12-Step Programs: Definition, Usage, How It works, 12 Steps, Pros and Cons, Effectiveness.
Substance use disorders are highly prevalent and negatively impact multiple aspects of life, including physical, psychological, social, legal, vocational, familial, and educational domains.
12-step programs, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), serve as crucial, accessible resources for individuals seeking recovery from SUDs. These programs are available at no cost and are widely accessible globally.
The principles of Alcoholics Anonymous (AA) are centered on self-reflection, spiritual growth, and helping others which also serve as the foundation for all other 12-step programs.
As of 2012, AA had nearly 64,000 groups with 1.4 million members in the United States and Canada, and over 114,000 groups with 2.1 million members worldwide. NA had more than 58,000 weekly meetings in 131 countries according to Alcoholics Anonymous. Estimates of AA groups and members as of January 1, 2012. New York, NY: A.A. General Service Office; 2012.
What is A 12-Step Program?
A 12-step program is a mutual support group based on a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioral problems, typically involving the acknowledgment of a higher power, making amends for past behaviors, and helping others achieve sobriety through similar means. Alcoholics Anonymous (AA) was created by Dr Bob and Bill Wilson created the 12 steps of Alcoholics Anonymous (AA) with inspiration from the Oxford Groups in 1935 to help people struggling with alcohol use recover from their addiction.
Today, 12-step programs are used by individuals with various addictions, including marijuana, narcotics, and cocaine. Depending on the substance, you can join groups like Narcotics Anonymous (NA) or Cocaine Anonymous (CA).
These programs follow the same 12-step recovery ideology as Alcoholics Anonymous (AA), adapted to the specific needs of the participants and substances. When you join, senior members volunteer as sponsors to guide you through the 12 steps, sharing their experiences and offering personal support.
Selecting a sponsor carefully is crucial, as they will play a significant role in your recovery journey.
What are the 12 Steps Of Alcoholics Anonymous?
The 12 steps are listed below.
1. Honesty: Admitting You Are Powerless
Being honest with yourself that you have an addiction problem is the first step. This also helps your family and friends address that you have a substance use disorder.
This first step is the hardest because many addicts live in denial. They think they are fine because addiction may have disrupted their brain circuitry and chemistry, especially the parts associated with reward and motivation.
The first step also requires you to accept that you are powerless as far as alcohol or drugs are concerned, that you cannot control your drug use or drinking problem, and that your motivation and willpower cannot help you stop using drugs or drinking alcohol. Further, you must admit that your life has become unbearable or unmanageable because of your drug use problem.
Step one isn’t as easy as it sounds, but it is an essential starting point. After recognizing that you have a problem, you can move on to the next steps in this program.
More Resources on Addiction:
2. Faith: Believing in a Higher Power Than Yourself
After admitting that your addiction is stronger than your willpower, the next step is to believe that a power greater than your willpower exists.
This spiritual part of the 12-step program suggests that you believe in a higher power. Of course, you are free to choose what or who to believe in as your higher power.
Some AA members turn to organized religion to find their belief in a higher power, but many people focus on a more abstract, personal version. The aim of step two is to help you accept that you need supernatural help with your recovery.
3. Surrender: Turn Your Life Over to God
Once you believe there is an external power greater than your own and that this power can help you stop drinking or using drugs, the program suggests surrendering your life to that higher power.
Recognize the fact that you have tried to stop using drugs but failed. Surrender is a key part of recovery.
The famous Serenity Prayer forms a strong foundation for step three of this recovery program.
4. Soul Searching: Take Moral Inventory of Your Life
Taking a moral inventory of your life means that you take a look at your life and acknowledge how that drinking or drug use has affected you and others. It is easy to forget that your friends, family, colleagues, and employers often pay a price because of your addiction.
When soul-searching, you must be fearless and comprehensive. You have to be honest enough to recognize your shortcomings and how you have hurt others. It is advisable to write down the people you have wronged and how you have hurt them.
Creating this list is the vital part of step four. You are called upon to cite past experiences, feelings, thoughts, and incidents, some of which can be embarrassing. As you work on this list, you will realize how your decisions have made you cross many people’s paths.
