Alcoholics Anonymous is one of the best-known organizations in the world and is the originator of the now-famous and widely used 12-step model of recovery. Alcoholics Anonymous groups and other 12-step fellowships can be found in virtually every corner of the U.S. and in scores of other countries. In many high-quality addiction treatment programs, participating in AA is an integral and essential part of recovery.
The Twelve Steps: A Way of Life
The Twelve Steps are a group of spiritual principles that act as a clear, actionable guide for a way of life free of addiction. Moving through the steps ideally leads to long-term sobriety, a stronger sense of purpose in life, spiritual wholeness and overall happiness.
While Alcoholics Anonymous created and defined the 12-step process and is the best-known example of a 12-step program, the 12 steps can apply to a wide range of addictions, compulsive behaviors and mental health problems. As such, 94 official fellowships have been established to address various issues. These include Narcotics Anonymous, Cocaine Anonymous, Gamblers Anonymous, Overeaters Anonymous and Sex Addicts Anonymous.
A Brief History of Alcoholics Anonymous and the 12-Step Model
The National Prohibition Act took effect in 1920 and outlawed the manufacture, sale and consumption of alcohol. During its 13-year span, drinking behaviors were indeed curbed, but because people were purportedly not drinking, virtually all of the country’s asylums closed their doors and self-help societies faded away. As a result, people who needed help grappling with an alcohol addiction were unable to find it.1
In 1935, Bill W. of New York City and Dr. Bob S. of Akron, Ohio, met through their involvement with the Oxford Group, a more-or-less non-alcoholic fellowship that emphasized spirituality in everyday life. Through his affiliation with the group, Bill had overcome an intense alcohol addiction and maintained it by devoting his life to working with others who were addicted to alcohol. Dr. Bob was still struggling with alcoholism when he met Bill, who inspired him to become sober once and for all.
Together, Bill and Dr. Bob went to work helping alcoholics at City Hospital in Akron, and after one patient quickly attained sobriety, the three men met frequently to support one another. This was the first Alcoholics Anonymous fellowship, and by 1939, two more were in full swing in New York and Cleveland. In four years, 100 men achieved successful recovery through regular fellowship meetings. In 1939, Bill wrote Alcoholics Anonymous, the textbook informally known as “The Big Book,” which has been used for more than 80 years to help scores of people recover from alcohol addiction.
Alcoholics Anonymous explained the group’s philosophy and methods, at the core of which were the Twelve Steps of recovery. After the Cleveland Plain Dealer published a series of positive stories about AA in 1939, membership in that city’s AA fellowship shot up from 20 to 500 in a matter of months.
A trusteeship for the organization was established with friends of John D. Rockefeller serving as members of the board, which was known as The Alcoholic Foundation. An office was opened in New York to field inquiries and distribute “The Big Book.” By 1941, AA had 6,000 members spread across the U.S. and Canada, and by 1950, that number had reached 100,000, thanks to a great deal of positive publicity.
Today, it’s estimated that there are over two million members of AA in over 117,000 groups worldwide, and “The Big Book” has been translated into 28 languages.
A Brief Overview of Addiction
The National Institute on Drug Abuse characterizes addiction as the inability to stop using a substance despite the negative consequences it causes in your life.2 These consequences may be related to finances, legal status, relationships or physical or mental health.
Addiction is progressive, which means that without help, it almost always gets worse. It’s also chronic and relapsing, meaning that while it can’t be cured, it can be sent into remission through abstinence. However, using a substance again after a period of abstinence can lead to a relapse of the addiction, once again characterized by the inability to stop using despite negative consequences.
In order to overcome an addiction, complete abstinence is essential. But without the help of a recovery program, facing challenges and overcoming barriers is an overwhelming prospect that, more often than not, leads quickly to relapse.
Twelve step programs provide support and education to help people new to recovery navigate the often-rocky road to long-term sobriety.
Participants in 12-step groups move through the steps one by one, with each step leading seamlessly to the next. Following is a brief overview of each step as outlined in AA’s guide, Twelve Steps and Twelve Traditions.3
Step One: Admit Powerlessness
“We admitted we were powerless over alcohol [or drugs]—that our lives had become unmanageable.”
The negative consequences of substance abuse are often far-reaching and can destroy relationships, result in job loss and cause devastating health or legal problems. Still, someone with an addiction will continue to use a substance anyway, largely due to changes in the brain’s learning, memory and reward centers that affect thought patterns and behavior.
