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12-Steps Therapy In Addiction Treatment: Meaning, Benefits, and  How it Works

12-Steps Therapy In Addiction Treatment

The 12-step therapy is a structured approach to addiction treatment that emphasizes personal responsibility, peer support, and spiritual growth, as demonstrated in the 2005 study by Galanter M., “My Name Is Bill: Bill Wilson—His Life and the Creation of Alcoholics Anonymous, “published in the American Journal of Psychiatry. It involves a series of steps, each building on the previous one, guiding individuals from an admission of powerlessness over their addiction to a life of sustained sobriety and helping others.

The 12-step therapy in addiction treatment is highly effective in maintaining sobriety according to the 2013 study by Donovan, D. M., et al., “12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview”, published in Social Work in Public Health Journal. The study shows that the average duration of abstinence for people attending two to four 12-step therapy sessions weekly is more than 5 years.  

The 12-step therapy in addiction treatment bases its foundation on spiritual principles, establishing a mutually supportive community, and providing a structured framework for recovery. Additionally, the 2024 article by Buddy T., “What Are the 12 Steps of Recovery” from Very Well Mind, demonstrates that the 12-step therapy emphasizes personal responsibility, integration with professional treatment, adaptability, and continuous personal development.

Alternatives to the 12-step therapy in addiction treatment include  SMART Recovery, a scientific self-help group that focuses on self-empowerment, LifeRing Secular Recovery, a non-religious self-help group for people who are recovering from addiction, and Women for Sobriety (WFS), a self-help group for women who are recovering from alcohol addiction. According to the 2018 study by Zemore S E., et al., “A Longitudinal Study Of The Comparative Efficacy Of Women For Sobriety, Lifering, Smart Recovery, And 12-Step Groups For Those With AUD”, SMART Recovery, LifeRing Secular Recovery, and Women for Sobriety (WFS), are as effective as the 12-step therapy.

What Is 12-Steps Therapy In Addiction Treatment?

The 12-step therapy is a widely used addiction treatment approach linked to Alcoholics Anonymous (AA), a mutual, peer-led support group as demonstrated in the article “Twelve Steps and Twelve Traditions” from AA. According to the 2005 study by Galanter M., “My Name Is Bill: Bill Wilson—His Life and the Creation of Alcoholics Anonymous, “published in the American Journal of Psychiatry, the 12-step therapy was originally developed in the 1930s in the United States by Bill Wilson. Over time, the 12-step model evolved into a core program for many other addiction recovery programs, focusing on peer support and a structured path to healing.

What Is 12-Steps Therapy In Addiction Treatment

Wilson started AA and the 12-step therapy at a drug rehab center in Manhattan, where he was undergoing detox for alcohol addiction. Wilson had no formal training in psychology or the medical field. Rather, he combined his knowledge in philosophy and religion to craft the 12 steps and traditions in the AA book, commonly known as “The Big Book”.

According to the article “Twelve-Step Facilitation” from the Connecticut State Department of Mental Health and Addiction Services (DMHAS), Alcoholics Anonymous is the largest 12-step program, with a significant global presence. It has over 123,000 groups worldwide, and literature has been translated into over 100 languages. AA serves as a foundational model for numerous other 12-step programs, including Narcotics Anonymous (NA) and Al-Anon, a support group for families of people battling addiction. 

What Are The 12 Steps Of Alcoholics Anonymous?

The 12 steps of AA include the admission of powerlessness, belief in a higher power, the decision to surrender to high power, moral inventory, admission for wrongs, desire to change, request for the removal of faults, making amends for wrongs done, making amends where possible, continuous personal inventory, enhance conscious contact with the higher power, and sharing the recovery message with others. 

The 12 Steps Of Alcoholics Anonymous

The 12 Steps serve as a framework for individuals seeking recovery from addiction. According to the “ Big Book” from Alcoholics Anonymous, the steps encourage participants to acknowledge their struggles, seek help from a higher power (which can be interpreted in various ways), and engage in self-reflection and amends-making. The 12 steps of AA are:

  1. Admit Powerlessness: Acknowledge that the person is powerless and unable to control their addiction.
  2. Believe in a Higher Power: Trust that a greater force is capable of restoring sanity.
  3. Turn Will Over To a Higher Power: Decide to surrender one’s life to this higher power.
  4. Moral Inventory: Conduct a thorough self-assessment.
  5. Admit Wrongs: Confess the nature of one’s wrongs to oneself and other people.
  6. Readiness for Change: Be prepared to have character defects changed.
  7. Humbly Ask for Help: Request the removal of shortcomings.
  8. Make Amends: List those harmed due to the person’s actions and undertake to make amends.
  9. Direct Amends: Make direct amends wherever possible.
  10. Continue Personal Inventory: Regularly assess one’s actions and admit wrongs.
  11. Improve Conscious Contact: Seek to enhance one’s relationship with the higher power through prayer and meditation.
  12. Carry the Message: Share the recovery message with others and practice these principles in all aspects of life.

What Are The Principles And Practices Of 12-Step Therapy?

The principles and practices of the 12-step are mutual support, spiritual growth, sponsorship, and long-term recovery. The 2021 study by Withers R., “Why I Embrace 12-Step Principles as a Therapist”, from the National Alliance of Mental Illness, indicates that the principles of 12-step therapy emphasizes spirituality, support, and long-term recovery.

The principles and practices of 12-step therapy include:

  1. Mutual Support: The 12-step therapy creates a network of like-minded group members that participants rely on in times of need. During therapy sessions, recovering substance abusers engage in group meetings where they share experiences and support one another, fostering a sense of community and accountability.
  2. Spiritual Growth: The 12-step therapy encourages participants to grow spiritually by surrendering to a higher power.  Though it encourages spirituality, the 12-step therapy accommodates various beliefs, allowing participants to define their understanding of a higher power.
  3. Sponsorship: In the 12-step-therapy, sponsors are more experienced members. Sponsors guide newcomers through the steps, providing personal support and accountability.
  4. Long-term Recovery Focus: The 12-step approach focuses on long-term sobriety. It promotes ongoing participation in meetings and the community to maintain sobriety and personal growth over time.

What Are The Benefits Of 12-Step Therapy In Addiction Treatment?

The benefits of the 12-step therapy in addiction treatment include a structured support system, peer support and accountability, a spiritual component, a focus on personal responsibility, accessibility and affordability, accessibility and affordability, and long-term efficacy. According to a 2013 study by Donovan, D. M., et al., “12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview”, published in Social Work in Public Health Journal, the 12-step therapy is an easily accessible, readily available, community-based program at no cost.

What Are The Benefits Of 12-Step Therapy In Addiction Treatment
  1. Structured Support System: A structured support system is an established framework or network in the community that offers guidance, and accountability.  The 12-step therapy provides a structured network, and framework that acts as a support system to promote recovery from addiction. The support network offers a safe place for individuals to address their addiction through a series of steps that encourage personal growth and accountability. According to the 2023 study by Islam, M. F., et al, “ The Importance of Social Support in Recovery Populations: Toward a Multilevel Understanding”, published in the Alcoholism Treatment Quarterly, a a social support system is critical for recovering substance abusers as it helps them build a sense of community and belonging, which significantly enhance their recovery journey.
  2. Peer Support and Accountability: Peer support refers to a group of people with similar experiences networking to support each other. One of the core elements of 12-step programs is peer support. Participants share their experiences, challenges, and successes, fostering a supportive community that understands their struggles. According to “A.A. Around the World”, from Alcoholics Anonymous, AA has about 123 support groups globally, and 2 million members from 180 countries. The peer-driven support system is crucial for maintaining accountability, as members encourage each other to stay committed to sobriety.
  3. Spiritual Component:12-step programs encourage participants to seek guidance from a higher power to assist recovering abusers in their journey of sobriety. According to the 2013 study by Tonigan, J. S., “Spirituality as a Change Mechanism in 12-Step Programs: A Replication, Extension, and Refinement”, published in Substance Use & Misuse Journal, the spiritual aspect provides emotional and psychological support, helping individuals find purpose and meaning in their recovery. The spiritual component is a crucial factor in helping individuals cope with the challenges of addiction and maintaining long-term sobriety.
  4. Focus on Personal Responsibility: Personal responsibility refers to the willingness to own up to your decisions, and actions. According to Shalenko K., in “ Why Does AA Focus on Your Choices Instead of Other Causes of Alcoholism, from Sober, step four of Alcoholics Anonymous requires the recovering substance user 12-step to take personal responsibility, encourage participants to acknowledge their role in their addiction and take proactive steps toward recovery. This approach helps individuals develop a sense of ownership over their recovery process, which empowers and motivates sustained effort.
  5. Accessibility and Affordability: Accessibility refers to the ability of people to join, or use the 12-step program, while affordability describes the ability to enlist or afford it without incurring high costs.  According to the 2021 data review “Estimates of A.A. Groups and Members”, from Alcoholics Anonymous, there are 64,541 AA groups and more than 1.3 million members in the US. In April 2021, the 71st General Service Conference of A.A. recommended the recognition of virtual groups. Currently, there are 309 online groups in the US and Canada. The high number of 12-step groups and members is due to the accessibility of the programs including virtually.

The 2013 study by Donovan DM., et al “12-Step Interventions And Mutual Support Programs For Substance Use Disorders: An Overview”, published in Social Work in Public Health, demonstrates that 12-step programs are widely accessible and free of charge, making them an attractive option for individuals seeking help with addiction. The widespread availability of these programs means that individuals access support regardless of their financial situation, providing an essential resource for those in need. According to the study, there are more than 2,000 virtual groups globally, which are accessible by everyone who has access to the internet.

  1. Long-Term Efficacy: The 12-step program is highly effective in promoting long-term recovery. A study by Erickson M.,” Alcoholics Anonymous Most Effective Path To Alcohol Abstinence”, from the Stanford School of Medicine found that participants who regularly attended 12-step meetings had higher rates of sustained sobriety compared to those who did not participate. The ongoing support and sense of community are critical factors contributing to these positive outcomes.

How Does 12-Step Therapy In Addiction Treatment Work?

The 12-step therapy in addiction treatment works by basing its foundation on spiritual principles, establishing a mutually supportive community, providing a structured framework for recovery, emphasizing personal responsibility, integration with professional treatment, adaptability, and continuous personal development. According to the 2024 article by Buddy T., “What Are the 12 Steps of Recovery” from Very Well Mind, the 12-step therapy works by providing substance abusers with a clear path to lasting recovery, sobriety, and a life free from addictive substances.

Foundation on Spiritual Principles

The 12-step therapy by Alcoholics Anonymous (AA) is based on 12 spiritual concepts including acceptance, hope, faith, courage, honesty, and patience. According to the 2021 study by Volenik A., “Spiritual Principles of Alcoholics Anonymous”, published in Psychiatria Danubina, these principles encourage individuals to acknowledge their powerlessness over the addiction and seek guidance from a higher power. This foundation aims to foster spiritual awakening and transformation, which is considered vital for long-term recovery. The focus on spirituality helps individuals build a strong moral and ethical framework, which aids in overcoming the psychological aspects of addiction​​.

Mutual Support and Community Engagement

A core element of the 12-step approach is the creation of a supportive community through regular meetings and group activities. Participants share their experiences, challenges, and successes, fostering a sense of belonging and mutual support. According to Reid S.’s article “AA and Other Peer Support Groups for Alcohol Addiction,” this communal aspect helps reduce feelings of isolation and provides a platform for sharing coping strategies. It also offers a nonjudgmental environment where members openly discuss their struggles with addiction​​.

Structured Framework for Recovery

The program provides a structured framework that guides individuals through different stages of recovery. The steps include admitting powerlessness over the addiction, making amends for past wrongs, and continuing personal inventory and growth. This structured approach helps individuals systematically address various aspects of their lives affected by addiction, and promotes holistic recovery​.

