The 12-Step Model for Treating Addiction: The Research and How it Works

Alcoholics Anonymous is the original and best-known example of the 12-Step model, which is a recovery program for people who are addicted to drugs or alcohol. Twelve-Step programs are an integral part of many treatment programs and help countless people recover from an addiction for the long-term. Here, we look at the history of the 12-Step model, outline the steps and benefits and consider what the research says about 12-Step recovery programs.

A History of the 12-Step Model for Treating Addiction

In 1935 the prohibition had just ended. Since people had purportedly not been drinking for the past decade or so, there were few established recovery programs to help people end an alcohol addiction. Bill W., in recovery from a severe alcohol addiction, met Dr. Bob S. through the Oxford Group, a sober fellowship. Bill’s relationship with Dr. Bob helped him achieve sobriety and led him to devote his life to helping others recover from alcoholism. The two men formed the first Alcoholics Anonymous fellowship, and in just four years, 100 men had ended their alcohol addiction through regular AA meetings in three cities. In 1939, Bill wrote Alcoholics Anonymous, known in AA as The Big Book. The book outlined the program’s philosophy and methods.

By 1941, AA’s membership reached 6,000, and by 1950, more than 100,000 people were attending AA meetings across the U.S. and Canada. Today, it’s estimated that more than two million people engage with one of AA’s 117,000 fellowships across the world. The Big Book is currently available in 28 languages.

The Twelve Steps: A Pathway to Personal Transformation Free From Addiction

The 12-Step model is based on a series of steps that lead to greater spirituality, a stronger sense of purpose and authentic happiness in a life of sobriety. It’s a blueprint for moving individuals through a process of change and a fundamental shift in thinking.

“We admitted we were powerless over alcohol [or drugs], that our lives had become unmanageable.”

The first step of the 12-step model is admitting powerlessness over drugs or alcohol. Addiction doesn’t involve choice, and according to the National Institute on Drug Abuse, once an addiction develops, good intentions and willpower are rarely enough to end it for the long-term.1 Addiction is characterized by compulsive substance abuse despite negative consequences, and admitting that you can’t control your drug or alcohol use leaves you willing to “become as open-minded to conviction and as willing to listen as the dying can be,” according to The Big Book.

“We came to believe that a Power greater than ourselves could restore us to sanity.”

The Substance Abuse and Mental Health Services Administration stresses that hope is the foundation of recovery.2 Step Two is all about hope, which is the belief that it’s possible to overcome challenges and live a healthy, happy life according to your values.

Hope, according to The Big Book,is supported by a greater power than oneself. Having faith that something outside of yourself can help you find the strength and motivation to carry on in sobriety is the basis of Step Two. Your Higher Power may be God, Allah, Yaweh or Jah, or it may be the Universe, Love, Family or your deeper spiritual self. The point is that having faith in something larger than yourself can fill you with the strength and resolve you need to pursue long-term recovery.

“We made a decision to turn our will and our lives over the care of God as we understood him.”

Because your Higher Power accepts you unconditionally and operates with eternal compassion, turning your life and will over to this power helps you release your own negative feelings about yourself and treat yourself with more kindness, patience and compassion. Step Three opens you up to new ways of thinking about yourself and your addiction, and it provides spiritual support as you move forward to meet the challenges of recovery.

“We made a searching and fearless moral inventory of ourselves.”

Step Four is about responsibility and accountability. During Step Four, a moral inventory is taken, which involves writing a list of all the ways other people were wronged while addicted. This is meant to be a fearless process, because you’ve already turned your life and will over to your forgiving and compassionate Higher Power. Holding steady in the present moment, judgement is meant to be withheld about wrong deeds. This step is also about the understanding that you have the power to make things right moving forward.

“We admitted to God, to ourselves, and to another human being the exact nature of our wrongdoings.”

Admitting your wrongdoings to your higher power allows you to experience grace and forgiveness, and admitting them to yourself brings you fully out of denial and ready to move forward with a clear head. Admitting out loud to another person the wrongs perpetrated while addicted helps to break down the barriers you’ve built to hide your shame and guilt. The alternative is isolation and stagnancy.

“We were entirely ready to have God remove all these defects of character.”

Guilt, shame, blame, grudges and resentments impede recovery, and when you’re ready to let go of these and other negative states of mind that are holding you back, you’ve mastered Step Six. This step allows for awareness of emotions and the faulty thought and behavior patterns previously followed. This awareness allows for the adjustment of thinking and behavior as needed.

“We humbly asked Him to remove our shortcomings.”

Step Seven is all about the asking. It’s about humility and embracing hope for a better future. When you ask your Higher Power to remove your shortcomings, you commit to continued growth and development as a sober person striving to do what’s right.

“We made a list of all persons we had harmed, and became willing to make amends to them all.”

Step Eight is the first step in the process of repairing the damage done while under the influence of addiction. During this step, a list is written of all of the people harmed while were addicted and notes are made about how you might make it right. Then, you work on becoming ready to make those amends. This begins a process of learning to be honest with yourself and others and forgiving yourself and the people who have hurt you.

