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SOBRIETY 101: What happens at recovery meetings, how did they start and why are they necessary?

recovery meetings

With so many references to recovery meetings by those who are working on obtaining or maintaining sobriety, it’s understandable if you think they’ve somehow landed jobs at high-profile ad agencies or law firms where brainstorming sessions with partners and clients occur on an hourly basis.

Often, their references are arbitrary and perhaps even cryptic: “I can’t come over until after my meeting.” “I’ll be there, but I have to leave in time for the meeting.” “Hey, do we have anything planned for Saturday night? There’s a speaker at a meeting I want to go hear.”

For those not in recovery, or for individuals considering the journey and trying to get a feel for the landscape, it’s a language that may not make a lot of sense. So if you find yourself asking, “What the hell are these meetings, and what happens in them?” – don’t worry. You’re not alone.

Maybe we can shine a little light on the subject for you.

So What Are Recovery Meetings?

Meetings, simply put, are peer support groups whose members gather on a regular basis to help one another stay clean and sober. There are a number of different recovery organizations that utilize the meeting format, but perhaps the most widely known are two that utilize the 12 Steps – Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). (If you want to know more about the 12 Steps – where they come from and what they are – you can read that here.)

The format is different depending on the organization, and even within individual organizations, meeting styles can vary from one geographic area to the next. We’ll get into some generalities in a bit, but it’s important to understand why, exactly, the recovery meetings that these groups hold can be an invaluable tool of recovery from addiction and alcoholism.

Perhaps no other organization has touted the benefits of peer support more than Peers for Progress, an organization associated with the University of North Carolina’s Gillings School of Global Public Health. According to them [1], “Peer support links people living with a chronic condition such as diabetes. People with a common illness are able to share knowledge and experiences – including some that many health workers do not have. Peer support is frequent, ongoing, accessible and flexible. Peer support can take many forms – phone calls, text messaging, group meetings, home visits, going for walks together, and even grocery shopping. It complements and enhances other health care services by creating the emotional, social and practical assistance necessary for managing the disease and staying healthy.”

In other words, peer support groups can provide a safety net for those suffering from chronic conditions – like addiction and alcoholism – that extends far beyond acute treatment at drug and alcohol rehabs. Most residential treatment centers have a model of care based on roughly 30 days of inpatient treatment (depending, of course, on financial logistics). While some have aftercare and sober living programs that can extend beyond a month, it’s rare that patients stay longer than 90 days in any given program.

So, what happens when it’s time for them to return to their lives? How can they remain clean and sober? Recovery meetings are an excellent resource in which to do just that. In AA, NA or other recovery-related organizations, addicts and alcoholics find a group of individuals who face the same challenges, share the same experiences and want the same things. According to a 2016 article in the peer-reviewed journal Substance Abuse and Rehabilitation [2], “Historically, peer support has been shown to be a key component of many existing addiction treatment and recovery approaches such as the community reinforcement approach, therapeutic communities, and 12-step programs; the community reinforcement approach has demonstrated the importance of valued social roles in maintaining abstinence, which is the foundation of the peer support relationship.”

Why Are Recovery Meetings Necessary?

recovery meetingsTo understand how recovery meetings contribute to sustained abstinence, it’s important to understand the biological changes to the brain that take place during addiction. The Recovery Research Institute, an arm of Massachusetts General Hospital, points out [3] that “addictive drugs can provide a shortcut to the brain’s reward system by flooding the nucleus accumbens with dopamine. Additionally, addictive drugs can release 2 to 10 times the amount of dopamine that natural rewards do, and they do it more quickly and reliably. Over time, drugs become less rewarding, and craving for the drug takes over. The brain adapts to the effects of the drug (an effect known as tolerance), and because of these brain adaptations, dopamine has less impact. People who develop an addiction find that the drug no longer gives them as much pleasure as it used to, and that they have to take greater amounts of the drug more frequently to feel high.”

It gets worse: According to the National Institute on Drug Abuse (NIDA) [4], “Like other chronic diseases such as heart disease or asthma, treatment for drug addiction usually isn’t a cure. But addiction can be managed successfully. Treatment enables people to counteract addiction’s disruptive effects on their brain and behavior and regain control of their lives.”

