Twelve-step rehabilitation methods and 12-step recovery groups are one of the most accessed and utilized forms of substance use treatment within the United States. Overall, the premise of 12-step support is that people can help one another, which includes helping to maintain abstinence from drugs and alcohol. Much of the healing comes from surrendering to a higher power, but peer support and remaining connected to other sober people is essential.
However, those who struggle with the 12-step approach struggle with the strong religious element. Modern-day substance use treatment centers offer an alternative to the 12-step methodology yet encourage group counseling and peer support.
What is Twelve-Step Substance Use Treatment in the Modern Day
The 12-step method helps recovering addicts become sober and maintain sobriety by carefully applying the 12-step philosophy. Also, it is the process of sharing experiences with others who have suffered similar issues with drugs and alcohol. Most participants, whether attending a treatment program or a 12-step meeting, find another member that serves as a sponsor that provides guidance and help. The sharing and group support approach, whether done at an inpatient or outpatient facility, or as part of aftercare recovery, has benefited countless addicts and helped them achieve long-lasting sobriety. The main barrier with 12-step approaches is garnering participation, yet this could be said with any approach to substance use rehabilitation.
However, when compared to cognitive-behavioral therapies or non-traditional approaches, 12-step approaches and counseling are not as successful. According to an article, Attitudes and Beliefs About 12-Step Groups Among Addiction Treatment Clients and Clinicians: Toward Identifying Obstacles to Participation, "The effectiveness of 12-step groups may be somewhat limited by a high attrition rate. Moreover, a large minority of substance users never attend 12-step meetings (introduction)." However, when someone is introduced to the 12-step process during treatment, there does tend to be a higher rate of attendance with meetings during aftercare. Yet, maintaining regular attendance and applying the methodology depends on the willingness of the individual, which would contribute to success.
The History of the 12-Step Method
The twelve steps were written in 1938 by the founders of Alcoholics Anonymous, and everything was put down in what is now referred to as the Big Book. However, according to the Alcoholics Anonymous website, the origins of Alcoholics Anonymous can be traced back to the Oxford Group, which a religious group population in the United States and Europe in the 20th century. The initial steps for self-improvement involved a formula of performing self-inventory, admitting wrongs, making amends, using prayer and meditation, and carrying the message to others.
The roots of Alcoholics Anonymous began with Rowland H. from Rhode Island and Edwin T., who was also friends with Bill W.—it was a group of struggling alcoholics utilizing the teachings from the Oxford Group and they were able to keep from drinking because of these. Since 1935, Alcoholics Anonymous spread across the globe and has branched into other forms of peer support helping millions of people achieve a sense of peace and an ability to maintain a healthy and productive life.
Bill W. wrote the Big Book and the steps came about from the six-step program within the Oxford Group and what he had developed through his experience applying these steps. The Big Book was intended to help people who could not attend the meetings, but it became the model for countless programs across the nation. The steps and treatment process has since been adopted for a wide range of addiction peer-support and self-help programs, which create the necessary behavioral change to overcome addiction. Offshoots of Alcoholics Anonymous include Narcotics Anonymous, Cocaine Anonymous, Gamblers Anonymous, or even Heroin Anonymous.
The 12-Steps and the Recovery Process Utilizing the Twelve Step Methodology
The 12-Steps, as outlined in the Big Book presented by Alcoholics Anonymous, are as follows:
- We admitted we were powerless over alcohol (our addiction), that our lives had become unmanageable.
- We came to believe that a Power greater than ourselves to the care of God as we understood Him.
- We made a decision to turn our will and our lives over the care of God as we understood Him.
- We made a searching and fearless moral inventory of ourselves.
- We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- We were entirely ready to have God remove all these defects of character.
- We humbly asked Him to remove our shortcomings.
- We made a list of all persons we had harmed and became willing to make amends to them all.
- We made direct amends to such people wherever possible, except when to do so would injure them or others.
- We continued to take personal inventory and, when we were wrong, promptly admitted it.
- We sought through prayer and meditation to improve our conscious and 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 (addicts) and to practice these principles in all our affairs.
The Substance Abuse and Mental Health Services Administration states that the treatment effectiveness of the 12-steps is believed to be maximized the more an individual can personalize the concepts expressed by the steps into their lives.
The 12-step methodology has been utilized within many forms of rehabilitation, but many people still ask when 12-step treatment is the best option. For example, long-term and short-term residential drug rehabilitation programs incorporate 12-step treatment methods as part of rehabilitation. The process is also seen within outpatient treatment centers, and most treatment providers encourage peer support as a method of aftercare, which includes 12-step meetings. According to the National Institute on Drug Abuse, Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)-- "twelve-step facilitation therapy is an active engagement strategy designed to increase the likelihood of a substance abuser becoming affiliated with and actively involved in 12-step self-help groups, thereby promoting abstinence."
Usually, 12-step treatment programs or support groups are one of the first methods of rehabilitation for an addict, and there is a degree of effectiveness, especially for someone maintaining a level of spirituality. Per the American Society of Addiction Medicine, 12-step facilitation is a tried and true effective approach. The therapist or the person running the group actively probes and nudges, encouraging attendance and participation. As stated by the ASAM, "it explains the potential benefits of working with a sponsor and promotes the individual developing a relationship with a sponsor." The process helps curb any resistance to attending meetings or working the steps, while also developing a relationship with another sober individual.
