Addiction treatment has grown over the past few decades. In response to the cocaine crisis in the 1980s and the opioid epidemic we’re experiencing today, there is an expansive range of treatment options available. However, one of the oldest modern approaches to addiction is still widely used today. Twelve-step programs have their roots in the early 20th century when we were just beginning to understand that addiction was a disease that could be treated. The use of this approach to addiction treatment has only grown in popularity over the decades.
Learn more about 12-step programs, their effectiveness, and how they work.
What is a 12-Step Program?
A 12-step program is a process that’s designed to help people overcome addiction through a connection to a community of their peers. There are 12-step programs for a variety of addictions, including alcohol, drugs, and behavioral issues like eating disorders. These programs share a set of common 12-steps with slight variations depending on the specific group.
Alcoholics Anonymous was the first 12-step program, and it was originally developed in 1935. Since its founding, the same 12 steps were adapted for addiction to narcotics and other substances. There are even 12-step programs for the family members of addicted people.
The 12-step approach is defined by two aspects of the program. The Twelve Traditions are an outline of the group’s core values and internal operations. The traditions aim to maintain group unity and keep the focus on the mission of helping people overcome addiction. The traditions are also practical and define the group’s relationship with the world at large.
The Twelve Steps outline the process a person goes through when they enter a program like AA. The steps are designed to facilitate your own acceptance of your loss of control over addiction. They also help to heal broken relationships and ease guilt and shame you might feel.
The philosophy and process of 12-step programs were first introduced by Alcoholics Anonymous in their guiding book called Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, also called The Big Book. The book discusses the core philosophy and strategies of AA, chief among them is the concept of unity. The AA founders believed that unity was the key to addressing alcoholism. So much so that the book says, “No society of men and women ever had a more urgent need for continuous effectiveness and permanent unity.”
The book has gone through several adaptations to fit other addictions like narcotics.
What are the 12 Steps?
The 12 steps essentially walk participants through a process of self-reflecting, acceptance, interpersonal healing, continued abstinence, and helping others through the process. Some of these same principles are used today in formal addiction treatment. For instance, accepting a loss of control is an important step in increasing your readiness to change. The 12 steps also focus on spiritual healing and accept the idea of a higher power. The Big Book acknowledges that some of these concepts might be difficult for non-religious or non-spiritual people to accept.
Nevertheless, Bill Wilson writes, “We found that as soon as we were able to lay aside prejudice and express even a willingness to believe in a Power greater than ourselves, we commenced to get results, even though it was impossible for any of us to fully define or comprehend that Power, which is God.”
Another big part of the 12 steps is forgiveness and seeking to make amends. Seeking forgiveness can heal broken relationships and alleviate some of your own shame for past wrongs that occurred during active addiction. Below are the 12 steps as written in the Big Book:
- 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.
Are 12-Step Programs Effective?
The 12-step approach to addiction was created early in our understanding of substance use disorders, and it was one of the first methods that treated addiction as a disease. In the early 20th century, Alcoholics Anonymous founders Bill Wilson and Bob Smith developed the 12 steps. The steps weren’t developed through scientific study. Rather, the goal of the steps was to facilitate spiritual healing and fellowship with other people with similar goals.
So is this approach to addiction treatment effective?
AA and similar 12-step programs have become one of the most ubiquitous addiction resources all over the world. Countless people have gone through the 12-steps and consider the programs to be instrumental in their recovery. But how does it stand up to scientific study? In 2009, there was a review that compiled results from four different studies that looked into the effectiveness of AA. Two studies found that AA produced positive results, one study showed negative results, and one was inconclusive.
They also found that rates of abstinence were twice as high for people that attended AA and rates of attendance were related to higher rates of abstinence. However, the failed and inconclusive studies show that 12-step programs may not be universally effective for everyone.
Still, today, we’ve come to realize that healthy interpersonal connection is instrumental in combating addiction. AA and other 12-step programs are effective when it comes to connecting individuals to communities where they can build up their support system, seek accountability, and develop meaningful connections with other people.
The 12 Steps as Aftercare
Though 12-step programs may not be effective for everyone who needs addiction treatment, it can be useful as an aftercare program. Aftercare is a concept in addiction treatment that refers to programs that aid in continued recovery after formal addiction treatment. Continuing to pursue recovery after treatment increases the likelihood of achieving long-term sobriety. On the other hand, people that finish addiction treatment and return to their normal lives without taking steps to actively continue recovery may be more likely to relapse.
As an aftercare program, 12-step programs offer some noteworthy benefits. One of the most important benefits is that they’re everywhere. The key to long-lasting relapse prevention is to consistently pursue recovery in yourself and others. Alcoholics Anonymous and Narcotics Anonymous groups are all over the U.S., and they can even be found globally. Wherever your life takes you after treatment, you’ll likely be able to find a 12-step group.
Another benefit is cost. Twelve-step programs are free community resources, and groups like AA never charge you to attend meetings. Treatment can be expensive, but it’s well worth it for most people with substance use disorders because active addiction can be even more financially taxing. But when it comes to long-term aftercare programs that you plan to attend indefinitely, a low financial cost is helpful.
One of the most vital benefits of 12-step as an aftercare resource is that it strengthens your support network. As you go through treatment, you’ll receive help from professionals, speak to a therapist regularly, and participate in group sessions. After treatment, you might continue therapy, but you may also be finished with formal treatment.
Twelve-step programs, which can begin while you’re still in treatment, can introduce you to a community of people that can bolster your support system. Many people develop strong friendships with people in 12-step groups that continue over a lifetime. That also means having accountability, as sponsors and peers check up on you and look out for your well-being in recovery.