Pros and Cons of Twelve-Step Programs
What are the pro and cons of twelve-step programs? In the early 20th century, Bill Wilson founded Alcoholics Anonymous in an attempt to address and ultimately cure his confounding and baffling condition. The approach and philosophy of AA are based on medical insights, ancient spiritual traditions, and consultation with a handful of psychologists and more than a few alcoholics.
Today, AA and other 12-step programs are easily the most widely known and available support for addiction. Although AA is the original, many splinter groups have formed based on the same 12-step philosophy, including Narcotics Anonymous, Sex Addicts Anonymous, and Debtors Anonymous.
I’ve often referred clients to twelve-step groups if I think they’d be a good fit for such a group and if they’d likely find it helpful. But I’ve realized that AA and its variations aren’t for everyone. Here are some of my thoughts about the pros and cons of twelve-step programs to help you determine what’s right for you.
PROS OF TWELVE-STEP PROGRAMS
The benefits of 12-step programs are easily recognizable. All 12-step programs are free and supported entirely by donations of their participants. That there are 12-step meetings of all kinds everywhere (even online) makes accessing support easy.
For these reasons, 12-step programs are by far the most popular and well-known of the groups offering support for those struggling with addiction. Millions of people have journeyed through the groups and found hope and healing in these programs, many more than other groups of its kind.
Because 12-step programs are so well attended and because of the structure of the programs, 12-step programs offer excellent social support. The programs require the participant to make regular calls to others in the same group, meet regularly with a sponsor, and encourage meeting with group members outside of meetings for additional support. This social support can greatly reduce the shame that many addicts feel about their struggles, especially as they talk with others with similar (or worse) stories.
Many addicts who are also people of faith find 12-step programs attractive and helpful because of their emphasis on spirituality. Twelve-step programs begin with the requiring the addict to acknowledge and surrender to a Higher Power, which those of faith identify as God or the god(s) of their belief system. Moreover, as Ernest Kurtz describes in his book The Spirituality of Imperfection, the 12-step model is based on ancient traditions that are prevalent throughout the world’s religions and faiths.
Finally, the powerlessness model of the 12-step programs is easy to understand and to apply to one’s life. Its accessible wisdom is a comfort to many. That its model conceives of addiction as a disease for which there is no cure but abstinence offers a simple and comprehensible path toward healing and freedom from addiction.
CONS OF TWELVE-STEP PROGRAMS
As useful as the 12-step paradigm of addiction can often be, it greatly oversimplifies the biological, psychological, social, cultural, and spiritual aspects of an individual’s relationship with drugs or compulsive behavior. Addiction is an enormously complex phenomenon that cannot be neatly reduced to being a disease only.
The danger of approaching addiction from the perspective of the disease model and 12-step perspective only is that those who struggle to achieve or maintain sobriety can ignore important facets of their struggle that are actually contributing to their addiction. Often the solution is simply to work the program harder.
Another drawback is that there isn’t much evidence that 12-step programs are effective. Critics of 12-step programs cite the lack of published success rates (there is no system to track effectiveness in the programs anyway). Some studies suggest that attrition rates, especially in the first 90 days of attendance, are high (see B. Jones’ article Addiction and Pathological Accommodation for a brief discussion of these studies).
More importantly, according to one website, 37% of alcoholics and 53% of drug addicts suffer from some form of mental illness, and the 12-step program is no substitute for mental health treatment. Without addressing the mental illness and the addiction at the same time in what’s called a dual-diagnosis program, 12-step meetings and support will be of very limited value to those struggling with addiction.
Many in need of help are turned off by the 12-step program’s emphasis on spirituality. They may not align with a spiritual or religious tradition, or they may not like the language of powerlessness that the program advocates. Others find the idea of submitting to the program’s spiritual program and practices difficult for other reasons. And yet, instead of respecting these beliefs and expressed feelings, according to the rubric of the program, these individuals are not ready to change yet and need to hit bottom.
So, as the 12-step program is ultimately a spiritual program, and as spirituality can have its dark sides, its philosophy can be applied in ways that encourage exclusion, shaming, and rigidity. Either you’re in recovery or drinking, sober or using, and so on. This language can lead to a great deal of shame about even minor slips or relapses; even though the program encourages its members not to kick others when they’re down (i.e., after a relapse), it happens often.
That’s because 12-step meetings are not led my mental health professionals to ensure the health and emotional safety of the groups, which can lead to what I’ve heard other addiction therapists describe as “bad meetings” or “good meetings.”
COUNSELING AND SUPPORT FOR ADDICTION IN VENTURA COUNTY
If you’re struggling and need help with an addiction, please reach out. I’m happy to speak with you and at the very least point you in the right direction. Please contact me at (805) 256-3497 or firstname.lastname@example.org
Here’s a list of websites with popular meetings for addiction in Ventura County. Be sure to check the listings by city.