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  • While there are many different programs, philosophies, and approaches to addiction treatment and recovery, the 12-Step model is the oldest and one of the best-regarded.

    According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2017 National Survey of Substance Abuse Treatment Services, 12-Step programs/Alcoholics Anonymous (AA) are hosted, at least occasionally, at 73% of treatment centers nationwide.

    Organizations that use the 12-Step model include:

    What Is The 12-Step Model?

    The 12-Step model originated in the United States in 1938 when Bill Wilson, a founder of Alcoholics Anonymous (AA or Al-Anon) wrote down a set of ideas and principles gleaned from his experience with alcohol dependence and recovery. 

    These ideas were refined and reprinted and eventually became known as the Big Book, which is still used to this day.

    How The 12-Step Model Works

    At its core, the 12-Step model aims to bring people with similar treatment goals together for mutual support. It establishes a spiritual foundation for personal recovery and restoration. 

    Accordingly, the program requires that participants acknowledge and surrender to a higher power in order to achieve sobriety.

    While 12-Step programs have roots in Christian tradition, diverse interpretations of a higher power are possible and many agnostic or nonreligious participants have found 12-Step self-help groups to be extremely useful and supportive.

    Note that 12-Step fellowships focus on achieving abstinence from drug or alcohol use, not moderating drug abuse or alcohol abuse or tapering down use over time.

    What Are The 12 Steps?

    The 12 Steps, as defined by AA, are as follows:

    1. Honesty, admitting powerlessness over your addiction and acknowledging that your life has become unmanageable
    2. Faith, believing that a higher power (in any form) can help you
    3. Surrender, deciding to turn control over to your higher power
    4. Soul Searching, taking a personal and moral inventory
    5. Integrity, admitting to your higher power, to yourself, and to others the wrongs you have done
    6. Acceptance, being ready to have the higher power correct any shortcomings in your character
    7. Humility, asking your higher power to remove your shortcomings
    8. Willingness, making a list of wrongs you have done to others and being willing to make amends for those wrongs
    9. Forgiveness, contacting those you have hurt, unless doing so would cause them harm
    10. Maintenance, continually taking moral inventory and admitting when you are wrong
    11. Making contact, seeking connection with your higher power via prayer and meditation
    12. Service, spreading the message of the 12 steps to others in need

    Steps 1-3 in particular are considered the foundation of the 12-Step program, and those working through their recovery are encouraged to practice these three steps daily. 

    And while the steps do provide a roadmap for recovery from drug or alcohol addiction, they can also be a guide towards an honest and spiritually open way of life.

    Learn more about The 12 Steps Of Addiction Recovery Programs

    What To Expect From A 12-Step Program

    There are plenty of misconceptions or assumptions regarding 12-Step facilitation (TSF), including:

    • that you’ll be required to state well-known “I am an alcoholic” line (though many do)
    • that you’ll be required to pray
    • that you’ll be required to join in group hugs

    Instead, you should expect to meet in a building, typically with some connection to a church, community center, or treatment center. The number of individuals present can vary, and coffee is typically available.


    Facilitators and participants will begin by reading the AA preamble (or a similar document), the “Serenity Prayer,” “How it Works,” the “Twelve Traditions,” and “The Promises.”


    After this, newcomers may be recognized and the discussion will often turn to one of the 12 Steps, with readings followed by stories of different experiences by those in attendance.

    The meeting may or may not end in a prayer, after which attendees may socialize or leave at their preference.


    Newcomers at 12-Step meetings may be paired with a mentor or sponsor. This sponsor, who must have completed a 12-Step program previously, is expected to always be on-call and ready to help if you find yourself struggling with cravings and need support or reassurance.

    12-Step Programs Rules

    The only set of rules 12-Step programs typically are:

    • try to be on time
    • no smoking
    • no cross-talking over others
    • court vouchers are to be signed at the end of a meeting, not the beginning

    Alternatives To 12-Step Programs

    While it’s long proven an effective treatment, twelve-step facilitation therapy isn’t for everyone. 

    Accordingly, there are many different variations on the 12-Step program as well as alternative peer-sharing recovery options like SMART Recovery or Moderation Management, which focus on building control over drug use during recovery rather than surrender.

    Personalized inpatient or outpatient treatment programs may also use psychotherapies including motivational enhancement therapy (MET) and cognitive-behavioral therapy (CBT) with or without active participation in a 12-Step program.

    If you or a loved one struggles with substance use disorder, or are interested in learning more about how our team uses the 12-Step model of recovery in our treatment programs, please contact Ark Behavioral Health today.

    Find 12-Step Support Groups Near You

    12-Step Program FAQs

    Do 12-Step Programs Work For Those Who Don’t Believe God?

    Atheists, agnostics, and others can certainly benefit from the 12-Step approach and the mutual support, encouragement, and accountability that these meetings foster.

    While many 12-Step programs like AA do use spiritual language and may include religious elements in their meetings, participants are never required to engage with any spiritual components of the program.

    Learn more about How Atheists Can Benefit From 12-Step Recovery

    Are The 12-Steps Christian?

    Although the 12-steps are rooted in Christian tradition, the principles and teachings of AA are open to interpretation. While some groups may emphasize the 12-step’s Christian roots, others focus on fellowship, hope, and other secular or non religious points of view.

    How Many 12-Step Programs Are There?

    The oldest and most well-known 12-step program is Alcoholics Anonymous (AA). 

    However, there are about 50 other programs that have adapted the 12 steps of AA to help people recover from other addictions and mental health concerns. There are also several programs that are inspired by AA but don’t follow the 12 steps exactly.

    How Does Sponsorship Work In 12-Step Programs?

    In a 12-step sponsorship, a sponsor guides a sponsee through the 12-step recovery process. 

    In most cases, sponsees are new to the program, while sponsors have worked through all 12 steps and maintained sobriety for at least one year. Most sponsor-sponsee relationships include regular phone calls, in-person meetings, and other forms of contact. 

    To learn more, read a 12-Step Sponsorship Guide for sponsors & sponsees

    Why Do 12-Step Programs Work For Some But Not Others?

    There are many reasons why 12-step programs don’t work for some people. For example, while many people enjoy the 12-step structure, some find it too rigid. They might wish they could perform the steps in a different order or skip some steps altogether. 

    Other people find 12-step programs ineffective because:

    • they dislike the program’s emphasis on spirituality 
    • they feel uncomfortable opening up to a group
    • they find discussions of drug use triggering
    • they feel judged for receiving medication-assisted treatment 

    Learn more about Why 12-Step Programs Won’t Work For Everyone

    Written by Ark Behavioral Health Editorial Team
    ©2024 Ark National Holdings, LLC. | All Rights Reserved.
    This page does not provide medical advice.

    National Institute on Drug Abuse (NIDA) - Where do 12-step or self-help programs fit into drug addiction treatment?
    National Institutes of Health, Project Match Research Group - Twelve Step Facilitation Therapy Manual: A Clinical Research Guide for Treating Individuals with Alcohol Abuse and Dependence
    Substance Abuse and Mental Health Services Administration (SAMHSA) - 2017 N-SSATS

    Medically Reviewed by
    Kimberly Langdon M.D.
    on May 25, 2022
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