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12-Step Programs: Do They Actually Work?

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT
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Alcoholics Anonymous, Narcotics Anonymous, Codependents Anonymous…If you’re a teen who has struggled or is struggling with alcohol addiction, drug abuse, or other mental health issues, you’ve probably heard of the 12-step approach to recovery. These mutual-help groups, as they’re known, operate under a set of 12 guidelines that encourage self-searching humility, faith, and honesty as methods to achieve abstinence. These peer-led groups have regular meetings, usually on a weekly basis, and are completely free.

People Thought the 12 Steps Would Never Work

It’s interesting to note that at the time of AA’s founding, many were dubious and cynical that addicted men, women and teens would find recovery in a set of principles inspired by spirituality. Medication? Sure. CBT? Definitely. But putting your recovery in the hands of a higher power?

Dr. John Kelley, a professor of addiction at Harvard Medical School, has been studying the history of AA extensively. He describes how many mental health professionals felt, at the time, that addicts would never be helped by the touchy-feely support groups like the religious-rooted AA. These experts believed, in his words, that “the only ‘steps’ these addicted individuals should [have been] taking are the ones that lead them up and out of the church basement and into the sunlight of real clinical science[.]”

However, to everyone’s surprise, AA and the other 12-step programs took off with increased popularity. There are now more than 2 million members and 115,000 AA groups—not counting Narcotics Anonymous, Emotions Anonymous, or any of the others. (NA has more than 60,000 meetings around the globe!) With thousands of meetings in every location, one can attend a different meeting every day of the week.

Research: Are 12-step programs actually effective?

Researchers have found that it’s been difficult to examine the rate of 12-step groups’ effectiveness, mainly because of the anonymity in its members. No names are taken down, there’s no sign-up sheet, no way of following up once you leave the room. That makes it hard to track members’ progress or rates of relapse.

However, in 2014, AA conducted an internal survey in which 6000 of its members participated. Despite the self-report bias, the average length of members’ sobriety was almost ten years.

Other external studies have also shown the effectiveness of these 12-step programs. In one well-known study Dr. Kelley conducted on adolescents, he found that teens who participate in AA and NA are more likely to achieve long-term recovery from drug and alcohol addiction. Following 160 teens for 8 years after they discharged from residential treatment at several teen drug rehab centers in California, he found that those who went to meetings in the first 6-12 months after treatment had a higher likelihood of staying clean and sober up to 8 years down the road. There was a significant positive association between attending AA/NA meetings and staying abstinent.

Another study analyzed 3,000 substance abuse addicts divided into three groups. One group of addicts received outpatient treatment. Another group attended 12-step programs. The third group did both. (Ouimette et al. 1998). This third group had the best treatment outcome, suggesting that 12-step programs have the most benefit when combined with professional treatment.

How do these groups work?

Ok—so 12-step programs work. But how, exactly, are they effective? Research has found that the predominant mechanism of change in these mutual-help groups is the aspect of social support (Kelly, 2017). These groups increase a teen’s social network for the better, resulting in better treatment outcomes and longer abstinence periods.

As research has shown, even adding one abstinent friend to your social circle increases your chances of staying sober by 25%. In addition to meeting other individuals struggling through the same challenges as they are, adolescents can get a sponsor and/or contact other members between meetings or whenever they need motivational support. Call it positive peer pressure, call it informal group therapy…whatever you call it, it’s working.

For this reason, it’s not just AA or NA that is effective: Other programs like SMART Recovery have been found to be as effective as the traditional 12-step groups for those with substance abuse disorders since they also work through the mutual-help concept.

So, let’s revisit the above claim that 12-step groups are not based on science. At the end of one of this articles, Dr. Kelley writes: “To superficially dismiss AA as a potentially effective addiction recovery support option on the grounds that it is ‘religious’ and therefore unscientific, is inconsistent with the body of rigorous research accumulated during the past 25 years.”

Finding a 12-step Group You Like

Since the mechanism of change in AA is a positive social network, it’s important to realize that if you’re not happy at your specific fellowship (which is what every AA chapter is called), you may not be receiving the primary benefit of this program. That’s why, if your first experience at a meeting wasn’t a good one, keep trying. If a certain AA or NA group isn’t working out for you, find one that is. It’s important to find a group where you feel like you belong. For example, if you’re addicted to heroin but your other NA members are addicted to cocaine, marijuana, or Benzodiazepines, you may relate more to a different group, e.g. of opioid users.

Or, if you’re in meetings where there are many older adults and you can’t relate to any of them, try to find ones where more teens attend. There are special Young People’s AA Groups for this very reason. This Young People and AA pamphlet includes personal stories of adolescents’ first-time experiences at AA.

Your goal is to try to find acquaintances and friends that can help encourage your abstinence, so shop around until you find this community.

How to Find a 12-step Program Near You

There’s really nothing to lose by attending twelve-step programs—only everything to gain. There is no cost. You can attend whenever you want. You don’t need to even give your full name. Unlike typical appointments, teens are able to attend these self-help groups at times “when they are at higher risk of relapse, such as evenings and weekends” (Kelly and Yeterian 2008b).

There are groups meeting every single day in almost every single location around the world. This translates into tens of thousands of groups a year. To find one near you, search online at AA.org or NA.org. The AA website will direct you to your specific county site, where you can search for local meetings. For example, if you live in Los Angeles, you can find meetings near you on the LA County AA site. You can even filter your preferences down to night of week, time of night, type of meeting (open, closed, LGBTQ-friendly, Young People) and more.

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