One of the most highly publicized addiction treatment models also happens to be one of the longest-standing in the United States. Twelve-step programs are probably what most people think about when they consider drug and alcohol treatment. These programs essentially pioneered a modern approach to addiction treatment. 

Until the mid-20th century, addiction was often seen as a moral failing, best addressed with criminal action and spending the night in “drunk tanks.” Yet, around the same time, scientists were examining the effects of addictive substances and finding that it was more akin to chronic disease. Alcoholics Anonymous, the first 12-step program, took that idea and sought to treat alcoholism by addressing the spiritual needs of the person, rather than answering them with punishment.

Today, 12-step programs have been adopted by addiction centers all over the world to treat everything from cocaine addiction to overspending. But, what is a 12-step program, and how does it work? Is it worth the recognition it’s receiving? Learn more about how 12-step programs work and their effectiveness in drug and alcohol treatment.

What is a 12-Step Program?

Twelve-step programs essentially come down to a set of principles that guide a person through acceptance of their problem with addiction, trusting a higher power to take control, addressing moral issues, seeking to make amends for mistakes, and helping others do the same. The program accomplished sobriety through two basic objectives: answering spiritual needs and connecting to a community of people who understand what you are going through. It has proven to be a powerful methodology. 

The program was initially outlined by Bill Wilson, a co-founder of Alcoholics Anonymous and author of it’s guiding document Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism.The book, also called the Big Book, outlines the twelve steps and the groups twelve guiding principles. It also gives advice to people approaching AA for the first time and guides members through each of the twelve steps.

Though AA wasn’t developed with scientific standards or studies, it is currently one of the most popular evidence-based treatments in the United States. Though it was not started through scientific means, it did have influences from psychologist Carl Jung and William Silkworth (a doctor that treated Bill Wilson and was an early proponent of the addiction as a disease idea). Today, we recognize that healthy connections play a large role in overcoming addiction, just as addiction can put a strain on relationships. 

History of 12-Step Programs

Alcoholics Anonymous started the 12-step recovery program in 1939 as a fellowship of people (primarily men at first) who were looking to get out from under alcoholism. Before AzA, alcoholism was typically seen as a moral failing which needed to be punished by law. Around the turn of the century, the country was embroiled in the Temperance Movement and prohibition. When AA was started by fellow recovering alcoholic users, rather than political groups, and it acknowledged that addiction was a disease, it attracted people immediately.

AA was born out of a Christian fellowship called The Oxford Group, which was founded in 1921. The group was intended to be a place where men could come together to confess sins and gain support and accountability to help them change whatever issues they were struggling with. The Oxford group was founded on four pillars: honesty, purity, unselfishness, and love; four virtues that would greatly influence the principles of AA.

Bill Wilson saw the Oxford Group as a way to overcome his own struggle with alcoholism after his promising career was finished because of his problematic drinking. He was invited by a friend and attended a few meetings. His drinking  resulted in being put in the hospital several times under the care of Dr. William Silkworth, who believed that addiction was a disease in need of treatment. During one hospitalization, Wilson was given a mixture that included hallucinogens and belladonna. While in treatment, he had a profound spiritual experience and conversion. After his release, he was inspired to re-join the Oxford Group. Wilson’s Last Drink was in December of 1934.

While Wilson was in the Oxford Group, he was joined by several other people who were seeking to overcome alcoholism, including Dr. Bob Smith, who would later become a co-founding member of Alcoholics Anonymous. After Smith entered recovery, the two resolved to help others fight alcoholism and achieve sobriety as they did.

As the number of people within the Oxford Group to address alcoholism grew, some members of the group accused Wilson of focussing too exclusively on one issue. After this rift, Wilson left the group to form a new organization. Wilson also took issue with the Oxford Group’s habit of seeking publicity, which would later influence AA’s commitment to anonymity.

After separating from the Oxford Group, Wilson sought to create a widespread program to help overcome addiction. To kick it off, he wrote the program’s guiding principles in his book titled, Alcoholics Anonymous in 1939. AA grew in popularity and spread across the country. Soon, people looking to deal with other addictions began to join AA. However, though general meetings were open to anyone who wanted to come, closed meetings were only open to those who were expressly there to deal with alcoholism.

Narcotics Anonymous became the first group to adapt AA’s principles to combat another addiction. Today, the 12-step program model has been applied to dozens of addictions all over the world. Though AA doesn’t officially partner with or recognize any specific treatment program, organization, or company, many addiction centers refer people in recovery to 12-step programs to help maintain sobriety.

What are the 12 Steps?

