Treatment and a group are not alternatives, they are different things. NHS and community treatment gives you an assessment, a keyworker and prescribing, which no meeting can do. A fellowship or SMART Recovery gives you people on a Tuesday evening, which no appointment can do. Most people who get somewhere use one of each. All of it is free.
Route one: treatment
The NHS route starts in one of two places, and neither requires you to have stopped first.
**A GP.** "A GP may be a good place to start. They can discuss your problems with you and help get you into treatment."
**A local service, directly.** [We Are With You](https://www.wearewithyou.org.uk/help-and-advice/) lists free drug and alcohol services across England and Scotland and runs a webchat staffed by trained recovery workers. FRANK is 0300 123 6600, 24 hours.
**What it asks of you.** Roughly an hour of honest answers at an assessment, then keeping appointments.
**What you get that a meeting cannot give you.** A keyworker, first of all: "you'll also be given a keyworker, who will support you throughout your treatment." One named person who knows your case. And prescribing, where it applies: "if you're dependent on heroin or another opioid, you may be offered a substitute medicine, such as methadone or buprenorphine." The National Institute on Drug Abuse states that ["treatment with methadone, buprenorphine, or naltrexone is standard of care for opioid use disorder"](https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction).
If you are physically dependent, or you also drink heavily, this route is not optional and it is not second. [What detox actually involves](/guides/drugs/what-detox-actually-involves) sets out which substances need a prescriber and why.
Route two: the twelve-step fellowships
They are not interchangeable, and the difference that catches people out is what each one asks you to abstain from.
**Narcotics Anonymous.** In its own words: ["This is a program of complete abstinence from all drugs. There is only one requirement for membership, the desire to stop using."](https://na.org/what-is-the-na-program/) Complete abstinence from all drugs, not only your drug of choice. UK helpline 0300 999 1212, 10am to midnight.
**Cocaine Anonymous.** Broader still, and it says so explicitly: ["Anyone who wants to stop using cocaine and all other mind-altering substances (including alcohol and other drugs) is welcome."](https://ca.org/literature/what-is-ca/) Alcohol is named. UK helpline 0800 612 0225.
**Crystal Meth Anonymous.** Its stated membership requirement is worded more narrowly: ["The only requirement for membership is a desire to stop using."](https://www.crystalmeth.org/to-the-public/what-is-crystal-meth-anonymous/)
**What they ask of you.** Turning up, repeatedly. Working the twelve steps, usually with a sponsor, which means one person who has done them and will go through them with you. The steps use language about a power greater than yourself, which some people read as religious and others do not.
**What you get.** Meetings almost everywhere, at almost every hour, in person and online, that do not depend on your local service having capacity. Somebody to ring at nine on a Tuesday. For a lot of people the sponsor relationship is the part that does the work.
**The catch worth knowing in advance.** If you still drink, or you are on a prescribed substitute medicine, you may meet people who tell you that you are not really in recovery. That is an individual's opinion, not a clinical fact, and services take a different view. Rooms vary a great deal, and one room is not the fellowship.
Route three: SMART Recovery
Built on cognitive and rational-emotive behavioural methods, explicitly secular, and scoped to problem behaviours rather than to any one substance. Its own framing is the opposite pole from powerlessness: ["The power to change addictive behaviors resides within each individual."](https://smartrecovery.org/about-us/)
**What it asks of you.** Attending a meeting run by a trained facilitator rather than a sponsor, and doing exercises. Cost-benefit analyses, urge-management tools, written plans. Closer to a workshop than to a fellowship.
**What you get.** A four-point programme with tools you can use between meetings, no belief requirement, and a format that suits people whose problem is not only drugs.
**Where to start.** SMART Recovery UK is 0330 053 6022.
**The catch.** Meeting coverage is still thinner than the fellowships in much of the UK, and there is no sponsor equivalent, which some people miss badly.
How they compare on the things that actually decide it
| | Treatment | NA or CA | SMART Recovery | |---|---|---|---| | Abstinence required to attend | No | No, only a desire to stop | No | | Abstinence expected from everything | No | Yes, all drugs; CA names alcohol | Not a membership condition | | One named person for you | Keyworker | Sponsor, if you get one | Facilitator, not the same role | | Medication available | Yes | Not applicable | Not applicable | | Available at nine on a Tuesday | No | Usually | Sometimes | | Cost | Free | Free | Free |
One neutral point about how the fellowships are organised, from a government guideline rather than from a fellowship: they ["maintain independence from professional bodies and make sure they remain led by people in recovery in a volunteer capacity and do not accept funding from external sources"](https://www.gov.uk/guidance/clinical-guidelines-for-alcohol-treatment/6-recovery-support-services-and-lived-experience-initiatives).
Picking one this week
Stop trying to choose correctly and start collecting evidence.
- **Make the treatment call first.** GP or service, this week. That is the route with medication and a keyworker on the end of it, and it takes the longest to start, so start it first.
- **Go to one fellowship meeting and one SMART meeting in the next fortnight.** Online counts and is much easier for a first attempt.
- **Judge on a low bar.** Did you feel less alone leaving than arriving, and could you imagine doing this weekly?
- **Give the one you prefer six goes** before deciding anything. One meeting tells you about that room on that evening, not about the organisation.
Two at once is normal, not excessive. A keyworker and a Wednesday meeting cover different failure modes.
What none of them do at eleven at night
All three are appointments, and the difficulty is not scheduled. Whatever you pick, you still need a routine for the hour a craving lands, which is [a separate problem](/guides/drugs/getting-through-a-craving-without-using), and the supply routes closed, which is [a twenty-minute job](/guides/drugs/cutting-off-your-dealer-and-your-supply).
Samaritans is 116 123 at any hour if the gap between meetings is where it gets bad.
Common questions
**Do I have to be clean to go to Narcotics Anonymous?** No. NA states that the only requirement for membership is a desire to stop using. Its programme is one of complete abstinence from all drugs, which is what members work towards rather than a condition of walking through the door.
**Can I go to NA if I still drink?** You can attend. Be aware that NA's programme is abstinence from all drugs and Cocaine Anonymous explicitly includes alcohol, so you are in a different position from someone whose only issue is one substance. Say it out loud to a keyworker rather than deciding alcohol does not count.
**Will a fellowship tell me to come off my prescription?** Some individuals may, and that is their opinion. The NHS offers substitute medicines to people dependent on opioids and NIDA describes them as standard of care. Prescribing decisions belong with your prescriber.
**Is SMART Recovery better than the twelve steps?** Neither has been shown to be the right answer for a particular individual in advance. Choose on which format you will keep attending, and change your mind freely if the first choice does not stick.
**How much does any of this cost?** Nothing. NHS and community treatment, NA, CA, CMA, SMART Recovery and services such as We Are With You are all free. If someone is selling you a residential placement before anybody has assessed you, ring a free service for a second opinion first.
Sources
- [NHS, Drug addiction: getting help](https://www.nhs.uk/live-well/addiction-support/drug-addiction-getting-help/), for the GP route, keyworkers and substitute prescribing.
- [Narcotics Anonymous](https://na.org/what-is-the-na-program/) and [Cocaine Anonymous](https://ca.org/literature/what-is-ca/), for each fellowship's own statement of what it asks abstinence from.
- [SMART Recovery](https://smartrecovery.org/about-us/), for its own statement of its approach.
- [NIDA, treatment approaches for drug addiction](https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction), for methadone, buprenorphine and naltrexone as standard of care for opioid use disorder.
