Understanding AA & 12 Step Treatment | Alternatives or Non-12 Step Addiction and Alcohol Treatment Programs & Centers

Alcoholics Anonymous and Working Through the 12 Steps

An international fellowship of people who struggle or have had issues with alcohol abuse and/or addiction, Alcoholics Anonymous (AA) has over 100,000 groups meeting in around 180 countries worldwide and more than 2 million members in its ranks as of January 2017, the General Service Office publishes. Founded in the early 1930s out of the religious movement the Oxford Group, Bill Wilson and Dr. Bob Smith started the first AA group in Akron, Ohio, in July 1935. It was based on concepts of spirituality, mutual support, abstinence, and the idea that alcoholism is a disease.

The Development of AA

By 1939, two more AA groups had formed – one in Cleveland and one in New York – and Dr. Bob wrote and published the textbookAlcoholics Anonymous, detailing the fellowship’s principles and philosophies. Within the textbook, often called the Big Book (currently in its fourth edition), the “Twelve Steps of Recovery” were outlined, which are still the backbone of AA today.

By 1950, AA boasted over 100,000 recovering alcoholics in its membership, and they hosted their first International Convention in Cleveland where the 12 Traditions of Alcoholics Anonymous were adopted. These traditions explain that groups are to be anonymous, self-supporting, nonprofessional, and strive toward common welfare and unity while accepting God as the ultimate authority. AA groups have one major rule: Members must have a desire to stop drinking. Groups are free and open to anyone who battles issues with alcohol and wishes to achieve sobriety and remain abstinent.

The Effectiveness of AA

In general, the 12-step programcan be a very beneficial component of addiction recovery as studies have shown that people who attend AA meetings regularly are about twice as likely to remain abstinent than those who don’t, the Journal of Addictive Disorders publishes. When used as part of a comprehensive treatment plan, Alcoholics Anonymous can help people minimize relapse and sustain a long recovery.

how effective is aa and 12 step treatment

Understanding the 12-Step Program

AA has its members work through 12 Steps in a systematic manner as they move into recovery. These 12 Steps are meant to become a way of living life without alcohol. Individuals may spend more time on one step than another, or even come back and revisit a step after they have worked through others. Highlighted below are the 12 Steps of Alcoholics Anonymous:

  1. Admitting to being powerless over alcohol and that life is out of control: A person does not have to hit rock bottom to realize that alcohol is an addiction that can take over and wreak havoc, disrupting normal life functions.
  2. Came to believe that a higher power can restore order to life: Spirituality is an important aspect of AA, and this step is about relinquishing control as a person grows in faith and belief. Spirituality is an ongoing and changing process.
  3. Agree to turn life over to a higher power (God as he is to be understood by the individual): Basically, this step is about making the decision to work through the program – a kind of call to action.
  4. Do a complete and honest inventory of self: Here, people are asked to write down fears, resentments, negative things that might have been done to others because of the addiction, and basically anything that makes it hard to connect with others.
  5. Admit shortcomings, failures, and exact mistakes to God, oneself, and one other person: During this step, an individual shares what they wrote for the previous step with their sponsor who can typically relate and help a person to understand that they are not alone and that God forgives them.
  6. Be ready to have God improve oneself: A sponsor will help individuals to understand what their character defects are and how to begin to work through them.
  7. Ask God humbly to take away moral failings.: An individual is strengthening their spiritual connection and allowing God to remove shortcomings, which can include sources of temptation.
  8. Write a list of all people harmed and be willing to make amends to everyone: A person is to take what they wrote in Step 4 and expand on these items to include direct harms to individuals. This helps the person to better understand how addiction has impacted loved ones.
  9. Make amends directly to those who were harmed unless doing so would harm them: During Step 9, individuals make direct amends to those who they detailed in the previous step, not just apologizing but actually reflecting on how they have changed. This step can take time and is all about reconnection and mending relationships. In some cases, it may be hurtful to bring up old wounds; when it is harmful to do so, it should not be done.
  10. Continue to take stock of oneself and fix any wrongs as they appear: Known as the “growth step,” Step 10 has individuals look at themselves critically and take inventory again. Any wrongdoing is immediately recognized and amends sought.
  11. Use prayer and meditation to enhance a connection with God (as he is understood), praying for God’s will and knowledge as guidance and the power to carry it out: Using prayer and talking to God on a daily basis to continue to live a spiritual life are the hallmarks of Step 11.
  12. Having experienced a spiritual awakening from working through the steps, continue to practice these principles in all parts of life and carry the message to others struggling with addiction: The spiritual awakening is an understanding that life has changed for the better. By continuing to live by these practices, growth will be ongoing. After working through all 12 Steps, a person is encouraged to serve others through sponsorship or other helpful service opportunities.


