The 12 Step Program began with the advent of Alcoholics Anonymous (AA) in 1938. Today, AA has millions of members in countries all over the world, and there are 12 step programs for almost every behavioral health disorder. Additionally, most alcohol and drug addiction treatment facility offers some version of a 12-step program as a part of its treatment program. With the ubiquity of the program, many people wonder whether it is actually a beneficial treatment option, as well as how it compares to other forms of treatment.
To be considered a 12-step program, there needs to be a set of guiding-principles amounting to 12 that create a specific course of action that facilitates the recovery of addiction or other behavioral health problems. The process typically involves an admission of lack of control, recognizing a higher power and asking for strength, recognizing past errors and making amends, living a new life with following a certain code of behavior, and helping others who suffer from the same affliction. These programs typically have a sponsor or mentor system in place. A 12-step program is usually in the form of a group support meeting, run by members.
At its foundation, a 12-step program works as a way to support a person through recovery without working on the psychological underlying causes of the condition. When done on its own, it is often considered a self-help method of treatment. However, 12-step programs also play an important part of a comprehensives and holistic treatment protocol, providing a structural support for when a person leaves rehab. The social support provided by the 12-step program, combined with the psychological and emotional treatment provided by a dedicated treatment program, provides the best chance at recovery.
Studies on the Efficacy of the 12-Step Program
Studies have shown that attending group support meetings, such as those with a 12-step program, improves a person's chance at a full recovery and reduces the risk of relapse. The majority of evidence demonstrating the efficacy of the 12-step program focuses on its place as a support system, rather than as an actual form of treatment. However, there is a limited number of studies available on the efficacy of the 12-step program.
One of the largest studies involving AA is known as Project MATCH, which was published in 1998 and supported by the National Institute on Alcohol Abuse and Alcoholism. The aim of the study was to find ways in which to match people with the most suitable addiction treatment.
They used the personality and characteristics of a person, called client attributes, which included traits such as anger and readiness to change. The researchers wanted to see how well certain treatments worked on 21 different typical personality attributes. They compared three types of treatments: 12-step facilitation therapy, cognitive behavioral therapy, and motivational enhancement therapy. About 30 percent of clients abstained from drinking, and the two most powerful predictors were readiness to change and self-efficacy. There was minimal difference between the three treatments.
Another study based on data from Project Match found that 12-step programs reduce drinking due to the social support. Clients with many close friends and family members who drank a lot, otherwise known as a high support system for drinking, had trouble finding support for abstaining. The researchers found that those with such a network but were involved in a 12-step program had an 83 percent success rate, compared to 66 percent with motivational enhancement therapy.
A 2008 report from AA entitled "Alcoholics Anonymous Recovery Outcome Rates: Contemporary Myth and Misinterpretation" states that for 26 percent of newcomers to the program remain attending meetings by the end of their first year. Those who are in their fourth month have a 56 percent chance or remaining through the year.
These studies and others have found at least a small success rate to the program. In a disease such as alcoholism or addiction that has a 40 to 60 percent relapse rate, these results show a decent success. Additionally, a 12-step program provides a way to maintain a treatment program long term to reduce the risk of relapse.
According to a 2007 AA study, 33 percent of 8,000 North American members who were surveyed remained sober for more than 10 years, 12 percent for 5 to 10 years, 24 percent for 1 to 5 years and 31 percent for less than a year. A 2007 study by the National Council on Alcoholism reported that a 12-step program accounted for a 49.5 percent abstinence rate after the first year, compared to CBT programs that had a 37 percent abstinence rate. A 2006 study published in the Journal of Clinical Psychology surveyed 628 people and found that those who attended AA for at least 27 weeks had more improved 16 year outcomes than those who had no treatment.
Completely valid and accurate statistics about the numbers and efficacy of 12-step programs are difficult to obtain due to the anonymity associated with these programs. Therefore, only a handful of studies about AA and other 12-step programs have been conducted, making it difficult to know just how well these programs work. Many of the statistics come from AA, which creates a potential for bias in the results. The results mostly show that the program works, or at least provides some benefits to those who engage in the program.
Each different 12-step program will have some slight changes or adaptations to the 12-steps, depending on what it is treating and other factors. However, each program more or less features the same 12-steps that began with AA in the 1930s. One of the main features of the 12-step program is an emphasis on the powerless of an individual and the importance of turning to a higher power for help. Other important aspects of the program include atoning for past mistakes. The steps in the program build on one another, and a person can take as long as necessary to go thorugh the different stages of recovery.
