Twelve-step program

A Twelve-step program is a set of guiding principles for recovery from addictive, compulsive, or behavioral problems, originally developed by the fellowship of Alcoholics Anonymous (abbreviated A.A.) to guide recovery from alcoholism. The twelve steps were first laid out in the text Alcoholics Anonymous ("The Big Book"). This method has been adapated as the foundation of other twelve-step programs such as Narcotics Anonymous, Overeaters Anonymous, Crystal Meth Anonymous, and Codependents Anonymous. Working the twelve steps involves:

• admitting that one has a serious, uncontrollable problem;
• recognizing that outside power could help;
• conscious reliance upon that power
• inventorying and admitting character defects;
• seeking deliverance from these defects;
• making amends to those one has harmed; and
• helping others with the same problem.

Overview of Twelve-Step Programs

The way of life outlined in the 12-steps as written by Alcoholics Anonymous has been adapted widely. The effects of AA recovery within the family unit providing improved quality of life resulted in fellowships like Al-Anon; substance-dependent people who did not relate to the specifics of alcohol dependency started meeting together as Narcotics Anonymous; similar groups were formed for sufferers of cocaine addiction and crystal meth addiction. Behavioral issues involving compulsion and/or addiction with sex and food were found to be solved for some willing people with the daily application of the 12-steps in such fellowships as Sexual Compulsives Anonymous and Overeaters Anonymous. Over 300 fellowships composed of millions of recovery members, all based in the same principles, are found around the world.

These programs share a few things in common, most obviously their emphasis on addiction or alcoholism as an illness that mere abstinance will not cure. In theory within the twelve-step environment, it is thought that the illness of addiction or alcoholism is attributed to a physical allergy that creates uncontrollable cravings coupled with a psychological obsession that keeps finding rationalizations for relapse. Recovery from the illness can occur by taking individual responsibility for one's own recovery by relying on the will of a power not controlled by such cravings. True to the Twelve Traditions, twelve-step programs do not take positions on outside issues, including medicine.

The Twelve Traditions

The twelve steps are accompanied by twelve traditions of group governance as developed by Alcoholics Anonymous through its early formation. Most 12-step followships also adopted these principles as their structural governance. In AA, the empathetic desire to save other drunks resulted in a radical emphasis on service to other sufferers only. Thus “the only requirement for AA membership is the desire to stop drinking”. Similar membership guidelines were adopted by other fellowships, with particular emphasis on freedom from alcohol because of the history of the traditions (note that alcohol is considered a drug in most substance-related twelve step groups).

One of the most widely-recognized characteristics of twelve-step groups is the requirement that members focus on the admission that they "have a problem". In this spirit, many members open their address to the group along the lines of, "Hi, I'm Pam and I'm an alcoholic" — a catchphrase now widely identified with support groups.

Attendees at group meetings share their experiences, challenges, successes and failures, and provide peer support for each other. Many people who have joined these groups report they found success that previously eluded them, while others — including some ex-members — criticize their efficacy or universal applicability. This varied success rate, along with the fact that twelve-step programs have been associated with the belief in a higher power -- a belief often associated with religion -- has caused some controversy.

The Twelve Steps

These are the original Twelve Steps as defined by Alcoholics Anonymous:

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. 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.
12. 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.

Other twelve-step groups have modified the twelve steps slightly from those of Alcoholics Anonymous to refer to problems other than alcoholism.

The Twelve Traditions

Main article: Twelve traditions

These are the Twelve Traditions of Alcoholics Anonymous, they are similar in all twelve-step fellowships.

1. Our common welfare should come first; personal recovery depends upon A.A. unity.
2. 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.
3. The only requirement for A.A. membership is a desire to stop drinking.
4. Each group should be autonomous except in matters affecting other groups or A.A. as a whole.
5. Each group has but one primary purpose-to carry its message to the alcoholic who still suffers.
6. An A.A. group ought never endorse, finance or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property and prestige divert us from our primary purpose.
7. Every A.A. group ought to be fully self-supporting, declining outside contributions.
8. Alcoholics Anonymous should remain forever nonprofessional, but our service centers may employ special workers.
9. A.A., as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
10. Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.
11. Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio and films.
12. Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.

