Narcotics Anonymous: Anonymity, Admiration, and Prestige in an Egalitarian Community

Narcotics Anonymous (NA) supports long-term recovery for those addicted to drugs. Paralleling social dynamics in many small-scale societies, NA exhibits tension between egalitarianism and prestige-based hierarchy, a problem exacerbated by the addict’s personality as characterized by NA’s ethnopsychology. We explore how NA’s central principle of anonymity normatively translates into egalitarianism among group members. Turning to the lived reality of membership, building on Carr’s (2011) concept of script flipping, we identify script embellishment as speech acts that ostensibly conform to normative therapeutic discourse while covertly serving political ends. We argue that, in spite of the overtly egalitarian context, NA members differ dramatically in prestige, with more experienced members being admired and emulated. Critically, prestige acquisition occurs via structural functions that are central to the maintenance of the institution, as experienced members serve a central role in the transmission and enforcement of cultural norms, paradoxically including norms of egalitarianism. [Twelve-Step Program, Narcotics Anonymous, Prestige, Egalitarianism] All else being equal, egalitarianism inherently entails a status-based version of the tragedy of the commons (Hardin 1968), as, while the group’s interests are best served by minimizing status differences between individuals, any given actor’s interests will often be best served by pursuing higher status. As a consequence, egalitarian societies and organizations face a fundamental tension between egalitarian norms and the actions of status-striving individuals. Importantly, this tension is exacerbated by (1) the fact that knowledge transmission between experts and learners automatically yields inequality, as it generates prestige-based hierarchies in which experts are admired by learners (Henrich and Gil-White 2001), and (2) the need for governance in any social group (Van Vugt 2006; Van Vugt et al. 2008). In this article, we aim to examine and elucidate how the tension between egalitarianism and status-striving is manifest and managed in the actions of individuals participating in one of the most popular institutions supporting the recovery of addicts, Narcotics Anonymous (NA). As we will discuss in detail, NA, like other Twelve-Step self-help programs, is an explicitly egalitarian system. The structure of such programs brings into stark relief the conflict between egalitarianism and the social dynamics of knowledge transmission. In contrast to most societies, in which the majority of learners are children or adolescents, individuals are almost always adults when they join a Twelve-Step program. This creates knowledgebased asymmetries between individuals who are ostensibly equals in the social structure. ETHOS, Vol. 42, Issue 4, pp. 440–459, ISSN 0091-2131 online ISSN 1548-1352. C © 2014 by the American Anthropological Association. All rights reserved. DOI: 10.1111/etho.12063 NARCOTICS ANONYMOUS 441 Compounding this threat to egalitarianism, new members of NA often exhibit problems of impulse control and generalized resistance to norm compliance, features that constrain efforts by existing group members to impose conformity to egalitarian ideals. At the same time, by virtue of the circumstances and attributes that bring them to the group, new members are often quite vulnerable to exploitation by other members, including those who seek status advantages. Against this backdrop, new members legitimately strive for selfefficacy in the domain of cultural competency within the local group. Those who succeed both progress in their struggle with addiction and, in so doing, recreate anew the social dynamics that pose a challenge to egalitarianism; this problem is then compounded by the need for leaders in a self-governing group characterized by a heterogeneous and shifting membership. The codified norms and institutional practices of NA both recognize these multiple threats to egalitarianism and provide avenues for mitigating them. NAmeetings are thus characterized by social dynamics wherein individuals navigate a culturally constituted social arena that both affords and constrains the pursuit of status; in turn, these dynamics are integral to the maintenance and reproduction of the institution itself.1 NA is a Twelve-Step self-help/mutual-aid group patterned after, and historically derived from, Alcoholics Anonymous (AA). Like AA, NA is a free, long-term recovery-oriented program, frequently offered to individuals in need via referrals by healthcare and criminal justice institutions. However, while volumes of clinical reports and ethnographic works address AA, NA remains woefully understudied. The majority of descriptive works concerning AA focus on discourse and identity change and take at face value the claim that egalitarianism characterizes social relationships in Twelve-Step programs (Bateson 1971; Brandes 2002; Cain 1991; Holland et al. 1998; Humphreys 2004; Jensen 2000; Wilcox 1998). We argue that, while accurate, this characterization is superficial. In NA, below the surface of an overt ethos of egalitarianism exists an implicit prestige hierarchy. The social terrain of an ideology of egalitarianism juxtaposed with a prestige-based social structure is navigated by members as part of their identity change, as their own social standing is inextricably linked to their identity. Members negotiate their social standing within the NA community according to the orthodoxy of the organization and norms taught and modeled by experienced members. Hence, NA relies on prestigious individuals to form the core structure of this decentralized institution, maintaining it in a relatively uniform fashion across numerous instantiations around the world. In this way, while nested within larger nation-states, NA parallels the dynamic tension in small-scale societies between egalitarianism and hierarchies based on prestige. Of particular importance, as is likely true of many small-scale societies, in NA it is largely prestigious individuals who reinforce local norms—including the norm of egalitarianism. One prominent exception to the largely descriptive existing literature on addiction recovery is E. Summerson Carr’s explorations of the semiotics of power in recovery (2006, 2011). Carr richly portrays the power dynamics at work in a homeless women’s outpatient drugtreatment center. In this context, counselors who oversee patient progress are also in effect the gatekeepers of critical and basic social services, as any instance of patient relapse can result in an end to public aid to the patient. Carr provides two key observations: First, narratives