12-Step Programs

Thanks to AA and other substance recovery programs, you've probably at least heard of the Twelve Steps even if you aren't quite sure how they work. The Twelve Steps, originated by Alcoholics Anonymous (AA), is a spiritual foundation for personal recovery from the effects of alcoholism, both for the person using alcohol as well as their friends and family in Al-Anon Family Groups.

The 12 steps are also used in recovery programs for addictions other than alcohol.

For many members of 12-step recovery programs, these steps aren't merely a way to overcome addiction—they are a guide toward a new way of life. Some of the best-known 12-step programs include Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA).

Let's examine these 12-step programs more closely, including the individual steps and the traditions that help guide them. We'll also explore their effectiveness, the pros and cons you should consider, and how to make them work as part of a treatment plan.

As explained in Chapter 5, "How It Works," in the book Alcoholics Anonymous, the Twelve Steps provide a suggested program of recovery that worked for the early members of AA and continued to work through the years for many others, regardless of the type of substance they used.

The Twelve Steps themselves are the essence of Alcoholics Anonymous. They are the directions meant to provide members a path to lasting sobriety and a substance-free lifestyle.

Twelve-Step meetings are considered the "fellowship" part of the AA mutual support groups, where people come together and share their experiences.

For many people, these groups may serve as their primary resource for changing their behavior, but they also often augment formal treatment. Such programs can also be helpful for long-term support and care.

Worldwide, approximately 118,000 groups are supporting more than 2 million members in 180 nations.


Though the original Twelve Steps of AA have been adapted over time, the premise of each step remains the same for all recovery programs that use a 12-step model.6

By exploring the steps in depth and seeing how others have applied the principles in their lives, you can use them to gain insight into your own experiences, and to gain strength and hope for your own recovery. The steps and their principles are:

Honesty: After many years of denial, recovery can begin with one simple admission of being powerless over alcohol or any other drug a person is addicted to. Their friends and family may also use this step to admit their loved one has an addiction.

Faith: Before a higher power can begin to operate, you must first believe that it can. Someone with an addiction accepts that there is a higher power to help them heal.

Surrender: You can change your self-destructive decisions by recognizing that you alone cannot recover; with help from your higher power, you can.

Soul Searching: The person in recovery must identify their problems and get a clear picture of how their behavior affected themselves and others around them.

Integrity: Step 5 provides great opportunity for growth. The person in recovery must admit their wrongs in front of their higher power and another person.

Acceptance: The key to Step 6 is acceptance—accepting character defects exactly as they are and becoming entirely willing to let them go.

Humility: The spiritual focus of Step 7 is humility, or asking a higher power to do something that cannot be done by self-will or mere determination.

Willingness: This step involves making a list of those you harmed before coming into recovery.

Forgiveness: Making amends may seem challenging, but for those serious about recovery, it can be a great way to start healing your relationships.

Maintenance: Nobody likes to admit to being wrong. But it is a necessary step in order to maintain spiritual progress in recovery.

Making Contact: The purpose of Step 11 is to discover the plan your higher power has for your life.
Service: The person in recovery must carry the message to others and put the principles of the program into practice in every area of their life.


Just as the 12 steps outline the path to recovery for individuals struggling with addiction, there are also 12 Traditions that are the spiritual principles behind the 12 steps.7 These traditions help guide how 12-step recovery programs operate. The traditions focus on unity, effective leadership, and independence. They also address questions related to financing the group and managing public relations.

The purpose of the 12 traditions is to help provide guidelines about the relationships between the group and the community and between individual members of the group.

The 12 steps of recovery introduced by the founders of Alcoholic Anonymous are:

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 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.

While the 12 steps in use today are based on the same ideas written by the founders of AA in the 1930s, the understanding of the term “God” has since broadened to refer to any “higher power” that a person believes in.


Believing in this higher power may help someone find meaning in their life outside of addiction.9 For instance, they may find a greater sense of community by joining a spiritual or religious group. Or, they may engage in prayer and meditation. These can be healthy coping mechanisms someone turns to as they progress through recovery.

There are many different paths to substance use recovery, and 12-step programs are just one resource that people may find helpful. Research suggests that 12-step interventions and mutual support groups can be essential in recovery.10

Self-report information collected by AA, NA, and CA suggests that the median length of abstinence among currently attending members is five years. Around a third of members report remaining abstinent between one and five years.11

More formal research also supports the findings of support group surveys. For example:

Attending 12-step recovery programs in addition to specialized substance use treatment is associated with better overall outcomes.
Greater involvement, particularly when a person first connects with a 12-step program, is also linked to better outcomes.
Participating in activities and attending meetings may help reduce the likelihood of a relapse.

A 2020 review found that Alcoholics Anonymous and other 12-step facilitation treatments produced benefits that were similar to other treatments. The research also found that these 12-step approaches were superior to other methods for maintaining continuous abstinence and reducing remission rates. Such programs are also a cost-effective way to deliver treatment.10

While participating in the 12 steps of recovery can be beneficial for many people, consider the advantages and disadvantages of these programs before you decide if this approach is right for you.

These programs offer a number of benefits, including:

▪ A free resource for communities to address substance use problems.
▪ Readily available.
▪ Community-based.
▪ Encourages members to take an active part in recovery.
▪ Offers online and in-person options.

However, 12-step mutual support groups may not be for everyone. Some challenges or possible disadvantages include:

▪ Co-occurring mental health or chronic health conditions may make participating in 12-step groups more challenging.

▪ This approach places full accountability for addiction and recovery on the individual.

▪ 12-step groups may be less effective for certain groups, including women, BIPOC, and sexual minorities.

▪ The emphasis on powerlessness can feel disempowering to some people.

▪ Emphasis on a higher power can alienate some people.

▪ Does not address the physical aspects of recovery, such as drug detox and withdrawal.