CA, AA, NA and SMART – differences and similarities

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In the next part of my interview with Tom, a doctor in recovery, he explores the relationships between different sorts of mutual aid.


What’s the overlap between CA, AA, NA and SMART?

My experience is that there can sometimes be some friction between the different fellowships. I’m not entirely sure why this happens but I suspect it is due to a degree of fear and tribalism. There is no doubt in my mind that the CA programme works. However I have witnessed the AA, NA and SMART programmes also working.

Similarities and Differences

The differences between the 12 step programmes are subtle and are far outweighed by the similarities. I sometimes worry about the invisible divisions that form between the fellowships. It is clear that the number of people in recovery in the Lothians is very small compared to the numbers in active addiction.

We need to nurture whatever recovery is present. Newcomers need to feel welcomed to whatever fellowship they attend and don’t need to witness divisions within the small recovery community. We have a responsibility to lead by example and I try my best to remain non judgemental and leave my opinions out of any discussion with a newcomer. Recovery is driven by personal experience.

What’s the reason for division?

I suspect that the tribalism that can occur is down to self preservation. Early in my own recovery I was rigid in my way of thinking and it was hard not to see “my way” as the only way to get better. If I found a way that worked, then anybody not doing it my way would cast doubt on the validity of my own recovery process. This doubt has lessened as the belief in my own recovery process has grown. I feel more secure and worry less about what others “need” to do to remain well.


In my experience many people attend multiple fellowships especially when they first go to meetings. There seems to be a natural draw on an individual basis to a particular fellowship as time passes. This often simplifies things. However many people continue to successfully attend multiple fellowships. This includes SMART meetings. I have seen many people engage with SMART and CA simultaneously with no adverse effects!


The overlap between CA and AA is especially strong. This is because CA uses the same literature as AA, namely the AA big book. CA evolved in California in the 1980s from AA group members. Many were abstinent from alcohol but using cocaine and other substances. They weren’t feeling very “recovered” and decided that maybe they needed to address the cocaine issue as well. Thus CA evolved and AA gave permission to use the big book.

This can be confusing at times. Personally I don’t believe I have ever experienced true addiction to alcohol but have experienced this with drugs, mainly opiates. AA is clear that it can help those with an alcohol problem but it’s very survival means it must remain neutral on outside issues. Drug addiction is not AA’s business. This was discussed at great length in the mid 20th century within AA.

AA’s limitations

AA accepts its own limitations. This jarred with me when I first went to meetings of AA, but I didn’t understand how important this issue was. I sometimes perceived AA members as antagonistic towards me when I introduced myself as a drug addict or talked about my drug addiction in their meetings. Nobody had explained to me that the meeting was there to help “real alcoholics”, any diversion from this path put the newcomer alcoholic at risk.

Responsible and spiritually well AA members would often suggest attending the other fellowships may be helpful to those with drug issues. I believe that treatment centres also have a responsibility with this issue. Some simple education around how a particular fellowship operates may diffuse some of these tensions.

CA welcomes anyone with any substance problem – right?

CA was originally cocaine focused but this has changed over the years. CA world service has been clear that CA welcomes those with non specific drug and alcohol problems. This has caused some friction within the fellowship. There is an argument that CA should follow a similar pure message to AA and be cocaine specific.

A newcomer needs to identify and share experience. It can be argued that those addicted to cocaine have a unique experience that other drug users don’t have. This raises the concern that this identification process may be diluted by other drug experiences and that a cocaine addict cannot succesfully be taken through the steps by a non cocaine addict. This has led to another fellowship forming in London called Cocaine Addicts Anonymous.

‘The inclusive nature of CA drew me in’

I was not aware of this tension when I first came into CA. I have limited experience with cocaine. This potential division makes me feel uncomfortable. The inclusive nature of CA in Edinburgh was what drew me in at the start. I have worked with addicts of varying types within CA and have seen several recover even though our drug of choice differed.

My drug taking experience was fairly unique –ie stealing prescription opiates from work, but I still found profound identification with heroin, cocaine and alcohol addicts. The growth of CA in Edinburgh is also evidence that “singleness of purpose” may not be necessary within CA for people to recover.

Read the other parts of this interview:

Part 1: A doctor finds recovery in Cocaine Anonymous

Part 2: Addiction – losing the power of choice

Part 3: Power and powerlessness in addiction and recovery

Part 4: We have a responsibility to share how we recovered.

Part 5: Recovery in Scotland – mutual aid at the heart

    9 Responses to "CA, AA, NA and SMART – differences and similarities"
    1. lindlou says:

      I’ve been going to Na for many years but I too and also many people I know get a cold reception when we go to an aa meeting. It seems to be the older ones who take offence to us being there. If I need a meeting and aa is the only one on I will go as its a 12 step fellowship, end of the day we are all addicts just with different vices

      • djmac says:

        I posted a blog just the other day on a study that showed that those with non-alcohol substance dependence seem to benefit from attending AA and that when NA meetings were not available, AA was a viable alternative. I guess the warmth of the welcome might vary from meeting to meeting.

    2. Adam says:

      What’s with this websites promotion of the CA fellowship?
      Its the smallest out of the four mutual aid groups and probably least relevant to overall drugs policy discussion.
      I’m sure its got an important place within the infrastructure for people who focus on their cocaine use, but this site seems to be expressing a personal prejudice relating to what I’m guessing is a single person’s beliefs.

      • djmac says:

        Apart from the interview with a CA member which was too long for a single post, as far as I can remember there have only been two other posts (out of about 170) which focus CA on the blog, so I’m not sure that qualifies as ‘promotion’. I’ve certainly covered research on other mutual aid groups more often.

        This blog is primarily about recovery in the broadest sense, not ‘drugs policy discussion’ although that’s touched on from time to time.

    3. Jocelyn says:

      This series of interviews have been incredibly insightful and helpful. “Tom” has an ability to articulate concepts about recovery and meetings which I find particularly concise and clear. I am also an healthcare worker (nurse) who has the “unique” story of stealing and using prescription medications. My recovery has included mutual aide meetings (AA/NA) and service, reading, connecting with others, and having a gradual but profound spiritual awakening through working through the 12-Steps. Thank you again for your honesty, experience and hope.

    4. Les Banton says:

      Well stated look forward to further Comment/ Blogs

    5. Deirdre says:

      I am an AA member who loves CA meetings. Welcoming all drugs including alcohol, CA helps (for me) to focus on what is common to all of us in addiction and recovery, our shared past and our shared ways to stay in recovery. The openness and welcome there is wonderful.

    6. Tom says:

      Thanks for the feedback. I was asked to do an interview about my experience of Cocaine Anonymous. When I am passionate about something I write a lot. DJMAC has kindly broken my interview down into bite size chunks.
      Maybe this blog will raise the profile of CA a little bit? Maybe it will reach a health professional, family member or addict that hasn’t heard of CA before?
      Personally I would like to see similar interviews with AA/NA/SMART/GA/ALANON group members.

    7. Trevor Watts says:

      For me a meeting is helpful whatever fellowship if it helps someone get a day clean it’s worth it . Sometimes there isn’t Mutch choice so you have to take what you can.Anyone judging you at the meeting needs to look at themselves

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