Refuge Recovery

1. Introduction

Version followed: the Refuge Recovery program as set out in Noah Levine, Refuge Recovery: A Buddhist Path to Recovering from Addiction (HarperOne, 2014), and as presented by Refuge Recovery World Services (RRWS) on its website (archived captures from 2021 and 2022) and in its GuideStar nonprofit profile. The programme's structure here comes from the library catalogue contents note, published reviews and the archived official site, not from the book's own text [uncertain]. The 2018–19 organisational history below is drawn from Tricycle reporting (2018 and 2019), Buddhistdoor Global (2019), Los Angeles Magazine (2019), a peer-reviewed article in the Journal of Global Buddhism (2020) and the July 2019 joint statement of the Refuge Recovery board and Levine; RRWS's current programmes come from GuideStar, and the six programme components and the 2020 rights donation from the archived official site. The inventory questions, the individual meditation instructions, the full meeting script and the mentoring guidance are in the book and fellowship literature only and are marked [uncertain] below. The separate Recovery Dharma programme, which split off in 2019, is mentioned only for contrast. [source: archived refugerecovery.org; Spokane Public Library catalogue record; Tricycle 2014 review; GuideStar RRWS profile]

What it is. Refuge Recovery is a peer-led mutual-aid fellowship. It is not a therapy that a clinician delivers. It adapts the Buddhist Four Noble Truths and Eightfold Path into a non-theistic recovery programme for any addiction. The official site lists substances, food, sex, technology, gambling, relationships and spending. The programme says it does not ask members to believe anything. It asks them to trust the process and do the work. Membership is open to anyone, and the only criterion is a desire to be free from addiction. Meetings are free, confidential and run by a peer who knows the programme. [source: archived refugerecovery.org; AA Agnostica 2019]

Core idea of change. The programme defines addiction as a repeated cycle of feeding cravings to escape or control present-moment conditions that feel unbearable. This brings short-term relief and long-term harm. It uses the image of the "hungry ghost". Recovery means three things: healing the underlying causes and conditions, abstaining from acting on cravings, and being able to stay present with reality whether it is pleasant or unpleasant. Change is expected to come from four sources: understanding suffering and craving (through written inventories), daily meditation (described as the cornerstone of the path), ethical living along the Eightfold Path, and belonging to a community (sangha). Members take "refuge" in awakening, truth and community, in place of the substance or behaviour that once served as a false refuge. [source: archived refugerecovery.org; Tricycle 2014 review]

Organisational history relevant to referral. Levine's book appeared in June 2014. Seattle meetings were already running by 2015 and are described as among the longest-running groups in the US. [source: northwestdharma.org 2015] The first Refuge Recovery nonprofit (San Jose, CA) has an IRS ruling year of 2016, which matches a 2025 Boston University clinician handout that dates the nonprofit to 2016; GuideStar now flags that entity's tax-exempt status as automatically revoked for non-filing. The current organisation, RRWS, has an IRS ruling year of 2020. [source: GuideStar Refuge Recovery profile; GuideStar RRWS profile; BU CARE 2025] So meetings predate the nonprofit, which accounts for the varying founding dates in other sources. Clients may have heard of the history below. Ask about it rather than avoiding it, and keep to the published record (see 4.15 and section 5).

2018: the Against the Stream investigation. Levine also founded the Against the Stream Buddhist Meditation Society (ATS). In late March 2018 ATS announced that it was investigating an allegation of sexual misconduct against him and suspended him from teaching. Levine publicly denied the allegation, saying the alleged non-consensual contact "never happened". [source: Tricycle, 3 Apr 2018; Tricycle, 27 Aug 2018; Journal of Global Buddhism 2020] The investigation was carried out by workplace investigator Roberta Yang at ATS's request (Tricycle's 2019 report describes it as commissioned by the ATS teachers' council). On 25 August 2018 ATS announced the finding: Levine had more likely than not violated the Third Precept of its Teacher's Code of Ethics, "to avoid creating harm through sexuality". The investigation did not determine whether any crime had been committed. ATS removed him from its board and from teaching, and closed its Los Angeles, Santa Monica and San Francisco centres on 30 September 2018, citing the financial impact of the controversy. [source: Tricycle, 27 Aug 2018; Tricycle, 13 Jul 2019; Buddhistdoor Global, 28 Feb 2019; LA Magazine, 10 Jul 2019] The Los Angeles Police Department investigated the assault allegation for several months and did not charge Levine. [source: LA Magazine, 10 Jul 2019; Journal of Global Buddhism 2020] Levine's response, as reported by Tricycle: he continued to deny sexual misconduct, said the accusers were not his students, and acknowledged "some unskillfulness" as a founder. [source: Tricycle, 27 Aug 2018]