Treatment for any chronic disease is more complex than simple cessation of the substances or habits that have contributed to its development. With diabetes, addiction or asthma, it’s about a change of behaviors that have maintained the disease in its active state, and simply stopping drinking and using isn’t enough. As Dr. Charles P. O’Brien writes in a 2009 article for the journal Dialogues in Clinical Neuroscience [5], “detoxification is simply removal of the drug from the body and treatment of withdrawal symptoms. Now we know that the essence of addiction continues long after the last dose of the drug, often lasting for years … addiction is fundamentally a memory trace that manifests itself by reflex activation of brain circuits, especially the reward system, resulting in motivation to resume drug-taking behavior when drug-related cues are encountered.”

The peer support nature of recovery meetings, in whatever format they take, can reduce that motivation and increase the support system that those in recovery have as a means of remaining abstinent.

Do Recovery Meetings Work?

There is no foolproof method to remaining sober for a lifetime, because addiction is a chronic and progressive disease. According to the NIDA, “Relapse rates for people treated for substance use disorders (40-60 percent) are compared with those for people treated for high blood pressure and asthma (50-70 percent). Relapse is common and similar across these illnesses. Therefore, substance use disorders should be treated like any other chronic illness. Relapse serves as a sign for resumed, modified, or new treatment.”

And while it’s difficult to gauge the efficacy of recovery meetings – particularly 12 Step groups, given their non-affiliation with any other organization and their emphasis on anonymity – studies do exist that show that, at the very least, they don’t cause any harm. To the uninitiated, they may seem sketchy – because there are alcoholics and addicts at those meetings! Yes, there are – but they’re also looking for a way to stay clean and sober, and there’s power in the unity and camaraderie of shared experience.

Kathlene Tracy and Samantha P. Wallace, writing for Substance Abuse and Rehabilitation [2], examined 10 studies and found that the evidence supports peer support as a means of addiction recovery: “Those who participated in treatments, including peer support groups, showed higher rates of abstinence than common in substance-abusing populations while also being more satisfied with the treatment. Furthermore, significant reductions in relapse rates were shown in addition to significant reductions in return to homelessness in a challenging population to treat. Reported benefits extended beyond those being the recipient of the peer support groups to those also delivering the services, where significant reductions in alcohol and drug use were shown not only for mentees but also for sustained abstinence in the majority of mentors.”

That’s not all: In an examination of the science behind peer support, Peers for Progress found that [6] “much evidence supports that peer support is a critical and effective strategy for ongoing health care and sustained behavior change for people with chronic diseases and other conditions, and its benefits can be extended to community, organizational and societal levels. Overall, studies have found that social support:

  • decreases morbidity and mortality rates
  • increases life expectancy
  • increases knowledge of a disease
  • improves self-efficacy
  • improves self-reported health status and self-care skills, including medication adherence
  • reduces use of emergency services

Additionally, providers of social support report less depression, heightened self-esteem and self-efficacy, and improved quality of life.”

It’s important to point out that one widely quoted study critical of recovery meetings (12 Step recovery), published in 2006 in the Cochrane Review [7], states that “no experimental studies unequivocally demonstrated the effectiveness of AA or [Twelve-Step Facilitation] TSF approaches for reducing alcohol dependence or problems.” However: The same article also states that “there is no conclusive evidence to show that AA can help to achieve abstinence, nor is there any conclusive evidence to show that it cannot.”

Ultimately, the efficacy of recovery meetings can be summed up by a passage in a paper by Dr. Gregory Brigham, written in 2003 for the journal Addiction Science and Clinical Practice [8]: “Twelve-step organizations appear to be helpful to a wide range of AOD (alcohol and other drug)-dependent individuals. However, clinical observation and research indicate that not all patients respond equally. It is difficult to predict who will benefit from 12-step organizations.”

Anecdotally, however, there are thousands, if not millions, of recovering addicts and alcoholics who have benefited from recovery meetings for more than 80 years. Many of them never participate in studies, and because of the emphasis on anonymity, seldom discuss their sobriety publicly. With that in mind, the lack of public advocacy should not be confused for ineffectiveness.

A History of 12 Step meetings

recovery meetingsThe sobriety of Bill Wilson, the co-founder of AA, has been well-documented, but as the literature of NA points out, “A meeting happens when two or more addicts gather to help each other stay clean.” In that regard, the first “meeting,” then, took place in 1935 in Akron, Ohio. Bill had recently gotten sober and was on a business trip; seized by a desire to drink, he contacted a local clergyman, asking for another alcoholic with whom he could talk.