“Make direct amends to such people whenever possible, except when to do so would injure them or others.”

With the list from step eight in hand, you set about righting your wrongs wherever possible, and wherever it doesn’t cause more pain. During this step, the last vestiges of guilt, regret and shame fall away, and you no longer feel the need to make excuses. This allows you to move forward in recovery with a clear conscience and a better understanding of how your actions affect others.

“We continued to take personal inventory and when we were wrong promptly admitted it.”

Step Ten finds you in a growth stage. Step Ten has no end point. It’s a lifelong pursuit. During this step, you practice daily vigilance of old patterns, which can easily work their way back into your life while you’re not looking. You continue to become more aware of your emotions, thoughts and behaviors, and you continually assess your state of mind and physical state and make choices that honor your intrinsic values.

“We 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.”

Prayer and meditation keep you connected to your Higher Power and your higher spiritual self. Prayer is direct communication with your higher power, and meditation keeps you rooted in the present moment and brings you closer to your deeper self. Both prayer and meditation foster positive changes in your emotions, thoughts and actions.

“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.”

The final step of the 12-Step model is to commit to the goal of helping others recover from addiction. Having worked through the steps, you’ve achieved emotional stability and mastered mindfulness, and you make good decisions that have a positive impact on your life and the lives of others.

This is the point at which you may choose to become a sponsor to someone just beginning the recovery process. A sponsor can easily see others’ destructive patterns and understand the challenges faced in early recovery. Once you reach this stage of recovery, you’re more motivated than ever to stay sober for the long-haul and continue helping others do the same.

Benefits of 12-Step Programs for Treating Addiction

Ideally, those involved in a 12-Step program will attend a meeting every day. In early recovery, some people may attend more than one meeting each day. The more engaged you are in meetings, the more likely you are to reap the benefits, which are far-reaching. Benefits of the 12-Step model include:

A High Level of Support

Your peers in a 12-Step group know what you’re going through, because they’ve all been there or are there now. A high level of support is central to successful recovery, and meetings provide daily support to help you stay on track with sobriety.

Personal Accountability

Meeting participants hold each other to a high level of personal accountability and responsibility. Excuses and dishonesty are called out, and members help each other navigate challenges and celebrate milestones.

Social Interaction

Early recovery can be an isolating time as you let go of old, unhealthy relationships and develop new, healthier ones. But isolation is a dangerous trigger for relapse. 12-Step meetings provide opportunities to socialize and develop beneficial relationships with other non-users.

Sponsorship

Members of 12-Step groups are provided with a sponsor. A sponsor is someone active in the group who has worked through the steps and can provide a high level of support. Your sponsor is the first person you should call during times of crisis or in the event of a lapse or relapse.

Improved Self-Awareness

The nature of the 12-Step model fosters greater self-awareness as members help each other examine faulty thought and behavior patterns and develop healthier ways of thinking and behaving. Participants in a 12-Step group have had similar experiences, and they can help each other achieve the ability to evaluate emotions and experiences accurately and honestly.

Enhanced Spirituality

Finding a Higher Power can be transformative for many people in recovery. Faith in a higher power, whether that’s God, a spirit guide or your own higher consciousness, helps you see a bigger picture and find a higher purpose for your life. Drawing on the power and strength of a higher entity can lead to greater self-confidence, self-awareness, self-compassion and empathy for others.

Effectiveness of the 12-Step Model for Treating Addiction

The anonymous nature of the 12-Step model makes it particularly challenging to scientifically evaluate the effectiveness of 12-Step groups. However, studies that have been conducted show that the 12-Step model is beneficial to people in recovery, particularly when it’s used alongside a comprehensive treatment program.

A study cited in Alcoholism Treatment Quarterly found that people who attend 12-Step meetings are twice as likely to remain abstinence than those who don’t. 3 A study published in the Journal of Substance Abuse Treatment found that people who engage with a 12-Step program stay in treatment longer and are more likely to complete the treatment program -an important factor in successful recovery.4 The study found that people who engage in both treatment and a 12-Step program are more likely to maintain abstinence than those who engage only in treatment or only in the 12-Step program.

Detractors of 12-Step programs cite its one-size-fits-all approach, and some criticize its central tenet of identifying and relying on a higher power. Indeed, 12-Step programs don’t appeal to or work for every person in recovery, and more secular alternatives do exist, including LifeRing Secular Recovery, Secular Organizations for Sobriety and SMART Recovery.

The 12-Step Model Can Help with Recovery from Addiction

While scientific research into the effectiveness of the 12-Step model is limited, the studies that have been conducted have found that 12-Step programs are effective, especially when used within the context of a high-quality treatment program. That’s why most treatment programs include 12-Step participation in their arsenal of effective therapies and interventions.

A 12-Step group can help you stay focused on recovery, and it gives you an added layer of support from people who understand what you’re going through. Attending meetings every day and participating fully in each meeting will help you grow in recovery and maintain abstinence for the long haul.