Refuge Recovery's position in 2018. No separate investigation by Refuge Recovery itself has been reported [uncertain]. In August 2018 its interim board chair and executive director announced a video conference for members about the ATS findings. Levine stepped down from the Refuge Recovery board in 2018. He kept the rights to his book and his separate for-profit Refuge Recovery treatment businesses. [source: Tricycle, 27 Aug 2018; Tricycle, 13 Jul 2019]

2019: lawsuits, Spirit Rock and the split. The Refuge Recovery board asked Levine to give up the "Refuge Recovery" name. He refused, and in January 2019 the board filed a federal lawsuit against him and he filed a countersuit. [source: Tricycle, 13 Jul 2019; Buddhistdoor Global, 28 Feb 2019; LA Magazine, 10 Jul 2019] On 20 February 2019 Spirit Rock Meditation Center's Ethics and Reconciliation Council and Jack Kornfield withdrew Levine's authorisation to teach indefinitely. The council had made its own inquiry: meetings with Levine, interviews with women who alleged harm and with ATS and Refuge Recovery staff, and review of documents including the lawsuits. It cited "repeated breaches of the precepts of nonharming" and recommended that he stop all Buddhist or meditation teaching. [source: Tricycle, 22 Feb 2019; Buddhistdoor Global, 28 Feb 2019] On 6 July 2019 the board and Levine issued a joint statement. All parties withdrew their legal claims. Levine's team created RRWS as a new nonprofit to support groups staying in Refuge Recovery. The board formed the Recovery Dharma Collective for groups wanting an alternative. The original nonprofit was to be dissolved. The statement speaks of "differing views about the path forward" and does not mention the misconduct findings. [source: Joint Statement, 6 Jul 2019; Tricycle, 13 Jul 2019] Levine's own account of the dispute, in a Los Angeles Magazine interview, is that his critics "didn't like the irreverence, the swearing, the smoking, the motorcycles". [source: LA Magazine, 10 Jul 2019; Tricycle, 13 Jul 2019]

Since 2019. The archived RRWS site states that in 2020 Levine donated the book's copyrights, trademarks and proceeds to RRWS. [source: archived refugerecovery.org, 2022 capture] [uncertain: not confirmed in independent reporting] RRWS's GuideStar profile (IRS ruling year 2020) lists Levine as its principal officer. [source: GuideStar RRWS profile]

2. Framework

Refuge Recovery has no fixed phases or session count. It is an open-ended programme with a daily practice. The official site names six components: meetings, meditation, personal inventory, mentorship, retreat and service. The book's structure gives a rough order of work: [source: archived refugerecovery.org; Spokane catalogue contents note; Tricycle 2014 review]

Stage (the book's order)	Goal	Main activity	Moving on
First Truth: addiction creates suffering	See clearly the harm addiction has caused	First written inventory of the suffering and damage	Inventory done (the sources give no fixed criterion) [uncertain]
Second Truth: the cause of addiction is repetitive craving	Understand how craving, chasing pleasure and avoiding pain drove the addiction	Second written inventory	Inventory done [uncertain]
Third Truth: recovery is possible	Build trust that freedom is achievable	Taking refuge in awakening (Buddha), truth (Dharma) and community (Sangha)	Not specified
Fourth Truth: the path to recovery	Live the recovery path	The eight factors, grouped as wisdom, ethics and concentration: understanding; intention; communication/community; action/engagement; livelihood/service; effort/energy; mindfulness/meditations; concentration/meditations	Ongoing; lifelong
Heart practices and continuing practice	Heal shame, resentment and isolation	Loving-kindness, compassion, appreciation, equanimity, forgiveness; retreat; service; mentoring	Ongoing

