The 12-Step approach to addiction recovery has been around for over 70 years, though it didn’t come into being all at once. The steps were developed naturally over time in the first years of Alcoholics Anonymous (AA) until they were officially put into writing by AA co-founder Bill Wilson. According to Wilson, the steps required very little editing and have remained much the same since then, even across programs for other types of addiction, including Narcotics Anonymous (NA) and groups that deal with process addictions.
For the most part, the original version of the 12 Steps were only edited to make them less religious and more inclusive, but they still have deep roots in spirituality. Wilson was originally directed to the Oxford Group, a Christian organization, as a solution to his debilitating alcohol addiction. Working from ideals he picked up there, he founded AA and later created the 12-Step method. Today, AA alone has over 2 million members.
The Steps
The actual steps in any 12-Step program are quite similar no matter what type of addiction is being addressed. These steps include:
- Admitting that the addiction can’t be overcome on one’s own
- Acknowledging that some kind of higher power is needed to overcome the addiction
- Consciously deciding to turn oneself over to that higher power
- Making a “moral inventory” – identifying past regrets, guilt, anger, etc.
- Admitting to past poor behavior
- Admitting to being ready to have the higher power “remove” the faults listed in the moral inventory
- Asking said higher power to remove these faults
- Making a list of all the people wronged due to one’s addiction
- Making amends with these people, if possible
- Committing to monitoring oneself for bad behaviors related to addiction
- Committing oneself to a regular spiritual practice (meditation, prayer, reading spiritual texts, etc.)
- Committing to helping other individuals who are struggling with addiction
Most addiction support groups (and all that accept federal funding) accept nonreligious and atheist individuals, but there are also secular options as well as alternatives to the 12-Step method.
Variations and Alternatives
There are many support groups that follow the AA and NA model of treatment but that are specific to certain types of addiction or other psychological issues. There are groups for specific drugs, such as Heroin Anonymous and Cocaine Anonymous, groups for process addictions like Sexaholics Anonymous and Gamblers Anonymous, groups for family members of addicted persons, and groups for survivors of abuse and trauma. Other groups focus on everything from debt to general mental health issues.
Clearly, the exact same steps would not work for both AA and a group like Survivors of Incest Anonymous. For support groups dealing with trauma, the focus is on dealing with negative behaviors caused by that incident or series of incidents rather than anything caused by a current behavior. Making amends to those harmed involves making amends to oneself and one’s “inner child,” though they are largely the same.
Although the AA 12-Step method has been effective for many, there is no one treatment method that will work for everyone. Some people may try 12-Step meetings and find they aren’t right for them. In these instances, there are plenty of alternatives to consider.
One of the biggest complaints about the traditional 12-Step model is how much it focuses on spirituality and a “higher power,” even if that higher power can be anything the person chooses. For atheist or agnostic individuals, the idea of giving oneself up to any kind of higher power can make them feel uncomfortable, and they may feel like outsiders in meetings that focus on this idea. According to the Pew Research Center, 7 percent of people in the US identified as atheist or agnostic in 2014.
One popular alternative for nonspiritual or nonreligious individuals is the Secular Organizations for Sobriety (SOS). This group was founded in 1985 by James Christopher, a man who felt that a focus on self-reliance and personal responsibility was more effective for him than turning his life over to a higher power. SOS has no central structured program, preferring to rely on a set of guidelines and principles while allowing individuals to find their own paths to recovery. They do accept religious persons suffering from addiction, but their methods are not based in any kind of spirituality.
Other alternatives include:
- Women for Sobriety (WFS): This is a program that was created by women for women that focuses on empowerment rather than humility, working on the idea that addiction is caused by different factors in women than men.
- SMART Recovery: This program uses a scientific basis for its methods and attempts to evolve as the science around addiction evolves. It relies heavily on cognitive-behavioral treatments and a four-point guide rather than a series of steps.
- LifeRing Secular Recovery (LSR): This group was founded by those who had a difference of opinion on how SOS should be structured. LSR focuses much more on complete abstinence than its counterpart.
Some addicted individuals may decide to forgo a specific support group altogether and simply attend individual and/or group therapy. This can be helpful for those who have other issues in addition to addiction and feel they would be better served by crafting a more individualized treatment program. Individual therapy is also a good choice for those who feel uncomfortable in groups or have trouble expressing themselves. That being said, most comprehensive treatment programs incorporate both individual therapy and peer support programs.
Other Aspects of Addiction Treatment
Comprehensive addiction treatment takes clients through the entire recovery process. When in comes to substance addiction treatment in particular, there’s an initial detox process that may require medical intervention. It’s then generally recommended that the individual go through an inpatient or outpatient rehabilitation program that lasts for several weeks or months. Treatment centers may use a 12-Step model during this process as well as complementary therapies. Many inpatient programs require that clients regularly attend 12-Step meetings either at the treatment center or out in the community. If clients attend meetings offsite, transportation is generally provided.
Rehabilitation programs also often include screening for underlying mental illness (other than the addiction disorder) as mental health issues and addiction are often co-occuring and tend to feed on one another. Individual and group therapy can facilitate the process of understanding and listing one’s flaws and destructive behaviors, as well as identifying those who may have been hurt by the individual’s addiction. Once this is done, healthier behaviors can be identified to replace those that are fueling the addiction and any life instability and stress.
Treatment centers who use 12-Step programs and principles tend to focus on the idea of abstinence from all intoxicants due to the fact that studies tend to support the effectiveness of this method. A study published in 2015 found that those who remained completely abstinent after treatment were much more likely to have improved mental health than those who used substances to some extent. After three months, 51.8 percent of the abstinent group were found to be “flourishing” compared to 28.8 percent of the non-abstinent group. After 12 months, the non-abstinent group’s amount of flourishing individuals fell to 25 percent while the abstinent group grew to 65.9 percent.
When facing addiction, it’s important to research any potential treatment center to ensure that its methods are research-based and fit well with one’s values and preferences. Twelve-Step programs have been helpful for a lot of people, but the most important thing is to ensure that treatment is tailored to the individual so that each person’s unique issues, behavioral patterns, and life stressors are addressed. A combination of 12-Step or similar support programs, appropriate therapy, and life adjustments tends to be the most effective path to recovery.