12 Step Programme

Dealing with addiction can feel incredibly overwhelming. For many people struggling with substances, it can be difficult to know how to start on the path to recovery. The 12 step programme was developed to establish a clear set of guidelines to help individuals working towards recovery find their footing. By following the steps one by one, the aim is that each aspect of the therapy will get you closer to sobriety.
However, this type of therapy focuses on more than just abstinence. By considering addiction as a holistic experience, the 12 step aims to achieve wellness by addressing all areas of life: the physical, emotional, behavioural and spiritual. The 12 step is fundamentally rooted in ideas of growth, growth beyond drugs and alcohol, but also a growth that transcends the context of addiction.

12 step therapy

12 step therapy was initially established by Alcoholics Anonymous (AA). Whilst 12 step was designed specifically with alcoholism in mind, it can also be applied in the context of drug addiction. In a rehabilitation context, the 12 steps can be guided by professionals. In other circumstances – such as if you are in attendance at Alcoholics Anonymous group meetings – 12 steps can be facilitated through peer-to-peer support. This makes it a particularly useful tool for individuals searching for social support both in and outside formal rehab.

How was the 12 step developed?

12 step is a programme developed by Bill Wilson, founder of AA. We might think of addiction support groups as a relatively new phenomenon. But, in actual fact, Wilson began Alcoholics Anonymous in 1935. Wilson himself struggled with an addiction to alcohol. He developed the concept of AA whilst receiving treatment for addiction in rehab. This means that the 12 steps are uniquely influenced by lived experience. Whilst many other treatment models firmly situate addiction treatment in the realm of objective science, Wilson’s approach was more personal. This is appealing to many, as it suggests that the 12 step approach is genuine and relevant, not prescriptive or judgemental.

Threading together aspects of Wilson’s own experiences and theology, 12 steps tackles addiction through the mode of religiously-informed philosophy. The 12 steps are tenets to Wilson’s belief that a change in mindset can help shift the burden of drug and/or alcohol addiction.

The 12 steps themselves act as a reworking of the 12 commandments of the Old Testament. This mirroring of structure alludes to the powerful, almost ‘sacred’ nature of these steps, emphasising how living by these tenets can bring increased well-being and even peace.

The 12 steps

Chapter three of the Alcoholics Anonymous text opens by defining their conceptualisation of alcoholism. An alcoholic, from the 12 step perspective, must first accept themselves as such:

‘We learned that we had to fully conceded to our innermost selves that we were alcoholics. This is the first step in recovery. The delusion that we are like other people, or presently may be, has to be smashed. We alcoholics are men and women who have lost the ability to control our drinking.’

Once the realisation that a problem with alcohol is present, then the work of the 12 steps can begin.

The eponymous 12 steps are all associated with a specific task, emotion, or mental shift. These can broadly be arranged into the following thematic categories:

The idea is that as an individual progresses through these 12 stages, they begin to feel further enlightened, empowered, and less weighted by their relationship with drugs and/or alcohol.

How is this put into practice?

Out of context, these steps may seem somewhat vague. In order to assist with this, each of these 12 steps has been described in a sentence.. These can be referred to as affirmations and act as reminders of the essence of that specific step.

Step 1: Recognition

‘We admitted we were powerless over alcohol – that our lives had become unmanageable.’
The first step requires the individual to recognise that they have an issue with drinking and that this is causing damage to their lives.

Step 2: Faith

‘Came to believe that a Power greater than ourselves could restore us to sanity.’

The second step involves putting faith in a higher power. 12 step therapy uses the idea of God. However, AA does address that you do not have to believe in a God to engage in the 12 steps, stating, ‘When, therefore, we speak to you of God, we mean your own conception of God.’

You may replace the idea of a deity with the power of the universe, karma, or some other power you can identify as larger than yourself.

Step 3: Release

‘Made a decision to turn our will and our lives over to the care of God as we understood Him.’

Step three is about liberation. The aim is to recognise that we will succeed with the support of our God (or otherwise conception of God).

Step 4: Self-Reflection

‘Made a searching and fearless moral inventory of ourselves.’

Step 4 is about honest reflection, being candid with ourselves about how we think, feel, and behave, and beginning to consider how this may need to shift in future to aid our recovery.

Step 5: Acknowledgment

‘Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.’

This step requires owning up to these reflections – admitting our wrongs. This can be uncomfortable at first, but it can also be an empowering act. You can achieve this in practice by sharing your reflections with a loved one, a therapist, or a peer in AA.

Step 6: Freedom

‘Were entirely ready to have God remove all these defects of character.’

The natural progression from recognising and admitting the parts of ourselves that could be improved upon is being ready to change in these aspects of our lives. This stage is about preparing – and being open to – working on ourselves in the future.

Step 7: Change

‘Humbly asked Him to remove our shortcomings.’

This step is about actual, tangible change. This could be reducing or becoming abstinent from drinking, being kinder to those around you, or generally being more thoughtful about the impact of your actions.

Step 8: Preparing for Reparations

‘Made a list of all persons we had harmed, and became willing to make amends to them all.’

Step 8 signals a second type of reflection. This time, you think specifically about how your drinking may have caused you to hurt others in the past. Creating a physical list is recommended here.

Step 9: Making Reparations

‘Made direct amends to such people wherever possible, except when to do so would injure them or others.’
Using the physical list you have created, you can begin to make reparations for any hurt you may have caused. This could be simply an apology, or it could be a small, specific act appropriate to your situation.

Step 10: Continued Practice

‘Continued to take personal inventory and when we were wrong promptly admitted it.’
Step 10 acts as a reminder that we must continue to be conscious of the way we act, feel, think and behave. The 12 step programme aims to be a lifelong practice. Continuing to reflect on how we can improve ourselves and how we can better interact with and impact the lives of others offers a nudge to take these steps forward in the long term.

Step 11: Belief

‘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.’
This penultimate step is about trust – trust in ourselves, but also trust in our self-identified higher power. It is a belief that things have improved, and things will continue to believe, given the continuation of our positive mindset.

Step 12: Community

‘Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practise these principles in all our affairs.’
The final step is about community impact. Like Bill Wilson, is it possible, once recovered, for you to aid in the recovery of a friend? 12 step foregrounds the principle of social support. This indicates the principle that addiction can be quelled most successfully when we tap into our support networks – and begin to extend our hand to others.

How effective are 12 step programmes?

The 12 step is used widely in communities. There are an estimated 2.1 million AA members worldwide. This indicates that a large percentage of individuals find the 12 step method helpful in managing their addictions. Given the ease of access to both the 12 steps and the Alcoholics Anonymous handbook, community support groups are available across the UK.

That being said, how effective is 12 step rehab?

The overarching goal of 12 steps is to allow individuals struggling with addiction to regain a sense of control and find new, non-maladaptive methods of coping with difficult situations and emotions. The effects of this, if achieved, can manifest in a variety of positive ways, including:

These positive impacts are typically achieved as the programme continues through the steps. There is a chance that at the beginning of engaging with AA, you feel that your addiction can lead to anxiety, even in recovery. This is because, during the 12 steps, you may feel particularly vulnerable in the initial stages. Typically, in order to heal from something, we need to expose ourselves to it first.

Some people find that at the beginning of any therapeutic endeavour, their mood may feel slightly destabilised for some time. That means that the wound can feel fresh, to begin with, but over time, the sting will lessen. With the help of peers in AA, you can begin to follow the motions of the 12 steps; you may realise that sitting in honesty and allowing yourself to feel discomfort can be an invaluable tool in your recovery journey.

How long does 12 step rehab take?

Studies into the effectiveness of 12 steps have indicated that the average time spent in active engagement with AA is 5 years or more. Around a third of the individuals who engage in twelve steps for this time have been sober for anywhere between 1 to 5 years. On average, people engaging with AA attend between 2 and 4 meetings each week.
This suggests that twelve-step has positive rates of success for individuals willing to engage with AA in the longer term. For this reason, it is recommended that attending AA or NA (narcotics Anonymous) support groups is integrated into both formal rehab and continued aftercare.
Some people decide to stay in AA after feeling they have reached the end of their journey. They may do this as a way to stay accountable, or they may choose to remain in AA to act as a facilitator or support for others just beginning their 12 step path.

Get help for addiction

Starting recovery on your own can feel like falling in quicksand. Understanding the range of therapeutic interventions that are aimed at giving you the best chance of long-term recovery within addiction treatment is vital. Along with 12 step therapy, addiction services can provide a range of psychotherapies and physical support options to assist you on the way to sobriety. With therapy, it is important to keep in mind that every individual is different, and therefore, be aware of the potential need to adapt support options to suit your current circumstances.