7 Common Questions about Twelve Step Recovery Programs

Admitting powerlessness. Humbly accepting your shortcomings. Understanding the exact nature of your wrongs. Removing defects of character. Making direct amends. Taking a fearless moral inventory. Improving your conscious contact. Experiencing a spiritual awakening. Not only does the terminology of Twelve Step recovery from addiction seem a little like a foreign language (at least at first), many aspects of the program itself are widely misconstrued or misunderstood.

Whether you or a loved one is struggling with a substance use disorder (commonly referred to as drug or alcohol addiction, alcoholism or substance abuse), Twelve Step recovery programs could be an effective source of help and support. Here are answers to seven frequently asked questions about Twelve Step programs, principles and practices.

How Do 12 Step Programs Work?

The Twelve Steps are a set of guiding principles as outlined in Alcoholics Anonymous, first published in 1939 and familiarly known as the Big Book. The Steps set forth a course of action for recovery from addiction and, more broadly, a new way of thinking and living. Core concepts of Twelve Step recovery are grounded in the acceptance of being "powerless over alcohol" the recognition that, as a result of alcohol use, your life has become unmanageable and the willingness to change whatever you can (your attitudes and your reactions to people and events) in order to get your life back from addiction. As a part of Twelve Step recovery, participants make a list of all persons they have harmed and, if it won't cause further harm, attempt to make amends. Taking an ongoing personal inventory and honestly acknowledging ways you have hurt yourself, your relationships and others is also a core Twelve Step recovery practice. Trust, acceptance, love, goodwill and forgiveness are also key components of a Twelve Step recovery model.

Twelve Step support groups are another core concept of Alcoholics Anonymous (AA) recovery. Participating in a mutual support group allows individuals to experience the recovery journey at their own pace—accepting responsibility for their behavior—with the help and understanding of a supportive peer environment.

A number of self-help groups have adopted variations of AA's Twelve Step program to address different types of addiction or compulsive behaviors. These self-help programs include:

• Narcotics Anonymous
• Cocaine Anonymous
• Crystal Meth Anonymous
• Marijuana Anonymous
• Heroin Anonymous
• Sex Addicts Anonymous
• Gamblers Anonymous
• Overeaters Anonymous
• Workaholics Anonymous
• Debtors Anonymous
• Al-Anon
• Alateen
• Co-dependents Anonymous

What Happens in an Alcoholics Anonymous or Other 12 Step Meeting?

First, you should know that the door is open to people of all socioeconomic backgrounds and faith traditions—no judgment or questions. The idea is to help you see that you are not alone in your struggles with addiction. As often noted, the first word of the First Step is "We."

The rules at Twelve Step meetings are simple: Be on time, be respectful and don't talk over others. Some other key points:

• AA is not an addiction treatment program; it's a peer-based mutual help program.
• Meetings are free and open to the public. Participants remain anonymous, a tradition that came about, in part, as a way of emphasizing the equality of all AA members and the unity of recovery.
• "Crosstalk"—giving advice—is discouraged (however, members can speak freely of their own experiences).
• Attendees aren't required to speak at the meeting; sharing is optional and voluntary.
• There's no one-size-fits all Twelve Step meeting. Some people recommend trying a few different meetings before finding the right fit.
• Some people attend AA meetings before establishing sobriety. That's fine. The only requirement for joining is the desire to stop drinking.
• If you've ever worried that your drinking or drug use could lead to a downward spiral unless you do something, attending a Twelve Step meeting could be that something to help turn things around.
• Working through the Steps is a continuous and repetitive process designed to strengthen your recovery practice; a final "completion" of the Steps isn't the end goal.
• Members typically learn how to work the Steps with the help of a "sponsor" who is familiar with the recovery program. The sponsor can provide additional and one-on-one recovery support beyond group meetings.
• AA considers abstinence the recovery goal.

If you are nervous about attending your first meeting, remember that every person in the room was a newcomer once, too. They likely felt the same reservations before walking through the door.

Do You Need to Believe in God to Attend a 12 Step Meeting?

You don't need to be religious to attend or benefit from Twelve Step support groups. While Alcoholics Anonymous embraces people from all different faith traditions and spiritual beliefs, atheists are just as welcome. What's important is that you accept the idea that you are not the center of the universe. The AA concept of "higher power" doesn't need to be interpreted as God. Your higher power could be the fellowship of Alcoholics Anonymous, love, family, nature or positive energy.

If the Program Isn't Religious, Why Are 12 Step Meetings Held at Churches?

In communities throughout the U.S. and around the world, churches often donate space for Twelve Step meetings. You can also typically find Twelve Step meetings at schools, community centers, health care centers or addiction treatment centers. 

Are There Other Types of Addiction Recovery Support Groups?

Yes. If a Twelve Step approach doesn't feel like the right fit, other options to explore include SMART Recovery, LifeRing, Women for Sobriety and Moderation Management, as well as addiction recovery support groups that have a particular religious affiliation, such as The Calix Society and Jewish Alcoholics. Find more detailed descriptions about many alternative recovery support organizations.

How Do 12 Step Recovery Programs Help People Stay Sober?

Twelve Step recovery programs combine accountability measures, inspiration, education and connection to help participants change their inner dialogue. The group dynamic helps to reinforce healthy thinking and behaviors. As an evidence-based model, Twelve Step recovery has been studied and replicated for years. According to a study published in the National Center for Biotechnology Information, a branch of the National Institutes of Health (NIH), "Beginning 12-Step participation while in treatment, especially at group meetings held at the treatment program, and 12-Step attendance at the same time that one is enrolled in specialty addiction treatment, are associated with better outcomes. In addition, consistent, early, and frequent attendance/involvement is associated with better substance use outcomes. Although even small amounts of participation may be helpful in increasing abstinence, higher "doses" may be needed to reduce the likelihood of relapse."

How Do 12 Step Programs Help with Treatment Aftercare?

Psychologists, psychiatrists and addiction counselors often recommend participation in Twelve Step groups as a form of aftercare following inpatient addiction treatment.. After completing an inpatient program, many continue their journey in outpatient treatment. (Think of managing other chronic diseases—you may take blood thinners after experiencing a heart attack or track your insulin after a diabetes diagnosis.) Twelve Step recovery programs offer safety and support during early recovery—setting patients up for long-term success.

According to the NIH, "Increased involvement in 12-Step meetings and activities following formal treatment may serve as an important source of support and a form of continuing care that has been shown to lead to decreased utilization of mental health and substance abuse treatment services and associated costs." Group meetings offer a safe place to share one's experience, strength and hope, and to give and receive support and fellowship. This social support helps individuals avoid relapse. Listening to personal stories of recovery and learning how others avoid triggers and cope with environmental cues or social stresses without resorting to alcohol or other drugs can be incredibly helpful on the path to healing.