This step is very emotional as your eyes can now open and see how your addiction has affected your spouse and children. Step four can take a long time, and you may need to pray and get encouragement from your sponsor and other group members.
5. Integrity and Confession: Admitting Mistakes
Listing your wrongdoings alone isn’t enough.
You must take the next step by confessing your sins or errors. Admit to God, or your higher power, that you made the mistakes, and ask for forgiveness.
Then, choose someone you trust, and confess your sins to them.
During your drinking and drug use years, you were likely isolated from society. Step five is supposed to reconcile you with society to start life anew. This activity will humble you, but the good news is that it will leave you feeling cleansed emotionally.
6. Acceptance: Prepare Yourself for a Higher Power to Remove Your Defects
The sixth step is about accepting yourself for who you are and allowing a higher power, such as God, to eliminate your defects.
You can pray and ask God to remove the defective issues in your life. This step requires you to understand that you often derive pleasure from your own sins and flaws, so getting rid of them is an uphill task.
Since you have reached this step, you must trust in yourself with the help of your higher power. For this step to be practical, you can list down all your moral defects alongside positive statements to provide you with new methods to help with your recovery. The aim of step six is to help you let go of your past and start a new life with no character defects.
7. Humility: Ask the Higher Power to Remove Your Shortcomings
Step seven is all about humility.
Here, you will seek the will of God concerning how you should live your life and ask him to remove the shortcomings you listed in the previous step. This requires you to realize the power of God in your life and acknowledge that you need a higher power in your recovery journey.
Your humility should not come from regret for your failures or sufferings, but it should come voluntarily. The most critical tool in the seventh step is meditation, which will help you look introspectively and learn how to live a life of humility.
8. Willingness: List Your Wrongs and Be Ready to Make Amendments
For step eight, you must be willing to reconcile with the people you have wronged.
Start the process by listing them. You are encouraged to be as honest as possible when creating the list of those you have harmed directly or indirectly.
Be careful not to overlook or undermine any mistake you make, no matter how small. The point of this step is to relieve you of past resentments and develop positive relationships.
Since you have forgiven yourself, you also need to seek other people’s forgiveness.
9. Forgiveness: Make Direct Amends
The ninth step requires you to ask for forgiveness directly from the people you wronged.
So, you must have the courage to approach them, apologize, and ask for their forgiveness. Choose a trusted person to accompany you as you go to those you have wronged to assist with reconciliation.
Understandably, some of these people may still be angry with you. Showing true remorse and explaining that you are willing to change will go a long way in earning people’s forgiveness.
However, when confessing your wrongdoings to other people, don’t bring up issues that can further hurt them and lead to family breakups, fights, or injuries. Remember that in step nine you apologize for what you did under the influence of alcohol or drugs and for the harm your addiction caused.
If possible, be willing to offer indemnity as you seek reconciliation and forgiveness, even though some people will not accept it. This step is very important in reconnecting you with society.
10. Maintenance: Continue Taking Personal Inventory and Admitting Your Wrongdoings
Step 10 recognizes that you can never be perfect and still make mistakes.
It requires that you be accountable for your daily actions. Whenever you make a mistake or hurt someone, you must be willing to admit the wrongdoing and ask for forgiveness.
Recovery from addiction isn’t a one-day affair, so you must continue examining your actions, behaviors, words, and thoughts. It means you will be taking a daily inventory of your life, correcting any wrongs immediately.
Step 10 will help you make a habit of being more aware of yourself and your behaviors. It is a personal reflection to keep your emotional balance.
11. Making Contact: Improve Your Contact With God and Do the Right Things
You must maintain contact with God through self-examination, meditation, and prayers.
Your spiritual life will be strengthened when you are in tune with yourself emotionally and physically. Once you complete Step 11, you will develop a sense of belonging and understand that your God watches over and loves you.
In this step, you are supposed to keep praying for knowledge, the will of God, and the energy to carry out God’s will in your life.
12. Service: Carry the Message of Recovery to Others and Continue Practicing Recovery Principles
Recognizing that the best way to maintain your sobriety is by helping those still struggling with drug addiction is the key to this step.
