A twelve-step programme is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioural problems. Originally proposed by Alcoholics Anonymous (AA) as a method of recovery from alcoholism, the Twelve Steps were first published in the book, Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism in 1939. The method was then adapted and became the foundation of other twelve-step programmes such as Narcotics Anonymous, Overeaters Anonymous, Co-Dependents Anonymous and Debtors Anonymous. As summarised by the American Psychological Association, the process involves the following:
- Admitting that one cannot control one’s addiction or compulsion
- Recognising a greater power that can give strength
- Examining past errors with the help of a sponsor (experienced member)
- Making amends for these errors
- Learning to live a new life with a new code of behaviour
- Helping others that suffer from the same addictions or compulsions.
Twelve-step methods have been adopted to address a wide range of substance abuse and dependency problems. Over 200 self-help organisations (often known as fellowships) with a worldwide membership of millions, now employ twelve-step principles for recovery. Narcotics Anonymous was formed by addicts who did not relate to the specifics of alcohol dependency. Similar demographic preferences related to the addicts’ drug of choice has led to the creation of Cocaine Anonymous, Crystal Meth Anonymous and Marijuana Anonymous. Behavioral issues such as compulsion for, and/or addiction to, gambling, food, sex, hoarding, debting and work are addressed in fellowships such as Gamblers Anonymous, Overeaters Anonymous, Sexual Compulsives Anonymous, Clutterers Anonymous, Debtors Anonymous and Workaholics Anonymous. Auxiliary groups such as Al-Anon and Nar-Anon, for friends and family members of alcoholics and addicts, respectively, are part of a response to treating addiction as a disease that is enabled by family systems.
Alcoholics Anonymous (AA), the first twelve-step fellowship, was founded in 1935 by Bill Wilson and Dr. Bob Smith, known to AA members as “Bill W.” and “Dr. Bob”, in Akron, Ohio. They established the tradition within the “anonymous” twelve-step programmes of using only first names “at the level of press, radio and film.”
As AA was growing in the 1930s and 1940s, definite guiding principles began to emerge as the Twelve Traditions. A Singleness of purpose emerged as Tradition Five: “Each group has but one primary purpose — to carry its message to the alcoholic who still suffers”. Consequently, drug addicts who do not suffer from the specifics of alcoholism involved in AA hoping for recovery, technically are not welcome in “closed” meetings unless they have a desire to stop drinking alcohol. The reason for such emphasis on alcoholism as the problem is to overcome denial and distraction. Thus the principles of AA have been used to form many numbers of other fellowships for those recovering from various pathologies, each of which in turn emphasises recovery from the specific malady which brought the sufferer into the fellowship. In 1953, AA gave permission for Narcotics Anonymous to use its Steps and Traditions.
The Twelve Steps of Alcoholics Anonymous
These are the original Twelve Steps as published by Alcoholics Anonymous:
- We admitted we were powerless over alcohol—that our lives had become unmanageable.
- Came to believe that a Power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of God as we understood Him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- We’re entirely ready to have God remove all these defects of character.
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to make amends to them all.
- Made direct amends to such people wherever possible, except when to do so would injure them or others.
- Continued to take personal inventory and when we were wrong, promptly admitted it.
- 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.
- 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.
In some cases, where other twelve-step groups have adapted the AA steps as guiding principles, they have been altered to emphasise principles important to those particular fellowships, to remove gender-biased or specific religious language.
In the twelve-step programme, human structure is symbolically represented in three dimensions: physical, mental, and spiritual. The problems the groups deal with are understood to manifest themselves in each dimension. For addicts and alcoholics, the physical dimension is best described by the allergy-like bodily reaction resulting in the compulsion to continue using substances after the initial use. The statement in the First Step that the individual is “powerless” over the substance-abuse related behavior at issue refers to the lack of control over this compulsion, which persists despite any negative consequences that may be endured as a result.
The mental obsession is described as the cognitive processes that causes the individual to repeat the compulsive behaviour after some period of abstinence, either knowing that the result will be an inability to stop or operating under the delusion that the result will be different. The description in the First Step of the life of the alcoholic or addict as “unmanageable” refers to the lack of choice that the mind of the addict or alcoholic affords concerning whether to drink or use again.
The illness of the spiritual dimension, or “spiritual malady”, is considered in all twelve-step groups to be self-centredness. This model is not intended to be a scientific explanation, it is only a perspective that twelve-step organisations have found useful. The process of working the steps is intended to replace self-centredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action In twelve-step groups, this is known as a spiritual awakening or religious experience. This should not be confused with abreaction, which produces dramatic, but ephemeral, changes. In twelve-step fellowships, “spiritual awakening” is believed to develop, most frequently, slowly over a period of time.
It is suggested that members regularly attend meetings with other members who share their particular recovery problem. In accordance with the First Step, twelve-step groups emphasise self-admission by members of the problem they are recovering from. It is in this spirit that members often identify themselves along with an admission of their problem, e.g. “Hi, I’m Wendy and I’m an alcoholic.” Such catchphrases are now widely associated with support groups. Some meetings are known as dual-identity groups, which encourage attendance from certain demographics, so that some areas have for example, women’s groups; men’s groups; and gay, lesbian and trans-gendered groups. There are also, in some areas, beginners’ groups as well as “old-timer” groups that limit who can share, or speak during the meeting, by the length of time the members have in that fellowship.