Alcoholics Anonymous is one of the best-known organizations in the world and the originator of the now-famous 12-step model of recovery. AA groups and other 12-step fellowships meet in virtually every corner of the U.S. and in scores of other countries. In many high-quality addiction treatment programs, taking part in AA is an essential part of recovery.
The Twelve Steps as a Way of Life
The Twelve Steps are a set of spiritual principles that act as a clear, actionable guide to a life free of addiction. Working through the steps ideally leads to long-term sobriety, a stronger sense of purpose, and greater overall well-being.
While Alcoholics Anonymous created and defined the 12-step process and remains the best-known example, the steps apply to a wide range of addictions, compulsive behaviors, and mental health problems. Dozens of fellowships have since been established to address different issues, including 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 transportation of alcohol. During its 13-year span, drinking did decline, but because people were officially not drinking, the country’s inebriate asylums closed and self-help societies faded. People who needed help with an alcohol addiction had nowhere to find it.1
In 1935, Bill W. of New York City and Dr. Bob S. of Akron, Ohio, met through the Oxford Group, a largely non-alcoholic fellowship that emphasized spirituality in everyday life. Through the group, Bill had overcome an intense alcohol addiction and maintained his sobriety by devoting himself to helping others who were addicted to alcohol. Dr. Bob was still struggling when the two met, and Bill inspired him to get sober for good.
Together, Bill and Dr. Bob went to work helping people at City Hospital in Akron. After one patient quickly attained sobriety, the three men began meeting regularly to support one another. This was the first Alcoholics Anonymous fellowship, and by 1939, two more were active in New York and Cleveland. Within four years, 100 people had achieved lasting recovery through regular fellowship meetings. In 1939, Bill wrote Alcoholics Anonymous, the textbook known informally as “The Big Book,” which has been used for more than 85 years to help people recover from alcohol addiction.
Alcoholics Anonymous laid out 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 fellowship jumped from 20 to 500 in a matter of months.
A trusteeship called The Alcoholic Foundation was established, with friends of John D. Rockefeller serving on the board. An office opened in New York to field inquiries and distribute the Big Book. By 1941, AA had 6,000 members across the U.S. and Canada, and by 1950, that number had reached 100,000.
Today, Alcoholics Anonymous estimates over two million members in more than 123,000 groups worldwide, and the Big Book has been translated into more than 70 languages.
Understanding Addiction
The National Institute on Drug Abuse characterizes addiction as the inability to stop using a substance despite the negative consequences it causes.2 Those consequences may touch your finances, legal status, relationships, or physical and mental health.
Addiction is progressive, which means that without help it almost always gets worse. It’s also chronic and relapsing: it can’t be cured, but it can be sent into remission through abstinence. Using again after a period of abstinence can bring the addiction roaring back, once again marked by the inability to stop despite the consequences.
Overcoming an addiction generally requires complete abstinence. Without the support of a recovery program, facing the challenges and barriers along the way can be overwhelming, and that often leads quickly to relapse. Twelve-step programs provide the support and education that help people new to recovery navigate the often-rocky road to long-term sobriety.
The 12 Steps of Recovery, Explained
Participants move through the steps one by one, with each step leading into the next. Here’s 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 consequences of substance abuse are often far-reaching and can destroy relationships, cost people their jobs, and cause devastating health or legal problems. Even so, a person with an addiction keeps using, largely because of changes in the brain’s learning, memory, and reward centers that shape thought and behavior.
The first step is admitting that you’ve lost control over your substance use, and that the consequences have left you feeling hopeless and defeated. This, according to the Big Book, is what leads many people 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 accept that you’re powerless over the compulsion to use, despite wanting and trying to quit, you become willing to do whatever it takes to reclaim your life.
Step Two: Find Your Higher Power
“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, and a sense of failure, 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 a person’s strengths, talents, resources, coping skills, and values, and it’s the foundation of recovery.4
That hope is supported by a power greater than yourself. Whether you call it “God,” “the Universe,” “love,” “family,” or something else, the point is having faith that something beyond yourself can give you strength to overcome the challenges of recovery.
Step Three: Turn Your Will Over to Your Higher Power
“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 and faith. In Step Three, your attention turns to the higher power you identified in Step Two as you acknowledge that recovery requires help beyond yourself. Whatever you call that power, it’s bigger than you, and more accepting of you than you are of yourself.
Step Three leads you to release your grip on the minutiae of your life and listen to a wiser, more compassionate voice. It leads you to let go of guilt, anger, frustration, and self-hatred, and to realize that your current state represents only a sliver of who you are. In doing so, you open your mind to new possibilities and prepare yourself for the steps that follow.
Step Four: Take a Moral Inventory
“Made a searching and fearless moral inventory of ourselves.”
Step Four is a time of soul-searching. At the root of our inability to truly know ourselves is denial, the act of ignoring our negative traits because confronting them is frightening. Denial lets us justify or rationalize harmful thoughts and behaviors so we feel better about them.
