For those affected by drug and alcohol addiction, finding a steady and reliable path to sustained sobriety can be a challenge.
There is no single way to wellness, and while many afflictions can be aided or even cured with medical intervention, this is not an option for those struggling with addiction.
The social, mental, physical, spiritual, and emotional complexities which surround addiction make it uniquely difficult to combat in a clinical or medical sense.
Whether it is you yourself seeking help, or you’re looking to support a loved one it can be hard to know how to proceed; for many people, a 12-step programme is a huge part of their journey to recovery and long-term sobriety.
To put it simply, a 12-step programme is a mutual help programme or group in which those living sober lives following addiction come together in order to form a supportive community.
The common goal of achieving sustained sobriety.
The end goal, of course, is to help those affected by addiction to live sober (or ‘clean’ in some circles) lives so that they can reach out to and help others as well.
These sobriety programmes are mutual help and support groups which use socialisation and the concept of group accountability to encourage recovery and abstinence through changes to the outlook and environment of those struggling with addiction to alcohol, drugs, gambling, or even less commonly acknowledged addictions to things like sex.
It would be pointless to deny that the 12-step system pioneered by Bill Wilson and Dr Bob Smith in 1935 (the system which was the foundation of Alcoholics Anonymous, or AA) is the most recognisable and famous example of this methodology.
However, what most people don’t realise is that despite being used in around 74% of treatment centres, AA’s 12-step programme is not the only sobriety programme, and is not the oldest sobriety programme, either.
The 12-step philosophy as imagined by Bill Wilson was the result of his own struggle with alcoholism and the positive effects that he noticed when fellow sufferers shared their stories and experiences.
While the concept of mutual support and help is a key factor in the programme, the iconic 12 steps were actually formulated by combining the philosophies of other sobriety groups he had attended.
Perhaps most influential was the Oxford Group, headed by Episcopal priest Sam Shoemaker, who Bill Wilson credited as the person who gave AA the ‘concrete knowledge’ of how they could use other abstinence philosophies in a practical and effective way.
This religious influence can be seen in what is now called The Big Book.
This written format of the AA programme was penned by Bill Wilson and was intended for those who were unable to attend AA meetings in person, but it quickly became a template of sorts for a range of groups aimed at those dealing with drug and gambling issues.
Nonetheless, the 12 steps, today, remain as they were when first penned; differentiations have been made by groups with specific focusses, but all share the same goal of ongoing sobriety.
At their most basic, 12-step programmes are intended to help those afflicted by addiction to gain and maintain a state of sobriety, but there is much more to such programmes than this simple goal.
The 12 steps are, in fact, an outline of the steps one should take to return to and stay in sobriety in a clear, workable, and realistic way that promotes mental, physical, and emotional wellbeing.
This begins by first encouraging those suffering from addiction to recognise and admit that their lives have become unmanageable.
By doing so in a supportive, understanding environment, amongst people who have had similar experiences, it is far easier to believe that permanent change is possible.
From this point, the purpose of the programme is to encourage those who have been affected by addiction to recognise the extent of the damage caused to themselves and others.
More than this, however, the purpose of any 12-step programme is to encourage moral responsibility and acceptance in a way that does not overwhelm those seeking help.
The founders of AA understood only too well how extreme emotional and mental distress can trigger relapses, and so the steps are literally that; small steps towards the ability to attain and maintain sobriety even in the face of upheaval.
As one of the oldest mutual help groups, AA is has had great influence over many people seeking sobriety and many other groups who seek to help those struggling with addiction in all its forms, AA is widely considered to be one of the most successful programmes, and with 2 million members in around 115,000 groups worldwide, it is certainly the largest.
Due to its heavily religious nature, this ‘original’ 12-step programme has as many proponents as it does detractors, but it is undeniably helpful to those who participate wholeheartedly and willingly (as studies referenced later will demonstrate).
