12-step programs: definition, steps of recovery, process, and effectiveness

12-step programs are peer-led mutual help groups designed to help individuals quit their addiction to substances and/or unhealthy and dysfunctional behaviors.

The typical 12 steps of recovery are: admitting powerlessness; believing in a higher power; surrendering to a higher power; taking moral inventory; admitting past wrongs; becoming ready for transformation; seeking help; listing amends; making the amends; continuing self-reflection; seeking conscious contact; and carrying the message.

12-step programs work by catalyzing spiritual growth to effect personal transformation. The processes involved include working on the 12 steps; the sponsor acting as a role model; forging supportive bonds with group members; and living a structured life guided by a purpose.

12-step programs are effective in promoting lasting abstinence, enhancing psychosocial capabilities, and improving self-sufficiency.

What are 12-step programs?

12-step programs are self-help mutual support groups that aim to help individuals attain and sustain sobriety by overcoming addiction to substances or dysfunctional behaviors. These programs are led by non-professional peers who form a supportive social network and foster bonds between group members. These programs follow the 12-step methodology, a set of 12 guiding principles designed to catalyze positive behavioral change.

12-step programs are available globally. They offer a readily accessible, no-cost community-based addiction recovery tool to complement conventional treatment practices.

What is the history of 12-step programs?

The history of 12-step programs is inextricably tied to the Alcoholics Anonymous (AA). AA was founded in 1935 by Dr. Bob Smith, a surgeon from Akron, Ohio, and Bill Wilson, an entrepreneur and stockbroker from New York.They both had alcohol addiction and were exploring ways to attain and maintain sobriety. The 12 steps they eventually formulated were inspired by the principles of the Oxford Group, a religious sect that aimed to promote the practice of 1st-century Christianity.

Smith and Wilson published Alcoholics Anonymous: The Story of How More than One Hundred Men Have Recovered from Alcoholism in 1939 outlining their interpretation of 12 steps, shorn of all religious doctrines. Since then, more 12-step programs modeled on AA were founded to address addiction to substances other than alcohol and dysfunctional behaviors.

What is the basic concept of a 12-step program?

The basic concept of a 12-step program is that individuals help one another achieve and maintain abstinence from substance use by sharing their stories to provide insights, support, hope, strength, and inspiration. The philosophy emphasizes developing a spiritual foundation that will affect the personal transformation required for continued abstinence. The 12-step concept is grounded in the tenets of acceptance, personal spiritual growth, minimization of self-centeredness, and service to others to help them attain abstinence.

What are the typical 12 steps of recovery?

The typical 12 steps of recovery are listed below.

1. Admit you are powerless
2. Believe in higher power
3. Surrender to higher power
4. Take moral inventory
5. Admit wrongs
6. Become ready for change
7. Ask for help
8. Make a list of amends
9. Make amends
10. Continue self-reflection
11. Seek conscious contact
12. Carry the message

1. Admit you are powerless

Change starts with the acknowledgment that there is a problem. However, admitting to a problem does not mean admitting to weakness. On the contrary, it is the realization and acceptance that nobody is perfect and the lone individual is powerless in the face of a complex and chronic disease like addiction. Admitting to powerlessness conditions an individual to reach out and seek help.

2. Believe in higher power

Believing in a higher power entails acknowledging the presence of a being more powerful than oneself and one who has the ability to heal those seeking recovery. Such a belief instills hope. The 12 Steps manifesto originally contained the word “God,” which was eventually replaced with “higher power” to remove the religious overtone. The objective was to make the program accessible to everyone regardless of their religious beliefs. The higher power is any entity that is meaningful to the individual in recovery. It is an entity that is outside of them and greater than them or their ego, for instance, nature, the universe, an addiction recovery group, destiny, the healthcare personnel treating them, or their support network.

3. Surrender to higher power

Trying too hard to control the direction of one’s life and enforce specific outcomes is exhausting, stressful, and eventually, futile. Surrendering to a higher power means giving up the urge to control. It is a coping mechanism with multiple benefits. Firstly, it gives a sense of control because the individual makes the “choice” to commit to a specific action. “Choosing” is a way of taking back power from a situation where they had been ruled and directed by their addiction. Choosing, thus gives a sense of personal autonomy.

