Twelve-step methods have been adopted to address a wide range
substance abuse and
dependency problems. Over 200
self-help organizations–often known as
fellowships–with a worldwide membership of millions, now
employ twelve-step principles for
recovery. Narcotics Anonymous was formed by addicts who did
not relate to the specifics of alcohol dependency.
Similar demographic preferences related to the addicts' drug of
choice has led to the creation of
Crystal Meth Anonymous and
Marijuana Anonymous. Behavioral issues such as compulsion
for, and/or addiction to, gambling, food, sex,
work are addressed in fellowships such as
Sexual Compulsives Anonymous,
Debtors Anonymous and
Workaholics Anonymous. Auxiliary groups such as
Nar-Anon, for friends and family members of alcoholics and
addicts, respectively, are part of a response to treating
addiction as a disease that is
enabled by family systems.
Alcoholics Anonymous (AA), the first twelve-step fellowship,
was founded in 1935 by
Bill Wilson and
Dr. Bob Smith, known to AA members as "Bill W." and "Dr.
Bob", in Akron, Ohio. They established the tradition within the
"anonymous" twelve-step programs of using only first names "at
the level of press, radio and film."
As AA was growing in the 1930s and 1940s, definite guiding
principles began to emerge as the Twelve Traditions. A
Singleness of purpose emerged as Tradition Five: "Each group
has but one primary purpose -- to carry its message to the
alcoholic who still suffers."
drug addicts who do not suffer from the specifics of
alcoholism involved in AA hoping for recovery technically are
not welcome in "closed" meetings unless they have a desire to
The reason for such emphasis on alcoholism as the problem is to
overcome denial and distraction. Thus the principles of AA have
been used to form many numbers of other fellowships for those
recovering from various
pathologies, each of which in turn emphasizes
recovery from the specific malady which brought the sufferer
into the fellowship.
In 1953 AA gave permission for Narcotics Anonymous to use its
Steps and Traditions.
These are the original Twelve Steps as published by
- We admitted we were
powerless over alcohol—that our lives had become
- Came to believe that a Power greater than ourselves
could restore us to sanity.
- Made a decision to turn our will and our lives over to
the care of
as we understood Him.
- Made a searching and fearless moral inventory of
- Admitted to God, to ourselves, and to another human
being the exact nature of our wrongs.
- Were entirely ready to have God remove all these defects
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became
willing to make
amends to them all.
- Made direct amends to such people wherever possible,
except when to do so would injure them or others.
- Continued to take personal inventory and when we were
wrong promptly admitted it.
- Sought through
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.
- 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.
In some cases, where other twelve-step groups have adapted
the AA steps as guiding principles, they have been altered to
emphasize principles important to those particular fellowships,
to remove gender-biased or specific religious language.
The Twelve Traditions accompany the Twelve Steps, the
Traditions provide guidelines for group governance. They were
developed in AA in order to help resolve conflicts in the areas
of publicity, religion and finances.
Most twelve-step fellowships have adopted these
principles for their structural governance.
The Twelve Traditions of Alcoholics Anonymous are as follows.
- Our common welfare should come first; personal recovery
depends upon AA unity.
- For our group purpose there is but one ultimate
authority—a loving God as He may express Himself in our
group conscience. Our leaders are but trusted servants; they
do not govern.
- The only requirement for AA membership is a desire to
- Each group should be autonomous except in matters
affecting other groups or AA as a whole.
- Each group has but one primary purpose—to carry its
message to the alcoholic who still suffers.
- An AA group ought never endorse, finance, or lend the AA
name to any related facility or outside enterprise, lest
problems of money, property, and prestige divert us from our
- Every AA group ought to be fully self-supporting,
declining outside contributions.
- Alcoholics Anonymous should remain forever
non-professional, but our service centers may employ special
- AA, as such, ought never be organized; but we may create
service boards or committees directly responsible to those
- Alcoholics Anonymous has no opinion on outside issues;
hence the AA name ought never be drawn into public
- Our public relations policy is based on attraction
rather than promotion; we need always maintain personal
anonymity at the level of press, radio, and films.
- Anonymity is the spiritual foundation of all our
traditions, ever reminding us to place principles before
In the twelve-step program human structure is symbolically
represented in three dimensions: physical, mental, and
spiritual. The problems the groups deal with are understood to
manifest themselves in each dimension. For addicts and
alcoholics the physical dimension is best described by the
allergy-like bodily reaction resulting in the compulsion to
continue using substances after the initial use. For groups not
related to substance abuse this physical manifestation could be
more varied including, but not limited to:
eating disorders, dysfunctional
irritability, lack of
poor impulse control,
The statement in the First Step that the individual is
"powerless" over the substance-abuse related behavior at issue
refers to the lack of control over this compulsion, which
persists despite any negative consequences that may be endured
as a result.
