The 12-step model to overcoming addiction was originated by Alcoholics Anonymous (AA), which was founded in the United States in 1935. AA was the first organization dedicated to helping people overcome addictions — first to alcohol, then later to other substances or behaviors, including cocaine (Cocaine Anonymous), narcotics (Narcotics Anonymous), and gambling (Gamblers Anonymous).
Although there has been some controversy surrounding AA’s approach to recovery, the program has supported millions of people worldwide as they stop abusing drugs or alcohol and begin a journey to end their addictions.
AA has faced criticism for its rejection of evidence-based treatment practices, which currently include medication-assisted treatment (MAT), easy access to naloxone to temporarily stop overdoses, and cognitive behavioral therapy.
While AA can still be a great form of group support, it is not recommended as a primary form of addiction treatment. It does not take the place of traditional treatment that involves withdrawal management and therapy.
The 12-step program is based on the Christian faith. It puts a lot of emphasis on a higher power, although much of the modern literature maintains that this power is defined by the participant and is not inherently the Christian God.
The goal with 12-step programs is complete abstinence from the vice, whether it is a substance or a behavior. Each step provides one action that should be taken to overcome addiction.
People in 12-step groups are required to attend at least once per week initially. Some people attend meetings every day when they are first starting or when they are going through periods of high stress.
Research into any kind of support group, including AA, finds that those who go regularly and participate in meetings are the most likely to remain abstinent from alcohol or drugs for the longest period. People who follow each of the 12-steps and stay in the program, returning as needed, can stay abstinent for the long term.
Millions of people attend 12-step meetings for various kinds of addictions, in part because the meetings are free to anyone. They are run by people who have completed many or all of the 12-steps, but they are not professionals, like counselors or therapists.
Anyone can attend 12-step meetings for as long as they like. There is some orientation toward the goal of completing the steps, with the help of a sponsor in many cases. This does not mean participants will not need further support later in life. They will often need to return to the steps due to a relapse.
While it is a requirement to keep participants names anonymous so they can be protected from scrutiny or shame, individual members are allowed to out themselves after they have participated for a while.
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Alcoholics Anonymous is considered the first program in the world to provide a set of steps for a person to take to overcome their drinking or drug use, save their relationships with others, and preserve their health.
Prior to AA, people who abused alcohol or other substances were believed to have weak wills or a moral failing of some kind. They were not helped.
Partially thanks to AA, the medical community, and especially social and psychiatric medicine, people have worked to improve their understanding of addiction. Since AA’s founding, the science of treating addiction has developed so much that the place of 12 steps in treatment is being questioned.
One of the most prominent studies conducted on AA’s effectiveness was a 2006 Cochrane Review, which analyzed information from past studies and concluded that AA was no more effective than other types of addiction treatment, including professional counseling. People participating in other forms of treatment and those participating in AA were equally likely to cut back on how much they drank.
With over 1 million Americans attending AA meetings at one of the 60,000 groups in the U.S. alone in 2013, the sheer popularity of 12-step meetings makes them seem very effective. However, further studies suggest that AA is not effective at preventing relapse or even keeping participants in long-term treatment. Most people drop out after a year of meetings or less.
Peer-reviewed studies, per a book published in 2014, found that the success of the AA program was between five and 10 percent. About one in every 15 people who enter AA remains abstinent long-term. This is in stark contrast to AA’s self-reported figures. For example, in 2007, the organization reported that 33 percent of members had been sober for more than a decade, and 31 percent were sober for a year or less.
The peer-reviewed studies found that AA did not count the people who attended fewer than a year’s worth of meetings and then dropped out of the program. They only looked at those who continued to go to meetings even after lapses or relapses. Some research reports that 95 percent of AA attendees quit within the year.
Another study comparing various groups who had been diagnosed with alcohol dependence found that AA’s actual success at getting participants to maintain sobriety was comparable to spontaneous remission rates.
Sometimes, people who are addicted to alcohol will quit drinking on their own, without medical or social intervention, and stay sober for a long time.
Yet another survey found that AA experienced higher participant dropout rates than other forms of counseling. The Brandsma study found that 50 percent of the untreated control group diagnosed with alcohol dependence had spontaneously quit drinking at the end of the survey period; 88 percent of treated participants reported overall reductions in drinking. This could vary by therapy type:
People in the AA group also reported higher rates of binge drinking before their six-month follow-up point than anyone else, including the untreated control group.
A more recent study, published in 2018, compared the differences between several programs that are based on the 12 steps or presented as alternatives to the 12-step model.
There was little difference in recovery among all these groups, and much of the self-selection into the program was based on personal philosophy, more than physical or mental needs. There was a little difference between them. For example, those participating in SMART Recovery fared slightly worse across all outcomes, while those in LifeRing had lower odds of total abstinence. However, these effects were not considered significant.
Those who want social support but do not have intensive medical needs, like MAT or co-occurring disorders, can also benefit from the mutual support group structure of 12-step programs.
AA, or a related group like Narcotics Anonymous, can be a great addition to other forms of treatment, including therapy and medically assisted detox.
There are some potential downsides to the AA or NA program. For example, many people have trouble with the reminder that they have no control over their condition. In contrast, current evidence-based treatment focuses on the individual’s ability to manage symptoms with help from medical professionals.
In addition, the 12-step model is a one-size-fits-all approach to treatment, which the National Institute on Drug Abuse (NIDA) states clearly does not work. Treatment must have many facets so everyone with unique mental and physical health needs can overcome their addiction to drugs or alcohol.
Ultimately, the 12-step program can be an effective component of your recovery plan, but it shouldn’t be the only method used.
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(February 7, 2018) Medication-Assisted Treatment (MAT). Substance Abuse and Mental Health Services Administration (SAMHSA). Retrieved from https://www.samhsa.gov/medication-assisted-treatment
(August 2016) The Twelve Steps of Alcoholics Anonymous. AA.org. Retrieved from https://www.aa.org/assets/en_US/smf-121_en.pdf
(2012) Alcoholics Anonymous 2014 Membership Survey. AA.org. Retrieved from https://www.aa.org/assets/en_US/p-48_membershipsurvey.pdf
(March 25, 2014)= The Surprising Failures of 12 Steps. The Atlantic. Retrieved from https://www.theatlantic.com/health/archive/2014/03/the-surprising-failures-of-12-steps/284616/
(2009) How Effective is AA and 12 Step Treatment? HAMS.cc. Retrieved from http://hams.cc/effective.pdf
(May 2018) A Longitudinal Study of the Comparative Efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-Step Groups for Those with AUD. Journal of Substance Abuse Treatment. Retrieved from https://www.journalofsubstanceabusetreatment.com/article/S0740-5472(17)30490-7/abstract
(January 2018) How Effective is Drug Addiction Treatment? National Institute on Drug Abuse (NIDA). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment