Program Types
Alcoholics Anonymous (AA) was the first twelve-step program, and it was designed for alcoholics wishing to recover from their alcoholism. AA was launched in 1935 in Akron, Ohio, by two alcoholics, physician Bob Smith and businessman Bill Wilson. The official launch date was the first date of sobriety for Smith.
According to its 2014 member survey, AA has more than 115,000 groups globally, and white men represent the majority of members. The average age of the AA member is fifty years.
Other organizations for other types of addictions have modeled themselves on the twelve steps of AA. For example, Narcotics Anonymous (NA) was created in 1953 for persons addicted to narcotics. NA has an estimated 200,000 members in the United States and 131 other countries.
In 2013, NA surveyed more than sixteen thousand members and found that 57 percent are male. The largest percent (31 percent) was fifty-one to sixty years of age, followed by those age forty-one to fifty years (28 percent). Just over one-half of the surveyed members learned about the existence of NA through treatment or counseling centers. The majority of NA members surveyed were white, and the average time that members had been clean from narcotic use was 11 years. Most NA members (59 percent) were employed.
Cocaine Anonymous (CA) was launched in 1982 and Marijuana Anonymous was created in 1987. Crystal Meth Anonymous debuted in 1992. These organizations offer meetings throughout the United States and other countries. Pills Anonymous (PA), launched in the latter part of the twentieth century (the exact date is unknown), is an organization for persons addicted to prescription drugs. PA has meetings in Arizona, California, Colorado, Illinois, Nevada, New York, and Virginia. Heroin Anonymous began in 2004 and offers meetings in Arizona, California, Illinois, Michigan, and Texas.
Overeaters Anonymous (OA) is a twelve-step group for persons with eating problems. The majority of members are white and female. In a 2010 survey of OA members, 44 percent said that food first became a problem for them as children. For example, 44 percent said that food first became a problem for them when they were between one and ten years of age, while 24 percent developed an overeating problem when they were from eleven to fifteen years of age. Most survey participants (95 percent) said they were compulsive eaters or overeaters. The broad majority (69 percent) said they had lost weight since they joined OA.
“My Name Is Andy and I’m an Alcoholic”
Many addicts deny that they are dependent on a substance or that they engage in a problematic behavior, so twelve-step groups help members to acknowledge the severity of their problems by asking them to provide their first name along with an admission of their addiction. It can be extremely difficult for the individual, who may have denied an active addiction for many years, to openly admit that he or she is an addict. However, acknowledgement and awareness are both crucial to working toward recovery.
All alcohol- and drug-related twelve-step groups promote complete abstinence from the problematic substance. Some persons are addicted to multiple substances, such as alcohol and cocaine, and they may wish to attend both AA and CA groups. Another twelve-step group, Dual Recovery Anonymous (DRA), is focused on persons with dual diagnoses.
According to research by addictions specialist Alexandre B. Laudet, who compared reasons for attendance at meetings for both AA and NA members, the key reason for attendance by AA members is support, acceptance, and fellowship (58 percent), followed by the organization’s promotion of recovery and sobriety (41 percent). Among NA members, the key reasons are reversed: The promotion of recovery and sobriety was most important (59 percent), followed by support, acceptance, and fellowship (33 percent).
In all twelve-step groups, no attendance is taken and no fees are charged; donations are accepted, however, to cover the cost of the meeting room. To protect the privacy of the participants and to insure they to return to the group, attendees are instructed to avoid talking to others outside the room about what was said by anyone during meetings.
Meetings are usually held every day; in some cities, meetings are available several times each day. Most meetings are open to anyone but some are open only to persons with the specific “problem” of the group. The goal of groups oriented to alcohol or drugs is lifelong abstinence from the substance. This emphasis on abstinence may be the key behind the success of members who are alcoholics or drug addicts because, in their personal and family lives, they may have strong associations with others who are heavy drinkers or alcoholics. Making new connections with those who do not drink or use drugs may provide the important social network that is needed and that was absent before the addict joined a twelve-step group.
Often, persons who have been sober for years continue to participate in twelve-step meetings because they still believe they are at risk for relapse. All attendees, regardless of length of sobriety, introduce themselves at meetings as addicts.
Furthermore, the twelve-step group is not meant to be a form of therapy. To that end, mental health professionals and physicians are banned from all meetings unless they are addicts themselves.
The Steps and the Traditions
The first step of all twelve-step groups is the acknowledgement of the individual’s powerlessness over controlling the substance abuse or other problem. The steps are adapted to the particular organization. For example, CA’s first step is the following: “We admitted we were powerless over cocaine and all other mind-altering substances—that our lives had become unmanageable.”
The second step for all twelve-step programs is the acceptance that there is a greater power than the addict and that this power can help the addict restore stability to his or her life. The third step involves surrendering individual will and one’s life to this higher power. The higher power may be God or some other higher power as defined by the individual. The next few steps involve making a moral inventory of one’s life and admitting faults.
