What is 12-step rehab?
The 12-Step philosophy pioneered by Alcoholics Anonymous is used by about 74 percent of treatment centers. The basic premise of this model is that people can help one another achieve and maintain abstinence from substances of abuse, but that healing cannot come about unless people with addictions surrender to a higher power. The 12-Step movement can be a force for good for many people, but some struggle with the religious basis of the program. Most addiction treatment programs offer alternatives to 12-Step methodology for those who are opposed to the idea of a higher power.
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One of the most well-known and commonly used types of recovery support is the12-Step model. Just about everyone has heard of these meetings or of the organization that originated the idea – Alcoholics Anonymous.
Twelve-Step programs remain a commonly recommended and used treatment modality for various types of addiction. According to the Substance Abuse and Mental Health Services Administration (SAMSHA) in its National Survey of Substance Abuse Treatment Services from 2013, 12-Step models are used, at least occasionally, by approximately 74 percent of treatment centers.
The History of the 12-Step ProgramAlcoholics Anonymous (AA) originated the idea for the 12-Step model in 1938, when founder Bill Wilson wrote out the ideas that had been developing through his experience with and vision of alcoholism. He wrote about the positive effects experienced when people struggling with alcoholism shared their stories with one another.
The 12-Step PracticeThe basic premise of the 12-Step model is that people can help one another achieve and maintain abstinence from the substances or behaviors to which they are addicted. They can do this through meetings in which they share their experiences with one another and support each other in the ongoing effort of maintaining abstinence.
In research, as seen in a recent article from the journal Addiction Research and Theory, abstinence practices (as supported by 12-Step programs) can account for high levels of what experts call flourishing, which is positive mental health and can contribute to longer-term recovery. In the study, those who maintained abstinence were more likely to flourish in the long-term, with 40.7 percent flourishing after three months (as compared to 9.3 percent languishing) and nearly 40 percent flourishing after 12 months (compared to 12.4 percent languishing). Based on this study, those who abstain altogether from substances – as advised in the 12-Step model – have better mental health outcomes than those who don’t abstain.
The 12-Step model gives people a framework from which to surrender their addiction, process their experience, and move forward into new patterns. As described in an article on Psych Central called Recovery Using the 12 Steps, following the model assists an individual by helping build the following mental and emotional transformative practices and tools:
- The ability to recognize and admit that one is experiencing an addiction problem
- A surrender to the fact that the addiction exists and a decision to seek control through an outer guide
- Self-observation and awareness of the behaviors that were part of and arose from the addiction, as well as those that help promote self-restraint
- A chance to practice that restraint and build self-esteem in one’s positive capabilities
- Achievement of self-acceptance and the ability to change behaviors
- Compassion, both for those who have been affected by the addiction and for others who similarly struggle with addiction
- Tools that make the process a continual practice throughout the individual’s life
By providing these experiences and tools, the 12-Step model can be a method for change in many types of behavior. As a result, it can help individuals who wish to overcome addiction to find a path to recovery.
The 12 Steps, as outlined in the original Big Book and presented by AA are:
- Admitting powerlessness over the addiction
- Believing that a higher power (in whatever form) can help
- Deciding to turn control over to the higher power
- Taking a personal inventory
- Admitting to the higher power, oneself, and another person the wrongs done
- Being ready to have the higher power correct any shortcomings in one’s character
- Asking the higher power to remove those shortcomings
- Making a list of wrongs done to others and being willing to make amends for those wrongs
- Contacting those who have been hurt, unless doing so would harm the person
- Continuing to take personal inventory and admitting when one is wrong
- Seeking enlightenment and connection with the higher power via prayer and meditation
- Carrying the message of the 12 Steps to others in need
Since its origin with AA, the 12-Step model has been adopted and altered by many groups to fit other programs – for addiction treatment and otherwise. Many groups, like Narcotics Anonymous, use the steps exactly as they were conceived by AA. Others have modified the steps to fit their own needs and cultures.
For example, a Native American group has combined the 12 Steps with the Native American concept of the Medicine Wheel to create a program designed specifically to help indigenous Americans who struggle with alcoholism and addiction, the Medicine Wheel and 12 Steps program. Others have come up with similar ideas to integrate the basic ideas of the 12 Steps into a cultural framework that makes sense for members of that culture.
Another variation comes from the fact that some people are uncomfortable with the specific, religious aspects of the 12-Step program. As stated above, and as evident by the steps themselves, the 12-Step model originated from a Christian point of view. Those who are not Christian have modified the steps to refer to their specific religious or spiritual practice as a way to connect more with the structure of the 12-Step program. In addition, a number of non-religious 12-Step groups have modified the steps to fit a secular model that can help those who are agnostic or atheist practice the program without feeling forced to adhere to a religion they don’t believe in.
According to the National Institute on Drug Abuse’s Principles of Drug Addiction Treatment: A Research-Based Guide, short-term residential programs developed the idea of using a modified 12-Step approach to provide a shorter stay in treatment that included follow-up through a 12-Step fellowship. This is seen as a way to provide the important post-treatment structure that helps people maintain long-term recovery.
Other programs have also incorporated the 12 Steps, both by encouraging clients to attend 12-Step fellowship meetings, and by incorporating 12-Step ideas into their practices. While 12-Step facilitation programs don’t necessarily follow the steps, they promote the use of a 12-Step methodology, in the hope that clients will move to a 12-Step program after rehab to help maintain sobriety.
In addition, certain treatment centers base their model for service around some of the ideas promoted through the 12-Step program. These centers can offer research-based services and promote a more scientific understanding of addiction treatment, but they incorporate some of the spiritual, psychological, and practical practices that the 12-Step program promotes. This results in an encompassing model of care designed to support clients through rehab and to give tools that they can use after treatment to maintain their recovery for the long-term.