Twelve-step program

A twelve-step program is a set of guiding principles for recovery from addiction, compulsion, or other behavioral 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 in 1939. The method was then adapted and became the foundation of other twelve-step programs such as Narcotics Anonymous, Overeaters Anonymous, Co-Dependents Anonymous and Debtors Anonymous. The process of twelve-step recovery has been characterized by Dr. Bob - one of AA's co-founders - as "Trust God, clean house, help others". As summarized by the American Psychological Association, the process involves the following:

• admitting that one cannot control one's addiction or compulsion;
• recognizing 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 behavior;
• helping others that suffer from the same addictions or compulsions.

Overview

Twelve-step methods have been adopted to address a wide range of substance abuse and dependency problems. Over 200 self-help organizations - known as fellowships - with a world-wide membership of millions, now employ twelve-step principles for recovery. Narcotics Anonymous was formed by substance-dependent people who did not relate to the specifics of alcohol dependency. Similar groups now exist for sufferers of cocaine addiction: Cocaine Anonymous, as well as other specific drug addictions, such as Crystal Meth Anonymous and Marijuana Anonymous. Behavioral issues such as compulsion with and/or addiction to gambling, food, and sex are addressed in fellowships such as Gamblers Anonymous, Overeaters Anonymous and Sexual Compulsives Anonymous. Fellowships such as Al-Anon - for families and friends of the person with the addiction - are responses to what is identified by some mental health professionals as the problem of addiction as a disease that flourishes in and is enabled by family systems. Other groups address problems with certain types of behaviors, including Clutterers Anonymous, Debtors Anonymous, and Workaholics Anonymous.

History

Further information: History of Alcoholics Anonymous

Alcoholics Anonymous (AA), the first twelve-step program, 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 programs of using only first names. In 1953 AA gave permission for Narcotics Anonymous to use its Steps and Traditions.

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 emphasizes recovery from the specific malady which brought the sufferer into the fellowship.

Twelve Steps

These are the original Twelve Steps as published by Alcoholics Anonymous.

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 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 emphasize principles important to those particular fellowships, to remove gender-biased or specific religious language.

Twelve Traditions

Main article: Twelve Traditions

The Twelve Steps are accompanied by the Twelve Traditions, guidelines for group governance developed by AA during early days in order to help resolve conflicts in the areas of publicity, religion and finances.

Most twelve-step fellowships have adopted these principles as their structural governance. In AA, the empathetic desire to save other alcoholics resulted in an exclusive emphasis on service to other sufferers, which led to the third tradition, the only requirement for AA membership is the desire to stop drinking. The Twelve Traditions of Alcoholics Anonymous are as follows.

1. Our common welfare should come first; personal recovery depends upon AA 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 AA membership is a desire to stop drinking.
4. Each group should be autonomous except in matters affecting other groups or AA as a whole.
5. Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.
6. An AA group ought never endorse, finance, or lend the AA name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
7. Every AA 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 workers.
9. AA, 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 AA 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.

Process

Twelve-step programs symbolically represent human structure in three dimensions: physical, mental, and spiritual. The disorders and diseases 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 inability to stop using substances after the initial use. For groups not related to substance abuse the physical manifestation could be much more varied including, but not limited too: agoraphobia, apathy, distractibility, forgetfulness, hyperactivity, hypomania, insomnia, irritability, lack of motivation, laziness, mania, panic attacks, poor impulse control, procrastination, self-injury, suicide attempts, and stress. The mental obsession is described as the mental processes that cause the addict or alcoholic to repeat that initial use, either knowing the result will be an inability to stop or suffering under the delusion that the result will be different. The illness of the spiritual dimension, or "spiritual malady", is considered in all twelve-step groups to be self-centeredness. This model is not intended to be a scientific explanation, it is only a perspective that twelve-step organizations have found useful.

The process is intended to replace self-centeredness 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 groups, "spiritual awakening" is believed to develop, most frequently, slowly over a period of time.

Members are encouraged to regularly attend meetings with other members who share their particular recovery problem. In accordance with the First Step, twelve-step groups emphasize 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 limit attendance to certain demographics, so that some areas have for example, women's groups; men's groups; and gay, lesbian, transgendered groups. There are also in some areas beginner's 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.

