This series of posts will explore the ongoing nature of 12-step group therapy and its application in the recovery process.  The following are the 12-steps as originally published from the 1935 development of Alcoholics Anonymous:

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

When AA was initially developed by Dr. Bob and Bill Wilson in the 30’s, Bill W. had reached the end of the road in his search for an effective treatment of alcoholism.  He had consulted with Carl Jung in an attempt to utilize psychoanalysis as treatment, which ultimately was ineffective.  Dr. Jung suggested that a last resort may be the search for a life-changing spiritual experience to help Bill W. become sober.  This proved effective for him and has been an effective approach for countless alcoholics struggling over multiple generations since.

From a research perspective, it has been consistently difficult to develop clinical data regarding the efficacy of AA.  This is partly because AA is essentially a grass-roots community organization rather than a treatment clinic.  The treatment providers are peers rather than professionals.  This was discussed in great detail by George Vaillant in his landmark book “The Natural History of Alcoholism” (Vaillant, 1983).  This book reviews the Harvard Cohort Study and the collection of addiction recovery data present at the time.  In this book, he describes the nontreatment factors associated with abstinence as:

  1. Substitute dependency (exercise, volunteering)
  2. Behavior modification (supervision, legal monitoring, Antabuse)
  3. Enhanced hope/self-esteem (religion, AA)
  4. Social rehabilitation (new love relationships)

One of the questions I often consider when working with a patient is the potential application for AA (or other 12-step groups) in that particular person’s recovery plan.  For young adults, this can be exceedingly difficult.  I recently was forwarded this article from the Washington Post which nicely describes the dilemma of engaging in a 12-step group if you are a young adult or teenager.  It can be very overwhelming to look at the recent problems with alcohol or drugs as a lifelong disease (more to come on this concept) when that young person is first starting to experience what the world has to offer and what experiences will be in store.  As discussed above, the spiritual experience was viewed as the ‘last resort’ for those struggling with lifelong alcoholism, not a new diagnosis of alcohol abuse or dependence in a 21 year-old.  This being said, many young adults and teens do find a strong community support, validation, and accountability through AA.