Twelve step programs are those based on a set of largely religious or spiritual principles developed by Alcoholics Anonymous (AA) and now often used in an effort to help alcoholics and addicts recovery.

Alcoholics Anonymous developed the original 12 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 we 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.1

Dozens of 12 step programs have modified these steps to apply to narcotics, gambling, compulsive shopping, overeating, and many other problems.

Spontaneous Remission (or Natural “Cure”)

Different diseases and conditions have different spontaneous remission rates. The common cold has a virtually 100% spontaneous remission rate whereas many cancers have a near zero rate.

Knowing the spontaneous remission rate is essential in understanding if any particular program or treatment is successful. As one observer explains:

Imagine that there is a nasty disease that kills 50% of the people who get it. A pharmaceutical company has a new medicine that they want to test. So they give the drug to a bunch of the people who have the disease, and 50% of them get better.

The drug manufacturer cheers and brags, "Look at how great our new medicine is! We saved half of the patients!"

Wrong. The new drug saved nobody. The half who survived were the ones who were going to survive anyway. The drug had an effective zero percent cure rate, above and beyond normal spontaneous remission.

To compute the success rate of any medicine or treatment program, you have to subtract the normal rate of spontaneous remission from the apparent success rate. In this example, fifty percent minus fifty percent yields a zero percent success rate for the new medicine. The new medicine didn't make anybody recover.

And if the survival rate of the patients who were taking the new medicine was less than half, then the new medicine was actually poisoning people and keeping them from recovering.2 (Emphasis in original)

AA claims a one-year success rate of five percent. That is, one of twenty members who begins the program will be sober at the end of one year.3 But that claimed 5% must be examined in light of the spontaneous remission rate for alcoholism.

Based on a national-wide sample of over 43,000 people, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that "About 75 percent of persons who recover from alcohol dependence [alcoholism] do so without seeking any kind of help...”4

Others have reported a range of spontaneous remission rates. The reported spontaneous remission rates for alcoholism and drug addiction vary widely, depending largely on what is counted as remission, how it is counted, and who is counting it. Nevertheless, in addition to the Federal survey reported above, the reported remission rates are all higher than AA’s self-reported five percent.

  • An eight year follow-up of alcoholic felons who received no treatment found that about 18% were abstinent for at least two years.5
  • An abstinence rate of 11% was found among untreated alcoholics over an unspecified period of time.6
  • Fifteen percent of untreated alcoholics were abstinent after a seven year follow-up period of time.7
  • A follow-up of alcoholics who received no treatment found that 15% were abstaining at one year and 11% were abstaining after three years.8

The research strongly suggests that AA is less effective than participating in no program or therapy.

How Do 12 Step Programs Compare to Other Programs?

Alcoholics who had been arrested for public drunkenness were randomly assigned to one of three groups. One group was assigned to AA treatment, another to lay or non-professional Rational Behavior therapy, and the third to no treatment (control group).

Three months after the end of treatment, those assigned to AA were five times more likely to binge than those who received no treatment and nine times more likely to binge than those who were assigned to lay Rational Behavior Therapy.9

Convicted public drunkenness offenders were randomly assigned to one of three conditions: to attend AA, to receive treatment at a professional alcoholism treatment clinic, or to receive no treatment.

The offenders were followed for at least a year following conviction. Those in the no-treatment group were the least likely to be re-arrested for public intoxication whereas those who attended AA were significantly more likely to be re-arrested.10

A study of inmates who participated in a Texas correctional substance abuse treatment program found that those who participated in an in-prison 12 step program had the same drug recidivism rates as non-participants.11

Workers who were newly identified as abusing alcohol were randomly assigned to one of three groups. One was assigned to compulsory inpatient treatment, one was assigned to compulsory AA meetings, and one had a choice of options. The groups were compared on 12 measures of drinking and drug use during a two year follow-up period.

On most measures of alcohol use, the inpatient group had the fewest problems whereas the compulsory AA group had the most problems. On measures of drug use the compulsory AA group was the least successful in moderating or quitting. In addition, workers who were abusing both cocaine together and alcohol were especially unsuccessful in the AA group. The cocaine users who were assigned to the AA group had the most drinking problems and were the most likely, at every follow-up assessment, to report continued use of cocaine.12

Researchers evaluated 48 different approaches to alcoholism treatment based on empirical evidence and assigned an effectiveness score to each. Brief intervention had the highest score (390). Twelve step facilitation received a score of -82 (minus 82) and Alcoholics Anonymous received a score of -94.

The researchers then ranked approaches from the most effective (number 1) down to the least effective (number 48). Brief intervention was number 1, acupuncture was 17, exercise was 20, twelve step facilitation was 37, followed by Alcoholics Anonymous at number 38.13

The research evidence clearly indicates that AA and other 12 step programs are less effective than most other programs or techniques.

Why Are AA and Other 12 Step Programs so Ineffective?

Twelve step programs are less effective than spontaneous remission -- they’re actually counter-productive for most people. Thus, they do something or some combination of things that hinders the natural processes reducing alcohol and drug problems.

The 12 step doctrine that consuming any alcohol triggers an uncontrollable urge to continue drinking and to do so in excess becomes a dangerous self-fulfilling prophesy. Research has demonstrated that alcoholics who reject the belief are much more likely to drink without problems after ending treatment than are those who believe it.14

This is understandable. If a person breaks down and has a drink, the person has been taught to believe that “falling off the wagon” is inevitable. Therefore, the person binges because that is what 12 step programs insist is what always happens.