The moral inventory is a thorough, honest written list of the wrongs you committed while caught in your addiction. You can undertake it fearlessly because in Step Three you turned your life over to a higher power that’s forgiving. SAMHSA stresses that knowing where you’ve come from is essential to finding your way forward.5 By naming what you’ve done, you free yourself to make better choices going forward.
Step Five: Admit the Nature of Our Wrongs
“Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.”
Once the inventory is made, it’s time to step out from behind the guilt, self-deception, and pride that isolate you. It’s time to take down the walls you built to hide shame and self-loathing, the walls that make it hard to examine what underlies the addiction.
With Step Five comes a profound shift: who you are is no longer defined by your worst deeds, but by self-forgiveness and by sharing the weight of those deeds with a trusted, supportive person. You come out the other side forgiven and whole, no longer hiding behind a veil of deceit, and you move into the next phase of recovery with honesty and an open mind.
Step Six: Find a Willingness to Change
“Were entirely ready to have God remove all these defects of character.”
Step Six is about reflection, preparation, and a willingness to change. Being ready to surrender your “defects of character” to a higher power means you’re ready to let that power move you in a healthier direction. It’s becoming willing to let go of the things that keep you from progressing in your recovery.
Step Six is the process of reaching that readiness, of finding that you’re truly prepared to do the daily work of evaluating and adjusting your thoughts and behaviors, even through the setbacks that are a natural part of recovery.
Step Seven: Ask Your Higher Power to Remove Your Shortcomings
“Humbly asked Him [or Her, or It] to remove our shortcomings.”
Step Seven is about humility, not the expectation that your higher power will wave a wand and instantly transform you. You’re human, and shortcomings are part of the human condition.
Humility is the ability to see yourself as you actually are, with both strengths and weaknesses, so you can make a sincere effort to become who you want to be. By humbly asking your higher power to remove your shortcomings, you embrace hope and commit to doing your part to clear away the obstacles in your path.
Step Eight: Make a List of Those You Harmed
“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 and restoring relationships where possible. As with the moral inventory, you first make a list of the people you hurt and note how you might make amends. Then you work toward a genuine willingness to do so.
Step Eight demands honesty about your relationships. It begins the process of forgiving people who hurt you and being forgiven by those you hurt, and it builds awareness of your changing attitudes toward yourself and others.
Step Nine: Make Amends
“Made direct amends to such people wherever possible, except when to do so would injure them or others.”
Step Nine helps clear your conscience and release the lingering guilt, regret, and shame that distort your self-perception and lead you to blame others or make excuses. Shame and guilt can fuel denial and cause further harm.6 By making amends to the best of your ability, you clear your conscience, improve your self-esteem, relieve stress, and let go of blame.
The first step is forgiving yourself, and forgiving others for any part they played. The second is coming clean, trying to make up for your actions, and in most cases accepting the forgiveness offered to you. This step helps you see clearly how your actions affect the people around you.
Step Ten: Maintain Recovery
“Continued to take personal inventory and when we were wrong promptly admitted it.”
Step Ten is about maintaining recovery by staying alert to your actions, attitudes, and emotions so you don’t slip back into old patterns. Regular check-ins throughout the day help you catch selfish, dishonest, or fear-driven behavior and make amends right away, so you can live free of guilt and shame.
Daily self-examination helps you recognize the emotional states that tend to lead you into mistakes, and it helps you forgive others rather than react. Step Ten is a lifelong practice that keeps your slate clean and keeps you honest.
Step Eleven: Improve Conscious Contact With Your Higher Power
“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 daily life as part of ongoing recovery. The purpose of prayer here, whatever form it takes, is to stay mindful of where you are and where you’re going, and to draw strength from your higher power. Meditation helps you connect to a deeper part of yourself and bring about change from the inside out.
Step Twelve: Carry the Message
“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 carrying a message of hope to others who are just starting out. By now you’ve found emotional stability and live with far less of the guilt and confusion that once drove you. You’re ready to sponsor someone who needs guidance and to show, by example, that the barriers to recovery can be overcome.
Because you’ve been there, made the excuses, and lied to yourself and others, you’re in a unique position to see through those same behaviors in others. You can show that hope is everything, that recovery can be joyful, and that life is worth it even when it feels like it isn’t. You’ll always be a work in progress, and you’ll still face setbacks, but by now you know enough to light the way for others so they can transform their lives too.
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, in part because AA keeps few statistics in order to preserve anonymity.
AA is a spiritual fellowship rather than a clinical treatment, which makes it inherently difficult to study with the tools of science.
Because it’s spiritually based, science and medicine long dismissed AA, particularly the parts about powerlessness and a higher power. That changed over time, starting with Project MATCH, a major federally funded study whose long-term results, published in 1998, found 12-step facilitation therapy worked as well as cognitive-behavioral therapy and motivational enhancement therapy for promoting long-term abstinence.7
A peer-reviewed study cited in the journal Alcoholism Treatment Quarterly found strong evidence that abstinence rates among people who attend AA are roughly twice as high as among those who don’t.8
Another study, published in the Journal of Substance Abuse Treatment, found that people who attended 12-step meetings before entering treatment stayed in treatment longer and were more likely to complete the program. It also found that people who took part in both treatment and a 12-step program had higher abstinence rates than those who did just one or the other.9
Some studies have found the evidence for AA inconclusive. Still, for many people it’s an important pathway to long-term recovery that improves well-being, purpose, and overall quality of life. The 12 steps have 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.