Writing “Twelve Defining Moments in the History of Alcoholics Anonymous,” William White and Ernest Kurtz elaborate even further [10]: “The call from the Mayflower Hotel was the first incident in AA history in which an alcoholic picked up a telephone rather than a drink, affirming the potential of replacing dependence upon a drug with interdependence between members of a recovering community. This event also set the basic relationship within AA as one in which no member could claim moral superiority over another.”

According to the AA website, both men visited struggling alcoholics at the City Hospital in Akron, helping another man find sobriety and planting the seeds for the first AA group. By the fall of that year, another group began meeting in New York, and by 1939, a third group started in Cleveland. That same year, the Big Book of Alcoholics Anonymous was published, and suddenly this new method of sobriety was being touted as something of a breakthrough.

Even those who didn’t consider themselves strictly alcoholics found relief through AA: Dr. Tom M., according to a paper authored by William White, Chris Budnick and Boyd Pickard, was introduced to the AA Big Book in 1939 [11], and he became “the first known person to achieve sustained recovery from morphine addiction through Alcoholics Anonymous.” In addition, the AA group he helped establish in North Carolina “became a resource for AA General Headquarters in New York to respond to inquiries about a solution for drug addiction.”

The Evolution of Recovery Meetings

recovery meetingsThere were serendipitous moments along the way that helped establish 12 Step traditions that persist even today:

  • When Wilson was offered a paid position at Towns Hospital as a “lay alcoholism therapist,” “The response of his fellow recovering alcoholics … marked one of the first examples of what would come to be called ‘group conscience’ in Alcoholics Anonymous,” White and Kurtz write [10]. “The group rejected the idea on the grounds that their emerging fellowship could be hurt by tying itself to a hospital and that Bill’s accepting a paid position could destroy this fledgling community of recovered alcoholics.”
  • Writing in “The History of Gay People in Alcoholics Anonymous,” author Audrey Borden details [12] how Tradition Three (“the only requirement for membership is a desire to stop drinking”) came about: A gay man wanted to join the fledgling fellowship, and in the context of 1930s societal norms, the members debated until, Wilson recalled, “dear old Bob looked around, and blandly said, ‘Isn’t it time folks to ask ourselves, “What would the Master do in a situation like this?” Would he turn this man away?’ And that was the beginning of the AA tradition that any man who has a drinking problem is a member of AA if he says so, not whether we say so.”
  • The Seventh Tradition of the fellowships being self-supporting, declining outside contributions, stemmed from a 1938 decision by wealthy businessman and philanthropist John D. Rockefeller not to give $50,000 – the equivalent of more than half a million dollars in today’s money – out of fear that such a sum would harm the organization: “AA co-founders later reflected that Rockefeller’s refusal had saved them from themselves. The fellowship’s pledge of corporate poverty is in marked contrast to a multi-billion dollar addiction treatment industry and the pressure addiction treatment organizations experience to maintain and increase their revenues,” according to White and Kurtz [10].
  • The spiritual, not religious, nature of 12 Step recovery came about when AA split from its predecessor organization, The Oxford Group, as the 1930s came to a close: “The split affirmed that whatever this new group was, it was not a religion, nor did it have any religious affiliation … this transition opened the doors of entry to AA to future generations of alcoholics of multiple faiths and of no faith.” [10]

By the 1940s, the Big Book had been established, and AA found itself in the spotlight. Articles in newspapers and magazines around the country – which focused on the organization rather than any representative individuals – began to increase membership dramatically. By the end of 1940, AA’s membership stood at 2,000; a decade later, it had grown to 100,000, and that same year, the first international convention was held and the Traditions were formally adopted, and the following year, an AA central office was established in New York to oversee logistics on a national scale.

Twelve Steps: Not Just for AA

As AA flourished, individuals who struggled with drug addiction began to reach out to one another. Some notable names of the program in the 1940s and 1950s include Houston S., who got sober in 1944 and became passionate about helping individuals addicted to both alcohol and drugs [11]. In 1947, with the encouragement of the director of Lexington, Kentucky’s Narcotics Farm (an early treatment hospital for addicts), he helped establish Addicts Anonymous at the hospital, based on the principles of AA but open to those addicted to other substances.

