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

J Addict Med. Nov/Dec 2019;13(6):493-499. doi: 10.1097/ADM.0000000000000526.


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 ((Equation is included in full-text article.)= 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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Behavior Control / methods*
  • Behavior Control / psychology
  • Cross-Cultural Comparison*
  • Female
  • Humans
  • Interpersonal Relations
  • Interview, Psychological
  • Iran
  • Linear Models
  • Male
  • Middle Aged
  • Self-Help Groups / organization & administration*
  • Self-Help Groups / statistics & numerical data
  • Spirituality*
  • Substance-Related Disorders / rehabilitation*
  • Surveys and Questionnaires
  • United States