Addiction has been around for almost as long as there have been people. Alcohol and opioids have affected modern society for hundreds of years but we have only recently begun to understand it. That understanding was partly pioneered in the middle of the 20th century by Alcoholics Anonymous (AA). The idea that addiction wasn’t just a bad habit or a moral failing, but a disease that is complicated, but treatable.
What is the 12-Step Program?
The ideas behind AA led to the creation of the original 12-steps, a set of stages designed to help people in addiction achieve sobriety and spiritual healing. These guiding principles outline a specific process that is focused on admitting that you have a problem, recognizing a higher power that can help, examining past failings, making amends for these errors, and helping others through the process. The 12-step process has spread from alcoholism to dozens of other disorders and support programs and it’s become a popular tool in addiction treatment all over the globe. Even addiction treatment centers may incorporate 12-step methodologies into treatment or refer clients to a 12-step program after they complete treatment.
One of the most important aspects of the 12-step model is connecting with a community of other people that share your goals and can help you along the way. This aspect has made it a popular tool for continued recovery after addiction treatment is completed. Instead of going back to normal life on your own, it may be helpful to engage with a 12-step group and continue your commitment to recovery.
However, with new addiction treatment methodologies emerging in response to the opioid crisis, is the 12-step model still relevant? Is an addiction solution that was developed in the 1930s still an effective option by today’s standards? Learn more about 12-step programs and whether or not they are truly effective compared to other addiction therapies.
The History of 12-Step Programs
The first 12-step program was published in 1935 when the founders of AA, Bill Wilson and Dr. Robert Smith, released the group’s guiding document, Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, better known as “The Big Book”. The book was the first official publication of the original 12-steps; however, the ideas behind AA began to be developed earlier in Wilson’s life.
Wilson was a Wall Street businessman with a promising career ahead of him that was cut short by alcoholism. His apparent alcohol use disorder sent him to the hospital for treatment several times. His desire to address the problem would initiate his involvement in a local fellowship called the Oxford Group. The group was a Christian organization that was founded as a way to help men overcome bad habits, moral shortcomings, and particular sins. The core tenets of the Oxford Group were honesty, purity, unselfishness, and love, virtues that would later be emphasized in AA.
Wilson found a newly kindled commitment to sobriety and The Oxford Group after a spiritual awakening he had in the hospital. Wilson was under the care of Dr. William Silkworth, a man who was among researchers who pioneered the idea that addiction is a disease and would later write a chapter of “The Big Book”. Wilson underwent a treatment that involved Belladonna, a poisonous plant that can cause delirium and hallucinations.
After the experience, Wilson told Silkworth about his spiritual conversion moment and the doctor advised him not to discount it. This surprising advice coming from a doctor would later be echoed by the psychologist Carl Jung when he treated a patient named Rowland Hazard who would later be instrumental in forming AA. Jung told Hazard that his only hope of recovery after several relapses was to “become the subject of a spiritual or religious experience” or a “genuine conversion,” as reported by Wilson in “The Big Book”.
As the number of members seeking help with alcoholism in The Oxford Group grew, Wilson met Dr. Robert Smith, who also struggled with alcoholism. He helped Smith reach sobriety and the two resolved to continue to help others do the same. Eventually, Wilson was criticized by other Oxford Group members for focusing too heavily on alcoholism, which led to the formation of AA.
Today, the 12-step program has spread beyond alcoholism. It was first adapted for narcotics in 1953 and then to dozens of other disorder and issues.
What Are the Steps of the 12-Step Program?
The 12 steps were first conceived by Wilson and Smith and published in “The Big Book”. They have been adapted for dozens of other addiction programs, 12-step groups, and other support group organizations. However, the wording generally remains the same and is only revised when the steps specifically mention alcohol. For instance, in Narcotics Anonymous, the first step states, “We admitted that we were powerless over our addiction”.
Here are the original 12 steps as they were written for Alcoholics Anonymous:
- 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.
- We’re 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.
Each of the 12 steps is a specific action towards the goal of spiritual healing, from increasing your awareness of your substance abuse problem to helping others achieve their goals. The steps can be broken into sections that are designed to accomplish a few major goals. The first four steps help to increase a person’s readiness to change. Not everyone attends treatment or a 12-step meeting with the same level of enthusiasm for addressing their addictions. Some are just curious, others go to placate family members, and some are even there on a court order.
Steps five through eight deal with the preparation stage of change. At this point in the process, you will have accepted that you need help overcoming your addiction and that you have decided to take specific steps towards recovery and making amends. In it this section of the steps, you will start to take visible actions. First, you admit to God that your addiction has caused moral missteps and that you acknowledge character flaws that lead to the wrongdoings of your past. Then you are required to confess these wrongdoings to another person. This section ends with you making a list of the people that you’ve wronged in the past with the intent to make amends with each of them.