It’s like you are giving back to society. You will be taught to share your spiritual experience with others and help them recover after they come to rely on a higher power, such as God.
Since you have been an addict, sharing your struggles and testimonies will encourage and give hope to other addicts. Step 12 adds purpose to your life.
It makes you feel useful. A sense of happiness occurs when you see others regaining their feet as a result of your testimonies.
The 12th step in a 12-step program is to “carry the message” of recovery to others suffering from addiction and to practice these principles in all aspects of life. This step emphasizes the importance of helping others and sharing the recovery experience to maintain one’s own sobriety and support the broader recovery community.
Start The 12 Steps Today
Our admissions team is standing by 24/7 for a confidential conversation.
What Are The Different Types Of 12-Step programs?
The types of 12-Step programs are listed below.
- Alcoholics Anonymous (AA): For individuals with alcohol addiction.
- Narcotics Anonymous (NA): For individuals with drug addiction.
- Cocaine Anonymous (CA): For individuals addicted to cocaine.
- Al-Anon/Alateen: For families and friends of alcoholics.
- Gamblers Anonymous (GA): For individuals with gambling addictions.
- Overeaters Anonymous (OA): For individuals with eating disorders.
- Debtors Anonymous (DA): For individuals dealing with compulsive debt.
- Sex Addicts Anonymous (SAA): For individuals with sex addiction.
- Sex and Love Addicts Anonymous (SLAA): For individuals with sex and love addiction.
- Sexaholics Anonymous (SA): For individuals struggling with sex addiction.
- Marijuana Anonymous (MA): For individuals addicted to marijuana.
- Nicotine Anonymous (NicA): For individuals trying to quit smoking.
- Pills Anonymous (PA): For individuals addicted to prescription medications.
- Crystal Meth Anonymous (CMA): For individuals addicted to crystal methamphetamine.
- Dual Recovery Anonymous (DRA): For individuals with both mental health disorders and substance abuse issues.
- Workaholics Anonymous (WA): For individuals with work addiction.
- Food Addicts in Recovery Anonymous (FA): For individuals with food addiction.
- Clutterers Anonymous (CLA): For individuals dealing with compulsive hoarding and cluttering.
- Emotions Anonymous (EA): For individuals with emotional and mental health issues.
What Are the Principles in the 12 Steps of AA?
There are 12 steps in AA, each with an underlying principle that guides the recovery process. These principles not only form the foundation of AA but also guide other 12-step programs. Below are the 12 steps and the principles behind each step.
- Step 1: Honesty
- Principle: Honesty
- Description: “We admitted that we were powerless over alcohol — that our lives had become unmanageable.” This step involves admitting powerlessness over alcohol, focusing on being honest with oneself about the addiction.
- Step 2: Hope
- Principle: Hope
- Description: “Came to believe that a power greater than ourselves could restore us to sanity.” This step is about finding faith in a higher power and maintaining hope, even during setbacks.
- Step 3: Surrender
- Principle: Surrender
- Description: “Made a decision to turn our will and our lives over to the care of God as we understood Him.” This step involves surrendering to a higher power and moving beyond the selfishness of addiction.
- Step 4: Courage
- Principle: Courage
- Description: “Made a searching and fearless moral inventory of ourselves.” This step requires documenting past mistakes and facing painful regrets with courage.
- Step 5: Integrity
- Principle: Integrity
- Description: “Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.” This step involves sharing the moral inventory with God, oneself, and another person, fostering integrity.
- Step 6: Willingness
- Principle: Willingness
- Description: “Were entirely ready to have God remove all these defects of character.” This step is about being ready to let go of past sins and move forward.
- Step 7: Humility
- Principle: Humility
- Description: “Humbly asked Him to remove our shortcomings.” This step involves seeking forgiveness and recognizing one’s place in the bigger picture with humility.
- Step 8: Love
- Principle: Love
- Description: “Made a list of all the persons we had harmed and became willing to make amends to all of them.” This step is about showing empathy and compassion by listing those harmed and being willing to make amends.
