12-Step Programs

One of the most popular  recovery programs from a variety of addictions is the 12-step program. This is a program type that revolves around 12 key steps to achieving long-term, successful addiction recovery. Examples of 12-step programs include Alcoholics Anonymous and Narcotics Anonymous. Let’s examine the beginnings of 12-step programs as well as the services and success rates participating in such programs provides.

What are the 12 Steps?

The 12 steps of Alcoholics Anonymous have been copyrighted in 1952, 1953, 1981, and 2016 by Alcoholics Anonymous World Services, Inc.2

Sometimes, a person will see the word “God” replaced with “Higher Power.” Also, a person may change the “We were powerless” statement to better reflect the substance or addiction they suffer from.

The 12 Steps

  1. We admitted we were powerless over alcohol–that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore our sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. We’re entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory and when we were wrong, promptly admitted it.
  11. 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.
  12. 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 of our affairs.

Laguna Shores - 12 Step Programs

What Are Some Different Types of 12-Step Programs?

There are a number of groups that practice the 12-step program principles like Alcoholics Anonymous. Examples include:

  • Cocaine Anonymous
  • Co-Anon, a group for the friends and family of addicts
  • Debtors Anonymous
  • Gamblers Anonymous
  • Heroin Anonymous
  • Marijuana Anonymous
  • Neurotics Anonymous
  • Overeaters Anonymous
  • Sexaholics Anonymous
  • Survivors of Incest Anonymous
  • Workaholics Anonymous

These are just a few examples of some of the many groups that utilize the 12 steps in recovery.

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History of the 12-Step Program

The Higher Power Dynamic

What Do The Steps Mean by “Higher Power”?

Seven of the twelve steps make reference to a higher power or sometimes, depending on the book, will specifically mention God. In addition to the 12 steps, the Serenity Prayer, whose first lines are “God grant me the serenity to accept the things I cannot change” also has mention of a higher power. Therefore, it can be difficult for some people who do not identify as religious or who do not believe in God to participate in a twelve step program. Some may feel the words they are saying are disingenuous and have difficulty incorporating religion into their recovery.

According to an article in a 2018 edition of the journal Addiction, while spirituality and mention of a higher power play a role in Alcoholics Anonymous meetings, they are not usually the part of the meeting participants find most beneficial.4

Socialization and attention to changing thinking about drug or alcohol abuse was reported by the journal as the most effective aspects of 12 step programs.

How Do People That Are Not Religious Participate in 12-Step Groups?

A person does not have to be religious to participate in 12-step groups. However, if someone finds they cannot state or follow the 12 steps due to the mentions of a higher power, there are other alternatives.

According to the New York Times, across the country there are more than 150 groups  who offer a non-religious Alcoholics Anonymous meeting. These organizations also hold an annual convention for their members and leaders.3

Sometimes, the organizations are called “secular” Alcoholics Anonymous or other groups. These groups may interpret portions of the 12 steps in different ways. For example, one group re-constructed step 2 to say “We needed strengths beyond our awareness and resources to restore us to sanity”.

One of the key tenets in any 12-step organization is a open environment and non-judgmental attitude. Ideally, 12-step programs offer an environment where a person can find, regardless of their spiritual beliefs, a place to get sober.

Do 12-Step Programs ``Work``?

According to an article in the journal Addiction, prior to 1990, there was little high-quality research surrounding Alcoholics Anonymous and other 12-step program groups to discover if they were truly effective in treating addiction and reducing relapse rates.1 After this time, the Institute of Medicine and the National Academy of Sciences started to invest funding in studying the 12-step methods to determine their effectiveness versus other known interventions in helping a person remain sober and extending their periods of sobriety between relapses.
A meta-analysis of studies that involved 12-step facilitation was published in the Journal Addiction. This means researchers reviewed available research studies and combined all the results together to try to measure the effectiveness of 12-step groups. Key findings from the research included:

In a large-scale clinical trial called Project MATCH, those who participated in 12-step groups were more likely to be in full remission a year after an initial rehabilitation stays than those who were not.

The researchers found that twelve-step group participation resulted in lower healthcare costs overall for participants.

The researchers found those with a lower addiction severity (such as those who had not been addicted for long duration), experienced the greatest benefits of 12-step participation due to the social support the group provided.

The researchers found that men reported benefiting most through their participation in Alcoholics Anonymous because it helped them cope with how to handle high-risk drinking situations in public. While women reported this benefit, they tended to experience it to a lesser degree.