Format. Weekly or more frequent peer-led meetings, in person or online. The BU 2025 handout counted 11 in-person meetings in Massachusetts and 79 online meetings in the US. RRWS reports supporting about 400 peer-led meetings, and supplies meeting materials, pamphlets and individual inventory worksheets. Members also meditate daily at home, write inventories, meet a mentor, and attend retreats and do service. Together the two inventories run to about 60 multipart written questions. [source: BU CARE 2025; GuideStar RRWS profile; archived refugerecovery.org; Tricycle 2014 review]
Eightfold Path wording. The factor names above follow the book's chapter titles as catalogued. Levine reworked the traditional factors to give more weight to community and service. The book's explanation of each factor is not summarised here [uncertain]. [source: Spokane catalogue; Tricycle 2014 review]
Abstinence. Recovery is defined to include abstaining from acting on cravings. No programme-specific rules on medication or harm reduction are published on the official site [uncertain]. [source: archived refugerecovery.org]
Criteria for moving on. None are published [uncertain]. A 2014 reviewer noted that the inventories come at the start, unlike AA's Steps 4 and 8, and asked whether people in early recovery can manage them. Clinicians should therefore set the pace with the client (see 4.13). [source: Tricycle 2014 review] [synthesis]

3. Guiding principles

These are the principles for a clinician who refers clients to Refuge Recovery or works alongside it. Those from the programme are cited. Those that are clinician stance are marked [synthesis].

Non-theistic, no required belief. No faith or Buddhist identity is required. Use this as an option for clients put off by the Higher Power language of 12-step groups. [source: archived refugerecovery.org; Tricycle 2014 review]
Open to any addiction. One criterion, the wish to be free from addiction. Clients with process addictions or several addictions can use the same meetings. [source: archived refugerecovery.org]
No addict identity required. Attendees need not call themselves addicts or alcoholics. Reassure clients who reject labels. [source: AA Agnostica 2019]
Meditation is the cornerstone. Daily practice is expected, not optional. Assess whether the client can tolerate meditation before referral. [source: archived refugerecovery.org; BU CARE 2025]
Investigation rather than belief. Change comes through written self-inquiry into suffering and craving. Treat the client's inventories as meaningful work you can support, while respecting the client's choice about what to share. [source: Tricycle 2014 review; Pressreader publisher description]
Community as refuge. Recovery is meant to be practised with others. Isolation is the risk to watch for. [source: Tricycle 2014 review; archived refugerecovery.org]
Peer-led, not teacher-led. The facilitator is a peer, not a therapist. Do not expect clinical containment in meetings. [source: AA Agnostica 2019]
No cross-talk. Members share without being interrupted, questioned or advised. Prepare the client to work through reactions in therapy rather than in the meeting. [source: AA Agnostica 2019]
Your role is to support, not to run. The clinician refers, prepares, coordinates and helps the client make sense of what happens. The clinician does not lead the fellowship's practices or act as the client's mentor. [synthesis]
One option on a menu. Present mutual aid as one choice among several and match it to the client's preferences. [source: BU CARE 2025]
Name the history and the choice of organisation. Two Buddhist fellowships share this lineage, so help the client choose knowingly. [source: Tricycle 2019] [synthesis]

4. Intervention inventory

Part A (4.1–4.9) describes the fellowship's own tools as the programme publishes them. Members do these with peers and mentors. The therapist does not run them. Part B (4.10–4.17) gives the clinician's procedures for referring to Refuge Recovery and working alongside it. Part B is mostly [synthesis], with general mutual-aid referral guidance cited where it applies. The book's 17 meditation practices are not named individually in the public sources, so 4.6–4.7 cover only the practices that the sources do name. [uncertain]

