Do the 12 steps work?

July 14th, 2011

An ideal program for addiction recovery should be accessible to a wide range of people, regardless of divisive cultural tendencies. Furthermore, an effective recovery program won’t compromise long-term well-being for the sake of short-term gain.

Unfortunately, one of America’s most prevalent recovery programs, the 12 step program, may fall short of these goals.

The 12 steps have been used since the creation of Alcoholics Anonymous in 1935. Since then, they have been officially adopted into over 200 12 step recovery programs across the nation, addressing issues from narcotics addiction to overeating. The collective membership of these organizations is estimated to be anywhere from 2 to 5 million people, with many more who come and go. The prevalence of 12 step programs and their place in the American consciousness is therefore difficult to understate.

However, reading the 12 steps, one might be surprised that this system is intended to reach millions of addicts in our country. I’d like to address three aspects of the 12 steps (religion, relegation of power, and defect of character) that might undermine its efficacy. Below is a copy of the original 12 steps, still widely in use:

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 Godas 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.

Religion

God is mentioned quite frequently in the 12 steps. This poses a problem for the non-religious, but even adherents may not identify with the god mentioned in the 12 steps. It’s safe to say that this is the Judeo-Christian deity; alcoholics anonymous founder Bill W. was a lifelong Catholic, and the language of the 12 steps refers to a deity with traditional Judeo-Christian characteristics (anthropomorphic traits, a desire to expunge the failures of His people, etc.) Since a full quarter of our nation is not Christian, it seems unjustifiably exclusive for our country’s most well-known recovery program to presuppose Christian beliefs as a key to success.

Relegation of Power

Furthermore, 12 step followers are instructed to shoulder all of the blame for their addiction yet little of the responsibility for their recovery. The 12 steps encourage followers to essentially hand the reins of their lives over to God: He will “remove [their] defects of character” once they “make a decision to turn [their] will and lives over to [Him]”.

Of course, the 12 steps do encourage some personal initiative, but this is solely through making amends with those who have been harmed (steps 8 and 9). This is a worthy endeavor of course, but the 12 steps encourage no other measure of personal agency, such as removing oneself from situations where relapses might happen or examining the nature of drug and alcohol cravings. Any strength in combating addiction itself is to come from god, according to the 12 steps. Regardless of God’s capabilities, relying on another entity to rescue you from addiction will leave you feeling powerless. And indeed, this is confirmed in the first step (“We admitted we were powerless over alcohol—that our lives had become unmanageable.”)

So, by relegating all power to God, the 12 steps actually encourage an addict to believe that they are powerless. It is natural to feel powerless when in the throes of addiction. But is an addict objectively powerless? The fact that addicts are able to recover shows that they aren’t powerless in the face of their addictions, and since the 12 steps are based on the assumption that recovery is possible, their belief in an addict’s “powerlessness” seems a bit contradictory. Believing in powerlessness may seem relieving at first, but it could also weaken one’s sense of responsibility in the future.

Defects of Character

The 12 steps are full of language that pegs the addict as morally amiss. She or he has lost “sanity” and wishes for God to expunge his or her “defects of character”. One can see the Christian, individualist influence in this language, which places blame for tumbling off of the “right” path solely on the individual.

I question why this is considered an effective way of rehabilitating someone with addiction. In the short term, it may seem to work because the individual is literally shamed into sobriety, but that seems like an admission ticket to another problem–the burden of lifelong guilt. Furthermore, an individual who is invested in the 12 steps may attribute any cravings to a defect in character that has not been properly cleared out. Not only will this reduce his or her feeling of self-control, it’s a bit dehumanizing and ignores any societal responsibility to reduce addictive behavior. No one would argue that someone who is perfectly content, with a sense of purpose, solid social network, and stable livelihood, is likely to be an addict. Drugs and alcohol are usually seductive because of underlying anxiety or sadness. Attributing addiction to a “personal defect” not only prevents effective introspection, it encourages a kind of self-loathing that may worsen preexisting problems.

Why Are the 12 Steps Successful?

I’m not trying to claim that Alcoholics Anonymous and its offshoots are bad recovery programs. They have helped millions of people recover from debilitating addictions, and our country has clearly benefited from their existence. However, I would argue that the success of these groups is due to characteristics beyond the aforementioned critiques. Social support is essential to recovery, perhaps moreso than any other single factor, and Alcoholics Anonymous provides caring, non-judgmental support through its group therapy. Furthermore, the 12 steps encourage some self-reflection and self-awareness (steps 4, 10, and 11), two other indispensable tools on the road to recovery.

While the 12 steps have helped many people, they have also failed to prevent relapses among many others (Alcoholics Anonymous has estimated that 50% of its members are sober after five years). If the program were made more culturally accessible, and if long term effects were considered more carefully, the 12 steps could be an even more effective tool for helping those with addiction.

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“Alcoholics Anonymous (AA) Recovery Outcome Rates.” 1 January 2008: 2. Print.