or when mutual aid is first discussed. [synthesis]
Steps:
1. Ask about past experience of any twelve-step or other mutual-aid group, what helped and what put them off.
2. Clarify the client's goal: complete abstinence, abstinence from one drug, reduction, or undecided. Explain that all these fellowships aim at abstinence and most count alcohol and other drugs (see 4C).
3. Identify the primary drug and identity factors: NA welcomes addiction to any drug including alcohol [source: NA: A Resource in Your Community]; drug-specific fellowships offer stronger identification but fewer meetings (MA reports about 300 weekly meetings, mostly online and phone; PA about 60) [source: MA FAQ; Wikipedia PA].
4. Check medication: anyone on opioid agonist treatment or other psychoactive prescriptions needs the preparation in 4A.5.
5. Check access: in-person versus online or phone meetings, transport, childcare, schedule; specialised meetings (women, LGBTQ+, young people, language) [source: Wikipedia CMA; Wikipedia PA; CA professionals page].
6. Screen for vulnerabilities that need a plan: severe social anxiety, trauma history with groups or religion, psychosis, recent victimisation, court mandate.
7. Agree on one or two named meetings (day, time, place or link) to try first.
Example language (illustrative): "There are several fellowships for drug problems. NA is the largest and takes any drug; there are also ones just for cocaine, meth, heroin, pills, cannabis and nicotine. Which of those would feel most like 'your people'?"
Watch for: Client agreeing only to please you (ask what they expect to happen); stated goal of controlled use (be honest that the meeting will assume abstinence); fit improves when the client can name a reason to go beyond "you told me to".

4A.2 Teach how to read a meeting directory and pick meetings

Purpose: Remove the practical barrier of choosing a meeting; avoid a poor first match. From MAAEZ's introductory session, where participants learn directory codes and pick meetings in session [source: MAAEZ manual].
Steps:
1. Open the fellowship's meeting finder together (NA, CA, CMA, MA and NicA all publish finders or local lists) [source: NA: A Resource in Your Community; CA professionals page; MA professionals page].
2. Explain open versus closed: open meetings welcome anyone; closed are for those with (or who think they have) the problem [source: IP #29].
3. Explain formats: discussion or participation, speaker, step or literature study, question and answer, business meetings [source: IP #29; CA 2026 Meeting Formats; Wikipedia PA].
4. Suggest a speaker or participation meeting for the first visit and a newcomer-friendly time; for online or phone meetings, check technical access.
5. Have the client choose two or three meetings this week and write them down.
Example language (illustrative): "Let's pick two to try this week. A speaker meeting is easiest at first, because you can just listen."
Watch for: Choosing only meetings far away or at impossible times (an avoidance signal); success is the client attending a chosen meeting and being able to name it next session.

4A.3 Prepare the client for meeting culture and etiquette

Purpose: Prevent early drop-out caused by surprise at rituals, sharing norms or language. Covered in MAAEZ's principles-not-personalities session (myths, diversity, etiquette, ritual) [source: MAAEZ manual]; content below from fellowship materials.
Steps: Walk through a typical meeting:
1. Opening: chair welcomes, often a moment of silence and the Serenity Prayer (CA, NicA), readings such as a preamble, the Steps, the Traditions [source: CA 2026 Meeting Formats; NicA sample meeting].
2. Newcomers are often asked to introduce themselves by first name and may receive a welcome keytag, chip or packet; they can say they only want to listen [source: IP #29; NicA sample meeting].
3. Sharing: usually once, five minutes or less (CA three to five); no crosstalk; share own experience [source: IP #29; CA 2026 Meeting Formats]. In CA formats members who used in the last 24 hours are asked not to share [source: CA 2026 Meeting Formats]. NA: focus on addiction and recovery, not drug details [source: IP #29].
4. Collection: voluntary member contributions only; no fees [source: IP #29].
5. Closing: often a circle with a short prayer or reading; hugs common but can be declined [source: IP #29].
6. Etiquette: silence the phone, no side conversations, no drugs or paraphernalia; unwelcome sexual, romantic, financial or religious approaches are discouraged and can be reported to the meeting leader or a trusted servant [source: IP #29].
7. Advise arriving early, staying late, and asking members questions [source: IP #29].
Example language (illustrative): "You won't be put on the spot. If they ask newcomers to introduce themselves, your first name is enough, and you can say you're just listening."
Watch for: Strong reactions to prayer, holding hands or hugging (rehearse an opt-out); client recounting drug details at NA and feeling judged (prepare in advance).