Sponsorship

A sponsor is a more experienced person in recovery who guides the less-experienced aspirant ("sponsee" or variously, "sponsoree") through the program. New members in twelve-step programs are encouraged to secure a relationship with at least one sponsor. Publications from twelve-step fellowships emphasize that sponsorship is a "one on one" relationship of shared experiences focused on working the Twelve Steps. According to Narcotics Anonymous:

Sponsors share their experience, strength, and hope with their sponsees... A sponsor's role is not that of a legal adviser, a banker, a parent, a marriage counselor, or a social worker. Nor is a sponsor a therapist offering some sort of professional advice. A sponsor is simply another addict in recovery who is willing to share his or her journey through the Twelve Steps.

Sponsors and sponsees participate in activities that lead to spiritual growth. These may include practices such as literature discussion and study, meditation, and writing. Completing the Twelve Steps implies being competent to sponsor to newcomers in recovery. Sponsees typically do their Fifth Step, review their moral inventory written as part of the Fourth Step, with their sponsor. The Fifth Step, as well as the Ninth Step, have been compared to confession and penitence. Many, such as Michel Foucault, noted such practices produce intrinsic modifications in the person—exonerating, redeeming and purifying them—it unburdens them of their wrongs, liberates them, and promises their salvation.

The personal nature of the behavioral issues that lead to seeking help in twelve-step fellowships results in a strong relationship between sponsee and sponsor. As the relationship is based on spiritual principles, it is unique and not generally characterized as "friendship." Fundamentally, the sponsor has the single purpose of helping the sponsee recover from the behavioral problem that brought the sufferer into twelve-step work, which reflexively helps the sponsor recover.

A study of sponsorship as practiced in Alcoholics Anonymous and Narcotics Anonymous found that providing direction and support to other alcoholics and addicts correlates with sustained abstinence for the sponsor, but that there were few short-term benefits for the sponsee.

Effectiveness

See also: Alcoholics Anonymous: Effectiveness, Crystal Meth Anonymous: Effectiveness, Emotions Anonymous: Effectiveness, Gamblers Anonymous: Effectiveness, Nicotine Anonymous: Effectiveness, Self-help groups for mental health: Effectiveness, and Effectiveness of Alcoholics Anonymous

There have been several studies, large and small, measuring with various methodologies the effectiveness of Alcoholics Anonymous or Twelve Step Facilitation as a treatment modality for alcoholics and problem drinkers. Alcoholics Anonymous is the largest of all the twelve-step programs followed by Narcotics Anonymous meaning a large majority of twelve-step members are recovering from addiction to drugs or alcohol. The majority of twelve-step programs, however, address illnesses other than addiction. For example, the third largest twelve-step program, Al-Anon, treats codependence. About twenty percent of twelve-step programs are for addiction recovery, the other eighty percent address a variety of problems from debt to depression.

Criticism

Main articles: Alcoholics Anonymous § Criticism and controversy, Celebrate Recovery § Criticism, Emotions Anonymous § Criticism, Gamblers Anonymous § Criticism, Narcotics Anonymous § Controversies, Overeaters Anonymous § Criticism, Self-help groups for mental health § Criticism, and Sexaholics Anonymous § Criticism

The criticisms of twelve-step groups are as varied as the pathologies they address. People have attended twelve-step meetings, only to find success eluded them. Their varied success rate and the belief in a Higher Power suggested in them, are common criticisms of their universal applicability and efficacy.

Confidentiality

The Twelve Traditions encourage members to practice the spiritual principle of anonymity in the public media and members are also asked to respect each other's confidentiality. However, the programs rely on 'obedience to the unenforceable' and there are no legal consequences or sanctions within the program to discourage those attending twelve-step groups from revealing information disclosed during meetings. Statutes on group therapy do not encompass those associations that lack a professional therapist or clergyman to whom confidentiality and privilege might apply. Physicians who refer patients to these groups, to avoid both civil liability and licensure problems, have been advised that they should alert their patients that, at any time, their statements made in working through the Twelve Steps might be disclosed.

Cultural identity

One review of twelve-step programs warned of detrimental iatrogenic effects of twelve-step philosophy, and labeled the organizations as cults. However, a further study concluded that these programs bore little semblance to religious cults because the techniques used appeared beneficial. Another study found that a twelve-step program's focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity replacing it with the deviant identity. A survey of twelve-step group members, however, found they had a bicultural identity and saw twelve-step programs as a complement to their other national, ethnic, and religious cultures.

See also

• Addiction recovery groups
• Drug rehabilitation
• Group psychotherapy

• List of twelve-step groups
• Self-help groups for mental health
• Recovery model

Further reading

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