These support programs can be an invaluable resource for some people in recovery. But they don't work for everyone, and 12-step programs alone are not an adequate substitute for evidence-based medical treatment for addiction.
Accessing evidence-based treatment for addiction is incredibly difficult. And even after overcoming the barriers to beginning treatment, ongoing social support is essential to a life in recovery.
Twelve-step programs are a widespread, free resource that can help support an individual’s recovery. These peer-support programs, like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), often incorporate a spiritual element, and are built on the notion that participants must “admit that they’re powerless over a substance.”
While such programs are often viewed as a classic method to “treat” addiction, it is important to clarify that these programs are not themselves evidence-based medical treatment for addiction. And just as with other types of addiction support, 12-step programs may not be right or appropriate for every person with a substance use disorder . Ultimately, programs like these are one of many forms of support for individuals in recovery, and are often recommended in combination with other interventions such as therapy or medications.
What is a 12-step program?
Twelve-step programs provide a course of action for recovery, in which participants proceed through twelve progressive actions. Twelve-step programs focus on anonymity, regularly-scheduled meetings, connection between members for support (usually via telephone), and sponsorship, which is a mutually beneficial relationship in which an experienced member provides support to another member. All 12-step fellowships are based on and adapted from the 12-step recovery program of Alcoholics Anonymous put forth in the Big Book, 12 Steps, and 12 Traditions. Many 12-step programs are centered around some form of spirituality or recognition of a higher power, though this is not a requirement for attendance or participation. Meetings vary widely in format both from group to group and from meeting to meeting, but generally include a discussion of one of the twelve steps, sharing of personal stories of recovery, reading of twelve-step literature, and prayer.
Twelve-step programs are found widely throughout both the US and the world. Since the creation of Alcoholics Anonymous (AA) in 1935, the number of programs (such as Narcotics Anonymous, Crystal Meth Addicts Anonymous, Overeaters Anonymous, etc.) has grown rapidly, as has the number of groups and attendees. By AA’s own figures, there are currently approximately 120,300 AA groups worldwide, and 2,087,840 active members.
Twelve-step programs are one form of self-help group for substance use. Self-help groups/organizations refer to any non-professional, peer-operated organization devoted to helping individuals with substance use-related problems, including groups that are non-religious or do not follow the 12-step philosophy. Little research exists on the effectiveness of non-12-step self-help groups.
Benefits of 12-step programs
For those with substance use disorders, 12-step programs can be a useful place to find support regarding the use of alcohol, narcotics, maintained methadone treatment, or other substances. Many people state that their participation in a 12-step program literally saved their life, and the number of groups around the world continues to grow. On their own, these programs have been shown to increase both adult and adolescent abstinence over the short and long-term, though such research is limited. More rigorous research has showed that 12-step programs paired with treatment enhances long-term recovery outcomes, as compared to similar programs without the twelve-step group component.
Participating in 12-step programs has also been shown to reduce patient use of outpatient and inpatient mental health services. While this may save individuals money, it is critical to understand that 12-step programs are not a replacement for professional mental health services.
Although 12-step programs are not the same as medical treatment for addiction, they may be the only means of support for individuals without healthcare coverage or other support. Therefore, these programs can play a critical role in recovery for individuals, whether or not they are engaged in formal addiction treatment.
Additionally, participation in 12-step programs has been shown to act as a buffer to stress, potentially by giving participants hope, emotional support, and a sense of control or security, leading to increased life satisfaction. Research demonstrates that attending 12-step group meetings after initiating evidence-based SUD treatment improves outcomes and can help reduce health care costs.
Limitations of 12-step programs
While 12-step programs can serve as a tool for some individuals in recovery (or may be the individual’s primary support mechanism), 12-step programs do not constitute evidence-based addiction treatment. While individual experiences vary, overall 12-step programs used alone are not very effective at improving substance use outcomes and instead should be paired with behavioral or medical treatments as determined by a medical professional. This can greatly increase the program's efficacy and long-term benefits.
Additionally, 12-step programs have been criticized due to members’ experiences while using medications under the advice of a medical professional, particularly in the case of medications for addiction treatment (MAT). While the 12-step literature allows for the use of medications as directed by a healthcare professional and some groups openly welcome individuals using MAT, others maintain the misconception that medication as treatment is another form of addiction, or a ‘crutch’ for recovery, and therefore such groups hold and perpetuate negative attitudes and incorrect information about the use of MAT. This can create shame and fear among attendees and reduce likelihood of using MAT, despite proven effectiveness and medical advice, which can be harmful to individuals and the addiction treatment system.
Twelve-step programs may not be right for all individuals seeking support. Twelve-step programs place a strong emphasis on spirituality, which may alienate some members. Similarly, a common reason individuals stop attending 12-step meetings is a lack of fit, or feeling that 12-step programs are not relevant to them personally. Twelve-step programs are just one form of social support following SUD treatment – just as each individual’s recovery is unique, so too is the support they will most appreciate following treatment. When selecting a support group, individuals should consider different options.
Twelve-step programs represent a valuable support resource for many in recovery. However, it is critical to distinguish between evidence-based behavioral and medical interventions, and supportive services (which can include 12-step programs). Treatment providers can encourage 12-step involvement during treatment as one potential mechanism for recovery support, recognizing such groups may not be right for all individuals. There are several forms of evidence-based treatment available to those struggling with addiction, and it is important that any individual with a substance use disorder receive an assessment by a medical professional and an individualized biopsychosocial treatment plan to determine how best to manage their condition.
Twelve-step programs represent one of many support resources for people in recovery, but should be used in conjunction with medical treatment for the best outcomes in order to increase the likelihood of individuals recovering to live healthy lives.