4A.4 Address spirituality and the Higher Power concept

Purpose: Defuse the most common objection for secular or religiously wounded clients. MAAEZ's spirituality session presents spirituality without requiring religion or belief in God, reframing through honesty, open-mindedness and willingness and "Good Orderly Direction" [source: MAAEZ manual].
Steps:
1. Ask what the client has heard and what their beliefs are.
2. Share the fellowships' own statements: no belief system mandated; room for all beliefs; Higher Power is self-defined [source: NA: A Resource in Your Community; MA FAQ].
3. Offer interpretations members use (the group, principles, good orderly direction) and stress the client decides.
4. Agree how to handle prayers (stand quietly, or join as a group ritual).
5. Homework: after a meeting, talk with a member who has more clean time about how they relate to the spiritual side [source: MAAEZ spirituality homework, adapted].
Example language (illustrative): "Plenty of members are atheists. Some treat the group itself as the power greater than themselves. You don't have to sign up to a belief to sit in the room."
Watch for: Religious trauma (go slow; consider secular alternatives); relief when the client hears of others with similar beliefs.

4A.5 Prepare clients on medication (including opioid agonist treatment)

Purpose: Protect evidence-based medication while enabling fellowship access. NA welcomes people on drug replacement therapy, holds no opinion on medical matters, but individual groups decide whether people on medication may share or serve; members may welcome or strongly oppose medication [source: IP #29; PRMAT].
Steps:
1. Tell the client plainly that NA's literature says they are welcome and that NA has no opinion on their medication, and that some groups and members may disagree [source: PRMAT].
2. Encourage several meetings; search online or ask locally for groups known to be welcoming to people on medication [source: PRMAT].
3. If useful, contact the local NA public relations or public information committee (or pr@na.org) for a member contact who can advise on welcoming groups [source: PRMAT].
4. Suggest the client read IP #29 and IP #11 Sponsorship, and NA's In Times of Illness for questions about medication [source: PRMAT; IP #29].
5. Agree in advance: medication changes are decided with the prescriber, never because of a group or sponsor. Rehearse a response if someone says they are "not clean" [synthesis].
6. For other psychotropics, note MAAEZ's position that prescribed psychotropic medication is acceptable while some members disagree [source: MAAEZ manual]. CMA's abstinence definition excludes medication not taken as prescribed, implying prescribed use is compatible [source: Wikipedia CMA] [uncertain]. HA, CA and PA positions on medication are [uncertain].
7. For NicA, nicotine-containing withdrawal aids (patch, gum, inhaler) are named as aids that contain nicotine; no official policy on their use was found [source: NicA To the Newcomer and Sponsorship] [uncertain].
Example language (illustrative): "Your buprenorphine is between you and your doctor. NA's own pamphlet says you're welcome. Some groups are friendlier about it than others, so let's find one of those."
Watch for: Client stopping or tapering medication suddenly after a meeting (high overdose risk after loss of tolerance; review immediately with prescriber); shame about medication; success is the client attending without concealing or abandoning treatment.

4A.6 Coach sponsorship

Purpose: Sponsorship is the main route into step work. MAAEZ's sponsorship session covers what a sponsor does, how to pick one and how to ask, with role-plays for asking for a temporary or permanent sponsor and handling a refusal [source: MAAEZ manual].
Steps:
1. Explain the role: an experienced member who shares their own experience and guides the newcomer through the steps; not a therapist, lender or authority [source: IP #29; Wikipedia CMA].
2. Selection: listen for members the client relates to and who have worked the steps; PA literature notes same-sex sponsors are common but not required [source: IP #29; Wikipedia PA].
3. Method: MA suggests attending many meetings, announcing that one is looking, then asking a good fit [source: MA FAQ]. NicA suggests getting one early, even before quitting, on a temporary basis [source: NicA To the Newcomer and Sponsorship].
4. Role-play the ask and a possible "no" in session.
5. Homework: ask one person for a temporary sponsor, or connect with an existing one [source: MAAEZ sponsorship homework].
6. Afterwards, review: does the sponsor respect boundaries, medication and therapy? [synthesis]
Example language (illustrative): Client role-play line: "I'm new and looking for a temporary sponsor. Would you be willing, or could you suggest someone?"
Watch for: Sponsors giving medical or psychiatric directives, exploitative or romantic interest (see section 5); success is regular sponsor contact and the start of step work.

