With nearly one in ten adults in the United States experiencing a substance use disorder, or an addiction to drugs or alcohol, in the past year, the need for substance abuse treatment is greater than ever. The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline received 68,683 calls per month in the first quarter of 20181, up from last year. Only around 10% of Americans seek treatment for their substance use disorder, while others go untreated or seek the support from recovery support fellowships, such as a 12-step group like Alcoholics Anonymous, or a non-12 step group like SMART Recovery or Refuge Recovery.
Whether a person does get help at a treatment facility or not, research shows that participation in a recovery support community outside of treatment improves outcomes2. The key to achieving longterm recovery is for an individual to find a recovery support group that aligns with their core beliefs, which increases participation, and thereby, improving outcomes. While the membership of alternative, non-12 step recovery support groups are growing, the 12 Step community is by far the largest in the world with millions of members. There are basic tenants of the Twelve Steps that lead some to search for non-12 step communities.
Alcoholics Anonymous and The 12 Steps
Developed in 1935 by New York stockbroker, Bill W., and surgeon Dr. Bob S.–both alcoholics–Alcoholics Anonymous is a fellowship of people struggling with alcohol use disorders. The foundation of Alcoholics Anonymous are the 12 Steps of recovery, as outlined in the Big Book, which was first published in 1939. The 12 steps are the philosophy and methods for achieving longterm sobriety, and have helped millions of people in the almost 80 years of existence.
THE 12 STEPS OF 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.
- Were 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 or 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 response to criticism and questions about religion, donations, purpose and public relations, the Twelve Traditions were developed and adopted a short time later.
THE 12 TRADITIONS OF ALCOHOLICS ANONYMOUS
- Our common welfare should come first; personal recovery depends upon AA unity.
- 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.
- The only requirement for AA membership is a desire to stop drinking.
- Each group should be autonomous except in matters affecting other groups or AA as a whole.
- Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.
- 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.
- Every AA group ought to be fully self-supporting, declining outside contributions.
- Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
- AA, as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
- Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.
- Our public relations policy is based on attraction rather than promotion; we need always to maintain personal anonymity at the level of press, radio, and films.
- Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.3
With meetings taking place in bars, restaurants, churches and halls around the world, there are now over thirty different support groups based on the 12 steps, that vary from support for codependency (CoDA) and gambling (GA) to overeating (OA) and addictions to specific substances, including Heroin Anonymous (HA) and Cocaine Anonymous (CA). Some of the text is changed in the 12 Steps and 12 Traditions, depending on the group’s focus, for example Narcotics Anonymous uses the word ‘addict’ in place of the world ‘alcoholic’; but the steps that guide the philosophy and the traditions that provide guidelines for the fellowship remain the same.
You can find a listing of 12-step meetings at www.AA.org.
Effectiveness of the 12 Steps
The challenge in measuring the efficacy of a specific recovery support group is that there are too many variables that impact individual outcomes, including whether or not they have gone through treatment, live at home or at sober living, whether they have untreated mental health issues or trauma that contribute to their substance use or behavioral disorder, among countless others. As with any fellowship, studies have found that the outcomes for people in AA and other 12 Step groups are mixed, and vary greatly depending on the person’s commitment and participation level. We do know that millions of people have found help for their addictions, substance use disorders and other behavioral disorders through the 12 Steps.
Criticism of the 12 Steps
Even with this fellowship of millions of people around the world struggling with addictions and other challenges, the 12 Steps support groups have faced criticism due to the focus on God, religion, spirituality and prayer. “Working a program” requires one to subscribe to the doctrine of the steps and a belief in a higher power, though the definition of such has been broadened to mean whatever one believes it to mean. Another criticism of the 12 Step community is its admonishment of the use of psychotropic medications for those suffering from a mental health issue. Many consider the use of medications to mean that a person is not “clean and sober”. This alone leads some people to seek a more inclusive and progressive community of which to be a part.
Non-12 Step Recovery Support
In the past few decades, people recovering from drugs and alcohol, who found the 12 steps did not work for them, have developed alternative, non-12 step recovery support groups that provide the essential elements: fellowship, commitment, accountability and hope; while they differ in their approach.
SMART Recovery is a “science-based”, non-12 step self-help group that teaches, “common sense self-help procedures designed to empower you to abstain and to develop a more positive lifestyle”.4 The program is based on a form of Cognitive Behavioral Therapy called Rational Emotive Behavior Therapy, or REBT, which is founded on the belief that your thinking creates your feelings, and then leads you to act on those feelings.
SMART Recovery believes that drinking and using serve a purpose–to cope with emotions–and by managing the beliefs and emotions that lead you to drink or use, you can empower yourself to quit. SMART focuses on four key areas for its members:
- Enhancing motivation;
- Refusing to act on urges to use;
- Managing life’s problems in a sensible and effective way without substances; and
- Developing a positive, balanced, and healthy lifestyle.
Much like 12 step groups, SMART intends to provide widely-accessible meetings that a community member can find at locations around the world. SMART is an abstinence-based program that also embraces medical progress and does not preclude the use of medications among its members. Because the program does not reference a higher power or require its members to admit to being powerless over their alcoholism or addiction, people in recovery who are not religious or find it difficult to surrender their will over to another tend to prefer this philosophy. The community welcomes people who have a religious faith, however.
