Twelve-step program

A twelve-step program is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioral problems. Originally proposed by Alcoholics Anonymous (AA) as a method of recovery from alcoholism,[1] the Twelve Steps were first published in the 1939 book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism.[2] The method was adapted and became the foundation of other twelve-step programs.

As summarized by the American Psychological Association, the process involves the following:[1]

admitting that one cannot control one's alcoholism, addiction or compulsion;
coming to believe a higher 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 who suffer from the same alcoholism, addictions or compulsions.

Overview

Twelve-step methods have been adapted to address a wide range of alcoholism, substance-abuse and dependency problems. Over 200 self-help organizations—often known as fellowships—with a worldwide membership of millions—now employ twelve-step principles for recovery. Narcotics Anonymous was formed by addicts who did not relate to the specifics of alcohol dependency.[3]

Demographic preferences related to the addicts' drug of choice has led to the creation of Cocaine Anonymous, Crystal Meth Anonymous and Marijuana Anonymous. Behavioral issues such as compulsion for, and/or addiction to, gambling, crime, food, sex, hoarding, getting into debt and work are addressed in fellowships such as Gamblers Anonymous, Overeaters Anonymous, Sexaholics Anonymous and Debtors Anonymous.

Auxiliary groups such as Al-Anon and Nar-Anon, for friends and family members of alcoholics and addicts, respectively, are part of a response to treating addiction as a disease that is enabled by family systems.[4] Adult Children of Alcoholics (ACA or ACOA) addresses the effects of growing up in an alcoholic or otherwise dysfunctional family. Co-Dependents Anonymous (CoDA) addresses compulsions related to relationships, referred to as codependency.

History

Alcoholics Anonymous (AA), the first twelve-step fellowship, was founded in 1935 by Bill Wilson and Dr. Robert Holbrook Smith, known to AA members as "Bill W." and "Dr. Bob", in Akron, Ohio. In 1946 they formally established the twelve traditions to help deal with the issues of how various groups could relate and function as membership grew.[5][6] The practice of remaining anonymous (using only one's first names) when interacting with the general public was published in the first edition of the AA Big Book.[7]

As AA chapters were increasing in number during the 1930s and 1940s, the guiding principles were gradually defined 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".[8] 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 unless they have a desire to stop drinking alcohol.[9]

The principles of AA have been used to form many numbers of other fellowships specifically designed for those recovering from various pathologies; each emphasizes recovery from the specific malady which brought the sufferer into the fellowship.[10]

Twelve Steps

The following are the original twelve steps as published by Alcoholics Anonymous:[11]

We admitted we were powerless over alcohol—that our lives had become unmanageable.
Came to believe that a power greater than ourselves could restore us to sanity.
Made a decision to turn our will and our lives over to the care of God as we understood Him.
Made a searching and fearless moral inventory of ourselves.
Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Were entirely ready to have God remove all these defects of character.
Humbly asked Him to remove our shortcomings.
Made a list of all persons we had harmed, and became willing to make amends to them all.
Made direct amends to such people wherever possible, except when to do so would injure them or others.
Continued to take personal inventory, and when we were wrong, promptly admitted it.
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.
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, step one is uniquely different for each organization, for example in Overeaters Anonymous, the first step reads, "We admitted we were powerless over compulsive overeating- that our lives had become unmanageable." The first step is also sometimes altered to emphasize principles important to those particular fellowships, or to remove gender-specific pronouns language.[12][13][14][15]

Twelve Traditions

The Twelve Traditions accompany the Twelve Steps. The Traditions provide guidelines for group governance. They were developed in AA in order to help resolve conflicts in the areas of publicity, politics, religion and finances.[16] Alcoholics Anonymous' Twelve Traditions are:[7]

Our common welfare should come first; personal recovery depends upon AA unity.
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.
The only requirement for AA membership is a desire to stop drinking.
Each group should be autonomous except in matters affecting other groups or AA as a whole.
Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.
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.
Every AA group ought to be fully self-supporting, declining outside contributions.
Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
AA, as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.
Our public relations policy is based on attraction rather than promotion; we need always to maintain personal anonymity at the level of press, radio, and films.
Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.