The first of the twelve steps involves admitting that you have lost control over your drug use, and as a result, negative consequences have left you feeling hopeless and defeated. This, according to “The Big Book,” is what leads many addicted individuals to AA, where they “discover the fatal nature of our situation.”3 Only then do they “become as open-minded to conviction and as willing to listen as the dying can be.”
Once you truly understand and come to terms with the fact that you’re powerless over your drug-seeking and -using compulsions despite wanting or trying to quit, you’re willing to do whatever it takes to defeat the addiction and reclaim your life.
Step Two: Find Your Higher Power
“We came to believe that a Power greater than ourselves could restore us to sanity.”
Step Two is about hope and faith. Despite disappointment, guilt, depression, a sense of failure and other destructive emotions, there is always hope for a better future. Hope, according to the Substance Abuse and Mental Health Services Administration, is the belief that the challenges of sobriety can be overcome through an individual’s strengths, talents, resources, coping skills and inherent values, and it’s the very foundation of recovery.4
Hope is supported by a power greater than ourselves. Whether you call this power “God,” “the Universe,” “love,” “family” or something else entirely, this means having faith that something beyond yourself can imbue you with the strength to overcome the challenges of recovery.
Step Three: Turn Your Will Over to Your Higher Power
“We made a decision to turn our will and our lives over to the care of God as we understood him.”
The first two steps are deeply personal and serve to restore hope for the future and faith that a power beyond your own flawed self can help you overcome your addiction. In Step Three, your attention turns to the higher power you identified in Step Two as you acknowledge that recovery requires help beyond the flesh, blood and brain synapses that make you who you are. However you defined your higher power in Step Two, that power is something bigger and more powerful than you, and it’s more accepting of you than you are of yourself.
Step Three leads you to mindfully release the death grip you have on the minutia of your life and listen to a deeper voice that’s far wiser and more compassionate than you are. It leads you to let go of your preconceived notions of yourself, release your guilt, anger, frustration and self-hatred and realize that your current state and the problems in which you’re mired represent only a sliver of your greater self.
In Step Three, you turn your life over to the forces that drive your deeper, spiritual self so that you can effectively navigate the difficult steps that follow and open your mind to new possibilities and ways of thinking about yourself. In doing so, you open yourself to the humbling life lessons coming your way in the following steps so that they will resonate in a deeply meaningful way.
Step Four: The Moral Inventory
“We made a searching and fearless moral inventory of ourselves.”
Step Four is a time of soul-searching. At the core of our inability to intimately know ourselves is denial, the act of ignoring our negative aspects and pretending they don’t exist because confronting them is terrifying on so many levels. Denial enables us to justify or rationalize our harmful thoughts and behaviors to make ourselves feel better about them.
The moral inventory is a comprehensive, brutally honest written list of all of the wrongs you perpetrated while mired in your addiction. It’s undertaken fearlessly because in Step Three, you turned your life over to your higher power, which is eternally compassionate and forgiving. During Step Three, you withhold self-judgment and, for now, accept your failings as a part of your past and regard them with impartiality.
The Substance Abuse and Mental Health Services Administration stresses that knowing exactly where you’ve come from is essential for finding your way to where you want to go.5 In extracting the unfortunate deeds you’ve done, these can now be replaced by an indelible lightness of being. You exist in the present, and you now have the power to make choices that will preclude you from making the same mistakes again.
Step Five: Admit the Nature of Our Wrongs
“We admitted to God, to ourselves, and to another human being the exact nature of our wrongdoings.”
Once the fearless moral inventory has been made, it’s time to step out from behind the mask of guilt, self-deception and pride that isolates you from others and prevents you from being honest with yourself. It’s time to knock down the walls you’ve constructed to hide your shame and self-loathing, walls that make it difficult to analyze the issues underlying the addiction and move forward with certainty and clarity.
With Step Five comes a profound inner shift wherein who you are is no longer defined by your sordid deeds, but by self-forgiveness and sharing the weight of those deeds with a wise, supportive soul. Not only will you come out on the other side forgiven and whole, but you’ll also find that you’re no longer apart from humanity, no longer hiding behind a veil of deceit. You’ll move into the next phase of recovery with open-mindedness and honesty.
Step Six: Reflect and Find a Willingness to Change
“We were entirely ready to have God remove all these defects of character.”