Emphasis on Personal Responsibility

One of the critical aspects of the 12-step therapy is its emphasis on personal responsibility. Individuals are encouraged to take responsibility for their actions and make amends to those they have harmed. This process not only helps in repairing relationships but also fosters a sense of accountability and self-discipline, which are essential for maintaining sobriety​.

Integration with Professional Treatment

While the 12-step therapy is primarily a peer-support model, it is often integrated with professional treatment modalities, as demonstrated in the 2024 article from Very Well Mind. Many rehabilitation centers incorporate 12-step facilitation therapy, where counselors actively engage clients in the 12-step process. This integration helps individuals access both the communal support of the program and the clinical expertise of professional therapists, enhancing the overall effectiveness of the treatment​.

Adaptability and Global Reach

The principles of the 12-step therapy have been adapted to address a variety of addictions beyond alcohol, including narcotics, gambling, and overeating. The program’s adaptability and the global network of support groups make it accessible to a wide range of individuals struggling with different forms of addiction. According to the 2013 study by Donovan DM., et al, “12-Step Interventions And Mutual Support Programs For Substance Use Disorders: An Overview”, published in Social Work in Public Health, the 12-step therapy has adapted over the years to include people struggling with narcotics, known as Narcotics Annonymous, and Cocaine Annonymous, for people cocaine users. This broad applicability has made the 12-step program one of the most widely recognized and utilized models in addiction treatment worldwide​.

According to the 2019 study by Galanter M, et al “Cross-cultural Applicability of the 12-Step Model: A Comparison of Narcotics Anonymous in the USA and Iran”, published in the Journal of Addiction Medicine,  the Narcotics Anonymous World Services (NAWS) held more than 70,000 meetings in 139 countries in 2017. Out of the 70,000 meetings, 40 percent, or 27,677 were in the US. 

Continual Personal Development

The program encourages continual personal growth and self-improvement. Steps such as taking a daily moral inventory and making ongoing efforts to improve oneself are crucial components. This focus on continual development helps individuals maintain their recovery and prevent relapse by fostering a proactive approach to managing life challenges.

What Are The Alternatives To 12-Step Therapy In Addiction Treatment?

Alternatives to the 12-step therapy in addiction treatment include SMART Recovery, LifeRing Secular Recovery, and Women for Sobriety (WFS). The 2018 study by Zemore S E. et al., “A Longitudinal Study Of The Comparative Efficacy Of Women For Sobriety, Lifering, Smart Recovery, And 12-Step Groups For Those With AUD”, demonstrates that SMART Recovery, LifeRing Secular Recovery, Women for Sobriety (WFS), are as effective as the 12-step therapy.

The Alternatives To 12-Step Therapy In Addiction Treatment

SMART Recovery

SMART Recovery is an international non-profit organization that provides free, self-empowering, science-based mutual help groups to help people recover from addictive behaviors. According to the article ” What is SMART Recovery”, from the SMART Recovery website About Us page,  SMART stands for Self-Management and Recovery Training. SMART Recovery uses an evidence-based approach rooted in cognitive-behavioral therapy, motivational interviewing, and rational emotive behavior therapy.

According to the 2023 study by Kelly JF., et al, “An Investigation Of Smart Recovery: Protocol For A Longitudinal Cohort Study Of Individuals Making A New Recovery Attempt From Alcohol Use Disorder”, published in the British Medical Journal (BMJ Open), there are 1200 SMART Recovery groups in the US, and an additional 1000 groups internationally.   

The SMART Recovery 4-Point Program helps participants:

  1. Build and maintain motivation
  2. Cope with urges and cravings
  3. Manage thoughts, feelings, and behaviors
  4. Lead a balanced life

SMART Recovery meetings are held in-person and online, led by trained facilitation. The program is effective for overcoming a range of addictive behaviors including alcohol, drugs, gambling, overeating, internet use, and other addictive habits. SMART Recovery is inclusive, stigma-free, and congenial to participants using medications as part of their recovery.

LifeRing Secular Recovery

LifeRing Secular Recovery is a non-profit peer-run support group for individuals seeking recovery from addiction to alcohol and drugs. According to the article “ The LifeRing Organization”, from the LifeRing Secular Recovery website, the organization was founded in California in 1997. It emphasizes a secular, abstinence-based approach to recovery, distinguishing itself from traditional twelve-step programs like Alcoholics Anonymous.