Overall, 12-step methods are an ideal option for someone in recovery and maintaining aftercare, or someone beginning their treatment process. There are benefits with 12-step methods, but not every form of rehabilitation works for every addict. There are countless methodologies of counseling and therapy, along with relapse prevention and aftercare. It is crucial to explore multiple options or receive an assessment to help. Also, the recovery process is unique to the individual going through it—their experiences are not the same as the next but are similar in different ways. If someone were to get anything from 12-step support, it is connecting with other individuals with similar experiences and using those experiences to support one another through recovery.
Attending your First 12-Step Program or Going to your First Twelve-Step Meeting
Attending your first drug rehabilitation program or meeting is a major step; whether this is done voluntarily or through intervention, it is crucial to make an effort and seek help. Rehabilitation centers providing 12-step methodologies usually involve a detox process first, followed by inpatient or outpatient group counseling utilizing 12-step methodology. Most aftercare support involves 12-step meetings and remaining connected to other sober people. Attending meetings is helpful for most recovering addicts because it provides stability and support.
The meetings might be held in a building connected with a church, community center, or treatment program. When you arrive, most of the people there are for that particular meeting, and the meetings begin with the chairperson reading the Alcoholics Anonymous Preamble, then leading in a group prayer, which is the Serenity Prayer. Some members of the group will read brief AA literature about how it works and what the twelve traditions and the promises are.
The person chairing the meeting will ask if there are any newcomers or people attending for the first time. If the meeting is a step meeting, the chairperson will announce which step they would be discussing. Also, they would ask if anyone had any experience, strength, or hope relating to the step. During the meeting, people begin talking and sharing their experiences—this process continues until the meeting concludes. Different meetings have different ways of doing things, but overall, they all run in similar ways, although no two meetings are alike.
Some meetings are purely discussion meetings where the topic is random, or the chairperson would feature a person to talk about their experience, strength, and hope in regard to their recovery. Some of the meetings call on random people to share and talk, but no one is obligated to. It is important to know that no one is pestered to speak—it does not matter if you sit at the back of the room drinking coffee or leave immediately after the meeting. You may run into someone you recognize or who recognizes you—it is important that you are there and take something out of it.
What are the Alternatives to Twelve-Step Treatment?
There are numerous alternatives to 12-step therapy and peer support. Cognitive Behavioral Therapy or CBT was a method developed to prevent relapse. The therapy strategies are based on the theory that the substance use behaviors can be changed, and individuals can learn to identify and correct problematic behavior. Patients apply a range of different skills that can be used to stop drug and alcohol abuse. The primary purpose of this method of therapy is to help patients anticipate problems and enhance their self-control. The techniques help patients explore the positive and negative consequences of drug use while learning how to self-monitor, recognize cravings, and identify situations. Patients begin to develop strategies for coping with cravings and avoid those situations.
Motivational Enhancement Therapy uses a counseling approach that helps individuals through their hesitation of attending treatment and stopping the use of drugs. The process brings about rapid and internally motivated change. The therapy consists of an initial assessment, followed by two to four individual treatment sessions with a therapist. The interviewing principles are used to strengthen motivation while developing a plan for change. The therapy is beneficial for someone resistant to other forms of therapy and counseling. These two therapies are also used in combination with Family Behavioral Therapy, which addresses substance abuse and other co-occurring problems.
Additionally, there is experiential therapy, which is a hands-on approach that uses engaging activities to help clients process and cope with past trauma. Some of the therapies include sculpting, rock climbing, music therapy, recreation therapy, adventure therapy, and even wilderness therapy. The programs are designed to help develop a stronger sense of self by coming to terms with past trauma and emotions. Recovering addicts learn to face these issues without having to turn to drugs or alcohol. Therapists guide patients through different treatment exercises, which is tailored to their treatment needs. These programs are especially successful for adolescents or young adults.
Common Terminology Associated with 12-Step Rehabilitation
Peer Support—this is a supportive relationship between people who have a lived experience in common.
AA Group Meetings—a set of meetings that happen regularly.
The Big Book—this is the book of Alcoholics Anonymous, which describes the 12-steps, the program, and how one can recoverin from addiction.
The 12-Steps—this the spiritual program that is guided by the Big Book of Alcoholics Anonymous; the steps are to help individuals recover from their addiction and restore a manageable life.
Alcoholics Anonymous—is a fellowship of men and women who are sharing their experience, strength, and hop with each other to solve their common problem and help each other recover from alcoholism.
Fellowship—a term used for the society or fraternity of Alcoholics Anonymous
12 Traditions—these are the general guidelines for healthy relationships between the group, member, and other groups.
12 Concepts—these are the principles to help ensure that various elements of the service structure for each meeting remains responsive and responsible to those they help.
Sponsor—these are members who serve as a mentor to anyone new in the program or meeting. Typically, a sponsor helps a new member work the 12-steps and stay on the recovery track.
Chips—members of 12-step groups receive coins to mark milestones such as 30 days, 60, or 90 days and one year, etc.
Preamble—this is the short description of Alcoholics Anonymous that is often read out loud at the start of a meeting.
Chair—this is the service position filled by a member the keeps the meeting running.