Step Six is about reflection, preparation, and a willingness to change. Being willing and ready to surrender your “defects of character” to a higher power means that you’re ready to let that higher power—God, Love, Buddha, The Universe, Allah, Nature—touch your life and move you in a spiritual direction. It’s becoming willing and ready to let go of certain things in your life that prevent you from progressing in your recovery and your spiritual growth.
Step six is the process of reaching this state of readiness, the process of finding that you’re truly prepared to make the daily effort required to evaluate and adjust your thoughts and behaviors to foster healthy expressions of your humanity.
Being willing to surrender your deficits of character to your higher power and continue to move into the light—even despite setbacks, which are a natural part of recovery—is an indication of your readiness to mindfully and honestly address imbalances in your life to promote spiritual growth and long-term recovery.
Step Seven: Ask Higher Power to Remove Your Shortcomings
“We humbly asked Him [or Her, or It] to remove our shortcomings.”
Step Seven is about humility rather than the expectation that your higher power will swoop in and erase your shortcomings with a magic wand and instantaneously transform you into a brand-new being. You’re human, after all, and shortcomings are a part of the fundamental human condition.
Humility is the ability to see yourself as you actually are—comprised of both strengths and weaknesses—so that you can make a sincere attempt to become what you want to be. Humility is essential for moving away from yourself and your limitations and toward others and your higher power. By humbly appealing to your higher power to remove your shortcomings, you’re embracing hope and committing to doing your part to rid your life of stumbling blocks that will inhibit your spiritual growth.
Step Eight: Make a List of Those You Harmed
“We made a list of all persons we had harmed, and became willing to make amends to them all.”
In Step Eight, you work toward repairing the damage you’ve done to others, attaining forgiveness and restoring relationships whenever possible. Similar to the moral inventory, Step Eight requires first making a list of the people you hurt and recording thoughts about how you might make amends. Then, you work toward a willingness to make those amends.
Step Eight demands honesty about your relationships with others. It’s the beginning of the process of forgiving people who have hurt you and being forgiven by those you’ve hurt, and it helps build an awareness of your new and changing attitudes about yourself and your relationships.
Step Nine: Make Amends
“Make direct amends to such people whenever possible, except when to do so would injure them or others.”
Step Nine serves to help clear your conscience and banish the lingering vestiges of guilt, regret and shame—which may be long buried and all but forgotten—that shapes and skews your self-perception and leads you to blame others, justify unjustifiable actions and make excuses for your behaviors, all of which are unhealthy and impact your clarity and serenity.
Shame and guilt can fuel denial and lead to other negative consequences.6 By making amends to the best of your ability, you’re able to clear your conscience, improve your self-esteem, relieve stress and let go of blame.
The first step is forgiving yourself for your wrongdoings and forgiving others for any part they may have played in your wrongful actions. The second step is coming clean, trying to make up for your actions, and–in most cases–enjoying the forgiveness bestowed upon you. This step helps you examine your actions under a microscope and understand how what you do affects others.
Step Ten: Maintain Recovery
“We continued to take personal inventory and when we were wrong promptly admitted it.”
Step Ten is about maintaining recovery by staying ever vigilant of your actions, behaviors, attitudes and emotions to ensure you don’t revert to old, harmful ways of thinking and behaving. Spot-checks throughout your day enables you to identify selfish, dishonest, or fear-driven behaviors that can cause others harm. This, in turn, gives you the opportunity to make amends immediately so that you can live free of guilt and shame.
Daily examination of your thoughts and actions helps you identify emotional states that tend to lead you to make mistakes that affect others and compromise your recovery. It also helps you forgive others for their undesirable attitudes and behaviors that at one time might have led you to make regretful choices.
Step Ten is a lifelong endeavor that helps you keep your slate clean. It enhances your sense of compassion for yourself and for others, and it keeps you honest.
Step Eleven: Improve Conscious Contact with Your Higher Power
“We 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.”
Step Eleven brings prayer and meditation into your daily life as an integral part of your ongoing recovery. The purpose of prayer in recovery, whether it’s a plea to God or a heartfelt and earnest wish sent to the universe from your heart of hearts, is to be ever mindful of where you are and where you’re going and to draw strength from your higher power. Meditation helps you make an explicit connection to a higher part of yourself to bring about meaningful change from the inside out.
Step Twelve: Spread the Word
“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.”
Step Twelve, the final step, is about spreading a message of hope to others who are just starting their recovery journey. By now, you’ve achieved emotional stability and live a mindful life mostly free of actions that lead to guilt, shame, confusion and other negative emotions. Now, you’re qualified to be a sponsor to someone in need of personal guidance. You show others by example that you overcame the many barriers to recovery, and if you can do it, anyone can.