Secondly, surrendering is liberating because the individual is finally able to get off the rollercoaster ride of trying hard to quit their habits only to find themselves falling back to old, unhealthy behaviors. They derive peace by acknowledging that it is not possible to overcome a complex and chronic disease like addiction on their own. This acceptance opens them up to seeking and receiving help. Lastly, surrendering to and trusting in a higher power instills a sense of hope.

4. Take moral inventory

Taking moral inventory is an act of deep self-reflection and involves taking stock of one’s moral strengths and flaws, honestly, fearlessly, and thoroughly. It is an exercise where the individual reflects on their past behaviors and actions to understand why they behaved in a specific way, made particular decisions, or felt certain emotions while using substances. This helps them identify maladaptive behavioral patterns that contribute to drug use. Taking moral inventory is not just about identifying the negative in oneself. It is also about unearthing one’s strengths that have the potential to become powerful weapons to usher lasting positive change. For instance, self-reflection and attempts to understand oneself better help identify values, goals, and motivations, which then serve as guideposts when making decisions about how to behave.

5. Admit wrongs

Admitting one’s wrongs to oneself, a higher power, or another supportive individual is a daunting step, yet it brings immense relief. Harboring secrets and suppressing feelings of shame and guilt are exhausting and weigh heavily on an individual. This creates an inner state of turmoil and anxiety that individuals tend to cope with by continuing to abuse substances. Furthermore, these feelings prevent them from seeking treatment, thereby perpetuating a vicious cycle. Admitting one’s wrongs is a liberating act and a cathartic experience. The individual is finally able to release their negative thoughts and move forward in their journey of healing.

6. Become ready for change

This step entails accepting that transformation is necessary and becoming ready and willing to do what is needed to move forward in the journey to recovery. The earlier act of releasing the negative emotions of guilt and shame has cleansed their minds. They are now prepared to move ahead in the journey of self-growth and transformation by shedding behaviors, attitudes, and thought processes that are no longer serving them and learning and developing those that will help them heal.

7. Ask for help

In this step, the individual seeks the help of a higher power to remove their shortcomings so that they are able to release the attitudes and behaviors that had contributed to their addiction. This step calls for humility to recognize that one is powerless in the face of addiction and trust in an all-powerful higher power.

8. Make a list of amends

In this step, the individual seeking recovery makes a list of all the people they have harmed, accepts their responsibility for harming or hurting another individual, and expresses their intent to make amends to these people. It is the step where an individual turns the focus away from themselves and their all-consuming need for substances and instead, empathizes with others around them. This is a difficult step but it helps heal estranged relationships and builds stronger and deeper connections where there is acceptance of each other’s imperfections, and love, respect, and empathy despite one’s shortcomings.

9. Make amends

This step involves reconciliation where the individual in recovery attempts to make direct amends to those they have harmed in the past, except those who are likely to be re-wounded or harmed by such attempts. This step aims to repair old wounds and heal the past so that a healthier future begins on a clean slate.

10. Continue self-reflection

This step entails taking responsibility for one’s continued growth. The individual in recovery chooses to forego a past where they had been controlled by their compulsive and impulsive drug-use habits and embrace a present with self-agency and personal accountability. The individual continues to take personal inventory by regularly engaging in self-reflection and promptly admitting when they make a mistake.

11. Seek conscious contact

This step involves spiritual growth where the individual connects with and maintains constant conscious contact with a higher power seeking to receive the knowledge to do what is right and the strength and power to do it. This exercise is an attempt to remain grounded and committed to a sense of purpose that transcends the self. An individual has the liberty to carry out this exercise using any means, such as praying, meditating, or journaling, that they are comfortable with.

12. Carry the message

This step is about serving others and entails sharing the learning, experience, hope, and strength gained during the 12-step journey with others who are struggling with addiction and feeling lost. The individual also continues to practice the lessons they have learned from the 12-step program in all aspects of their lives.