One early participant, Danny C., was released and started a community-based chapter in New York, opting to call it Narcotics Anonymous to avoid confusion between one AA program and the mother fellowship. On Jan. 25, 1951, NA was officially incorporated, but a lack of money, meeting space and the public perception that the fellowship was simply a front for drug users to engage in the trade slowed its growth. And, as the paper “Narcotics Anonymous: History and Culture” points out [11], “The NA created by Danny C. and others existed not as an organized fellowship but as isolated groups lacking connection through a common service structure. Some of the groups even chose names other than Narcotics Anonymous. The Chicago group, for example, referred to itself as Drug Addicts Anonymous. While attempts to adapt AA’s Steps are evident across these groups, there is a marked absence of references to the use or adaptation of AA traditions.”

Out on the West Coast, former patients of the Narcotics Farm had established their own programs that focused on addiction rather than alcoholism. There were periods of cooperation and enmity between AA and these groups, but one individual – Jimmy Kinnon – got sober in AA, corresponded with Danny C. and wanted to started a group that was more methodical and organized in its approach to 12 Step recovery. On Aug. 17, 1953, the first official meeting of Narcotics Anonymous – as it exists today – was held [11], and while the organization struggled during its first six years, “NA’s definition of the problem as a process of ‘addiction’ that transcended one’s drug choice and required a common recovery process may be viewed by future historians as one of the great conceptual breakthroughs in the understanding and management of severe alcohol and other drug problems.”

As NA found its footing, other organizations saw that the blueprint first laid out by AA could provide relief from any number of obsessions, addictions and ailments:

  • The first Gamblers Anonymous meeting was held on Sept. 13, 1957, organized by two men who had met earlier that year, discovered their mutual obsession with gambling and “concluded from their discussions that in order to prevent a relapse it was necessary to bring about certain character changes within themselves.” [13]
  • Overeaters Anonymous was established on Jan. 19, 1960, when Rozanne S., attending a Gamblers Anonymous meeting identified with the members and “knew then that the Twelve-Step and Twelve-Tradition program founded by Alcoholics Anonymous (AA) and modeled by GA offered her a chance to change her life.” [14]
  • The first meeting of Cocaine Anonymous was held on Nov. 18, 1982, after members of an AA group in Hollywood, California – feeling apart from because of the focus of the group on drinking as opposed to drugs, specifically cocaine – established an organization solely for cocaine addicts. [15]

Today, according to a 2016 article on the recovery website The Fix [16], the numbers of 12 Step organizations are staggering, from Clutterers Anonymous to Cleptomaniacs & Shoplifters Anonymous to Underearners Anonymous. In other words, “If you can think of a problem, there’s a 12-step group out there to cure it.”

So What Happens In Those Recovery Meetings?

recovery meetingsAlthough it’s important to understand that the formats of recovery meetings vary according to organization and region, there are some common denominators that tie them together (especially those based in 12 Step recovery).

It’s important for anyone to understand, however, that attendance is strictly voluntary. (Although some individuals are court-ordered to attend recovery meetings as part of sentencing for drug- and alcohol-related offenses, such an arrangement is never made at the request or behest of the recovery groups themselves.) No one is forced to attend, forced to stay or forced to return.

Typically, meetings are “run” by a chairperson – an individual responsible for distributing literature, taking attendance, making coffee and unlocking the doors. Most 12 Step organizations treat everyone as equals, so even though the chairperson shepherds the meeting, he or she isn’t “in charge,” so to speak. That individual’s role is to begin the meeting, steer its progress and end it – and most groups allow any individual who wishes to become more involved in group logistics to volunteer as meeting chairpersons.

Most meetings open with the Serenity Prayer [17], and some close with it (or the Lord’s Prayer) as well. What happens in between those prayers may include one, some or all of the following:

  • Readings from the literature of the perspective recovery organization, including the 12 Steps, daily meditation readings;
  • The collection of Seventh¬†Tradition donations – money freely given by attendees to purchase literature, buy coffee, pay rent, etc.;
  • The distribution of coins, chips or key tags to donate varying periods of sobriety and clean time – those who are just beginning their journey are met with enthusiastic support and encouragement, and those who are marking multiple years and equally lauded; and
  • Announcements of upcoming events, activities or business meetings.