- Step 9: Responsibility
- Principle: Responsibility
- Description: “Made direct amends to such people wherever possible, except when to do so would injure them or others.” This step involves making amends to others, reflecting responsibility for past actions.
- Step 10: Discipline
- Principle: Discipline
- Description: “Continued to take personal inventory and when we were wrong promptly admitted it.” This step requires ongoing personal inventory and admission of wrongs, demonstrating discipline.
- Step 11: Awareness
- Principle: Awareness
- Description: “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.” This step emphasizes maintaining awareness of a higher power through prayer and meditation.
- Step 12: Service
- Principle: Service
- Description: “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 our affairs.” This final step is about helping others through their recovery journey and practicing these principles in daily life.
Can 12-step principles be applied to behavioral addictions, and if so, how?
Yes, 12-step principles can be applied to behavioral addictions such as gambling, eating disorders, and sex addiction. Programs like Gamblers Anonymous (GA), Overeaters Anonymous (OA), and Sex Addicts Anonymous (SAA) adapt the 12-step framework to address the unique challenges of these behavioral issues, helping individuals achieve recovery through structured support and community.
How Effective are 12-step Treatment Programs?
12-step treatment programs, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), have been widely studied and are considered highly effective for many individuals seeking recovery from addiction.
Research Findings on Effectiveness:
- Comparison with Psychotherapy: A study led by Keith Humphreys, PhD, a professor of psychiatry and behavioral sciences, found that AA was nearly always more effective than psychotherapy in achieving abstinence. This conclusion is supported by multiple studies indicating that regular participation in 12-step programs significantly improves the likelihood of long-term sobriety.
- Membership and Engagement: In 2021, AA was estimated to have about 2 million active members and over 120,000 active groups worldwide, according to AA.org.
This large and active membership base highlights the program's reach and the strong community support it provides.
- Social Support Network: The effectiveness of 12-step programs is partly due to the robust social network they offer. Members support each other through regular meetings, sponsorship, and shared experiences, fostering a sense of belonging and mutual accountability.
- Long-term Outcomes: Studies have shown that individuals who engage consistently with 12-step programs are more likely to achieve and maintain long-term abstinence.
This is attributed to the structured approach of the 12 steps, which guide individuals through a process of self-reflection, amends, and personal growth.
- Cost-Effectiveness: 12-step programs are free and widely accessible, making them a cost-effective option for many individuals. This accessibility allows people from various backgrounds to participate without financial barriers.
Key Components Contributing to Effectiveness:
- Structured Framework: The 12 steps provide a clear, structured path to recovery, helping individuals to systematically address their addiction and related behaviors.
- Spiritual and Moral Support: While not religious, the emphasis on a higher power and moral inventory can provide additional layers of support and motivation for many participants.
- Peer Support: The community aspect of 12-step programs is crucial. Peer support helps individuals feel less isolated in their struggles and more motivated to stay on track.
- Ongoing Engagement: The continuous nature of the program, with regular meetings and ongoing participation, helps reinforce sobriety and prevent relapse.
The effectiveness of 12-step programs like AA and NA is well-documented.
They offer a unique combination of structured guidance, community support, and accessibility, which together foster a supportive environment for individuals to achieve and maintain sobriety. For many, these programs provide a lifeline that extends beyond mere abstinence, promoting overall personal and spiritual growth.
What Are The Downsides And Negative Aspects of the 12 Steps?
While 12-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) have helped many individuals achieve and maintain sobriety, they are not without their criticisms and potential downsides.
1. Spiritual Aspect:
- Barrier to Entry: The spiritual component of 12-step programs can be a significant barrier for some individuals. The steps include references to a “higher power” and involve practices such as prayer and meditation.
For those who are atheists, agnostics, or who follow non-theistic belief systems, this emphasis on spirituality may feel incompatible with their personal beliefs.
- Perception of Religion: Some individuals perceive the spiritual elements of 12-step programs as being too closely aligned with organized religion. This perception can deter people who have had negative experiences with religion or who prefer secular approaches to recovery.
2.