History

The first such program was Alcoholics Anonymous (A.A.), which was begun in 1935 by Bill Wilson and Dr. Bob Smith, known to A.A. members as "Bill W." and "Dr. Bob", in Akron, Ohio. They established the tradition within the "anonymous" twelve-step programs of using only first names. The Twelve Steps were originally written by Wilson and represented Wilson's incorporation of the teachings of Rev. Sam Shoemaker about the Oxford Group life-changing program.

Upon recognizing a surprising level of recovery among alcoholics working the program, Wilson had the idea to write a book about the program. The original Akron program was developed in 1935 by Wilson and Smith in a Christian Fellowship that derived most of its simple ideas from the Christian Endeavor Movement of Dr. Bob's youth as well as ideas about abstinence, conversion, reliance on the Creator, elimination of sin, obedience to God, and growth in Fellowship through Bible study and prayer and religious literature. Working with others to help them get straightened out was essential. These fundamental ideas came primarily from the Rescue Missions, the Salvation Army, and the YMCA. Early hospitalization was considered a "must."

The program was investigated by A.A. Trustee-to-be Frank Amos who, in 1938, reported on its elements and successes. His report is fully described in A.A.'s Dr. Bob and the Good Oldtimers. The Akron success rate had produced 75% cures and astonished the New York people. Wilson returned to New York and wrote of a program based primarily on what he had learned from the Rev. Samuel M. Shoemaker, Jr., rector of Calvary Episcopal Church in New York, and a leader of the Oxford Group people in America. To Shoemaker's ideas, which are found almost verbatim in the Twelve Steps, Bill added in his Big Book (the new basic text) ideas about alcoholism from Dr. William D. Silkworth, ideas about the necessity for a conversion from Dr. Carl G. Jung, ideas about a so-called "higher power" primarily from psychologist William James and practical techniques from Richard Peabody set forth in his Common Sense of Drinking book, and a variety of words and phrases thought to originate from New Thought teachings such as "Creative Intelligence," "Spirit of the Universe," "fourth dimension of existence," and "higher power." Then Wilson announced this "program of recovery" which consisted of the "Twelve Steps" the pioneers had taken to find God.

Bill asked Shoemaker to write the Steps, but Shoemaker declined. The Steps can be recognized in the Oxford Group teachings Wilson received from Rowland Hazard and Ebby Thacher in late 1934 and early 1935, but neither the Oxford Group nor early A.A. in New York or Akron had any "steps" at all. Instead, the Oxford Group had what it called Four Absolutes: absolute purity, absolute honesty, absolute unselfishness and absolute love coupled with a moral inventory, confession and restitution.

The Twelve Steps were eventually matched with Twelve Traditions, a set of guidelines for running individual groups and a sort of constitution for the fellowship (i.e., A.A.) as a whole.

Many other programs since have adapted A.A.'s original steps to their own ends. Related programs exist to help family and friends of those with addictions as well as those with problems other than alcohol. These programs also follow modified versions of the Twelve Steps of Alcoholics Anonymous and include groups like Al-Anon/Alateen, Cocaine Anonymous (CA), Overeaters Anonymous (OA), Gamblers Anonymous (GA), Narcotics Anonymous (NA), Emotions Anonymous (EA), and Nar-Anon.

One organization which is often confused with an "Anonymous" twelve-step program, due to the intentional similarity of its name — but is not one — is Narconon. Narconon is a branch of the Church of Scientology, presenting Scientology doctrine and practices as a therapy for drug abusers. Narconon does not use the Twelve Steps, and is not related to either Narcotics Anonymous (NA) or to Nar-Anon, despite the similarity of names.

Acceptance of a Higher Power

A primary tenet of 12-step recovery requires a member to surrender willful self-reliance (a purported characteristic of afflicted persons), to adopt the practice of reliance on God, or another "Higher Power" of the member's own understanding. Proponents of twelve-step programs allege that agnostics and even atheists can be helped by the program, as a member’s concept of a Higher Power may originate (and/or remain) with the 12-step group itself. With time, any other entity, thing(s) or object(s) that aid a member in accepting their powerlessness over their problem, are claimed to become the Higher Power that will help them to recover. It is colloquially stated that any Power perceived as being greater than oneself will do, provided the power is not any other, single individual, or one's own unaided will.

