Twelve-step program

A twelve-step program is a set of guiding principles for recovery from addiction, compulsion, or other behavioral problems. Originally proposed by Alcoholics Anonymous (AA) as a method of recovery from alcoholism, the Twelve Steps were first published in the the book, Alcoholics Anonymous in 1939. The method was then adapted, and became the foundation of other twelve-step programs such as Narcotics Anonymous, Overeaters Anonymous, Co-Dependents Anonymous and Emotions Anonymous. As summarized by the American Psychological Association, working the Twelve Steps involves the following.

• admitting that one cannot control one's addiction or compulsion;
• recognizing a greater power that can give strength;
• examining past errors with the help of a sponsor (experienced member);
• making amends for these errors;
• learning to live a new life with a new code of behavior;
• helping others that suffer from the same addictions or compulsions.

Overview

Twelve-step methods have been adapted widely. For example; the effects of Alcoholics Anonymous recovery within the family unit providing improved quality of life resulted in fellowships like Al-Anon; substance-dependent people who did not relate to the specifics of alcohol dependency started meeting together as Narcotics Anonymous; similar groups were formed for sufferers of cocaine addiction, methamphetamine (crystal meth) addiction and other chemical dependencies. Behavioral issues such as compulsion and/or addiction with sex, food, and gambling were found to be solved with the daily application of the Twelve Steps in such fellowships as Gamblers Anonymous, Overeaters Anonymous and Sexual Compulsives Anonymous. Other groups addressing problems with certain types of behaviors include Clutterers Anonymous, Debtors Anonymous and Emotions Anonymous (formerly Neurotics Anonymous). Over fifty fellowships composed of millions of recovery members, all based in the same principles, are found around the world.

History

Further information: History of Alcoholics Anonymous

Alcoholics Anonymous (AA), the first twelve-step program, was founded in 1935 by Bill Wilson and Dr. Bob Smith, known to AA members as "Bill W." and "Dr. Bob", in Akron, Ohio. They established the tradition within the "anonymous" twelve-step programs of using only first names. In 1953 AA gave permission for Narcotics Anonymous to use its Steps and Traditions.

As AA was growing in the 1930s and 1940s, definite guiding principles began to emerge as the Twelve Traditions. A singleness of purpose emerged as tradition five: "Each group has but one primary purpose -- to carry its message to the alcoholic who still suffers." Consequently, drug addicts who do not suffer from the specifics of alcoholism involved in AA hoping for recovery technically are not welcome in "closed" meetings for alcoholics only. The reason for such emphasis on alcoholism as the problem is to overcome denial and distraction. Thus the principles of AA have been used to form many numbers of other fellowships for those recovering from various pathologies, each of which in term emphasizes recovery from the specific malady which brought the sufferer into the fellowship.

The Twelve Steps

These are the original Twelve Steps as published 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.

In some cases, where other twelve-step groups have adapted the AA steps as guiding principles, they have been altered to emphasize principles important to those particular fellowships, to remove gender biased or specific religious language.

The Twelve Traditions

Main article: Twelve Traditions

The Twelve Steps are accompanied by the Twelve Traditions, guidelines for group governance developed by AA during early days in order to help resolve conflicts in the areas of publicity, religion and finances.

Most twelve-step fellowships have adopted these principles as their structural governance. In AA, the empathetic desire to save other alcoholics resulted in an exclusive emphasis on service to other sufferers, which led to the third tradition, the only requirement for AA membership is the desire to stop drinking. The Twelve Traditions of Alcoholics Anonymous are as follows.

1. Our common welfare should come first; personal recovery depends upon AA 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 AA membership is a desire to stop drinking.
4. Each group should be autonomous except in matters affecting other groups or AA as a whole.
5. Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.
6. An AA group ought never endorse, finance, or lend the AA name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
7. Every AA 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. AA, as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
10. Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.
11. Our public relations policy is based on attraction rather than promotion; we need 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.

Process

Twelve-step programs symbolically represent human structure in three dimensions: physical, mental, and spiritual. The disorders and diseases the groups deal with are understood to manifest themselves in each dimension. For addicts and alcoholics the physical dimension is best described by the "allergy-like bodily reaction" resulting in the inability to stop using substances after the initial use. For groups not related to substance abuse the physical manifestation could be much more varied including, but not limited too: agoraphobia, apathy, distractibility, forgetfulness, hyperactivity, hypomania, insomnia, irritability, lack of motivation, laziness, mania, panic attacks, poor impulse control, procrastination, self-injury, suicide attempts, and stress. The illness of the spiritual dimension, in all twelve-step groups, is considered to be self-centeredness. This model is not intended to be a scientific explanation, it is only a perspective that twelve-step organizations have found useful.

