What Is the 12-Step Model?
The 12-step model is an addiction treatment program where participants complete 12 steps for recovery and, ideally, long-lasting sobriety.1 This model is the basis for programs such as Alcoholics Anonymous, Narcotics Anonymous and many more. Today, those struggling with all types of addictions use the 12 steps as a means to make peace with themselves and others in order to mend past hurts of substance abuse.
History of the 12-Step Model
The 12-step model has its origins in the early 20th century with a movement from the Oxford Group. This is a religious group that used some of the steps that would become the 12 steps to take an inventory of one’s self and make improvements.
The Evolution to Addiction Recovery
The steps were further developed when several men who were struggling with alcoholism in the mid-1930s started to use the steps from the Oxford Group to get sober. As more and more men were able to achieve sobriety, a recovering alcoholic named Bill Wilson started to gather a group of people together who had struggled with substance abuse and work through the steps. Bill had looked into moving the program to a nearby hospital but was met with resistance.
Ultimately, he and Dr. Robert Holbrook Smith secured funding to start a recovery hospital. They used this work to also write a book that would be published in 1939. The book was titled “Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism.”
While some organizations may alter the wording for their purposes, especially that of the first step, the steps have remained the same otherwise since this time.
How Does the 12-Step Model Work?
Participation in a 12-step program starts with attending a 12-step meeting. These meetings are usually led by a therapist or other group members. The therapist may speak on a specific topic and also encourages those attending to speak about their experiences, struggles and successes in achieving sobriety.
Many 12-step programs, including Alcoholics Anonymous and Narcotics Anonymous, encourage participants to find a sponsor, who acts as a mentor and accountability partner, to ensure that a person has a go-to mentor who can answer questions about the 12 steps.
Ideally, a person will attend 12-step meetings every week to experience the benefits of mentorship and sharing in each other’s struggles and challenges. It is important that participants know anonymity is vital to the participation process.4
Only first names are used in the meetings. Participants who see each other in public likely will not acknowledge how they know each other. This anonymity ideally encourages others to participate in the program without fear of friends or loved ones finding out if a person wants to protect their anonymity.
Misconceptions About the 12-Step Model
A common misconception surrounding the 12-step model is that a person must believe in God or be a Christian to participate in or benefit from the program. While it’s true the foundation of the program comes from a belief in a higher power, there are many variations of the program available for those who do not wish to pursue a religious-influenced program.
Another common misconception surrounding 12-step participation is that those who participate are like a “cult” and people may have difficulties getting into or leaving a group.
While those who participate in 12-step groups do tend to have close relationships, this is mostly because they have a shared experience of drug or alcohol abuse. Participation in the group is largely voluntary, save for those who must participate via court-ordered mandate.
It’s the only Solution
A final misconception is that participation in a 12-step program can “fix” anyone. The truth is that not all people find a 12-step program resonates with them. They may not identify with the 12 steps or find they enjoy the structure of the meetings. If this is the case, there are other program and counseling types that a person should try.
Just because they do not respond to a 12-step program doesn’t mean they won’t like another approach that can help them receive additional support to quit abusing drugs and alcohol for good.
Effectiveness of the 12-Step Model
According to The American Psychiatric Publishing Textbook of Substance Abuse Treatment, several large-scale studies have shown that regular attendance at 12-step meetings is associated with “good” substance abuse outcomes. One study cited was the MATCH trial, which compared the substance use outcomes for those with an alcohol disorder who participated in 12-step, cognitive behavioral or motivational enhancement programs. The researchers found that attending regular 12-step meetings frequently in the first three months were associated with greater long-term abstinence result.
A separate study for Narcotics Anonymous also found similar results. According to the book, people who attended 12-step groups for drug disorders on a weekly basis were more likely to maintain their abstinence at the six- and 24-month marks.
In addition to supporting studies on the benefits of 12-step programs, the authors from the American Psychiatric Association also found that there was a strong correlation between 12-step program participation and certain behaviors. These include regular attendance at 12-step meetings, identifying one’s self as a member of a 12-step group and an acceptance of the 12-step ideology.2 In addition, researchers found that participants who believed in the idea that it isn’t possible to use drugs in a non-problematic way experienced better results.
Conversely, researchers have studied people who participated in 12-step groups, yet were not successful. Clients who delayed their entrance into a 12-step program by a year or more were less likely to experience positive results. Patients who did not participate in long-term 12-step programs, such as those who dropped out after several months of participation, were also less likely to maintain their sobriety.