What is a 12-Step Programme?
Any programme based on the 12 Steps is designed to help people recover from compulsive, out-of-control behaviours and to restore balance and order in their lives.
The 12 Steps are a set of guiding principles, often used in addiction treatment. They provide a structured framework for tackling problems such as alcoholism, drug addiction and process addictions – through which a variety of therapeutic interventions can be woven, depending on individual needs.
The 12 Steps were originally created in the 1930s by the founders of Alcoholics Anonymous (AA) – Bill Wilson and Dr. Bob Smith – to establish a set of guidelines for recovery from alcohol addiction. They are at the heart of the AA community-based programme, designed to help those with problematic drinking get sober with the support of their peers, through daily meetings and discussions.
Two unique features of 12-Step programmes are:
- A group setting
The 12 Steps of recovery are discussed and applied in 12-Step meetings/recovery groups, where members support each other. The group setting is intended to provide recovering addicts with structure, direction and solidarity as they adjust to a new way of life. The presence of a mutually supportive community of peers is the primary agent of change, known to help in achieving sustained, long-term recovery.
A sponsor is a more experienced recovering addict, who acts as a mentor or guide for newer members of the group. They provide guidance and support in times of crisis. Studies reveal that sponsorship leads to improved group attendance and better treatment outcomes.
Over the years, the original 12-Step programme has been adopted as a model for a wide range of addiction peer-support and self-help recovery programmes designed to help drive behavioural change. These programmes have found different ways of incorporating the 12 Steps into their practices – adapting them to meet the specific needs of their group members – and include:
- Gamblers Anonymous
- Narcotics Anonymous (for people addicted to substances other than, or in addition to, alcohol)
- Sexaholics Anonymous
- Food Addicts in Recovery Anonymous
- Dual Recovery Anonymous (for people diagnosed with addiction and another, additional mental health disorder)
- Al-Anon/Alateen (for families and friends of alcoholics).
There are over 54 different types of 12-Step programme available, covering almost every form of addiction and behavioural disorder.
Many public and private treatment centres (including those for adolescents) also subscribe to the 12-Step model, as part of their treatment programmes, for conditions such as:
- substance use disorders
- process addictions (such as gambling, online gaming and food addictions)
- dual diagnosis (such as alcohol addiction and depression, opioid addiction and PTSD, cocaine addiction and bipolar disorder).
These treatment programmes typically concentrate on the first five steps during primary treatment at the centre, including 12-Step group therapy sessions. The remaining steps are addressed as part of an aftercare plan, where individuals continue with meetings and find a sponsor to guide and support them on their recovery journey.
12-Step programmes remain a commonly used treatment modality for various types of addiction. According to the Substance Abuse and Mental Health Services Administration (SAMSHA), 12-Step models are used, at least occasionally, by approximately 74% of treatment centres.
What are the 12-Steps?
In 1939, Alcoholics Anonymous published its original 12-Step method of recovery in the book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism (known as the Big Book of AA).
The Steps take into account that addiction is an illness, which affects mental and physical health in such a way that individuals are unable to control their behaviour or substance use.
They encourage the practice of honesty, surrender, acceptance, open-mindedness, courage, compassion, forgiveness and self-discipline – as pathways to positive behavioural change, emotional wellbeing and spiritual growth.
The 12 Steps, as defined by Alcoholics Anonymous, are:
- 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 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.
One major adaptation to this original framework has been changes to the explicitly Christian overtones, to reflect more secular (and agnostic) philosophies – allowing for different interpretations and religious beliefs. AA has also adapted a more ‘spiritual focus’ to allow its members to define a ‘higher power’ in their own way.
What are the 12 Traditions?
The 12 Traditions are associated with the 12 Steps, and were officially published in 1946.
Rather than personal guidelines for individual addicts, they are positive cultural attitudes and spiritual principles to keep the support groups focused on their primary purpose. They also support and encourage healthy relationships between the group members.
According to AA, ‘By 1946, it had become possible to draw sound conclusions about the kinds of attitude, practice and function that would best suit AA's purpose. Those principles, which had emerged from strenuous group experience, were codified by Bill in what today are the Twelve Traditions of Alcoholics Anonymous. A successful formula for AA unity and functioning had been achieved and put into practice.’
The 12 Traditions are (short-form):
- Our common welfare should come first; personal recovery depends upon AA unity.
- 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.
- The only requirement for AA membership is a desire to stop drinking.
- Each AA group should be autonomous except in matters affecting other groups or AA as a whole.
- Each group has but one primary purpose – to carry its message to the alcoholic who still suffers.
- 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.
- Every AA group ought to be fully self-supporting, declining outside contributions.
- Alcoholics Anonymous should remain forever nonprofessional, but our service centers may employ special workers.
- AA, as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
- Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.
- 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.
- Anonymity is the spiritual foundation of all our Traditions, ever reminding us to place principles before personalities.
How effective is a 12-Step Programme?
It is difficult to know just how effective the 12-Step model is, due to the emphasis on preserving anonymity, and therefore the lack of formal research available. However, the prominence of this model of treatment – as well as success stories from countless recovering addicts – suggests it is effective in treating addiction conditions.
One long-term study, conducted at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that people who received formal treatment and also attended an AA group, had a better chance of staying sober than those who only received formal treatments. The study concluded that stronger connections between community-based meetings and professional treatment resources would equate to a more efficient systemic approach to managing addiction disorders.
In general, the effectiveness of the 12-Step model is believed to be maximised the more an individual is able to personalise the concepts expressed by the Steps into their own life.
Some advantages of 12-Step programmes:
- Although few studies have been conducted, due to the high level of anonymity in these programmes, the 12 Steps are widely known, established and very well organised. (They are one of the oldest programmes around.)
- While it provides a structure, there is no wrong way to approach the 12 Steps. It is a personal journey, with flexibility allowing people to revisit steps, take a break between steps, spend longer on one step than another, and even tackle more than one step at a time.
- Those struggling with addiction have access to an immediate and broad social network of peers within their existing community, which studies have shown greatly enhances recovery and commitment.
- Each person has a sponsor to guide and support them. Whilst not a therapist, a sponsor can offer a level of support unique to the programme, as they have survived addiction and completed the programme. Studies reveal that sponsorship support leads to improved group attendance and better treatment outcomes.
- Finding a local meeting where the 12 Steps are practiced is relatively easy.
- There is little to no cost to members, making it an affordable option.
Some disadvantages of 12-Step programmes:
- Some people are not comfortable participating in group meetings, particularly those with a co-occurring mental health condition whose symptoms may be exacerbated in a social setting.
- Some people are put off by the religious foundation of the 12-Step philosophy and the reliance on an ‘outside power’ to guide their process.
- The 12-Step model emphasises the powerlessness of the individual in battling their addiction alone. Studies have shown this approach to be less effective for women, who respond better to empowerment models.
- Due to the anonymous nature of the group, there is a lack of evidence-based research or official shared success rates.
- The 12 Steps have been criticised for not fully addressing the needs of those struggling with a co-occurring mental health disorder / dual diagnosis or the adverse health effects of recovery (e.g. withdrawal or detox symptoms).
- When the 12 Steps were originally created, several scientific discoveries had yet to be made, for example the genetic link to addiction.
As the very least, a 12-Step programme will provide support, encouragement and accountability for people who genuinely want to overcome their addiction. The sponsorship model, as well as regular meeting times, encourages the kind of social support known to help people stay in recovery and achieve lasting results.
Taking the first step towards recovery is a big step, but you don’t have to take it alone. Please contact us to find out about our 12-Step treatment programme, and how we can help to connect you with the right 12-Step support group in your area.