The 12 steps of AA are neither linear nor ‘one-time’ in nature; they can be revisited as often as needed, and many groups suggest that steps 1 to 3 are repeated on a daily basis to reinforce members resolve (especially in the early days of recovery).
The 12 steps, as defined by AA, are:
Designed to encourage and nurture a sense of moral responsibility and a willingness to own up to our misdeeds and failings, these 12 steps are considered incredibly helpful for those afflicted with addictions by increasing their awareness of their addiction and its consequences.
AA also operates with 12 mirroring traditions which apply to the group as a whole.
In the early days of AA’s operation, those leading groups quickly came to realise that the attitude of the group as a whole was vital in preserving the focus and structure of groups, as well as the resolve of members.
The result of this first-hand experience was the 12 traditions which are now laid down in what is affectionately called The Big Book by AA members around the world.
Formally accepted by the AA as a whole at the 1950 International Convention in Cleveland, Ohio, these are the 12 traditions:
These traditions are not entirely binding but have nonetheless been accepted by the majority of members as the basis for all of AA’s internal and external relationships.
This strong focus on anonymity, group conscience, and the importance of common wellbeing is not only key in keeping AA out of political and social messes, but it removes possible power plays and allows for the collective enforcement of accountability.
Each member is accountable to the next and the next, and none is above the rest.
While the routine may differ for those in different stages of recovery (people in the early days of recovery may attend multiple meetings in a week), AA meetings share a set of core principles which ensure that they are recognisable to any existing members regardless of their homegroup.
Meetings come in two types, open and closed; open meetings allow the attendance of family, friends, or other loved ones whereas closed meetings do not.
Closed meetings are only open to those struggling with alcoholism, but neither type of meeting is open to counsellors, psychologists, or psychiatrists unless they are seeking help themselves.
During an open meeting, the 12 steps and traditions will first be read, and then a member will usually come to the front and share a story of recovery and hope.
At closed meetings, by contrast, there will still be a reading of the 12 steps and traditions, but thereafter the focus will be on group reading and discussion as well as confessions, progress updates, and the sharing of recovery stories.
All AA meetings are informal; run by those affected by alcoholism for the benefit of others facing the same struggles.
As you might imagine, anonymity is very important at all meetings.
Those seeking help introduce themselves by only their first name and may speak about any of their own experiences, but are not encouraged to speak about the experiences of others, and crosstalk is not allowed.
By this, it is meant that members should not try to offer advice to other members.
All meetings are confidential, and it is frowned upon to discuss their details with those outside of the group.
If advice is needed or sought, members are encouraged to talk to their sponsors first and foremost.
While many people who have never struggled with alcoholism or addiction may be sceptical of tackling such a tough undertaking without professional help, studies have shown that mutual help groups like AA (where people rely on their peers primarily) are not only effective but that they benefit long-term recovery and wellbeing.
The role of the sponsor in the AA structure, as informal as it is, is a prime example of this.
Sponsors are there to help new members stay sober and cope with any relapses that may occur; they are not medical professionals but are likely to be ‘veteran’ members of a group.
Sponsors are usually in recovery themselves but have the experience that can be beneficial to newcomers.
They share their knowledge and offer advice when asked, but do not impose their personal views on those they are guiding.
As a result, they need to have a certain level of emotional detachment from the members they advise; while sponsors do (and should) care about those they sponsor intimate or romantic relationships are discouraged.
This is because of the vulnerable state in which many new members enter a group and the potential for relapse that intense emotional upsets pose.
Of course, there are many different 12-step programmes now, but as the oldest and largest AA is one of the few to have studied in any meaningful sense.
What is most interesting from a medical standpoint, perhaps, is the fact that medical professionals are only now coming to the same conclusions that have driven AA since it’s advent.
The concept of recovery and relapse in addiction as in illness, for example, is relatively new in some medical disciplines but has been a conceptual cornerstone of AA throughout its life.
It is perhaps this understanding approach which has led to such high membership and success rates.