What are the different types of 12-step programs?

The different types of 12-step programs are listed below.

• Alcoholics Anonymous (AA): AA was founded in 1935 and is the pioneer of the 12-step recovery model. Today, it is present in about 180 countries where there are more than 1,23,000 groups with more than two million members. The primary goal of Alcoholics Anonymous is to help its members overcome their drinking problems and maintain lasting sobriety.
• Narcotics Anonymous (NA): NA was founded in California in 1953 and is the second-largest 12-step recovery organization after AA. It has a presence in 144 countries and conducts more than 70,000 meetings. Despite its name, NA membership is not restricted to individuals addicted to narcotics. Narcotics Anonymous welcomes anyone who is addicted to a substance of abuse, including alcohol.
• Pills Anonymous (PA): PA officially began its journey as a charitable, non-profit organization in 2008. However, it is believed that it originated in 1972. It is a mutual help group of individuals addicted to prescription drugs. Pills Anonymous offers a 20-question survey to anyone who wants to find out if they are addicted to pills. Answering “yes” to three or more questions in the survey indicates, according to PA, that the individual is addicted. However, this is not a formal medical diagnosis.
• Cocaine Anonymous (CA): CA was founded in 1982 as a fellowship of individuals who wish to recover from their addiction to cocaine. Although a large number of members of CA are addicted to cocaine, the organization is open to anyone who is addicted to mind-altering substances, such as alcohol and drugs other than cocaine, and wants to quit.
• Crystal Meth Anonymous (CMA): CMA began in 1994 as a fellowship of recovering crystal meth addicts helping each overcome their addiction to methamphetamine. It was founded by Bill C. who was himself a recovering meth addict with 16 years of sobriety in AA.
• Gamblers Anonymous (GA): GA began in September 1957 to help individuals overcome their compulsive gambling habits. The GA offers the Twenty Questions survey to anyone who believes they have a gambling problem. The questionnaire helps them find out if they are compulsive gamblers and then decide if they want to quit the habit.
• Eating Disorders Anonymous (EDA): EDA was started in 2000 by the sober members of AA with the primary purpose of helping individuals recover from eating disorders, either past or current, and sustain their recovery. The EDA focuses on helping individuals identify and make sensible and responsible life choices based on the principles of nutrition without obsessing over body image or being rigid with food choices.
• Overeaters Anonymous (OA): OA is a 12-step mutual help group founded in 1960 to help individuals who struggle with their compulsive overeating and food behaviors and describe themselves as food addicts. These include those with problems like bulimia, anorexia, and obesity. Those seeking help want to recover from their unhealthy relationships with food and negative body image issues.
• Debtors Anonymous (DA): DA helps anyone who is unable to control their spending habits and wants to stop incurring unsecured debt, which typically takes the form of credit card debt. Their habits cause multiple problems in their lives, such as bank checks bouncing, having to pay late fees, and dealing with creditors knocking on their doors.
• Workaholics Anonymous (WA): WA is a 12-step recovery program based in the US for individuals who describe themselves as feeling powerless in the face of their compulsive work, anxiety, or activity. Despite the moniker, WA is not just for overworkers or those who have an activity addiction. They are also for individuals suffering from work aversion, uncontrollable procrastination or work avoidance, and burnout. WA started in the 1980s, and most meetings are held online.
• Dual Recovery Anonymous (DRA): DRA is a fellowship of individuals with a dual diagnosis–the presence of a psychiatric or emotional disorder and chemical dependency. The program focuses on preventing relapse and helping its members enhance the quality of their lives. It is open to anyone recovering from any mental health disorder and any addiction.

How do 12-step programs work?

12-step programs work by triggering behavioral changes through a combination of processes, a number of those being specific to mutual help groups and others, common across different behavioral therapies. Positive transformation occurs through the initiation of a “spiritual awakening” or a “psychic change” that occurs as members work through the 12 steps, according to authors John F. Kelly and Julie D. Yeterian in their 2011 article titled “The Role of Mutual-Help Groups in Extending the Framework of Treatment” published in the journal Alcohol Research & Health.