According to the 2022 report “Overview”, from LifeRing Secular Recovery Organization, the group is active in 8 countries including the US. In 2022, the support group held about 80 online meetings weekly with approximately 50 to 80 members attending the sessions.

Core Principles

LifeRing operates on a philosophy encapsulated in the “3 S’s”. According to LifeRing Secular Recovery, the Three Ss stand for :

  1. Sobriety: LifeRing promotes complete abstinence from alcohol and non-prescribed drugs, viewing sobriety as a personal responsibility.
  2. Secularity: The organization welcomes individuals from all belief systems, asserting that religious views are personal and not a requirement for participation. This inclusivity allows both religious and non-religious individuals to feel comfortable in the recovery process.
  3. Self-Empowerment: Members are encouraged to develop their own Personal Recovery Plans (PRP), tailoring their recovery strategies to their individual needs and circumstances. This principle fosters a sense of ownership over one’s recovery journey.

Women for Sobriety (WFS)

Women for Sobriety (WFS) is a peer-support organization established in 1975, specifically designed to assist women in overcoming substance use disorders (SUDs). According to the article “Founder”, from Women For Sobriety (WFS), the organization was founded by sociologist Jean Kirkpatrick, after she struggled with alcoholism for years. WFS offers a unique alternative to traditional twelve-step programs like Alcoholics Anonymous (AA), focusing on the distinct challenges and needs faced by women in recovery.

The WFS program is centered around the New Life Program, which comprises thirteen affirmations that encourage positive self-image and personal empowerment. Unlike AA, WFS emphasizes self-esteem, responsibility, and cognitive strategies rather than the notion of powerlessness. This approach aligns with modern psychological practices, including elements of cognitive behavioral therapy, promoting the idea that individuals possess the ability to change their thinking and behaviors.

According to the 2021 study by Davey, C., “Online Sobriety Communities for Women’s Problematic Alcohol Use: A Mini Review of Existing Qualitative and Quantitative Research”, published in Frontiers in Global Women’s Health Journal, women are far less likely to seek help for alcohol abuse from conventional treatment and support programs such as A.A. due to family commitments, and stigma. This makes women-only treatment and support groups such as WFS ideal for women substance users.

Additionally, the 2020 survey “Women Slides for the 2020 National Survey on Drug Use and Health”, from the Substance Abuse and Mental Health Services Administration (SAMHSA), indicates that 10.4 million women used marijuana in the past month in 2020. This emphasizes the need for a support program customized for women using addictive substances.

Key Features

  1. Supportive Environment: WFS meetings are exclusively for women, fostering a safe space for sharing experiences and challenges without judgment. This environment is crucial for many women who feel more comfortable discussing their issues in a female-only setting.
  2. Meeting Structure: Meetings typically involve discussions based on WFS literature, where members share positive experiences and support each other. The focus is on personal growth and the application of the affirmations in daily life, rather than recounting past drinking experiences.
  3. Inclusivity: The program is open to all women, regardless of their background, financial status, or previous experiences with addiction. This inclusivity is a core value of WFS, emphasizing compassion, connection, and empowerment.
  4. Resources and Community: WFS provides various resources, including online forums, workbooks, and an annual conference that brings together women from around the world for workshops and support.

How Effective Is Smart Recovery Compared To 12-Step Therapy?

SMART Recovery emphasizes self-empowerment and cognitive-behavioral strategies. It focuses on building and maintaining motivation, coping with urges, managing thoughts, feelings, and behaviors, and living a balanced life. On the other hand, the 12-step Therapy revolves around admitting powerlessness, relying on a higher power to give you strength to change, making amends, and living a new life. 