4A.7 Build a phone list and early contact network

Purpose: Reduce isolation between meetings; every fellowship drawn on lists the phone or contact list as a tool [source: CA Tools of Recovery; NicA sample meeting].
Steps: (1) Ask the client to collect two or three numbers at their next meeting; (2) assign one call to a member before the next session [source: MAAEZ principles homework]; (3) for NicA, coach calling the sponsor before a craving, not only in a crisis [source: NicA To the Newcomer]; (4) plan who to call in a high-risk moment.
Example language (illustrative): "Your homework is small: get one number and make one call this week, even just to say hello."
Watch for: Client collecting numbers but never calling (rehearse a first call); calls used for drug contacts (review).

4A.8 Living-sober skills (people, places, things; HALT)

Purpose: Teach practical relapse-prevention ideas used in the fellowships. MAAEZ's living-sober session covers HALT (hungry, angry, lonely, tired), avoiding slippery people, places and things, and sober fun [source: MAAEZ manual]; CA lists getting rid of drugs and paraphernalia and avoiding people, places and things linked to using [source: CA Tools of Recovery].
Steps: (1) Map the client's triggers; (2) plan disposal of drugs and paraphernalia; (3) identify which people and places to avoid; (4) use HALT as a quick self-check; (5) schedule one sober social activity with a fellowship member [source: MAAEZ living-sober homework].
Example language (illustrative): "Before you reach for anything, quickly check HALT: are you hungry, angry, lonely or tired?"
Watch for: Over-rigid avoidance cutting off all supports; success is fewer high-risk exposures and a growing sober network.

4A.9 Between-session homework and check-in

Purpose: Keep linkage active. In MAAEZ each session begins with a 15-minute check-in on homework, and every session's homework includes attending a meeting within seven days and a short reading [source: MAAEZ manual].
Steps: (1) Each session ask: which meetings, what was it like, who did you talk to, any sponsor contact; (2) assign one meeting, one reading (for NA, MAAEZ suggests Basic Text sections such as Who Is an Addict, Recovery and Relapse, Just for Today) and one contact task; (3) praise effort, problem-solve barriers without lecturing.
Example language (illustrative): "What did you notice at the meeting? Was there anyone whose story sounded like yours?"
Watch for: Rote reports; MAAEZ advises speaking privately with reluctant members rather than confronting them in group [source: MAAEZ manual].

4A.10 Running a MAAEZ-style preparation group (group programmes)

Purpose: Prepare several clients at once in a treatment programme [source: MAAEZ manual].
Steps: Six-week rolling cycle, weekly 90-minute sessions with a 10-minute break: Week 1 introductory (why attend, how to choose meetings), four core sessions in any order (spirituality; principles not personalities; sponsorship; living sober), graduates return at week 6 to share with newcomers. Each session: 15-minute check-in, about 55 minutes topic content with open questions to the group, 5-minute summary, homework. Crosstalk is allowed in this group, unlike in meetings. The manual specifies a facilitator who is in recovery and active in AA, NA or CA, using limited self-disclosure (one or two stories a session) [source: MAAEZ manual]. If no such facilitator is available, adaptation is [synthesis].
Example language (illustrative): "In this group you can respond to each other, which you won't do at meetings. Let's talk about what put people off at their first meeting."
Watch for: Facilitator self-disclosure crowding out members; graduates' stories that idealise; success is the proportion of members attending meetings and getting sponsors during the cycle.