Step nine is often considered one of the most daunting and challenging tasks to complete in the 12-step model. It involves making efforts to make amends with the people you’ve wronged. It’s more than just an apology. It involves seeking the opportunity to actually fix your mistake. This process can take years and, in cases where you cannot make amends (the person is diseased, refuses to see you, cannot be found), you might commit to a daily personal task to take the place of making real amends.
The last few steps are about maintenance and helping others through the process. These steps are largely ongoing and may never be truly completed. However, if you earnestly work through them, some may consider that you’ve completed the 12-steps, even if you continue to pursue your recovery and help others do the same.
Types of 12-Step Programs
There are several types of 12-step programs available all over the world. Since Alcoholics Anonymous pioneered the program, the 12-steps have been applied to many different addiction-related issues with very little variation. After people that were addicted to other substances started to show more and more interest in the program, Narcotics Anonymous was formed. There are also 12-step programs for eating disorders, gambling, and sexual addiction.
Other groups were formed that were tailored to the families of people with substance use disorders, including Al-Anon and Nar-Anon. Addiction is often rooted in family dysfunction and may be referred to as the family disease, which makes these particular programs useful.
There are also variations on the 12-step programs for people with substance use disorders. Celebrate Recovery® is a popular 12-step program that has a specifically Christian focus. While AA and NA both have spiritual components and acknowledge a higher power, Celebrate Recovery® acknowledges Jesus as that high power.
SMART Recovery® is another self-help group for addressing addiction issues, but it offers the biggest deviation from the 12-step model. It’s often considered a support group alternative to 12-step programs.
Are 12-Step Programs Effective?
The 12-step program wasn’t developed by clinicians, therapists, or scientific researchers. It was developed by regular people who were seeking help for their own struggle with substance abuse issues. So does the 12 step program really work? But can 12-step actually be an effective tool in the addiction treatment toolbox? With 12-step programs elevating to such a level of popularity that there are meetings all over the United States and the World, there have been several studies that explore the effectiveness of groups like AA and NA.
A 2009 review of the research into the effectiveness of 12-step programs (specifically AA) pointed out that the results have been mixed. Two studies were positive; AA seemed to be a largely successful option for those seeking help for alcoholism. Another study was inconclusive and a fourth was negative. Of course, a rule of thumb for addiction treatment is that there is no one option that will work for everyone across the board. But with so many treatment centers utilizing the 12-step method or referring people to programs like AA and NA, it’s important to know if that’s a positive next step after treatment.
Other studies focused on the effectiveness of 12-step programs specifically as an aftercare tool. A study in 1999 determined that it is generally a good practice to refer people to 12 step programs with weekly meetings after treatment. Another study in 2009 by the Society for the Study of Addiction found that referrals to 12-step programs actually improved substance use outcomes even among people who had been exposed to 12-step groups and addiction treatment before.
Are 12-Step Programs Evidence-Based?
According to the research, 12-step programs do seem to have some efficacy in treating people with substance use problems, at least as supplemental to other treatment options. But how can an approach to dealing with drug misuse and alcoholism that was developed so many years ago be effective today, especially considering it wasn’t developed through medical or psychological research?
Effective addiction treatment is grounded in evidence-based therapies. Evidence-based therapies are approaches to treatment that have been tested and proved effective in scientific settings. Other therapies that are used in treating addiction that has not been tested or proven to be effective are often called alternative therapies. They include things like yoga and acupuncture, which may be engaging and helpful to some people, but they haven’t shown to be effective enough to apply as a foundational treatment method for many people. It’s also important to note that evidence-based treatment isn’t guaranteed to work for everyone. However, they are more likely to have some value in treating addiction than unproven therapies. 
But is 12-step evidence-based? As previously mentioned, there is some evidence to suggest that 12-step programs can help people that are in recovery. Despite the fact that the 12-step model was developed outside of scientific research and hasn’t changed much over the years, there are several evidence-based approaches that share similarities with the 12-step model.
In fact, 12-step facilitation is an evidence-based practice that encourages people in recovery to go through a 12-step program as a part of their treatment process. There are other evidence-based approaches that have been inspired by 12-step programs, including contingency management, which offers motivational incentives for completing milestones. For instance, in AA, you may receive chips for time spent in sobriety, which is a form of contingency management.
While 12-step programs employ some elements that are similar to evidence-based approaches, they are best used as a supplemental approach to treatment. They may be best as a free or low-cost way to continue to pursue recovery after formal addiction treatment.
Seeking Addiction Treatment
Addiction is a complicated disease that needs a complex solution. Addiction treatment needs to be able to answer multiple needs at once including psychological, medical, social, and cognitive needs. The 12-step model is primarily focused on helping you with spiritual needs of redemption and forgiveness as well as social needs. While 12-step proves to be a helpful tool, it may not meet all the needs of people seeking addiction treatment.
To learn more about addiction treatment and how drug and alcohol addiction can be overcome, call The Palm Beach Institute’s addiction specialists at (855) 960-5456 or contact us online. Addiction is a chronic disease but you don’t have to go through it alone, learn more about your addiction treatment options today.