One-Size-Fits-All Approach:
- Individual Differences: The 12-step model is designed as a universal approach to addiction recovery, but it may not address the unique needs and circumstances of every individual. Some people may require different therapeutic methods, such as cognitive-behavioral therapy (CBT), medication-assisted treatment, or other evidence-based practices.
- Resistance to Change: The structure and traditions of 12-step programs have remained largely unchanged since their inception.
This rigidity can be a drawback for individuals who prefer more flexible or modern approaches to treatment.
3. Focus on Powerlessness:
- Empowerment Concerns: The first step of admitting powerlessness over addiction can be empowering for some, but it may feel disempowering to others. Some individuals prefer treatment approaches that emphasize personal empowerment and self-efficacy rather than focusing on powerlessness.
4. Social and Cultural Fit:
- Inclusivity Issues: Although 12-step programs are open to everyone, some people may feel out of place due to social or cultural differences. For example, younger individuals, people from diverse cultural backgrounds, or those from the LGBTQ+ community may not always find a group that feels welcoming or relatable.
5. Efficacy and Retention:
- Varied Success Rates: The effectiveness of 12-step programs can vary widely. While many people find success through these programs, others may struggle to achieve long-term sobriety or drop out due to a lack of fit with the program’s philosophy or methods.
- Support System Dependency: The reliance on peer support can be a double-edged sword.
While it can provide strong community bonds, it may also lead to dependency on the group for recovery, making it challenging for some individuals to maintain sobriety independently.
What Are Alternatives to the 12 Steps?
To make 12-step programs more inclusive, some groups have adapted the language and approach to be more secular. For example, some AA and NA groups use terms like “higher purpose” or “inner strength” instead of “higher power.” Additionally, there are alternative recovery programs that offer similar peer support without the spiritual component, such as SMART Recovery (Self-Management and Recovery Training) and LifeRing Secular Recovery.
These alternatives focus on evidence-based practices, personal empowerment, and self-reliance, offering different pathways to recovery for those who find the spiritual aspect of traditional 12-step programs to be a barrier. By providing various options, individuals seeking recovery can choose the program that best aligns with their personal beliefs and preferences, increasing the likelihood of successful long-term sobriety.
What Is The History Of The 12 Steps?
Alcoholics Anonymous (AA) began in 1935 in Akron, Ohio, as the result of a meeting between Bill W., a New York stockbroker, and Dr. Bob S., an Akron surgeon, both of whom were struggling with alcoholism.
They had previously been influenced by the Oxford Group, a fellowship that emphasized universal spiritual values. Bill W. had found sobriety through the support of the Oxford Group and his friend Ebby T., and he maintained his recovery by helping other alcoholics, although none had recovered before meeting Dr.
Bob. Dr.
Bob, who had also been involved with the Oxford Group, found immediate support and understanding in Bill W. and soon achieved sobriety himself, leading to the founding of AA.
In the fall of 1935, a second group began to form in New York, followed by a third in Cleveland in 1939. The early years saw slow growth, with about 100 sober alcoholics by 1939 across the three founding groups.
The publication of the book “Alcoholics Anonymous” in 1939, written by Bill W. and reviewed by early members, outlined the 12 steps of recovery and included case histories of thirty recovered members. This book marked the beginning of rapid growth for AA.
A series of articles in the Cleveland Plain Dealer in 1939 brought widespread attention and many requests for help, leading to a surge in membership. The establishment of a trusteeship in New York, supported by friends of John D. Rockefeller, Jr., and the creation of the Alcoholic Foundation helped organize and support the burgeoning fellowship. Despite initial fundraising challenges, a small office was opened in New York to handle inquiries and distribute the AA book.
The growth continued with significant media coverage, including an article in Liberty magazine in 1939 and a notable piece by Jack Alexander in the Saturday Evening Post in 1941, which spurred further expansion. By the end of 1941, AA had grown to 6,000 members and spread across the U.S. and Canada. By 1950, there were 100,000 recovered alcoholics worldwide.
During these years, Dr. Bob played a crucial role in Ohio, providing hospital care and introducing alcoholics to AA principles.
He and Sister Ignatia at St. Thomas Hospital in Akron helped bring AA to thousands of sufferers.
