What Is 12-step?

For decades, 12-step meetings have been the go-to method for treating alcoholism and addiction. Whether by doctors’ offices or the US court system, someone struggling with an inability to quit drinking or using drugs is usually referred to the rooms of Alcoholics Anonymous or Narcotics Anonymous to address their problem. The primary principle that drives 12-step is the idea that the person is powerless over the substance and faced with an incurable disease, namely the inability to stop engaging in behaviors that have proven to be continuously harmful. The solution, according to AA, is complete abstinence and turning one’s will over to the care of a Higher Power. The rest of the steps involve taking inventory of one’s past mistakes, making amends to anyone they might have harmed while active in their addiction and continuing to admit fault and acknowledge their shortcomings. Finally, AA suggests its members be of service wherever possible and, when given the opportunity, take others through the 12 steps. Twelve-step recovery fosters the notion that the person must continue a practice of spiritual maintenance via meeting attendance, working the steps and keeping in contact with a Higher Power for the rest of their life in order to stay sober.

There are many people who disagree with the concept of 12-step—arguing that declaring one’s self as “powerless” is a detriment to healing. Individuals take issue with the notion of simply praying to or relying upon God or a Higher Power in order to get better. And seeing as how AA is not governed or regulated by any one person or entity, but kept active through the voluntary participation of its own members, there are no hard statistics proving whether or not it “works,” so to speak. While it has undoubtedly helped countless people since its inception in the 1930s—otherwise it wouldn’t have been the go-to solution for addiction for this many years—it does not have any official records of its success rate. Additionally, it’s often viewed as a spiritual program, rather than one based in science. Yes, there have been studies examining why aspects of its programming can be effective but there are increasing sects of the addiction and recovery field promoting other forms of treatment for a number of reasons.

The Growth of Evidence-Based Practices

Plenty of addiction experts now emphasize the importance of implementing more evidence-based treatment practices—tactics that have been studied and analyzed for their results in a scientific or medically oriented setting. An example of evidence-based treatment would be Cognitive Behavioral Therapy (CBT) facilitated by a licensed psychologist who specializes in addictive behaviors or Motivational Enhancement Therapy (MET). While the overall opinion regarding which strategies have enough studies to warrant them as evidence-based is still forming, advocates do assert, according to a 2010 study published in the Health Policy Journal by researchers from UCLA Substance Abuse Programs, “If clinical decision-making and practice are informed by experimental studies that have established the effectiveness of particular interventions for specified clinical populations, this should (i) increase treatment effectiveness, (ii) facilitate consistency in practice, (iii) establish accountability of health service providers to funding sources, (iv) increase cost-effectiveness of treatment, and (v) improve the overall quality of treatment.”

Doctors and addiction experts have even started advocating for new terminology in order to disassociate individuals with the stigma around addiction and alcoholism. Not wanting to be labeled by the terms “alcoholic” and “addict” is often a deterrent for individuals who might want to seek help. In fact, those terms have evolved in medical settings to what’s considered non-stigma inducing language like “Substance Use Disorder (SUD)” or, more specifically, “Alcohol Use Disorder (AUD).” Some view this as a continued effort to separate from the confines of what’s been defined solely by the literature of Alcoholics Anonymous, which wasn’t authored by a scientist.

Non-12-Step Based Rehab

The reality is, 12-step meetings are free and a person has the option to attend and commit at their own will. So if someone checks into a drug and alcohol treatment facility that offers programming driven primarily around the 12 steps, it could be argued that they are essentially paying for a resource that’s available for free. Because of this and an increasing belief that 12-step is not going to work for everyone, a great number of facilities are now offering programming that is not 12-step based. Recovery Malibu, for example, is not-12-step oriented.  Being a high-end residential rehab, its primary advantage is individualized treatment, or the idea that there is not a one-size-fits-all approach (such as AA) to addressing addiction and therefore each person’s unique circumstances must be taken into account. Based on that, a unique treatment plan is tailored to fit the person and can include a myriad of other approaches to getting well. Group and individual therapy are core facets of programming but clients can also expect holistic treatment—methods that aim to treat the “whole person,” mind, body and spirit. This is executed not only through intense therapy driven by evidence-based practices but also through physical exercise and sound nutrition. Programming is further supplemented with experiential therapies like equine therapy and acupuncture and plenty of wellness-oriented activities such as yoga, hiking or surfing. Additionally, high-end facilities like Recovery Malibu almost always have the necessary resources to treat co-occurring disorders, a resource not available in 12-step recovery.

It’s worth noting that the treatment team at Recovery Malibu, as is the case with many other luxury rehabs, does not necessarily discourage clients from exploring AA or NA but it certainly doesn’t require attendance at meetings as part of the treatment regimen. A lot of individuals prefer to use peer support meetings—whether it’s AA/NA, Celebrate Recovery or SMART Recovery—as an adjunct to actual treatment. Twelve-step is one of many tools available in the quest for recovery from drug and alcohol addiction but it’s wise to consider choosing a rehab that incorporates a multitude of evidence-based practices and holistic modalities in order to maximize the effectiveness of treatment.