What are 12-Step Programmes?

12-step programmes are designed to support the recovery of those struggling with addiction. This was first developed in the 1930s by Alcoholics Anonymous (AA) specifically devised for alcoholism. [1]

Since the early 1900s, different organisations (known as ‘fellowships’) have used this 12-step approach to address a variety of addictions and dependencies, such as sex, drugs, gambling, alcoholism, and eating disorders.

This group treatment is a process that was summarised by the APA, the American Psychological Association, as involving the following ideas:

• Admitting that addiction is not in our direct control
• Believing in higher powers that can give you the strength to carry on through recovery
• Learning from and examining past errors, and making changes to current and future behaviour and attitude
• Adapting to a new life with new codes of conduct and goals
• Helping others whilst helping yourself

12-step programmes might not be right for everyone, but they offer tried-and-tested coping mechanisms for people struggling themselves, and groups offer a feeling of support and community.

The idea underpinning 12-step programmes is that in order to heal, we must surrender to a higher power. This need not be a religious God, but it could be as simple as being vulnerable to the community, universe, or anything, person, or spirit you see fit.

These programmes are commonly recommended, and used in around 74% of treatment centres. [2]

What are the ’12 Steps’?

The AA published the ‘Big Book’, outlining their 12-steps of recovery: [3]

1. Admitting powerlessness over the addiction
2. Believing that a higher power (in whatever form) can help
3. Deciding to turn control over to the higher power
4. Taking a personal inventory
5. Admitting to the higher power, oneself, and another person the wrongs done
6. Being ready to have the higher power correct any shortcomings in one’s character
7. Asking the higher power to remove those shortcomings
8. Making a list of wrongs done to others and being willing to make amends for those wrongs
9. Contacting those who have been hurt, unless doing so would harm the person
10. Continuing to take personal inventory and admitting when one is wrong
11. Seeking enlightenment and connection with the higher power via prayer and meditation
12. Carrying the message of the 12 Steps to others in need

These steps were created by the founder of AA, Bill Wilson. His own experience of alcoholism led him to create a sturdy foundation from which future alcoholics can learn. He specifically discussed the positive effects that sharing stories has on each person suffering from alcoholism or alcohol dependency.

Originally, the ‘higher power’ referred to was from Christian inspiration, as Wilson drew much of his strength and motivation from God in 1938. Since then, the 12 steps have been developed using evidence found in different recovery programmes.

These 12 steps have now formed the foundation for addiction recovery, adapted as a model for support and post-rehab programmes built to aid personal change and development.

Those that use the 12-step programmes join together to share stories regarding their addiction, recovery, and treatment. This has been proven to help mental health, contributing to both long-term recovery and flourishing.

This is done by providing the tools and mechanisms to build on emotional and mental strength: [4]

• Ability to recognise addiction
• Ability to admit you have a problem
• Surrendering control to an external guide
• Self-awareness and observation
• Practice self-restraint and control
• Self-acceptance and achievement
• Compassion and ability to change

The 12-step model uses these building blocks as tools to help behavioural change and enable a smoother recovery from addiction.

Timeline and Efficiency

The time and length of recovery programmes are entirely relative, meaning they are different for everyone.

This often depends on: [5]

• Severity of addiction
• Time attributed to working on addiction
• Goals set
• Motivation for change

The average time it takes to work through 12-step programmes can vary, depending on sponsors and the availability of meetings near you. Sponsors act as mentors or guides to help you through recovery.

They often have experience and have previously been through recovery for over a year.

When you attend meetings, you may confide in them when you are unsure or uncomfortable about certain topics. You may also share things with them outside of the allotted meeting times.

Newcomers to 12-step facilitation groups are normally asked to attend at least one meeting a day for the first 3 months of therapy.

The phrase used in meetings is ‘it works if you work it’, meaning the more effort you put in, the more effective the programme will be for you personally.

Attending every meeting you can and being actively involved gives you the best chance of a successful recovery.

However, this does not always mean 12-step programmes will work for you, so doing research on other addiction treatment programmes will prove to be helpful.

The Different 12-Step Programmes

The following fellowships (12-step groups) follow similar traditions to AA:[6]

• ACA: the Adult Children of Alcoholics, for those who have been raised in families broken by alcohol
• NA: narcotics anonymous, for those struggling with drug addiction
• AI-Anon: for the concerned others (friends and family) of alcoholics
• CA: cocaine anonymous, for those struggling with a cocaine addiction
• CMA: crystal meth anonymous, also linked to Co-Anon, for those affected by others’ cocaine addiction
• COSLAA: sex and love addict anonymous
• EDA: eating disorders anonymous, for those suffering from a range of eating disorders such as anorexia or bulimia
• GA: gamblers anonymous, for those who struggle to stop gambling
• NicA: nicotine anonymous, for smokers who can’t or struggle to quit
• DA: debtors anonymous
• OA: overeaters anonymous

The process of breaking addiction is very difficult, people often work towards recovery for their whole life whilst using the support of others and medically crafted rehab plans.

The Lessons Underlying Each Step

Acceptance: the first step of any form of recovery from addiction is admitting you are struggling. This acceptance will open you up to help and enable you to access different parts of the mind in order to work on them.

Trust: if you don’t trust in the process, you are less likely to put effort into changing your life. If you trust the recovery programme and the people you are working with you are more likely to have a successful recovery.

Liberation and freedom: believing in a higher power is liberating, you are healing using other channels of motivation rather than relying solely on yourself. During treatment you submit yourself to higher powers for help, believing that they will recraft and help you with defects of character, behaviour, or mindset.

