Addiction is characterized by compulsive drug-seeking behavior or an intense desire to use a drug despite severe medical or social consequences, including the risk of death.1 In the United States, addiction is a major public health problem—in 2013, approximately 22.7 million Americans (8.6% of the population) needed treatment for a drug or alcohol problem, but only 2.5 million people actually received treatment.2
For those who do seek help, a range of treatment options are available, including:
- Detox programs.
- Inpatient or residential rehabilitation programs.
- Outpatient treatment programs.
- Aftercare programs.
The first 12-step group was Alcoholics Anonymous (AA), started in 1935 by Bill Wilson (a stockbroker) and Dr. Bob Smith (a surgeon)—they are also the group’s original members. Since then, AA has grown into an international organization with more than 73,000 groups worldwide; in 2017, estimates cite 1,124,125 AA members and 52,476 AA groups in the United States.3,4 Over time, people have modified the 12 steps to address a number of substance abuse and behavioral issues such as narcotics, cocaine, and gambling.
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12-Step Treatment Philosophy
The 12-step treatment philosophy is based on AA’s founding principles, a model that instructs members to surrender to their addiction, and realize that they are powerless over drugs or alcohol.
All 12-step programs have their own list of steps, with the wording varying slightly depending on the group. For example, Heroin Anonymous (HA) substitutes the words “heroin” and “drug addict” in the first and last steps.
AA’s original 12 steps are well-known to many people:5
- We admitted we were powerless over alcohol [our addiction]—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 a 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 [addicts] and to practice these principles in all our affairs.
Examples of 12-step programs include:
- Alcoholics Anonymous.
- Narcotics Anonymous.
- Celebrate Recovery.
- Cocaine Anonymous.
- Gamblers Anonymous.
- Heroin Anonymous.
- Co-Dependents Anonymous.
- Crystal Meth Anonymous.
Although the 12-step approach can be extremely beneficial for some people, not everyone is comfortable with some of the more spiritual aspects of the program. Because of this, some non–12-step programs have been created as alternatives.
Some examples of non–12-step groups include:
- LifeRing Secular Recovery.
- SMART Recovery.
- Women for Sobriety.
- Moderation Management.
- Recovery 2.0.
- Recovery International.
- Secular Organizations for Sobriety.
Effectiveness of 12-Step Drug Addiction Treatment
Over time, researchers have investigated how well 12-step programs work. Although AA has been around for almost a century, its efficacy remains uncertain. This is in part due to the nature of 12-step groups; their voluntary and anonymous structure makes it difficult for researchers to conduct randomized controlled trials.
Despite the challenges of studying this population, studies do exist and the findings are mixed:
- A 2006 meta-analysis found that there are no experimental studies that indisputably demonstrated the efficacy of AA or other 12-step programs.6
- A review of the available literature found strong evidence of AA’s effectiveness and that rates of abstinence are about 2 times as high among those who attend AA compared to those who don’t.7
- One study found that 46% of those who attended formal treatment reached abstinence compared to 49% percent of the AA-only group. The study also found that the longer a person stayed in AA in the first 3 years of recovery, the greater likelihood of them remaining abstinent.8
- A study of 3,018 male inpatients found that those who attended 12-step meetings were more likely to be abstinent at follow-up. Patients in the 12-step groups also were less likely to be depressed and have more friend resources. However, patients who attended both 12-step programs and outpatient treatment had the best outcomes.9
- A study found that involvement in AA led to decreased alcohol consumption and fewer alcohol-related problems.10
Questions remain about whether 12-step programs are the ideal setting for people with dual diagnoses since the focus of 12 steps is on substance use and not mental health. In addition, some groups many not feel comfortable with 12-step meetings because they are perceived to be male-dominated, spiritual, and targeted toward an older population.11
Despite the contrasting evidence regarding effectiveness, 12-step facilitation is prevalent in rehab centers; at least 74% of treatment facilities use the model.12
How to Find a 12-Step Drug Addiction Recovery Program
All 12-step groups are free and open to anyone who is serious about stopping alcohol or drug use or a behavioral disorder. During meetings, you may share personal stories, read from the Big Book, talk about the 12 steps and related themes, and celebrate other members’ sobriety. You will work the steps—some steps may be harder than others. The amount of time you spend in a 12-step program may depend on the severity of your addiction, your drug of choice, your support system, and how committed you are to recovery.
Millions of people have found healing and hope through 12-step programs.
If you are one of the 24.6 million people (9.4%) who reported using an illicit drug in the past month or you are addicted to alcohol and looking for ways to get sober, you can always check out a 12-step program in your area by:2
- Searching online.
- Looking at insurance listings.
- Word-of-mouth referrals (from friends/family/personal doctors).
Millions of people have found healing and hope through 12-step programs—perhaps they will be a helpful part of your recovery journey too.
- Soyka, M. (2017). Treatment of Benzodiazepine Dependence. New England Journal of Medicine, 376(12), 1147–1157.
- National Institute on Drug Abuse. (2015). Nationwide Trends.
- Substance Abuse and Mental Health Services Administration. (1999). Chapter 4—Twelve-Step-Based Programs.
- Alcoholics Anonymous. (2017). Estimates of A.A. Groups and Members.
- Alcoholics Anonymous. (2016). The Twelve Steps of Alcoholics Anonymous.
- Ferri, M., Amato, L., & Davoli, M. (2006). Alcoholics Anonymous and other 12‐step programmes for alcohol dependence. The Cochrane Library.
- Kaskutas, L. A. (2009). Alcoholics Anonymous effectiveness: Faith meets science. Journal of Addictive Diseases, 28(2), 145–157.
- Moos, R. H. & Moos, B. S. (2006). Participation in treatment and Alcoholics Anonymous: A 16‐year follow‐up of initially untreated individuals. Journal of Clinical Psychology, 62(6), 735–750.
- Ouimette, P. C., Moos, R. H., & Finney, J. W. (1998). Influence of outpatient treatment and 12-step group involvement on one-year substance abuse treatment outcomes. Journal of Studies on Alcohol, 59(5), 513–522.
- Kelly, J. F., Stout, R., Zywiak, W., & Schneider, R. (2006). A 3‐Year Study of Addiction Mutual‐Help Group Participation Following Intensive Outpatient Treatment. Alcoholism: Clinical and Experimental Research, 30(8), 1381–1392.
- Kelly, J. F. & Yeterian, J. D. (2011). The role of mutual-help groups in extending the framework of treatment. Alcohol Research and Health, 33(4), 350.
- Substance Abuse and Mental Health Services Administration. (2013). National Survey of Substance Abuse Treatment Services (N-SSATS): 2012. Data on Substance Abuse Treatment Facilities.