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      Cross-cultural Applicability of the 12-Step Model: A Comparison of Narcotics Anonymous in the USA and Iran

      research-article
      , MD, , MA, , MS
      Journal of Addiction Medicine
      Lippincott Williams & Wilkins
      addiction recovery, Iran, Narcotics Anonymous

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          Objective:

          Narcotics Anonymous (NA), a nonprofessional 12-step fellowship for people seeking recovery from addiction, reports 27,677 meetings in the USA, where it was founded, but there is limited literature on its adaptability cross-culturally. We studied NA within the Islamic Republic of Iran to ascertain its relative adaptation in a different cultural setting.

          Method:

          We surveyed 262 NA members in Iran, supplemented by member interviews, and compared demographic and substance use-related characteristics of members, and also the nature of their respective involvement in NA, to the survey results of a previous US survey (n = 527).

          Results:

          NA in Iran reports 21,974 meetings. The Iranian respondents surveyed differed relatively little (d < 0.50) from US members on demographics and prior ambulatory substance use disorder treatment, but did have fewer female members (means for Iran and US: 42.4 vs 39.0 years; 77% vs 87%; 6% vs 28%, respectively). They were, however, more involved in the fellowship (d > 0.50) in terms of reporting service as sponsors, experience of spiritual awakening, and achievement of diminished craving (scores of 1–10) (85% vs 48%; 95% vs 84%; 1.03 vs 1.89, respectively). Surveyed NA members in Iran publicized the fellowship with public (36%) and religious (20%) figures, and systematically worked the 12 steps in large sponsor-led groups ( = 19 members).

          Conclusion:

          NA, a 12-step program developed in a Western, predominantly Christian-oriented country, was adapted widely in the Islamic Republic of Iran, a setting different in culture, language, ethnicity, and religious orientation. The growth in its membership derives, in part, from specific innovations that may have broader applicability in other settings.

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          Most cited references32

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          Naltrexone in the treatment of alcohol dependence.

          Seventy male alcohol-dependent patients participated in a 12-week, double-blind, placebo-controlled trial of naltrexone hydrochloride (50 mg/d) as an adjunct to treatment following alcohol detoxification. Subjects taking naltrexone reported significantly less alcohol craving and days in which any alcohol was consumed. During the 12-week study, only 23% of the naltrexone-treated subjects met the criteria for a relapse, whereas 54.3% of the placebo-treated subjects relapsed. The primary effect of naltrexone was seen in patients who drank any alcohol while attending outpatient treatment. Nineteen (95%) of the 20 placebo-treated patients relapsed after they sampled alcohol, while only eight (50%) of 16 naltrexone-treated patients exposed to alcohol met relapse criteria. Naltrexone was not associated with mood changes or other psychiatric symptoms. Significant side effects (nausea) occurred in two naltrexone-treated subjects, and one naltrexone-treated subject complained of increased pain from arthritis. These results suggest that naltrexone may be a safe and effective adjunct to treatment in alcohol-dependent subjects, particularly in preventing alcohol relapse.
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            Epidemiology of illicit drug use disorders in Iran: prevalence, correlates, comorbidity and service utilization results from the Iranian Mental Health Survey.

            Drug abuse is a significant social and public health problem in Iran. The present study aimed to provide prevalence estimates and information on correlates of illicit drug use disorder and opioid dependence, as well as service use for these disorders in Iran.
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              Corrected US opioid-involved drug poisoning deaths and mortality rates, 1999-2015

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                Author and article information

                Journal
                J Addict Med
                J Addict Med
                ADM
                Journal of Addiction Medicine
                Lippincott Williams & Wilkins
                1932-0620
                1935-3227
                Nov-Dec 2019
                01 April 2019
                : 13
                : 6
                : 493-499
                Affiliations
                Department of Psychiatry, New York University School of Medicine, New York, NY (MG); and Chestnut Health Systems, Normal, IL (WLM, BDH).
                Author notes
                Send correspondence to Marc Galanter, MD, Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016. E-mail: marcgalanter@ 123456nyu.edu .
                Article
                JAM-D-18-00167
                10.1097/ADM.0000000000000526
                6846120
                30939500
                685392b2-8504-43a3-9e02-a0d788f6a5b8
                Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Addiction Medicine.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 10 September 2018
                : 22 February 2019
                Categories
                Original Research
                Custom metadata
                TRUE

                addiction recovery,iran,narcotics anonymous
                addiction recovery, iran, narcotics anonymous

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