Part A: Programme tools (as the fellowship publishes them)

4.1 The Refuge Recovery meeting

Purpose / when to use: The core weekly peer-support setting, open to anyone wanting freedom from any addiction. The book's appendix gives detailed instructions for leading a meeting and encourages members to start new groups. [source: Tricycle 2014 review; AA Agnostica 2019]
Steps (typical sequence, as reported): (1) a peer facilitator opens with a short introduction; (2) the Four Noble Truths and Eightfold Path are read aloud; (3) about 20 minutes of group meditation, sitting silently in a circle; (4) a reading from the literature or a speaker on a recovery topic; (5) group sharing: each person speaks for a few minutes, and interrupting, questioning or advising (cross-talk) is discouraged; (6) an optional donation, reported to average about five dollars. Meetings are free and confidential. There are in-person and online formats, and some meetings focus on one topic; for example, a listed "Shadow Autopsy" meeting is described as an inventory meeting in which members work through the First and Second Truth inventories and share their experience. [source: AA Agnostica 2019; northwestdharma.org 2015; BU CARE 2025; buddhistrecovery.org listing] [uncertain: the full official meeting script is not public]
Example language (illustrative): "In the meeting you'll sit for about twenty minutes, then people take turns speaking. Nobody will comment on what you say. You're also free to just listen."
Watch for: whether the client actually goes, how they react to the silent sit, and whether they feel they belong. It is working if the client goes back without being prompted, starts to know other members, and talks about the meeting with some ease.

4.2 Taking refuge (the Third Truth)

Purpose / when to use: Gives an alternative refuge to the false refuge of the substance or behaviour, and supports hope that recovery is possible. [source: Tricycle 2014 review; archived refugerecovery.org]
Steps (as described): The member takes refuge in three things. The first is the Buddha, understood as their own potential for awakening. The second is the Dharma, understood as the Four Truths. The third is the Sangha, the group met in Refuge Recovery meetings. The official site describes refuge as a safe place and contrasts it with the "dark and lonely repetitive cycle" of addiction. No ritual wording is given here. [source: Tricycle 2014 review; archived refugerecovery.org]
Example language (illustrative, for the therapist exploring it): "Where did you go for safety before? Where are you going now when things get hard?"
Watch for: a refuge that is only an idea, with no real people behind it. It is working if the client names specific people, practices or places they turn to when craving hits.

4.3 First Truth inventory: addiction creates suffering

Purpose / when to use: Early in the programme. A written look at the misery and damage the addiction has caused, to build clarity and motivation. [source: Tricycle 2014 review]
Steps (as described): The member answers a set of written, multipart questions about the harm addiction has caused. The reviewer gives two examples of the themes: lying to hide the addiction, and what life might look like without addiction's suffering. The completed inventory is usually shared with a mentor; some groups hold inventory meetings where members work through the First and Second Truth inventories together. [source: Tricycle 2014 review; buddhistrecovery.org listing] [uncertain: the exact question set and sharing procedure are in the book only; use the client's own copy.]
Example language (illustrative): "You don't need to finish this in a week. Which question feels most important to bring here first?"
Watch for: waves of shame, an overwhelming list of losses, and trauma memories surfacing. It is working if the client describes the harm specifically rather than in global self-blame, and this leads to commitment rather than despair.

4.4 Second Truth inventory: the cause of addiction is repetitive craving

Purpose / when to use: After the first inventory. A written look at how craving, chasing pleasure and avoiding pain fed the addiction. [source: Tricycle 2014 review]
Steps (as described): Multipart written questions on the causes and conditions of the addiction and on the craving cycle. The book describes these as written investigations into the causes and conditions of addiction. The two inventories together run to about 60 questions. [source: Tricycle 2014 review; Pressreader publisher description]
Example language (illustrative): "When you trace a craving back, what were you trying to get away from or hold on to in that moment?"
Watch for: craving maps that stay intellectual. It is working if the client spots craving earlier in real time and can name what it is reaching for or away from.