4A.11 Liaise with the fellowship's service committees

Purpose: Bring the fellowship to clients who cannot yet reach meetings, and learn local culture. NA H&I committees hold meetings or presentations in hospitals, jails, treatment and detox centres; NA PR offers presentations to clinicians and courts; MA members host H&I meetings in treatment centres, schools, hospitals and jails, run by members, not staff; CA's public information committee offers presentations [source: NA: A Resource in Your Community; MA professionals page; CA professionals page].
Steps: (1) Contact the local or world PR/PI or H&I committee through the fellowship website or phone line (MA: call, text or email, response aimed within 48 hours) [source: MA professionals page]; (2) request an H&I meeting or information session; (3) provide a room and time but leave the meeting itself to members; (4) attend an open meeting yourself to see the culture first-hand [source: PRMAT].
Example language (illustrative, to committee): "We run a residential unit and would like to host an H&I meeting for residents, or have members speak to staff."
Watch for: Staff trying to steer the content (breaches the fellowship's autonomy); success is clients meeting members before discharge.

4A.12 Mandated attendance and verification

Purpose: Handle court, probation or employer requirements without breaching anonymity.
Steps: (1) Ask the client what exactly the referrer requires; (2) explain that verification is at each group's discretion: NA groups often sign court cards as a courtesy but some do not [source: IP #29]; MA leaves it to each meeting, online hosts may email proof and MA phone meetings have their own system [source: MA FAQ]; CA offers stamped chit cards [source: CA professionals page]; (3) client asks the group in advance; (4) keep verification separate from therapy engagement [synthesis].
Example language (illustrative): "Ask the secretary before the meeting whether they sign cards. If not, we'll find one that does."
Watch for: Client attending only for signatures (explore motivation); verification dominating sessions.

4A.13 Integrating step work with therapy [synthesis]

Purpose: Prevent conflict between sponsor-guided step work and therapy, and make use of it. No source describes this; all of it is [synthesis].
Steps: (1) Ask the client which step they are on and what it involves for them, without directing it; (2) for inventory-type steps, check for trauma material or excessive self-blame and offer to process in therapy; (3) for amends-type steps, help the client weigh safety (for example around abusers or legal exposure) and discuss with their sponsor; (4) keep therapy goals distinct.
Example language (illustrative): "You don't have to tell me what's in your inventory. I'm interested in how it's affecting you."
Watch for: Shame spirals, retraumatisation, or unsafe contact plans.

4B Shared fellowship tools (as published; the client uses them, you support)

Meetings: daily attendance suggested early (NA: at least 90 days; CA: daily); a home group is commonly chosen [source: IP #29; CA Tools of Recovery; Wikipedia PA].
Sponsorship and the Twelve Steps [source: all fellowship materials].
Phone or contact list [source: CA Tools of Recovery; NicA sample meeting].
Literature of each fellowship (see 4C), and reading at home.
Service: simple meeting jobs, later service positions and H&I [source: CA Tools of Recovery; NicA To the Newcomer].
One day at a time; prayer and meditation toward a Higher Power of one's own understanding [source: CA Tools of Recovery].
Making recovery the priority: disposal of drugs and paraphernalia; avoiding using associations; asking for help [source: CA Tools of Recovery].
Written reasons list (NicA): a written list of reasons to stay nicotine-free, reread under stress [source: NicA To the Newcomer].

4C.1 Narcotics Anonymous (NA)

Membership: a desire to stop using; not limited to any drug, alcohol included; still-using addicts welcome [source: PRMAT; NA: A Resource in Your Community].
Abstinence: a programme of complete abstinence; clean usually means free of all drugs including alcohol; abstinence and membership are not the same [source: PRMAT].
Size and reach: an estimated 63,000+ weekly meetings in 132 countries (2014 estimate); in a 2013 member survey 52% said they first found NA through treatment or counselling centres [source: NA: A Resource in Your Community]. Founding date and place [uncertain].
Literature: the Basic Text Narcotics Anonymous; information pamphlets (IPs) including IP #29 An Introduction to NA Meetings and IP #11 Sponsorship; booklet In Times of Illness; The NA Way Magazine; most meetings give IPs free [source: IP #29; PRMAT; NA: A Resource in Your Community].
Meetings: open or closed; participation, speaker, question-and-answer, topic discussion or combinations; informally structured, same time and place weekly; members take turns opening and closing; welcome keytag for newcomers; some have a short break [source: NA: A Resource in Your Community; IP #29].
Distinctive features: language of "addict" and "addiction" rather than drug names; groups may ask members to avoid explicit drug or using details; NA says it has no opinions on medical matters, but group practice on members receiving medication varies (sharing and service may be limited by some groups) [source: IP #29; PRMAT].
Clinician notes: NA is the default referral for polydrug use and where drug-specific meetings are scarce [synthesis]. Use PRMAT with clients on opioid agonist treatment (4A.5). NA's professional materials invite clinicians to attend an open meeting and to contact local PR or public information committees [source: PRMAT].