The original twelve steps from AA are as followed:
- We admitted we were powerless over alcohol—that our lives had become unmanageable.
- Came to believe that a power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of God as we understood Him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- Were entirely ready to have God remove all these defects of character.
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to make amends to them all.
- Made direct amends to such people wherever possible, except when to do so would injure them or others.
- Continued to take personal inventory, and when we were wrong, promptly admitted it.
- Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
- Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
Although AA has a background in Christianity, having been founded on Christine doctrine, today most 12-step programs, including AA, have an open approach to spirituality. The twelve steps can be adjusted to work with any belief or spiritual practice, as long as a person believes in some sort of higher power. Individuals and groups have adapted the 12-steps to work with a wide variety of cultural and spiritual beliefs, including those from the Judeo-Christian, Muslim, Buddhist, and Hindu faiths, as well as paganism and agnostic philosophies. Some programs have a strong connection with the spiritual aspect of the program by being associated with a particular religious or spiritual belief. Some programs adapt the traditional 12-step program to be explicitly connected with a particular religion or belief system, such as Celebrate Recovery, LDS Family Services, and Pagans in Recovery. However, most programs are inclusive of all beliefs.
Dr. Bob Smith and Bill Wilson, known as Dr. Bob and Bill W. respectively, founded alcoholics Anonymous. They published the first basic text detailing the steps in 1939, which is now in its fourth edition. Today, there are AA meetings all around the world, with over 2 million members. One of the most important aspects of the program is the anonymity. The group meetings are set up to provide people a place to come and receive support without worrying about legal ramifications, or any media or press inquiries. Meetings are open to all members, and there are occasionally open meetings to which non-alcoholics may attend.
Finding AA Meetings
It is easy to find local AA meetings. The official website lists many of the local meetings with a date and time. Many places will have several options for meetings, making it easy to find a day and time that works with any schedule. Recovery treatment programs and facilities often include AA meetings as part of their programs, and make it easy for their clients to find the nearest meeting, which might include providing transportation.
Narcotics Anonymous (NA) was the first group to break away from AA to form another 12-step program based on the original principles. In 1953, NA was created to provide an atmosphere for those addicted to substances other than alcohol. Anyone with an addiction to any substance, including alcohol, can attend NA meetings. There are more than 61,000 weekly NA meetings held in 129 countries around the world. NA members and meetings follow the detailed guide, Basic Text, Living Clean: The Journey Continues, It Works: How and Why, which is now in its sixth edition. Members are encouraged to purchase the book to assist them in their journey of recovery.
Other 12 Step Programs
Although AA is the most well known of the 12-step programs, and this type of recovery is largely associated with recovery from drugs and alcohol addiction, only 20 percent of programs are actually associated with AA. There are more than 200 different 12-step programs that have worldwide membership and organizations for a wide variety of problems. Many support groups for a range of behavioral health conditions have adapted the 12-step approach to help people overcome a variety of problems, from depression to overeating to financial problems. It has become the model for building support groups to help people overcome problems.
Many self-help support groups have adapted the 12-step program to help people overcome various addiction and behavioral problems. There are also support groups for friends and family members of the addict, such as Al-Anon. Types of problems with 12-step support groups include over-eating, eating disorders, gambling, sex addiction, hoarding, codependency, overworking, emotional problems, mental health problems, self-mutilation, shopping, and debt.
The following is a list of 12-step programs, although it is not mean definitive. It demonstrates the variety of problems this type of program helps, as well as the specificity of many of the programs. Some behavioral health problems have more than one group dedicated to helping those suffering from it, providing a multitude of choices.