AA’s Big Book claims an impressive 50% success rate (with 25% remaining sober after some relapses), but this has been, understandably, viewed with scepticism by the scientific community as the statistics were provided by the AA themselves.
Thankfully, there has been a rise in impartial scientific research surrounding the topic of addiction and recovery in recent years, and much of it is positive (if cautious) when it comes to AA.
A study undertaken in 2009 by Dr Lee Ann Kaskutas raised many interesting points, not least the fact that regular, consistent AA attendance has a positive effect upon sobriety in those struggling with alcohol addiction.
Dr Kaskutas found that roughly 72% of those in her study who attended meetings weekly over a 2 year period maintained sobriety, while around 39% of those who attended no meetings were able to do so.
This statistic, along with many others, is something that she attributes to a number of things including spirituality, a sense of meaning, and the change of environment (as well as positive role models) which AA provides to its members.
This theory of the positive support network is supported by many studies, including Dr John Kelly and Dr Julie Yeterians study into the beneficial effect of mutual help groups as a whole; Drs Kelly and Yeterian found that those in recovery who were socially involved in MHG programmes like AA were abstinent for 20% more days than those who did not attend at all.
Of course, for all it’s positive effects AA does experience criticism regarding its effectiveness, but also because of the strong religious overtones of the meetings.
Dr Lance Dodes is one of the most notable and reputable of AA’s detractors.
He claims that only 5 – 10% of members achieved lasting sobriety and that those who do benefit do so mostly because of the social aspects of the meetings, not the steps themselves.
While it is true that studies have found the social support aspects of AA to be some of the most compelling and effective, his citation of a 90% failure rate is dubious at best as previously cited works have shown.
Yet, Dr Dodes is plausible in that he notes an undeniable truth: AA is not for everyone.
The religious element of AA’s programme is one that many people struggle with – as Dodes notes, the concept that those struggling with addiction are powerless but for the help of God is one that many people find unpalatable.
Of course, there are options out there for those who want to benefit from group dynamic recovery groups which do not involve such obviously spiritual elements.
There are many 12-step programmes for those afflicted by alcohol, drug, or gambling addictions (and many other, less well-known addictions), and many are secular or non-denominational.
However, most 12-step programmes do reference a ‘higher power’.
This power need not be God, but rather something bigger than ourselves; a fundamental part of any 12-step programme is looking at the bigger picture, looking beyond the self to understand the true impact of addiction in a wider sense.
Certainly, the group conscience and accountability factors are considered to be beneficial by even official bodies such as the American Society of Addiction Medicine.
For those who find the 12 steps themselves acceptable, there is now a range of organisations which focus on issues beyond alcohol addiction.
Narcotics Anonymous (NA), Gamblers Anonymous (GA), and Heroin Anonymous (HA) are all considerable programmes which operate in the same way as AA.
There are non-12-step programmes, such as SMART and Moderation Management, but some studies suggest that their overall outcomes are not as positive, perhaps due to their less rigid focus on total abstinence.
Nonetheless, these non-12-step models share the group conscience and peer-to-peer models which have been hailed as some of the driving factors in the success of organisations like AA, NA, and GA.
Furthermore, there are non-12-step groups which keep the overall goal of total abstinence as opposed to moderation, and the admittedly small studies which focus on these instances have thus far found that rates of sobriety and abstinence are comparable to those enjoyed by 12-step programme members.
It seems, based on these findings, that the main focus in dealing with addiction for any individual should be finding a sobriety programme that provides the support and guidance needed in a format that they can accept and have sustained contact with.
Likewise, many professionals now suggest that a mixed approach (that is a mixture of 12-step programme attendance and medical approaches like cognitive behavioural therapy) is an effective method of attaining sobriety for many individuals coping with drug or alcohol addiction.
In the end, what matters most is that those affected by addiction know they have an array of options and support systems at their disposal when they feel ready to begin their own journey towards sobriety and wellness.