4C.2 Cocaine Anonymous (CA)

Membership: a desire to stop using cocaine and all other mind-altering substances; CA says it addresses addiction to all mind-altering substances including alcohol [source: CA 2026 Meeting Formats; CA professionals page].
Abstinence: total abstinence from all mind-altering substances [source: CA Tools of Recovery]. Founding date and place [uncertain].
Literature: pamphlets including Tools of Recovery, ...And All Other Mind-Altering Substances, 12 Principles, A Guide to the 12 Steps, A Higher Power, A Message to Professionals, A New High from H&I, Choosing Your Sponsor, C.A. is for the LGBTQ+ Addict, Too Young to Recover?, The First 30 Days [source: CA Tools of Recovery page; CA professionals page; CA search results]. CA meeting formats include AA-derived readings reprinted with AA's permission and state AA is not affiliated with CA [source: CA 2026 Meeting Formats]. CA's book-length literature and any use of the AA Big Book as a study text were not verified [uncertain].
Meetings (2026 approved formats): four formats: participation (open sharing, question and answer, newcomers encouraged to ask questions); literature study or topic (reading approved literature paragraph by paragraph around the room, then sharing on the step read); general speaker (speaker then participation); group business [source: CA 2026 Meeting Formats]. Participation sequence: leader introduces self as an addict; optional silence and Serenity Prayer; members with under 30 days and first-timers introduce themselves; fellowship statement; readings (We Can Recover, the Traditions, optionally Who Is a Cocaine Addict?, Who Is a C.A. Member? or Alcohol); sharing rules; Seventh Tradition collection; optional break; chip announcements; time call and announcements; closing reading (The Promises, A Vision for You, Reaching Out or Unity); anonymity statement, silent meditation and a closing prayer [source: CA 2026 Meeting Formats].
Distinctive features: sharing 3–5 minutes; no crosstalk; members who have used drugs or alcohol in the last 24 hours are asked not to share; chips at 1 week, 30, 60, 90 days, 6, 9 months, 1 year, 18 months, 2+ years and a cake every 365 days; meetings in 30+ countries; stamped chit cards for attendance verification [source: CA 2026 Meeting Formats; CA professionals page].
Clinician notes: Prepare clients that they may be asked not to share if they used in the past day, so they can attend and just listen without shame [synthesis based on CA format]. Request professional pamphlets and meeting lists from CA's public information committee [source: CA professionals page].

4C.3 Crystal Meth Anonymous (CMA)

Source note: CMA's own site is not drawn on; content below is from a Wikipedia summary citing CMA's FAQ, history, traditions and 2024 survey [uncertain].

Membership and origins: desire to stop using; members decide for themselves whether they are addicts; founded 16 September 1994 in West Hollywood, California, by Bill C., first meeting at the West Hollywood Alcohol and Drug Center [source: Wikipedia CMA].
Abstinence: complete abstinence from methamphetamine, alcohol, inhalants and any medication not taken as prescribed [source: Wikipedia CMA].
Literature: Crystal Clear: Stories of Hope (2011); Voices of the Fellowship: Our Recovery (2021); A Sober Cell (2022); Voices of the Fellowship: Our Families (2025); pamphlets including What Is CMA? and What About God?; CMA also recommends AA's Big Book and Twelve Steps and Twelve Traditions; regional books (e.g. NYCMA, CMA UK) are not CMA World Services publications [source: Wikipedia CMA].
Meetings: open or closed; speaker, step, literature and sharing formats; in person, online and hybrid; H&I meetings; designated meetings (LGBTQ+, women, men, young people) open to all who meet the requirement [source: Wikipedia CMA].
Distinctive features: large LGBTQ+ membership, founded amid concern about methamphetamine use and HIV risk among gay and bisexual men; 2024 survey: median age 45, 74% saw relapse as part of recovery, a third attended daily [source: Wikipedia CMA].
Clinician notes [synthesis]: For clients whose meth use is tied to sex, offer an LGBTQ+ meeting option and coordinate with sexual-health services; plan for prolonged low mood and sleep disruption in early abstinence when attendance often drops; the alcohol-included abstinence definition matters for clients who only intend to stop meth.

