12 Steps of Alcoholics Anonymous and Drug Recovery Programs

AA is an international organization of individuals who have struggled with drinking at some point in their lives. These people come together to share their experience, strength, and hope with one another, with the only requirement to join being a desire to stop drinking alcohol. Estimates state that there are more than 2 million recovering alcoholics in AA throughout the world today. The group does not ask for membership fees, just donations, and only then if you can manage it.

The history of Alcoholics Anonymous (AA) dates nearly as far back as the Prohibition era in America. In 1935 (2 years after the Prohibition ended), two men struggling with alcoholism—Bill Wilson and Dr. Bob Smith—helped each other stop drinking. After working together, the men got sober and maintained their sobriety by working with other alcoholics. In 1939, Bill Wilson published a book called Alcoholics Anonymous that described each of the steps in the 12-step program and AA’s philosophy. 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. Over time, people have modified the 12 steps to address a number of substance abuse and behavioral issues such as narcotics, cocaine, and gambling.

AA has certain unique aspects that set it apart from other support groups, including:

  • Tokens: After 24 hours of sobriety, you receive your first token. Following the first token, you can receive tokens for the following sobriety benchmarks: 1 month, 2 months, 3 months, 6 months, 9 months, and 1 year of sobriety.
  • The AA Big Book: AA’s main text is called the Big Book and it outlines the 12 steps, the 12 promises, and the 12 traditions for members.

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. 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.

For those who do seek help, a range of treatment options are available, includingDoctor talks about treatment with sad female patient

WHAT ARE THE 12 STEPS, 12 PROMISES, AND 12 TRADITIONS OF ALCOHOLICS ANONYMOUS?

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.

The 12 steps of AA:

  1. We admitted we were powerless over alcohol [our addiction]—that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take a personal inventory and when we were wrong promptly admitted it.
  11. 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.
  12. 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.

The 12 promises of AA:

  1. If we are painstaking about this phase of our development, we will be amazed before we are halfway throughPeople in 12 step treatment group talking
  2. We are going to know a new freedom and a new happiness.
  3. We will not regret the past nor wish to shut the door on it.
  4. We will comprehend the word serenity, and we will know peace.
  5. No matter how far down the scale we have gone, we will see how our experience can benefit others.
  6. That feeling of uselessness and self-pity will disappear.
  7. We will lose interest in selfish things and gain interest in our fellows.
  8. Self-seeking will slip away.
  9. Our whole attitude and outlook upon life will change.
  10. Fear of people and of economic insecurity will leave us.
  11. We will intuitively know how to handle situations which used to baffle us.
  12. We will suddenly realize that God is doing for us what we could not do for ourselves.

The 12 traditions of AA:

  1. Our common welfare should come first; personal recovery depends upon AA unity.
  2. For our group purpose there is but one ultimate authority—a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.
  3. The only requirement for AA membership is a desire to stop drinking.
  4. Each group should be autonomous except in matters affecting other groups or AA as a whole.
  5. Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.
  6. An AA group ought never endorse, finance, or lend the AA name to any related facility or outside enterprise, lest problems of money, property and prestige divert us from our primary purpose.
  7. Every AA group ought to be fully self-supporting, declining outside contributions.
  8. Alcoholics Anonymous should remain forever nonprofessional, but our service centers may employ special workers.
  9. AA, as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
  10. Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.
  11. Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio and films.
  12. Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.

WHAT ARE SOME NON-12 STEP RECOVERY PROGRAMS?

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.

DOES THE 12 STEP PROGRAM WORK?

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 2014 survey of more than 6,000 AA members stated that 27% were sober for less than 1 year, 24% were sober between 1 and 5 years, 14% were sober between 5 and 10 years, 14% were sober between 10 and 20 years, and 22% were sober for more than 20 years.
  • 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.
  • 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.
  • 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.
  • A study found that involvement in AA led to decreased alcohol consumption and fewer alcohol-related problems.

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.

Despite the contrasting evidence regarding effectiveness, 12-step facilitation is prevalent in rehab centers; at least 73% of treatment facilities use the model.

In addiction treatment, your counselors help you open up about any issues you are facing in recovery and may encourage you to attend 12-step groups, participate, and work with a sponsor. AA is a great space to explore what activities are available outside of drinking alcohol. For example, you can get involved in volunteering at an AA home group or an AA clubhouse, or you can volunteer at AA events such as retreats, conventions, holiday events, sobriety anniversaries, or sober parties.

Going to a 12-step group may also help you address your underlying psychology and how your beliefs and behaviors can lead to addiction. While you work the steps, you deepen your understanding of spirituality, values, connectedness to others, and your willingness to ask for help when you need it.

FINDING THE RIGHT 12 STEP RECOVERY PROGRAM FOR YOU

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.

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:

  • 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.

When you are ready to join an AA meeting, you may notice that meetings are advertised as open or closed. Here is the difference between the two:

  • Closed meetings are intended for people who are struggling with alcohol or drug abuse. The closed atmosphere provides a safe space for you to freely talk about your issues with people who will understand what you are going through. When you share your story with other addicted individuals, it can help you identify with a new group of people who have found hope and a sense of direction after struggling with alcoholism.
  • Open meetings may be attended by anyone in the public. In some cases, family members, friends, addiction professionals, probation officers, or judges are interested in learning how AA groups function. In open meetings, only AA members are allowed to speak, which permits people from the outside to observe how AA functions. If you are celebrating a recovery anniversary, your group may make the meeting an open one so that your friends and family outside of AA can join you.

If you are looking for an AA meeting, you can visit the AA website to find a local group in your area.

Sources

  1. Soyka, M. (2017). Treatment of Benzodiazepine DependenceN Engl J Med376, 1147–1157.
  2. National Institute on Drug Abuse. (2015). DrugFacts: Nationwide Trends.
  3. Substance Abuse and Mental Health Services Administration. (1999). TIP 32: Chapter 4—Twelve-Step-Based Programs.
  4. Alcoholics Anonymous. (2017). Estimates of A.A. Groups and Members.
  5. Alcoholics Anonymous. (2016). The Twelve Steps of Alcoholics Anonymous.
  6. Alcoholics Anonymous. (2014). Alcoholics Anonymous 2014 Membership Survey.
  7. Kaskutas, L. A. (2009). Alcoholics Anonymous Effectiveness: Faith Meets ScienceJ Addict Dis28(2), 145–157.
  8. Moos, R. H., Moos, B. S. (2006). Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated IndividualsJ Clin Psychol, 62(6), 735–750.
  9. 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. J Stud Alcohol59(5), 513­–522.
  10. 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 Research30(8), 1381–1392.
  11. Kelly, J. F., Yeterian, J. D. (2011). The Role of Mutual-Help Groups in Extending the Framework of Treatment. Alcohol Res Health33(4), 350.
  12. Substance Abuse and Mental Health Services Administration. (2018). National Survey of Substance Abuse Treatment Services (N-SSATS): 2017. Data on Substance Abuse Treatment Facilities.

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