Process

In the twelve-step program, the human structure is symbolically represented in three dimensions: physical, mental, and spiritual. The problems 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 compulsion to continue using substances after the initial use.[17][18] The statement in the First Step that the individual is "powerless" over the substance-abuse related behavior at issue refers to the lack of control over this compulsion, which persists despite any negative consequences that may be endured as a result.[19]

The mental obsession is described as the cognitive processes that cause the individual to repeat the compulsive behavior after some period of abstinence, either knowing that the result will be an inability to stop or operating under the delusion that the result will be different. The description in the First Step of the life of the alcoholic or addict as "unmanageable" refers to the lack of choice that the mind of the addict or alcoholic affords concerning whether to drink or use again.[20]

The illness of the spiritual dimension, or "spiritual malady," is considered in all twelve-step groups to be self-centeredness.[17][18] The process of working the steps is intended to replace self-centeredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action.[18] In twelve-step groups, this is known as a spiritual awakening.[21] This should neither be confused with abreaction, which produces dramatic, but ephemeral, changes,[22] nor with a religious experience. In twelve-step fellowships, "spiritual awakening" is believed to most frequently develop slowly over a period of time.[23]

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, often as "Hi, I’m [first name only], and I’m an alcoholic".[24]

Sponsorship

A sponsor is a more experienced person in recovery who guides the less-experienced aspirant ("sponsee") through the program's twelve steps. New members in twelve-step programs are encouraged to secure a relationship with at least one sponsor who both has a sponsor and has taken the twelve steps themselves.[25] Publications from twelve-step fellowships emphasize that sponsorship is a "one on one" nonhierarchical relationship of shared experiences focused on working the Twelve Steps.[26][27][28] According to Narcotics Anonymous:

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.[29]

Sponsors and sponsees participate in activities that lead to spiritual growth. Experiences in the program are often shared by outgoing members with incoming members. This rotation of experience is often considered to have a great spiritual reward.[30] These may include practices such as literature discussion and study, meditation, and writing. Completing the program usually implies competency to guide newcomers which is often encouraged.[31] Sponsees typically do their Fifth Step, review their moral inventory written as part of the Fourth Step, with their sponsor. The Fifth Step, as well as the Ninth Step, have been compared to confession and penitence.[32] Michel Foucault, a French philosopher, noted such practices produce intrinsic modifications in the person—exonerating, redeeming and purifying them; relieves them of their burden of wrong, liberating them and promising salvation.[32][33]

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.[25]

A study of sponsorship as practiced in Alcoholics Anonymous and Narcotics Anonymous found that providing direction and support to other alcoholics and addicts is associated with sustained abstinence for the sponsor, but suggested that there were few short-term benefits for the sponsee's one-year sustained abstinence rate.[34][35]

Effectiveness

Alcoholics Anonymous is the largest of all the twelve-step programs (from which all other twelve-steps programs are derived), followed by Narcotics Anonymous; the majority of twelve-step members are recovering from addiction to alcohol or other drugs. The majority of twelve-step programs, however, address illnesses other than substance addiction. For example, the third-largest twelve-step program, Al-Anon, assists family members and friends of people who have alcoholism and other addictions. About twenty percent of twelve-step programs are for substance addiction recovery, the other eighty percent address a variety of problems from debt to depression.[36] It would be an error to assume the effectiveness of twelve-step methods at treating problems in one domain translates to all or to another domain,[37] therefore, readers are directed to relevant sections in each group's Wikipedia article.

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.[38]

Confidentiality

The Twelve Traditions encourage members to practice the spiritual principle of anonymity in the public media and members are also asked to respect each other's confidentiality.[39] This is a group norm,[39] however, and not legally mandated; there are no legal consequences to discourage those attending twelve-step groups from revealing information disclosed during meetings.[40] Statutes on group therapy do not encompass those associations that lack a professional therapist or clergyman to whom confidentiality and privilege might apply. Professionals and paraprofessionals who refer patients to these groups, to avoid both civil liability and licensure problems, have been advised that they should alert their patients that, at any time, their statements made in meetings may be disclosed.[40]

Cultural identity

One review warned of detrimental iatrogenic effects of twelve-step philosophy and labeled the organizations as cults,[41] while another review asserts that these programs bore little semblance to religious cults and that the techniques used appeared beneficial to some.[42] 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.[43] Another study asserts that the prior cultural identity may not be replaced entirely, but rather members found adapted a bicultural identity.[44]

gollark: You can use ffmpeg or something, but don't, GIFs are an awful format.

gollark: Personally, I find not having keepinv very annoying.

gollark: They probably (try and) detect VMs, too, because only !!!!!EVIL CHEATERS!!!!! need VMs.

gollark: Which is very annoying, because apart from the privacy (it can read basically any data and is designed so that you cannot know/see what it does) and security (they could have exploits) implications, it breaks stuff like WINE.

gollark: As I said, lots of anticheat things run in the kernel already.

References

VandenBos, Gary R. (2007). APA dictionary of psychology (1st ed.). Washington, DC: American Psychological Association. ISBN 978-1-59147-380-0. OCLC 65407150.
Bill W. (June 2001). Alcoholics Anonymous (4th ed.). Alcoholics Anonymous World Services. ISBN 1-893007-16-2. OCLC 32014950.
Narcotics Anonymous (1987). "Chapter 8: We Do Recover". Narcotics Anonymous (4th ed.). Van Nuys, CA: Narcotics Anonymous World Service Office. ISBN 0-912075-02-3. OCLC 14377415.
Crnkovic, A. Elaine; DelCampo, Robert L. (March 1998). "A Systems Approach to the Treatment of Chemical Addiction". Contemporary Family Therapy. Springer Science + Business Media. 20 (1): 25–36. doi:10.1023/A:1025084516633. ISSN 1573-3335.
Hartigan, Francis (2001). Bill W.: A Biography of Alcoholics Anonymous Cofounder Bill Wilson. pp. 161–162. ISBN 0-312-28391-1. OCLC 42772358.
"Barefoot's World". barefootsworld.net. Retrieved 24 March 2018.
"The Twelve Traditions". The A.A. Grapevine. Alcoholics Anonymous. 6 (6). November 1949. ISSN 0362-2584. OCLC 50379271.
Twelve Steps and Twelve Traditions. Hazelden. February 2002. ISBN 0-916856-01-1. OCLC 13572433.
"For Anyone New Coming to A.A.; For Anyone Referring People to A.A." Alcoholics Anonymous World Services, Inc. Archived from the original on 2008-01-17. Retrieved June 15, 2006.
Vaillant, George E. (2002). "Singleness of Purpose" (PDF). About AA: A Newsletter for Professionals (Fall/Winter).
Bill W. (June 2001). "Chapter 5: How It Works" (PDF). Alcoholics Anonymous (4th ed.). Alcoholics Anonymous World Services. ISBN 1-893007-16-2. OCLC 32014950.
"World Service Board of Trustees Bulletin #13: Some thoughts regarding our relationship to Alcoholics Anonymous". Narcotics Anonymous World Services. February 23, 2007. Archived from the original on October 6, 2007. Retrieved October 7, 2007.
"NA History Chronology". January 13, 2006. Archived from the original on March 3, 2009. Retrieved October 7, 2007. 1953: ... this committee met regularly ... From the beginning ... 12 Steps ... 12 Traditions ... All Steps had ‘We’
"The 12 Steps of Recovery". Archived from the original on 2012-11-05. Retrieved August 28, 2010.
"The Twelve Steps of Marijuana Anonymous". Retrieved September 28, 2012.
Bill W. (April 1946). "Our A.A. Experience Has Taught Us That". The A.A. Grapevine. Alcoholics Anonymous. 2 (11). ISSN 0362-2584. OCLC 50379271.
Kurtz LF, Chambon A (1987). "Comparison of self-help groups for mental health". Health & Social Work. 12 (4): 275–83. doi:10.1093/hsw/12.4.275. PMID 3679015.
Ronel, Natti (2000). "From Self-Help to Professional Care: An Enhanced Application of the 12-Step Program". The Journal of Applied Behavioral Science. 36 (1): 108–122. doi:10.1177/0021886300361006. ISSN 1552-6879. OCLC 1783135.
Alcoholics Anonymous (2001-06-01). "Chapter 2: There Is a Solution" (PDF). Alcoholics Anonymous (4th ed.). Alcoholics Anonymous World Services. p. 21. ISBN 1893007162. OCLC 32014950. At some stage of his drinking career, he begins to lose all control of his liquor consumption, once he starts to drink.
Alcoholics Anonymous (2001-06-01). "Chapter 2: There Is a Solution" (PDF). Alcoholics Anonymous (4th ed.). Alcoholics Anonymous World Services. p. 21. ISBN 1893007162. OCLC 32014950. These observations would be academic and pointless if [he] never took the first drink, thereby setting the terrible cycle in motion. Therefore, the main problem...centers in his mind....The fact is that most alcoholics...have lost the power of choice in drink...unable, at certain times, to bring into [his] consciousness with sufficient force the memory of the suffering and humiliation of a month or even a week ago. [He] is without defense against the first drink.
Roehe, Marcelo V. (2004). "Religious Experience in Self-Help Groups: the neurotics anonymous example". Psicologia Em Estudo (in Portuguese). 9 (3): 399–407. doi:10.1590/S1413-73722004000300008. ISSN 1413-7372.
Marmor J (1980-04-01). "Recent trends in psychotherapy". The American Journal of Psychiatry. 137 (4): 409–16. doi:10.1176/ajp.137.4.409. PMID 6987904.
Alcoholics Anonymous (1976-06-01). "Appendix II. Spiritual Experience". Alcoholics Anonymous. Alcoholics Anonymous World Services. ISBN 0916856593. OCLC 32014950. Archived from the original on 2008-12-05.
Hayes, Terrell (February 2000). "Stigmatizing Indebtedness: Implications for Labeling Theory". Symbolic Interaction. 23 (1): 29–46. doi:10.1525/si.2000.23.1.29.
"Sponsorship Q&A (pamphlet)" (PDF). New York: Alcoholics Anonymous World Services. Cite journal requires |journal= (help)
"NYCMA: What is a Sponsor?". New York Crystal Meth Anonymous Intergroup. Archived from the original on 2016-03-03. Retrieved October 8, 2007.
"#SLAA Online Group of Sex and Love Addicts Anonymous: Sponsorship Online". February 5, 2007. Archived from the original on June 8, 2015. Retrieved December 19, 2015.
"Overeaters Anonymous Unity Intergroup Website: Sponsorship". September 19, 2007. Retrieved October 8, 2007.
Narcotics Anonymous (2004). "Sponsorship, Revised (pamphlet): What does a sponsor do?" (PDF). Van Nuys, CA: Narcotics Anonymous. Archived from the original (PDF) on 2009-01-17. Cite journal requires |journal= (help)
"The A.A. Group…Where it all begins How a group Functions How to get started" (PDF). P-16 The A.A. Group ... where it all begins. Alcoholics Anonymous World Services, Inc. Retrieved 26 September 2016.
"Questions & Answers on Sponsorship" (PDF). P-15 Questions & Answers on Sponsorship. Alcoholics Anonymous World Services, Inc. Retrieved 26 September 2016.
Kriz, Kerri-Lynn Murphy (May 2002). The Efficacy of Overeaters Anonymous in Fostering Abstinence in Binge-Easting Disorder and Bulimia Nervosa. Virginia Polytechnic Institute and State University.
Morenberg, Adam (July 2004). Governing Wayward Consumers: Self-Change and Recovery in Debtors Anonymous (PDF) (Master of Arts, Sociology). Tampa, Florida: University of South Florida. OCLC 56564118. Archived from the original on December 19, 2015. Retrieved December 19, 2015.
Crape, Byron L.; Latkin, Carl A.; Laris, Alexandra S.; Knowlton, Amy R. (February 2002). "The effects of sponsorship in 12-step treatment of injection drug users". Drug and Alcohol Dependence. 65 (3): 291–301. doi:10.1016/S0376-8716(01)00175-2. PMID 11841900.
"NCJRS Abstract: National Criminal Justice Reference Service". Ncjrs.gov. February 1, 2002. Retrieved March 5, 2009.
Makela, Klaus (1996). Alcoholics Anonymous as a Mutual-help Movement: A Study in Eight Societies. University of Wisconsin Press. ISBN 0-299-15004-6.
Saulnier, Christine Flynn (1996). "Images of the Twelve-Step Model, and Sex and Love Addiction in an Alcohol Intervention Group for Black Women". Journal of Drug Issues. 26 (1): 95–123. doi:10.1177/002204269602600107.
Brandsma, Jeffrey M.; Dicarli, M (1976). "Toward a More Rational Alcoholics Anonymous". Rational Living. 11 (1): 35–37. doi:10.1016/j.nuclcard.2007.06.118. ISSN 0034-0049. OCLC 1763461. PMID 17826317.
Levine, Betsy; Kellen, Bonnie (2000). "Chapter 18: Debtors Anonymous and Psychotherapy". In Benson, April Lane (ed.). I shop, therefore I am: compulsive buying and search for shelf. pp. 431–454. ISBN 0765702428. OCLC 301650820.CS1 maint: multiple names: authors list (link)
Coleman P (2005-12-01). "Privilege and confidentiality in 12-step self-help programs. Believing the promises could be hazardous to an addict's freedom". The Journal of Legal Medicine. 26 (4): 435–74. doi:10.1080/01947640500364713. PMID 16303734.
Alexander, F.; Rollins, M. (1985). "Alcoholics Anonymous: the unseen cult". California Sociologist. Los Angeles: California State University. 17 (1): 33–48. ISSN 0162-8712. OCLC 4025459.
Wright, Kevin B. (1997). "Shared ideology in Alcoholics Anonymous: a grounded theory approach". Journal of Health Communication. 2 (2): 83–99. doi:10.1080/108107397127806. PMID 10977242.
Levinson, David (1983). "Current status of the field: an anthropological perspective on the behavior modification treatment of alcoholism". Recent Developments in Alcoholism. 1: 255–61. doi:10.1007/978-1-4613-3617-4_14. ISBN 978-1-4613-3619-8. PMID 6680227. Cite journal requires |journal= (help)
Wilcox, D.M. (1998). "Chapter 7: Language, Culture, and Belief". Alcoholic thinking: Language, culture, and belief in Alcoholics Anonymous. Westport, CT: Greenwood Publishing Group. pp. 109–124. ISBN 0-275-96049-8.