4C.4 Heroin Anonymous (HA)

Membership and purpose: the only requirement is a desire to stop suffering from heroin addiction; members aim to stay sober and help other heroin addicts achieve sobriety; programme adapted from the 1935 AA programme and its Twelve Steps, not affiliated with AA; no counselling or treatment provided [source: heroinanonymous.org].
Origins: founded 2004 in Phoenix, Arizona [source: Wikipedia HA, secondary]; HA's site says founder Paul F. began writing pamphlets and meeting formats as literature chair in 2004 [source: heroinanonymous.org]. Groups in 19 US states and the UK; world conventions 2014, 2018, 2021, 2024 [source: Wikipedia HA].
Abstinence: complete abstinence from all drugs and alcohol [source: Wikipedia HA citing HA site].
Literature: a local HA source describes AA's Big Book used as a guidebook [source: Wikipedia HA citing a local group page] [uncertain]; an HA book titled No More Suffering appears in HA's site listings [uncertain].
Meetings: first names only; members share about addiction, difficulties and accomplishments [source: Wikipedia HA]. Format details not verified [uncertain].
Medication: HA's position on methadone or buprenorphine is [uncertain]. Ask the local group or members before referring a client on agonist treatment.
Clinician notes [synthesis]: HA's population carries high overdose risk; pair every referral with naloxone and overdose-risk education, and warn that returning to use after any abstinent period is especially dangerous. If an HA group is hostile to the client's medication, use a medication-friendly NA group instead (4A.5).

4C.5 Marijuana Anonymous (MA)

Membership and purpose: the only requirement is a desire to stop using marijuana; primary purpose to stay free of marijuana and help others do the same; founded 1989; modelled on AA [source: MA FAQ; MA professionals page].
Abstinence: MA's pages refer only to freedom from marijuana; MA's stance on alcohol, other drugs and CBD was not stated there (a pamphlet What about CBD? exists) [uncertain]. MA has no opinion on legalisation [source: MA FAQ].
Literature: Life with Hope (basic text and 12-step workbook); Living Every Day with Hope (daily reader); pamphlets For the Newcomer, Working the Program, Why Marijuana Anonymous, Detoxing from Marijuana, Dangers of Cross-Addiction, The Twelve Questions of Marijuana Anonymous (a self-assessment, not reproduced here); MA app and online resource library [source: MA professionals page; MA FAQ].
Meetings: 300+ weekly meetings, many virtual and by phone, some in person; open meetings for anyone; H&I meetings run by members in treatment centres, schools, hospitals and jails [source: MA FAQ; MA professionals page].
Distinctive features: no sold chips but free virtual chips and an app sobriety counter; attendance verification at each meeting's discretion; a newcomer support team reachable by call, text or email (aims to reply within 48 hours) [source: MA FAQ; MA professionals page].
Clinician notes: Useful for clients who do not identify with NA's hard-drug culture [synthesis]. Use the Detoxing from Marijuana pamphlet when preparing clients for withdrawal irritability and sleep problems [source: pamphlet title from MA professionals page] [uncertain]. Check whether online-only access suits clients with social anxiety [synthesis].

4C.6 Pills Anonymous (PA)

Source note: from a Wikipedia summary citing PA's own website and book [uncertain].