4.5 The Eightfold Path (the Fourth Truth)

Purpose / when to use: The ongoing practice framework for living in recovery, grouped as wisdom, ethics and concentration. [source: Tricycle 2014 review]
Steps (factors as catalogued): understanding; intention; communication/community; action/engagement; livelihood/service; effort/energy; mindfulness/meditations; concentration/meditations. The book reworks the traditional factors so that community and service count for more. A review of the book also describes the intention to renounce greed, hatred and delusion as something that leads members to practise honesty, humility and integrity. [source: Spokane catalogue; Tricycle 2014 review; Spirituality & Practice review] [uncertain: the detailed practice instructions for each factor]
Example language (illustrative): "Of the eight, which one are you leaning on this month, and which one are you avoiding?"
Watch for: perfectionism about the path. It is working if the client can link a concrete behaviour change, such as honest speech, service or a work decision, to a factor.

4.6 Daily meditation (mindfulness and concentration)

Purpose / when to use: The cornerstone practice, done daily and in every meeting. It is used to calm cravings, work with emotion and build presence. The official site offers guided meditations as audio and as downloadable PDFs. The book contains 17 practices keyed to different stages of recovery. [source: archived refugerecovery.org; Tricycle 2014 review; AA Agnostica 2019]
Steps: The individual instructions are in the book and the programme's recordings and are not reproduced here [uncertain]. An attendee quoted by AA Agnostica described the practice as watching the present moment without judging or labelling it. Point the client to the programme's own guided recordings rather than writing a script for them. [source: AA Agnostica 2019]
Example language (illustrative): "Try the meeting's recording for ten days and note what happens to cravings afterwards, not during."
Watch for: dissociation, panic or trauma intrusions during silent practice (see 4.14 and section 5). It is working if the client practises regularly and reports more of a gap between craving and acting on it.

4.7 Heart practices: loving-kindness, compassion, appreciation, equanimity, forgiveness

Purpose / when to use: The "path to heartfulness" section of the book. These practices work on shame, resentment and relational harm. Forgiveness practice is directed towards everyone the member has harmed through words or actions. [source: Spokane catalogue; Spirituality & Practice review]
Steps: The individual instructions are in the book only. The practices are named but not described here. [uncertain]
Example language (illustrative): "If the forgiveness practice brings up someone who hurt you, it's fine to pause. We can look at that here."
Watch for: the client being pushed into forgiving an abuser before they are ready, or self-directed kindness being swamped by self-hatred. It is working if self-criticism softens and the client can think about repair without falling apart.

4.8 Mentorship

Purpose / when to use: One of the six components of the daily programme. A more experienced member guides a newer member. [source: archived refugerecovery.org]
Steps: The cited public sources do not set out how to choose a mentor, what qualifies someone to mentor, or what mentor and mentee do together [uncertain]. Rely on what the client's local group says.
Example language (illustrative): "What would you want from a mentor, and what wouldn't you want them to do?"
Watch for: power imbalances, sexual or financial boundary problems, and mentors advising against prescribed medication (see section 5). It is working if the relationship is regular, supportive and respects boundaries.

4.9 Retreat and service

Purpose / when to use: Deepen practice and build connection through generosity. Both are named components of the daily programme. RRWS also offers teacher-led meditation retreats and professional treatment options, and publishes recorded talks on its YouTube channel and podcast. Its GuideStar profile describes the retreats as professionally led, multiple-day residential retreats, about 5 to 10 a year. [source: archived refugerecovery.org; Tricycle 2019; GuideStar RRWS profile]
Steps: Service can include helping to run or set up meetings, which the book encourages. [source: Tricycle 2014 review] For retreats, RRWS gives only the format and frequency (see Purpose); content, cost and eligibility vary by event, so check each one with the client [uncertain].
Example language (illustrative): "Is there a small job at the meeting you could take on? It often helps people feel they belong."
Watch for: service used as a way to avoid one's own work, and retreats taken on too early or without clinical planning for a vulnerable client. It is working if the client feels more connected and responsible.

