Twelve Step Programs

The Twelve Step program started with Alcoholics Anonymous in 1935, and has grown to include programs directed at a number of addictions to substances or behaviors, including over-eating, gambling, sex addiction, co-dependency, hoarding, debting, work, and specific drugs (crystal meth, cocaine, marijuana, etc.). In fact, there are more than 200 different programs using the Twelve Steps to help people with life problems.

Auxiliary groups such as Al-Anon, Nar-Anon, and Adult Children of Alcoholics (ACA or ACOA) for friends and family of alcoholics and addicts,  address the effects of growing up or living in an alcoholic or otherwise dysfunctional family. These programs are not about the addict/alcoholic, they are about the traumatic imprint that the alcoholic/addict has left on others.

The Twelve Step program is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioral problems. The Twelve Steps were first published in the 1939 book "Alcoholics Anonymous," largely written by A.A. co-founder Bill Wilson.

This book, also known as the "Big Book" of A.A. has had a profound impact on the world. The Big Book is one of the best-selling books of all time, having sold 30 million copies, as of 2009. In 2011, Time magazine placed the book on its list of the 100 best and most influential books since 1923 (Time magazine's first year in print). In 2012, the U.S. Library of Congress designated it as one of the 88 "Books that Shaped America".

In brief, the Twelve Step process involves the following:

• admitting that one cannot control one's alcoholism, addiction or compulsion;
• recognizing a higher power that can give strength;
• deep self-examination of one's past wrong-doings and sharing this experience with a sponsor,
• identifying "character defects" that led to these wrong-doings
• becoming willing to change these character defects and striving to do so,
• making amends to those who have been hurt or wronged by past behaviors,
• learning to live a new life with a new code of behavior,
• helping others who suffer from alcoholism, addictions or compulsions.

Among the keys to success of the Twelve Step program is the mutual support provided by the program. its membership is collectively known as "the fellowship" and it provides a wide network of supportive and understanding fellow alcoholic/addicts in recovery ("only an alcoholic/addict can understand another alcoholic/addict"). This support is most evident in the "sponsor" system.

Every Twelve Step member is encouraged to get a sponsor, which is another member with some significant recovery time and experience. "Sponsors share their experience, strength, and hope with their sponsees... A sponsor's role is not that of a legal adviser, a banker, a parent, a marriage counselor, or a social worker. Nor is a sponsor a therapist offering some sort of professional advice. A sponsor is simply another addict in recovery who is willing to share his or her journey through the Twelve Steps" (From the 12 Step program "Questions and Answers on Sponsorship" pamphlet, available at for free download from Alcoholics Anonymous World Services (Click Here).

Probably the most prolific misconception about Twelve Step programs is that they are religion-based. To be fair, the Big Book mentions "God" frequently, but makes it abundantly clear that the program is inclusive of all beliefs and customs, including atheists and agnostics. Rather than religion, the program is based on "spirituality," which has proven to be a tremendously successful approach to treating addictions of all kinds.

For an explanation of what is meant by "spirituality" and why it's applicable to treating addictions - from the medical perspective - see "Why do they call alcoholism / addiction a spiritual sickness?" (Click Here).

An overwhelming volume of research studies since 2005 have shown the Twelve Steps to be the most effective program there is for treating alcoholism and addictions, both in the short- and long-term. I can provide anyone who is interested with a reference list upon request.

There is also some confusion around which meeting is appropriate to attend for people who are addicted to more than one substance. While I have been unable to find any data on the subject, it would appear that a large proportion of alcoholics are also addicted to other substances or behaviors. Because of this, many A.A. members are also drug addicts, and many N.A. members are also alcoholics. The correct thing to do is for people to join the fellowship they are most comfortable being a part of.

The main strength recommending the Twelve Step program is its time-tested and research-proven effectiveness. As well, members who have worked the Twelve Steps widely report a peace of mind and ability to function in relationships and in life that is better and more functional than they have ever previously known, even before their addiction. "I came to the Twelve Steps looking for sobriety but I found so much more."

In terms of weaknesses, I would include the abundant use of the word "God" in the A.A. literature, especially the Big Book. Although the text is clear that anyone's beliefs or convictions fit with the program (it is truly an all-inclusive and accepting program), the appearance of the word "God" is uncomfortable for some people. Fortunately, most people see past this, and there are many such people - including agnostics and atheists - who feel very much at home in the program.

Another weakness that I see in the program is what I would call insufficient recognition of co-morbidity in addictions (the presence of other mental health illness). Well over half of people with addictions suffer other mental health problems, and addictions and mental health illness are closely tied together genetically and in terms of other causes (see "The Link BetweenMental Health and Alcoholism / Addiction" Click Here). To be fair, the program encourages "seeking outside help" from doctors and counsellors for such issues.

I would suggest that anyone who suffers from addiction to alcohol or other substances, or to addictive behaviors, and cannot stop but has a desire to do so attend a Twelve Step meeting to see what they have to say. I also suggest that they follow the advice of the program by "keeping an open mind" while they do so.

For more information on the Twelve Step programs, they each have an official website. Alcoholics Anonymous (Click Here), Narcotics Anonymous (Click Here), Cocaine Anonymous (Click Here), Gamblers Anonymous (Click Here), and Al-Anon (Click Here) are among the more commonly sought out. As well, each program has local websites with meeting lists and contact info.



To learn more about understanding the science and psychology of addiction and recovery, see the author's book The Alcoholic / Addict Within.

Available for sample or purchase in paperback (Click Here) and ebook (Click Here).