Membership and origins: a desire to stop using pills; no dues; founded 1972, longest-running known group in New York City; over 60 weekly meetings; patterned closely on AA but not affiliated [source: Wikipedia PA].
Abstinence: clean means complete abstinence from all mood- and mind-altering substances including alcohol; PA has no opinion on outside issues, including medicine [source: Wikipedia PA].
Literature: There Is A Solution: The Twelve Steps and Twelve Traditions of Pills Anonymous (2013, text and study guide); PA World Service Manual (2008); Local Service Manual (2009); Public Information Guide (2010) [source: Wikipedia PA].
Meetings: open or closed; open sharing, round-robin, speaker, step or literature meetings; "common needs" meetings (gender, sexual identity, age, language) that are not exclusionary; medallions for anniversaries; home groups; frequent closing with the Third Step Prayer or Serenity Prayer [source: Wikipedia PA].
Sponsorship: highly recommended; same-sex sponsors common but not required; choose someone who understands the Traditions [source: Wikipedia PA].
Clinician notes [synthesis]: Clients dependent on prescribed opioids, benzodiazepines or stimulants need a medically supervised plan (taper, pain management, treatment of the underlying condition) agreed with the prescriber; abrupt self-discontinuation of benzodiazepines can be dangerous. Clarify with the client how they will talk about ongoing legitimate prescriptions at meetings.

4C.7 Nicotine Anonymous (NicA)

Membership: the desire to stop using nicotine; newcomers welcome even if still using nicotine in any form [source: NicA sample meeting].
Abstinence: stopping all nicotine; cigarettes, vaping, cigars, pipes, dipping and chewing named, the common element being nicotine; patch, gum and inhalers described as withdrawal aids that contain nicotine; no official policy on their use found [source: NicA To the Newcomer and Sponsorship] [uncertain]. Founding date not verified [uncertain].
Literature: Nicotine Anonymous: The Book; pamphlets To the Newcomer, Sponsorship; Our Promises; meeting starter kit [source: NicA sample meeting; NicA search results].
Meetings (sample format): one hour; silence and Serenity Prayer; chair identifies as powerless over nicotine; preamble; newcomer welcome with chip or packet; Steps passed round and read, one Tradition read; five tools named (meetings, literature, sponsorship, phone/email list, service); collection; speaker then sharing, or reading from the Book with sharing after each section; first names only; no crosstalk, criticism or unsolicited advice; closing with Our Promises, anonymity reminder, take-what-helps disclaimer, Serenity Prayer [source: NicA sample meeting].
Distinctive tools: call the sponsor before using any nicotine and before a craving starts; written list of reasons to be nicotine-free; get a sponsor even before quitting; start a meeting if none exists [source: NicA To the Newcomer and Sponsorship].
Clinician notes [synthesis]: NicA can sit alongside evidence-based cessation pharmacotherapy and counselling; prepare clients that members may differ on nicotine replacement and agree the client's own plan with their prescriber. Useful for clients in drug or alcohol recovery who still smoke or vape.

5. Handling problems

The fellowship sources say little about clinical problems; most guidance here is [synthesis] unless a source is tagged.

