This is the 2007 version. Click here for the 2017 chapter 14 table of contents.

12-Step Programs

Addiction and related problems are involved in a majority of the problems dealt with in mental health clinics, yet clinicians have a hard time dealing with any of the addictions. People may improve for a time after counseling, but often they slide back into their old ways. Recidivism (backsliding) is very common when people try to quit addictive behaviors. Recidivism occurs with approximately equal frequency in all addictions. The same percentages of people fail, whether they are trying to quit heroin or cigarette smoking (Squires, 1982).

How are all addictions alike, with respect to recidivism? What is the basic approach of Alcoholics Anonymous?

Treatment of alcoholism usually centers on total abstinence from the drug, especially in the United States. Alcoholics Anonymous (AA) gives group support and provides a comprehensive program to help addicts stay off alcohol. AA works by encouraging a "total personality change," not just abstinence. Spiritual elements are strong in the AA program. Addicts are encouraged to admit personal weakness and submit their lives to God.

The basic approach pioneered by Alcoholics Anonymous has been used to treat other addictions. Often there is a conscious attempt to adopt the Alanon (Alcoholics Anonymous) program, modified as appropriate for a different addiction. For example, Gamanon (Gambler's Anonymous) has over 10,000 members and uses 12 Steps to Recovery, modeled after the almost identical 12 steps used by Alcoholics Anonymous.

1. We admitted we were powerless over gambling, that our lives had become unmanageable.

2. We came to believe a Power greater than ourselves could restore us to a normal way of thinking and living.

3. We made the decision to turn our will and our lives over to the care of this Power, of our own understanding.

4. We made a searching and fearless moral and financial inventory of ourselves.

5. We admitted to ourselves and to another human being the exact nature of our wrongs.

6. We're emotionally ready to have these defects of character removed.

7. We humbly ask God of our understanding to remove our shortcomings.

8. We made a list of all persons we have harmed and became willing to make amends to them all.

9. We made direct amends to such people wherever possible except when to do so would injure them or others.

10. We continued to take personal inventory and when we were wrong, promptly admitted it.

11. We felt through prayer and meditation to improve our conscious contact with God as we understand Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having made an effort to practice these principles in all our affairs, we try to carry this message to other compulsive gamblers.

What element of the 12-step approach is often modified?

Details of the 12-step program vary somewhat, with more or less emphasis on conventional religion. During the 1980s, the AA program was adapted for use in Russia, then the Soviet Union, and all references to God were deleted. In 2002 an American student told me, "I belong to a group which uses a 12-step program, and we specifically mention a Higher Power without mentioning God, to avoid alienating people who are not religious." The above version of the 12-step program was reproduced from a Gamanon pamphlet, but the basic approach is the same for all addictions and all countries. Apparently it works for a lot of people.

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