12-Step programs for alcohol and drug addiction

What are 12-step programs?

Twelve-step programs provide a set of principles to practice as a way of life to manage an alcohol or drug problem. The meetings are free of charge and are run by recovering people—rather than professional counsellors—who are dedicated to helping themselves and others stay sober.

These programs offer people support in abstaining from alcohol and drug use for life. Because lifelong abstinence is a significant challenge, the programs encourage people to take it “one day at a time.” Members are advised to attend regular meetings and talk about their challenges without revealing their last names (a practice known as “anonymity”).

While members may have an occasional relapse, or slip, where they temporarily go back to using alcohol or drugs, a 12-step program can offer refuge and access to sober support that is difficult for a struggling addict to find elsewhere, providing the tools that can help arrest a relapse before it becomes a destructive spiral.

Twelve-step groups also provide the opportunity for sponsorship. A sponsor in Alcoholics Anonymous (AA) is a person with a long period of sobriety who is willing to support a newly sober person. Sponsors agree to help sponsees work through the steps, and to be available to assist when a sponsee struggles with sobriety. The support provided by a sponsor while following the 12-step self-help programs has been shown to increase the chances abstinence, according to a study by John F. Kelly, a specialist in addiction medicine at Harvard Medical School. As more sober time is gained, the sponsee can then sponsor others, helping his or her own recovery by giving back to the group.

Key steps of the 12-step program

Step 1. Admit that you have a problem. This is acknowledgement that you are powerless over your addiction.

Step 2. Seek help from a higher power. At the heart of all 12-step programs is a belief that conquering addiction requires a spiritual awakening.

Step 3. Decide to turn over your life to a higher power (however you understand the higher power). This step involves making a commitment to living a spiritual life rather than agreeing to join any specific religion.

Step 4. Make a moral inventory. Part of the recovery process involves reflecting on your past and writing a life history. The key to this process is taking accountability for actions and decisions.

Step 5. Confide in someone about your past behavior. In most 12-step programs, the addict selects a sponsor—someone in the program who has already completed all the steps, has a long period of sobriety, and can provide guidance during the recovery process.

Step 6. Work on rebuilding your character. According to the 12-step philosophy, recovery entails acknowledging your personal shortcomings so that you can change them.

Step 7. Ask your higher power to remove your personal shortcomings.

Step 8. List those whom you have harmed and become willing to make amends. While in the throes of an addiction, a person often acts irresponsibly (for example, lying or stealing). To recover, addicts must acknowledge all those whom they have hurt in the past and try to make restitution.

Step 9. Actively begin to make amends to others.

Step 10. Continue the process of taking a personal inventory (begun in step 4).

Step 11. Seek a closer tie to your higher power. As people in recovery develop their spirituality, they typically use prayer and meditation to strengthen this relationship.

Step 12. Work with others. Helping others face their addictions can boost your self-esteem and provide emotional rewards.

How meetings work

Most meetings last about an hour. AA recommends that new members attend 90 meetings for the first 90 days in the program but don’t pressure you to meet this goal. In fact, members of 12-step programs are free to choose any attendance pattern that works for them. People tend to go to meetings more frequently when they are just starting the program and when they find themselves going through stressful periods. Most members attend at least one meeting a week.

There are several types of 12-step meetings:

Open-discussion meetings. Open to addicts, their families, and anyone interested in addressing the problem of addiction. These meetings follow a set pattern. A leader describes the 12-step program and introduces one to three speakers who relate personal stories.

Closed meetings. Limited to people struggling to understand their alcohol/drug problem and achieve sobriety, these meetings allow members to share their problems in attempting to stay sober.

Beginners’ meetings. In these meetings, one or more veterans of the program are present to answer questions from newcomers.

Step meetings. These closed meetings are devoted exclusively to understanding the meaning of one of the 12 steps.

In addition to holding face-to-face meetings, many groups allow members to speak by email, telephone, audio or video chats, or in online discussion forums. Group members in some programs, including AA, may make home visits to people who can’t attend meetings because of an illness, injury, or disability.

Common concerns about 12-step programs

Even though 12-step programs have proved to be remarkably successful for people from all walks of life, many people are reluctant to try one. Skepticism can also stem from a desire to avoid committing to recovery rather than from an accurate assessment of the 12-step philosophy.

Here are the common concerns:

“I am an agnostic, so the emphasis on spirituality excludes me.” Although people in AA often speak of God, the program uses the term “higher power” and gives people great freedom in interpreting it. It is described as anything outside yourself that you believe can help you to get better; it can be God, the AA fellowship, or nature if that works for you. Twelve-step programs have no ties to any organized religion. You may define spirituality however you wish. People of many beliefs belong to AA and have found it useful to follow the steps.

“I am too shy to attend all those meetings.” Many people at first feel this way. But the programs offer a setting that helps people improve their social skills. If you worry about meeting strangers, you might go to meetings early and offer to help set up, or stay late and help clean up. Having a task to accomplish can reduce social discomfort. You may also choose a meeting in a neighbouring town if you do not wish to run into people you know. Ultimately, battling addiction entails learning how to forge healthy connections with others. Also, keep in mind that members can choose not to share, that is, to “pass” at any time during the meeting.

“But my real problem isn’t addiction, it’s depression.” Dual disorders—an addiction plus a mental health disorder—are common among people in 12-step programs. Psychiatric treatment (for example, taking an antidepressant) might help your depression but may not address your addiction. Often a combination of mental health treatment and a 12-step program is helpful. It is healthy to remember that even if addiction begins because of another psychological issue, it becomes its own primary problem that must be addressed directly.

Ways to find a 12-step group or more information

Here are some of the largest and best-known 12-step programs:

Alcoholics Anonymous 
The AA website includes a form to which you can enter your postal code to identify a meeting location near you. You can also send an message or call AAs central headquarters at 1.212.870.3400.) The Online Intergroup site for AA (http://aa-intergroup.org) has information about meetings that take place by email, phone, and audio or video chats.

Cocaine Anonymous 
CA has information on how to find groups that can help you recover from using cocaine or any another mind-altering substance. Its online service, Cocaine Anonymous Online (http://www.ca-online.org), has additional programs including online meetings and Sisters in Sobriety, an email support group for women.

Double Trouble in Recovery
A site for people who have both an addiction and a mental health concern. Search the site for “Double Trouble in Recovery” or DTR.

Narcotics Anonymous 
NA has background information and can help you find a local support group.

12-step programs for families and friends of addicts

Because alcohol and drug addiction affect the entire family, there are also 12-step programs for the relatives and friends of addicts..

Adult Children of Alcoholics
A 12-step program for people who grew up in alcoholic or otherwise dysfunctional homes.

Al-Anon Family Groups
A self-help program for families and friends of alcoholics, regardless of whether the alcoholic is seeking help. This site also has links to Alateen, a program that helps teenagers.

Nar-Anon Family Groups
A 12-step program for those affected by the addiction of someone close to them.

12-step programs for other addictions

In recent years, 12-step programs have emerged for a host of other addictions including overeating, compulsive spending or debt, sexual addiction, and gambling. These are sometimes referred to as “process addictions.” www.drugrehab.ca is a starting point for help in finding a 12-step behavioural addiction program.