The success of Twelve-step groups in aiding in recovery of addictive illnesses is an argument of significance in some parts of the United States, where the criminal justice system has ordered 12-step group participation to convicted felons as well as inmate addicts as a condition of parole or shortened sentences. U.S. judges have often required attendance at AA meetings as a condition of probation or parole or as an element of a sentence for defendants convicted of a crime. The New York Court of Appeals ruled in Griffin v. Coughlin, 88 N.Y.2d 674 (1996) that doing so compromises the Establishment Clause of the United States Constitution on the grounds that A.A. practices and doctrine are (in the words of the district court judge who wrote the decision) "unequivocally religious". The Supreme Court of the United States denied certiorari and allowed the New York court's decision to stand.

Critics of the 12-step programs, however, often hold that this reliance is ineffective, and offensive or inapplicable to atheists and others who do not believe in a salvific deity. Other critics see forms of authoritarian mind control in the 12 step approach.

Some critics state that 12-step groups are religious in nature. The only authorized literature in most 12-step groups is their own publications, as these groups claim no outside affiliation. The members of 12-step groups make the distinction that the groups are spiritual, and not religious; members of 12-step groups are also members of a wide variety of religious bodies. Nearly every meeting begins with the Serenity Prayer, a prayer addressed to "God." The Big Book states that its "main object is to enable you to find a Power greater than yourself which will solve your problem."

Some critics also question the idea of giving up on self-reliance, which, they argue, results in a form of idealized despair. Others acknowledge a debt to the twelve-steps movement but do not have a culture of belief in God.

Relation to religion

The original A.A. program fashioned in Akron was described as a Christian Fellowship, held "old fashioned prayer meetings," stressed Bible study and prayer and the reading of religious literature, and aimed to bring people to an acceptance of Jesus Christ as the way to a relationship with God.

While meetings were held by alcoholics and Oxford Group members, the work was said to be that of a "clandestine lodge" of the Oxford Group because its stress was on helping alcoholics to recovery, abstinence, resistance of temptation, old fashioned revival meetings, and conversion to Christ — which seemed to derive from the ideas, principles and practices of United Christian Endeavor Society of Dr. Bob's youth.

According to its supporters, the program achieved a 75% to 93% success rate originally. However, at the time of Dr. Bob's funeral, Bill Wilson said that he thought the current success rate was closer to 5%. Its adherents said they felt the answer to their problems was in the "Good Book" (as they called the Bible). There were no Steps, no basic text, only one regular meeting. The emphasis was on Bible study, prayer, seeking God's guidance, conversion, visiting hospitalized alcoholics, fellowship and witnessing. In a word, it was called "love and service" — the watchwords of United Christian Endeavor.

There is no strong evidence to support that either Bill Wilson or Dr. Bob ever accepted Jesus Christ as their personal savior or that they ever argued or were intent on secretly converting anyone to Christianity. In fact, in Bill Wilson's own words, he looked upon the Oxford Group and felt inspired, but to the idea that the common denominator from all religions could be gathered to create a program that worked for everything, and gave members the power to choose their own understanding of God, Higher Power, or whatever they chose to call "a power greater than themselves."

"The Oxford Group was a nondenominational evangelical movement, streamlined for the modern world and then at the height of its very considerable success. . . . They would deal in simple common denominators of all religions which would be potent enough to change the lives of men and women."

— Bill W.,

There are many different ways of interpreting the intent behind twelve-step programs. And as with the Bible, there are those who argue strongly for a relatively literal adherence to program literature, and then there are those who advise "take what you like and leave the rest" and advocate a much more liberal approach. (Note: The phrase "take what you like and leave the rest" cannot be found in the Basic Text of AA or any other A.A. literature. The Big Book makes it abundantly clear that following the 12 steps to the letter is one powerful way for an alcoholic of the kind described in the Big Book to stay sober, although it also says clearly that AA has no monopoly on the truth.) Two books that look at the twelve-step literature from a more liberal point of view are The Zen of Recovery by Mel Ash and A Skeptic's Guide To The Twelve Steps by Phillip Z. Another book, "The Recovery Spiral: A Pagan Path to Healing" by Cynthia Jane Collins, looks at the 12 steps through a Pagan perspective.

In psychotherapy and related fields, Twelve-step has sometimes been critiqued as essentially "religious" in nature; however, many therapists report practical success with the method or similar methods. Therapy-oriented organisations like Re-evaluation Counselling that have policies on addictive behaviour do not always agree with 12-step methods.

See also

• Free 12 Step videos
• List of Twelve-Step groups
• Alcoholics Anonymous suite