Because you’ve been there and made the excuses and played the victim and lied to yourself and others, you’re in a unique position to see through these behaviors in others struggling with addiction. You can show that hope is everything, that recovery is joyful and that even when life feels meaningless, it’s anything but.
You will always be a work in progress. You will always have to attend to steps nine and ten, and you’ll still face challenges and experience setbacks. But by now, you’re strong enough and know enough to be a beacon to light the way for others so that they, too, can transform their lives.
What the Research Says About 12-Step Programs
For years, only a handful of studies set out to document the effectiveness of AA and other 12-step programs, largely due to the fact that to preserve anonymity, few statistics are kept by AA.
According to the Hazelden Betty Ford Foundation, historian and author Charles Bishop, Jr. stresses that categorizing AA as a form of addiction therapy does it a disservice because it’s a spiritual fellowship rather than a treatment strategy.7 “The underlying difficulties of applying the scientific method to spirituality should give every scholar pause,” he points out, noting that research on the effectiveness of the organization should be approached gingerly.
Because it’s a spiritually based program, science and medicine for many years scoffed at AA—particularly the bits about personal powerlessness and higher powers. But over the years, science has changed its tune considerably, starting with a major federal study published in 1998 that found 12-step facilitation therapy to work as well as cognitive-behavioral therapy and motivational enhancement therapy for promoting total abstinence for the long-term.7
A peer-reviewed study cited by an article published in the journal Alcoholism Treatment Quarterly found strong evidence for the effectiveness of Alcoholics Anonymous in the abstinence rates in those who attend AA, which is two times higher than the abstinence rates of those who don’t.8
Another study published in the Journal of Substance Abuse Treatment found that people who attended 12-step meetings prior to entering treatment stayed in treatment longer and were more likely to complete the program.9 The study also found that people who participate in both treatment and a 12-step program had higher abstinence rates than those who participated in just one or the other.
Although some studies have found the evidence for AA inconclusive, the bottom line is that for many, it’s an extremely important pathway to long-term successful recovery that enhances well-being, spirituality and purpose as well as leads to an overall higher quality of life.
Most people have heard of some of the popular 12-Step programs used in addiction recovery; however, not everyone knows what these programs are really about. A 12-step program is made up of a set of guiding principles that define a course of action for handling problems such as drug addiction and alcoholism. The 12 steps have been proven to be an effective complement to standard addiction treatment, and most recovery programs encourage clients to take part in a 12-step group during and after rehab.
The Power of the Program
What makes the 12 steps so effective? A number of factors contribute to the success rate of the program. The sense of community at meetings is powerful – participants have the chance to meet others who share the same goals and struggles, and they can avoid the sense of isolation that often leads to relapse.
At meetings, members can ask each other how they handle certain situations and share relapse-prevention techniques. The process of “working the steps” is empowering for participants, and members gain strength by acknowledging their personal accountability to themselves and the group.
Recovery isn’t just about stopping your drug or alcohol use, it’s about learning a whole new way of life. For many recovering individuals, 12-Step programs provide the structure and support they need to get started on this unfamiliar journey. Like any approach to addiction treatment, the 12 steps may not be the right choice for everyone. However, the payoff can be great for people who are willing to give it a chance.
The 12 Steps and Relapse
How can someone who has completed all 12 steps relapse? The Alcoholics Anonymous: Big Book says, “What we really have is a daily reprieve contingent on the maintenance of our spiritual condition.” (pg.85) Regardless of what we have done, it only matters what we continue to do. Our recovery from alcoholism and addiction is only as strong as what we do today. So how and what does happen to recovery when we relapse?
The treatment field teaches that a relapse starts long before the substance is ever actually taken. The first year of recovery is usually based around just staying clean and sober. Recovery is something new, and there is a joy in at last having found some relief from our damaging and demoralizing addiction that has plagued us for so long. A lot of times we talk about a “pink cloud” or new sense of well-being that overwhelms us in early recovery.
If this is where we stop working a program, simply we because we feel better, we are doomed. But, that is not what this article is about, it is about the person who does buy into the 12-step program and starts a life of recovery. At this stage of the game, we are usually willing to take suggestions and keep an open mind.
As time moves on, we start to get things back. Things we have placed on the back burner, in order to ground our lives in recovery, begin to return. Usually in years 2-5, we begin to seek a more serious form of employment or even a career, return to school or maybe enter into a relationship. Hopefully, by now we have completed the steps with our sponsor and have a home group. Life becomes more of a balancing act. Where initially our main focus was recovery, now life has crept back in.
