The basis for many modern addiction treatment programs is the 12-Step program. This treatment model is based on the experiences of two men who, in the early 20th century, founded Alcoholics Anonymous through their discovery that, in helping each other with their addictions, they were able to help themselves.
As summarized by 12step.org, the steps are as follows:
- Admit powerlessness over addiction.
- Accept hope.
- Surrender to a higher power.
- Take a moral inventory.
- Admit wrongs.
- Be ready to remove shortcomings.
- Ask one’s higher power to help.
- List amends.
- Make amends.
- Continue the personal inventory.
- Pray or meditate.
- Help others.
The process created by these men and the organizations that followed them is encapsulated in The Big Book, a summary of the steps they discovered could help them learn to manage their addiction issues. As implied by the name of the program, there are 12 of these steps.
These steps and traditions, and how they work to help people recover from addiction, are more thoroughly discussed below. The discussion takes a more general approach than the one originally designated by AA, because the steps have grown and evolved over the decades to reach a broader audience.
1. Admit Powerlessness over Addiction.
Many people have probably heard the saying, “The first step to solving a problem is admitting there is one.” Well, the origin of this quote is very likely to be the first step in the 12-Step program, as defined originally by Alcoholics Anonymous and The Big Book.
In this first step, the goal is for the individuals to admit that they do have a problem with alcohol or drugs. This problem can be recognized, most basically, in three elements:
- The individual has a compulsive need to use drugs or alcohol.
- The use of drugs or alcohol is causing major disruption or consequences in the person’s life.
- The person has tried to quit using, and failed, multiple times.
When the individual accepts that these are true, and realizes that help is needed to recover from this problem, that is quite literally the first step toward recovery.
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2. Establish Hope.
The hope in this step is achieved when the individual realizes that help from a higher power can provide a way to reach recovery. This realization provides a source of hope that change and improvement are indeed possible. This hope is sometimes focused on God for those who are religious, but it can also be connected to a more generic higher power.
For example, through research-based treatments, a person who believes in their ability to recover from substance abuse, and who applies that hope through commitment to treatment, can learn to manage the condition. The National Institute on Drug Abuse (NIDA) demonstrates that this hope is valid. However, the idea of this step is that it’s not just the treatment that matters; it’s the person’s willingness to have faith in the ability to manage the condition.
Sometimes this recovery can be challenging – substance abuse is a chronic condition with relapse rates similar to other chronic conditions like asthma and diabetes. However, this does not mean that treatment fails. Instead, it means that if the person holds on to that hope and commitment, the commitment against relapse can be continued and the person can learn to stay abstinent. This leads to the next step.
3. Surrender to a Higher Power.
Giving the process over to a higher power is the result of having faith that recovery is possible. As described in an article from Psych Central, the idea of surrendering to a higher power does not necessarily mean that the individual has to believe in a particular form of God or follow a religious path. What it does mean is that the individual lets go of control and becomes willing to give over to the recovery process, letting go of their own ideas about how to control the addiction – which obviously haven’t been working so far – and becoming humble enough to learn.
It can be hard to let go of that control, and it can be scary. However, trusting that others have been able to get through it and come through on the other side can help in letting go.
4. Take a Moral Inventory.
Once these first three steps have been completed, this next step is possible. When a person is looking to transform their life and behavior, it helps to take a good look at what’s going on in the present. To do this, the person needs to analyze their behaviors to figure out just where things have gone wrong.
As explained on StepStudy.org, it can be challenging to know exactly what to analyze. However, the consensus is that the intent is to find out where the person’s goals and aspirations have fallen and describe exactly what those personal defects are.
5. Admit Wrongs.
Once these wrongs have been identified, the challenge is to admit to them. The goal of this step is to share what has been learned in Step 4, thereby also admitting it to the self. As explained by 12Step.org, this can be particularly challenging. No one wants to admit personal defects. However, reflecting back to Step 1, it is in doing so that the individual is able to bring problems to light, so that those problems can then be worked on and, hopefully, resolved, aiding in the journey toward recovery.
To accomplish this, the individual shares the Step 4 inventory with the self, the higher power, and one other person.
6. Be Ready to Remove Shortcomings.
Once the moral inventory has been taken to heart, the individual is then ready to commit to the work of righting the wrongs and repairing the defects. In other words, this is the stage in which the individual commits to the process of recovery, and the personal and mental work of learning to manage the addictive behaviors that have been interfering with life and relationships.