Part B: Clinician procedures (referring and working alongside)

4.10 Assessing fit

Purpose / when to use: Before suggesting Refuge Recovery to any client with a substance or behavioural addiction. [synthesis]
Steps: (1) Ask what the client thinks of 12-step language, spirituality and Buddhism. Refuge Recovery suits people who want a non-theistic, meditation-based group [source: archived refugerecovery.org]. (2) Ask about past meditation and how they reacted to it, including any trauma history, dissociation, psychosis or panic during silent sitting [synthesis]. (3) Ask whether they can manage written self-inquiry about harm now, or whether that should wait [source: Tricycle 2014 review; synthesis]. (4) Ask about medication, including medications for opioid use disorder (MOUD), antidepressants and anti-anxiety medication. Some mutual-aid members stigmatise these, so plan for that (see 4.16) [source: BU CARE 2025]. (5) Check which meetings exist locally and online and what formats they use [source: BU CARE 2025]. (6) Lay out the options: Refuge Recovery, Recovery Dharma, 12-step groups, SMART Recovery, others [source: BU CARE 2025].
Example language (illustrative): "Some people find the God language in AA a barrier. This group draws on Buddhist meditation instead and doesn't ask you to believe anything. Would you like to hear more?"
Watch for: a client agreeing only to please you. A good fit shows as curiosity and a concrete plan for which meeting to try first.

4.11 Preparing the client for a first meeting

Purpose / when to use: Once the client agrees to try a meeting. Preparation reduces early drop-out. [synthesis]
Steps: (1) Walk through the usual sequence: readings, about 20 minutes of silent meditation, a reading or speaker, sharing without cross-talk, and an optional donation [source: AA Agnostica 2019]. (2) Explain that they can pass when sharing, that they need not call themselves an addict, and that it is free [source: AA Agnostica 2019]. (3) Suggest going with a friend or relative and trying several different meetings [source: BU CARE 2025]. (4) Help them pick a format (in person or online) and a population (for example women's, LGBTQ+ or young people's meetings, where these exist) [source: BU CARE 2025]. (5) Plan a coping step for the silent sit, such as opening the eyes, slowing the breath or shifting posture. Recovery Dharma's published format names options like these. Refuge Recovery formats were not checked for this [source: shareselfhelp.org Recovery Dharma format; synthesis]. (6) Arrange to debrief at the next session.
Example language (illustrative): "If twenty minutes of silence feels like too much, keep your eyes open and feel your feet on the floor. That's allowed."
Watch for: high anticipatory anxiety. Readiness shows as the client naming the day, time and meeting they will go to.

4.12 Clinician attendance and liaison

Purpose / when to use: To learn what clients will meet there and to find meetings you trust for referral. [source: BU CARE 2025]
Steps: (1) Go to an open meeting as an observer, arriving early or staying late to ask questions. The BU handout says physicians are welcome at any meeting [source: BU CARE 2025]. (2) Respect confidentiality and do not recruit or treat anyone there [synthesis]. (3) Keep a short referral list of meetings, with format notes [synthesis]. (4) Use the official meeting locator listed in the BU handout [source: BU CARE 2025].
Example language (illustrative, to a facilitator): "I'm a counsellor and I'd like to understand the format so I can describe it accurately to clients. Is it all right if I just sit in?"
Watch for: your own presence affecting a client's meeting. Avoid meetings your current clients go to. [synthesis]

4.13 Pacing and supporting the inventories in therapy

Purpose / when to use: When the client is working on the First or Second Truth inventory. [synthesis]
Steps: (1) Ask the client to bring the questions from their own copy of the book, and do not copy them into your notes [synthesis]. (2) Agree a pace, for example a few questions a week, with a stopping rule if distress rises sharply [synthesis]. (3) Use sessions to work through shame, grief and trauma material that the inventory brings up. Leave the formal sharing of the inventory to the fellowship's mentor relationship [synthesis]. (4) Where it is relevant, link inventory insights to the case formulation (triggers, functions of use) [synthesis]. (5) If trauma memories appear, think about postponing detailed trauma content until stabilisation is in place [synthesis].
Example language (illustrative): "This question took you somewhere painful. Shall we slow down here and come back to the writing next week?"
Watch for: relapse after a heavy writing session, and self-punishing rumination. It is working if understanding grows while the client stays stable.