What happens when you lose focus on your recovery?
Sometimes old patterns of behavior, that may or may not have been addressed during the steps, begin to rear their ugly heads. This is where we may start to see a relapse begin. Relationship issues begin to surface, whether that is with a boss, co-worker, peer or a loved one, these can detract from our newfound serenity.
Some things such as codependency, overextending oneself or perfectionism issues, which may have been dormant in early recovery, begin to become more magnified as we seek a healthy balance between life and recovery. Many people replace their recovery with work, the gym or a relationship. For women, perhaps it may be child birth. We may forget how we got to this point in our lives.
Some just get cocky. Contact with recovering addicts starts to diminish, meeting attendance declines, and so on. This is the un-working of Step 12, failure to carry the message to other Alcoholics. We can begin to be so caught up in the other aspects of life that one of the fundamental pieces of our recovery begins to fall by the wayside.
Next, we may stop praying or meditation. This is the undoing of our conscious contact with a Higher Power. It may be a subtle change at first. It is common practice for many in recovery, who once got on their knees to pray, to discontinue this practice. Where is that desperation for recovery we once had? Our awareness of a higher-power begins to fade.
Here we plummet; un-working steps 10 through 4 in one mighty swoop. A nightly personal inventory slips into weekly or non-existent. If there is no inventory, there is no need for amends. There are no shortcomings visible to us. Controlling our defects of character becomes like trying to corral a litter of energetic puppies, trying to escape in all different directions. We lose sight of the moral inventory we once made.
Now comes the really scary part: We make a decision to take our will back. Not just a little, as we may have done with certain situations in the past, but the whole enchilada. The power we once believed could restore us to sanity has gone out the window, most likely with our sanity. If our sanity is gone, we once again believe this time will be different.
We believe we now have the power, and we can manage our own lives. As we spiral down to insanity, we end up in that disheartening space we thought we had left behind. We once again get that feeling of a deep dark hole in our souls, a void so vast that nothing can fill it no matter how hard we may try.
So what can we do to keep relapse from happening?
One way to maintain our program is to make sure we have a home group. A meeting we attend, at the very minimum, on a weekly basis. Allow these people to really know us. Take commitments such as coffee maker, greeter, or many of the others available at meetings we attend. Allow close friends in our support group to take our inventory.
Keep your sponsor close and be open to feedback. All these little things help us to be accountable to our program of recovery. The Alcoholics Anonymous: Big Book says, “We are unable, at certain times, to bring into our consciousness with sufficient force the memory of the suffering and humiliation of even a week or a month ago. We are without defense against the first drink.” (pg. 24) If we thoroughly understand this, we can see how imperative it is to remain perseverant with our recovery.
Blocker Jr., J. S. Did Prohibition Really Work? Alcohol Prohibition as a Public Health Innovation. (2006, February). American Journal of Public Health, 96(2); 233-243. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470475/
The Science of Drug Abuse and Addiction: The Basics. (2014, September). Retrieved from https://www.drugabuse.gov/publications/media-guide/science-drug-abuse-addiction-basics
Twelve Steps and Twelve Traditions. (2012, July). Retrieved from http://www.aa.org/pages/en_US/twelve-steps-and-twelve-traditions
Recovery and Recovery Support. (2015, October). Retrieved from http://www.samhsa.gov/recovery
Chapter 4: From Precontemplation to Contemplation: Building Readiness. (1999). Treatment Improvement Protocol (TIP) Series, No. 35. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64968/
Substance Abuse Treatment for Adults in the Criminal Justice System: Major Treatment Issues and Approaches. (2005). Treatment Improvement Protocol (TIP) Series, No. 44. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64124/
Toft, D. Recent Research Offers Compelling Support for the Effectiveness of Twelve Step-Based Treatment. (2000). Retrieved from https://www.hazelden.org/web/public/vcsum0research.page
Krentzman, A. R., et. al. (2010, December 29). How Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) Work: Cross-Disciplinary Perspectives. Alcoholism Treatment Quarterly, 29(1); 75-84. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140338/
Fiorentine, R. and Hillhouse, M. P. (2000, January). Drug Treatment and 12-Step Program Participation: The Additive Effects of Integrated Recovery Activities. Journal of Substance Abuse Treatment, 18(1); 65-74. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10636609