The reason this step is so important is because it signals the individual’s true motivation to change. Research summarized by the Substance Abuse and Mental Health Services Administration’s Treatment Improvement Protocols shows that the elements that result in the most positive outcomes for addiction treatment are the individual’s motivation, desire, and commitment to complete the treatment process and avoid relapse. As a result, maintaining this motivation is the central element of most research-based treatment programs.
7. Ask One’s Higher Power to Help.
Once the motivation has been established, the individual remembers the first steps and, recognizing the fact of powerlessness over addiction, returns to a state of humility and asks their higher power from Step 2 for help in completing the continued work by removing the shortcomings established through the moral inventory.
This step reaffirms Step 3, reminding the individual to give up the need to control the process. This enables the wisdom and knowledge of others to enter and opens the individual up to learning about the ways that change is best established.
8. List Amends.
In order to remove the blemishes on the moral inventory, it is important to recognize the results of those negative behaviors and aspects of the inner self. Step 8 helps with this by requiring the individual to review past behaviors and recognize where and when wrong has been done to others as a result of addictive behaviors. Through this step, negative actions that have caused hurt are listed and acknowledged, along with the names of the people those behaviors affected.
The list is created out of intention toward the next step. As described on 12step.org, the intention is to move forward and ask forgiveness for these wrongs.
9. Make Amends.
In order to heal the wounds of past wrongs, the individual takes the intention of the last step and moves forward to engage the people who have been wronged, acknowledge that the wrong occurred, make amends, and ask forgiveness. For many, this can be the hardest step of the program. It reinforces the sense of humility, and it can be uncomfortable, especially if forgiveness isn’t granted. However, this is not all the step entails.
It’s important to understand that making amends doesn’t end with a simple apology for wrongs committed. The process also involves trying to make up for the wrongs committed; repairing damaged property or another form of restitution is one example. In the case where the individuals can’t be approached directly or can’t be found, providing community service or other forms of indirect restitution can fulfill this step.
10. Continue the Personal Inventory.
Step 10 involves continuing the process of performing a moral inventory, noting where wrongs or unhelpful behaviors are changed and overcome, finding where new ones develop, and repeating other steps in an effort to continue the process of self-improvement and change. Through Step 8, the individual realizes that change is an ongoing, continual process that never ends and carries through a full lifetime.
11. Pray or Meditate.
As explained by AA Agnostica, spirituality is life force, and continuing connection with that spiritual center can provide daily reinforcement of Steps 2 and 3. Prayer to the higher power, or meditation on the process of recovery and the beliefs that continue to maintain hope, are strong tools for keeping the motivation from Step 6 to continue the work of recovery and avoid relapse.
12. Help Others.
Finally, experienced, humbled, recovering individual can strengthen inner resources by helping others who are also struggling with addiction to go through the steps as well. Becoming a sponsor, continuing with the group into the future, and supporting the goals of the 12-Step program give the individual a sense of purpose and meaning to continue into the future, maintaining motivation and strength while being buoyed by the unity of the group.
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The 12 Traditions
The other major aspect of the 12-Step program is the 12 Traditions, which were originally defined by AA. These traditions form the foundation of why the 12-Step program is set up the way it is. These traditions, based on those defined by the Alcoholics Anonymous website, are:
- The common welfare and the unity of the group form the basis for personal recovery.
- The leaders of the group do not govern; all group members submit to their higher power.
- The only requirement to be part of the group is the desire to stop abusing substances.
- Each individual group is run separately from others, except in elements that affect the 12‑Step program as a whole.
- The main purpose of each group is to connect with people who are struggling with substance abuse.
- The groups do not support outside organizations, in order to make sure money and notoriety will not affect the members or their recovery.
- Each group is self-supporting and does not accept outside contributions.
- The organization is fully volunteer-based except for people employed in central service centers.
- The main 12-Step program is not a corporation or similar organization; however, groups or boards may be formed to support the people they directly serve.
- Twelve-Step programs do not get involved in public or political controversy.
- The organizations use public relations only to connect with those who need them, not to publicize themselves or the groups.
- Anonymity is the foundation of all these traditions, as it serves to make the program’s principles and ideals more important than the people who implement them.