A powerful mediator of change is believed to be the shift in the social network of the individual in recovery, according to a 2013 article by Donovan et al., published in the journal Social Work in Public Health, titled “12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview.” The other behavior change processes include fostering supportive bonds; providing behavioral standards and structure; instilling meaning; engaging in rewarding and sober activities; and enhancing self-efficacy. The sponsor acting as a role model also acts as an agent of change.

What happens during a 12-step program meeting?

During a 12-step program meeting, there is typically, a welcoming and opening address and an explanation of the 12-step philosophy. A moment’s silence is observed and the Serenity Prayer is recited. The participants undertake a pledge of confidentiality, and it is reiterated that the group is inclusive and membership is free of cost. These activities are followed by readings from the 12-step literature that the particular group adheres to. New members and the speaker for the session are next introduced. The members share narratives of how past drug use affected their minds, bodies, lives, and relationships and what they did to overcome their addictive habits. They also share how they are living a life of recovery now. The meetings usually end with a closing prayer after the collection plate for voluntary donations is passed around. These meetings are generally 60-90 minutes long.

Do you share anything personal at 12-step meetings?

Yes, you share anything personal at 12-step meetings if you are comfortable doing so. Sharing personal stories related to the challenges of addiction and recovery inspires others and invites suggestions, tips, and novel insights. However, it is not mandatory to speak during meetings.

Is spirituality a part of the 12-step programs?

Yes, spirituality is a part of the 12-step programs. However, this spirituality has no religious connotations and only refers to the practice of the highest and finest qualities of the human mind like kindness, service, generosity, honesty, and humility. Spiritual growth, in this regard, is recognized as a change mechanism in 12-step programs, according to a 2013 article by Tonigan et al., published in the journal Substance Use & Misuse, titled “Spirituality as a Change Mechanism in 12-Step Programs: A Replication, Extension, and Refinement.”

What is the role of a 12-step sponsor?

The role of a 12-step sponsor is to act as a guide, mentor, confidant, support system, and accountability partner. They help individuals navigate membership; lend an ear when their sponsees want to confide; and support them, emotionally and practically, when they encounter challenges. Sponsors resolve queries and offer advice, tips, and insights to help their sponsees work on the 12 steps. They introduce their sponsees to new, sober connections, thereby expanding the latter’s abstinence-based social circle. Literature shows that having a sponsor increases 12-step engagement and improves outcomes, according to a 2011 article by Kristina N. Rynes and J. Scott Tonigan published in the journal Psychology of Addictive Behaviors, titled “Do Social Networks Explain 12-Step Sponsorship Effects? A Prospective Lagged Mediation Analysis.”

How can one join a 12-step program?

One can join a 12-step program by visiting the website of the particular 12-step recovery organization they are interested in, locating a group near where they reside, and then, simply showing up to a meeting. If a particular group doesn’t feel right or welcoming after attending a few meetings, an individual is free to search for and join another program or group where the interpersonal dynamics feel more comfortable and the shared stories of personal experiences resonate.

Are there any requirements to attend 12-step programs?

No, there are no requirements to attend 12-step programs. The individual in recovery only needs the desire to stop using drugs or alcohol and the willingness to commit to the recovery journey.

How long does it take to go through the 12 steps?

The time it takes to go through the 12 steps varies for individuals. It is possible to complete all the steps in a few months. However, if an individual encounters challenges during the journey, completing all the 12 steps will likely take several years. Finding a sponsor early during the recovery process who acts as a mentor and guide eases the process of going through the steps and makes it possible for an individual to complete all of them in a shorter duration than someone who chooses to go through the steps themselves.

The time it takes to go through the 12 steps also depends on the commitment of the individual, their readiness for transformation, and the amount of self-reflection they are willing to do. It is possible to never really “finish” going through all the steps. The 12 steps are designed to serve as guideposts to living a drug-free life, which means that individuals will likely revisit a step years after they thought they had mastered it.