Dr. Bob’s death in 1950 marked the end of a pivotal era, but his contributions continued to influence AA.
In 1950, AA held its first International Convention in Cleveland, where the Twelve Traditions of Alcoholics Anonymous were adopted to ensure unity and effective functioning of the fellowship. The following year, the General Service Conference was created to link AA’s trustees with the Fellowship, ensuring that the organization remained accountable and effectively served its members.
By 1955, AA had become self-sustaining, with the General Service Conference proving its value. The 20th-anniversary convention in St.
Louis celebrated this milestone, marking AA’s transition to independent governance. AA’s continued growth saw the establishment of a global presence, with a World Service Meeting held biennially since 1972, alternating between New York and international locations.
Today, AA exists in approximately 180 nations, demonstrating its ability to transcend barriers of race, creed, and language, continuing to provide support and a pathway to recovery for alcoholics worldwide. Inspired by the success and principles of AA, many other 12-step programs have been developed to address various addictions and compulsive behaviors.
Programs like Narcotics Anonymous (NA), Cocaine Anonymous (CA), Overeaters Anonymous (OA), and Gamblers Anonymous (GA) have been born from the foundation of AA, extending the message of hope and recovery to individuals who do not identify as alcoholics but struggle with other forms of addiction. These programs adapt the core principles of AA to meet the specific needs of their members, continuing the legacy of support and recovery that AA started.
What is the Difference Between Cocaine Anonymous (CA) and Narcotics Anonymous (NA)?
Cocaine Anonymous (CA) is a 12-step program specifically designed to help individuals recover from cocaine addiction and other mind-altering substances. CA follows the 12-step framework originally developed by Alcoholics Anonymous (AA), but it is adapted to address the unique challenges of cocaine addiction.
CA provides a supportive community where individuals can share their experiences, strength, and hope with one another. Meetings are a core component of the program, offering a safe space for members to discuss their struggles and progress.
Members work through the 12 steps, which involve admitting powerlessness over addiction, seeking help from a higher power, making amends for past wrongs, and helping others achieve sobriety. For example, a person struggling with cocaine addiction joins CA and begins attending regular meetings.
They find a sponsor who has successfully maintained sobriety and works through the 12 steps with their guidance. Through the program, they learn to manage cravings, rebuild relationships, and develop a new, healthier lifestyle.
Narcotics Anonymous (NA) is a 12-step program that supports individuals recovering from drug addiction, including prescription medications and illicit drugs. NA uses the 12-step model from Alcoholics Anonymous but has adapted it to be inclusive of all types of drug addiction. NA offers a community of support where members can discuss their addiction and recovery journey.
Regular meetings provide a space for sharing personal stories and receiving encouragement from peers. The program emphasizes working through the 12 steps, which include recognizing the impact of addiction, making amends, and maintaining a connection with a higher power.
For example, an individual addicted to various prescription drugs joins NA and starts attending meetings. They connect with a sponsor who supports them through the 12 steps.
Over time, they gain the tools to handle their addiction, repair damaged relationships, and build a drug-free life.
The primary focus of Cocaine Anonymous (CA) specifically targets individuals struggling with cocaine addiction and related substances. In contrast, Narcotics Anonymous (NA) broadly addresses all forms of drug addiction, including both prescription and illicit drugs.
In terms of terminology, CA members may identify themselves as cocaine addicts or simply addicts, while NA members identify themselves as addicts, which encompasses any type of drug addiction. The literature used in CA is a modified version of AA’s Big Book, tailored to the experiences of cocaine and poly-drug users.
In contrast, NA uses the “Basic Text” of Narcotics Anonymous, which is designed to cover a wide range of issues related to drug addiction. Additionally, CA meetings and discussions often focus on the specific challenges of cocaine addiction, whereas NA meetings address a broader spectrum of drug-related issues, providing a more inclusive environment for those with various types of drug dependencies.
Both CA and NA offer robust support systems for individuals seeking recovery from addiction, but they cater to different types of substance abuse and have distinct approaches in their support structures.
Share This Post
Dr. Ryan Wakim M.D.
All author posts
YOU MAY ALSO BE INTERESTED IN
