The 12-step program aims to help people attain abstinence from substance use disorders or make a behavioral change through peer support. This intervention provides a supportive social network and fosters bonding among group members, which adds to the benefits. Members often run the groups without the involvement of healthcare professionals.

The first 12-step program was Alcoholics Anonymous (AA). Later, AA evolved to address substance misuse. Today, that 12-step program is known as Narcotics Anonymous (NA), but there are other programs that focus on mental health conditions, such as eating disorders, and maladaptive patterns of behavior, such as compulsive gambling.

Although studies indicate that the programs are effective for people with alcohol use disorder, the research on their effectiveness for those with substance misuse is still preliminary.

This article discusses the 12-step program in more detail, including its history, how it works, its effectiveness, and the possible risks. It also lists similar organizations and provides resources for getting help.

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The 12-step program is a strategy that aims to help people recover from alcohol use disorder, substance use disorder, and other forms of addiction. Members of the programs run them, and they involve low or no costs. They are available in many communities.

Each program follows 12 standard steps. Below are the 12 steps of AA, which all the other programs adopt, making only minor variations to address their specific purpose:

  1. We admit that we are powerless over alcohol and that our lives have become unmanageable.
  2. We believe that a power greater than ourselves can help us.
  3. We decide to turn our wills and lives over to the care of a higher power, whatever that may be.
  4. We make a searching moral inventory of ourselves.
  5. We admit to a higher power, ourselves, and another person the exact nature of our wrongs.
  6. We are ready to have a higher power remove these defects in character.
  7. We humbly ask the higher power to remove our shortcomings.
  8. We make a list of people we have harmed, with whom we are willing to make amends.
  9. Whenever possible, we make amends to these individuals.
  10. We continue to take a personal inventory and promptly admit when we are wrong.
  11. We ask for the knowledge of a higher power’s will for us and the strength to carry it out.
  12. We try to carry this message to other people with alcohol use disorder and practice these principles in all our affairs.

According to research, a person can distill the 12 steps into six phases, which include:

  • refraining from drinking or misusing drugs
  • going to meetings
  • asking for help
  • getting a sponsor
  • joining a group
  • becoming active

People typically use the programs as an add-on to treatment or as a form of continuing support following treatment.

An older 2010 study notes that the first 12-step program, AA, began in 1935. AA’s cofounders were Bob Smith, a surgeon from Ohio, and Bill Wilson, a New York City stockbroker and entrepreneur. Wilson was the first person whom Smith helped recover from alcohol use disorder.

AA now has almost 2 million members around the world, with groups in 180 countries. More than 1.2 million members are in the United States.

Later in the 20th century, other programs followed, and the founders modeled them after AA.

NA emerged in the 1950s. As of 2010, it had almost 200,000 members in the U.S., along with groups in 130 countries.

Older research from 2013 reports that Cocaine Anonymous launched in 1982. As of 2013, it had about 30,000 members and 2,000 groups globally.

Today, a broad array of 12-step programs addresses mental health conditions and potentially dysfunctional behaviors. Examples of these include:

  • Debtors Anonymous
  • Eating Disorders Anonymous
  • Gamblers Anonymous
  • Workaholics Anonymous

Evidence states that a key feature involves the provision of support, or a social network, to help people remain substance-free or achieve other behavioral goals. In fact, it appears that the so-called fellowship, or social benefit, is one of the aspects of the program that most closely links to abstinence.

Membership in one of the groups changes a person’s social network. It reduces the number of people in their life who engage in substance misuse while increasing those who abstain from it. This social shift results in decreased exposure to activities and behaviors relating to substance use and increased opportunities to take part in unrelated activities.

The bonding among group members is another factor that underlies the program’s effectiveness. Bonding leads to the provision of role models for attaining abstinence and fosters goal directedness.

Studies show that the programs are as effective as other nonmedical treatments, such as cognitive behavioral therapy (CBT), for alcohol use disorder. However, researchers have not carried out studies comparing them with medication, which remains the gold standard in most cases of alcohol use disorder.

The research from 2013 looked at data that indicated the effectiveness of the programs. It found that the medium length of abstinence among AA and NA members is longer than 5 years. Better outcomes are associated with:

  • regular, early, and frequent attendance of meetings, such as attending three per week
  • beginning the programs while in treatment
  • engaging in other program activities, such as calling other group members or performing a service at a meeting

In other words, a link exists between the degree of involvement in the program and positive outcomes. Despite this association, it is not a cause-and-effect relationship.

Findings suggest that 12-step programs have few risks. However, there are some possible negatives.

One is that some people might not feel comfortable with religion or spirituality. Rather than accepting the concept of powerlessness and surrendering to a higher power, they might prefer the idea of taking action and responsibility themselves. Another possible downside is the lack of trained professionals leading the groups.

One study also critiqued the 12-step program for being too inflexible and marginalizing and for including nonnegotiable beliefs and ideologies.

Another study interviewed 11 former AA members. Although these individuals said that they experienced some positives through AA membership, they also felt that they had remained a part of the AA because it had indoctrinated them into “a particular way of understanding themselves.” The researchers concluded that there is a large disparity between the reality that AA members experience and the “idealistic principles” of the AA.

An alternative to a 12-step program is a support group. A small, older 2008 study looked at the effectiveness of peer support groups in addiction recovery. The findings suggested that these groups might have a significant positive influence.

Examples include:

  • SMART Recovery, a worldwide community of support groups for people with substance or alcohol use disorder
  • LOOSID, a website that offers chat groups and other resources for those with alcohol use disorder
  • LifeRing Secular Recovery, a website that provides online meetings for people with a history of drug misuse

The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a free 24-7 helpline on 800-662-HELP (4367). People with substance use disorders or mental health conditions can contact SAMHSA for information or a referral.

Other organizations that aim to help people attain abstinence from unhealthy behaviors include:

The following programs seek to help family members or friends of people with substance use disorders or other problematic patterns of behavior:

Learn more about some of the best alcohol support groups here.

Help is available

Seeking help for addiction may feel daunting or even scary, but several organizations can provide support.

If you believe that you or someone close to you is showing signs of addiction, you can contact the following organizations for immediate help and advice:

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Alcoholics Anonymous developed the first 12-step program, but such programs now exist in many different forms.

The 12-step program is a strategy for overcoming alcohol use disorder and other substance use disorders. It uses 12 distinct steps to guide people toward recovery.

There is limited research into its effectiveness, but one drawback is that it relies on people effectively surrendering themselves to a higher power. People who are not religious or spiritual may struggle with this concept.

That said, there are an estimated 2 million AA members worldwide, with even more people belonging to similar organizations. Many individuals have found success in treating their substance use disorders with the 12-step program.

People interested in partaking should speak with a relevant organization or healthcare professional about ways in which to treat and manage their substance and alcohol use disorders.