Components of AA

Anyone can attend an AA meeting; there is no fee to join and no sign up sheet. Meetings are often held in churches and meeting halls, and there are AA resources in most local communities that can direct individuals to nearby meetings.

In general, there are two main types of meetings: open and closed. Open meetings are for anyone wishing to attend, and closed meetings are reserved for those struggling with alcoholism directly. Family members, treatment providers, and loved ones may attend open meetings while closed meetings are typically “sharing meetings” and reserved for those who battle alcohol issues themselves.

Who Can Join an AA Group?

Anyone who wishes to stop drinking can join an AA group at any point, and identities of members are protected. People can also choose to share their personal stories at meetings, although no one has to share if they don’t want to do so. AA does not outline a set length of time that people must attend meetings, and members can go to meetings as often or as little as they like and deem necessary. Individuals can attend multiple groups and different meetings as well.

What Does a 12-Step Program Look Like?

Typically, AA meetings are very informal and about an hour in length, often beginning with the Serenity Prayer. These meetings may have a speaker, be more of an open forum for discussion, focus on working through the 12 Steps and 12 Traditions (12 & 12), or be bookwork sessions where members use the Big Book for study. There is often fellowship time before and/or after the meeting where people can gather with coffee and conversation.

A collection plate is also usually passed around during the meeting for those who wish to give in order to keep the group self-sustaining financially. Depending on the group, there are many options for service as well, be it helping to make the coffee, speaking on a particular topic, or helping with the group’s leadership and operations.

What Is the Sponsorship Program?

One of the big components of AA is sponsorship. This program matches up a newcomer with someone who has already worked through the 12 Steps, who has been sober for many months or years already. The sponsor offers support and encouragement, and is available 24/7 should the person need help at any point.

Sponsorship is fairly informal, as is the rest of AA, and all a person needs to do is ask someone to be their sponsor. A sponsor should be stable in their life, lead by example, and able to provide the kind of support needed to sustain sobriety. Sponsorship can also be a great way for a person to give back, essentially a service opportunity for those who are ready.

Alternatives to the 12-Step Model

While AA is not a religious organization in and of itself, the spiritual aspects of the program may not be right for everyone. AA uses the label of alcoholic and requests that individuals admit they are powerless and need to relinquish control of their lives to a higher power. This may not resonate with everyone. There are several other alternative support and recovery groups that individuals may seek out instead of AA. A few of these are outlined below.

  • SMART Recovery: A self-help and empowering program with meetings around the world and offered online, SMART Recovery uses a 4-Point Program to enhance recovery. This program helps people to build and sustain motivation to remain sober, learn how to control urges, lead a more balanced life, and manage feelings, thoughts, and actions. This is not a 12-Step treatment program; rather, it uses scientific research in efforts to help individuals become independent from addiction.
  • Secular Organization for Sobriety (SOS): A nonprofit organization with meetings offered in many locations around the globe, SOS is a secular alternative to the spiritual AA program. Anonymous groups are self-sustaining, nonprofessional, and free to attend. Groups provide peer support and encouragement to sustain sobriety.
  • Moderation Management (MM): This program is entirely different in that it does not ask that members stop drinking altogether if they don’t wish to. Instead, MM focuses on teaching people how to moderate and control their drinking by working through the Steps of Change. MM asks people to keep a drinking diary at first in order to identify problems associated with drinking. People are also expected to go through a 30-day period of abstinence to work through controlling urges and getting a handle on how to drink safely in moderation in the future. Moderation Management helps people to understand how alcohol can be problematic and how to make its consumption less so.
  • Women for Sobriety (WFS): The first women-only self-help group for those battling addiction involving alcohol, WFS uses 13 Affirmations for positive and encouraging thoughts and behaviors. Women are asked to go through these before beginning each day. WFS meetings are offered all over and provide support for a positive lifestyle free from the binds of alcohol and addiction.
  • LifeRing Secular Recovery: With meetings around the United States and Canada, LifeRing is a secular recovery program that provides peer support with an abstinence-based philosophy. Members are encouraged by mutual support to grow personally and develop strategies to learn how to live a fulfilling and self-directed life.

