The Twelve Steps Program in Alcohol Addiction Treatment

The Twelve Step Program is a set of principles that has been adapted and developed by Alcoholics Anonymous and were first published as “Alcoholics Anonymous” also known as the Big Book. Since first being promulgated the Twelve Steps Model has become adopted by 90% of alcohol rehab centers and programs in the country dealing with alcohol addiction treatment. Further, the success of the Twelve Steps Model has not been limited to alcohol addiction treatment but has been successfully adapted in the treatment of many addictive problems including drug and substance abuse.

The Twelve Steps

The original twelve steps set out by Alcoholics Anonymous are as follows:

1. We admitted we were powerless over alcohol – that our lives had become unmanageable

2. Came to believe a Power greater than ourselves could restore us to sanity

3. Made a decision to turn our will and our lives to the care of God as we understood him

4. Made a searching and fearless moral inventory ofourselves

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 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 alcoholics, and to practice these principles in all our affairs.

The basis of a religious or spiritual approach to alcohol addiction treatment is clear, and this should not be a surprise given that they are based on the teachings of Reverend Sam Shoemaker, a member of the Oxford Group which dealt with implementing life changes. The principles were then formulated as the Twelve Steps by Bill Wislon and Dr Bob Smith who began Alcoholics Anonymous to help support alcohol addiction treatment.

Wilson and Smith first recognized the level of recovery among alcohol dependent individuals while working in a Christian Fellowship program for alcohol addiction treatment. They wrote the Big Book and started the first AA fellowship in Akron in 1935. The approach drew largely on the reliance on the Creator ideology that had been used to effect by the Salvation Army and the YMCA, and recognized the character of alcohol dependency as a disease that required intervention and hospitalization.

Early recovery rates were believed to be as high as 75% which at the time was unheard of, and the program spread as practitioners of alcohol addiction treatment investigated the Twelve Steps Model. Critics today challenge the recovery rates that were claimed and some believe that in fact the recovery rate was as low as 5%. Further, at the time of the alcohol addiction treatment program that was implemented in Akron, there were in fact no twelve steps and the fellowship had the character of a revivalist meeting that focused on Christian belief, bible reading and the singing of hymns.

The Twelve Steps Model for dealing with alcohol addiction treatment with AA ia implemented by a process of sponsorship. A member of the AA meeting will actively seek out an alcohol dependent individual and sponsor them into the group and in effect becomes their de facto mentor. The idea behind this lies in the cathartic effect that not only has a recovering patient dealt with their own alcohol dependency but is now in a position to help others and this serves to reinforce the need for the patient to remain alcohol free. The relationship between sponsor and sponsee frequently becomes extremely close as they interact outside of the AA meetings, in fact the sponsor is effectively on call for the new member in the event of any sense of uncontrollable compulsion to return to alcohol use.

Some critics of the Twelve Step Model for alcohol addiction treatment challenge the principles that require a surrender to a higher power. They argue that the model is religious in nature and this has led to numerous legal challenges when mandated alcohol addiction treatment has been ordered by the courts using 12 Steps. It has been argued that mandated attendance at a Twelve Steps program for alcohol and other addictions is compelling an individual to attend what is in effect a religious indoctrination course rather than a medically sanctioned treatment regime. The members and organizers of AA claim that in fact they are spiritual in nature rather than religious and that as stated in The Big Book, the object of alcohol addiction treatment through their approach is to find a Power that is greater than oneself that will help cure the disease that the patient suffers.

Whatever the debate on the religious connotations, the Twelve Steps Model is used extensively across the spectrum of addiction and not just restricted to alcohol addiction treatment. That is not to say that it is used exclusively by practitioners but it does find its place alongside the armoury of other treatment regimes such as psychotherapy and medication. The transfer of the principles behind the approach to other areas of addiction treatment, as well as dealing with other compulsive and behavioural disorders is testament to the perceived benefit that patients and practitioners have derived from Twelve Steps Model. Success rates from alcohol addiction treatment centers vary widely depending on the severity of addiction and the history of addiction, but combinative therapies have the best results rather than focusing on delivering one treatment regime. There is also no doubting the value of the fellowship provided by Alcoholics Anonymous to recovering patients once they have been discharged from the initial treatment phase of alcohol addiction treatment.