The researchers concluded that “Even when compared to the theoretically driven state-of-the-art interventions, twelve-step facilitation tends to produce as good, or better, alcohol use outcomes”.

Another review article published in the magazine Scientific American found that the percentage of alcohol-free days a person experienced rose from 20 percent before alcohol treatment to 80 percent post-alcohol treatment and participation in Alcoholics Anonymous.4

Why Support Groups Are Vital in Recovery

Researchers have scientifically proven that participation in groups like Alcoholics Anonymous can help a person stay sober longer and sometimes for a lifetime. In these groups, it’s possible to find others who have also struggled with addiction and are committed to their sobriety. One of the key aspects of the 12-step program is finding a “sponsor” or mentor that the person can call if they are struggling with temptations to return to drug or alcohol abuse. Forming these relationships and bonds with others can help with sobriety.

In addition to mentorship and social aspects, participants can learn from others about coping strategies.6 They can hear from a someone who has been there about how they deal with the daily struggles associated with sobriety. Sometimes, hearing this information from the position of a person who has been there can have a greater impact than hearing it from a therapist or doctor.4

Support groups like 12 step ones usually follow a general format that involves people sharing their stories of how they came to the program, what their life has been like since they are sober, or even some of their daily struggles.6 A participant can then receive encouragement and advice from other participants.

Some of the key benefits of support groups like the 12 step programs is that member participation is completely free. Membership is open, and there are no requirements beyond a desire to stay abstinent from a particular problem.

According to the National Council on Alcoholism and Drug Dependence, Incorporated, “Research has consistently and clearly demonstrated the active involvement in self-help support groups significantly improves a person’s chances of long-term recovery”. An estimated 5 million people in the United States participated in some type of support group, including 12-step groups.

of those who participated in Alcoholics Anonymous were sober over the course of 16 years

How to Deal With Cliques in Support Groups

One of the barriers to access in a support group can be a fear that the group already has established cliques or people who know each other and won’t accept outsiders into their group.7 This makes a person fear they will be left out, or worse, alienated, from the other group members. The results of this fear or rejection from a group could potentially leave a person in a more stressful and anxiety-ridden situation, which could impair recovery instead of help it.

Frame Fear into Collaboration

The goals of a 12-step group are to create an open environment where people can come and listen to and share their experiences in a non-judgmental way. However, there are still perceptions and fears by new participants that they will not be welcomed or that the other group members already know each other. However, one researcher writing in Psychology Today encourages participants to think of this in another way. For a group to succeed, it’s important that they take an interest in each other and associate with each other positively. This sense of collaboration can lead to greater conversations and trust among members.

As a result, a person can go into group participation in support groups with a different mindset. They can think about how over time, they can become one of those collaborative members of the group and look forward to seeing others they get to know over time. It’s also important to remember that participation in a 12-step group is not a guarantee. Not all members may be open and outgoing. Sometimes, a person’s personality may be that of an introvert or shy person who may not speak as much. Others may perceive this personality type as standoffish, when it is really a person’s own shyness.

Body Language of Interest

Some of the ways a person can go into a new 12-step group in a positive way is to remember that everyone had to start as the new person at some point in time. If you want to make a good impression, try making eye contact with others whenever possible, actively listen to others as they speak, and asking questions to engage other members and show interest.

experiential therapy for addiction

Rates of Relapse from 12-Step Program Groups

Addiction is a chronic medical condition. This means that when a person struggles with addiction, they often do so all their life. Even at 20 years sober, a person who has suffered from addiction may still have to do some work on a daily basis to resist the pull of drugs, alcohol, or other substances or behaviors. Doctors often call addiction a chronic, relapsing disease.

This means that relapse can unfortunately be a part of anyone’s story with addiction, and that a person may go through several episodes of relapse before achieving a longer-term sobriety.

Reducing Relapse

12 Step programs are intended to reduce relapse rates and help people maintain their sobriety at no cost to the participant. However, research shows that participation in 12 step groups are not a guarantee of lasting sobriety and that people do still relapse when the participate in Alcoholics Anonymous. According to Scientific American, an estimated 40 percent of those who participate in Alcoholics Anonymous meetings in any given year drop out.5

While those who participate in Alcoholics Anonymous do relapse, the relapse rates are often reduced compared to those who do not seek help at all for their drinking. According to Scientific American, in a 16-year study of persons who tried to quit drinking on their own, saw a therapist, or tried to get help from Alcoholics Anonymous, 67 percent of those who participated in Alcoholics Anonymous were sober over the course of 16 years.

This amount can be compared to the 34 percent of people who did not participate in Alcoholics Anonymous who were still sober.

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