Alcoholics Anonymous can be a very helpful tool for those who are wishing to achieve sobriety and sustain a long-term abstinent lifestyle. Connecting with others who have “been there” provides encouragement and hope for the future. By understanding that alcoholism is a disease, people can learn to accept that addiction has a hold on them and learn tools for coping and managing it to minimize relapse.

Other 12-step groups for different addictions are options as well, such as Narcotics Anonymous (NA), Cocaine Anonymous (CA), and Marijuana Anonymous (MA). There are several secular alternatives to AA that may be appealing to people if the spiritual aspect of AA is off-putting. These self-help and peer support groups all have one thing in common: Members support each other in recovery. The groups help individuals to become self-reliant and contribute to healthy, fulfilled, and balanced lives in recovery.

The 12-Step Model and Other Treatments

The 12-step model can also be integrated into various residential treatment programs to provide patients with a comprehensive experience, while offering a robust post-treatment structure that helps them achieve long-term recovery. While these programs may not necessarily follow the 12 steps, they tend to promote 12-step ideas in the hope that patients will continue attending AA meetings after the residential treatment.

By integrating the psychological and spiritual practices of the 12-step model into a more research-based treatment program, treatment centers can help set the patients up for successful recovery in the long-term. Such an approach aims to both support the patient through rehab, as well as provide them with tools and resources they can fall back on after the treatment.

In general, the 12-step model may offer significant benefits for individuals undergoing addiction treatment, both during and after their stay at the treatment facility. However, since faith-based recovery may not be an ideal choice for everyone, individuals should research different treatment options and determine whether a more secular approach may be more suitable.

Frequently Asked Questions

  • While the 12 Steps followed in AA groups are guidelines which participants should follow on their path to recovery, the 12 Traditions can be seen as principles behind these steps. These traditions emphasize that AA groups are to be self-supporting, nonprofessional, and anonymous. They should also strive toward unity and common welfare while recognizing God as their ultimate authority. Here are the 12 Traditions as devised by Alcoholics Anonymous:1
    1. Personal recovery of the individual depends on the common welfare and unity of the group.
    2. God, as He might express himself in the group conscience, is the only ultimate authority.
    3. The desire of the individual to stop drinking is the only requirement for joining an AA group.
    4. All AA groups are to be autonomous, except when their actions affect other groups or the AA fellowship as a whole.
    5. The primary purpose of each group is to carry the overall message to the individual still struggling with alcohol abuse.
    6. No AA group should ever finance, endorse, or borrow the AA name to any outside enterprise or related facility.
    7. Each AA group is to be self-supporting, declining contributions from outside sources.
    8. AA groups are to remain nonprofessional, although the service centers might employ specialized workers.
    9. Alcoholics Anonymous should not be organized, but it may rely on committees or service boards that are directly responsible to the individuals they serve.
    10. AA should hold no opinions on external issues and the name should never be involved in public controversies.
    11. The public relations policy of AA should be based on attraction, not promotion. Personal anonymity should be maintained in channels such as radio, television, films, and press.
    12. Anonymity is the core spiritual foundation of AA traditions, encouraging members to place their principles before their personalities.

  • Twelve-step programs offer easily accessible and free resources for individuals struggling with alcohol abuse and/or addiction. Although AA support groups are widely and readily available, it is important to evaluate their effectiveness in helping their members achieve long-term sobriety.According to a study published in 2013, early and consistent involvement in a 12-step program is associated with better psychological and substance abuse outcomes.2

    Membership Surveys

    Although these surveys are not considered scientifically rigorous, they show valuable findings with respect to length of abstinence and meeting attendance later corroborated by empirical evidence.

    In particular, AA, NA, and CA members report a median length of abstinence greater than 5 years, with approximately ⅓ of each surveyed group having a length of abstinence between 1 and 5 years. On average, the respondents attended 2-4 group meetings per week.

    Overall, the findings of these mutual support membership surveys indicate that regular and consistent meeting attendance increases the chances of achieving long-term abstinence and recovery.