The process is intended to replace self-centeredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action. In twelve-step groups, this is known as a spiritual awakening or religious experience. This should not be confused with abreaction, which produces dramatic, but ephemeral, changes. In twelve-step groups, "spiritual awakening" is believed to develop, most frequently, slowly over a period of time.

In accordance with the First Step, twelve-step groups emphasize self-admission by members of the problem they are recovering from. It is in this spirit that members often identify themselves along with an admission of their problem, e.g. "Hi, I'm Wendy and I'm an alcoholic." Such catchphrases are now widely associated with support groups.

Sponsorship

"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 NA's Sponsorship, Revised

A sponsor is a more experienced person in recovery who guides the less-experienced aspirant ("sponsee" or variously, "sponsoree") through the program. New members in twelve-step programs are encouraged to secure a relationship with at least one sponsor. Publications from twelve-step fellowships emphasize that sponsorship is a "one on one" relationship of shared experiences focused on working the Twelve Steps.

Sponsors and sponsees participate in activities that lead to spiritual growth. These may include practices such as literature discussion and study, meditation and writing. Completing the Twelve Steps implies being competent to sponsor to newcomers in recovery.

Sponsees typically do their Fifth Step with their sponsor. The Fifth Step, as well as the Ninth Step, have been compared to confession and penitence. Many, such as Michel Foucault, noted such practices produce intrinsic modifications in the person—exonerating, redeeming and purifying them—it unburdens them of their wrongs, liberates them and promises their salvation.

The personal nature of the behavioral issues that lead to seeking help in twelve-step fellowships results in a strong relationship between sponsee and sponsor. As the relationship is based on spiritual principles, it is unique and not generally characterized as "friendship." Fundamentally, the sponsor has the single purpose of helping the sponsee recover from the behavioral problem that brought the sufferer into twelve-step work, which reflexively helps the sponsor recover.

A study of sponsorship as practiced in Alcoholics Anonymous and Narcotics Anonymous found providing direction and support to other alcoholics and addicts correlates with sustained abstinence for the sponsor, but that there were few short-term the benefits for the sponsee.

Effectiveness

See also: Alcoholics Anonymous: Effectiveness, Crystal Meth Anonymous: Effectiveness, Emotions Anonymous: Effectiveness, Gamblers Anonymous: Effectiveness, Nicotine Anonymous: Effectiveness, Self-help groups for mental health: Effectiveness, and Effectiveness of Alcoholics Anonymous

Evaluating the effectiveness of twelve-step programs has been difficult, based on the relative paucity of well-controlled, peer-reviewed studies. The non-professional nature of most 12-step programs also limits the opportunities for effectiveness studies. In some cases, professional treatment facilities, such as those at the Palo Alto Veterans Administration Hospital in California, incorporate 12-step programs into their addictions rehabilitation programs. Although these 12-step programs are run by professional therapists and, therefore, cannot be directly compared with community-based AA or NA groups, some studies have been carried out to compare the results of these programs with other techniques. In a study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at ten Departments of Veteran Affairs medical centers around the United States, five of which were based on twelve-step principles, but run by professional therapists, and five used cognitive-behavioral therapy. Over 45% of the men in enrolled in the inpatient professional twelve-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy.

Criticism

For more details on this topic, see the related sections in the following articles: Alcoholics Anonymous: Criticism and controversy, Celebrate Recovery: Criticism, Emotions Anonymous: Criticism, Gamblers Anonymous: Criticism, Narcotics Anonymous: Controversies, Overeaters Anonymous: Criticism, Self-help groups for mental health: Criticism and Sexaholics Anonymous: Criticism

The criticisms of twelve-step groups are as varied as the pathologies they address. People have attended twelve-step meetings, only to find success eluded them. Their varied success rate, and the belief in a Higher Power suggested in them, are common criticisms of their universal applicability and efficacy.

Confidentiality

The Twelve Traditions ask members to respect each other's confidentiality, but there are no legal consequences to discourage those attending twelve-step groups from revealing information disclosed during meetings. Statutes on group therapy do not encompass those associations that lack a professional therapist or clergyman to whom confidentiality and privilege might apply. Physicians who refer patients to these groups, to avoid both civil liability and licensure problems, should alert their patients that, at any time, their statements made in working through the Twelve Steps might be disclosed.

Cultural identity

One review of twelve-step programs warned of detrimental iatrogenic effects of twelve-step philosophy, and labeled the organizations as cults. However, a further study concluded that these programs bore little semblance to religious cults because the techniques used appeared beneficial. Another study found that a twelve-step program's focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity replacing it with the deviant identity. A survey of twelve-step group members, however, found they had a bicultural identity and saw twelve-step programs as a complement to their other national, ethnic, and religious cultures.

See also

• Addiction recovery groups
• Drug rehabilitation
• Group psychotherapy
• List of twelve-step groups

• Rehabilitation
• Self-help groups for mental health
• Treatment

Further reading

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