Twelve step programs also teach alcoholics that they are completely powerlessness and must submit to the will of God and other AA members. Constant self-criticism and confession sessions are central to 12 step programs. This is humbling and even humiliating. “After he left the Betty Ford Center, Chevy Chase reported that he had often been angry at the counselors, who heckled the residents mercilessly, constantly denigrating them and claiming they had been living worthless lives."15 AA co-founder Bill Wilson insisted that alcoholics must have their egos crushed.

As indicated above, research by Dr. Brandsma and his colleagues found that alcoholics assigned to AA were five times more likely to binge than were those who received no treatment and nine times more likely to binge than those who were assigned to lay Rational Behavior Therapy.16 He suggested that such behavior was a result of AA members trying to assert their power and re-establish their egos in the face of being constantly humiliated by self-criticism and confessions of their horrible behaviors.

Dr. Brandsma’s explanation for why participation in AA lead to more binge drinking is supported by a major psychological theory (reactance theory) that would predict exactly such a reaction to 12 step teachings and actions.17

To see the devastating effects of 12-step programs on just one person's life visit What NOT to Do.

It’s often said that AA and NA are cost-effective because they are free. However, they generally make it harder for people to lead sober lives. This can lead to hospitalization and other costs. These “free” programs often lead to very expensive programs in addition to their costs in terms of unnecessary human tragedy, destroyed marriages, lost jobs and careers, lower income, increased traffic deaths, and so on.

AA and NA also impose a very heavy “opportunity cost.” That is, when people attend them instead of (a) letting spontaneous remission occur or (b) participating in an effective program, they needlessly suffer much lower success rates. Thus, they’re forced to carry an unnecessarily burden of alcoholism or drug addiction.

Conclusion

Twelve step programs appear in general not to be as effective as doing nothing; in fact, they appear to slow or even halt progress to sobriety. However, for that small minority of alcoholics who are able to follow the 12 steps, the programs can be effective.

An alternative is to choose a non-12 step rehab, of which there are a number. Fully accredited by the Commission on Accreditation of Rehabilitation Facilities and licensed to provided on-site medical detox is the St. Gegory Retreat Center. It welcomes most health insurance plans, is a member of the National Association of Addiction Treatment Providers and is highly ranked by the Better Business Bureau.

However, many people find that they don’t need to go to a rehab but achieve sobriety through using free or low-cost alternatives such as Moderation Management, HAMS (Harm reduction, Abstinence, and Moderation Support), LifeRing Recovery, Women for Sobriety, Rational Recovery, SMART Recovery (Self-Management and Recovery Training), SOS (Secular Organizations for Sobriety) and the Life Process Program.

Disclaimer: This website is informational only. It makes no suggestions or recommendations about alcohol, drinking, rehabs, programs, or any other matter and none should be inferred. Neither this website nor your host receives any compensation, directly or indirectly, from listing or describing any program. Such listing or description does not imply endorsement. [+]

References

  • 1. Alcoholics Anonymous. How It Works. In: Alcoholics Anonymous (4th ed.). NY: Alcoholics Anonymous World Services, 2001.
  • 2. Orange, A. The Effectiveness of the Twelve-Step Treatment. Orange Papers Organization website (orange-papers.org/orange-effectiveness.html)
  • 3. The United States Food and Drug Administration (FDA) would never approve any medication that has a success rate of only only 5%.
  • 4. Dawson, D.A. Correlates of past-year status among treated and untreated persons with former alcohol dependence: United States, 1992. Alcoholism: Clinical and Experimental Research, 1996, 20(4), p. 773.
  • 5. Goodwin, W. W., et al. Felons who drink: an eight-year follow-up. Quarterly Journal of Studies on Alcohol, 1971, 32, 136-147.
  • 6. Lemere, F. What happens to alcoholics. American Journal of Psychiatry, 1953, 109, 674-675.
  • 7. Kendall, R. E. and Stanton, M. C. The fate of untreated alcoholics. Quarterly Journal of Studies on Alcohol, 1966, 27, 30-41.
  • 8. Imber, S., et al. The fate of the untreated Alcoholic. Journal of Nervous and Mental Disorders, 1976, 162, 238-247.
  • 9. Brandsma, J.M., et al. Outpatient Treatment of Alcoholism. Baltimore, MD: University Park Press, 1980, p. 105.
  • 10. Ditman, K.S., et al. A controlled experiment on the use of court probation for drunk arrests. American Journal of Psychiatry, 1967, 124(2), 160-163.
  • 11. Peele, S. Drunk with power. Reason, 2001, 33(1), p. 34.
  • 12. Walsh, D.C., et al. A randomized trial of treatment options for alcohol-abusing workers. New England Journal of Medicine, 1991, 32, 775-782.
  • 13. Hester, R.K. and Miller, W.R. Handbook of Alcoholism Treatment Approaches: Effective Alternatives. NY: Pergamon Press, 1989.
  • 14. Heather, N., et al. An empirical test of a cultural delusion of alcoholics. Psychological Reports, 1982, 50, 379-382.
  • 15. Peele, S. Diseasing of America: Addiction Treatment Out of Control. Lexington, MA: Lexington, 1989.
  • 16. Brandsma, J.M., et al. Outpatient Treatment of Alcoholism. Baltimore, MD: University Park Press, 1980, p. 105.
  • 17. Cooper, J.M. Cognitive Dissonance: 50 Years of a Classic Theory. London: Sage, 2007.

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