Monday, August 20, 2018

Do 12-Step Programs Really Work?

AA meetings
As addiction science continues to advance, many people wonder about the effectiveness of 12-Step programs and how they impact an individual's recovery from substance abuse or process disorders.

The most famous 12-Step program is Alcoholics Anonymous (AA), established in 1935, designed to foster "an international fellowship of men and women who have a drinking problem." The 12-Steps are considered a roadmap to recovery by helping participants:

  • Observe aspects of accountability through acknowledgement of a problem; attendance in public or private meetings to encourage mutual support; and recognition of how addiction may have impacted other people
  • Develop readily-accessible coping mechanisms for handling recovery challenges in daily life
  • Offer solace and guidance in times of desperation, need, or compulsivity

AA's directives are outlined in what's known as the Big Book.

Since AA's founding, dozens of organizations adopted the 12-Step philosophy and structure to address other compulsive and addictive behaviors, including:


Experts at in-patient rehabilitation facilities often introduce 12-Step programs during treatment and as part of an aftercare plan. For example, at Cottonwood Tucson, residents have the opportunity to use 12-Step recovery material in individual or group therapy sessions; attend 12-Step meetings on campus; and access community resources for meetings and programs for when they return home.

How a 12-Step Program May Help You

In an article for the American Society of Addiction Medicine, addiction psychiatrist Dr. Michael Miller defined recovery as "a concept that implies not only improvement, but potentially remission…a process as well as a destination." He stressed that "recovery activities" such as 12-Step programs are not professional treatments, but can "promote recovery just as professional treatment can." He indicated if there's an endpoint to addiction, "it's to change one’s life for the better, to gain stability in one’s life, and to become more functional in one’s family and in one’s community."

In this way, a 12-Step program provides many people with a foundation toward achieving this new sense of balance and engagement. Too often, individuals suffering from substance abuse disorders associate with others who travel that same road. The simple first step of changing the company you keep to be with people who understand your challenges and now have similar goals of recovery is why many believe in the success of 12-Step processes—placing much of program's importance on fellowship.

Other advantages include:

  • Taking a "moral inventory" of past actions and present life, with or without the influence of spirituality
  • Allowing for better examination of personal values
  • Providing reliable structure and necessary responsibility
  • Offering a no- or low-cost way to uphold abstinence

What Some Scientists Say About 12-Step Effectiveness

While most of the controversy surrounding 12-Step programs involves the concept of spirituality, there's also a concern that some people with substance abuse problems rely on a program as a form of treatment.

"Most people can't deal with their addiction, which is deeply driven, by just being in a brotherhood," said Dr. Lance Dodes, when interviewed by NPR about his book, The Sober Truth, released in 2014. Dodes cited evidence that indicates the success rate of AA and other 12-Step programs is approximately 5–10 percent.

Conversely, in 2011, Scientific American reported studies that stress the recovery rate is much higher among people who attend 12-Step programs while also seeing a therapy professional. Nearly 60 percent of respondents reported long-term sobriety when they did both.

This continuing quest for effective post-residential treatment support is why some medical professionals offer alternatives to 12-Step processes. One such option is SMART Recovery. Founded in 1994 by mental health experts and based on psychological approaches, the secular organization states its mission is "to empower people to achieve independence from addiction problems with our science-based 4-Point Program."

The four points center on self-directed approaches such as:

  • Improving motivation
  • Refusing to act on the compulsion to use
  • Developing problem-solving skills without substances
  • Creating a healthy and balanced lifestyle

This method addresses a number of substance abuse and process disorders.

In 2018, VeryWell Mind shared some additional details about SMART recovery, as well as how it compares to 12-Step programs. Because the process isn't as widespread or as well-known as various 12-Step options, its overall effectiveness is hard to quantify. Although online meetings make proximity less of an issue, this convenience may also make it more difficult for some people to develop a sense of accountability and belonging.

Stay Open-Minded

In addiction recovery, nothing is more important than individualized treatment. There are numerous techniques that provide an initial approach to quality care. But as the true causation for addiction is revealed through dedicated processes, options for sustaining wellness often vary considerably between each person.

The best way to determine what aftercare program might be beneficial for your needs is to try various options, including different meeting times and locations, to see what you respond to. Keep in mind—a "one and done" approach may not provide all the information necessary to make a quality assessment. You may need to immerse yourself in a program for a couple of months to gain an authentic understanding of the approach and whether it serves you.

Talk with your continuing care provider about the most effective approach for your stages of progress.

By Tracey L. Kelley

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