What is a 12-Step Program for Alcohol or Drug Addiction?

A 12 step program is perhaps the most well-known type of recovery support in the country. Millions of people are currently attending these groups; many more have done so in past generations when they were often the only addiction treatment option.

Although these programs do not offer treatment, they are a valuable means of support and experience for the people who use them. In addition, many addiction rehabilitation centers use some version of this program, especially in group therapies.

The 12 steps were developed by the founders of Alcoholics Anonymous, or AA. This group was founded in the 1930s and later branched out into Narcotics Anonymous and other groups. They were very successful in their first decades because it was the only style of support or treatment available for people who had an addiction back then. This was truly an innovative approach in its time.

12 step programs began as free support groups where members affirmed their dedication to the program and supported each other. New members were matched with a sponsor who would be available to them day and night if they needed support outside of the meetings.

Over eighty years ago, addiction was viewed as a moral weakness rather than a disease. As a result, the 12 steps emphasize reliance on God, and may seem more moralizing than many modern programs. However, the program has changed so that people of different faiths and spiritual backgrounds can use it successfully.

Today, people can still find valuable peer support in 12 step anonymous meetings. In addition, many modern recovery programs incorporate the 12 steps into their curriculum. Although this program does not work for everyone, it has been a lifeline for many people who need it.

What are the 12 Steps of Recovery?

The 12 steps of AA remain very much the same as they were in the early years of the program. Many programs use slightly different steps, although the basic idea is the same. They are the following:

  1. Admitting that you are powerless over alcohol and/or your other substances of choice
  2. Believing that a higher power can help you overcome the addiction
  3. Making a decision to turn one's addiction over to this higher power
  4. Taking a moral inventory of oneself
  5. Admitting to oneself, the higher power, and another human being that you have done wrong and cannot control the addiction
  6. Allowing the higher power to remove moral defects including the addiction
  7. Asking the higher power for help
  8. Making a list of the people you have harmed with your addiction
  9. Making amends for these damages
  10. Continuing to take personal responsibility throughout recovery
  11. Seeking to be closer to one's higher power, such as through prayer or meditation
  12. Helping other people in these steps when they are ready to begin recovery

These steps can be completed all at once or in any order. In fact, many people find that it is helpful to go back and revisit steps as needed in sober life. Members of 12 step programs such as Alcoholics Anonymous generally view recovery as a lifelong endeavor. As a result, the bonds formed in these groups can be as strong if not stronger than family ties.

The History Behind the 12-Step Program

The 12 steps program began with Bill Wilson, the founder of Alcoholics Anonymous. He struggled with alcoholism and was able to recover using these steps. He shared the steps with other alcoholics, some of whom were also able to recover. He then encountered support groups for people struggling with addictions and the program was born.

Wilson eventually published several books that are still used in many 12 step programs. However, his program has since been modified in several ways. Narcotics Anonymous, Gamblers Anonymous, and a variety of other groups sprung up for people with other addictions. Although the original 12 steps came from a Christian perspective, the language was changed to accommodate other beliefs.

Lastly, the program has been changed in a variety of ways for new treatment programs. We now know that addiction is not a moral failing requiring the forgiveness of God, but rather a disease that requires professional treatment. Despite these changes, 12 step programs can be a powerful source of aid. For many people, admitting that they are powerless over addiction and adopting some sort of spiritual path allows them the freedom to finally seek recovery.

Does the 12-Step Program Work?

There has been a great deal of controversy with 12 step programs. Many people seeking treatment often wonder about the AA success rate. Is it possible to get effective treatment for free? Can a higher power really help people change their lives and overcome a deadly disease?

Several studies have found that Alcoholics Anonymous and similar programs are not often effective on their own. Most people will have a better chance of recovery when they undergo a structured treatment program. Many drugs, including alcohol and opiates, cannot simply be stopped. They require medical management of withdrawal symptoms which can be deadly without medical supervision. A support group cannot overcome this basic fact.

In addition, there are huge initial challenges to recovery even after the dangerous withdrawal period has passed. Cravings can be difficult to overcome without trained staff. In addition, support groups cannot overcome the need for skilled therapy and treatment both for addiction and for the psychological issues that often accompany it.