4.14 Supporting meditation safely

Purpose / when to use: For clients practising daily meditation as the programme asks. [source: archived refugerecovery.org; synthesis]
Steps: (1) Ask about sessions: how long, what kind, what they noticed [synthesis]. (2) For clients who dissociate or have trauma, suggest shorter sits, eyes open, attention anchored outside the body (sounds, feet), or movement, and say these changes are legitimate [synthesis]. (3) Watch for worsening mood, depersonalisation, intrusive memories or psychotic symptoms, and reduce or pause practice if they appear [synthesis]. (4) Help the client use the programme's guided recordings rather than unguided long sits at first [source: archived refugerecovery.org; synthesis].
Example language (illustrative): "Meditation is meant to steady you. If it's flooding you, we change how you do it. That isn't failing."
Watch for: the client pushing through distress because practice feels compulsory. It is working if the client recovers more quickly after cravings and emotional spikes.

4.15 Helping the client choose an organisation

Purpose / when to use: When the client is choosing between Refuge Recovery and Recovery Dharma, or has heard about the 2018–19 controversy. [source: Tricycle 2019]
Steps: (1) Give the factual history briefly and neutrally, attributing each point to its source (section 1): the 2018 ATS finding, Levine's denial, Spirit Rock's 2019 withdrawal of his teaching authorisation, and the negotiated July 2019 split [source: Tricycle 2018–19; Joint Statement, 6 Jul 2019]. (2) Explain the practical differences as published. Both are peer-led meetings based on the Four Truths and Eightfold Path, and both were described in 2019 as democratically governed. Refuge Recovery uses Levine's book, and RRWS also offers teacher-led retreats and treatment options. Recovery Dharma did not take on retreats or treatment, and uses its own peer-written texts [source: Tricycle, 13 Jul 2019; shareselfhelp.org Recovery Dharma format]. (3) Let the client decide, and help them visit both if both are available [synthesis].
Example language (illustrative): "There are two related groups because of a split in 2019. Would it help to try one meeting of each and see which feels right?"
Watch for: distress or mistrust linked to the misconduct history, especially in clients who have experienced sexual harm. Respect that as a reason to choose otherwise. [synthesis]

4.16 Medication and MOUD conversations

Purpose / when to use: For any client on psychiatric medication or MOUD. [source: BU CARE 2025]
Steps: (1) Before referral, warn the client that some mutual-aid members stigmatise medication [source: BU CARE 2025]. (2) Agree that medication decisions stay with the prescriber, not with peers or mentors [synthesis]. (3) Rehearse a short reply the client can give if challenged [synthesis].
Example language (illustrative, for the client to use): "My medication is part of my treatment plan with my doctor."
Watch for: the client stopping medication after meeting contact. Ask about this directly at follow-ups. [synthesis]

4.17 Monitoring engagement and integration

Purpose / when to use: Throughout treatment. [synthesis]
Steps: (1) At each review, ask about meetings attended, days meditated, inventory progress, contact with a mentor and service [source: archived refugerecovery.org components; synthesis]. (2) Ask whether they have a mentor and are working the programme, adapted from the BU suggestion to ask about sponsor and steps [source: BU CARE 2025]. (3) Link fellowship language to therapy goals, for example craving cycles or refuge, without taking over the fellowship's role [synthesis]. (4) If engagement drops, explore the reason before assuming lack of motivation (section 5) [synthesis].
Example language (illustrative): "How many meetings this month, and how often did you sit? What got in the way on the other days?"
Watch for: engagement that is all or nothing. Steady, moderate engagement is the sign that it is working.