- Alcoholics Anonymous
- Adult Children of Alcoholics
- Al-Anon/Alateen (friends and family members of alcoholics)
- Cocaine anonymous
- Computer Gaming Addicts Anonymous
- Clutterers Anonymous
- Crystal Meth Anonymous
- Co-Anon (for friends and family members of addicts)
- Co-Dependents Anonymous (those with codependency issues)
- Codependents of Sex Addicts
- CoSex and Love Addicts Anonymous
- Debtors Anonymous
- Emotions Anonymous (for those with mental and emotional problems)
- Families Anonymous (another one for relatives and friends)
- Food Addicts in Recovery Anonymous
- Food Addicts Anonymous
- Gamblers Anonymous
- Gam-Anon/Gam-a-Teen (friends and family members of gamblers)
- Heroin Anonymous
- Marijuana Anonymous
- Neurotics Anonymous
- Nar-Anon (friends and family members of addicts)
- Nicotine Anonymous
- Obsessive Compulsive Anonymous
- Overeaters Anonymous
- Online Gamers Anonymous
- Pills Anonymous
- Shoplifters Anonymous
- Sexaholics Anonymous
- Smokers Anonymous
- Sex Addicts Anonymous
- Sexual Compulsives Anonymous
- Survivors of Incest Anonymous
- Sex and Love Addicts Anonymous
- Underearners Anonymous
- Workaholics Anonymous
The Power of the Group
One of the major reasons that 12-step programs have the success rate they do is the support provided by other addicts. Having a strong support network during recover reduces the risk or relapse. Although friends and family play an important role in the support network, being surrounded by those who have gone through a similar experience helps a person through recovery. When they share their stories, there is no judgment; instead, they find understanding. This can help a person deal with the problem in a nurturing and supportive environment, giving them the strength they need to overcome the problem. The other members of the group also provide advice on how to overcome craving, handle difficult experiences, and more. Having a scheduled meeting also can help a person feel accountable to a group for remaining sober.
Sponsorship is an essential element of most 12-step programs, and part of the reason that many people succeed. Studies have found that by helping another person through the program as a sponsor, a person is more likely to remain sober him or herself. That is why many of these programs encourage members to become a sponsor to someone else, after they have achieved all 12-steps. Those who are being sponsored have a one-to-one level of support by someone who knows what they are going through and understands.
Sponsors offer a special type of support. Sponsors often work as a trusted person to guide the recovering addict through the 12-steps. They can provide information about recovery, including what to expect in the future. They will listen to problems anytime, day or night, and will help put any problems into perspective to help the person avoid drinking. Sponsors will also watch over the person for any signs of relapse, and support the person if it does happen. A sponsor is a person to whom to reach out whenever they feel the urge to drink or use drugs. The sponsorship model provides an important way to reduce the risk of relapse and keep both sponsor and person being sponsored on the right track to recovery.
Using the 12 Step Program in Recovery
Although 12-step programs are largely associated with support group meetings, many residential and outpatient rehab facilities utilize the 12-steps in their programs. When a person goes through treatment, whether in-patient or outpatient, some of the programs will include the first few steps of the 12-step program. Their therapists, counselors, and group leaders guide them through the initial stages of the program. By assisting a person through the initial steps, the hope is that the person will continue through the rest of the steps on their own once they leave treatment.
Additionally, most facilities encourage their clients to attend local meetings. This provides them with a larger support system to facilitate their treatment. It also helps to create a habit that the person can continue to do once they have left the facility. If a person is already familiar with the support meetings while in a supportive environment, they will be more likely to continue once they have left treatment. This is especially beneficial for those receiving treatment locally. Once they leave the treatment facility, they will already have a trusted support group with which they can continue to meet.
Each treatment facility differs in its emphasis and use of the 12-step program. Some facilities focus strongly on the program, while others only use it as a tool to provide clients with a support group outside of the facility. There are also treatment facilities that forgo the 12-step program method completely.
Many 12-step programs believe that membership should be a lifelong commitment. In order to gain the full benefits, it is recommended that recovering addicts remain in the program for an extended period of time, and possibly for the rest of their lives. The longer a person stays in the program, the less chance they have of relapsing. Many recovering addicts continue to regularly attend meetings decades after their last drink or drug use. Some will stop attending meetings, but then return when they feel they need some additional support during a tough crisis.
What the 12-Step Program Does Not Do
Although the 12-step program is widely held to be a strong treatment option for people recovering from alcohol or drug addiction and other behavioral health problems, there are certain aspects of the problems with which it cannot help. The number one factor to which a 12-step program cannot help is psychological and emotional problems. Although it provides a place for people to talk and discuss problems, it is not set up to provide psychotherapy. The group meetings are run by other recovering addicts, not licensed professionals experienced in treating psychological problems. If a person's behavioral health problem is related to emotional or psychological problems, then he or she will need to undergo psychotherapy in addition to a 12-step program. That is why most recovery professionals recommend the 12-step program as a complimentary method, not a stand-alone treatment method.
A 12-step program cannot help everyone. Some people do not do well with releasing power to a higher power, regardless of the spiritual or religious context. There are other reasons that some people do not find success in the program as well. The main reason it has the success rate it does is that it provides ongoing support through the long, often troublesome journey of recovery. The group meetings provide support and a place to turn to during difficult times. There are other methods that do not follow the 12-steps but instead focus on self-empowerment to overcome the problem. One of the most common non-12 step program is SMART Recovery.