Why the 12 Steps Work
What makes the 12 steps so effective? Several factors contribute. The sense of community at meetings is powerful. Participants meet others who share the same goals and struggles, which helps them avoid the isolation that so often leads to relapse.
At meetings, members ask one another how they handle specific situations and share relapse-prevention strategies. The process of “working the steps” is empowering, and members gain strength by holding themselves accountable to the group.
Recovery isn’t only about stopping your substance use. It’s about learning a whole new way of life. For many people, 12-step programs provide the structure and support they need to get started. Like any approach to addiction treatment, the 12 steps aren’t right for everyone, but the payoff can be significant for those willing to give it a real chance.
The 12 Steps and Relapse
How can someone who has completed all 12 steps relapse? The Big Book says, “What we really have is a daily reprieve contingent on the maintenance of our spiritual condition.” Regardless of what we’ve done, what matters is what we continue to do. Recovery is only as strong as what we do today.
The treatment field teaches that a relapse starts long before the substance is ever taken. The first year of recovery usually centers on simply staying sober. There’s real joy in finding relief from an addiction that has caused so much harm, and people often describe a “pink cloud,” a new sense of well-being, in early recovery.
As time goes on, things we set aside to focus on recovery start to return. Often, in years two through five, people pursue more serious work or a career, return to school, or enter a relationship. By now they’ve ideally completed the steps with a sponsor and found a home group. Life becomes a balancing act, and where the focus was once entirely on recovery, ordinary life starts to crowd back in.
What Happens When You Lose Focus on Recovery?
Old patterns that may not have been fully addressed during the steps can start to resurface, and that’s where relapse can begin. Conflicts with a boss, a co-worker, or a loved one chip away at hard-won serenity.
Issues like codependency, overextending yourself, or perfectionism can grow more pronounced as you look for a healthy balance between life and recovery. Many people replace recovery with work, the gym, or a relationship, and lose sight of how they got to a good place to begin with.
Some people simply get complacent. Contact with others in recovery thins out, meeting attendance drops, and the work of Step Twelve, carrying the message, falls away. As the other parts of life take over, one of the foundations of recovery starts to slip.
Next, prayer or meditation may stop, undoing the conscious contact of Step Eleven. From there it can unravel quickly: the nightly personal inventory of Step Ten becomes weekly, then nonexistent. Without inventory there are no amends, and without amends our shortcomings become invisible to us. Eventually a person decides to take their will back entirely, and the power that once restored them to sanity goes out the window, often along with the sanity itself. Believing they can manage on their own, they spiral back toward the place they worked so hard to leave.
How to Keep Relapse From Happening
One way to protect your recovery is to have a home group, a meeting you attend at least weekly, where people really know you. Take on commitments such as making coffee or greeting newcomers. Let close friends in your support network give you honest feedback.
Keep your sponsor close and stay open to what they tell you. These small habits keep you accountable. The Big Book puts it plainly: “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.” Understanding that is exactly why it’s so important to stay consistent with your recovery.
Get Support for Your Recovery
The 12 steps work best alongside professional treatment. At Destination Hope, we combine evidence-based care with the kind of ongoing support that helps recovery last, including intensive outpatient programming for the months and years after rehab. If you or someone you love is ready to start, call us at (954) 302-4269.
Sources
- Blocker Jr., J. S. (2006, February). Did Prohibition Really Work? Alcohol Prohibition as a Public Health Innovation. American Journal of Public Health, 96(2), 233-243. ncbi.nlm.nih.gov
- National Institute on Drug Abuse. Drugs, Brains, and Behavior: The Science of Addiction. nida.nih.gov
- Alcoholics Anonymous. Twelve Steps and Twelve Traditions. aa.org
- Substance Abuse and Mental Health Services Administration. Recovery and Recovery Support. samhsa.gov
- SAMHSA. Enhancing Motivation for Change in Substance Use Disorder Treatment. Treatment Improvement Protocol (TIP) Series, No. 35. ncbi.nlm.nih.gov
- SAMHSA. Substance Abuse Treatment for Adults in the Criminal Justice System. Treatment Improvement Protocol (TIP) Series, No. 44. ncbi.nlm.nih.gov
- Project MATCH Research Group. (1998). Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH Three-Year Drinking Outcomes. Alcoholism: Clinical and Experimental Research, 22(6), 1300-1311. pubmed.ncbi.nlm.nih.gov
- Krentzman, A. R., et al. (2010, December). How Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) Work: Cross-Disciplinary Perspectives. Alcoholism Treatment Quarterly, 29(1), 75-84. ncbi.nlm.nih.gov
- 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. pubmed.ncbi.nlm.nih.gov
