12 Step Programs: How They Work, Benefits & Criticisms

What are 12 Step Programs?

Alcoholics Anonymous is often interchangeable with the idea of alcohol recovery and long-lasting sobriety.

Founded in 1935 by Bill W. and Doctor Bob Smith, AA’s 12 Step Program became a foundational approach to alcohol recovery. Over the years, the scientific understanding of alcohol abuse, alcohol use disorder (AUD), and substance abuse evolved. 

The 12 Step Program continues to be a supportive part of alcohol recovery. Whether during or after professional treatment and detox, the Twelve Steps are a way for recovering alcoholics to help take control of their recovery.

Addiction treatment experts and the global medical community accept twelve-step programs as a successful treatment tool. The Twelve Step approach has been applied to addictions beyond AUD, including: 

• Drug abuse
• Drug addiction (also called substance use disorder)
• Smoking
• Sex addiction
• Social anxiety
• Overeating
• Compulsive spending
• Gambling (Gamblers Anonymous)
• Narcotics Anonymous (NA)
• Cocaine Anonymous (CA)

What is Alcoholics Anonymous (AA)?

Alcoholics Anonymous (AA) is an international organization, with no formal membership, and a fellowship of men and women recovering from alcohol addiction.

Membership is open to anyone who wants to stop drinking and address their drinking problem.

Led by their 12 Step Program, AA offers meetings and groups around the world. AA meetings allow recovering alcoholics to interact with, learn from, and mutually support others struggling with alcohol use disorder.

“In its simplest form, the AA program operates when a recovered alcoholic passes along the story of his or her own problem drinking, describes the sobriety he or she has found in AA, and invites the newcomer to join the group.”

Alcoholics Anonymous

Why Did AA Create The 12 Steps?

The founders of AA created the 12 Step Program as the organization’s guiding principles.

Bill Wilson based much of the steps on those that influenced him in his recovery journey. The first was the Oxford Group. This evangelical group advocated “The Four Absolutes.” These absolutes were honesty, unselfishness, purity, and love. 

Another influence was the philosopher William James. James believed that spiritual awakening could transform everyone, no matter their situation. This idea became the source of AA’s emphasis on surrendering yourself to a higher power.

The 12 Steps of Recovery Defined by Alcoholics Anonymous

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

While there are Twelve Steps, there is no right or wrong way to follow them.

Recovering from alcohol is a lifelong, individual process. While some may choose to follow the steps in order, others may find it more effective to start in the middle. The steps work as guidelines throughout recovery, with many turning back to revisit steps throughout life.

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The 12 Traditions of AA

Unlike the Twelve Steps that focuses on the individual, the Twelve Traditions speak to AA members as a group.

The Twelve Traditions are as follows:

1. Our common welfare should come first; personal recovery depends upon A.A. unity.
2. For our group purpose, there is but one ultimate authority – a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.
3. The only requirement for A.A. membership is a desire to stop drinking.
4. Each group should be autonomous except in matters affecting other groups or A.A. as a whole.
5. Each group has but one primary purpose – to carry its message to the alcoholic who still suffers.
6. An A.A. group ought never to endorse, finance, or lend the A.A. name to any related facility our outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
7. Every A.A. group ought to be fully self-supporting, declining outside contributions.
8. Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
9. A.A., as such, ought never to be organized; but we may create service boards and committees directly responsible to those they serve.
10. Alcoholics Anonymous has no opinion on outside issues; hence the A.A. the name ought never to be drawn into public controversy.
11. Our public relations policy is based on attraction rather than promotion; we need to always maintain personal anonymity at the level of press, radio, and films.
12. Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.

You Can Still Follow the Twelve Steps Without Being Religious

Because the 12 Step Program is spiritually based, many non-religious alcoholics question if the program is right for them.

As many of the steps refer to God, contemporary programs change this term to “higher power.” This higher power does not need to be of a religious nature. One can look to family, friends, or another outside source as their higher power.

Success Rates of 12 Step Programs

When it comes to 12 Step Programs and their success rates, it often depends on who you talk to. Alcoholics Anonymous reports an average 50 percent success rate. 25 percent remain sober after relapse.

Many recovering alcoholics credit their recovery to the program. In contrast, some people do not benefit from the program as much. The scientific community is just as divided. Because of the anonymous nature of AA, very few studies have looked at the actual success rate. And those that have, offer mixed results. 

For example, a 2009 paper in the Journal of Addictive Diseases found there were two studies showing positive results for AA and the 12 Step Program. They also found one that showed no benefits and one that showed negative findings. However, despite the different findings, the report did show the program provides effectiveness on certain criteria.

Some key points include:

• Rates of abstinence are twice as high among those attending AA and 12-step meetings
• Higher levels of attendance relate to higher abstinence rates
• These relationships were found across different samples and follow-up periods
• Theories of behavioral changes are evident at AA meetings and throughout the steps

Do The 12 Steps Always Work?

On the other side of the spectrum, many see AA and the Twelve Steps as nothing more than pseudoscience.

Dr. Lance Dodes, a retired professor of psychiatry at Harvard Medical School, published the book The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. He points out that there is a large body of evidence that the current AA and Twelve Steps success rates are between five and 10 percent. 

Dodes notes that the idea that God or a higher power will heal a person that believes can be detrimental to believers when the program doesn’t work. In addition, AA and the 12-Step program receive worldwide recognition as the “right” way to give up alcohol. If you fail, Dodes worries that it sends the wrong message to those trying to recover. In the end, Dodes believes it may do more harm than good.

Combining Alcohol Treatment & The 12 Step Program

Recovery from alcohol addiction is an individual process and everyone recovers from addiction in different ways. Residential, inpatient, and outpatient detox programs offer the best place to start. 

Many of these combine the use of a 12 Step program as a guideline to follow during and after recovery. The support people receive from other recovering alcoholics is often just what they need to succeed. 

While 12-step groups may be beneficial for some, others still struggle with the spiritual aspect. In this case, alternative programs offer the same social support without a religious connection.

Other alternative alcohol support groups include:

• SMART Recovery
• LifeRing
• Women for Sobriety (WFS)
• Secular Organizations for Sobriety (SOS)
• Moderation Management (MM)

There is no right or wrong treatment plan and which program you choose should be one you are comfortable with. The goal of these programs is to help people stay alcohol-free and figure out which one works best for their long-term success.