Have 12-Step Programs Outlived Their Usefulness?

Alcoholics Anonymous (AA) was founded in the 1930’s, back when substance use disorder treatment was very rooted in a medical model. AA took off because it helped people in a way that treatment programs of the time didn’t. Since that time, countless 12-Step programs have developed based on the AA model, and countless people have found healing in “the rooms” of these 12-Step programs. There are 12-Step programs for issues from behavioral addictions to the social and emotional impact of dysfunctional family systems.

Treatment has changed exponentially since the early days of AA. Important pieces that were missing in the 1930’s are pretty well integrated into treatment approaches now, nearly 100 years later. It’s not hard to find a therapist or treatment program that looks at well-being through a biopsychosocial spiritual lens. We recognize the role of physical health on a person’s overall well-being, as well as mental, emotional, and social/relationship health. And lots of providers, myself included, consider the impact of spiritual health on well-being. For clarity, I distinguish between spirituality and religion, and I define spirituality fairly loosely as a sense of connection with something greater than your individual self.

One thing that may still be better addressed through 12-Step programs than professional treatment is moral injury, a syndrome that can develop when we’ve contributed to someone else’s harm in violation of our own innate morals, either through action or inaction. Trauma survivors often take responsibility for harm that was never our fault to begin with, but we’re also not perfect. In addition to relinquishing responsibility for harm we were never in a position to prevent, we may need to work through some difficult emotions for parts we’ve played in hurting other people. Some treatment providers recognize and address moral injury, but many don’t.

When I consider the medical model that dominated addiction treatment back when 12-Step programs first came about, it makes total sense to me that 12-Step just worked better. But what about now? I would argue that 12-Step programs still have a lot to offer, and a lot of people are missing out by not giving one of these programs a fair shot. I’ll say more about this in a moment, but first I want to acknowledge that (a) there will never be one approach that’s right for everybody, and (b) for anything to remain helpful over time, it has to evolve.

I’ve already mentioned that 12-Step programs may have more to offer than a lot of treatment approaches in helping people heal from moral injury, but this isn’t the only thing 12-Step offers that treatment doesn’t. 12-Step is often more accessible than treatment. Donations are appreciated to cover costs, but there are no fees for participation in 12-Step meetings and no one is profiting off of your participation. And 12-Step is peer led. There is no hierarchy – no power differential. The experience of showing up for yourself and for each other can’t be replicated in any setting where there’s a provider and a recipient. Some group counseling experiences come close and have similar benefits, but it is absolutely not the same. I believe therapy has an important place in the healing paradigm, and therapy has its limitations.

Some things that put people off from 12-Step programs are the emphasis on God as a source for healing, and the recitations. The twelve steps and twelve traditions are read at every meeting, for example, and there are lots and lots of catchphrases. If you’re unfamiliar with 12-Step culture, these elements can feel rather cult-like. I think it’s important to recognize that “cult-like” doesn’t equate to cult. Lots of people and cultures use guiding principles and mantras to support ideologies. All cultures have norms and expectations and ideologies. One of my favorite 12-Step catchphrases is “take what you like and leave the rest.” A cult isn’t going to share that message and mean it.

As for God, many 12-Step communities practice an inclusive approach. 12-Step groups are as diverse as any other sub-group of a larger population.They may replace the word God with the phrase “Higher Power.” If God fits for you, that’s welcome. If Goddess, Gods, the Universe, or Group of Drunks fits better, that’s welcome too. And people confuse the idea of powerlessness over such and such with the idea of absolute powerlessness: two different things. 12-Step programs are designed to help people hold themselves accountable in a safe and manageable way, with support from community and a Higher Power of your understanding.

If you’re struggling with just about anything and believe it could be helpful to find a community of support, I highly recommend looking into 12-Step programs. If you don’t know what 12-Step program may fit for you, read the 12 Steps of AA and replace the word “alcohol” with whatever it is you’re struggling with (e.g., powerless over my partner, powerless over depression, powerless over my impulses, etc.). Read these 12 steps with an open mind and see if this seems like a path that could offer you something you don’t already have.

Should you choose to try a 12-Step program, do some research to find the one that most closely reflects your needs and commit to attending at least five meetings. This gives you a chance to see past any initial discomfort that may come from experiencing something new and different. Be sure that you’re visiting at least two different groups, as different groups of the same 12 Step program can have completely different vibes and personalities. Having done this, you may decide that 12-Step isn’t for you at all or isn’t for you right now. You may also find a place that feels like hope and home, and becomes a life changing part of your healing journey.