These other steps include listing persons who were harmed by the addict in the past and creating a plan to make amends to those persons, if possible. In addition, the person is expected to continue to review his or her life and admit to past wrongs. The final step of AA and other twelve-step groups is to carry the message to others who suffer from the same problem. Research by Maria E. Pagano and colleagues indicates that the behavior of helping others has the effect of decreasing the depressive symptoms of alcoholics.
Each twelve-step group has its own twelve traditions in addition to the twelve steps. For example, the first tradition encompasses the welfare of the group. CA’s first tradition is “Our common welfare should come first; personal recovery depends upon CA unity.” Another tradition is that the only requirement to join the organization is a desire to change (stop consuming alcohol, cocaine, or other drugs, or stop the problematic behavior). Other traditions are to carry the message of the group to others with the same problem and that anonymity is a vital principle of the organization. Each twelve-step group provides its own particular twelve steps and twelve traditions.
Sponsors
Addicts who join twelve-step groups are matched with a sponsor, who is a sober member who has completed the twelve steps. The sponsor is available to the addict who feels a craving to drink, to use drugs, or to perform the problematic behavior.
In addition, if the addict cannot resist the compulsion and uses alcohol or drugs or continues to engage in other addictive behaviors, then the sponsor is to be contacted immediately. Sponsors realize that relapses are common with addictive behavior, and they also know that such setbacks do not mean that the person can never overcome an addiction. Sponsors share these insights with the addict and help the person return to recovery and sobriety.
Effectiveness of Twelve-Step Groups
Most twelve-step groups have not been studied or analyzed, with the exception of AA. Most studies of AA have concluded that the organization is effective with those alcoholics who stay with the program.
For example, researchers Rudolf H. Moos and Bernice Moos evaluated subjects who received assistance from AA compared with those who were untreated, looking at their success at one, three, eight, and sixteen years from their initial participation in AA. Moos and Moos found that subjects who had participated in AA for twenty-seven weeks or more had a significantly better outcome sixteen years later than those who did not participate for this length of time sixteen years earlier.
In another study, researcher Keith Humphreys and Rudolf H. Moos compared successes among 887 patients in twelve-step programs with 887 patients treated only with cognitive-behavior therapy (CBT), a form of therapy that helps a person to identify and challenge irrational thoughts contributing to the addiction.
After two years, both groups had about the same level of success. For example, 33.3 percent of the CBT group reported being free of substance-abuse-related problems, compared with 32.6 percent of the twelve-step group. In addition, 80.5 percent of the CBT group reported being free of psychiatric symptoms, compared with 81.6 percent of the twelve-step group. However, the twelve-step group had a significantly higher rate of abstinence than the CBT group (49.5 percent were abstinent, compared with 37 percent of the CBT group). The researchers also found that the overall costs were significantly lower for the subjects in the twelve-step group.
Some persons do not succeed with a twelve-step group or do not join in the first place. There may be many reasons for this. For example, the addict may not be ready to admit that he or she has a problem. Also, some persons are opposed to the higher power element of twelve-step groups, citing its religious overtones. Twelve-step organizations, however, deny any religious affiliation.
Furthermore, the twelve steps are sometimes understood by local groups to mean that no psychiatric drugs should be taken by members. As a result, persons with psychiatric problems may believe that the group does not regard them as “clean” if they take prescribed medications for their emotional or psychiatric illness. One solution is to join the twelve-step group DRA, which is focused on persons with dual diagnoses. Members are encouraged with certain suggestions, such as “Today I will be free of alcohol and other intoxicating drugs” and “Today I will follow a healthy plan to manage my emotional or psychiatric illness.”
Bibliography
Brook, David W., and Henry I. Spitz. The Group Therapy of Substance Abuse. New York: Haworth Medical, 2002. Print.
Gold, Michael S., and Christine Adamec. The Encyclopedia of Alcohol Abuse and Alcoholism. New York: Facts On File, 2010. Print.
Gross, Michael. “Alcoholics Anonymous: Still Sober after 75 Years.” American Journal of Public Health 100.12 (2010): 2361–63. Print.
Humphreys, Keith, and Rudolf H. Moos. “Encouraging Posttreatment Self-Help Group Involvement to Reduce Demand for Continuing Care Services: Two-Year Clinical and Utilization Outcomes.” Focus 5.2 (2007): 193–98. Print.
Laudet, Alexandre B. “The Impact of Alcoholics Anonymous on Other Substance Abuse Related Twelve Step Programs.” Recent Developments in Alcohol 18 (2008): 71–89. Print.
Moos, Rudolf, and Bernice S. Moos. “Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals.” Journal of Clinical Psychiatry 16.6 (2006): 735–50. Print.
Pagano, Maria E., et al. “Predictors of Initial AA-Related Helping: Findings from Project MATCH.” Journal of Studies on Alcohol and Drugs 70.1 (2009): 117–25. Print.
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