How many meetings are required for 12-step programs?

The number of meetings required for 12-step programs varies depending on the progress exhibited by an individual as they go through each step. 12-step sponsors typically encourage newcomers to attend 90 meetings over 90 days, or at least one meeting daily for three months. Attending frequent meetings, for instance, three or more per week, is associated with more favorable treatment outcomes, according to a 2013 article by Donovan et al., published in the journal Social Work in Public Health, titled “12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview.”

Is it possible to complete all the 12 steps?

Yes, it is possible to complete all the 12 steps. It is easy to complete the steps if an individual finds a sponsor early during the treatment and begins working on the steps as soon as they are able to.

Are 12-step programs effective?

Yes, 12-step programs are effective in prolonging the duration of abstinence, according to a 2013 article by Donovan et al., published in the journal Social Work in Public Health, titled “12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview.” Participation in a 12-step program is also associated with an increase in psychosocial functioning and enhanced self-efficiency. More pronounced improvements are noticed when an individual attends meetings more frequently and engages more actively with the group’s members and its activities.

Authors Kelly et al., in their 2020 review titled “Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers” published in the journal Alcohol and Alcoholism compare the effects of treating alcohol use disorder with the 12-step methodology to other non-medical treatments like cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET). It was found that 12-step programs produced similar benefits as CBT and MET when measured for all drinking-related outcomes except continuous abstinence and remission, where the 12-step methodology delivered superior outcomes.

What is the success rate of 12-step programs?

The success rate of 12-step programs is difficult to measure due to the anonymous nature of these organizations. However, authors John F. Kelly and Julie D. Yeterian in their 2011 article titled “The Role of Mutual-Help Groups in Extending the Framework of Treatment” published in the journal Alcohol Research & Health present the findings of a long-term prospective study on treatment outcomes in problem drinkers who received conventional treatment and those who participated in AA programs. It was found that half of the participants who had voluntarily taken part in AA were abstinent at the 1-year and 3-year follow-up points compared to only a quarter of those who received formal treatment. At the 8-year follow-up point, 49% of the AA attendees were abstinent compared to 46% of those who underwent formal treatment.

In a 2009 article titled “Alcoholics Anonymous Effectiveness: Faith Meets Science” that was published in the Journal of Addictive Diseases, author Lee Ann Kaskutas presents the findings from multiple studies on problem drinkers who attended 12-step programs of varying durations. According to one study, more than 70% of those whoattended a 12-step program weekly for 6 months were abstinent at the 2-year follow-up point. In another study, 70% of individuals with an untreated drinking problem who participated in AA programs for 27 weeks or more were abstinent at the 16-year follow-up point.

What are the pros and cons of 12-step programs?

The pros and cons of 12-step programs are listed below.