    Empirical studies

    The results from several empirical studies seem to corroborate the findings of these membership surveys and support the effectiveness of 12-step programs for addiction recovery. Overall, these studies have noted that regular participation in AA groups is associated with increased likelihood of long-term abstinence, often up to 16 years, as well as better psychological functioning and self-efficacy.3

    However, it is important to emphasize that early, consistent, and frequent involvement are crucial factors in the effectiveness of 12-step rehab programs. Although minimal participation may help increase the likelihood of abstinence, higher levels of involvement and engagement in additional 12-step activities both during and following formal treatment (e.g. sponsorship programs, service work at meetings, and reading literature on 12-step treatment) show greater potential for achieving lasting and sustainable recovery.4

  • The purpose of a 12-step program is to help guide individuals struggling with alcohol addiction towards lasting and sustainable abstinence. The duration of the program and the exact order of the 12 steps may depend on the unique needs of the person, as they may backtrack, skip around, or jump forward in their path to recovery. Essentially, 12-step programs don’t tend to have a clearly defined timeline that fits every single individual.

  • According to the final, 12th step of the AA Traditions, anonymity is the spiritual foundation of the fellowship that encourages placing greater importance on principles than personalities. It is often referred to as the essential form of protection that AA employs to assure its existence and continued growth. There are two vital functions of anonymity:5
    • Personal: Anonymity protects each member from being identified as an alcoholic in their social and professional groups, which is often important to newcomers.
    • Public: Anonymity at the public levels of TV, radio, press, film, Internet, and other media technologies helps protect the equality of AA members. This is achieved by preventing exploitation for power, recognition, and personal gain.

  • Although AA places a great emphasis on achieving recovery through religious or spiritual means, studies show that the beneficial effects of AA are primarily carried by social, affective, and cognitive mechanisms.6 In fact, the AA fellowship mobilizes therapeutic mechanisms that are similar to those used in formal treatment.Although Alcoholics Anonymous is a beneficial organization that accepts all shades of belief and non-belief, their programs still have spiritual aspects that may not be the right option for every individual. This is why there are a number of alternative support groups that rely on secular approaches to help non-religious individuals overcome their alcohol addiction.

  • According to the National Survey of Substance Abuse Treatment Services conducted in 2013, around 74% of treatment centers use the 12-step model in addiction treatment, at least occasionally.7 This means that AA support groups are easily accessible and readily available to a great number of individuals across the country. These programs remain a frequently recommended and utilized treatment for various types of addiction.Whether the program you or your loved one choose is primarily based on the 12-step model, contains some 12-step aspects, or relies on alternative forms of treatment, it is essential that the care is tailored to the specific needs of the individual. This is why working with addiction treatment professionals is a useful method for determining the right treatment modality that will lead to lasting recovery.

1. Alcoholics Anonymous (2020). AA timeline.

2. Alcoholics Anonymous. (2001). Alcoholics Anonymous: The story of how many thousands of men and women have recovered from alcoholism. 4th ed. New York City: Alcoholics Anonymous World Services.

3. Alcoholics Anonymous. (2019). Estimates of A.A. groups and members.

4. Alcoholics Anonymous. Historical data: The birth of A.A. and its growth in the U.S./Canada.

5. Alcoholics Anonymous. (1981). The twelve steps of Alcoholics Anonymous.

6. Alcoholics Anonymous. (1981). The twelve traditions of Alcoholics Anonymous.

7. Kaskutas L. A. (2009). Alcoholics anonymous effectiveness: Faith meets science. Journal of addictive diseases, 28(2), 145–157.

8. Alcoholics Anonymous (2020). Twelve steps and twelve traditions.

9. Alcoholics Anonymous. (2019). Understanding anonymity.

10. Donovan, D. M., Ingalsbe, M. H., Benbow, J., & Daley, D. C. (2013). 12-step interventions and mutual support programs for substance use disorders: An overview. Social Work in Public Health, 28(3-4), 313–332.

11. Humphreys , K., & Moos, R. (2001). Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study. Alcoholism, Clinical and Experimental Research, 25(5), 711–716.

12. Kelly J. F. (2017). Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of mechanisms of behavior change research. Abingdon, England: Addiction, 112(6), 929–936.

13. Moos, R. H., & Moos, B. S. (2006). Participation in treatment and Alcoholics Anonymous: A 16-year follow-up of initially untreated individuals. Journal of Clinical Psychology, 62(6), 735–750.

14. Substance Abuse and Mental Health Services Administration. (2014). National survey of substance abuse treatment services: Data on substance abuse treatment facilities.