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

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.