• A sense of structure: Participating in 12-step group activities creates a sense of structure. Having structure and routine in life helps individuals in recovery feel stabilized, secure, and grounded in a new normal where there is less chaos and more self-control. Being able to take back control of their lives also enhances self-esteem in members who had so long believed that they were powerless to fight addiction.
• Social benefits: Scientific literature mentions that the social support provided by 12-step communities is closely associated with abstinence, according to a 2013 article by Donovan et al., published in the journal Social Work in Public Health, titled “12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview.”Individuals in recovery reduce their interactions with their drug-using peers and instead, find companionship with other members ofthe 12-step group who do not abuse substances. This creates a healthy and supportive social network that promotes and sustains abstinence. They also indulge less in drug-related activities and instead, engage in alternative pursuits that do not involve the use of substances. Additionally, the sponsor and the group members act as role models and accountability partners to help an individual stay on track to sobriety.
• A sense of purpose: Being a part of a 12-step fellowship strengthens the commitment to sobriety and being of service to others. Individuals are thus motivated by a deep sense of purpose that alleviates boredom. Boredom is known to trigger relapse.
• Increased treatment retention: It has been found that individuals who have frequent pre-treatment 12-step involvement are more likely to stay in treatment and also complete it, according to a 2000 report by Robert Fiorentine and Maureen P. Hillhouse published in the Journal of Substance Abuse Treatment, titled “Drug treatment and 12-step program participation: The additive effects of integrated recovery activities.” A longer treatment duration and successful completion of the program are associated with favorable outcomes. So, 12-step programs are able to enhance the efficacy of traditional drug treatments.
• Accessibility: 12-step communities like AA, NA, and CA have a global presence. They have thousands of local groups in hundreds of countries and conduct tens of thousands of weekly meetings. Additionally, they have Internet-based chat rooms and conduct virtual meetings for those members who are unable to attend an in-person meeting. 12-step programs are thus, accessible to individuals across diverse geographies and with varied lifestyles and family, work, and/or school obligations.
• Ease of entry: It is easy to join a 12-step group. An individual just has to show up to a meeting with the intent to stop using substances. No physician referrals are needed. Admittance to a group is also not dependent on the amount of professional care the individual in recovery needs.
• Affordability: 12-step programs are free, making them accessible to all. Although these groups are not alternatives to formal and professional treatment, they are effective aftercare measures for uninsured individuals.
• Lack of universal applicability: Addiction is a complex disease caused by an interplay of diverse biological and psychosocial factors. So, there is no one-size-fits-all approach to addiction treatment. A 12-step program with its rigid structure and methodology fails to address a personalized issue like addiction. For instance, 12-step programs emphasize total abstinence. However, moderation is a more realistically achievable and sustainable goal for specific individuals, which means a 12-step program is unsuitable for their needs, as noted by Annette Mendola and Richard L. Gibson in their 2016 article titled “Addiction, 12-Step Programs, and Evidentiary Standards for Ethically and Clinically Sound Treatment Recommendations: What Should Clinicians Do?” published in the AMA Journal of Ethics.
• Lack of clinical interventions: 12-step groups are not suitable for individuals who require medical intervention to address their drug-use problems, such as those who are manifesting signs and symptoms of addiction. These programs are designed to provide only aftercare addiction recovery support.
• Lack of trained professional guidance: 12-step groups are peer-led programs that operate without professional guidance. So, individuals who need professional and structured addiction recovery support do not benefit from participating in these groups.
• Discomfort with the ideas of powerlessness and surrender: Individuals with specific personality traits and mental makeup are uncomfortable with the implication that they are unable to control the path of their recovery. Admitting powerlessness and surrendering to an invisible power are challenging acts because, in reality, there are ways to practice and develop mental control that influence recovery. The need to surrender and admit to powerlessness has been identified as a potent factor that is likely to act as a barrier to 12-step participation (Donovan et al., 2013).
• Perceived religious connotations and/or high degree of spiritualism: Individuals who are atheists or agnostics are likely to find it challenging to reconcile with the perceived religiosity and/or the high degree of spirituality in the 12-step philosophy (Donovan et al., 2013).
• Unsuitable for individuals who desire privacy: 12-step groups are unsuitable for individuals who do not want to share their life’s stories with a group. They are also not suited to those who are uncomfortable in group environments.

What are the differences between 12-step meetings and group therapy sessions?

The differences between 12-step meetings and group therapy sessions stem from variations in their composition, working principles, leadership profile, therapeutic focus, interventions used, and treatment outcomes. These differences are described in the table below.

Are 12-step programs available in drug rehabs?

Yes, 12-step programs are available in drug rehabs. Rehab facilities are known to provide 12-step programs as an adjunct to other evidence-based treatment modalities like psychoeducation and behavioral therapy.

Rehabs provide 12-step programs because it has been found that there is a synergistic positive effect of formal drug addiction treatment and 12-step involvement, according to a 2000 report by Robert Fiorentine and Maureen P. Hillhouse published in the Journal of Substance Abuse Treatment, titled “Drug treatment and 12-step program participation: The additive effects of integrated recovery activities.” Individuals who successfully complete treatment in drug rehab and concurrently attend 12-step meetings report higher levels of abstinence than those who are either treated at a drug rehab or participate in a 12-step program.