Client agrees but never goes (non-adherence). Shrink the step: one named meeting, a speaker meeting, or an online meeting with camera off. Explore what they predict will happen and test it. Offer to look at the meeting finder together in session (4A.2) [source: MAAEZ for in-session selection]. If a local member contact is available through the PR or PI committee, a client can meet a member first [source: PRMAT] [synthesis for the use].
Bad first meeting ("they're not like me"). Normalise; meetings vary and NA itself advises trying several [source: PRMAT]. Ask what did and did not fit and pick a different format, size, time or a drug-specific fellowship. Agree a fair trial (for example several different meetings) before deciding [synthesis; NicA likewise suggests several meetings before deciding, source: NicA sample meeting].
Objection to God, prayer or powerlessness (resistance). Use 4A.4; avoid arguing. Separate the client's goal (stop using) from adopting the language. If after a fair trial the spiritual framework remains a barrier, refer to a non-twelve-step mutual-aid group without implying failure [synthesis].
Moderation or harm-reduction goal. Be honest that these fellowships assume abstinence and many count alcohol [source: PRMAT; CA Tools of Recovery; Wikipedia PA, CMA]. Clients can still attend to listen (membership requires only a desire to stop), but do not pressure an abstinence goal they have not chosen; consider other supports [synthesis].
Client on opioid agonist or other medication is told they are "not clean" or urged to stop. Validate; restate that NA literature welcomes them and holds no opinion on medical matters, that group practice varies, and help them find a welcoming group [source: PRMAT; IP #29]. Review overdose risk if they are considering stopping; involve the prescriber; never endorse medication changes driven by a group or sponsor [synthesis].
Sponsor oversteps (medical, financial, controlling or sexual). Sponsors are experienced members sharing experience, not professionals [source: IP #29]. Help the client set limits or change sponsors; any sexual, romantic or financial pressure is the kind of solicitation NA discourages and can be reported to the meeting leader or a trusted servant [source: IP #29]. Safety-plan if the person is threatening or exploitative; consider different meetings [synthesis].
Overwhelm or social anxiety in meetings. Start with online or phone meetings (MA, CMA offer them) [source: MA FAQ; Wikipedia CMA]; arrive at the start and sit near the door; rehearse a first-name introduction and saying "I'll just listen"; use grounding before and after; debrief in session [synthesis].
Triggering shares or drug talk. Prepare for hearing using stories (some groups discourage explicit details) [source: IP #29]; plan to step out, call a contact, and use HALT [source: MAAEZ for HALT]; pick meetings with a recovery focus [synthesis].
Trauma surfacing during step work (inventories, amends). Offer to work with emotions and self-blame in therapy, without taking over the step; help weigh safety before any amends to abusive people; coordinate wording with the client so they can discuss limits with their sponsor (4A.13) [synthesis].
Lapse or relapse. Normalise as information, not failure; remind the client membership is about desire, not abstinence, and that still-using addicts are welcomed [source: PRMAT]; in CA, if they used in the last 24 hours, they can attend and listen [source: CA 2026 Meeting Formats]. Encourage contact with the sponsor the same day. Assess overdose risk after any period of abstinence (opioids especially), provide naloxone information, and review the treatment plan [synthesis]. Address "resetting the date" shame directly [synthesis].
Rupture between therapy and fellowship ("my sponsor says I don't need therapy" or "you're against the programme"). Acknowledge the client owns their fellowship involvement; clarify roles (sponsor shares experience, therapist offers treatment); avoid criticising the fellowship or the sponsor; ask how both can serve the client's goals. If the client feels you pushed meetings too hard, own it and renegotiate [synthesis].
Fellowship replaces all other care, or rigid black-and-white thinking. Explore the function of the rigidity (safety, identity); keep medical and psychiatric care separate and non-negotiable where risk is high; support balanced life goals [synthesis].
Co-occurring psychiatric illness (psychosis, bipolar disorder, severe depression). Choose calm, smaller meetings; prepare for prescribed medication questions (MAAEZ notes prescribed psychotropics are acceptable while some members disagree) [source: MAAEZ manual]; monitor for suicidal thinking after lapses or conflicts; follow standard risk assessment and safety planning [synthesis].
Mandated attendance. Clarify what the referrer needs; check each group's verification practice in advance (4A.12) [source: IP #29; MA FAQ; CA professionals page]; separate verification from therapy; explore the client's own reasons for going [synthesis].
Confidentiality and anonymity. Never ask the client to name members; record only the client's own participation with consent; do not disclose fellowship membership to third parties without consent [synthesis grounded in anonymity principle, source: NA: A Resource in Your Community].
No suitable local meeting for the drug-specific fellowship. Use NA (welcomes any drug) or online and phone meetings of the specific fellowship (MA mostly virtual and phone; CMA online) [source: NA: A Resource in Your Community; MA FAQ; Wikipedia CMA]. NicA encourages starting a meeting if none exists [source: NicA To the Newcomer], which suits clients with stable recovery, not newcomers [synthesis].
Polydrug use, mixed identities. Let the client choose by identification; many attend more than one fellowship [synthesis]. Note that CA and PA define abstinence to include alcohol and all mind-altering substances [source: CA Tools of Recovery; Wikipedia PA].
Young clients. Look for young people's meetings or literature (CA Too Young to Recover?; CMA young people's meetings) [source: CA Tools of Recovery page; Wikipedia CMA]; check safeguarding and parental consent issues for minors attending adult meetings [synthesis].
Clinician as group host (H&I in your service). Provide space and leave content to members; do not require staff to attend or steer meetings; MA specifies H&I meetings are run by members, not facility staff [source: MA professionals page].

Sources

Sources: