What Is the 12 Step Programme?
A twelve-step programme is a series of 12 guiding principles which act as a framework for recovery from substance abuse. Initially developed by one of the founders of Alcoholics Anonymous (AA), the 12 steps came to be the foundation of that organisation’s approach to supporting recovery from alcoholism. It has since been adopted by other fellowships catering for the needs of individuals suffering from substance abuse disorders and, more recently, other behavioural problems.
Although some organisations have modified the original 12 steps to recognise the specific needs and situations of their members, 12-step programmes generally adhere to the basic principles outlined in the original AA document, which outline a process which can be summarised as follows:
- admitting one’s inability to control one’s addiction
- identifying a higher power that can support one’s quest for abstinence
- investigating previous mistakes with the assistance of a sponsor
- committing to make amends for those mistakes
- adopting a new behavioural code enabling a new life
- helping other people suffering from the same addiction
Organisations providing 12-step programmes typically arrange meetings, which are usually held weekly and which are typically free to attend for anyone committed to leading an abstinent life. Those attending meetings can offer each other support, advice and companionship and assist each other in adhering to the 12 steps.
The History of the 12-Step Programme
The original 12-step programme was formulated by AA founder Bill Wilson in 1939 in the book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism – also known as ‘The Big Book’. Wilson, a former Wall Street businessmen whose career had been ruined by alcoholism, joined a spiritual movement encouraging abstinence and there met Robert Holbrooke Smith – “Dr Bob” – with whom he cofounded AA in 1935. The two men developed techniques aimed at helping fellow alcoholics achieve and sustain sobriety.
The publication of ‘The Big Book’ saw AA begin to grow to a national (within the USA) and then an international fellowship, and the ‘Twelve Steps’ outlined at the beginning of the book’s fifth chapter became established as the core of AA’s approach to addressing alcoholism. Alongside the 12 steps, the book contained the ‘Twelve Traditions’ which served, and still serve, as guidelines for the governance of AA groups and meetings.
As AA grew as an organisation and its effectiveness in supporting alcoholics became recognised, individuals suffering from addictions to other substances began to express a desire to attend AA meetings. Consequentially, in the early 1950s, Narcotics Anonymous was established in California, to provide support for people suffering from an addiction to drugs specifically. From the outset, NA operated a 12-step programme and governance mechanisms modelled on AA, and this approach has since been adopted by a significant number of other organisations catering to people suffering from an addiction for specific substances (such as Cocaine Anonymous) or to individuals suffering from behavioural disorders not including substance abuse, such as eating disorders, gambling and love & sex addiction. Today, only 20% of 12-step groups cater for people suffering from substance addictions.
The Original Twelve Steps
The following are the original twelve steps as published by Alcoholics Anonymous:
- 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.
- Decided 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.
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The Twelve Traditions
- 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 to 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 centres may employ special workers.
- AA, as such, ought never to be organised; 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 to 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.
The 12 Steps programme: what happens during treatment
Individuals participating in 12-step programmes may do so either as part of/during, or outside a structured addiction treatment programme. Many people engaging in outpatient addiction treatment are required, or advised, to attend support groups including those operating 12-step programmes. Some inpatient treatment programmes also incorporate the 12-step approach, as well as potentially featuring preparatory sessions aimed at familiarising clients with the 12 steps and preparing them for attendance at 12-step-based groups following treatment.
If, and exactly how, a given treatment facility utilises the 12-step approach within treatment depends very much on the nature of the facility itself. While the vast majority of addiction professionals are very familiar with the 12 steps, some choose not to incorporate 12-step programmes within their approach to treating addiction, in part because some of the steps (especially those relating to a “higher power”) may conflict with clients’ personal beliefs.
Twelve-step meetings themselves typically see a group of people suffering from addiction come together to discuss the challenges they face, share advice, offer support and sponsorship, and simply share time in a social manner which does not have substance abuse at its heart. Meetings usually involve attendees sitting in a roundtable format, taking turns to contribute on an anonymous basis, with a discussion moderated and guided by an appointed group leader.
Inpatient vs outpatient in the 12-step programme
Understandably, the biggest difference between inpatient and outpatient approaches to the 12-step model is that people suffering from an addiction in inpatient treatment engaging with a 12-step programme do so within the confines of a treatment facility. Outpatients do so in the outside world and are free to come and go as they please. Meetings featuring inpatients therefore typically address challenges associated with treatment itself, with group members all dealing with the issues resulting from residing in a treatment facility and supporting each other through treatment including therapy. Because rehabs are substance-free environments, the pressure of temptation is relieved, and inpatients participating in 12-step groups are – at least in good, secure environments – less likely to have to address the temptation to relapse during their treatment, focussing instead on encouraging each other through the course of treatment and helping prepare each other for life after rehab.
Those in outpatient addiction treatment, on the other hand, are exposed to the dangers of relapse and group meetings may include addressing the problems facing group members who either have relapsed or are struggling greatly with the temptation to do so. Rather than concentrating on treatment progress, outpatients in 12-step programmes are likely to seek support with the daily challenges of life in the outside world and how to resist the temptation to relapse.
Life after Rehab
Individuals who complete an addiction treatment programme in rehab should not consider their recoveries complete simply because they have come to the end of treatment. Indeed, in many ways, the hardest part of the recovery journey comes once someone leaves the secure confines of rehab and needs to apply the coping mechanisms and lessons they have learnt during treatment in the much more perilous environment of the outside world, and many people in recovery prefer to consider themselves still addicted even though it may be many years since their last instance of substance abuse, as this mindset helps to ensure the vigilance and dedication needed to continue to sustain their hard-won abstinence.
Twelve-step organisations can play a critical role in an individual’s ongoing recovery long after the completion of treatment and many rehabs providing aftercare to clients include a requirement to attend 12-step meetings in their aftercare programmes. Some individuals choose to participate in the meetings on a regular basis, often starting immediately upon completion of treatment; others prefer to attend sporadically, perhaps when they are feeling temptation especially keenly, or simply to keep up the habit of attending meetings and to offer support to fellow people in recovery.
Staying clean and sober
Avoiding relapse is key to a successful recovery – but one relapse should not be seen to signify the complete failure of treatment and indicate that the relapsing individual will automatically fall back into a full-blown addiction. Instead, relapse should be treated as a stumble on the path back to health and happiness – one which should be avoided wherever possible, but which does not mean that the journey is a doomed one.
Attendance at 12-step meetings, and adhering to the 12 steps themselves, should not be taken as a guarantee that the individual in question will thereby be immune to temptation: many people attending 12-step meetings constantly struggle with temptation, and some relapse despite their best efforts and those of their sponsors. However, working with other attendees can give individuals both the support and the companionship which can make the difference between resisting temptation and giving in to it, or between a solitary relapse and the descent into full-blown addiction once again.
Sponsors can be especially useful in this regard, and many people both in and after treatment take great benefit in being able to contact a sponsor whenever they feel an especially acute temptation to relapse. Sponsorship is a fundamental aspect of the 12-step programme, and many people also derive significant benefit from eventually becoming a sponsor to other people in recovery less far than themselves down the road to permanent abstinence.
Take control of your life – get started on the road to recovery
If you suffer from an addiction to a substance of abuse, it could cause you serious harm. However, in many if not most cases it is extremely hard, if not impossible, to defeat an addiction without professional help. The earlier you can admit to a condition and reach out for that help, the sooner you will be able to begin to receive it in one form or another.
Having reached the point of recognising that you need help, the first port of call should always be a GP who will be able to assess the nature and extent of addiction and current physical and mental condition. If necessary, a physician can recommend further treatment. It may also be beneficial to contact an addiction specialist, who can discuss treatment options of various kinds which may be appropriate to you, as well as educating you on the UK’s addiction landscape.
Although 12-step organisations are likely to meet in your area, depending on the nature and severity of your addiction, it may not be appropriate for you to engage with them immediately. Consult an addiction specialist about when it is most suitable to begin to participate in a 12-step programme, as well as to find out more about the 12-step model in general.
Help centres near you
There are now numerous treatment centres across the UK, both public and private, providing addiction treatment services of various kinds. However, for a host of reasons including cost, location, the types of treatment provided, the operating philosophies of particular centres, your personal preferences and many more, not every facility will be appropriate for every addict. As it is essential to match your treatment facility with your particular requirements, you should always do as much research as you can before enrolling at a given facility.
An addiction specialist can help with that research and give details on the various rehabs and other help centres either in the area or elsewhere in the country. Your GP may be able to refer you for addiction treatment on the NHS. However, places in NHS treatment are often very limited and waiting times can be discouragingly lengthy, and if you feel yourself in a moment of crisis or desire immediate treatment for any other reason you may prefer to investigate private treatment options – which, again, an addiction specialist can inform about.
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Is the 12-Step Programme Always Faith-Based?
Several of the original 12 steps formulated by the founders of AA explicitly mention God and a “higher power”, and this is often considered problematic by individuals who either do not believe in such power or whose personal religious beliefs are not monotheistic. However, most 12-step organisations do not consider themselves to be “faith-based”, and many addiction specialists encourage individuals who find that the steps in question conflict with their own beliefs either to adapt those steps so that they fall in line with their beliefs.
For many of those who are suffering from an addiction, who have gone through 12-step programmes successfully, the key elements of such programmes are not those relating to a “higher power” but the meetings, and the support and fellowship they derived from them. For individuals who wish to gain the benefits of 12-step programmes without adhering to the more spiritually focussed requirements of the original 12 steps, other models – including the SMART Recovery methodology – have been developed to take elements from the original 12 steps but do not include any spiritual aspects and do not require recognising the existence of any higher power. For more information on alternative approaches to support, get in touch with an addiction specialist.
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