5. Handling problems

The published sources give almost no guidance on problems. They raise only the concern about early inventories (Tricycle 2014), medication stigma and the need for matching (BU CARE 2025), and the organisational split (Tricycle 2019). Everything else here is [synthesis].

Stuck: goes to meetings but does no practice or inventory. Ask what gets in the way: time, literacy, shame or distrust of meditation. Break the work into small parts, such as a five-minute guided sit or one inventory question a week. Ask whether a mentor or a study group at the meeting could help. [synthesis]
Resistance to Buddhist content or to "refuge". Point out that the programme says it asks for no belief [source: archived refugerecovery.org]. Present the refuges as psychological anchors if that helps. If the resistance continues, offer SMART Recovery, a 12-step group or another option rather than pushing. [source: BU CARE 2025; synthesis]
Overwhelm from inventories. The 2014 reviewer asked whether people in early recovery can manage inventories that come so early [source: Tricycle 2014 review]. Slow down or pause the writing. Stabilise first: sleep, safety, craving management. Use sessions to process what comes up (4.13). Screen for suicidal thinking if shame or hopelessness is intense, and follow standard risk assessment and safety planning; make sure the client has crisis contacts, such as 988 (US) or Samaritans 116 123 (UK and Ireland). [synthesis]
Overwhelm or adverse effects from meditation. Change the practice (4.14). Watch for dissociation, panic, intrusive memories, mania or psychosis, and pause practice and review the treatment plan if these appear. The client can still attend while sitting the meditation out with eyes open, or arrive after it. [synthesis]
Non-attendance or drop-out. Normalise trying several meetings [source: BU CARE 2025]. Problem-solve logistics and consider online meetings [source: BU CARE 2025]. Look for social anxiety or a bad first experience, and rehearse going back. [synthesis]
Lapse or relapse. Treat it as information, using the craving lens the client already knows from the Second Truth. Encourage them to go back to meetings rather than stay away out of shame. Review the medical and treatment plan, including MOUD where appropriate. [synthesis]
Medication stigma. Prepare the client in advance (4.16) and back the prescriber's role [source: BU CARE 2025]. If a mentor or group keeps pressing, help the client find another meeting or mentor. [synthesis]
Mentor boundary problems. No published mentor procedures exist [uncertain]. If a mentor gives clinical or medical directives, makes romantic or sexual approaches, exploits the client financially or isolates them, treat it as a safeguarding issue. Help the client end or change the relationship and follow local duties where a vulnerable adult is at risk. [synthesis]
Distress about the founder controversy. Acknowledge the documented history (section 1) without detail beyond the published record [source: Tricycle 2019]. Offer Recovery Dharma or another fellowship as alternatives, and take seriously clients whose own experience of sexual harm makes the association unbearable. [synthesis]
Rupture with the therapist over the fellowship (feeling pushed or judged). Repair it explicitly. Say that mutual aid is optional, one item on a menu [source: BU CARE 2025]. Separate your support for the client's recovery from whether they attend. [synthesis]
Conflict between the fellowship's framing and the treatment model (for example abstinence goals versus a harm-reduction plan). Discuss the difference openly. The programme's definition of recovery includes abstaining from acting on cravings [source: archived refugerecovery.org]. Help the client decide which goal they are working towards, and choose a group that fits it. [synthesis]
Process addictions and several addictions. The programme welcomes all addictions [source: archived refugerecovery.org]. Check whether local meetings have a substance focus that may leave a client with, for example, a food or sex addiction feeling out of place. Look for topic-specific meetings where they exist. [synthesis]
Eating-related addictions. Screen for an eating disorder before framing food as an addiction, and coordinate with eating-disorder care where indicated. [synthesis]

Sources

Web pages cited:

Books cited:

Levine, N. (2014). Refuge Recovery: A Buddhist Path to Recovering from Addiction. New York: HarperOne. Its structure is taken from the catalogue contents note and reviews.

Not in the cited public sources [uncertain]: the official meeting script, the inventory question set, the 17 meditation instructions and the mentoring guidance.

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