The mental obsession is described as the cognitive processes
that causes the individual to repeat the compulsive behavior
after some period of abstinence, either knowing that the result
will be an inability to stop or operating under the delusion
that the result will be different. The description in the First
Step of the life of the alcoholic or addict as "unmanageable"
refers to the lack of choice that the mind of the addict or
alcoholic affords concerning whether to drink or use again.
The illness of the spiritual dimension, or "spiritual
malady," is considered in all twelve-step groups to be
self-centeredness. This model is not intended to be a scientific
explanation, it is only a perspective that twelve-step
organizations have found useful.
The process of working the steps is intended to replace
self-centeredness with a growing moral consciousness and a
willingness for self-sacrifice and unselfish constructive
In twelve-step groups, this is known as a spiritual awakening or
This should not be confused with
abreaction, which produces dramatic, but
In twelve-step fellowships, "spiritual awakening" is believed to
develop, most frequently, slowly over a period of time.
It is suggested that members regularly attend meetings with
other members who share their particular recovery problem. In
accordance with the First Step, twelve-step groups emphasize
self-admission by members of the problem they are recovering
from. It is in this spirit that members often identify
themselves along with an admission of their problem, e.g. "Hi,
I'm Wendy and I'm an alcoholic." Such catchphrases are now
widely associated with
support groups. Some meetings are known as dual-identity
groups, which encourage attendance from certain demographics, so
that some areas have for example, women's groups; men's groups;
and gay, lesbian, transgendered groups. There are also in some
areas beginner's groups as well as "old-timer" groups that limit
who can share, or speak during the meeting, by the length of
time the members have in that fellowship.
A sponsor is a more experienced person in recovery who guides
the less-experienced aspirant ("sponsee" or variously, "sponsoree")
through the program. New members in twelve-step programs are
encouraged to secure a relationship with at least one sponsor.
Publications from twelve-step fellowships emphasize that
sponsorship is a "one on one" relationship of shared experiences
focused on working the Twelve Steps.
According to Narcotics Anonymous:
Sponsors share their experience, strength, and hope with
their sponsees... A sponsor's role is not that of a legal
adviser, a banker, a parent, a marriage counselor, or a
social worker. Nor is a sponsor a therapist offering some
sort of professional advice. A sponsor is simply another
addict in recovery who is willing to share his or her
journey through the Twelve Steps.
Sponsors and sponsees participate in activities that lead to
spiritual growth. These may include practices such as
literature discussion and study, meditation, and writing.
Completing the Twelve Steps implies being competent to sponsor
to newcomers in recovery.
Sponsees typically do their Fifth Step, review their moral
inventory written as part of the Fourth Step, with their
sponsor. The Fifth Step, as well as the Ninth Step, have been
penitence. Many, such as
Michel Foucault, noted such practices produce intrinsic
modifications in the person—exonerating, redeeming and purifying
them—it unburdens them of their wrongs, liberates them, and
promises their salvation.
The personal nature of the behavioral issues that lead to
seeking help in twelve-step fellowships results in a strong
relationship between sponsee and sponsor. As the relationship is
based on spiritual principles, it is unique and not generally
characterized as "friendship." Fundamentally, the sponsor has
the single purpose of helping the sponsee recover from the
behavioral problem that brought the sufferer into twelve-step
work, which reflexively helps the sponsor recover.
A study of sponsorship as practiced in Alcoholics Anonymous
and Narcotics Anonymous found that providing direction and
support to other alcoholics and addicts correlates with
sustained abstinence for the sponsor, but that there were few
short-term benefits for the sponsee.
Alcoholics Anonymous is the largest of all the twelve-step
programs, followed by Narcotics Anonymous; the majority of
twelve-step members are recovering from addiction to drugs or
alcohol. The majority of twelve-step programs, however, address
illnesses other than addiction. For example, the third largest
twelve-step program, Al-Anon, treats
codependence. About twenty percent of twelve-step programs
are for addiction recovery, the other eighty percent address a
variety of problems from
It would be an error to assume the effectiveness of twelve-step
methods at treating problems in one domain translates to all or
to another domain,
therefore readers are directed to relevant sections in each
The criticisms of twelve-step groups are as varied as the
pathologies they address. People have attended twelve-step
meetings, only to find success eluded them. Their varied success
rate and the belief in a
Higher Power suggested in them, are common criticisms of
their universal applicability and efficacy.
Twelve Traditions encourage members to practice the
spiritual principle of
anonymity in the public media and members are also asked to
respect each other's
confidentiality. However, the programs rely on 'obedience to
the unenforceable' and there are no legal consequences or
sanctions within the program to discourage those attending
twelve-step groups from revealing information disclosed
group therapy do not encompass those associations that lack
clergyman to whom confidentiality and privilege might apply.
Physicians who refer patients to these groups, to avoid both
civil liability and
licensure problems, have been advised that they should alert
their patients that, at any time, their statements made in
working through the Twelve Steps might be disclosed.