Alcoholics Anonymous pioneered the 12 guiding steps for navigating their program, which would be the cornerstone of the 12-step recovery model across the globe. Though the application of a 12-step program varies widely, there is very little variation in the wording of each step across different 12-step programs. No matter what your drug of choice might be, if you join a 12-step program, you might find the following 12-steps, with only the mention of alcohol changed to suit your type of addiction.

Throughout the 12-steps, participants will accomplish a few basic goals, and each step guides you toward achieving those goals. The first goal is to show you that you have lost control of your substance use and that it’s actually not something you can control. The first few steps also help you realize your need for help from a higher power and from other people. 

Like the Oxford Group, AA was founded on the idea that God has the power to change you in ways that you aren’t able to change yourself and that relationships with fellow members are instrumental to that change. Today, the higher power has taken on a more vague meaning.

Secondly, the steps help guide you to search yourself, take a moral inventory, and correct character flaws and moral shortcomings. Wilson, in the Big Book, often points to self-centeredness as a root issue that leads to addiction and prevents meaningful change. 

The final stages of the 12-step process involve reaching out to others, initially to make amends for the wrongs of your past, then to help others in the program.

The Following is the Original Wording of the 12-Steps as Applied to AA:

  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 alcohol users and to practice these principles in all our affairs.

Facets of 12-Step Programs

Besides the 12-steps themselves, programs often have a number of other important facets that have become built into the fabric of each program. The steps are principles that guide you through the program, and the following facets are themes and traditions that help facilitate you further. 


Sponsorship is one of the most important aspects of the 12-step program, and it speaks directly to Wilson’s belief that alcohol users need fellow alcohol users in recovery to help them. Sponsors are program members that have completed the 12-steps and achieved lasting sobriety. Sponsors take on new or inexperienced members to guide through the program. They offer spiritual guidance, practical advice, and accountability to people in the program. However, they may also give them guidance through other parts of life, such as finding a job or raising a family. 

When you enter a program, you will pick your sponsor, and you are able to switch at any time. In some cases, a friend or another member may recommend a person to be your sponsor, and if you believe it to be a good fit, you may be paired with them.

In the chapter of The Big Book titled, “The A.A. Tradition” Wilson writes, “We alcoholics see that we must work together and hang together, or else most of us will finally die alone.” Sponsorship is one of the aspects of 12-step that helps facilitate this unity.


Meetings are weekly gatherings of members that allow them to discuss challenges to their sobriety, share insight into the challenges of other members, and vent frustrations you may encounter in everyday life. Generally, meetings allow members to connect to peers and grow their support network with people who understand the challenges specific to recovery.

Meetings can follow different formats and serve different goals. One may be for general sharing and connecting while the next is to go over a specific step in the process. Open meetings can include anyone who would like to come while close meetings are specifically for members to share with other members. 

Depending on the specific 12-step program you are in, you might be able to find meetings all over the country, especially if you are in one as common as AA or NA. However, the meeting you attend regularly is your homegroup. Attending homegroup meeting regularly has shown to be an important factor in maintaining sobriety after addiction treatment.


Spirituality is a clear theme in 12-step programs. However, the Big Book and other 12-step guidelines, draw a distinction between the general spirituality of the program and religion. In its inception, AA decided to avoid alignment with any one political or religious organization to be inclusive to all those seeking help dealing with alcoholism. Still, spirituality is a key factor of 12-step, and spiritual healing is a significant goal of the steps themselves.

Are 12-Step Programs Religious?

While twelve-step programs typically reference a higher power, the programs are not only for religious people. Studies released on the topic found that nonreligious participants of 12-step programs reap the benefits as much as religious individuals will. It speaks to the power of 12-steps and how it can positively affect someone’s life.

Some organizations may interpret a higher power to be something other than a religious purpose, and AA Agnostica, which is a secular self-help organization for agnostics and atheists with drinking problems, provides alternatives that omit references to a higher power. There are references to God in 12-step programs, but they are not inherently religious. A higher power can be anything, which is something bigger than you as a human being.

Twelve-step philosophy undoubtedly includes spirituality, and many support groups are compatible with evidence-based treatment approaches, including psychotherapy. Many mental health professionals encourage those with substance use disorders to sign up to a 12-step program.

AA is among the most popular of these programs worldwide. Nearly 1.3 million people in the United States are members of AA, with another 85,000 in Canada, and more than 705,000 in other countries. Researchers determined that nearly 10 percent of individuals in the United States have attended an AA meeting. 

Narcotics Anonymous (NA) helps its members focus on recovering from a multitude of substances, which includes alcohol. NA hosts more than 67,000 meetings every week in 139 countries. The average age of NA members is 48, and 74 percent of those members are Caucasian. Seventy-nine percent of United States members regularly abused alcohol, followed by marijuana, cocaine, meth, opiates, and crack.

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