The format of the bulk of the meeting may take one of several forms. The most common, discussion meetings, allows individuals to share, one at a time, about the struggles and successes – the problems they’ve faced, the tools they used to overcome them and the ways their lives have changed since they started the recovery process. Sharing is voluntary, although the chairperson may call upon individuals if there’s a lull or an extended period of silence.

Many groups also feature regular speaker meetings, in which a previously selected member of the program is asked to share at length his or her personal recovery journey. There are also literature studies, in which passages, chapters or pamphlets of the program’s literature are read aloud and discussed; topic meetings, in which various recovery-related topics and/or spiritual principles are discussed as the meeting’s central theme; “Ask It Basket” meetings, in which group members, over time, submit questions about recovery into a central location, and the chairperson draws them at random to ask of meeting volunteers; Step studies, in which part of the meeting may be dedicated to personal writing or journaling around specific Steps, and gender-specific meetings, which are segregated by sex in order to allow participants to process and discuss more sensitive issues and topics.

Recovery Meetings: Odds and Ends

recovery meetingsIt’s important to remember that many of those formats and styles are central to the primary 12 Step fellowships addressing alcoholism and addiction – AA and NA. However, many other 12 Step groups follow a similar format, and even those that have adapted their own programs – like SMART Recovery, Refuge Recovery or Celebrate Recovery – can use the same basic framework for their own meetings. Both SMART Recovery and Celebrate Recovery use group discussion formats, but meetings of the former includes time to apply program tools to address various issues, and the latter my feature a worship service before participants break up into small groups.

What else should you know? Here are a few bits of information that might be helpful.

  • How long do meetings last? Typically 60 to 90 minutes.
  • Where are they held? All over. The world service committees of recovery programs usually maintain websites that have meeting finder apps and programs, and many area branches of those programs oversee regional websites with meeting schedules as well.
  • While no one is forced to share, many meetings offer an opportunity for newcomers to introduce themselves – not to put anyone on the spot, but to give those individuals a chance to know and get to know others.
  • Some meetings, particularly in 12 Step fellowships, are classified as open or closed. Open meetings are just that – open to anyone, including family members who wish to attend for support. Those individuals are encouraged to simply observe – sharing time should be reserved for individuals who are seeking help for a particular problem – and if a basket is passed around for donations, many fellowships ask those observers not to contribute.
  • Speaking of the basket: The Seventh Tradition of 12 Step fellowships state that they should be fully self-supporting, declining outside contributions. No one is forced or guilt-tripped into giving, but it’s never a bad idea to throw a dollar or two into the basket, should you find that the meetings are helpful.
  • In addition to the above formats, some groups may hold various other meetings: Candlelight meetings, for example, are self-explanatory, meaning that after the readings are completed, the lights are doused and sharing is done by candlelight. Marathon meetings are what the name implies – meetings that can last for several hours or more, with participants coming and going at their leisure. (Many marathon meetings take place on significant holidays, which can be times of temptation or hardship for those in recovery, therefore giving them an outlet to seek support at any hour of the day or night.) Newcomer meetings are meant to provide an introduction to those new to the fellowship.

There are, of course, other formats too numerous to mention, but none of them are so complex that they require great planning for or knowledge of beforehand. The biggest takeaway should be that recovery meetings can and do provide the support necessary to bolster recovery – continuous participation over a three-year study [18] showed abstinence results two to five times greater than less continuous participation. In other words, according to a 2013 paper in the scientific journal Social Work in Public Health [19], “There is clear evidence from a variety of sources that early involvement, in the form of meeting attendance and engagement in recovery activities, is associated with better substance use and psycho-social outcomes as well as reduced health care costs.”

Additional research, published in the 2008 Textbook of Substance Abuse Treatment, demonstrates the effectiveness of recovery meetings [20]: Women, men, younger adults, older adults, religiously inclined individuals, agnostics and atheists, court-ordered and volunteer participants all show improvement after participating in these peer support programs.

In other words: They can work for anyone. There’s a saying in the rooms of recovery that “meeting makers make it,” used to emphasize the importance of meeting attendance, and while it should be pointed out that more is required to sustain long-term sobriety than just peer support, having that support in the form of recovery meetings can make a world of difference.

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