Understanding: try to read up on addiction and recovery. The more you understand the mental, physical, and spiritual changes you are going through, the easier it will be to cope with them.

Acknowledgement: knowing your wrongs, your errors, and your mistakes will mean admitting that you are not currently the best version of yourself. This does not mean the best version of you doesn’t exist, but it can be unlocked using medical help for your addiction such as 12-step therapy.

Growth and reflection: during the process of healing and recovery, it is important that you learn from the mistakes you have made. If that is a person you have hurt, think about making amends or learning from that error.

This reflection will allow you to grow as a person and hopefully prevent you from making the same mistake again. This spiritual awakening during 12-step meetings acts as an active ingredient in recovery.

Forgiveness: to recover, we must forgive ourselves and others that have been involved in the cycle of addiction.

If that is someone who either made your addiction worse or enabled negative behaviour, we must forgive them and move forward. This does not mean you continue the same relationship, as this often leads to relapse.

Help and connection: practising the principles laid out by each programme helps others going through similar challenges. It can be daunting to try and recover on your own, and many people find it intimidating to talk to medical professionals.

Programmes Available at Rehab Near You

12-step programmes are built for addictive behaviours to aid personal recovery. With a spiritual foundation, there is a wide range of 12-step treatments available to you through rehabilitation.

12-step programmes, also called ’12-step fellowships’, are used for a variety of disorders such as:

• Substance use disorder
• Addictive behaviours
• Alcohol use disorders
• Compulsive behaviours
• Dual diagnosis
• Eating disorders

Inpatient rehabilitation is a form of residential rehab. Patients temporarily move into a rehab centre specialising in the area they are struggling with. This is not usually offered through the NHS, so it is likely you will have to pay for inpatient rehab yourself. However, this is all-inclusive so there will be no hidden costs.

A 12-step programme will be implemented into part of your daily routine, where specialists will be on hand to guide you through each step. 12-step therapy is used alongside other forms of therapy, such as CBT (cognitive behavioural therapy), DBT (dialectical behavioural therapy), and holistic therapy.

Inpatient treatment usually lasts around 28 days, and it is common for people only to get through the first few steps. 12-step therapy is not usually completed during inpatient therapy, as each person goes at their own pace.

The philosophies of the 12 steps can be transferred to outpatient therapy, a part-time and flexible rehabilitation designed for those with a new or mild addiction.

12-step treatment is then worked on alongside other therapy and daily routines, helping guide you through the trials, challenges, and cravings that regular life presents.

Why Does it Work?

Looking at a problem as one large mountain to climb often makes us feel overwhelmed and unprepared, acting as a deterrent rather than a motivator. When we discuss the smaller and more realistic steps towards the same goal, the idea of overcoming the problem then seems less daunting.

Why? Challenges are multi-layered, this complexity creates a feeling of chaos and anxiety about whether you are able to overcome addiction.

Taking manageable steps makes people feel as though they have accomplished something after each step, no matter how big or small. Completing tasks and having a sense of accomplishment is important, as it gives people the motivation and positivity to tackle the next step head-on.

These steps towards recovery are worked on in groups. Group therapy offers a unique experience of sharing the struggles and achievements each person has been through.

This therapeutic environment allows people to express their feelings without feeling judged, as everyone has been in their situation and often has similar emotions.

Compassion and healthy behaviours are developed, enhancing social interaction to rid of feelings of loneliness. Further, people learn from the behaviours and mistakes of others.

People explain the negative impact certain actions and behaviours have had on others, and in hearing the consequences and effects, others are less likely to make the same mistake.

This is a learning circle of trust. A typical group therapy session for a 12-step programme looks like this:

• Group sizes of up to 12 people with a professional (therapist)
• If it is an ‘open session’, anyone may join at any time. ‘Closed sessions’ have a set number of people and nobody can join without agreement from the therapist and the group
• New patients are introduced to the group, but can only listen and observe in the first session to get them used to the group
• Sessions run from 1 to 2 hours, often with a break in the middle to encourage socialising

What is involved in group therapy depends on the therapy involved and what the main goals of the members are. For example, a session may include cognitive behavioural therapy, where members will identify issues and the root causes of their negative thoughts that cause damaging behaviour. Schema-focused therapy and dialectical behavioural therapy are also used.

Whatever is discussed, and whatever therapy method is used, 12-step treatment programmes offer a focused, social, and relaxed approach to recovery. Following guidelines and using the support of others makes journeys like these seem less daunting.

The principles and lessons learnt throughout treatment can be utilised outside of rehab and therapy, as you will learn how to implement new methods and coping mechanisms during treatment.

References

[1] VandenBos, Gary R. (2007). APA dictionary of psychology (1st ed.). Washington, DC: American Psychological Association. ISBN 978-1-59147-380-0. OCLC 65407150

[2] SAHMSA. (2013). National Survey of Substance Abuse Treatment Services.

[3] Alcoholics Anonymous. (2021). The 12 steps.

[4] Whitmont, Edward C. (1969). The Symbolic Quest. Princeton, N.J.: Princeton University Press.

[5] Laudet, A. B., Magura, S., Cleland, C. M., Vogel, H. S., Knight, E. L., & Rosenblum, A. (2004). The effect of 12-step based fellowship participation on abstinence among dually diagnosed persons: a two-year longitudinal study. Journal of psychoactive drugs, 36(2), 207–216.

[6] https://nida.nih.gov/publications/seeking-drug-abuse-treatment/5-how-do-12-step-or-similar-recovery-programs-fit-drug-addiction-treatment

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