12-Step Facilitation of Treatment
12-Step Facilitation of Treatment
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Adrianne L. Johnson, State University of New York at Oswego
As explored in the previous chapter, groups are a highly effective modality for the treatment of addictions, and have a long and successful history in the field of chemical dependency. Twelve-step groups may be more appropriately titled “self-help groups” (because not all self-help groups have exactly 12 steps). The terms will be used interchangeably throughout the chapter.
The primary focus of self-help groups is to provide emotional and practical support and an exchange of information. Such groups use participatory processes to allow people to share knowledge, common experiences, and problems. Through their participation, members help themselves and others by gaining knowledge and information, and by obtaining and providing emotional and practical support. Traditionally, self-help groups have been in-person meetings, but more recently, Internet self-help groups have become popular.
One of the most widely recognized groups for the treatment of addictions is Alcoholics Anonymous (AA). Miller and McCrady (1993) note that Alcoholics Anonymous is the “most frequently consulted source of help for drinking problems” (p. 3). In fact, approximately 1 in every 10 adults in the United States has attended an Alcoholics Anonymous meeting at least once (Doweiko, 1999; Miller & McCrady, 1993; Zweben, 1995). Concurrently, affiliation with 12-step groups has been consistently linked to the achievement of abstinence among persons experiencing alcohol and other drug problems (Laudet & White, 2005). It is highly recommended that counselors, even if they do not regularly incorporate these groups into their counseling practice, should at least be familiar with them. The goal of this chapter, then, is to help counselors meet the following objectives:
1. To have a basic understanding of the foundation, history, and development of the 12-step model of treatment for addictions;
2. To gain a basic knowledge of the advantages and disadvantages of these groups, and how to use this knowledge to make appropriate referrals; and
3. To understand how to incorporate 12-step groups into culturally sensitive and client-appropriate addiction treatment for the most effective outcome.
History: Development of 12-Step Groups
Alcoholics Anonymous
As will be discussed later, Alcoholics Anonymous (AA) is one of the most widely recognized 12-step groups, and has been an instrumental force in the establishment of other groups using its model. Alcoholics Anonymous was founded on June 10, 1935, when Dr. Robert Holbrook Smith, an alcoholic physician, had his last drink (Doweiko, 1999). His cofounder, Bill Wilson, a failed Wall Street stockbroker, had previously been affiliated with the New York Oxford Group, a nondenominational group of Christians committed to overcoming a common drinking problem. The two men met coincidentally in Ohio while Wilson was seeking support to stay sober during a business trip (Miller, 2005). The plan for the group was devised by the two men, with a shared aim to spread the supportive message of sobriety to other alcoholics.
During its early years, AA worked to find a method that would support its members in their struggle to both achieve and maintain sobriety. Within three years of its founding, three AA groups were in existence, yet, “it was hard to find two score of sure recoveries” (Twelve Steps and Twelve Traditions, 1981, p. 17). The then-new organization was unable to establish exactly how and why the message of the group worked for some members, but not for all. Since then, several dynamics have been identified that will be discussed later in this chapter. The new organization continued to grow to approximately 100 members in isolated groups by its fourth year (Doweiko, 1999). The early members decided to write about their struggle to achieve sobriety in order to share their discoveries with others, leading to the principles of the now well-established foundation. In the half century since its founding, Alcoholics Anonymous has grown to a fellowship of 87,000 groups including chapters in 150 countries, with a total membership estimated at more than 2 million (Doweiko, 1999; Humphreys & Moos, 1996). The first edition of Alcoholics Anonymous was published in 1939, detailing the well-known Steps and Traditions that now serve as the established guide to addictions recovery and maintenance among group members. The organization took its name from the title of the book, which has since come to be known as the “Big Book” of AA (Twelve Steps and Twelve Traditions, 1981).
Twelve Steps
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; and
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.
Twelve Traditions
1. Our common welfare should come first; personal recovery depends upon A.A. unity.
2. For our group purpose there is but one ultimate authority—a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.
3. The only requirement for A.A. membership is a desire to stop drinking.
4. Each group should be autonomous except in matters affecting other groups or A.A. as a whole.
5. Each group has but one primary purpose—to carry its message to the alcoholics who still suffers.
6. An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
7. Every A.A. group ought to be fully self-supporting, declining outside contributions.
8. Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special works.
9. A.A., as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
10. Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.
11. Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films.
12. Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.