Despite these shortcomings, there are merits to 12 step programs. Studies have found that regular engagement in these groups can help people to change the way that they think about their addiction and thus change their behavior. Patients stop seeing substance abuse as something that they can control and begin taking steps to achieve sobriety.

In addition, 12 step programs appear to be helpful for many people while in treatment and after the rehabilitation program has been completed. They offer support in times of crisis that can occur after people finish inpatient treatment. In addition, they allow people the chance to find a new peer group whose members do not use substances and are encountering many of the same challenges.

In summary, research indicates that a 12 step program can be extremely helpful when used in combination with more modern treatment programs. Anonymous meetings alone may not be enough, but they can be valuable during and after rehabilitation programs. As with many diseases, addiction requires a multidisciplinary approach that is tailored for the needs of each individual patient.

Alternatives to the 12 Steps of AA

Many people have successfully stopped using alcohol and drugs using the 12 steps of recovery. However, others have not been successful. Alcoholics Anonymous and similar programs require that people find a higher power that is an external source of control. This is not right for everyone.

For some people, the emphasis on a higher power is simply not compatible with their personal belief systems. In addition, some people actually have a higher chance of recovery when they find an internal source of power and control rather than relying on something outside of themselves. There are several alternatives to these programs if AA is not a good fit for you.

There are programs similar to AA and the 12 steps that do not focus on a higher power or a belief in total powerlessness. These programs usually empower members to find power and motivation in themselves. In addition, many are based on modern research and thus have more evidence-based practices.

Despite the differences, these groups have several key elements in common with Alcoholics Anonymous. Most are free, which is important for people who are recovering from the expensive disease of addiction. In addition, they all offer peer support with a framework of steps for recovering together. These alternative programs include:

  • LifeRing Secular Recovery - an organization offering peer support through group meetings, confidential emails, and private chats. The group focuses on moving forward and building a new and sober life. In addition to peer support, there are workbooks and other curricula that help people through the recovery process.
  • Self-Management and Recovery Training (SMART) - a program that includes traditional group meetings, online meetings, 24/7 chat support, and an online message board. The program includes four steps that focus on finding motivation and skills for undergoing successful recovery.
  • Moderation Management - a group that is gaining popularity because it does not restrict the use of substances. Rather, members seek to learn to use substances in a healthy and moderate way once again. This group is extremely controversial in many recovery circles.
  • Secular Organizations for Sobriety (SOS) - a support group that is identical to AA in most aspects. However, it is completely secular and does not feature belief in God or any other higher power. As with AA, the group's main benefits are accountability and peer support.
  • Women for Sobriety - a program founded in 1976 that includes peer support as well as a program emphasizing meditation, healthy lifestyle, and positive thinking as lifelong treatment for women who are addicted to alcohol.

These programs all are alternatives to Alcoholics Anonymous that have become more popular. However, none of them can replace an inpatient addiction rehabilitation program.

Using a 12 Step Program with Other Treatment Types

Regardless of their shortcomings, 12 step programs appear to be most successful when combined with other types of addiction treatment. Many people who struggle with addiction can benefit from a structured inpatient detox and rehabilitation treatment program that incorporates aspects of 12 step programs into their group therapy. After they graduate, they can then successfully transition to using group meetings however they may fit into their daily lives. This can be extremely effective because it gives people continuity.

Many programs use some variation of the original twelve steps, although they may not follow the same order or feature a higher power. Many people benefit from having this extremely structured framework. Working through recovery can be a very confusing and emotional time. Having a step-by-step structure can make the process easier for those who desire it.

In addition, many programs  (both outpatient and inpatient have incorporated some element of spirituality into their program. While this is not helpful for all patients, it can greatly aid in recovery for those who are interested in it.

Combining different treatment approaches can be extremely effective in recovery. For many patients, this offers the best of both worlds. As a result, many treatment programs offer a blend of medical approaches, therapy, spirituality, and 12 step groups so everyone can get their needs met.

Getting Help for Addiction

Whether 12 step programs and anonymous groups are right for you, there are multiple ways to approach treatment. There is no shame in suffering from a disease such as addiction or having a loved one who does. Regardless of how you ended up in this place, there is always a path forward. Many treatment centers around the United States are offering a multidisciplinary and evidence-based approach that offers the best odds of surviving and thriving in a healthy, sober future.