Should I attend a 12 Steps program for substance abuse or alcohol abuse? Or a Non 12 Steps program (also known as 12 Step Alternative)? What is the difference? This is a common question, and one where we have some relevant and first-hand experience with both a 12 Steps program and a non 12 Steps program.
Which is best for you? If you’re considering an inpatient residential treatment program, it’s important to research this one defining question.
12 Steps Programs
For many years the mainstream industry approach has been The 12 Steps Program of Alcoholics Anonymous (AA). It originated in the late 1930s at a time when there simply wasn’t anything else and society was desperate for a solution to out-of-control-drinking.
The 12 Steps is an important program and has its place.
But let’s be frank, it is a program, written by men, for men, at a time when conventional psychology was in its comparative infancy. So research and understanding was limited on the nature of addiction and how the human brain, social structures, and other elements of our whole self impacted one’s struggles with substance abuse or alcohol abuse.
Though the 12 Steps is effective for some who find its structure acceptable, it is thought to be an effective approach for less than 20% of the population. Since the inception of AA 75 years ago, there have been tremendous advances in the theory and application of psychology to the issues of addiction, alcoholism, drug abuse and mental illness. A non 12 Steps program is required to take advantage of these advances.
12 Steps Strengths
- Strong social network
- Abundance of AA meetings
- Low cost
The strengths of the 12 Steps approach are its social network, organization and the abundance of AA meetings worldwide. In fact, the vast majority of infrastructure for the rehab industry is built around supporting the 12 Steps process. As a “one-size-fits-all” approach, the 12 Steps program can be provided at relatively low cost. The instruction necessary is provided in Alcoholics Anonymous’ namesake bible - what they call the “Big Book” - and the foundation of the program revolves around attending regular AA meetings with others in the same situation.
12 Steps Program Tradeoffs
- Belief in powerlessness, negative affirmations, shame & guilt
- Coping over healing
- 80-90% failure rate (see Sober Truth: Bad Science of 12 Steps Programs)
- Not changed significantly since 1930s
The 12 Steps weaknesses include encouraging a belief of powerlessness, the use of negative affirmations, encouraging the use of shame, guilt and contriteness, and favoring coping skills over healing the underlying core issues causing the limiting behavior.
These are not insignificant weaknesses.
- Powerless: meaning I am not in control of my situation, myself, my destiny.
- Negative affirmations: I’m bad, something is wrong with me, over and over again. When I was in the 12 Steps program, I had to begin each meeting by standing up and saying, “My name is Betsy and I’m an alcoholic,” a technique and approach that is awash in shame, guilt and humiliation.
"81% of alcoholics who began attending meetings stopped within one month. At any one time, only 5% of those still attending had been doing so for a year.”
There is very little if any empirical evidence to suggest high success rates for the 12 Steps.
A recent review by the Cochrane Library, a health-care research group, of studies on alcohol treatment conducted between 1966 and 2005 states its results plainly: "No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [12 Steps facilitation] approaches for reducing alcohol dependence or problems."
Dr. Bankole Johnson cites equally dismal numbers: “In a 1990 summary of five membership surveys from 1977 through 1989, AA reported that 81% of alcoholics who began attending meetings stopped within one month. At any one time, only 5% of those still attending had been doing so for a year.”
The 12 Steps program was developed in 1930s. Think about it… before television. The program hasn’t changed materially since.
Non 12 Step Addiction Treatment Programs
There are many non 12 Steps programs available. The choices are vast so it is important to understand the specific program to see if it is right for you.
In general, a non 12 Step program will work with the physical, mental, emotional and spiritual issues associated with the underlying behavior that cause addictions and addictive behavior.
12 Steps alternatives often incorporate advances in psychology, spirituality and healing. They should offer more one-on-one counseling time and the small group therapy is more robust and deeper in content. A good 12 Steps alternative program will meet the individual exactly where they are. No shame or guilt, just authenticity and honestly is expected from the client.
Some broad categories of 12 Steps alternatives include:
- Instruct addicts and alcoholics to focus on being present in the moment
- This training helps those with addictive behaviors to have the tools to take control of urges and situations rather than being reactive
Cognitive Behavioral Therapy (CBT)
- The practice of working with thoughts and behavior to change the way you think and feel about a specific situation
- Provide skills to change undesirable behavior
- A broad category which can include elements of the above but also additional therapies and approaches such as object relations, reality therapy (behavioral therapy), rational emotive therapy, Gestalt therapy, psychosynthesis, person-centered therapy, and Neuro-Linguistic Programming (NLP), among others
- Can also includes eastern and alternative medicine techniques such as massage, acupuncture, nutrition, Reiki, meditation, and outdoor and group physical activities.
Non 12 Steps Strengths
- Incorporate advances in psychology and addiction research
- Address core issues leading to addictive behavior
- Diversified, complementary healing approach
In terms of tradeoffs, 12 Steps alternative approaches tend to cost substantially more due to the increased amount of individual care and having a more robust program. In addition, aftercare of the participant is more challenging given 12 Steps alternatives can’t plug into something as ubiquitous as the AA meeting network.
Non 12 Steps Tradeoffs
- Tend to cost more
- Aftercare may be more challenging
- Less of a track record
It is important to think about which approach is right for you. We suggest you look into both 12 Steps and 12 Steps alternatives to see which general approach resonates with you.
Next, as you look at individual programs, ask the hard questions and check out our post "How to Choose the Right Residential Treatment Center."
The Clearing clearly (no pun intended) falls into the non 12 Step category.
We’re a program of empowerment, strength, solutions and forgiveness. We use a lot of different and complementary techniques and therapies to drive to the core of an issue and help Participants heal for the last time.
We’re here to help. Please feel free to contact us if you have questions. We may or may not be the right program for you, but either way, we’ll help you understand your options and assess the best approach for you or your loved ones.
About The Clearing
The Clearing is a residential treatment center located on beautiful San Juan Island, Washington. We created The Clearing in response to the pervasiveness of treatment centers that focus more on luxury than modern, evidence-based therapy.
Our approach is based on healing the underlying core issues that cause addiction. If you'd like to learn more, contact us, or download our free eBook: