Addiction isn't a choice. That statement may not seem groundbreaking today, but the idea of alcoholism as an illness was a new concept in 1939 when the book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism was published. Known as the Big Book of Alcoholics Anonymous, the publication not only changed the conversation about alcoholism, but also catapulted the Twelve Step model of recovery into the public's eye. Today, Narcotics Anonymous, Cocaine Anonymous, Heroin Anonymous, Gamblers Anonymous, Sexaholics Anonymous and Food Addicts in Recovery Anonymous all offer a Twelve Step approach to recovery based on the success of the original AA model. The Twelve Steps were adopted nearly word-for-word by Al-Anon/Alateen, a program of recovery for the families and friends affected by a loved one's drinking (whether or not the alcoholic recognizes they have a drinking problem). What Are the Twelve Steps of Alcoholics Anonymous? The Twelve Steps are a set of guiding principles in addiction treatment that outline a course of action for tackling problems including alcoholism, drug addiction and compulsion. Step 1: We admitted we were powerless over alcohol—that our lives had become unmanageable. Step 2: Came to believe that a Power greater than ourselves could restore us to sanity. Step 3: Made a decision to turn our will and our lives over to the care of God as we understood Him. Step 4: Made a searching and fearless moral inventory of ourselves. Step 5: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. Step 6: Were entirely ready to have God remove all these defects of character. Step 7: Humbly asked Him to remove our shortcomings. Step 8: Made a list of all persons we had harmed, and became willing to make amends to them all. Step 9: Made direct amends to such people wherever possible, except when to do so would injure them or others. Step 10: Continued to take personal inventory and when we were wrong promptly admitted it. Step 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. Step 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. Where Did the Twelve Steps Originate? Bill Wilson and Dr. Bob Smith, the two men behind AA, drew their inspiration for the Twelve Steps from the Oxford Group who advocated that all problems rooted in fear and selfishness could be changed through the power of God by following the "Four Absolutes," a moral inventory of "absolute honesty, purity, unselfishness and love," and through public sharing/confession. The Oxford Group also believed in the work of American psychologist William James, particularly his philosophy of pragmatism and "The Will to Believe" doctrine (by changing the inner attitudes of the mind, we can change the outer aspect of life), and William Silkworth, MD, one of the first medical professionals to characterize alcoholism as a disease. When AA was founded in 1935 by Bill W. and Dr. Bob as a fellowship of alcoholics working together to overcome their drinking problems, the 12 Steps acted as a set of guidelines for spiritual and character development—a blueprint for recovery. The Twelve Steps serve the same purpose today. As described by Alcoholics Anonymous, following these guidelines "as a way of life, can expel the obsession to drink and enable the sufferer to become happily and usefully whole." What's the Purpose of the Twelve Steps? The purpose is to recover from compulsive, out-of-control behaviors and restore manageability and order to your life. It's a way of seeing that your behavior is only a symptom, a sort of "check engine" light to discovering what's really going on under the hood. How and Why Does it Work? According to the American Society of Addiction Medicine, "Twelve Step facilitation therapy is a tried-and-true proven approach." (There's a reason, after all, why people still "work the Steps" more than 80 years later.) How does it work? People are encouraged to take an honest look at themselves, then deconstruct their egos and rebuild, little by little. Why does it work? The Steps encourage the practice of honesty, humility, acceptance, courage, compassion, forgiveness and self-discipline—pathways to positive behavioral change, emotional well-being and spiritual growth. What Are the Twelve Traditions? The Twelve Traditions are associated with the 12 Steps, only rather than personal guidelines for the addict or alcoholic, they're general guidelines for healthy relationships between the group, members and other groups. According to AA, "By 1946, it had become possible to draw sound conclusions about the kinds of attitude, practice and function that would best suit AA's purpose. Those principles, which had emerged from strenuous group experience, were codified by Bill in what today are the Twelve Traditions of Alcoholics Anonymous. A successful formula for AA unity and functioning had been achieved and put into practice." Do You Have to be Religious in Order to Follow the Twelve Steps? No. While it's true that the 12 Steps were originally based on the principles of a spiritual organization, the world isn't the same as it was in 1935 when AA and the 12 Step program was founded. The word "God" was eventually replaced with "Higher Power" to be more accessible to everyone, regardless of faith traditions or beliefs. A Higher Power doesn't have to be God; it could be nature, the universe, fate, karma, your support system, the recovery group itself, medical professionals or whatever you feel is outside of and greater than yourself/your ego. What you believe to be a Higher Power is a very personal thing. In Step One: What Does it Mean to "Admit Powerlessness?" Admitting powerlessness is not the same as admitting weakness. It means asking for help, leaning on others and relying on your support system. It means admitting—and accepting—that you're living with a disease that alters your brain. It might seem backward, but when you can admit that you don't have power, you can actually access the power you need. How Long Does it Take for the Twelve Steps to Work? With the Twelve Steps, there is no hard and fast timeline. The Steps are meant to be addressed in sequential order, but there's no one "right" way to approach them. Sometimes people need a break between Steps, sometimes people need to spend longer on one Step than another, some people never stop working the 12 Steps because they become part of life. Pros of the Twelve Steps The Twelve Steps are widely known, established and organized. (It's one of the oldest programs around.) Those struggling with substance abuse have access to a supportive network of peers. It's easy to find a meeting where the Twelve Steps are practiced. There's little to no cost to those in need—it's a free intervention to address a chronic disease. Cons of the Twelve Steps Some people aren't interested in participating in group settings. Due to the anonymous nature of the group, there's a lack of official shared success rates. The Steps are criticized for not addressing the needs of those struggling with mental illness. When the Twelve Steps were originally created, science had yet to prove a genetic link to addiction. What Are Some Alternatives to a 12 Step Program? The Substance Abuse and Mental Health Services Administration (SAMHSA) identifies many national groups that offer an alternative approach to the Twelve Steps. These groups are secular in nature, emphasize internal control, evolve with changing research in the field of addiction and generally oppose labels that define past behavior. The SAMHSA list includes the following: Self-Management and Recovery Training (SMART Recovery): Emphasis on learning how to cope with urges and cravings, based on cognitive behavioral therapy and motivational interviewing. Established in 1994. Secular Organizations for Sobriety (SOS): Develop strategies to achieve and maintain sobriety (abstinence) from alcohol and drug addiction, food addiction, etc. Established in 1985. LifeRing Secular Recovery: The focus here is on the three Ss: sober, secular and self-directed. Established in 2001. Moderation Management: Designed for those who think their drinking has become a problem and they want to moderate it before it gets out of control. Focus on 30 days of abstinence and guidelines about moderate drinking. Established in 1994. Women for Sobriety: Focus on positive thinking, personal responsibility, embracing the future (rather than dwelling on past mistakes). Established in 1976. Some Other Alternative Recovery Programs Include: Refuge Recovery: This organization is grounded in the belief that “Buddhist principles and practices create a strong foundation for a path to freedom from addiction. This is an approach to recovery that understands: All individuals have the power and potential to free themselves from the suffering that is caused by addiction,” according to refugerecovery.org. The Wellbriety Movement: Advocating for Native American Recovery and Wellness, this movement carries the message of cultural knowledge about recovery for individuals, families and communities.