SMART Recovery also has an end point, which can be appealing to those who are more successful when they have a goal they are working toward. One can “graduate” from SMART Recovery, though they may continue to attend meetings and work on their abstinence. While the differences are clear, it’s important to note the similarities between SMART and other recovery support communities, which are the basic tenants: fellowship, commitment, accountability and hope. Many people who attend SMART meetings also attend 12 step meetings like AA or NA, as it is helpful to hear the words of others and the meetings are much more accessible.
For more information or to find meetings, visit www.SMARTrecovery.org.
Another recovery support community that has grown in popularity in the last few years is Refuge Recovery. Refuge is a Buddhist-oriented approach to recovery, and like SMART, it is founded on the belief that, “All individuals have the power and potential to free themselves from the suffering that is caused by addiction.” This empowerment comes from practicing self-compassion, and opening one’s heart and mind to respond to events and moments in life without self-harm. Like other recovery support communities, Refuge Recovery has guiding principles, which are the Four Truths: ONE: Addiction Creates Suffering; TWO: The cause of addiction is repetitive craving; THREE: Recovery is possible; FOUR: The path to recovery is available.
In an article, The Early History of Refuge Recovery, spiritual director Joseph Rogers explains the background.
The beginnings of Refuge Recovery can be traced to the Buddhism & Recovery conference held in Los Angeles at the Against the Stream Buddhist Meditation Society (ATS). It was here that Alan Marlatt, a researcher from the University of Washington, presented his findings on the impact of mindful meditation for clients in outpatient addiction treatment. His pioneering study showed that while mindfulness meditation improved the chances of clients reaching the 90-day recovery mark, if these clients stopped meditating post-treatment, their recovery rates returned to baseline. However, those clients who continued to meditate in supportive communities saw a continued higher rate of recovery post-treatment.
Alan believed that there needed to be a national network of meditation groups that supported the wave of clients who would soon be using mindfulness as an integral part of their recovery, something like a Buddhist-based 12-step program but with mindfulness meditation. 5
The Refuge Recovery program incorporates meditation and mindfulness into its approach, and emphasizes kindness, compassion, appreciation and equanimity. Refuge community members follow the Eightfold Path to Recovery:
According to their website, the Eightfold Path “is an abstinence based path and philosophy. We believe that the recovery process begins when abstinence begins. The Eight factors of the path are to be developed, experienced and sustained. This is not a linear path, it does not have to be taken in order, rather all of the factors will need to be developed and applied simultaneously. This is a guide to having a life that is free from addiction. The eight-fold path of recovery will have to be maintained throughout ones lifetime.”6
As we wrote about in an earlier article, much research into the benefits of meditation and mindfulness have come out in support of its role in recovery. Recently, more treatment centers have begun incorporating this practice into their programming, increasing interest in Refuge Recovery, which is based on these principles and practices.
For more information or to find meetings, visit www.refugerecovery.org.
Other Non-12 Step Recovery Support Communities
The Great Divide
A simple search of the internet will show you just how divided the recovery community is on the subject of recovery support groups. A large sector of the community believe the 12 steps are the answer for anyone struggling with drugs or alcohol, partly due to the fact that many people working in treatment centers are themselves recovering alcoholics or addicts who got sober using the 12 steps; while others believe non-12 step groups are more fitting due to their omission of religion or inclusiveness of other faiths. One will even find treatment centers whose curriculum is based on Twelve Step Facilitation (TCF), and others that denounce the steps and claim to be “Non-12 Step Rehab”.
Most of the literature that is available focuses on the differences between these two schools of thought, rather than the similarities in what they provide for people who are seeking help from their peers. The divide is harmful and the dangers of pitting fellowships against each other presents challenges to the recovery community, alienating individuals and groups, and suggesting that there is only one path to recovery. Creating the illusion that one community has better outcomes than the other, or that there exists only two clear options: 12-Step or Non-12 Step, forces people to place themselves in one of these two categories when, really, the recovery community as a whole should be unified and support one another regardless of the doctrine to which one subscribes.
Which Group is Best – 12 Step or Non-12 Step?
The answer to this question, as suggested earlier, depends on the individual and his or her belief system. Research has shown that people who are actively involved in a recovery support community achieve better outcomes and ‘success’, as they define it for themselves. One such study suggests that, “involvement in support groups significantly improves one’s chances of remaining clean and sober, regardless of the group in which one participates.” It goes on to say, “Respondents whose individual beliefs better matched those of their primary support groups showed greater levels of group participation, resulting in better outcomes as measured by increased number of days clean and sober.”
While the difference between communities, especially religion, may lead one to choose one over another, the reasons why active involvement in a recovery support community–regardless of the community–results in better outcomes, are the common themes among these groups, not the differences. Just as we urge clients in recovery to build empathy and compassion by finding the commonalities among them and their peers, rather than focusing on the differences, our approach to recovery support groups should be the same. What works for one, does not necessarily work for all.
Some treatment centers, like Roots Through Recovery, do not attach to any ideology or approach, and their philosophy is, “it doesn’t matter which community you join, but find one that speaks to you, and commit.” This approach embraces a belief in multiple paths to recovery, and encourages individuals to be both introspective and inclusive as they search for the community that they connect with most.