  1. Effectiveness: The 2023 study by Manning, V., et al., “Piloting The Integration Of Smart Recovery Into Outpatient Alcohol And Other Drug Treatment Programs”, published in the Addiction Science & Clinical Practice Journal, showed that participants in SMART Recovery reported high satisfaction levels, with high improvements in physical health (74%) and mental well-being (71%) after attending meetings. This suggests that SMART Recovery is particularly effective for those who prefer a secular approach. Additionally, the study found that SMART Recovery is as effective as 12-step programs, especially when participants have personal goals that align with their recovery efforts.
  2. Similarities: SMART Recovery shares some similarities with 12-step programs, such as the importance of peer support and community in recovery. However, they differ significantly in their foundational philosophies:
  3. Spirituality vs. Self-Empowerment: 12-step programs often emphasize surrendering to a higher power, while SMART Recovery emphasizes self-empowerment and personal responsibility.
  4. Structured Approach: SMART Recovery has a structured program with specific techniques for managing addiction, while LifeRing focuses more on peer-led discussions and personal goal setting.

What Are The Differences Between Women For Sobriety And The 12 Step Therapy?

The main difference between WFS and the 12-step therapy is that the WFS program is specifically tailored for women struggling with addiction and revolves around the New Life Program, with thirteen affirmations that encourage positive self-image and personal empowerment. On the other hand, the 12-step program is attended by both men and women and is guided by 12 principles including honesty, hope, surrender, courage, and integrity.

Philosophy and Approach

  1. WFS focuses on building self-esteem and personal responsibility, while 12-step programs emphasize powerlessness over addiction and reliance on a higher power.
  2. WFS uses a set of 13 “Acceptance Statements” that encourage positive thinking and personal growth, rather than the 12 steps.

Membership and Structure

  1. WFS is a women-only program, while 12-step groups are open to both men and women, though some have women-only meetings.
  2. WFS meetings are structured around sharing personal experiences and providing positive reinforcement, while 12-step meetings follow a more standardized format.

Effectiveness

  1. The 2023 study by Manning indicates that WFS members report higher satisfaction and group cohesion compared to 12-step members. However, there are no longitudinal studies directly comparing the long-term efficacy of WFS and 12-step programs for alcohol use disorder at the moment.

What Are The Common Challenges People Face When Following A 12-Step Therapy?

Common challenges people face when following the 12-step therapy include reluctance to attend the meetings, philosophical differences, lack of professional guidance as the groups are led by volunteers, and logistical barriers, such as the inability to get to meeting venues. According to the 2013 study by Donovan D. M.,” 12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview”, published in Social Work in Public Health Journal, barriers experienced by people engaging in AA programs include perception of religiosity, inability to commit to change, and incompatibility between the person’s belief system and AA’s philosophies.

Are There Specific Demographics That Benefit More From The 12-step Therapy?

All demographics benefit equally from the 12-step therapy, as demonstrated in the 2001 study by Hillhouse, M. P.,”12-Step Program Participation and Effectiveness: Do Gender and Ethnic Differences Exist”, published in the Journal of Drug Issues.

Do Onsite 12-Step Meetings Impact Recovery Outcomes?

Onsite 12-step meetings during addiction treatment significantly increase recovery outcomes. According to a 2007 study by Laudet, A. et al., “An Exploration Of The Effect Of Onsite 12‐step Meetings On Post‐treatment Outcomes Among Polysubstance‐dependent Outpatient Clients”, having 12-step meetings directly at the treatment facility (onsite) increases attendance and participation in these groups, both during and after formal treatment.

According to the study, onsite treatment programs (TSO) are associated with three times the number of attendees compared to non-TSO. In addition, the study found that TSO attendees were four times more likely to maintain sobriety compared to non-TSO attendees.

What Are Some Criticisms Of The 12 Steps Program?

Critics of the 12-step program argue that the program lacks a scientific basis, its spiritual focus does not appeal to everyone, particularly those uncomfortable with the concept of a Higher Power, and has a one-size-fits-all approach. In the 2016 study by Rodriguez T.,” Criticism of 12-Step Groups: Is It Warranted”, published in Psychiatry Advisor, Jeffrey Cohen, an addiction specialist, and psychotherapist argues that the 12-step program has a one-size-fits-all approach. In addition, he says that it lacks a science-based approach.

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