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Alcohol and Substance Abuse 12 Step Programs (AA/NA/CA/MA) and other Peer Support Groups

Mark Dombeck, Ph.D.

Whatever their choice of drug, most all drug or alcohol dependent persons who enter treatment are referred to what are known as "Twelve Step" groups. The oldest and best known of all the twelve step groups is Alcoholics Anonymous (AA). However, many communities also offer chapters of Narcotics Anonymous (NA), Cocaine Anonymous (CA), and even Marijuana Anonymous (MA). All such communities are run more or less according to the Twelve Steps that were developed by the founders of AA which are reprinted below.

Twelve Step groups are entirely composed of recovering addicts; no professional leadership is allowed. Recovering addicts with long periods of sobriety lead the groups, but any drug or alcohol dependent person with a sincere desire to recover is welcome to attend. Because addiction knows no class boundaries, members in any given twelve step group are drawn from all walks of society including rich and poor (In fact, twelve step groups may be one of the most democratic institutions in the entire world). Membership in twelve step groups is free and no fees need ever be donated to the group in exchange for participation. However, as in the case of collection in a church setting, donations are encouraged. Meetings are common (occurring multiple times per day in most communities! - there are a lot of drug and alcohol dependent people in the world).

Twelve Step group formats vary. Testimonial meetings are popular (wherein persons present at the meeting are invited to talk about their experiences with addiction), but 'reading' meetings are also common (wherein readings that illustrate the twelve steps are performed. As the word "anonymous" in their names implies, these groups are concerned about keeping their members' identities and what they have to say anonymous. The rule is "what is said in the rooms, stays in the rooms".

Here are the Twelve Steps in the original form from Alcoholics Anonymous. Groups that are focused on drugs reword them a bit but retain their essential meanings. The ideal of a Twelve step group is that each of it's members grows to believe and then live through deeds each of the twelve steps.

  1. We admitted we were powerless over alcohol in 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 of 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 doing so would injure them or others
  10. Continued to take moral 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 a result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

As is readily apparent with even a quick glance, the steps are based firmly in principles of submission to a higher power, the asking of forgiveness for wrongdoings, and efforts to make amends for wrong doing. The men who founded AA were Christians, and the message of their twelve steps is steeped in Christian concepts of sin and repentance. While this message is eagerly received by many drug and alcohol dependent persons, (and rightly so - because it is practical; it works to help sustain abstainence and to promote healing and recovery), there are many other people who rebel against the idea of submission to authority in any form and who come to resent the 'preachy' quality of some AA group members. Some use their disenchantment and discomfort with twelve step groups as an excuse to avoid attending. This is a shame. The twelve steps require submission to a power higher and greater than ones' self. This power need not be God - it can instead be submission to 'Good Orderly Direction': the idea that it is literally impossible for ones' self to stop drinking or drugging, so long as one clings to the idea that they can ever again take a drink or drug, and must now change the way one lives to avoid alcohol and drugs. Preachy AA members aside, AA offers a deep and valuable method to remain drug and alcohol free, regardless of your beliefs in God or your position about authority. The best clinical advice possible is to attend AA or a related group frequently, (Daily is not too much!) and work the steps as best you can. If preachy members get in your way, find a different meeting that isn't so preachy. For those who truly cannot tolerate the religious basis of AA and likeminded groups, there are alternative organizations to the twelve step groups in existence (such as Rational Recovery) that are founded on more humanistic principles. Unfortunately, such groups are much less common than AA style groups and usually are only present in major metropolitan areas.

Twelve step participants are helped in learning and acting out the steps by a sponsor, who is a same-sex recovering person with sober time under his or her belt. New members to a twelve step group are strongly encouraged to find a sponsor as soon as possible, as the one-on-one attention that the sponsor can provide is thought necessary to the working of the steps. To get a sponsor, new members to a group must ask someone present to act as one for them, and that person must agree to act as a sponsor. Sponsors typically encourage their members to call them while they are craving but before they act on those cravings, so that the sponsor can help the member to not relapse. Sponsors also often give their members twelve step homework to complete, and guide the members in when it is time to move from step to step.